It was a good week for the drug police. Lance Armstrong dropped his fight against the U.S. Anti-Doping Agency, and Oakland Athletics pitcher Bartolo Colon was banned 50 games by Major League Baseball for a positive testosterone test.
The enforcers should enjoy this moment while it lasts, because sports science is on the precipice of a potentially new era of performance enhancement: stem cell therapy, which could soon make testosterone injections as ancient as the typewriter and press enforcement agencies like USADA to play catch up once again.
"Sports medicine will definitely see a revolution in the next 10 to 50 years," says Allston Stubbs, associate professor of orthopedic surgery at Wake Forest Baptist Health. "We'll go from traditional scalpel surgery to biologic surgery. Now we operate with a knife, but we'll move to cells or growth factors."
This is both thrilling and daunting in the performance-enhancement realm, because stem cell therapy is potentially both an avenue to better performance and a doorway to undetectable enhancement.
Colon is an example of how both, if the science advances as some in the field of stem cell research believe it will, are inevitable.
First, a short primer: Stem cell therapy is where fat and/or bone marrow (both of which contain stem cells) are drawn from the body. The stem cells are then separated out from the extracted fluid and re-injected into an injured area (i.e. Colon's elbow) to help stimulate the re-growth of healthy tissue.
In 2010, Colon underwent stem cell therapy for his injured elbow and shoulder. He credited the procedure for saving his career. And even more recently, Peyton Manning reportedly traveled to Germany for a stem cell procedure on his injured neck. He's gone from the brink of retirement to the new starting quarterback for the Denver Broncos.
Certain stem cell treatments are allowed in the Unites States (usage of embryonic stem cells is not legal in the U.S.). But the science here in the States is far behind the rest of the world, which has been dabbling in stem cell therapy for years. For this reason, athletes tend to travel abroad. Colon, 38, was one of them.
[Related: Bartolo Colon tests positive for synthetic testosterone, suspended 50 games]
But there was a murky side to the story: Colon worked with a Florida-based doctor named Joseph R. Purita, who told the New York Times he has used Human Growth Hormone (banned by Major League Baseball) for the procedure in the past. Purita insisted to the Times he did not use HGH in Colon's procedure, which was conducted in the Dominican Republic. MLB investigators questioned Purita, but nothing came of it.
Now Colon is suspended for cheating.
There's no evidence the 2010 stem cell transplant had anything to do with Colon's 2012 positive drug test – especially since testosterone is not known to be used in stem cell procedures – but there's evidence to suggest HGH can act as a sort of fertilizer to help make stem cell therapy more effective. So if an athlete with the means (i.e. money) wants to improve his chances of better performance after the treatment, he can probably find a specialist who will oblige. And since there are no universally accepted tests for HGH, there may be no way to tell if a banned hormone was used.
"People will take this and use it to enhance in the future," says Ray Monto, who has been practicing orthopedic medicine for 20 years. "The stakes are too high. I think it's irresistible. It's going to happen."
There's also the same issue that presented itself at the beginning of the steroid era more than three decades ago: People start experimenting long before it becomes known whether a new method is safe. Getting cells to regenerate healthy cartilage and ligaments is exciting in an era where ACL tears (and re-tears) are common, but there's always the possibility that regeneration will go too far.
"The challenge comes down to what happens when you tip the scales too far in healing," says Stubbs. "Cells don't know when to stop growing. You may tip the scales into more of a tumor problem rather than a deficit problem."
The FDA has labeling requirements about what a product can claim, and it's too soon to say exactly what stem cell therapy can do. "We'd like to think stem cells are the answer to a variety of things," says Stubbs. "It's still a technology in its infancy. A lot of people are hesitant."
Over time, the technology will get better and the issue of mutating cells may be controllable. But the cheating problem is not going away. It will more likely get worse, because while stem cell treatment is meant to restore healthy cells, where's the line between restoration and enhancement? Where's the line between healing and doping? That's the central problem of the future.
"When you're talking about stem cells, you can't measure for [enhancement]," says Monto. "You can't test for that. It's essentially unmeasurable. It's [the patient's] own cells. At what point are we going to regulate people's medical treatments?
"My concern is it's going to happen quietly and we won't know it," he continues. "You won't know it. You won't. It is a Pandora's Box. The cheaters are among us. They will be among us, being frank about it. The question is: Do you want to know?"
And while sports leagues can simply ban steroids, good luck banning a treatment that many Americans will end up getting for everything from tennis elbow to arthritis. Now we grow older hoping that our current limbs will hold up, but future generations will want limbs that are better than the ones they were born with. How will leagues possibly justify forbidding athletes from enjoying the same advances? They can't. They won't.
"The current state is partial restoration [of an injury]; the goal being full restoration," says Stubbs. "The future goal is better than what you were born with. It's probably a couple of decades away."
So there's time to improve both medicine and detection. But the best athletes clearly aren't waiting around. Manning is back on the field as a starter in the NFL. Colon revived his career, at least until the suspension. Oakland Raiders linebacker Rolando McClain says pain in his knee and ankle is almost entirely gone after having stem cell treatment.
The treatments are expensive – they can cost tens of thousands of dollars – but that's dwarfed by the millions a player like Manning will make on his latest deal with the Broncos. Colon's 50-game suspension probably has him rethinking his testosterone use, but it's highly unlikely he'd give back the time or money he got in the aftermath of his stem cell treatment. In both of these cases, there's no direct evidence that the stem cell therapy worked. But extending careers is all the evidence most athletes need. And in both cases, that's happened.
[Les Carpenter: By giving up fight against USADA, Lance Armstrong raises questions]
"It's a game changer to keep guys healthy," says Dr. Jason Williams, who performed stem cell procedures at his Alabama practice on McClain and former University of Alabama wide receiver Marquis Maze. "It cuts back recovery time and avoids surgery. Some athlete's injuries will take, say, six to eight weeks to recover; this could cut that time in half. … Any team not heavily involved in this is going to be really behind."
Even though the so-called steroid era will inevitably give way to the stem cell era, and even though that is probably a very good thing, the barriers to cheating will probably get easier to cross. Everyone thinks steroids are evil, but most people will consider non-embryonic stem cell therapy a godsend. So it will be all too simple to claim the treatment was on the up-and-up, even if it wasn't.
Today, the Lance Armstrong controversy already feels old. But within 10 years, it will seem ancient – and probably simplistic compared to future debates we'll have over what's acceptable in sports performance and what's not.
"It's a huge, huge issue coming down the pike," says Monto. "And it's coming fast."
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