Dr. Gary Wadler on the George Mitchell Report
Gary I. Wadler, M.D., FACP, FACSM, FACPM, FCP, is an internist with special expertise in the field of drug use in sports. He is the lead author of the internationally acclaimed textbook, Drugs and the Athlete. Dr. Wadler currently serves as the Chairman of the World Anti-Doping Agency's (WADA) Prohibited List and Methods Sub-Committee and serves as an ex-officio member of WADA’s Health, Medicine, and Research Committee. Additionally, he has served as a Medical Advisor to the White House Office of National Drug Control Policy, a Trustee of the Board of the American College of Sports Medicine and of the Women’s Sports Foundation. Among his other sports medicine activities, he has served as Tournament Physician of the U.S. Open Tennis Championships.
For his groundbreaking work in the field of drug abuse in sports, Dr Wadler received the International Olympic Committee's President's Prize in 1993. He is a frequent lecturer on the subject and his opinions are widely sought by the print and electronic media nationally and internationally. In 2007, he was selected by the Institute for International Sport as “One of the 100 Most Influential Sports Educators in America” and serves Chairman of the Communications and Information Committee of the American College of Sports Medicine. In addition, he is Chairman of the American Ballet Theatre's Medical Advisory Board where he oversees the development of medical guidelines for the healthy and sound training of dancers in the United States. Dr. Wadler is the Chairman of the College Council of the State University of New York at Old Westbury. Dr. Wadler maintains a private practice in Internal Medicine and Sports Medicine in Manhasset, New York and is a Clinical Associate Professor of Medicine at the NYU School of Medicine.
Question: How do you rate the George Mitchell Report?
Gary Wadler: Well, I go back prior to that. You know, baseball has been in a state of denial for a long time. In 2003, the survey year, they did not anticipate crossing their five or seven percent threshold that would have triggered mandatory testing. Their position was we don’t have a problem in baseball. We certainly don’t have a steroid problem in baseball particularly. They subsequently went on and in fact the Lehrer News Hour one night there were two of us and they at that point said they didn’t have a stimulant problem in baseball either. I guess all of us who knew about greenies didn’t quite understand how they came to that conclusion. Because of all of that and Caminiti and Canseco and so on, obviously the House Government Reform Committee under the leadership of Davis and Waxman, now Waxman and Davis, had hearings and I testified at those hearings and I pointed out some of the specific deficiencies that existed then and there were many. What’s happened with baseball is a reaction. Each time there’s some sort of expose, there’s another increment towards their program. Their program is constantly getting improved increment by increment. My position has been, and remains to this day, and I think Senator Mitchell came to the same conclusion, and I said it back in Congress in ‘05- when were the hearings? ’05, ’05. Yeah. I said in the ’05 hearings in Congress that baseball ought to get out of-- and I’d say the same for the NFL-- out of the anti-doping business and hand it off to an independent, transparent, accountable agency, that they could not do this within the house. They had to externalize it, outsource it if you will. What they have done is take the World Anti-Doping Code and incrementally have taken pieces of it to satisfy critics I guess such as me and others. I say this is not a matter of incrementalism; this is a matter of taking the entirety of the code which was developed by an international process of governments and sporting bodies from all over the world, tremendous amount of effort went into this thing, led in many cases by athletes who wanted nothing more than the opportunity to participate in sports on a level playing field, didn’t come from some ogre, you know, some bureaucrat, and really the initiatives came from athletes, and make that the program for Major League Baseball.To this day, they will not do that. And so every X number of months they’ve opened up the collective bargaining agreement, which until the issue of doping arose they have never opened up these collective bargaining agreements, but they opened them up and they’ve made and tweaked and changed things. And to show how disturbing it is, the Mitchell Report, for example, pointed out that roughly a hundred cases of attention deficit disorder had suddenly emerged. That was after I made the case the stimulants was a problem in baseball. They reacted by banning some stimulants, all right? And so because their therapeutic use exemption program left something to be desired, suddenly all of a sudden there was an epidemic of attention deficit disorder which is treated with stimulants. So the baseball player who would have gotten dinged for taking a stimulant says, “Oh, I have ADD. Here’s a note from my doctor. I have ADD so now I can take the stimulant.” Well, that was in the footnote in the Mitchell Report. And I can go on and on. You’d have to take chapter and verse to do it justice, but the answer is get out of the business. Do exactly what the IOC did. Remember, they were at this since the 1960s and they really were the leaders in this field. They created the field. And they finally threw up their hands and said, “You know what? No matter what we do, we lose. No matter what we do, we lose. We got to totally go independent. We’ll be part of that process, we’ll help fund that process, but we’re gonna stay out of the line of fire of all this decision-making stuff.” Baseball can’t- we shouldn’t expect baseball to do what the World Anti-Doping Agency does. We shouldn’t expect baseball to spend hundreds of