Tuesday, November 20, 2012

"Houston, We Have A Problem"

By Jim Ferstle
In the Fall of 1988, Ben Johnson had just been busted in Seoul for steroid use.  A short time afterward a pediatrician in St. Paul had an appointment with a mother and her young son.  The son was a high school wrestler.  "I'd like you to prescribe some stanozolol for my son," the mother said to the doctor, who refused the request.

Not long ago, in another doctor's office in Illinois, a young athlete was also visiting his physician.  "You need to get bigger," the doctor told the boy and his parents.  "I should give your son some Human Growth Hormone."

Yesterday a study in the medical journal Pediatrics concluded that use of steroids, human growth hormone, protein shakes, and other methods advertised as being able to enhance muscularity in individuals were used by more than a third of the middle and high school students who were part of the study done in the Twin Cities.  The number of steroid users in the study was  higher than previously reported in similar surveys such of the self reported use of steroids by both boys and girls, athletes and non-athletes.

"This study did not find significant clustering of muscle enhancing behaviors within schools," the atuthors conluded.  "Rather than being driven by a particular school sports team coach or other features of a school’s social landscape, this diffusion suggests that muscle enhancing behaviors are widespread and influenced by factors beyond school, likely encompassing social and cultural variables such as media messages and social norms of behavior."

While the rate of steroid use was higher among athletes, it was not limited to them.  These conclusions are not unique, nor startling.  They've been reported before in lower numbers, and have the limitation of being from one area of the country and a self reporting survey that relies on the truthfulness and accuracy of the information provided by the subjects, but one would have to have the proverbial "head in the sand" not to understand that athletics and society in general has a drug/"enhancing substances" problem.

The major unanswered question of this latest survey is where are these middle and high school kids getting what are controlled substances, such as steroids, that are illegal to possess or sell without a prescription.  The answer may be in the second example cited of the doctor willing to prescribe HGH to a child that has no growth problem other than to "get bigger" to improve his chances in a sport where size matters. The other most common answer is "on the internet."

One level below the illegal activity, however, is the unregulated "supplement" industry where "prohormones," testosterone boosters, or other products that are advertised as "legal steroids" that may contain actual steroids.  These supplements are a category of substances that the researchers noted as being frequently used by the school kids in an attempt to enhance their muscularity.

In a space mission, whenever something  went wrong the catch phrase: "Houston, we have a problem," became associated with impending disaster or at least imminent danger.  Athletics, we have a problem.  It's not a new one.  As the recent USADA dossier on the systemic doping in cycling illustrated at the highest level of sport an industry has grown up to support doping in sport.

It appears to not yet have filtered down to the middle and high school level, and hopefully never will, but other countries, such as South Africa, have fears about the infiltration of doping into their school sports and are initiating programs to combat it.  The alarm bells are ringing, and hopefully it won't take a disaster the size and scope revealed by the USADA case against Lance Armstrong to stimulate a response.  Prevention is a more effective deterrent in this sort of situation than attempting to find a "cure" after the "disease" has already infected the "patient."

Pediatrics article is available HERE.


GZ said...

Can you cross link to the original article? I am interested in reading that. Thanks.

jdf said...

Full article link is http://pediatrics.aappublications.org/content/early/2012/11/14/peds.2012-0095.full.pdf+html

GZ said...

Thanks. Disturbing.

mike_hinterberg said...

Saw this from GZ's, thanks.
I appreciate the original article and am a fan of U of M's MPH dept (my wife's alma mater), but some of the concerns, and the meta-summary here I think is a bit misleading.

The most disturbing tidbit, to me, is the ~6% steroid use. I trust that previous reports were lower as mentioned, and a cursory glance suggests as much.
How are the steroids obtained? That question deserves more research, but I'm unsure about the appropriateness of the medical-office-in-Illinois anecdote. How about internet sales and sharing?

As for the other behaviours, I think it's misleading to lump them together as a concern. Some (or much) of the behaviour is no different than generally-accepted adult training behaviours, if not basic exercise physiology, of altering exercise and eating habits. The supplements mentioned include some advertised weekly on endurance podcasts, for better or worse.

Anyway, I personally think we should focus mostly on the steroid problem, but be clear about it's prevalance (6%) and source (unclear).

jdf said...

I agree that one of the major questions raised by the paper is where are these kids getting the steroids? The only "legitimate" way is via a physician's prescription for use of them as treatment. If they are being obtained via the internet, it's illegal for both seller and buyer. The "medical office in Illinois" example in the piece is also illegal. HGH is not authorized for use just to make a healthy, normal individual "bigger," it is available for physicians to prescribe for a condition where the individual does not produce normal levels of HGH. There have been an increasing number of prosecutions both of sellers and buyers of illegal anabolic steroids and HGH, as well as physicians who do "off label" prescribing of such substances for individuals. How widespread the illegal prescribing of controlled substances has not yet been documented. Yes, there is a booming industry of selling these substances or supplements advertised as being as effective as the controlled substances. The salient point here, however, is that selling and buying of controlled substances is illegal. The reason for this being that the practice is deemed dangerous and potentially harmful. There have been suggestions that it would be safer to "legalize" the sale and consumption of these substances and encourage the consumers of these products to be under the medical care of a competent physician to monitor any adverse health effects. The theory being that fewer people would be damaged by using these hormones if they were on a medically supervised program of administration. The counter argument being that there is no medically approved program for using these hormones on healthy individuals. Attempts to alter or "enhance" natural hormone levels is not seen as an acceptable, ethical, or medically sound practice. Especially for teenagers, who are going through a cascade of "normal" hormonal change during this time in their lives. It is a complex issue. The Pediatrics study provides a snapshot of some of the issues. The topic is not going to disappear anytime soon. It will, more likely, get more attention as science and technology advance to provide more challenges in this area. It is an interesting "window" through which to observe human behavior. The things we strive to obtain, achieve, or become and the methods we use to achieve those objectives.