Thursday, March 08, 2007

The HGH Story: FAQs

This posting was inspired by a comment from an anonymous reader of Pittsburgh Steelers Fanatic:

"I hope you have read the front page si.com (Sports Illustrated) article.

http://sportsillustrated.cnn.com/2007/more/03/06/
rx.trouble0312/index.html


This does not look good.

Richard Rydze, a Steeler team doctor, does not sound credible. Why?

1. This HGH doesn't have much medicinal value and he personally bought $150,000
of it on a credit card so he can get it cheap. What?
2. Reportedly 30% of NFL players are using it.
3. It is worth much more on the street than for medical use.
4. His excuse sounds lame. "I treat people early in the morning before my
regular practice." Sure.
5. At a minimum Rydze has shown incredibly bad judgement [sic]. And most likely:
Where there is smoke, there is fire.
"

The comment touches upon two separate stories -- the use of human growth hormones by athletes, and the recent controversy that has swirled around one of the Steelers' team physicians.

The story to which our friend refers -- a Sports Illustrated look at an ongoing investigation into the use of human growth hormones, HGH; which is the latest chapter in the story of sports and performance enhancing chemistry -- is an important, and frightening, one. Because while other efforts at better performance through chemistry have been counteracted by sophisticated and reliable testing, the use of HGH can only be detected via a blood test, something currently not allowed in any of the major, professional sports.

The following is one effort to bring just a little clarity to a very big story.

Q:What is it that human growth hormones (HGH) do, and what makes them so dangerous?

A:In their 2005 article for the Journal of the American Medical Association (294: 2086-2090) authors Thomas T. Perls, Neal R. Reisman, and S. Jay Olshanksy outline some of the positive effects, such as they are, of HGH therapy:
Growth hormone has been documented to improve some measures of body composition, including increased muscle mass, reduced total body fat, improved skin elasticity, and reduced rate of bone demineralization . . . but without positive effects on strength, functional capacity, or metabolism. . . Furthermore, the positive effects may be short-lived: in a study of 148 patients with adult GHD . . . the modest beneficial effects on body composition (eg, 5% increase in lean body mass) disappeared for most individuals after 24 months of treatment, and 38% of study participants dropped out because of lack of subjective improvement . . In addition, the healthy lifestyle that patients who receive injectible GH are often encouraged to adopt, rather than the GH itself, may contribute to changes in body composition."
But in the same article the authors also point out some of the risks associated with an HGH regimen, which include:
As if all of that wasn't enough Perls, Reisman, and Olshanky report this: "To our knowledge, no studies have assessed long-term efficacy or safety of GH administration as an antiaging intervention in humans."


Q: But Steelers Fanatic, isn't this kind of a new problem? Why all the worry?

A:Well, if by "new" you mean "going on for more than a quarter of a century" then perhaps you're right. But the failure to develop easy (i.e. urine), reliable testing for human growth hormones is especially disturbing when considered in the context of just how long this problem has been a part of the sports landscape. Consider this quote from weightlifter Dave Keaggy: "The real horrors are human growth hormones. This stuff can make your heart grow twice its size, and they haven't even begun to figure out how to test for it." That comment is from a New York Times article published August 25, 1983 ("Sports of the Times: Playing Catch-Up in Testing," pg. B11). The inability of some of the greatest scientific minds imaginable to develop effective urine testing can lead one to believe that the will to excel (even by cheating) far exceeds the collective will of the sports world to expose the cheaters.

Q: Gosh Steelers Fanatic, I had no idea! So, if the HGH problem is so well known then what's up with this Steelers' doctor? Who is he and was he doing something improper?

A: Pittsburgh Steelers Fanatic ardently subscribes to the philosophy of "innocent until proven guilty," especially when no crime has (as yet) been alleged. In the interst of fairness, it's critical that everyone remembers that Dr. Richard Rydze has not been accused, much less convicted, of anything.

