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Thread: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

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    Little Reds BandWagon Reds Nd2's Avatar
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    Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    http://sports.yahoo.com/mlb/news?slu...yhoo&type=lgns

    The pain principle

    By Jeff Passan, Yahoo! Sports
    September 21, 2006

    Every six months, New York Yankees pitcher Randy Johnson gets injected with a substance in his right knee that allows him to pitch without pain. With the injections, Johnson can work out longer and harder and stay fresh at 43 years old despite the complete lack of cartilage in his knee.

    And this treatment the one that seems to turn back Johnson's clock is completely legal by Major League Baseball's standards and endorsed by trainers and doctors around the game.

    How baseball reconciles Johnson's therapy with the murky world of performance-enhancing drugs is largely a matter of semantics. Doping doctors claim that treatments such as Supartz Johnson's preferred brand of hyaluronic acid, a substitute for the synovial fluid that keeps joints lubricated are for therapeutic uses. Drug companies go to lengths not to call hyaluronic acid a drug.

    Because with a condition such as osteoarthritis, where cartilage stops producing fluid, breaks down and causes bone-on-bone grinding, the goal is to return users to their previous levels of comfort.

    For athletes, however, the five once-weekly shots taken twice a year not only prolong, but save careers.

    "I know when I need those shots just by the swelling and the soreness in my knee," said Johnson, the left-hander who has won 56 games since he starting taking Supartz in 2003. "Doctors have told me here and in Arizona that I'll be a likely candidate for a knee replacement when I'm done playing, but for now I just get by on those shots, and, hopefully, they won't fail me for when I need them again.

    "I've had pretty good results with them."

    To determine its list of performance-enhancing drugs, the World Anti-Doping Association considers three criteria: Does the substance enhance performance, is it a significant health risk and does it violate the spirit of sport (i.e. is it cheating)?

    With viscosupplementation the medical name for hyaluronic-acid treatments athletes have shown they perform at higher levels with the treatment than they could without. Taken in the strictest sense, then, hyaluronic acid is a substance that enhances performance.

    Studies have shown hyaluronic acid to be safe, which rules out No. 2.

    The third criterion is the vaguest. One person's cheat is another's opportunist. There is a growing movement that considers the use of human growth hormone (hGH) as part of a larger hormone-replacement therapy. Essentially, patients take injections of hGH to return to their previous levels of testosterone just as Johnson claims Supartz has his knees feeling better than they have in years.

    "Without it, my knee would bother me," Johnson said. "It would swell. But the reason why it doesn't swell now is that buffer's in there. If I didn't have that, there would be more swelling and irritation, and I'd have to have my knee drained like it was in the past.

    "I could pitch (like that). How effectively and how long, I don't know."

    Less pain. Increased performance.

    Sound familiar?

    This is not an indictment of Johnson or any of the other dozen or so baseball players known to have taken hyaluronic acid as much as it is a showcase of the conundrums created in the intersecting world of modern medicine and baseball. What enhances performance and what rediscovers status quo? And in cases with aging athletes, is achieving what was previously there all of a sudden enhancing performance?

    "I think there's a general consensus among all the parties as to what therapy is," said Dr. Gary Wadler, a doping expert with WADA. "Basically, it's to take someone who has an illness and injury to get them back to baseline, to where they were before."

    Wadler sees hyaluronic acid on the same plane as surgery a medical procedure in hopes of repair once all other options, such as Tylenol, ibuprofen or ultrasound, have been exhausted. If a pitcher comes back throwing harder after Tommy John surgery, the reasoning goes, he got lucky.

    Nowhere in WADA's code does it specifically define therapy, nor does it address the vagueness of its criteria to choose what enhances performance and what doesn't, leaving decisions instead to a board. When a treatment such as hyaluronic acid is approved by the Food and Drug Administration for general use, it will usually receive WADA's rubber stamp, even if there are critics elsewhere.

    "I think they're expensive placebos," said Dr. David Felson, the chief of Boston University's Clinical Epidemiology Research Training Unit and a frequent detractor of hyaluronic acid since its FDA approval. "I think the data for the pivotal trial that led the FDA to approve the therapy shows no compelling evidence that it works. I don't know why Randy Johnson is helped."

    Hyaluronic acid was discovered in 1934 by scientist Karl Meyer. He found it in cow eyeballs. Later, high concentrations of hyaluronic acid were found in the red combs on top of roosters' heads. Drug company Pfizer began breeding its chickens to grow extra-large combs so big, in some cases, that they could no longer keep their heads up, according to a New York Times story three years ago.

    The rooster combs are synthesized into a gel that, when injected into the knee, serves as temporary cartilage. After exhausting other therapy options following knee surgery in 2003 the year after he won his fifth Cy Young Award Johnson tried Synvisc, which he didn't like, then went to Supartz and has stuck with it since.

    His right knee, which takes the brunt of the force when his 6-foot-10 frame lands with each pitch, was shot. Years of wear and tear, plus numerous surgeries, left the inside mangled, and Johnson said he would have tried anything within reason to salvage it, because that also meant saving his career.

    "I was never leery of it," Johnson said. "It makes pretty good sense. It's very safe. Your body absorbs it. It works."

    Despite Felson's claims of a placebo effect, there are legions of believers in hyaluronic-acid treatment, including Johnson's manager.

    The pain in Joe Torre's left knee was unbearable throughout July. He walked gingerly, looking more old man than confident leader. Today, he can lock his knees without them locking up on him.

    "When I called and said I'm hurting, he said we could try this," Torre said. "We did three weeks running, and thank goodness. I like just getting up on the road and walking down the street. For a time, I couldn't even do that."

