Q: What? How could that be?
A: I don’t know. Maybe HGH just enables your muscles to retain a little more water.
Q: I remember Andy Pettite saying that he used HGH to help recover from an injury. Can HGH help an athlete heal?
A: Maybe. On this question, we simply have no definitive information one way or the other.. MLB is funding a scientific study to examine this question.
Q: The only answers you’re giving us are “maybe”, “could be” and “who knows”. C’mon. Give it to us straight. Do you figure that HGH is performance-enhancing or not?
A: I don’t know. But I figure not.
Q: But if HGH was worthless, then athletes wouldn’t use it.
A: This is the question. Do we believe the scientists, who say that HGH does not enhance performance, or the cheating athletes, who seem to think that HGH is helpful? To confuse matters, there are scientists out there who choose to believe the athletes and not their fellow scientists. But athletes can be scammed, same as anyone else. Remember the idea that you weren’t supposed to give football players water when they trained in the heat? Or that athletes weren’t supposed to have sex the night before a competition?
Q: Oh yeah. Those were some stupid ideas. But I’d think that if cheating athletes were using HGH and seeing no results, they would have given it up long ago.
A: Maybe. But from what I’ve read, cheating athletes don’t use HGH alone. They use HGH in combination with other performance-enhancing drugs, like steroids and insulin.
Q: I see. So if the athletes are seeing results, maybe the results are being produced by those other drugs.
A: Maybe. Or maybe HGH is effective when used in combination with other drugs.
Q: OK. Enough about the effects of HGH. Let’s talk about testing. Why is it so hard to catch athletes that are doping with HGH?
A: One reason is that HGH is a natural substance. We all produce HGH. We all have it in our bloodstream.
Q: Yes, but our HGH is natural. The HGH used by doping athletes is artificial.
A: ARTIFICIAL??? NEVER use the word “artificial” here, not ever again! The correct distinction is between exogenous HGH, stuff produced OUTSIDE the body, and endogenous HGH, stuff produced INSIDE the body.
Q: Can I say “synthetic”?
A: That’s a better word. But you can get “natural” HGH from cadavers, and that would still be cheating. It’s doping if the HGH is produced outside of the body, no matter how it’s produced.
Q: Geez. Why so touchy?
A: Because idiots in the media and on the blogosphere use words like “synthetic” and “artificial” to imply that there’s some difference between endogenous and exogenous HGH, like you could pluck a molecule of HGH out of a doper’s bloodstream, and hold it up to the light, and say, “that looks artificial to me.” HGH is HGH. The HGH produced in the lab is the real thing.
Q: You’re confusing me. If there’s no difference between artificial …
A: exogenous …
Q: Um, right, exogenous and endogenous HGH, if there’s no difference between the two, how can you devise a test to catch the athletes doping with HGH?
A: Well, like I said, a molecule of HGH is a molecule of HGH, no matter whether it’s exogenous or endogenous. But there might be a statistical difference between a population of exogenous HGH molecules and a population of endogenous HGH molecules.
Q: You’ve lost me.
A: Let’s say I have a bunch of yellow M&Ms in my pocket. Without your knowing it, I take my yellow M&Ms and put them into your bag of M&Ms. My yellow M&Ms are exogenous, because they come from outside of your bag. How can you tell that you have exogenous M&Ms in your bag? Well, you can’t tell by testing any single M&M – they’re all genuine M&Ms. But if you empty the entire bag and count the number of M&Ms of each color, you’ll notice that there are too many yellow M&Ms. The M&M candy people wouldn’t put so many yellow M&Ms in the same bag. There has to be some other explanation.
Q: Like M&M doping?
A: Stick with me here. HGH comes in different “isoforms”. For our purposes, an isoform is like a “color” of HGH. Most endogenous HGH comes in a single isoform – let’s say that this isoform is like the yellow M&Ms. But there’s a little bit of endogenous HGH that is produced in other isoforms – let’s say that these HGH isoforms are like red and green M&Ms. So you naturally have HGH in your blood in a mix of “colors”. Now we come to the key point. The scientists think that ALL exogenous HGH comes in a single isoform – the isoform that’s like the yellow M&Ms. If an athlete dopes with HGH, he’s going to have too much “yellow” HGH, and the anti-doping testers will know that something is up.
