Transcript Charte Graphique Scor

PEDs : Performance Enhancing Drugs
Ronald J. Schaber, Jr., FALU, FLMI, ACS, AIAA, HIA
Assistant Vice President, Underwriting Research & Development
SCOR Global Life U.S. Re Insurance Co.
April 4th, 2011
PEDs: Performance Enhancing Drugs and Athletes,
Entertainers, and the Insurance Buying Public
U.S. Sales
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$ 20 Billion in 2007
$ 56 Billion in 2008
$ 79 Billion in 2009
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What are they?
W.A.D.A.: World Anti-Doping Agency
A Swiss private law foundation established in 1999 as an international independent agency
funded by sports organizations and governments worldwide
Activities include:
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Scientific Research
Education
Development of Anti-Doping Capacities
Monitoring of the World Anti-Doping Code
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2010 WADA International Prohibited List
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 Anabolic Steroids

Anadrol
 Anadur
 Anavar
 Andriol
 Aratest
 Clenbuterol
 Clomid
 Cyclofenil
 Cytomel
 Deca-Durabolin
 Dianabol
 Dinoprost
 Durabolin
 Dynabolan
 Finaject
 Halotestin

Laurabolin
 Miotolan
 Nandrolone Cypionate
 Nilevar
 Norandren
 Omnadren
 Primobolan
 Primoteston
 Sustanon 250
 Testosterone Cypionate
 Testosterone Enanthate
 Testosterone Heptylate
 Testosterone Propionate
 Testosterone Suspension
 Testoviron
 Winstrol
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2010 WADA International Prohibited List
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Peptide Hormones, Growth Factors
 Insulins
 HGH – Human Growth Hormone
 Platelet – derived preparations “blood spinning”
 Beta-2 Agonists
 Hormone Antagonists & Modulators
 Tomoxifen
 Diuretics and other masking agents - Thiazides
 Gene Doping
 Stimulants
 Amphetamines
 Andrenaline
 Ephedrine
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2010 WADA International Prohibited List (con’t)
 Narcotics
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

Heroin
Morphine
Oxycodone
 Marijuana
 Alcohol
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2010 WADA International Prohibited List (con’t)
 Beta Blockers

Acebutolol (Secretal®)

Atenolol (Tenormin®)
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Betaxolol (Kerlone®, Betoptic®)
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Bisoprolol (Zebeta®)
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Esmolol (Brevibloc®)
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Nebivolol (Bystolic®)
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Metropolol (Lopressor®, Toprol-XL®)
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Acebutolol (Sectral®)
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Carteolol (Ocupress®)
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Penbutolol (Levatol®)
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Pindolol (Visken®)
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Carvedilol (Coreg, Coreg CR®)
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Labetalol (Trandate®)
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Levobunolol (Betagan®)
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Metipranolol (OptiPranolol®)

Nadolol (Corgard®)
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Propranolol (Inderal®, Inderal LA®, InnoPran XL®)

Sotalol (Betapace®, Sorine®)

