PEDs : Performance Enhancing Drugs Ronald J. Schaber, Jr., FALU, FLMI, ACS, AIAA, HIA Assistant Vice President, Underwriting Research & Development SCOR Global Life U.S. Re Insurance Co. April 4 th , 2011
Dec 23, 2015
PEDs : Performance Enhancing Drugs
Ronald J. Schaber, Jr., FALU, FLMI, ACS, AIAA, HIAAssistant Vice President, Underwriting Research & Development SCOR Global Life U.S. Re Insurance Co.
April 4th, 2011
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PEDs: Performance Enhancing Drugs and Athletes, Entertainers, and the Insurance Buying Public
U.S. Sales
$ 20 Billion in 2007
$ 56 Billion in 2008
$ 79 Billion in 2009
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What are they?
W.A.D.A.: World Anti-Doping Agency
A Swiss private law foundation established in 1999 as an international independent agency funded by sports organizations and governments worldwide
Activities include:
• Scientific Research
• Education
• Development of Anti-Doping Capacities
• Monitoring of the World Anti-Doping Code
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2010 WADA International Prohibited List1
Anadrol
Anadur
Anavar
Andriol
Aratest
Clenbuterol
Clomid
Cyclofenil
Cytomel
Deca-Durabolin
Dianabol
Dinoprost
Durabolin
Dynabolan
Finaject
Halotestin
Laurabolin
Miotolan
Nandrolone Cypionate
Nilevar
Norandren
Omnadren
Primobolan
Primoteston
Sustanon 250
Testosterone Cypionate
Testosterone Enanthate
Testosterone Heptylate
Testosterone Propionate
Testosterone Suspension
Testoviron
Winstrol
Anabolic Steroids
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2010 WADA International Prohibited List1
Peptide Hormones, Growth Factors Insulins HGH – Human Growth Hormone Platelet – derived preparations “blood spinning”
Beta-2 Agonists
Hormone Antagonists & Modulators Tomoxifen
Diuretics and other masking agents - Thiazides Gene Doping Stimulants
Amphetamines Andrenaline Ephedrine
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2010 WADA International Prohibited List (con’t)
Narcotics Heroin Morphine Oxycodone
Marijuana Alcohol
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2010 WADA International Prohibited List (con’t)
Beta Blockers Acebutolol (Secretal®) Atenolol (Tenormin®) Betaxolol (Kerlone®, Betoptic®) Bisoprolol (Zebeta®) Esmolol (Brevibloc®) Nebivolol (Bystolic®) Metropolol (Lopressor®, Toprol-XL®) Acebutolol (Sectral®) Carteolol (Ocupress®) Penbutolol (Levatol®) Pindolol (Visken®) Carvedilol (Coreg, Coreg CR®) Labetalol (Trandate®) Levobunolol (Betagan®) Metipranolol (OptiPranolol®) Nadolol (Corgard®) Propranolol (Inderal®, Inderal LA®, InnoPran XL®) Sotalol (Betapace®, Sorine®) Timolol (Betimol®, Blocadren®, Istalol®, Timoptic®)
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What do they do?Stimulants:
These drugs are used by athletes to enhance their performance in their particular fields and also stimulate their bodies to give their best performance. Stimulants can also help in increasing awareness, alertness and aggressiveness and decreasing fatigue. Some of the commonly used stimulants are amphetamines and caffeine.
Lean Mass Builders:
These typical performance enhancers are used to amplify or drive the growth and development of lean body mass and muscle. These can also help in reducing body fat. These belong to the category of anabolic steroids, and the commonly used ones are beta-2 agonists and several other human hormones, such as human growth hormones.
Sedatives:
These enhancers are also used by athletes engaged in sports such as archery that demands a steady hand and a precise aim. Sedatives help in coping with nervousness and distress. Marijuana, beta- blockers and alcohol are some of the common examples.
