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Why is Toradol “ok” but Steroids and HGH “bad?”

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Did Papelbon inadvertantly open up a whole new PED angle? Photo Keith Allison via wikipedia/flickr

The latest salvo in the “Questionable Performance Enhancing Drug” storyline in today’s professional baseball landscape was this interesting statement from Jonathan Papelbon last week;  he and other Boston teammates frequently were injected with the drug Toradol by team doctors when they were feeling “run-down” or overly fatigued in order to get a quick pick-me-up for a game.  Apparently Toradol had the effect of giving players a four hour window of feeling “pretty damn good” and it was used by a portion of the Boston clubhouse.  Its also in use in many other clubhouses (though apparently not in Philadelphia, who told Papelbon his Toradol days were over).

Ok, how is Toradol not a Performance Enhancing Drug?  It certainly seems to qualify based on WADA’s “Three Criteria” for PEDs:

  1. The capacity to enhance performance (clearly, as discussed by Papelbon)
  2. Use can result in negative health consequences (absolutely; Jon Lester suffered some of them and had a serious internal bleeding issue, and now Boston is reportedly reviewing its use of the drug)
  3. Violate the spirit of sports. (opinion based .. but after reading what Toradol can do, how can you NOT argue that its use violates the “spirit of sports?”)

(2/15/13 update: The Red Sox trainer who administered all this Toradol apparently “flouted” state laws by doing so, as reported by Passan, who is all over this case.)

By the way, WADA adds a drug to its banned list if it qualifies for TWO of the above three categories (hence the addition of things like “Deer Antler Spray” despite it having no known side effects, since it clearly seems to violate the spirit clause).

This leads me to my larger question: Why is Toradol, and as a side effect Steriods and HGH “bad” but the use of Cortisone, Toradol considered “ok” in terms of usage?   What do Cortisone shots do?  They enable a player to play through pain that otherwise may keep him out.  Uh … isn’t that the definition of a “performance enhancing” substance??   Our own Ryan Zimmerman clearly benefitted from cortisone shots in 2012; his before/after splits are pretty distinct and obvious.   Cortisone itself also fits the 3 WADA principles; it enhances performance, it has side-effects that many doctors are quite worried about, and I’m sure some would agree it changes the “spirit of the game” in some ways.

If your answer involves something along the lines of “PEDs are banned because they’re illegal” then I’ll counter with this: Steroid’s aren’t illegal; they’re just controlled.  But so is Cortisone; you can’t just inject yourself with the stuff without a doctor’s order.  And so is Toradol; you can’t go into your local supermarket and buy injectable Toradol.   And so is HGH: ask yourself why most elderly persons keep bottles of the stuff on their bed-side table?  Even something like a B-12 shot raises some issues; lots of players get B-12 shots and swear by the natural effect it has, but as with Toradol I’m pretty sure you can’t just get injectable B-12 and administer it yourself.  Even though B-12 is naturally occuring, in order to naturally consume the amounts of B-12 being injected you’d likely have to eat a bushel of clams (or some other high B-12 food) every day.

Honestly I may have the biggest issue with the classification of HGH as a PED, when you think about what HGH is (a naturally occuring growth hormone that is generates solely to help the body heal itself after an injury or illness) and then think about what Cortisone accomplishes for athletes.  So its “ok” to take a Cortisone shot that treats inflammation from an injury/strain so that you can go out and play better … but its NOT ok to take a naturally occuring suppliment to help with the same issue??  The only reason adults don’t heal as fast as kids is precisely because our natural HGH generation slows as we age … and doctors prescribe HGH to help the elderly heal from illnesses and injuries all the time.  Isn’t this inconsistent?

And all the above just talks about various medications.  Lets talk about the in-vogue plasma-replacement treatments that Kobe Bryant popularized and which have now been done by others, including Alex Rodriguez and Bartolo Colon. In this op-ed piece from Jeff Passan from Dec 2011, he discusses the blurry line between PEDs and legitimate surgical procedures.  The article has a very in-depth description of the A-Rod procedure and raises the question as to what defines a Performance Enhancing Drug?   If blood doping is illegal, how is a procedure that filters out platelets and re-injects them to targeted spots legal?  Colon was out of the game in 2010, got the procedure and suddenly is a 116 ERA+ pitcher in 2013; isn’t this concerning?

