A steroid that's approved by baseball, but not the Olympics, By: Tom FitzGerald
June 10, 2007
If Barry Bonds were about to play left field in the Olympics, he wouldn't be allowed to take the powerful anti-inflammatory medicine that he says he has regularly used to lessen the swelling in his legs.
The medicine is prednisone, and it's a steroid, but this one's OK with Major League Baseball. It's a glucocorticosteroid, not to be confused with the anabolic variety, which enhances performance by bolstering muscle mass and reducing recovery time.
"The similarity is like that between orange juice and gasoline: They're both liquid,'' said Dr. Charles Yesalis, a steroids expert and professor emeritus at Penn State. "One is a performance enabler (the glucocorticosteroid) and the other is a performance enhancer -- it helps you beyond what your natural abilities would be.''
Bonds indicated the other day that he has taken prednisone orally in previous years and resumed taking it recently to alleviate leg pain.
"Normally, I take it to keep the swelling out of my body as I got older,'' he said, but until recently he "forgot about it.'' Now he's back on it.
Although prednisone and its cousin, prednisolone, are allowed in baseball, they and other glucocorticosteroids are banned by the World Anti-Doping Agency.
"When administered systemically (into the blood), glucocorticosteroids can produce a feeling of euphoria, potentially giving athletes an unfair advantage,'' the WADA Web site says.
They are prohibited from competition, including the Olympics and pro sports like tennis and soccer that adhere to the WADA strictures, when administered orally, rectally or injected into the bloodstream or a muscle. An athlete can apply glucocorticosteroids topically for skin rashes and may be allowed to take them for other specific ailments through what's known as a therapeutic-use exemption.
In many professional locker rooms in the United States, doctors administer shots of cortisone, another glucocorticosteroid, to alleviate pain. But in most of the world, that's against the rules.
Soccer's European governing body, UEFA, follows WADA guidelines, and that's why AC Milan striker Marco Borriello was suspended late last year for three months after testing positive for prednisone and prednisolone.
Dr. Gary Wadler, a member of the WADA committee that prepares an annual list of banned substances, said Friday that prednisone is prohibited unless there is no alternative drug that could be used that would not enhance performance.
The WADA uses three criteria in assessing whether a drug should be put on the prohibited list, he said. One is whether it enhances performance; Wadler does not believe prednisone does, although many athletes "believe it works,'' he said.
The other two criteria are more to the point in the case, he said. According to the WADA, prednisone involves a significant risk to health if used on a systematic basis, and it violates the spirit of the sport by giving some athletes a significant, pain-reducing advantage over others.
Asked if he thought athletes were cheating if they disobeyed WADA rules on prednisone, Wadler said, "Yes, I do think it's cheating. ... Clearly we know that corticosteroids have been abused with very large doses."
There's a long list of possible side effects, he said. "You could have a loss of blood supply to the hip bone, which might necessitate a hip replacement. The array of side effects include diabetes, obesity and a risk of infection. Most physicians should think long and hard at this drug, and look for alternatives.''
"Prednisone is not a drug you want to take long-term,'' agreed Dr. Peter Ambrose, a clinical pharmacist at UCSF who has worked as a doping control officer for the Olympics. "It can stunt your growth. It can lead to osteoporosis, a thinning of the bones. It can affect your blood-sugar.''
Bonds has arthritis in his knees, one reason to use an anti-inflammatory.
"I don't have his medical records, so I'm not in a position to comment on his treatment,'' Wadler said. "You usually have to have a significant disease, rather than just swelling in his legs, to justify the prescription of prednisone.''
Dick Pound, chairman of the WADA, based in Montreal, said his organization hopes the major pro leagues in the United States follow the WADA's lead and adopt similar restrictions on prednisone.
"Why would you have a different view from what the world consensus is?'' he asked.
Wadler pointed out that the WADA's banned-drug list is painstakingly put together by a large group of physicians around the world, using years of research.
"That can't be done by baseball and the NFL,'' he said. "How can those sports hope to do that? I don't know what the basis of their list is.''
Major League Baseball spokesman Patrick Courtney said prednisone is allowed because "it's something that's commonly used for inflammation. It's something you can get a prescription for, which you can't for anabolic steroids.''
The WADA, he pointed out, is "in a position where they don't have to deal with another body in collective bargaining.''
MLB has to negotiate its drug policies with the union. Calls to players' association director of communications Greg Bouris were not returned.
"A lot of people are taking therapeutic doses of prednisone,'' UCSF's Ambrose said. "It's a very common drug.''
Olympic officials "can be ultra-conservative at times,'' he said. "I don't know why (glucocorticosteroids) are banned. Sometimes they don't want people playing with injuries, for their own protection. It's not always that the drugs are performance-enhancing.''
Yesalis, the steroid expert, said he was "kind of nonplussed by the whole thing. The fact a 42-year-old athlete uses prednisone -- whoop de do. And the sun will rise in the east.''
