Developed by chemist Patrick Arnold and distributed to athletes by Bay Area Laboratory Co-Operative founder (BALCO) Victor Conte, “The Clear” is a prime example of a “designer steroid.” Designer steroids are unapproved, potent drugs that are undetectable by standard drug testing. Because they do not show up in standard tests, their discovery requires a lot of ingenuity and a little luck.
The BALCO scandal unfolded when Trevor Graham, a disgruntled sprinter coach, was convinced that certain track athletes were getting an unknown steroid from Victor Conte. Graham obtained a used syringe, which he claimed came from a trash can at a track meet, and sent it anonymously to the U.S. Anti-Doping Agency (USADA). USADA immediately sent the syringe to Don Catlin and his staff at the UCLA Olympic Analytical Laboratory for identification of the substance it had once contained.
Catlin’s team discovered that The Clear had a common structural mass to gestrinone, a known anabolic steroid, differing only by four mass units. Realizing this, Catlin’s team decided to hydrogenate gestrinone, and this resulted in a substance that matched the one from the syringe. The newly discovered substance was called tetrahydrogestrinone, or, what is more commonly known today as THG. Newsweek magazine deemed Trevor Graham’s decision to turn over the used syringe as one of the decade’s top ten history-altering decision. This is because its discovery, along with two other designer steroids, norbolethone and madol, were essential in catching numerous high profile athletes such as Barry Bonds and Marion Jones who were doping. Another one of them was American sprinter, Kelli White.
White was an average sprinter who decided to team up with Conte, who developed a complicated regimen of The Clear, EPO, hGH and insulin for her. Kelli White was a hyper-responder and Conte proclaimed her as one of his finest transformations. White went from participating in events to being the world’s number one sprinter in a span of just four months. After winning a gold medal in the 2003 World Championships in Paris, she was going after a historic double and when she finally achieved this, how did she feel? Extreme Guilt. In 2004, Kelli admitted that she was doping and her medals were stripped from her and given to the second place winners. Sadly, the second place winner also tested positive for steroids.
While most collegiate and professional teams employ athletic trainers and physicians on their staff, few employ persons qualified in recognizing and educating their athletes on the use of supplements. This is where pharmacists can play an integral role in monitoring and educating professional sport teams on agents that can possibly cause their athletes to fail drug tests.
Pharmacists are the drug experts in the medical field and are thus, highly qualified to help professional sport teams manage their athletes’ use of substances. For example, pharmacists are trained to decipher product labeling and chemical names, an important task in preventing athletes from unknowingly taking supplements that may be a part of the Banned Substance List. Their expertise in pharmacodynamics and pharmacokinetics can also be a vital tool when screening for banned substances and their metabolites; while their knowledge of pharmacology can be utilized in determining the legality of a substance. Pharmacists possess the ability to play a role in justifying the use of a banned substance for therapeutic purposes as well as monitor any substances an athlete receives. In addition, pharmacists are experts in evidence-based medicine. Many of the substances available to athletes have little or no evidence supporting their effectiveness or safety. Therefore, the ability to thoroughly filter out and appraise studies allows pharmacists to accurately give athletes recommendations on the use of supplements and prevent them from putting harmful substances in their bodies. Besides understanding the medical jargon, pharmacists can also can keep up-to-date on the contents of WADA codes and the codes of the athletic associations.
On the other side of the spectrum, pharmacists can also offer their services to the sports-governing bodies themselves. In this capacity, pharmacists can be used as resources or consultants on determining whether or not to prohibit, restrict, or permit the use of certain drugs or substances. Pharmacists can also be trained and certified to become drug testing collectors or analyzers. This service is particularly useful during out of competition testing especially since it can be done in the community setting. Having pharmacists collect specimens gives athletes direct access to a healthcare professional who is knowledgeable about drugs and can assist them with any question they might have.
The use of PEDs is both harmful to the body and to the spirit of competitive sports. Incidents such as BALCO are not isolated cases. It’s only a matter of time before the next THG is uncovered and this is a problem that may never go away. As long as there are medals to win, there will always be athletes willing to put everything on the line, even their health. Some professionals have even suggested that if you can’t beat them, join them. This way athletic associations can regulate what drugs can be taken and healthcare providers can properly monitor them. What ever the outcome, sports medicine is an avenue in need of pharmacists’ intervention, whether it is to educate athletes or to serve as a resource for drug information that could lead to the detection of PED use.
Currently, At WesternU there are no APPE’s offered in the field of sports medicine, but there are pharmacies in California that specialize in it. Mike Pavlovic, owner of Westcliff Compounding Pharmacy out in Newport Beach is one of them. Westcliff has catered their pharmacy to the needs of athletes for over 10 years and can be an opportunity for students interested in the field. Going beyond the community setting Dr. Peter Ambrose of UCSF School of Pharmacy is an expert in drug testing policies and procedures in sports. He has been offering UCSF students an APPE in sports pharmacy since 2006. Here at WesternU, I hope that one day we too can offer students a career path in sports medicine.
Posted By Jonathan Tang, PharmD Candidate 2015