With that in mind, I looked to see what more we can find out about Dr. Rydze. The Steelers' 2006 media guide isn't much help -- his name is listed on page six of a 464 page book, along with the names of five other members of the team's "Medical Staff." His page at UPMC.edu lists him as an internal medicine specialist, who did his undergraduate work at the University of Michigan, and received his medical degree in 1975 from the University of Pittsburgh. In addition to his work at UPMC and with the Steelers, Dr. Rydze is "currently medical director of the Little Sisters of the Poor Nursing Facility," a 47 bed facility on Benton Avenue in Pittsburgh. As if all that wasn't enough to keep the doctor busy, the Federal Aviation Administration lists him as a certified Aviation Medical Examiner.

What is more of a puzzlement to me is what seemingly cannot be found -- articles written by Dr. Rydze. This may be a product of my vocation (i.e. working at a university), but one of the first things one can do to find out more regarding a physician is to see if he or she has been published, and if so in what journals -- trust me, it's a big deal in academia (i.e. it is a tangible demonstration of one's contining involvement in their field). Considering that Dr. Rydze has been appointed to two hospitals -- UPMC South Side and UPMC Presbyterian -- that are both considered teaching hospitals it is reasonable to expect some literature from the doctor. Additionally, given the doctor's stated interest in supplying HGH to the elderly one would reasonably expect that the doctor would study the effects of such treatments, long-term or otherwise, and report his findings. However using multiple research databases (including Medline -- one of the most comprehensive medical research databases available and SportDiscus), no articles authored by Dr. Rydze could be found.

In the absence of any material written by the doctor himself I used Google to see what it could turn up. One web site that caught my eye was for the Antiaging & Longevity Project, established by "a baby boomer Regsitered Nurse" named "Tim." Scrolling down the screen one eventually sees photographs of Dr. Rydze with a comment that the doctor "reports that he prescribes rHGH & Testosterone HRT for older patients in his private practice." It is unclear if Dr. Rydze endorses the work of the Antiaging & Longevity Project, but the web site includes links to Dr. Rydze's page at the UPMC Corporate Health Program as well as the "Front Office Staff" page of Steelers.com

In the final analysis, the doctor has no apparent record of his own making by which to judge him. He may not be guilty of provding HGH to NFL players, but as our anonymous reader points out, his purchase of $150,000 worth of HGH shows "incredibly bad judgment."

Of possible concern is an apparent relationship between the team's orthopedist and Dr. Rydze. Specifically, in the Sports Illustrated article it is stated that "[a]ccording to Rydze, he dispenses HGH to '35 or 40' patients referred to him by other physicians, including the Steelers' orthopedist. (The orthopedist declined comment.)." Though unnamed in the article, the Steelers' media guide lists Dr. James P. Bradley as "Physician, Orthopedic" for the team (p. 6). Dr. Bradley's page at UPMC.edu indicates that he is the "head team physician for the Pittsburgh Steelers . . . past president of National Football League (NFL) Physicians Society and serves on the NFL Injury and Safety Panel." Dr. Bradley graduated from Penn State in 1975, earned his medical degree at Georgetown University, and trained at the Kerlan-Jobe Orthopaedic Clinic in Southern California. A search for literature authored by Dr. Bradley turned up fifteen articles -- from "Relieving Winter Skin Discomfort" to "Rotator Cuff Contusions of the Shoulder in Professional Football Players: Epidemiology and Magnetic Resonance Imaging Findings."


Q: So, what's next

A: As the Sports Illustrated observes, it "will take weeks, months perhaps, for authorities to sift through the client lists, hard drives, invoices and trash from Dumpsters that were seized in the raids -- more than a ton of documents was confiscated." However, according to media reports 8 individuals have been arrested, and 24 individuals face felony charges as the result of a year-long investigation into an online outlet for HGH. Meanwhile the Steelers have issued a statement indicating that they will "monitor this situation to make sure that we can continue to feel confident in our medical staff in this area," so it seems foolish to imagine that we have heard the last of this controversy.

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