Passan takes things one step further, comparing the healing effects of HGH with these new treatments that A-Rod and Colon got and makes a very good point; these new-fangled surgical procedures absolutely qualify for WADA’s 3 criteria.  Passan has also asked the same questions I’m asking in a June 2006 article that started about HGH but ended with this same general question.  And he makes very good points about cortisone, HGH, Testosterone and even Tylenol usage.  Its worth a read.

Here’s another question: why is it “ok” to have performance-enhancing surgical procedures (Lasik surgery, Tommy John surgery, or any manner of surgery involving transplanted ligaments or tendons) but it is NOT ok to use drugs that have the same general effect?   If I can take a pill that gives me 20-10 vision, which enables me to see the baseball better and become a better hitter, would that be considered a PED?  I’m pretty sure … but yet people go get laser surgery and can get their eyes fixed to this level of quality any day of the week.  Perhaps this is a ridiculous example but my point stands; whether or not your performance is enhanced by virtue of a bottle or by the knife, aren’t these valid questions?  We’re starting to hear of psychotic parents of teen-aged pitchers actually getting “preventative” Tommy John surgery done, knowing that most pitchers who have the surgery see improvement in certain aspects of their game (since the Ulnar Ligament connector is actually strengthened in this surgery over how it grows naturally).  Is this … ethical?

And then there’s this interesting point, which was proposed on a BS Report podcast done between Bill Simmons and Chuck Klosterman last week.  If HGH is considered a PED, and HGH’s sole purpose in life is to help people get better after being sick … then why aren’t classes of anti-biotics such as Amoxicillin also considered PEDs?  What is the difference?   Klosterman then made the additional (scary) point that PED usage and testing may all be for naught eventually; Genetic testing and DNA manipulation may get to the point where there can BE no test to find out whether someone’s been genetically manipulated in order to be a superior athlete.  Testing has been trailing the science for years in professional sports … it may eventually be rendered completely moot.  Of course, taken the the ridiculous extreme, do we really want a slew of genetically engineered super-athletes competing for our enjoyment?  Why not just invent a bunch of robots to play these games?

Food for thought.  I know we’ve discussed some of these topics here before but do you worry about the inconsistencies in professional sports PED policies?  I’m not sure I have an easy solution, but I will say that the classifications of drugs seems arbitrary in some cases.

9 Responses to 'Why is Toradol “ok” but Steroids and HGH “bad?”'

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  1. Great article, and thanks for the Passan link.

    Yes, I worry about the inconsistencies. Mostly, like your article, I just don’t understand where the lines are being drawn, and more importantly, why. I don’t support PED use, but as the vilification of PED users in baseball grows, I have asked myself ‘why don’t I feel as outraged as so many others’? It comes down to the questions in your article: I don’t get why some things are banned and others aren’t, and so I can’t get that upset when some players are using stuff that seems to fit the same criteria as other things that are fine. I think what is needed is a general discussion on why, because there are some startling inconsistencies across sports.

    What is the primary motivation behind these rules?

    Player health? It can’t be this, although it should be. I think it is pretty clear that football players are shortening their life span by playing the game through the professional levels. In other words, actually killing themselves to play. Drugs aren’t the only thing involved here certainly, but they play a part. Yet the game goes on, as America’s most popular sport. Is HGH or steriods less healthy than Toradol, or cortisone? Maybe it is, but I don’t hear that argument.

    Unfair advantage? This is the one that generates most of the outrage, in my opinion. But honestly, is there anything that generates more of an unfair advantage than TJ surgery? Before 1974, any pitcher who blew out his elbow was done. Career over, move on to broadcasting or selling cars. Now, it is barely a blip. Seems pretty dramatic to me.

    But maybe people ask it in terms of an advantage over what? Like, it is ok to use things to return yourself to a prior ‘natural’ performance level, but we don’t want to allow performance beyond what a player had naturally. OK, I get it, but then why not HGH, as you say. And why is Lasik ok?

    And why has basketball had almost no suspensions for PEDs? Can it really be that they don’t feel the same pressure to gain an ‘unfair advantage’?

    That ‘spirit of the game’ criteria is nothing more than a license to decide whatever they want. That is ok by me, but they do need to explain their thinking better.