Timolol (Betimol®, Blocadren®, Istalol®, Timoptic®)
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What do they do?
Stimulants:
These drugs are used by athletes to enhance their performance in their particular fields and also stimulate
their bodies to give their best performance. Stimulants can also help in increasing awareness, alertness
and aggressiveness and decreasing fatigue. Some of the commonly used stimulants are amphetamines
and caffeine.
Lean Mass Builders:
These typical performance enhancers are used to amplify or drive the growth and development of lean
body mass and muscle. These can also help in reducing body fat. These belong to the category of
anabolic steroids, and the commonly used ones are beta-2 agonists and several other human hormones,
such as human growth hormones.
Sedatives:
These enhancers are also used by athletes engaged in sports such as archery that demands a steady
hand and a precise aim. Sedatives help in coping with nervousness and distress. Marijuana, betablockers and alcohol are some of the common examples.
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What do they do? (con.’t)
Painkillers:
These drugs are very common and are used on a regular basis by the common mass as well. Athletes
prefer using these drugs to mask their pain in order to maintain their performance and ability to compete in
unfavorable conditions. These drugs allow the blood pressure levels to soar up, thus supplying the body
with ample quantity of vital oxygen to relief pain. Painkillers can be purchased over-the-counter and
includes medicines such as NSAIDS (acetaminophen and ibuprofen) and also certain prescribed
narcotics.
Masking Drugs:
These are rare drugs and are taken in order to prevent other classes of drugs from being detected. These
drugs can evolve quickly, almost as quickly as the methods of testing for them. Epitestosterone is the
most commonly recognized masking drug.
Diuretics:
These drugs are used for expelling water out of athlete’s bodies. Wrestlers have been using these drugs
in order to meet the weight restrictions. Some of the stimulants are believed to have secondary diuretic
effects.
Performance Enhancers:
These are usually taken as oral pills, although some injections are also available to be intravenously
injected.
With the improved technologies and development skills, the detection of performance enhancing
drugs in an athlete’s blood stream has become almost impossible. But preventive measures are
still being taken and
hopefully someday the World Anti-Doping Agency will be able to bring this
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issue to an end.2
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Adverse Effects
Steroids:
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Interrupted growth and virilization in children
Birth defects in the unborn
Severe virilization in women including growth of facial hair and cessation of menstruation
Testicular atrophy and baldness in men
Low testosterone in men
Liver dysfunction including cancer and hepatitis
Unpredictable changes in mood
Aggression
Fluid retention
High Blood Pressure
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Adverse Effects (con’t.)
HGH:
Little solid evidence it benefits athletic performance
Does not cause weight loss in obese people
Can cause joint and muscle pain
Swelling in arms and legs
Carpel Tunnel Syndrome
Insulin Resistance – Diabetes
Heart Failure
Diuretic Abuse:
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Potentially fatal electrolyte imbalance
Severe dehydration
Cardiac arrhythmias, palpitations
Headaches
Nausea
Dizziness
Kidney Damage
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Adverse Effects (con’t.)
Stimulants
Irregular Heartbeat
Dangerously High Body Temperatures
Seizures
Cardiovascular Failure
Hostility
Paranoia
Opiads
Drowsiness
Constipation
Severe Respiratory Depression
Death
Central Nervous System Depressants:
Addiction3
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Supplements – Another Word for PEDs
Purpose:
Athletic Performance
Weight Loss (Hydroxycut)
Stay Alert/Concentration/Energy
 Nearly all energy and weight loss drinks contain the stimulants
yerba maté, green tea, yohimbine and caffeine
 Sexual Function
2007 U.S. study showed 25% of the 58 supplement samples
tested contained steroids or stimulants banned by World AntiDoping Agency.
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Supplements – Another Word for PEDs
Manufactured by individuals/companies that purchase the raw materials
abroad, often from Asia.
Raw materials from oversea suppliers often not tested for content/purity.
 Examples:
 Ecdysterone – an insect development hormone with no effect on humans
 Brown seaweed extract with no effect on humans
 Ginseng – used for thousands of years in China; studies have found no proof it
enhances energy levels or athletic performance
 DHEA – a steroid prohormone legal but banned by NCAA, the NFL, NBA and
WADA. Studies show no improvement in muscle mass or brain function. It does
cause facial hair growth on women and high blood pressure in men.15
 Not manufactured by major drug companies like Pfizer or Merck
 Not FDA reviewed or approved
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Testing