Q: And the anti-doping testers have a test to look at the mix of “colors” in an athlete’s HGH?
A: Yes.
Q: Great! How many dopers has this test caught so far?
A: So far, since 2004, one doper.
Q: One doper? Not so great.
A: That’s an understatement.
Q: Why haven’t more people been caught?
A: The leading doping expert in the U.S., Dr. Don Catlin, says that this HGH test is not a useful test. It’s hard to say why the test isn’t working. Maybe taking exogenous HGH doesn’t always make large changes in the mix of HGH “colors” in the blood. Or maybe there’s enough natural fluctuation in the HGH color mix, from person to person or from day to day, that it’s hard to distinguish a natural “color” fluctuation from an artificial “color” bump caused by doping.
Q: You just used the word “artificial”.
A: Try to stay focused here. Another reason why it’s hard to test for HGH doping is that doping produces only a short-term change in the mix of HGH “colors” in the blood. After a day or two, the mix of “colors” returns to normal.
Q: OK. What about the new test announced in the NY Times article?
A: The New York Times article does not provide us with much information about the new test. Actually, this doesn’t seem to be a new test. The test appears to be the same as one proposed at least as early as 1999. For some reason that’s not clear to me, the World Anti-Doping Association initially rejected this test in favor of the isoform test. I cannot say what is causing all of the new interest in this (relatively) old test. [Here's a recent IIATMS posting on the types of tests.]
Q: Great. The new test is not new. This discussion could not get any more confusing. But if the “new” test is not new, can we at least say that the “new” test is different?
A: Yes. The “new” test takes a different approach. It does not look at the HGH in an athlete’s blood. Instead, the test looks at a “biomarker” associated with HGH.
Q: I bet whatever question I want to ask now, you’ll want to tell us about biomarkers.
A: “Biomarker” is a term used broadly in medicine. Wikipedia says that a “biomarker” refers to “anything that can be used as an indicator of a particular disease state or some other biological state of an organism.” In anti-doping, a “biomarker” is usually some measurable body state that is affected by the taking of a performance-enhancing drug. So, an HGH biomarker test would measure something in the athlete’s body that would be affected by the taking of HGH.
Q: If I say I don’t understand, are you going to start talking about M&Ms again?
A: OK, here’s a simple example. I want to devise a test to determine whether you’ve been kicked in the shin. My test is that I’m going to examine your shin for a black-and-blue mark. If you have a black-and-blue mark, that could be a biomarker for a kick in the shin.
Q: Or that I closed the car door on my leg.
A: Let’s use a better example. Let’s say that you want to catch athletes who do blood doping. Blood doping is a way for an athlete to increase the number of red blood cells in his blood stream. Red blood cells carry oxygen, and certain athletes (particularly endurance athletes) will perform better with a higher number of red cells in their blood. Moreover, there’s no anti-doping test that can directly detect blood doping (at least, so long as the athlete blood dopes with his own blood). However, blood doping has an effect on certain biomarkers. For example, when an athlete blood dopes, the body reacts by producing fewer new red blood cells (new red blood cells are called “reticulocytes”). A low reticulocyte count can be a biomarker for blood doping.
Q: OK … so when you can’t detect the doping, you try instead to detect an effect of the doping?
A: Very good! That’s one reason to test for biomarkers. There can also be a timing advantage in testing for biomarkers. A performance-enhancing drug like HGH can disappear from the bloodstream very quickly, as we’ve already noted. But an HGH biomarker might persist for much longer, maybe for a week, maybe for two weeks. This gives the anti-doping folks a better chance to catch the dopers.
Q: Gee … if biomarker testing is so terrific, then why aren’t all anti-doping tests designed to look for biomarkers?