    To the medical community, Johnson and Torre are triumphs of science, proof that treatments that weren't around in the United States even 10 years ago ease life and extend livelihoods. Repairing, and in some cases improving, knees, elbows and shoulders three of the essential joint structures for baseball players is a feat, while anything to do with testosterone levels faces social and political stigmatization.

    "What is doping anyway?" Felson said. "When do we label something as doping and medication? My guess is that it has to do with treating pain and treating disease, which are acceptable, instead of taking someone who doesn't have pain."

    Felson's definition lacks the ambiguity of WADA's, and it would seem to pass the sniff test until applied to players' workouts. In order to keep up, most players tax their bodies in the gym. As they age, they cannot lift the same amount of weight they did 10 years earlier, and when they try, their bodies scream. This is not something Tylenol, ibuprofen or ultrasound can remedy, and when players lose their fitness, they are in greater danger of losing their careers. In that vein, shouldn't they have access to an alternative treatment that would allow them to work out longer, just as hyaluronic acid does so many others?

    "Sometimes," Wadler said, "it's more complicated than that."

    No. It used to be complicated sometimes. Now it always is.
    So, just where do we draw the line at cheating?
    "...You just have a wider lens than one game."
    --Former Reds GM Wayne Krivsky, on why he didn't fly Josh Hamilton to Colorado for one game.

    "...its money well-spent. Don't screw around with your freedom."
    --Roy Tucker, on why you need to lawyer up when you find yourself swimming with sharks.

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    Member Red Heeler's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by Reds Nd2 View Post
    http://sports.yahoo.com/mlb/news?slu...yhoo&type=lgns



    So, just where do we draw the line at cheating?
    Hyaluronic acid is a medical treatment for a pathological condition. It has been used for years to treat arthritis in horses. In fact, I prescribed it for a lame horse today.

    If you consider HA to be cheating, then you would have to ban cortisone injections, which have a more dramatic effect in reducing the pain of arthritis, as well.

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    Little Reds BandWagon Reds Nd2's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    I don't consider viscosupplementation to be cheating any more than I consider the legal use of Androstenedione prior to April 12, 2004 to be cheating. Nor do I consider Curt Schilling taking injections of Marcaine in his ankle during the 2004 season to be cheating.

    The thing is though, and we hear it all the time, Player A cheated while Player B set his records naturally with god given talent. I'm not naive enough to believe that. The question remains though, where do we draw the line?
    "...You just have a wider lens than one game."
    --Former Reds GM Wayne Krivsky, on why he didn't fly Josh Hamilton to Colorado for one game.

    "...its money well-spent. Don't screw around with your freedom."
    --Roy Tucker, on why you need to lawyer up when you find yourself swimming with sharks.

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    Box of Frogs edabbs44's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    I gave this a thought a year or 2 ago when Clemens came out and said he was using Vioxx.

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    Rally Onion! Chip R's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    This is a prime example of getting into a gray area with performance enhancers. There's nothing wrong with performance enhancers per se but steroids and HGH have fallen under that blanket. You say Johnson is OK for using this stuff because it isn't any different from getting a shot. I say, hold your horses. This stuff he is using basically replaces his knee cartlidge. It's akin to giving someone who lost their vision an eye transplant that not only makes their vision as good as it was before but makes it even better. You are basically injecting an artificial substance to replace something natural. That's a little different than taking Ibuprofin or cortisone which just masks the pain. At what point do you draw the line? Johnson wouldn't be able to pitch as well and maybe not at all with this stuff. Some kid in the minors hitting .280 with 20 HRs says to himself that he has to take steroids to play at a higher level and rationalizes it by looking at someone who uses artificial methods to do the same even though it is legal and steroids aren't.

    The author makes a persuasive case for usage of this stuff. But another author could make just as a persuasive case for the banishment of it.
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Is it a performance enhancer or a performance preserver? It's not making him run faster or throw harder than he ever did. He's not even pitching at his peak. Most of all, it's not skewing the balance of the game, as in three no-hitters in a row, or something crazy like that. But things like this will rewrite the record books, when 40-year-old pitchers are able to keep pitching and set a bunch of career records, just from the longevity. We'll have to mentally adjust our comparisons to account for the era of shorter careers.

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    Member ochre's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Seems to me one's doctor prescribed, whereas the other isn't so much.
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by ochre View Post
    Seems to me one's doctor prescribed, whereas the other isn't so much.
    You can find plenty of doctors who would prescribe HGH.
    "I prefer books and movies where the conflict isn't of the extreme cannibal apocalypse variety I guess." Redsfaithful

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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by Johnny Footstool View Post
    You can find plenty of doctors who would prescribe HGH.
    For a legit medical deficiency I'm sure. How many of these athletes have brought their MDs in to testify on their behave that their consumption of said pharmaceuticals was part of a medical treatment regimine? I think there was one that did have a legit medical need, but it seems the others were a bit more "over the counter".
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    Rally Onion! Chip R's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by Johnny Footstool View Post
    You can find plenty of doctors who would prescribe HGH.
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    Churlish Johnny Footstool's Avatar
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by Chip R View Post
    Hi, everybody!

    Exactly.
    "I prefer books and movies where the conflict isn't of the extreme cannibal apocalypse variety I guess." Redsfaithful

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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    Quote Originally Posted by Johnny Footstool View Post
    You can find plenty of doctors who would prescribe HGH.

    Yep, our high school football team had a doctor which gave the kids anything they wanted. Having an MD after one's name doesn't automatically make one ethical.
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    Re: Hyaluronic acid: Performance-enhancing drug or therapeutic therapy?

    How many of these failed drug tests (HGH and Steroid) are accompanied by signed prescriptions and doctor affidavits? It's a bit of a red herring in this context I think.
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