NFL, NBA, MLB, NHL have formal testing programs approved by their
players unions.
NFL began steroid testing in 1987 – during pre-season physicals and
scouting combine
Blood tests for Human Growth Hormone developed in 2004, available in
the U.S. since 2008. Test has three day testing window.
NFL - hopes to start testing for Human Growth Hormone
NBA – does not test for Marijuana
MLB – bans amphetamines in 2005. Now 10% of players have Rx for
ADD; only 4% of general population have adult ADD.
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Methods of Cheating to Pass Drug Tests
There are 19 known methods of cheating to pass performance enhancing
drug tests.
1. Biosimilars
11. Micro-dosing (a, b)
2. Blood transfusions (a, b)
12. Perma Cleanse
3. Catheterization
13. Probenecid
4. The Cream
14. Protease (a,b)
5. Diuretics
15. Tattoos
6. Epitestosterone
16. Testosterone patches
7. Erythropoietin (EPO) (a, b, c, d, e)
17. Therapeutic use exemptions
8. Gene doping
18. Titrate testosterone/epitestosterone
9. Human Growth hormone (HGH)
19. Urine replacement (a,b)4
10. Masking Agents
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Masking Agents and Side Effects
Potential side effects of masking agents:
Diuretics:
The utilization of diuretics may result in the occurrence of heart arrhythmias, dehydration, muscle
cramping, blood volume depletion, significant drops in blood pressure and severe electrolyte imbalances.
These arrhythmias can occur as a result of a deficiency of potassium in the blood and dehydration.
Probenecid:
Probenecid use generally results in very few minor side effects. These side effects can include the
formation of kidney stones, acute gouty arthritis, hair loss, skin rash, headache, nausea, sore gums, fever
and, in very rare cases, severe anemias.
Alpha-Reductase Inhibitors:
The most significant side effects associated with the use of some of these masking agents are associated
with reproductive dysfunction. Reproductive side effects include a decreased libido, increased occurrence
of erectile dysfunction, and an increase occurrence in ejaculation disorders.
Plasma Expanders:
The use of plasma expanders such as albumin can very rarely result in adverse effects. These effects are
usually marked by nausea, fever, chills or hives.5
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How are PEDs Obtained?
Internet
Mail Order Steroids
Retail Stores
Wal-mart, Rite-Aid, 7-Eleven, Vitamin Shoppes
GNC
 2009 Net Income $ 70 million
 6,900 locations in 47 countries
 5,400 U.S. Retail Outlets
Anti-Aging Clinics
Wellness Centers
Anti-Aging Clinics/Wellness Centers have a doctor on staff or have arrangements with a
doctor to write prescriptions for patients the doctor never sees in person.
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Law Enforcement
“If you look at the dollar amounts that are trading hands, there has to be thousands of people
who are selling this. To call it a public health crisis is right on the money.”, Dr. Thomas Perls of
Boston University School of Medicine. 6
WADA head, Jon Fahley says, “… governments are increasingly realizing that abuse of
steroids and other PEDs are a serious public health issue and not just a problem for sports
administrators.” 7
The Journal of the American Medical Association (10/26/05), “… the distribution of Human
Growth Hormone for anti-aging and/or athletic purposes is both rampant and illegal and
punishable with up to five years in prison.8, 9
State and federal investigations into PED distribution by DEA, FDA, FBI, state and local police
departments
Sting operations of several unlicensed pharmacies and internet sites…
Anabolic steroids are a Schedule 3 controlled substance, meaning that even possessing them is
a crime.
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Who is using PEDs?
Athletes:
1989 – Atlanta Falcon lineman, Bill Fralic, testified to U.S. Senate that 75%
Lineman, Linebackers and Tight Ends use steroids.
1970s - Pittsburgh Steelers have been linked to steroid and amphetamine use.
Aug 2010 – Brian Cushing, Houston Texans; Over training caused positive
drug test due to hormone spike after stopping training.
Barry Bonds, Alex Rodriguez, Mark McGwire, Roger Clemens, Andy Pettite,
Lyle Alzado, John Matuszak, Tony Mandarich, Shawn Merriman.
Celebrities:
“Anyone over age 40 in Hollywood”
Mary J. Blige, 50 Cent, Timberlake, Wyclef Jean, Tyler Perry
“The music business (Hollywood) is a young person’s business, so there’s certainly a premium
on appearing young or appearing younger. Sometimes people go to very extreme measures in
their appearance to be able to give a youthful image.” This is according to John Battaglia, image
consultant for Justin Timberlake and Ushe.r 10
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Who is using PEDs? (con’t.)
Business People:
To improve decision making, concentration, calmness, focus, alertness
Inderal for stage fright
Adderall to improve focus and concentration
Nicotine
Caffeine
Baby Boomers:
Per a senior U.S. Customs official, “the amount of PEDs being brought into the US has risen dramatically in the past five years
and the overwhelming majority are destined for community gyms and sporting clubs rather than elite athletes. 11
Dr. Alan Mintz, founder of the anti-aging clinic Cenegenics Medical Institute in Las Vegas:

12,000 patients including moviestars, Las Vegas Entertainers, CEO’s, and the president of a foreign country

Treatment costs as much as $1,000 per month.

Cenegenics has a network of over 100 doctors in the U.S., Tokyo, Seoul, Hong Kong.

Some patients have been using PEDs for over 12 years now.12
Juveniles:
During a Congressional testimony in 2005, Representative Tom Davis, R- VA, stated “1 in 14 middle-school girls have tried
anabolic steroids.” 13
National Institute on Drug Abuse 2009 study shows 47% of High School seniors have taken illicit drugs and > 23% have taken
them within the last month. *
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The Future of PEDs
Neuroscientists working on psychoactive drugs
(neuroceuticals) that could improve wall street traders
decision making ability by 20 – 30 %.
“Designer Steroids” – steroid chemical structure altered
enough to cause a negative test, but drug still has same
effect on the body.
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DEA Spokesman, Rusty Payne, “Designer drugs are hard to
keep up with. We are adopting and evolving, and the bad
guys are doing the same thing to evade us.”
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Genetic Engineering
Genetic manipulation to enhance performance and reduce
recovery time
Goals: muscle formation, response to hypoxia, blood vessel
formation, lung function, pain control, and immune response
Could benefit people with Parkinsons Disease, Muscular
Dystrophy and chronic injuries
Adverse effects: Leukemia, death from complications
No practical tests are in use for Gene Doping
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Footnotes
1.
The World Anti-Doping Code, “The 2010 Prohibited List, International Standard” September 19, 2009
2.
Sanjana Antony, “Dangerous Facts About Performance Enhancing Drugs”, http://E___ Articles.com/?expert=Sanjana Antony
3.
NIDA Info Facts : Prescription and Over-the-Counter Meciations 7/09, http://www.drugabuse.gov/infofacts/painmed.html
4.
What are the 19 known methods of cheating to pass performance enhancing drug tests? 08/28/09,
http://sportsanddrugs.procon.org/raw.resource.php?resourceID=002706
5.
Making Agents FA
6.
HGH: Miracle-Gro for Humans?, The Work 04/23/2010
7.
WADA Chief focuses on steroid abuse at the local level, Steroid Nation 09/19/2008;
http://grg51.typepad.com/steroid_nation/2008/09/wada_chief_focu.html
8.
Selling the Promise of Youth, Business Week, 03/23/2006
9.
Aging in the 21st Century, CBS News 08/20/2006
10.
Why would 50 Cent, Tmberlake, Mary J. Blige Use Steroids? 01/15/2008;
http://www.mtv.com/news/articles/1579621/20080114/index.html
11.
WADA Chief focuses on steroid abuse at the local level – Steroid Nation 09/19/2008
12.
Aging in the 21st Century, CBS News 08/20/2006
13.
Lessons from the Celebrity Doping Scandal, Slate 10/03/2008
14.
Performance Enhancing Drugs in the Boardroom? 11/18/2008; http://www.micronative.com/2005/02/performance-enhancing-drugs-inthe-boardroom/
15.
David Epstein and George Dohrmann, “What you don’t know might kill you.”, Sports Illustrated, Volume 110, No. 20, May 18, 2009
*.
NIDA Info Facts: High School and Youth Trends 8/2010; http://www.drugabuse.gov/infofacts/hsyouthtrends.html
Q, http://www.nsca-liftorg/education/npedp/maskingagents.shtml
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