A: Remember that a biomarker test measures the effect that the performance-enhancing drug has on the biomarker. It’s possible that the same effect might be produced by something other than the performance-enhancing drug.
Q: Like my black-and-blue mark being caused by the car door.
A: Yes. Going back to our example of blood doping, we said that a low reticulocyte count might be a biomarker for blood doping. But there are other things that might cause a low reticulocyte count: for example, getting sick, or moving from a high to a low altitude. There’s also a certain natural variation in most biomarkers. In order for the HGH test to be valid, the scientists have to find a biomarker measurement that they can confidently link to HGH use – and only to HGH use.
Q: You mean, something other than HGH might affect the HGH biomarker?
A: Yes. For example, the biomarker might be affected by exercise.
Q: You can’t be serious.
A: Hopefully, the test can distinguish between an effect caused by exercise and an effect caused by doping.
Q: Can you tell us, what’s the biomarker that the scientists have found for HGH?
A: There may be more than one biomarker. It’s not clear from the New York Times article. But the primary biomarker appears to be IGF-1, the stuff we talked about in the beginning of this Q&A.
Q: You mean, the same stuff you said that anyone could find out about by reading Wikipedia? What’s taken the scientists so long to focus on this biomarker?
A: I’m asking myself the same question. These guys were asking this question two years ago.
Q: Do you think baseball should be testing for HGH, using the new biomarker test?
A: First we need to make certain that the test works well enough to be effective. Doping tests are supposed to go through extensive validation. The other big issue is that the HGH marker test appears to be a blood test. Baseball performs doping tests on urine samples taken from players, but the players have resisted blood testing.
Q: But you said in the beginning of this Q&A that HGH does not appear to be performance-enhancing? If HGH is not performance-enhancing, then why should baseball spend so much time and money testing for HGH?
A: That’s a tough question, one that we’ll try to explore in later posts. It seems that when it comes to anti-doping, perception is more important than reality. The players perceive that HGH is performance-enhancing. The fans perceive that HGH is performance-enhancing. The anti-doping forces believe that they have a foolproof test to catch the athletes using HGH. IN ALL LIKELIHOOD, NONE OF THESE PERCEPTIONS ARE TRUE. Yet the perceptions takes on lives of their own. It seems likely that baseball WILL go forward with some kind of HGH testing. The only question is when.
Q: One last questions for you. You talk a lot of smack for a non-expert. Why should I believe you?
A: Because unlike the NY Times, I cite sources. Click through to any of the references I’ve given you here.
Excellent interview. I will say it again: the best bloggers are putting old school reporters to shame. This blog is one of the best.
Far and away, this is the best explanation of so-called performance enhancing drugs that I've read. Wow. We can only hope this makes some small difference in how mainstream sources choose to portray HGH. Great job, Larry.
This is a very well thought out article, backed up with a lot of evidence. It doesn't go too far in any direction to give an "opinion" on the matter, but rather helps answer a lot of questions I'm sure people have, including myself, about what all this HGH nonsense is about. Well done.
This was an excellent post.
I'd second all of the comments above mine. Thanks for this piece.
Jason, when you say:
"They use HGH in combination with other performance-enhancing drugs, like steroids and insulin."
You forgot two much, MUCH bigger factors than steroids or any other PED that have shaped the average ballplayer over the last 20 years:
Fitness/weight training and nutrition.
I can't tell you how frustrating it is that EVERY discussion of PEDs seems to ignore these points entirely. An athlete with optimum nutrition and proper fitness training program will be stronger and faster than the non-trainers, EVERY TIME.
I could throw in modern medicine (for that "speeding healing" argument that enters the steroid/HGH debate), but that would be piling on.
