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Restating the obvious

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Road Cycling
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5 November 2005
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Bill C
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  1. In article <[email hidden]>,

    benjo maso said:

    "h squared" <[email hidden]> wrote in message
    news:[email hidden]...

    Quoted message said:
    benjo maso said:

    (and by the way, the health of the athletes is more an excuse than a
    justification of the anti-doping policy,

    the link to this article was posted before, but i still like the following
    bit, concerning "the health of the athletes" (i have no idea if it's
    factually correct, sorry):

    "To be banned by WADA, a drug has to meet at least two of three criteria:
    it must enhance performance, be harmful to health and (a very Victorian
    touch) be against the spirit of sport. Clearly, this would allow a drug to
    be banned if it had no adverse health effects but was, even so, ruled
    contrary to whatever is deemed to be the spirit of sport. Mr Pound, for
    one, seems to regard any use of a drug to enhance performance as against
    that spirit: it is, quite simply, cheating.

    A fierce critic of this approach to drugs in sport is Norman Fost,
    director of the medical-ethics programme at the University of Wisconsin.
    He calls the claims made about the harmful effects of steroids “incoherent
    and flat-out wrong”. Mostly, they have small, temporary side-effects, he
    says, not life-threatening ones. Indeed, the risks are much smaller than
    those routinely taken by athletes. A man who plays American football
    professionally for three years has a 90% chance of suffering a permanent
    physical injury.

    I'm deferring to Steven Bornfeld's assessment that steroids are more
    harmful than Mr. Fost asserts. Let's wait for the evidence, but they're
    really powerful drugs. People taking them for purely therapeutic reasons
    are often leery of the exciting and varied side-effects.

    Quoted message said:
    Quoted message said:

    If health is the chief concern, surely certain sports should be banned
    entirely—and athletes should not be allowed to smoke or drink, activities
    that do far more harm than taking steroids. As for enhancing performance,
    that is not seen as cheating if it is done by, say, training at high
    altitude or in a sealed space that simulates high altitude, says Dr Fost,
    though such training would have exactly the same effect—an increase in
    oxygen-carrying red blood cells—as the banned steroid EPO, which is
    especially popular with cyclists." (economist, august 5, 2004)

    The interesting thing about EPO is that it pretty much gets better and
    better at improving your performance right up to the point where your
    heart stops. There are natural risks in cycling that are similar (the
    fastest guy down the mountain is the one who comes closest to sliding
    off the mountain without actually doing so), but while very few races
    are won by being the fastest descender, what EPO boosts is pretty much
    the definition of a race-winning physiology.

    If an athlete smokes or drinks, his choice doesn't force other athletes
    to take new, very real risks with his health. Dose-response, if you know
    the term, is a big concern for me, as may be evident from my posts.

    My layman's understanding of dose-response is essentially this: for most
    drugs, the more you take the more they do of whatever it is they are
    supposed to do. This tends to include both good and bad effects.

    To pick on steroids again, the more you take, the more rapidly and
    powerfully you can recover/build muscle/train harder. But also the more
    you experience all the side effects, which vary from steroid to steroid,
    but include fun things like testicular shrinkage, kidney damage, and
    other things.

    When we use drugs therapeutically, we use them in doses that try to push
    the patient back to something approximating normal, be they SSRIs, EPO,
    or steroids. Even at that, side effects often have to be considered, and
    may prevent a treatment as potent as the doctor could hope (or side
    effects may be mitigated with other drugs, or drug substitutions happen
    to minimize side-effects and maximize therapy for a particular patient).

    Performance use isn't like that. With "normalcy" as a goal out the
    window, the user is pushing for some peak response that tends to arrive
    at higher doses, up where there is also maximum risk of harm.

    Maybe we have to balance these relative risks. But you know, I bet those
    cyclists who died in the 90s of EPO failure were going really fast the
    week before their hearts stopped beating.

    All this is pointing to one thing: many medical performance enhancements
    work their best right before they start doing maximum damage. So free
    use of dope to the limits of the riders' willingness to dope is likely
    to push most or all riders to the limits of doping. And it only takes a
    small cadre of pro-level riders doing maximal doping to force all riders
    to decide between competitiveness and safe (or no) doping.

    Quoted message said:

    The point is of course that the arguments against the use of certain
    products is very shaky indeed. "The spirit of sport" must be something
    between "participating is more important than winning" and "sport is war",
    as Rinus Michels, a famous Dutch soccer coach, used to say. "Harmful to
    health" - well, a Dutch doctor argued not so long ago that the health of a
    rider parycipating to the Tour would certainly benefit from a certain amount
    of epo. Concerning "enhance performance" - Norman Fost is quite right. The
    point is that the anti-doping idea is based on the traditional idea that men
    must compete in their "natural" state. That was the reason why Pierre de
    Coubertin, the fouding father of the Olympic Games, said once that training
    several hours a day was as much "cheating" as using drugs. Therefore the
    paradox Dr Fost is pointing out. Meanwhile training is accepted, using
    certain products not - or rather, not yet.

