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