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What do they do? (con.’t)Painkillers:
These drugs are very common and are used on a regular basis by the common mass as well. Athletes prefer using these drugs to mask their pain in order to maintain their performance and ability to compete in unfavorable conditions. These drugs allow the blood pressure levels to soar up, thus supplying the body with ample quantity of vital oxygen to relief pain. Painkillers can be purchased over-the-counter and includes medicines such as NSAIDS (acetaminophen and ibuprofen) and also certain prescribed narcotics.
Masking Drugs:
These are rare drugs and are taken in order to prevent other classes of drugs from being detected. These drugs can evolve quickly, almost as quickly as the methods of testing for them. Epitestosterone is the most commonly recognized masking drug.
Diuretics:
These drugs are used for expelling water out of athlete’s bodies. Wrestlers have been using these drugs in order to meet the weight restrictions. Some of the stimulants are believed to have secondary diuretic effects.
Performance Enhancers:
These are usually taken as oral pills, although some injections are also available to be intravenously injected.
With the improved technologies and development skills, the detection of performance enhancing drugs in an athlete’s blood stream has become almost impossible. But preventive measures are still being taken and hopefully someday the World Anti-Doping Agency will be able to bring this issue to an end.2
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Adverse Effects
Steroids:
• Interrupted growth and virilization in children
• Birth defects in the unborn
• Severe virilization in women including growth of facial hair and cessation of menstruation
• Testicular atrophy and baldness in men
• Low testosterone in men
• Liver dysfunction including cancer and hepatitis
• Unpredictable changes in mood
• Aggression
• Fluid retention
• High Blood Pressure
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Adverse Effects (con’t.)
HGH:
Little solid evidence it benefits athletic performance
Does not cause weight loss in obese people
Can cause joint and muscle pain
Swelling in arms and legs
Carpel Tunnel Syndrome
Insulin Resistance – Diabetes
Heart Failure
Diuretic Abuse:
• Potentially fatal electrolyte imbalance
• Severe dehydration
• Cardiac arrhythmias, palpitations
• Headaches
• Nausea
• Dizziness
• Kidney Damage
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Adverse Effects (con’t.)
Stimulants
Irregular Heartbeat
Dangerously High Body Temperatures
Seizures
Cardiovascular Failure
Hostility
Paranoia
Opiads
Drowsiness
Constipation
Severe Respiratory Depression
Death
Central Nervous System Depressants:
Addiction3
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Supplements – Another Word for PEDs
Purpose:
Athletic Performance
Weight Loss (Hydroxycut)
Stay Alert/Concentration/Energy
Nearly all energy and weight loss drinks contain the stimulants yerba maté, green tea, yohimbine and caffeine
Sexual Function
2007 U.S. study showed 25% of the 58 supplement samples tested contained steroids or stimulants banned by World Anti-Doping Agency.
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Supplements – Another Word for PEDs
Manufactured by individuals/companies that purchase the raw materials abroad, often from Asia.
Raw materials from oversea suppliers often not tested for content/purity.
Examples:
Ecdysterone – an insect development hormone with no effect on humans
Brown seaweed extract with no effect on humans
Ginseng – used for thousands of years in China; studies have found no proof it enhances energy levels or athletic performance
DHEA – a steroid prohormone legal but banned by NCAA, the NFL, NBA and WADA. Studies show no improvement in muscle mass or brain function. It does cause facial hair growth on women and high blood pressure in men.15
Not manufactured by major drug companies like Pfizer or Merck
Not FDA reviewed or approved
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Testing
NFL, NBA, MLB, NHL have formal testing programs approved by their players unions.
NFL began steroid testing in 1987 – during pre-season physicals and scouting combine
Blood tests for Human Growth Hormone developed in 2004, available in the U.S. since 2008. Test has three day testing window.
NFL - hopes to start testing for Human Growth Hormone
NBA – does not test for Marijuana
MLB – bans amphetamines in 2005. Now 10% of players have Rx for ADD; only 4% of general population have adult ADD.
