FANALYTICS: A PED misconception clarified

As much as we all keep hoping it will go away and allow us to focus on baseball games, performance-enhancing drugs refuse to leave the headlines.

The summer has been characterized by the Biogenesis "scandal." Even now, we continue to speculate about the handful of players whose suspensions are coming to an end. Will Jhonny Peralta see some playing time during the last week? Will Nelson Cruz play in October? How do we rate Evereth Cabrera and Ryan Braun for 2014? And the hypocrisies surrounding Alex Rodriguez are mind-numbing.

I have written 3,991 columns about PEDs over the past decade, including several this year.

Back in July, I asked: "If these players passed all their drug tests yet are guilty—per Biogenesis—then how can we trust that any other player is not potentially guilty as well? There are dozens of PED labs and distributors worldwide."

Last winter, I suggested that "maybe it's time to just embrace PEDs and try to work the uncertainty into our forecasting process."

I even took that a step further in this column, creating a parallel universe and speculating how PEDs might be viewed as an acceptable occupational hazard.

This last piece generated a bunch of angry comments. It's tough to view PEDs favorably. But for those who consider the topic overblown, one of the open questions is: "How are PEDs any different from other methods players use to improve their performance?"

In a segment on BaseballHQ Radio, host Patrick Davitt once asked, "Why do people have problems with PEDs but not LASIK surgery? Is it the use of the word "drug"?" I was involved in the discussion and even added, "I've taken steroids, prescribed by my doctor. What's the big deal?"

After that show aired, I received an email from listener Dr. Elio Gizzi. He wrote:

"I'm a physician. I'm no expert on PEDs but I want to make three points:

"1) Anabolic steroids are different than what you took or many people take. I prescribe steroids for my patients. These are anti-inflammatory steroids, not anabolic steroids. And there are real long-term risks with taking them even under physician supervision. Either type.

"2) As a pediatrician, the last thing I want is for my high school patients to increase whatever supplement usage they already are using. Making it legal at the professional level will undoubtedly lead to an increase in teen use. We have an obligation to our youth to model fair behavior for many reasons. Our youth simply don't have the frontal lobe development to exercise good judgement when considering short vs. long term risks/benefits.

"3) Anabolic steroids are different than LASIK surgery or Tommy John surgery. Elective surgery is a low risk / high reward situation that is usually limited to the organ at hand. And usually it is done when something is well below a functional level. Steroids are insidious. They affect multiple organs. They are not intended to correct a deficiency or injury but solely to raise performance. So it's a different situation. Lastly, HGH in pediatrics is prescribed very thoughtfully because it does have some pro-cancer producing risk. That risk does not disappear into adulthood. Treating it cavalierly is minimizing the long-term risk."

I thanked Dr. Gizzi for his thoughtful note. But there was one nagging question I still had. I asked: "Are there any conditions under which anabolic steroids would be administered under a doctor's care?"

He responded:

"Anabolic steroids and HGH can be prescribed under certain medical conditions, but these are unusual situations. In all settings, pediatric or adult, they are prescribed if there is a true absence or significant underproduction. This can be either congenital or acquired.

"Examples of congenital kinds would include genetic conditions of metabolic error leading to underproduction (growth hormone deficiency), or frank absence of the anatomic part (such as the pituitary gland or testes). Acquired versions are essentially the same from an endpoint perspective but the pathway of getting there is different. Organ trauma is typical (from an accident or as a result of radiation therapy, etc.).

"One other situation where testosterone is used under medical supervision: gender reassignment. So a female-to-male reassignment will require a lifetime of medically prescribed testosterone.

"In summary, yes to anabolic steroids/HGH under a doctor's care, but very rarely done as the conditions are unusual."

Dr. Gizzi also went on to write about how physicians are under increasing pressure to prescribe things that may tread ethical lines. Pharmaceutical companies have been known to create their own markets. How many people watch drug commercials on TV and end up asking their doctor to prescribe it for some malady they may or may not really have?

Perhaps this begs the question about who else might be complicit in driving demand for anabolic steroids. Did the players approach Biogenesis or did Biogenesis approach the players?

The short-term and long-term side effects of PED use have been well-documented. The effect of PED use on performance remains highly contested, though mostly because we cannot conduct a closed study of Major League ballplayers to measure these effects. The players might object.

So the best we can do is to continue to speculate. Speculate on who is using and who isn't. Speculate on the potential statistical gains from PED use. And speculate on the real impact of penalties (is it a "suspension" or a "vacation"?).

I suspect my ticker will continue to inch toward 4,000 next year.


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  For more information about the terms used in this article, see our Glossary Primer.