Historically, the very drugs that have helped patients are being abused by athletes, says Dr. Wadler.

Question: What does the next generation of performance-enhancing drugs look like?

Gary Wadler: Well, several things. One, if we look historically, the greatest advances have been made in medicine in the last fifty years and the drugs which we have great pride in because they really help patients are the very drugs that are being abused by athletes. If we look forward, we will continue to develop new drugs and new technologies and there’s no question that we already know factually that there are those who are already trying to get a hold of the new technologies. Now, when I graduated from medical school, we didn’t have diuretics. We had to inject people with mercury. And this sounds kind of wild, but it wasn’t that long ago. We had a very limited number of antibiotics and if you needed to get somebody’s blood count up, you had to give ‘em a lot of transfusions. Things have changed dramatically. Well, if we take several of those changes and see what’s happened; for example, for years people took anabolic steroids because they had anemia, for a variety of causes, to get their red cells up. Well, we realized that if you give them a substance called EPO, erythropoietin, you can stimulate somebody’s bone marrow to make more red cells and so there’ll be a decreased need for transfusions. And so EPO was developed. Now, it turns out, as one can anticipate, EPO was immediately abused. In fact, I reported an epidemic of deaths in four Scandinavian countries in two sports, a sport called orienteering and cycling. And it turned out that all these deaths occurred right after EPO was introduced into Europe. And although we can never prove it, all the evidence suggests it was probably related to EPO. Now EPO typically for a patient would be injected daily. However, we recognized-- or several times a week at least-- we recognized that if we can get a form of EPO that lasted longer, we’d need less injections. Well, sure enough, we developed that and comes along the Olympic Games in Salt Lake and we found that people were abusing the long-acting EPO. Now there’s technology being developed so that you wouldn’t have to inject EPO at all; that’s the gene therapy technologies. Rub a cream on that can turn on a switch in your body to make your own EPO and then turn it off by removing the cream. And, you know, we know that’s probably not too far down the road. Just like in many other forms of therapies, we try to make it easy for patients. And so that’s a good example of that kind of technology. Now, human growth hormone’s a whole other story. Human growth hormone prior to the mid 1980s for people who really needed it-- and I’ll tell you in a second who needs these things-- but people who needed human growth hormone, they were dependent on grinding up pituitary glands of cadavers. Well, it turns out that these cadavers in many cases contained a virus and produced a disease called Jakob-Creutzfeldt disease which is like akin to an Alzheimer’s dementia. Well, so obviously it couldn’t be used clinically because some of the athletes were using it, but with the development of recombinant DNA technology, the same kind of technology we used to develop EPO, they developed synthetic human growth hormone. And so we now are able to treat patients with human growth hormone safely. But as you can expect, human growth hormone has now become one of the mainstays of doping. Now, if it turns out you have a deficiency as a child, you’ll never reach your normal growth status, we treat those individuals. People with end-stage AIDS, wasting disease, we use human growth hormone to treat those people. Then there’s the people who are adults who need to legally be treated, need to have an absolute deficiency of growth hormone because their pituitary gland isn’t working because of either tumor, radiation surgery, trauma or hemorrhage in the area or whatever it might be. In fact, it’s the only drug I know of which you cannot use for off-label purposes. That is, you can only use it for the reason it was approved and it requires the approval of the Secretary of Health and Human Services; that’s how tightly regulated human growth hormone is in the United States. But that’s another example of sort of more primitive technology being replaced by a sophisticated technology and then finding that athletes are then trying to abuse those.

Recorded on: 04/25/2008