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Methods of Cheating to Pass Drug Tests
1. Biosimilars
2. Blood transfusions (a, b)
3. Catheterization
4. The Cream
5. Diuretics
6. Epitestosterone
7. Erythropoietin (EPO) (a, b, c, d, e)
8. Gene doping
9. Human Growth hormone (HGH)
10. Masking Agents
11. Micro-dosing (a, b)
12. Perma Cleanse
13. Probenecid
14. Protease (a,b)
15. Tattoos
16. Testosterone patches
17. Therapeutic use exemptions
18. Titrate testosterone/epitestosterone
19. Urine replacement (a,b)4
There are 19 known methods of cheating to pass performance enhancing drug tests.
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Masking Agents and Side Effects
Potential side effects of masking agents:
Diuretics:
The utilization of diuretics may result in the occurrence of heart arrhythmias, dehydration, muscle cramping, blood volume depletion, significant drops in blood pressure and severe electrolyte imbalances. These arrhythmias can occur as a result of a deficiency of potassium in the blood and dehydration.
Probenecid:
Probenecid use generally results in very few minor side effects. These side effects can include the formation of kidney stones, acute gouty arthritis, hair loss, skin rash, headache, nausea, sore gums, fever and, in very rare cases, severe anemias.
Alpha-Reductase Inhibitors:
The most significant side effects associated with the use of some of these masking agents are associated with reproductive dysfunction. Reproductive side effects include a decreased libido, increased occurrence of erectile dysfunction, and an increase occurrence in ejaculation disorders.
Plasma Expanders:
The use of plasma expanders such as albumin can very rarely result in adverse effects. These effects are usually marked by nausea, fever, chills or hives.5
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How are PEDs Obtained?Internet
Mail Order Steroids
Retail Stores
Wal-mart, Rite-Aid, 7-Eleven, Vitamin Shoppes
GNC
2009 Net Income $ 70 million
6,900 locations in 47 countries
5,400 U.S. Retail Outlets
Anti-Aging Clinics
Wellness Centers
Anti-Aging Clinics/Wellness Centers have a doctor on staff or have arrangements with a doctor to write prescriptions for patients the doctor never sees in person.
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Law Enforcement
“If you look at the dollar amounts that are trading hands, there has to be thousands of people who are selling this. To call it a public health crisis is right on the money.”, Dr. Thomas Perls of Boston University School of Medicine. 6
WADA head, Jon Fahley says, “… governments are increasingly realizing that abuse of steroids and other PEDs are a serious public health issue and not just a problem for sports administrators.” 7
The Journal of the American Medical Association (10/26/05), “… the distribution of Human Growth Hormone for anti-aging and/or athletic purposes is both rampant and illegal and punishable with up to five years in prison.8, 9
State and federal investigations into PED distribution by DEA, FDA, FBI, state and local police departments
Sting operations of several unlicensed pharmacies and internet sites…
Anabolic steroids are a Schedule 3 controlled substance, meaning that even possessing them is a crime.
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Who is using PEDs?
Athletes:
1989 – Atlanta Falcon lineman, Bill Fralic, testified to U.S. Senate that 75% Lineman, Linebackers and Tight Ends use steroids.
1970s - Pittsburgh Steelers have been linked to steroid and amphetamine use.
Aug 2010 – Brian Cushing, Houston Texans; Over training caused positive drug test due to hormone spike after stopping training.
Barry Bonds, Alex Rodriguez, Mark McGwire, Roger Clemens, Andy Pettite, Lyle Alzado, John Matuszak, Tony Mandarich, Shawn Merriman.
Celebrities:
“Anyone over age 40 in Hollywood”
Mary J. Blige, 50 Cent, Timberlake, Wyclef Jean, Tyler Perry
“The music business (Hollywood) is a young person’s business, so there’s certainly a premium on appearing young or appearing younger. Sometimes people go to very extreme measures in their appearance to be able to give a youthful image.” This is according to John Battaglia, image consultant for Justin Timberlake and Ushe.r 10
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Who is using PEDs? (con’t.)
