Not everything's clear when it comes to HGH, PRP

By Sally Jenkins
Thursday, May 20, 2010

The bottle-boyish doctor Anthony Galea has been charged with peddling syringe cocktails to some of our most prominent American athletes. His trial will be a good thing -- not for a certain Washington Redskin, or for Tiger Woods and Alex Rodriguez, whose reputations are bound to take further hits for being mixed up with him, but for the rest of us, who will be forced to ask ourselves a difficult question: What's the difference between doping and therapy?

Galea styles the treatments he gave to athletes as cures. Platelet-rich plasma treatments (PRP) involves re-injecting a patient's spun blood to an injured area to promote healing. Trouble is, Galea's assistant was nabbed at the border with HGH and a calf's blood extract called Actovegin, and Galea is charged with administering them to athletes along with PRP. Now, we can argue about whether Galea is a charlatan, or why athletes in question sought out a Canadian doctor known for championing HGH when perfectly legal PRP treatments are available right here. But one thing we won't be able to do is demonize these athletes in this case the way we have others, such as those caught up in the BALCO case. Instead we're going to have to talk about whether there are moral degrees in using substances, something we've not been willing to do.

The Galea case is going to personalize the issue for everyone, especially for those who watch the Redskins. A player on your home team is worried that his name is going to be revealed, and that his career is jeopardized, all because he tried to preserve his knees so he could get through another day at work.

Indirectly on trial along with Galea will be the properties of HGH, which Galea claims has healing and anti-aging benefits, though he denies giving it to active pro athletes. HGH is a tricky substance that gets at the heart of our confusion about "performance-enhancing drugs" -- and about what we expect from sport.

When we crack down on "performance-enhancers," are we trying to preserve the integrity of the competition or the health of the athlete? Is it safer and ethically more acceptable to use HGH to heal from an injury than to use it as a muscle-builder? If so, why isn't the difference reflected in doping regulations? Rather than work all of this out, we've allowed the anti-doping authorities to lump all substances and all athletes who sample them, regardless of their motives, into one equally guilty party. That way we don't have to do any hard thinking.

But the Galea case makes us think -- and it makes us confront a central truth that no one really likes to talk about: Some kinds of banned substances are extremely dangerous, and some are relatively harmless.

Lincoln Allison, founding director of Warwick University's Center for the Study of Sport in Society, wrote an article for the Guardian in 2004 in which he pointed out that, "In general, the risk to health from performance-enhancing drugs is considerably less than that from tobacco or alcohol." Allison added: "We ought not to apply paternalistic moral assumptions to sport that we are not prepared to apply to the rest of life."

In "The Physics of Football," physicist-author Timothy Gay estimates that the amount of force an NFL running back absorbs when a linebacker hits him is equivalent to being slammed by a small whale. Over the course of a game, offensive linemen expend the amount of energy it takes to push a small truck up a hill in San Francisco. Should we deny them a shot of calves blood extract if it can promote faster healing, lengthen their careers, and swathe them in lean muscle mass so as to spare them some degenerative joint damage in old age?

The most eloquent summarizer of our vagueness and self-contradiction on sports doping is Thomas H. Murray, president of the Hastings Center, a research institute dedicated to bioethics. Murray is a leading anti-doping advocate, but he zeroes in on the most troubling question in the Galea case: "If [the athletes] were seeking Galea's services not for performance enhancement but to help with healing and injury, how should we look at that? Purpose matters here, and so do effects."

Athletes are under enormous pressures to perform, whether from the public, their sizeable contracts, or a culture of pride, and they are more vulnerable than most of us to shysters peddling magical elixirs. I'm no apologist for athletes, but what I know from interviewing them for 25 years is that they aren't simple black-and-white characters, and neither are their motives. They are rewarded unfairly, but they are punished in equal measure by the cruelties of their professions. They start out believing in their own invincibility and slam into reality far more violently than the rest of us. Aging is harsher for them than for you or me. Their careers are over just when most of us are beginning ours, and they experience degrees of physical pain and repetitive injuries the rest of us will never know.

It's a sports maxim that a champion "is someone who is willing to make himself uncomfortable." How often do the rest of us make ourselves physically uncomfortable? Think about it. Do you slow down on the treadmill when it starts to hurt? Athletes speed it up just when it starts to ache. That's who they are.

"If you don't understand how sport works, how athletes experience sport, if you don't understand the networks in which they live and train, it's easy to just become moralistic about it," Murray says.

That's why Murray advises us to tackle the doping dilemmas by asking ourselves a larger question first: What is the point of sport? What do we believe competitive excellence in sport is about? Do we want games to be public entertainments with ever higher and more thrilling thresholds of performance? If so, then we should understand that could lead to unfettered extreme drug use, because athletes will seek higher dosages, and perhaps send us all on a spiral to a public health catastrophe.

Or do we want games to define excellence through moral components? If we believe in moral components, then we should stop insisting that athletes push themselves to the outer boundaries of human performance. In either case, is it right to demand that they play hurt -- and then deny them remedies?

If we want athletes to behave ethically, then we better get our own ethics straight first.

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