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Five years ago, I asked a question: What is a performance-enhancing drug? I had read a study from Denmark that espoused human growth hormone's ability to heal broken bones faster, and it turned my 20/20 vision on the issue to 20/20,000.
If HGH truly promoted healing when administered in safe doses by a doctor, not only did it belong off banned lists but it needed to be used as regular treatment in trainers' rooms. Drug regulation in Europe, of course, is far less stringent than in the United States, so studies replicating those findings haven't been – and won't be – done here anytime soon. Researchers there continue undeterred, and 20 countries now offer something called Orthokine.
Alex Rodriguez went to Germany for it, though he just as easily could have gone to Italy or Russia or Israel, where doctors too will draw your blood, spin it in a centrifuge with some sort of proprietary concoction to concentrate the growth factors that purport to prevent arthritis and then inject it back into an injured area. A-Rod got it in his balky right knee and left shoulder. He went on the advice of Kobe Bryant, who received treatment on his right knee.
And it's imperative to note that everyone who matters in the anti-doping world, from the zealots who rail against the use of PED's to the sports leagues that enforce the rules, consider Orthokine and its cousin, platelet-rich plasma therapy, a treatment and not a drug. How they make such a distinction I'm still not quite sure. And that's where we are in this great big intersection of sports and science: at a line that blurs by the day, one in which treatment and performance enhancement become indistinguishable.
Take Orthokine. Kobe raved about it enough that A-Rod traveled to Dusseldorf to work with the doctor, Peter Wehling, who conceived the procedure to help treat the aging battle osteoarthritis. Athletes glommed onto it, and A-Rod and Kobe are only the latest to visit a man many consider a healing shaman.
The procedure, as Wehling outlines it, does nothing against sporting bodies' drug laws. It takes a legal substance (a person's blood), manipulates it (like doctors do during, say, surgery) and uses it to heal (as cortisone, for example, does inflammation). There is seemingly no ethical or moral quandary.
Until realizing that to attack the interleukin-1 protein that doctors believe facilitates arthritis, Wehling's procedure involves stimulating growth factors – similar growth factors to IGF-1, which is on baseball's banned list, and other drugs non grata.
Why, then, are Orthokine and PRP not outlawed by the World Anti-Doping Agency? Why was Bartolo Colon allowed to have his fat stem cells harvested and injected into his balky arm? What is the difference between either of those and HGH taken responsibly?
[ Related: Kobe confirms he directed A-Rod to German doctor ]
"I was in the car today thinking about it," said Dr. Gary Wadler, a longtime member of the WADA committee that determines the banned list annually. "The distinction between enhancement and therapy – it's not easy."
For something to make the banned list, Wadler said, it must fulfill three criteria:
• The capacity to enhance performance
• Use can result in negative health consequences
• Violate the spirit of sports.
The criteria show the power of WADA and how sports leagues fear its negative press, because anybody can see that a list based on three such principles is insultingly subjective.
As troublesome as the first two tenets are – who's to say what constitutes performance enhancement, and almost any medicine can be bad if taken irresponsibly – the last one is abhorrent. From an ivory tower, a group of well-paid men and women determine what is right and wrong for the sporting consciousness. It's big government without an election to determine who does the governing.
WADA tries, Wadler said, to solicit opinions not just from the anti-doping community but sports leaders, political figures and others. Put enough good minds in a room and you'd like to think a rational-enough consensus will come together. And yet politics always has a way of interfering, and let's be honest: WADA exists solely because of the demonization of the very drugs it judges and of which it profits from testing.
A-Rod got flayed for taking one such drug, primobolan, an anabolic steroid. He did it, he admitted, to improve his performance. Had A-Rod offered healing from injuries as his excuse, maybe he would have gotten off with less grief. Probably not, because he's A-Rod, but in retrospect his honesty is admirable. Any player today who says he used a substance to heal may not get the benefit of the doubt but certainly gets off easier than those whose intentions would seem to violate WADA's ever-holy spirit.
Rodriguez isn't the only player to have called MLB asking permission for blood spinning. Others have contacted the commissioner's office, too, and have been told essentially the same thing A-Rod was: do it at your own risk.
Officially, the procedure receives neither approval nor disapproval from MLB, though if the league doesn't say no, it's essentially saying yes. It can't explicitly do so, though: If a player who gets it done happens to test positive for a banned substance, baseball wants to ensure he doesn't use even a tacit approval as a defense to overturn a potential suspension.
Frankly, nobody at MLB is quite sure what to make of Orthokine and PRP. A healed A-Rod is great for the game just as a healed Kobe is great for basketball. Still, as much as the league tries to shake off the double-standard – Kobe soaking in praise from TV broadcasters for doing all he could to get healthy, A-Rod catching another level of hell and impressing Dante in the process – baseball can't help but wonder where exactly this thing is going. If two players from its marquee franchise have been injected with their own blood and their own fat in the last two years, what's next?
"Science is moving forward to take care of patients, and that's what we're supposed to do," said Wadler, now an associate professor at the Hofstra North Shore-LIJ School of Medicine. "I don't want to not have things available to me as a doctor because of the abuse by athletes. We're going to continue to develop new technologies. Gene-based therapies – we realize the potential."
Once it comes to that – athletes turning on and off genes to calibrate success – the policing of performance enhancement almost certainly will die. For now, though, as the line remains even the slightest bit visible, WADA goes about its fight with vigor. It spent months, Wadler said, debating PRP before deeming it legal. There was not enough evidence, he said, that PRP significantly altered an athlete's blood, even if Wehling claims Orthokine enriches it up to 1,000 times.
"I promise you," Wadler said, "it's a very tedious prospect with a lot of debate. We try to get things right."
It's difficult to envy Wadler and those charged with regulating drugs in sports. Their mission is noble. They crave fairness. They try to stand for something good. They understand most fans, deep down, would prefer an even playing field over one with blown-up freaks. Athletes always will look for an edge, proven by a pair that took trips to Dusseldorf to work with a doctor whose product is not approved by the FDA. There will be more like it and more athletes who seek it.
And soon enough, when we ask that imperative question – what is a performance-enhancing drug? – not even the doctors in charge of determining the answer will know what to say.
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