Michael, thanks for your comment. I'm the author here, so the criticism should be directed at me. I did not mean to suggest that PEDs work magic on their own. It's not like I can take a pill and suddenly morph into Joe DiMaggio. But I don't understand why you're making this point in response to my article. I'm not trying to account for improvements in the physical abilities of ballplayers during the PED era, I haven't even argued (one way or the other) that any such improvement has taken place. I've participated in such arguments on other forums, and I've taken the position that PEDs are less effective than we might think, and that factors like exercise and nutrition play a larger role than we might think. (I think there's an exception for endurance sports, where drugs like EPO are extremely effective.) Moreover, I've made a pretty strong case here that HGH is not performance-enhancing. So while I pretty much agree with you, I don't know why you're aiming these comments at me!
Brian, TCM, Brad, Simon, Jamal: thanks!
Mike, what you’re discussing is doping control by performance analysis. There are credible people out there (scientists, even) who think that there are natural limits on human strength and speed, or on the ability of a person to improve athletic performance over time, or on the ability of a person to resist the effects of aging. If an athlete exceeds these limits, then he “must” be doping. For example, see the fifth question and answer here: http://bit.ly/1NGCXt.
I could not be more opposed to this way of thinking, but that’s an opinion on my part, and you should know that there are a lot of credible people who think that performance analysis has a place in doping control.
I have many arguments against this idea, and I cannot possibly discuss them all here. I’ll limit myself to two of these arguments.
First, if you read the arguments in favor of doping control by performance analysis, you’ll see that they’re not basing these arguments on a scientific analysis of the limits of the human body. Instead, their arguments are statistical in nature: they evaluate past performances, then determine what is statistically improbable for future performances. With any such analysis, there will naturally be outliers with unexpected performance levels. That is the nature of statistics, and there’s no way around this limit. Unless you’re willing to sanction an athlete for an exceptional performance, you cannot fairly label someone a doper because he did something that you find unlikely.
(In fairness, the most responsible voices in anti-doping would probably agree with me, and would argue only that outliers should be more heavily tested by conventional means. I don’t agree with this either, but that’s a discussion for another day.)
The second argument is a more practical one, which I’ll give you from one baseball fan to another: we love the game of baseball in part because of its limitless ability to astonish us. Do we really want to go to that cynical place where a 500 foot home run or a 100 MPH fast ball arouses our suspicion and not our amazement?
I learned much of what I know about doping (and anti-doping) as a fan of professional cycling, and I can tell you that cycling went over to that cynical place a long time ago. We used to joke that at the end of each Tour de France, the race winner would receive a gold medal followed by an immediate sanction for doping, since everyone knows that cyclists dope in the Tour de France, so naturally it’s impossible to win the race without doping. With the first place winner stripped of his gold medal, the second place winner would be elevated to first place, given a gold medal and immediately sanctioned. It would go on down the line until either we’d exhausted all of the riders or else it was too dark to continue. Sadly, our joke has a basis in reality – when the lead changes in a typical Tour de France, so does the identity of the guy who’s rumored to be doping.
Sure, I understand the risk of admiring an athlete whose performance is too good to be true, only to be told by the doping police that the performance actually WAS too good to be true. I’ll run that risk. The risk is greater if we allow doping speculation to run wild.
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Larry, I was thinking that there could be away of figuring out which players are using performance enhancing drugs whether HGH or steroids by the performance of the athletes themselves .When I say performance I don’t mean judging the stats of a player though that’s usually a big tip-off on who’s juicing but that isn’t conclusive, what I mean is judging the quickness of players bat speed which should never change but if steroids help your strength it should also help your agility . I see it all the time players like Delgado ,Howard,Tulowitzki to name a few look like their swinging in water then all of a sudden are lightning quick.Scouts say that Ryan Ludwig has super quick bat speed,of course they weren’t saying that a couple of years ago but suddenly out of nowhere he increased his speed . The same can be done with pitchers either by judging the speed of the pitch or the quickness of the delivery to the plate. Take someone like Oliver Perez ,two years ago for most of the season he was throwing 95 now after signing a contract he hardly reaches 87 !!! I think if anyone published daily speed on players it would be a site that everyone who follows baseball would have to visit .