Clemens, McNamee, and Congress Part II: Reflections on the Steroids Era, Baseball's Perdition -- and Redemption

Pippa Wysong

Disclosures

April 01, 2008

Editor's Note:

In this, the second part of Medscape Orthopaedics & Sports Medicine's 2-part look at the juiced game, Lewis Maharam, MD, sat down with Pippa Wysong to offer his perspective on topics ranging from Derek Jeter's call for blood testing, the Roger Clemen's abscess (is it or isn't it B-12?), HGH use in kids, and how Major League Baseball's response to the shadow of steroids has brought some light back to the national pastime.

Dr. Maharam is Clinical Assistant Professor in the Department of Orthopedic Surgery at New York University Medical Center. He is also the medical director for the ING New York City Marathon, and Elite Racing's Musical Marathons around the country. He is also Chairman, Board of Governors, for the International Marathon Medical Directors Association (IMMDA). He is known for being one of the first sports medicine physicians to speak out about the abuse of steroids in baseball.

Medscape: Dr. Maharam, let's continue our discussion by focusing a bit on the use of human growth hormone (HGH). What are some of the side effects associated with the use of HGH?

Dr. Maharam: Well, some of the worst side effects occur in kids who take HGH, and some of the problem cannot be reversed. HGH use can lead to the growth plates closing early, stunting growth. You're decreasing fat. You're changing cholesterol profiles. Steroids have a variety of dangers, such as increased the rate of different types of cancers, such as liver cancers. Cholesterol levels change, there is gynecomastia -- which is increasing breast tissue. There's acne, male-pattern baldness, the list goes on.

Medscape: And other bone problems too?

Dr. Maharam: Yes. Things related to closing growth plates early in kids is the big one, with both steroids and HGH.

Medscape: Yes. Are some of side effects we've discussed showing up in pro players?

Dr. Maharam: It used to be easy to detect steroid users during a physical. With male players you'd see testicle shrinkage, that was the easiest way to tell whether they were using steroids or not. And with the excess use of HGH would come acromegaly, an increase in bone mass and deformity.

Medscape: It sounds like that for the basic GP or sports medicine physician it's not that easy to detect steroid or HGH use in the clinic. Are players getting sneakier or better with the regimens so that maybe it is harder to detect use?

Dr. Maharam: Unfortunately, the desire by players for an edge in all professional sports -- across the board -- is ahead of the testing. For example, in the BALCO (Bay Area Laboratory Co-Operative) case, that cream that was made basically to use to bypass the testing, to elude detection. So, it's really important money be spent by all these major league organizations to stay ahead of the curve.

Medscape: Isn't there sufficient testing in MLB?

Dr. Maharam: Oh, there's plenty of testing in baseball now. In fact, baseball has reacted very well to these controversies, and has developed a very strong testing program. However, there is no blood testing in baseball yet. There's no urine test for HGH yet that is good enough to be reproducible, but there are rumors there may be one by the next Olympics. But baseball has certainly listened to the Mitchell Report. And they've done a good job with the Players' Association in trying to rid themselves of this. I'm pretty impressed with how far they've gone at this point.

Medscape: Weren't you an advisor for [Major League Baseball] MLB at one point?

Dr. Maharam: How do you know that? You read about that in the Mitchell Report?

Medscape: There's a quote in there, yes. How did you get involved at that level?

Dr. Maharam: Well, basically what happened was that after I came out and was talking about androstenedione, they had me come in to MLB and speak to them about what androstenedione was. And I gave that talk. Then, when they initially banned steroids in the minor leagues, they asked me to go down and talk to the minor league ball players and explain to them what steroids were, and why they were dangerous, and why they were being banned and tested for.

Medscape: So you had an educational role with them?

Dr. Maharam: Yes.

Medscape: You were quoted in the Mitchell Report. Were you a consultant for that? Or were you just one of the myriad people they interviewed?

Dr. Maharam: It was just an interview.

Medscape: Okay. Now, looking at where things are at now. Where should baseball, at this point, go with respect to testing? Is there more that can be done?

Dr. Maharam: Yes, more can be done. In the papers the other day Derek Jeter called for blood testing, which the Players' Association has resisted. But blood testing can certainly be more effective than urine testing. There are plenty of places to go with it. I think that they're on the right track. The Players' Association has been really a private organization that's been pushed to change. The owners now seem to have a real interest in trying to rid these drugs from the sport. But they need to spend the type of money needed to help to develop more effective tests. And they should continue with improving drug testing programs.

Medscape: What sorts of tests are available right now?

Dr. Maharam: Right now, urine tests are available. That's what they use.

Medscape: And that's about it?

Dr. Maharam: Well, the blood can tell you if you have a higher level of HGH. But the urine can't. But right now, for steroid testing, they use urine testing, not blood testing. So that's an area that may move in the future -- to bring in blood testing.

Medscape: Why is there resistance to blood testing for steroids if it's better than urine testing?

Dr. Maharam: It can be more effective than urine testing, and sports organizations don't do blood testing. They feel like that it is invasive. Where that's actually going to go in the future I don't know.

Medscape: There is one another issue that's been getting a lot of press recently, so I should ask your take on this. Looking at the whole Roger Clemens controversy as it came out of the Waxman Committee hearings, I have to ask about the abscess on his bottom. There is some debate about whether B-12 injections there could have caused that abscess. What, in your opinion, would cause that sort of lesion?

Dr. Maharam: It is very unlikely that a B-12 injection would cause an abscess -- because it's an aqueous solution, and it allows for immunity-type cells to get to any bugs that may have been injected in a dirty injection. Whereas a thicker injection -- such as a steroid -- may 'wall-off' the bacteria. This walling-off effect would be more likely to cause an abscess. Can I be sure without having seen Clemens in person, or seeing his record, or examined him at the time? No, I can't be absolutely sure, there's always room for doubt.

Medscape: In general?

Dr. Maharam: In general, it would be very unlikely that a B-12 shot would cause an abscess. Can it? Yes, but very unlikely. It's much more likely that a steroid or thicker type medication would cause the abscess.

Medscape: Do you have any other comments or any other take on steroids and HGH in baseball, and where it's going, or where it should go?

Dr. Maharam: No, I think it's going in the right direction. However, I'd like to emphasize that education is the key for our kids. They need to know that this stuff is bad, and why it's bad to use these substances. There is nothing better or more effective than good exercise and good nutrition to be healthy, for the short-term and the long-term. Shortcuts are simply not the way to go.

Medscape: I guess that wraps it up. Thanks very much for sharing your thoughts on these issues with Medscape.

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