Testimony before the
White House Commission on Complementary and Alternative Medicine Policy
January 23, 2001
by
Gary I. Wadler, M.D. FACP, FACSM, FACPM, FCP
Associate Professor of Clinical Medicine
New York University School of Medicine

 

I AM HERE TODAY WEARING A VARIETY OF HATS AS THEY RELATE TO THE CASCADING PROBLEM OF PERFORMANCE ENHANCING DRUG AND DIETARY SUPPLEMENT USE IN SPORTS, RANGING FROM THE GRASS ROOTS TO THE ELITE LEVEL.

AS AN INTERNIST AND SPORTS MEDICINE I SERVE AS MEDICAL ADVISOR ON DRUGS IN SPORTS TO THE WHITE HOUSE OFFICE OF NATIONAL DRUG CONTROL POLICY, AS A MEMBER OF THE WHITE HOUSE TASK FORCE ON DRUG USE IN SPORTS AND AS A MEMBER OF THE HEALTH, MEDICINE AND RESEARCH COMMITTEE OF THE WORLD ANTI-DOPING AGENCY.

FOR THE PAST TWO DECADES, I HAVE WORKED AND FOCUSED ATTENTION ON THE INCREASINGLY PERVASIVE AND MULTIDIMENSIONAL PROBLEM OF DRUGS AND SPORTS, A SUBJECT OF IMMENSE SCIENTIFIC AND ETHICAL COMPLEXITY.

IT IS IMPERATIVE THAT WE RECOGNIZE THAT THE ABUSE OF DRUGS IN SPORTS IS NOT JUST AN INDIVIDUAL PROBLEM OR A PROBLEM THAT IS LIMITED TO THE EXCLUSIVE DOMAIN OF ATHLETES.  IT IS BURGEONING PROBLEM THAT IS THREATENING OUR YOUTH AND NOW THREATENS THE PUBLIC HEALTH.

THIS MORNING, I WOULD LIKE TO FOCUS YOUR ATTENTION TO THE SUBJECT OF DIETARY SUPPLEMENTS AND PARTICULARLY THE SO-CALLED STEROID PRECURSOR DIETARY SUPPLEMENTS.

EVER SINCE MARK McGWIRE’S HOME ROOM RECORD FETE, COMBINED WITH THE REVELATION THAT HE HAD USED THE DIETARY SUPPLEMENT, ANDROSTENEDIONE, THERE HAS BEEN AN EXPLOSION IN THE SALE OF ANDROSTENEDIONE AND RELATED SUBSTANCE, SUCH AS 19 NOR-ANDROSTENEDIONE.

THESE SO-CALLED STEROID PRECURSORS ARE NOT ONLY A PROBLEM FOR ELITE ATHLETES, THEIR USE REPRESENTS A FAR BROADER THREAT TO THE PUBLIC HEALTH BECAUSE IT GOES BEYOND THE EFFECTS OF THESE SUBSTANCES ON MUSCLE.

WHAT IS MORE IMPORTANT, IT DEALS WITH THE SHORT AND LONG-TERM PHYSIOLOGICAL EFFECTS, OF ALL THINGS, THE FEMALE HORMONE, ESTROGEN. YOU MAY ASK WHY ESTROGEN?  THE SIMPLE REASON IS THAT THE HUMAN BODY CONVERTS ANDROSTENEDIONE INTO ESTROGENS IN MALE AND FEMALE ALIKE.  IN FACT, A RECENT STUDY HAS SHOWN THAT 100MGS OF ANDROSTENEDIONE CAN INCREASE ESTROGEN LEVELS BY 80 PERCENT.

WHY SHOULD THIS BE OF CONCERN TO THIS PANEL? THE ANSWER LIES IN THE FACT THAT JUST ONE MONTH AGO, AN EXPERT ADVISORY PANEL OF THE NATIONAL TOXICOLOGY PROGRAM OF THE UNITED STATES NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES RECOMMENDED  THAT ESTROGENS BE LISTED AS A “KNOWN” CAUSE OF CANCER IN HUMANS.

LET ME PUT THIS IN SOME PERSPECTIVE.

BECAUSE ANDROSTENEDIONE IS CONVERTED TO TESTOSTERONE, THIS DIETARY SUPPLEMENT IS OF INTEREST TO ATHLETES WHO ARE SEEKING TO INCREASE THEIR LEVELS OF TESTOSTERONE WITHOUT PURCHASING ANABOLIC STEROIDS AND THUS VIOLATING THE VERY STRICT CONTROLLED SUBSTANCES ACT OF 1990.  

