Dr. Gary Wadler: Major League Baseball should expand its drug-testing policies
Bartolo Colon throws against the Yankees in the first inning. (July 22, 2012) Credit: AP
In the discussion about testing for performance-enhancing drugs, or PEDs, conventional wisdom usually divides the debate between testosterone, which is an anabolic steroid, and human growth hormone.
Under Major League Baseball's program, players are screened for steroids via urine test on a regular, random basis year-round. That wide net caught Melky Cabrera and Bartolo Colon, both of whom came up positive for testosterone and received 50-game suspensions earlier this month.
As for HGH, that requires a blood test, and the newly passed collective-bargaining agreement allowed for that to happen only once in spring training this year before it is reviewed for possible expansion.
Now here's the problem: Testosterone and HGH often are used together by drug cheats, according to Dr. Gary Wadler, for a "synergistic" cocktail that actually helps offending players potentially escape detection.
Wadler, a clinical associate professor of medicine at the Hofstra North Shore-LIJ School of Medicine, has worked extensively for the World Anti-Doping Agency and is considered one of the foremost authorities on the subject. In his view, this link between testosterone and HGH use is just another reason for MLB to expand its testing policies as well as use an outside, independent agency to administer the program.
"There's some evidence to suggest that when they take testosterone and HGH, you get more of an enhancement -- they sort of reinforce each other," Wadler said during a phone interview. "You can take less testosterone to get the same degree of enhancement if you take HGH with it. That's been an issue."
To detect the presence of abnormal levels of testosterone, there are two tests.
One involves the T/E ratio, which monitors radical spikes in an athlete's testosterone level but can be manipulated by varying dosages with transdermal patches, creams or gels.
The other test relies on the carbon isotope ratio, or CIR, which accurately identifies synthetic testosterone at the molecular level. The latter is considered more reliable but also is more expensive to administer leaguewide. Wadler estimated the cost at about $400 for each one.
Regardless of the methods used to detect PEDs, everyone was reminded of two things this month: Players still are using them, despite the penalties, and they still are getting busted.
Wadler believes MLB's program has come "a million miles" from where it was when he testified during the congressional hearings in 2005. But some players evidently think the risk is worth the potential payoff. For pending free agents such as Cabrera, there could be as much as $100 million at stake, which explains a lot. In these cases, the dollar signs apparently override the deterrents. "I often make the point that it's one of the few drugs where the seller and the user both make money," Wadler said. "If the seller and the user are both making money, it's a pretty difficult incentive issue to try and break.
"They're told they can get away with it. The [drug] gurus are making a lot of money, so they say they have a new approach, X, Y or Z, and say 'they'll never catch you' and 'it will really jack up your performance.' If you're not tested very often, you may get away with it."
The new "delivery systems" for testosterone also can be used to thwart the random testing procedures. It no longer needs to be injected, and by applying some form of the drug on the skin, the steroid -- depending on the dosage -- can leave the body that much more quickly.
When it is injected, the drug stays in a player's system for three weeks, Wadler said. But when used daily -- in a cream or gel, for example -- Wadler said the testosterone has a half-life of anywhere from 10 minutes to 100 minutes. That's much more flexible if a player is trying to roll the dice with possible detection. Combine that with HGH, and the loophole widens.
That's what bothers Wadler, who would like to see MLB use what he calls the "gold standard" of testing followed by the World Anti-Doping Agency, the same one that ultimately nabbed Lance Armstrong. He stresses the need for a program that is "independent, transparent and accountable."
But that's unlikely to happen with two powerful entities, the Players Association and commissioner's office, having an aversion to adding a third party to the mix.
"I think it's a good program," Wadler said. "But we should not put our heads in the sand on issues that still need to be addressed."