    People started to get really picky about using certain products right
    after Tommy Simpson died. There were probably previous incidents of one
    type or another that turned people to thinking about cleaning dope out
    of the sport, but that one was sort of the key, much in the way Kvilev's
    death was the turning-point for mandatory helmets in the pro peloton.

    The Hct 50% limit came about after riders started dropping dead in their
    sleep in suspicious numbers.

    People do get hurt and die in sport. A local road race used to be named
    for the Cat 3 who died in a sprint crash in the race a few years ago.
    But we do try to limit the dangers so that no sport is truly a
    bloodsport, and nowadays most sportsmen retire and grow old.

    I think one of the confusions is that we can actually test against most
    of the common drug practices out there. Protocols (steroids) that are
    widespread in other sports would never be contemplated in pro cycling,
    not because they don't work, but because the rider would test positive
    almost instantly. What this means is that much of the harm that riders
    could do to themselves (and each other, as I have explained, for
    prisoner's dilemma reasons) is mitigated right there.

    --
    Ryan Cousineau [email hidden] http://www.wiredcola.com/
    "I don't want kids who are thinking about going into mathematics
    to think that they have to take drugs to succeed." -Paul Erdos

  2. In article <[email hidden]>,

    benjo maso said:

    "h squared" <[email hidden]> wrote in message
    news:[email hidden]...

    Quoted message said:
    benjo maso said:

    (and by the way, the health of the athletes is more an excuse than a
    justification of the anti-doping policy,

    the link to this article was posted before, but i still like the following
    bit, concerning "the health of the athletes" (i have no idea if it's
    factually correct, sorry):

    "To be banned by WADA, a drug has to meet at least two of three criteria:
    it must enhance performance, be harmful to health and (a very Victorian
    touch) be against the spirit of sport. Clearly, this would allow a drug to
    be banned if it had no adverse health effects but was, even so, ruled
    contrary to whatever is deemed to be the spirit of sport. Mr Pound, for
    one, seems to regard any use of a drug to enhance performance as against
    that spirit: it is, quite simply, cheating.

    A fierce critic of this approach to drugs in sport is Norman Fost,
    director of the medical-ethics programme at the University of Wisconsin.
    He calls the claims made about the harmful effects of steroids “incoherent
    and flat-out wrong”. Mostly, they have small, temporary side-effects, he
    says, not life-threatening ones. Indeed, the risks are much smaller than
    those routinely taken by athletes. A man who plays American football
    professionally for three years has a 90% chance of suffering a permanent
    physical injury.

    I'm deferring to Steven Bornfeld's assessment that steroids are more
    harmful than Mr. Fost asserts. Let's wait for the evidence, but they're
    really powerful drugs. People taking them for purely therapeutic reasons
    are often leery of the exciting and varied side-effects.

    Quoted message said:
    Quoted message said:

    If health is the chief concern, surely certain sports should be banned
    entirely—and athletes should not be allowed to smoke or drink, activities
    that do far more harm than taking steroids. As for enhancing performance,
    that is not seen as cheating if it is done by, say, training at high
    altitude or in a sealed space that simulates high altitude, says Dr Fost,
    though such training would have exactly the same effect—an increase in
    oxygen-carrying red blood cells—as the banned steroid EPO, which is
    especially popular with cyclists." (economist, august 5, 2004)

    The interesting thing about EPO is that it pretty much gets better and
    better at improving your performance right up to the point where your
    heart stops. There are natural risks in cycling that are similar (the
    fastest guy down the mountain is the one who comes closest to sliding
    off the mountain without actually doing so), but while very few races
    are won by being the fastest descender, what EPO boosts is pretty much
    the definition of a race-winning physiology.

    If an athlete smokes or drinks, his choice doesn't force other athletes
    to take new, very real risks with his health. Dose-response, if you know
    the term, is a big concern for me, as may be evident from my posts.

    My layman's understanding of dose-response is essentially this: for most
    drugs, the more you take the more they do of whatever it is they are
    supposed to do. This tends to include both good and bad effects.

    To pick on steroids again, the more you take, the more rapidly and
    powerfully you can recover/build muscle/train harder. But also the more
    you experience all the side effects, which vary from steroid to steroid,
    but include fun things like testicular shrinkage, kidney damage, and
    other things.

    When we use drugs therapeutically, we use them in doses that try to push
    the patient back to something approximating normal, be they SSRIs, EPO,
    or steroids. Even at that, side effects often have to be considered, and
    may prevent a treatment as potent as the doctor could hope (or side
    effects may be mitigated with other drugs, or drug substitutions happen
    to minimize side-effects and maximize therapy for a particular patient).

    Performance use isn't like that. With "normalcy" as a goal out the
    window, the user is pushing for some peak response that tends to arrive
    at higher doses, up where there is also maximum risk of harm.

    Maybe we have to balance these relative risks. But you know, I bet those
    cyclists who died in the 90s of EPO failure were going really fast the
    week before their hearts stopped beating.