TO ATHLETES, TESTOSTERONE MEANS LARGER AND STRONGER MUSCLES, LESS BODY FAT, AND INCREASED ASSERTIVENESS.   TO YOUNG MEN AND WOMEN WHO ARE NOT ATHLETES, IT MEANS A LEANER, MORE CONTOURED OR CUT PHYSICAL APPEARANCE.

ALARMINGLY, RECENT STUDIES HAVE REVEALED THAT AS MANY AS 3 PERCENT OF TEENAGE BOYS AND 3 PERCENT OF TEENAGE GIRLS HAVE USED CONTROLLED ANABOLIC STEROIDS.  THE RATE OF INCREASE IN TEENAGE GIRLS HAS BEEN  PARTICULARLY ALARMING.

FLYING UNDER THE RADAR SCREEN OF THE LAW TO ACHIEVE A STEROID EFFECT LEGALLY, THERE IS NO TELLING HOW MANY TEENAGERS HAVE USED THE OVER THE COUNTER DIETARY SUPPLEMENT ANDROSTENEDIONE AND RELATED SUBSTANCES, PLACING THEMSELVES AT RISK OF THE CARCINOGENIC EFFECTS AND OTHER UNDESIRABLE EFFECTS OF ESTROGEN IN FUTURE YEARS.

WHILE ANDROSTENEDIONE HAS BEEN PRIMARILY MARKETED TO ATHLETES AND YOUNG PEOPLE, ITS IMMEDIATE PRECURSOR, DEHYDROEPIANDROSTERONE, KNOWN AS DHEA, HAS BEEN MARKETED TO THE OLDER POPULATION AS THE ANTI-AGING  “FOUNTAIN OF YOUTH” AMONGST OTHER THINGS, TO INCREASE ONE’S SENSE OF WELL BEING.

BUT, IT MUST BE EMPHASIZED THAT DHEA IS METABOLIZED TO ANDROSTENEDIONE, ULTIMATELY EXPOSING THIS GROUP TO THE HEALTH RISKS ASSOCIATED WITH ELEVATED LEVELS OF TESTOSTERONE AND ESTROGEN.

THE DIETARY SUPPLEMENT AND HEALTH EDUCATION ACT OF 1994 (DSHEA), AN ACT INTENDED TO INSURE CONSUMERS AND MANUFACTURERS THAT SAFE AND APPROPRIATELY LABELED PRODUCTS REMAIN ON THE SHELF HAS CHANGED THE LANDSCAPE WITH RESPECT TO THESE STEROIDS IN A WAY, I AM CERTAIN, THAT WAS NEVER ENVISIONED OR INTENDED WHEN THE LAW WAS ENACTED. 


UPON REFLECTION, IT SEEMS AN ANOMALY THAT WE HAVE ONE LAW, THE CONTROLLED SUBSTANCE ACT, THAT PUTS SERIOUS CONSTRAINTS ON THE  PURCHASE OF TESTOSTERONE. AND THAT WE HAVE A REGULATORY SYSTEM THAT REQUIRES A PRESCRIPTION FOR THE  PURCHASE OF ESTROGENS. AND NOW WE HAVE A LAW THAT ENABLES THE PURCHASE OF THE PRECURSORS OF BOTH TESTOSTERONE AND ESTROGEN WITHOUT ANY PRESCRIPTION WHATSOEVER.  TO ME THIS IS UNACCEPTABLE AND POTENTIALLY DANGEROUS..

LAST YEAR, 343 ELITE ATHLETES FROM AROUND THE WORLD HAD POSITIVE URINE DRUGS TESTS FOR THE METABOLITES OF ANDROSTENEDIONE.  VIRTUALLY ALL WERE BELIEVED TO BE RELATED TO THE INGESTION OF DIETARY SUPPLEMENTS.

MY VIEW REGARDING THE PUBLIC HEALTH THREAT OF THE STEROID-BASED DIETARY SUPPLEMENTS IS SHARED BY SPORTS MEDICINE EXPERTS AND SCIENTISTS FROM AROUND THE WORLD.  THEY SEE UNITED STATES LAW AS HAVING CAUSED THE EXPLOSION OF THESE SUPPLEMENTS AND NOW THEY LOOK TO THE UNITED STATES TO CLOSE THE LOOPHOLE.

IT IS ESSENTIAL THAT THE DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF 1994 BE REVISITED FORTHWITH WITH AN EYE TOWARD RECLASSIFYING THESE SO-CALLED STEROID PRECURSORS AS PRESCRIPTIVE DRUGS.

I THANK YOU FOR YOUR ATTENTION AND I WOULD BE HAPPY TO ANSWER ANY QUESTIONS.

 

 

January 23, 2001