Business People:
To improve decision making, concentration, calmness, focus, alertness
Inderal for stage fright
Adderall to improve focus and concentration
Nicotine
Caffeine
Baby Boomers:
Per a senior U.S. Customs official, “the amount of PEDs being brought into the US has risen dramatically in the past five years and the overwhelming majority are destined for community gyms and sporting clubs rather than elite athletes.11
Dr. Alan Mintz, founder of the anti-aging clinic Cenegenics Medical Institute in Las Vegas:
12,000 patients including moviestars, Las Vegas Entertainers, CEO’s, and the president of a foreign country
Treatment costs as much as $1,000 per month.
Cenegenics has a network of over 100 doctors in the U.S., Tokyo, Seoul, Hong Kong.
Some patients have been using PEDs for over 12 years now.12
Juveniles:
During a Congressional testimony in 2005, Representative Tom Davis, R- VA, stated “1 in 14 middle-school girls have tried anabolic steroids.” 13
National Institute on Drug Abuse 2009 study shows 47% of High School seniors have taken illicit drugs and > 23% have taken them within the last month. *
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The Future of PEDs
Neuroscientists working on psychoactive drugs (neuroceuticals) that could improve wall street traders decision making ability by 20 – 30 %.
“Designer Steroids” – steroid chemical structure altered enough to cause a negative test, but drug still has same effect on the body. 14
DEA Spokesman, Rusty Payne, “Designer drugs are hard to keep up with. We are adopting and evolving, and the bad guys are doing the same thing to evade us.” 15
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Genetic Engineering
Genetic manipulation to enhance performance and reduce recovery time
Goals: muscle formation, response to hypoxia, blood vessel formation, lung function, pain control, and immune response
Could benefit people with Parkinsons Disease, Muscular Dystrophy and chronic injuries
Adverse effects: Leukemia, death from complications
No practical tests are in use for Gene Doping
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Footnotes1. The World Anti-Doping Code, “The 2010 Prohibited List, International Standard” September 19, 2009
2. Sanjana Antony, “Dangerous Facts About Performance Enhancing Drugs”, http://E___ Articles.com/?expert=Sanjana Antony
3. NIDA Info Facts : Prescription and Over-the-Counter Meciations 7/09, http://www.drugabuse.gov/infofacts/painmed.html
4. What are the 19 known methods of cheating to pass performance enhancing drug tests? 08/28/09, http://sportsanddrugs.procon.org/raw.resource.php?resourceID=002706
5. Making Agents FA Q, http://www.nsca-liftorg/education/npedp/maskingagents.shtml
6. HGH: Miracle-Gro for Humans?, The Work 04/23/2010
7. WADA Chief focuses on steroid abuse at the local level, Steroid Nation 09/19/2008; http://grg51.typepad.com/steroid_nation/2008/09/wada_chief_focu.html
8. Selling the Promise of Youth, Business Week, 03/23/2006
9. Aging in the 21st Century, CBS News 08/20/2006
10. Why would 50 Cent, Tmberlake, Mary J. Blige Use Steroids? 01/15/2008; http://www.mtv.com/news/articles/1579621/20080114/index.html
11. WADA Chief focuses on steroid abuse at the local level – Steroid Nation 09/19/2008
12. Aging in the 21st Century, CBS News 08/20/2006
13. Lessons from the Celebrity Doping Scandal, Slate 10/03/2008
14. Performance Enhancing Drugs in the Boardroom? 11/18/2008; http://www.micronative.com/2005/02/performance-enhancing-drugs-in-the-boardroom/
15. David Epstein and George Dohrmann, “What you don’t know might kill you.”, Sports Illustrated, Volume 110, No. 20, May 18, 2009
*. NIDA Info Facts: High School and Youth Trends 8/2010; http://www.drugabuse.gov/infofacts/hsyouthtrends.html