While Houston Texans linebacker Brian Cushing(notes) continues to proclaim his innocence in the face of his positive PED test last September, and with Texans owner Bob McNair meeting with NFL commissioner Roger Goodell on Monday to discuss the possibility of reducing Cushing's four-game suspension, Cushing has what he believes is a new reason for his test results. Cushing tested positive for HCG (Human Chorionic Gonadotropin), a drug that can be used to restart testosterone production after a steroid cycle. After consulting with doctors, Cushing told SI.com's Peter King that his test was the result of "Overtrained Athlete Syndrome."
In an interview here Friday, Cushing said he thinks he knows why he tested positive for elevated levels of HCG. "Everything points to that syndrome,'' Cushing said, walking back to the Texans' locker room after their afternoon practice. "I'm pretty sure it is. I'm pretty positive. I didn't take anything. It's not a tainted supplement. So all roads lead to that.''
The syndrome results from athletes training intensely for a long period, with the possibility of a testosterone imbalance resulting when an athlete stops training. I must stress the word "possibility,'' because no player in the history of the NFL substance-abuse program before Cushing tested positive for the higher level of HCG. The widespread belief in NFL circles was that a player who tests positive for HCG would be a steroid user trying to re-start regular testosterone production after it has been interrupted in a cycle of steroid use.
But according to another doctor familiar with the NFL's testing methods, "OAS" (or whatever people might want to call it from now on) is not what McNair, Cushing, and Cushing's representatives should be focusing on. I spoke with Dr. David Black of Aegis Sciences Corporation on Monday morning. According to its website, Aegis provides "Zero-Tolerance Drug Testing® for businesses, professional and amateur sports drug testing, pain management physicians, and medical examiners."
And from what Dr. Black told me, contesting the test should be more about the process than the result. "The way in which HCG testing is conducted in sports is that they use a combination of two screening tests," Dr. Black said. "They don't use what we would practically consider to be a confirmatory test in forensic testing. They give one test and if they have an elevated answer [result], they run a second screening test. The belief is that the two screening tests will show the elevated HCG, but that's not standard practice in forensic drug testing. Forensic drug testing would require a confirmatory test that is based on a second and different technology than the screening test. So, the question, I think, would still be undecided as to whether or not the test results indicate use of HCG, or whether or not this is a true violation of the program."
Dr. Black told me that the screening-test technology is based on an antibody-based test -- "these antibodies are developed that can recognize the possible presence of a drug or chemical. These kinds of screening tests are used for all sorts of drug testing. But the standard practice in forensic drug testing is that if you have a positive, you then want to use a confirmatory technology, and the confirmatory technology that is accepted in the court systems is called Mass Spectrometry. This is a much more elegant, sophisticated, and definite way of identifying if something is truly present. Screening tests are generally good to show when something is not present. If you really want to show that something is present, you use confirmatory test technology."
So, the NFL does not use Mass Spectrometry? "Not in this test. The NFL uses Mass Spectrometry in virtually all other tests. For this test, they just use the combination of the two different screening tests, which should not be standard practice for identifying if someone has used HCG. This is the way the Anti-Doping Agency approaches testing for this particular compound, and the NFL has generally adopted their approach. But because there are so few [non-negative results], and there's a lot of expense in conducting a Mass Spectrometry test, some scientists believe that it's acceptable. But this would certainly not be acceptable if it were a cocaine positive, or any other drug. If it were any other drug, it would require Mass Spectrometry identification."
Dr. Black also told me that he has testified to the NFL about the need for confirmatory tests in the case of another player, but the hearing panel disregarded his comments. "If I were testing an employee in some [business/professional] setting where HCG were not allowed ... if I tried to use this data to have them lose their jobs, it would not be accepted. I have argued that this is not acceptable practice in forensic drug testing, but [the NFL has] adopted this approach. It is not consistent with Federal or workplace testing programs. And almost all other drugs that are tested for in sports require Mass Spectrometry identification."
Dr. Black did not dismiss the "Overttrained Athlete Syndrome" concept, but said that he is not familiar enough with the syndrome to comment. "I don't know that there's any good evidence to suggest that this syndrome could lead to elevated HCG in the body, if that's what this test really indicates."
And that's really the question. How was Cushing tested, and are those results confirmatory? According to Dr. Black, the best that can be gathered from the antibody tests is a non-negative. If the NFL is still not using Mass Spectrometry to determine whether HCG is present, the league is doing itself and its players a grave disservice.
And if that's the case, Brian Cushing may have one more option.