    All this is pointing to one thing: many medical performance enhancements
    work their best right before they start doing maximum damage. So free
    use of dope to the limits of the riders' willingness to dope is likely
    to push most or all riders to the limits of doping. And it only takes a
    small cadre of pro-level riders doing maximal doping to force all riders
    to decide between competitiveness and safe (or no) doping.

    Quoted message said:

    The point is of course that the arguments against the use of certain
    products is very shaky indeed. "The spirit of sport" must be something
    between "participating is more important than winning" and "sport is war",
    as Rinus Michels, a famous Dutch soccer coach, used to say. "Harmful to
    health" - well, a Dutch doctor argued not so long ago that the health of a
    rider parycipating to the Tour would certainly benefit from a certain amount
    of epo. Concerning "enhance performance" - Norman Fost is quite right. The
    point is that the anti-doping idea is based on the traditional idea that men
    must compete in their "natural" state. That was the reason why Pierre de
    Coubertin, the fouding father of the Olympic Games, said once that training
    several hours a day was as much "cheating" as using drugs. Therefore the
    paradox Dr Fost is pointing out. Meanwhile training is accepted, using
    certain products not - or rather, not yet.

    People started to get really picky about using certain products right
    after Tommy Simpson died. There were probably previous incidents of one
    type or another that turned people to thinking about cleaning dope out
    of the sport, but that one was sort of the key, much in the way Kvilev's
    death was the turning-point for mandatory helmets in the pro peloton.

    The Hct 50% limit came about after riders started dropping dead in their
    sleep in suspicious numbers.

    People do get hurt and die in sport. A local road race used to be named
    for the Cat 3 who died in a sprint crash in the race a few years ago.
    But we do try to limit the dangers so that no sport is truly a
    bloodsport, and nowadays most sportsmen retire and grow old.

    I think one of the confusions is that we can actually test against most
    of the common drug practices out there. Protocols (steroids) that are
    widespread in other sports would never be contemplated in pro cycling,
    not because they don't work, but because the rider would test positive
    almost instantly. What this means is that much of the harm that riders
    could do to themselves (and each other, as I have explained, for
    prisoner's dilemma reasons) is mitigated right there.

    --
    Ryan Cousineau [email hidden] http://www.wiredcola.com/
    "I don't want kids who are thinking about going into mathematics
    to think that they have to take drugs to succeed." -Paul Erdos

  3. Steven Bornfeld said:

    I'll look for some materials tomorrow if no one else beats me to it.

    Steve

    The reason that glucocorticoids and anabolic steroids have such global
    effects and why abuse can carry such a wide variety of potential effects
    is because of their importance in the so-called
    hypothalamic-pituitary-adrenal axis:

    Hypothalamic-pituitary-adrenal axis

    Because variations in any component of the system triggers a sequence
    of changes in distant organs, it is often useful to think of these organ
    systems as functioning together.

    http://biochemistry.ucsf.edu/~fulton/PTF/Metabolism%20Links/HPA%20Axis%20Physio.pdf

    For these reasons, use (or abuse) of glucocorticoids and anabolic
    steroids can cause both short-term and long-term effects across a wide
    range of organ systems. The effects are well-known to both medicine and
    regulatory agencies.

    http://www.drugabuse.gov/about/welcome/messagesteroids305.html

    http://www.steroids.org/health.htm

    http://www.physsportsmed.com/issues/2000/12_00/steroids.htm

    Because these medications are not being used therapeutically in the
    context of sport, there are ethical concerns not only for the sport
    itself, but also for medicine.
    I find that this second consideration is not always easy for patients
    to understand. In fact, there are pressures all the time from patients
    to commit unethical behavior. However, there is no ethical or statutory
    authority anywhere that I know of permitting a medical professional to
    consent to unethical behavior even with the request and consent of the
    patient. A patient may NOT consent to unethical behavior by a medical
    professional. So this cannot be viewed narrowly as an issue of personal
    choice so long as medical professionals are involved. This is not only
    a well-established ethical constraint, but a legal one as well:

    http://www.thedoctorwillseeyounow.com/articles/bioethics/consent_3/

    "

    Courts generally frown upon so-called "releases of liability," and
    refuse to allow them to bar a suit for malpractice. The courts reason
    that patients typically are not in a position to refuse to sign releases
    of this sort, and therefore that it would be unfair to make such a
    release binding on the patient. (See, for example, Tunkl v. Regents of
    the University of California, 383 P.2d 441 [Cal. 1963] ).2 Yet at the
    same time, it is generally accepted that patients who give their
    informed consent to participate in a legitimate medical experiment
    cannot then sue the physicians merely for using experimental techniques.
    (See, for example, Colton v. New York Hospital, 98 Misc. 2d 957, 414
    N.Y.S.2d 866 [N.Y. Sup. Ct. 1979] ).3"

    Steve

    Quoted message said:


    Quoted message said:

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001

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