    Wally

    13 Feb 13 at 11:32 am

  2. Much like the fact that some people think its relatively arbitrary that Tobacco is legal while Marijuana is (mostly) illegal, it seems arbitrary how these drugs are finding themselves being classfied.

    Motivation to me is a mix of both health concerns and a level playing field. Pro athletes do a lot of things that are not in their long-term health best interests in order to stay on the field and earn the millions of dollars they’re being paid. I’ve had orthopaedists tell me they disagree with the use of cortisone altogether, because of the long term damage it does to soft cartilidge. Pro athletes sometimes get nearly weekly shots of the stuff. But, all that is thrown by the wayside if you find out that someone hit 73 home runs out of the blue in his late 30s to literally destroy one of the most cherished records in all of American sport with the help of a testosterone-laden cream.

    Listened to Buster Olney podcast today and they talked about why the union eventually acquiesed to drug testing at all; it was partly a Public Relations move in the wake of the home-run craze, but it was also due to significant voice from non-PED taking union members who found themselves with an unenviable choice; use these dangerous/illegal drugs to keep up at the risk of your long term health, or be out of a job/be paid less than cheating colleagues. Something had to be done.

    Todd Boss

    13 Feb 13 at 1:52 pm

  3. It strikes me as being fairly arbitrary, also. I now wonder why Gio Gonzalez is already being vilified as a “PED user” (in some circles…the same ones that chanted “cheater!” every time Pujols walked onto the field) while Zimmerman is called a “hero” for sucking it up, getting cortizone shots and continuing play. I suppose a level playing field is all fine and well if everyone has the same aims and goals but that’s not the case. Bonds, for example, was an excellent player who didn’t want to be excellent, he wanted to be the best, and PEDs were the way to do it. You could say he traded his future quality and length of life for a moment of glory and if that was his goal, fine. So be it. Perhaps all the guys that didn’t juice and who’s hearts won’t explode or collapse in their mid 60′s can go to his funeral. The point is that if an individual wants to make a trade like that, it should be his choice. Short of actual genetic engineering, the rule may as well be “anything goes as long as it’s legal in the USA” because anything else is going to be seen as capricious and arbitrary, based more on the volume of complaining than anything else.

    Mark

    14 Feb 13 at 8:09 pm

  4. Follow up came out today that’s even more chilling.

    http://sports.yahoo.com/news/red-sox-s-use-of-toradol-could-put-ex-trainer-at-odds-with-state-law–industry-guidelines—060042869.html

    Schilling said he took a shot of this stuff “nearly every game for 10 years” and talked about how he went from being a possible injury scratch to pitching a 1-hitter.

    Todd Boss

    15 Feb 13 at 9:38 am

  5. Gio’s career is forever altered by this report, fair or not. There are far far too many loud, uneducated voices both in the blogosphere and in the public in general who read what they want to read and hear what they want to hear. There’s people (speaking of Pujols) who still maintain doubt about Pujol’s real age, mostly because of his country of origin, never mind the fact that he grew up and went to american schools (who do their own versions of age-checking).

    Lots and lots of people still characterize Ryan Braun as a cheater who “got away with it” on a technicality. No he didn’t! His defensive team demonstrated rather simply what happens to Braun’s urine samples when not handled properly; they show up as a positive test. That’s because Braun’s specific body waste chemistry included lots of waste testosterone, which for whatever reason manifested itself when not properly stored upon evacuation … and it screwed up his test. That’s why he won his appeal. People think that tests for Testosterone ratios are simple yes/no answers like a pregnancy test; they’re not at all. People have wide variations of regular testosterone levels naturally, and then you can absolutely change your ratios depending on your mood or what you’ve eaten (much like people’s blood pressure drastically varies).

    Todd Boss

    15 Feb 13 at 10:28 am

  6. Personally, I don’t really care about PEDs as long as it’s not something illegal, as in against the law, and it doesn’t involve genetic changes. As I mentioned above, I think it’s a trade-off based on a personal decision and if that’s what someone wants to do, so be it. What I don’t like is the lying. I’m giving Gio the benefit of the doubt because…well, because he’s Gio and he says he didn’t do it. If it comes out that he did, I won’t think any less of him as a baseball player but I’ll think a lot less of him for lying about it. Enough so that my signed Gio jersey will come off the wall and get tossed into a box in the attic, probably forever. Same with Braun, except for the jersey part. :-) Bonds lied about like if he kept lying about it he’d win something. Clemens lied to congress about it! Oh sure, the charges were dropped but dno’t forget that OJ is in jail for armed robbery. Brian Roberts and Andy Pettitte admitted using steroids and I still like them both.

