Monday, 23 April 2012

The minister’s son: was the doping backed up by the science?


The elite rugby playing son of the UK government’s Environment Secretary was recently banned for 21 months for taking a range of substances including human growth hormone and anabolic steroids in order to aid recovery from an injury. In a family statement these were called “widely available”. Even though they are a class C drug no one will be surprised to hear that anabolic steroids are accessible. Human growth hormone (HGH) is a bit more unusual. It is a prescription drug that you need to reconstitute before injecting. The product will likely be labeled as to its primary use; this use is for conditions (mainly in children) that have growth deficiency due to a lack of this hormone. The most famous example of this being a certain footballer called Lionel Messi. The cost of treatment for the young thirteen year old (probably running to thousands of pounds) was funded by Barcelona, who Messi then signed up to play for, arguably the most economically successful drug prescription in history 1.

How does a drug, banned in sport and only approved for treating extreme growth deficiencies, become available to athletes? There is of course the black market. But it is also possible for any doctor to prescribe any prescription drug “off-label” i.e. for something other than the use that has been approved. Such use is only limited by the individual ethics of the doctor concerned; in their view any benefits to the patient should outweigh any risks. There is minimal evidence that HGH has any benefits in the normal population. However, there are a number of doctors (especially in the USA) who consider it a useful anti-ageing treatment. Consequently they prescribe the drug in this off-label way. Manufacturers are only allowed to advertise its approved use; in the past US government penalties for such illegal marketing have resulted in multi million dollar fines. This marketing has now stopped; nevertheless it is possible that pharmaceutical companies make more money via off label prescription than for the approved use. This “loophole” also results in another route for accessing HGH; internet sites based in the USA even offer prescriptions over the web. Whilst not quite as easy to get hold of as anabolic steroids, the minister’s comments on its availability are valid.

However, the more interesting part of this story is why the drugs were taken, namely to enhance recovery from injury. This is an explanation that has been used before. When his last chance at an Olympic medal seemed to be fading due to a recurrent hamstring injury, the British bobsleigher, Mark Tout, turned to anabolic steroids. He was discovered and banned for life (the penalty was later reduced to four years).

Athletes are desperate to recover from injury and may stoop to using methods they would normally shun. So these accounts are entirely believable, though clearly this is no excuse when you get caught. But do they work? Do anabolic steroids2 and human growth hormone aide recovery from injury? Both types of drugs have been available for many years. To my knowledge there is no validated clinical trial supporting their use in repairing damaged nerves and tendons, though HGH may possibly aid recovery from bone fractures. Whilst one observational study showed that people claiming to be on steroids recovered better from injury, some animal studies have shown that steroid treatment can actually make injuries worse.  The field is perhaps summed up by the titles of two recent papers this year looking at nerve and tendon damage in rats; contrast “Growth hormone does not stimulate early healing in rat tendons” with “Growth hormone treatment enhances the functional recovery of sciatic nerves after transection and repair”.

The truth may be out there, but science has not found it yet. If these class C drugs do aid recovery, the effect must be marginal at best. Certainly not worth risking the side effects or the sports ban.

Notes:

1   Thanks to my twelve-year-old son Alex for pointing the Messi story out to me.

2   This article refers only to the use of anabolic steroids; these are distinct from corticosteroids that are available on the NHS to reduce inflammation during recovery and are not banned by WADA if the athlete has a therapeutic use exemption.

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