man hours putting an annual list together of prohibited substances. That’s not their expertise. Their expertise is to field the great game of baseball and deal with contracts and length of seasons and all those things. It’s not to deal with the hardcore science and implementation of anti-doping initiatives. That’s not their thing. If you ask them why they have been resistant, they can only speculate. And my speculation relates to sanctions. And the sanctions in Major League Baseball has its own evolution as the first hearings in Congress when they originally said there was gonna be X number of days or a ten thousand dollar fine and the little word “or” showed up and so they had to change that. The issue of sanctions for a major offense is currently two years and it may go up to four years under the new code which goes into effect next year. I think they’d rather- they’re probably quite concerned with some of their superstars. They wind up out of the game at least for a couple of years. I can understand their apprehension about this. But if you’re really serious about getting doping out of your sport, then you got to bite the bullet. There’s no easy way out of this thing. We know that. History has taught us that over and over and over again. So they need to do what they need to do in their heart of hearts if they want to get doping out of their sport. And I’m saying this goes for the other professional sports in the United States as well, not just baseball.
Question: Has Congress handled this appropriately?
Gary Wadler: Well, it turns out, you know, the role of government in all of this has been rather significant whether it was the President in the State of the Union or whether it was the reclassification of anabolic steroids or whether it was investigations like the BALCO Affair or whether it was the hearings in Congress. There’s no question that more came out as a result of the Congressional hearings than anybody anticipated. Major League Baseball and the National Football League changed their programs substantially. That would not have happened in my judgment had there not been those hearings. You know, some people on the Congressional side of the table were caught up with the celebrity of all of this, but for the most part, I thought their questions were probing and insightful and I think baseball and football recognized they were in an untenable position. They tried to respond by incremental changes and hoping Congress and everybody else would go away and say, “All right, you fixed it. It’s over, kaput, done.” It turns out, no, the probing continues. Every time something happens, there’s another question. And so I think it’s holding their feet to the fire and I don’t think that would have happened without the Congressional investigation. I fully understand there’s big problems in the world, but I also recognize when we talk about the numbers of kids that were using these drugs. That’s a national concern. And so I think it’s appropriate for Congress to have dealt with that.
Question: Is it any different than taking something that would make you smarter?
Gary Wadler: You know, that reminds me of debating societies and, you know, that’s great fodder for somebody who wants to have a philosophical debate. I’m much more grounded in here and now in the realities of what’s happened and the abuse of drugs. But my concern are drugs are getting more and more sophisticated, more and more dangerous in some regards, more and more insidious in some regards and that we have to deal with that. I clearly obviously have heard these discussions, but I don’t want to take our eye off the ball to use that metaphor.
Recorded on: 04/25/2008
Was Congressional involvement appropriate?
- A huge segment of America's population — the Baby Boom generation — is aging and will live longer than any American generation in history.
- The story we read about in the news? Their drain on social services like Social Security and Medicare.
- But increased longevity is a cause for celebration, says Ashton Applewhite, not doom and gloom.
The calorie is the basic unit of measure of food — and it might be off.
- In a new article in 1843, Peter Wilson argues that counting calories is an outdated form of weight management.
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- Not all digestive systems are created equally; humans process foods at different rates under varying conditions.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
- They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
- The research raises many ethical questions and puts to the test our current understanding of death.
The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?
But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.
What's dead may never die, it seems
The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.
BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.
The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.
As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.
The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.
"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.
An ethical gray matter
Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.
The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.
Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.
Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?
"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."
One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.
The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.
"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.
It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.
Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?
The dilemma is unprecedented.
Setting new boundaries
Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."
She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.
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