    It is unfortunate that some people absolutely refuse to let anything go, ever. A bunch of years ago my family were in Viera watching the Nats play the Cards. Being as it was the Nats a few years ago, there were like 200 people in the ball park and since my son was a Cards fan, we sat in the 1st row on the 1B side, just beyond the Nats dugout, along with one of those other 200 people who was sitting a couple rows behind of us, of course, and would not stop yelling at Pujols. All kinds of insults about his age, steroid use (which puzzled me, he was one that DIDN’T appear on “the list” as I recall) and anything else the guy could yell. And he was in St Louis gear…even weirder. Anyway, this went on for several innings, non stop. My brother-in-law, a fairly big guy and also a Cards fan, intimated that if the guy yelled one more thing at Pujols, he would go shut him up himself. As he’s telling me this, Pujols looks over at the guy with this big, toothy grin, lifts the brim of his hat a bit so you could see his full face and flips the guy off. We almost fell out of seats laughing and I thought the loudmouth was going to have a stroke before he got up and stormed off. To top it all off, the last out for the inning was at 1B and Pujols trotted over to us, handing my son the ball and thanked him for being a good sport, then ran back to the Cards dugout. I bet that guy still tells stories about what a vile, disgusting human being Pujols is. :-D

    Mark

    15 Feb 13 at 11:59 am

  7. I think I care about PEDs … if only to create a level playing field. Well, that and to have some semblance of reality when it comes to statistics in the current era versus last. Saw on another blog a write up about OPS+, and the guy showed that Barry Bonds owns four of the best 11 seasonal OPS+ performances in history … at ages 36,37,38 and 39. This guy said we should throw out all four of those seasons, plus (of course) all his Home Run records. And, well, its hard to argue otherwise when talking about history.

    Interesting story about Pujols, though i’d say it illustrates a different point. Why some people get off going to professional sporting events just to yell things at other players is absolutely beyond me. The infamous Washington Wizards heckler comes to mind (who even has his own wiki page for crying out loud). Its like people who just post comments on newspaper articles that are clearly designed to get a rise out of the readers.

    Todd Boss

    15 Feb 13 at 2:43 pm

  8. Well, yeah, I care about PEDs in that, by and large, they appear to ruin your life in the long run, but I think the MLB bans and rules are just knee-jerk reactions to whoever is complaining the loudest and unsustainable in the long run. Perhaps it should be handled like drug testing in most private sector businesses where it’s really only for insurance and all they test for is meth, cocaine, alcohol and nicotine. If you can’t be insured for a reasonable price, you can’t for MLB. Go get a job somewhere else and come back when you’re clean enough to be insured.

    I’m not sure why I threw the Pujols story in there…I guess the steroids connection. I certainly do my share of heckling when it’s called for but I know when it’s called for and I also know when to stop. It’s also pretty rare when I heckle players on “my” team, but it can happen. Think Mike Bacsik. ;-) I don’t get guys like that either. I guess they feel that they paid for the ticket so they’re entitled to do whatever they please, as if no one else in the ballpark counts.

    Mark

    15 Feb 13 at 9:57 pm

  9. PEDs and the long haul for your health. Ask yourself; if you’re a run-of-the-mill IT programmer, but you could take a pill that would instantly make you one of the best IT developers in the world and would multiply your income 20-30 fold (if you’re a MLB min player at $500k and suddenly you’re a superstar making 15m) but you knew that taking this pill would take years off your life … Tell me with a straight face you wouldn’t do it either. Imagine if within a year’s time you could multiply your own income 10 fold. Uh, yeah, that’s lifechanging money. I don’t care if I only live to be 85 instead of 88 if I know I can provide for my family, get financial independence for the rest of my life, etc. AND that’s not even talking about the legacy aspect of baseball; by becoming these superstar talents, guys like McGwire, Sosa and Bonds transcended history and forever etched their names into the record books … that’s quite a carrot to chase.

    Todd Boss

    16 Feb 13 at 10:23 am

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