? to any physicians/orthopedists out there:

[DocJJ]

Is hGH or anabolic steroid EVER prescribed to help an athlete rehabilitate and recover from injury? I'm an ER doc so it might be outside my area of expertise, but as far as I know, these drugs are NEVER used for this purpose. Apart from treating congenital dwarfism and short stature, I don't know of any other hGH indication. Steroids PREVENT adequate wound healing, so it doesn't seem that they would prescribed for any legitimate purpose for an athlete.

Just want to put to rest the notion that a legitimate physician was legitimately prescribing these for the likes of Gibbons, Ankiel, Glaus, etc....

[Migrant Redbird]

I'm an ER doc so it might be outside my area of expertise, but as far as I know, these drugs are NEVER used for this purpose....

As a doc, you should be aware that there will always be a small minority of physicians outside the mainstream who will practice "unconventional" medicine.

Why Health Professionals Become "Quacks"

William T. Jarvis, Ph.D.

It is especially disappointing when an individual trained in the health sciences turns to promoting quackery. Friends and colleagues often wonder how this can happen. Some reasons appear to be:

Boredom. Daily practice can become humdrum. Pseudoscientific ideas can be exciting.

Low professional esteem. Nonphysicians who don't believe their professions is sufficiently appreciated sometimes compensate by making extravagant claims. Dental renegades have said "All diseases can be seen in a patient's mouth." Fringe podiatrists may claim to be able to judge health entirely by examining the feet. Iridologists point to the eye, chiropractors the spine, auriculotherapists the ear, Registered Nurses an alleged "human energy field," and so on. Even physicians are not immune from raising their personal status by pretension. By claiming to cure cancer or to reverse heart disease without bypass surgery, general physicians can elevate themselves above the highly trained specialists in oncology or cardiology.

Paranormal tendencies. [Nuff said!]

Paranoid mental state. Some people are prone to seeing conspiracies everywhere. Such people may readily believe that fluoridation is a conspiracy to poison America, that AIDS was invented and spread to destroy Africans or homosexuals, and that organized medicine is withholding the cure for cancer.

Reality shock. Everyone is vulnerable to death anxiety. Health personnel who regularly deal with terminally ill patients must make psychological adjustments. Some are simply not up to it. Investigation of quack cancer clinics have found physicians, nurses, and others who became disillusioned with standard care because of the harsh realities of the side effects or acknowledged limitations of proven therapies.

Beliefs encroachment. [Conflicts between medical science and religious beliefs.]

The profit motive. Quackery can be extremely lucrative. Claiming to have a "better mousetrap" can cause the world to beat a path to one's door. Greed can motivate entrepreneurial practitioners to set ethical principles aside. [I suspect this is the most prominent motivation. For some people, a "conscience" is an easily disposed-of luxury. The placebo effect also allows doctors to rationalize that they're really helping their patients anyhow, especially those afflicted with non-curable afflictions like aging. The Hippocratic Oath states something to the effect, "First, do no harm." Giving an elderly person some hope and faith that temporarily relieves their symptoms may be seen as helping them somewhat.]

The prophet motive. [Messianic impulses that get misdirected.]

Psychopathic tendencies. Studies of the psychopathic personality provide insight into the psychodynamics of quackery. Dr. Robert Hare who investigated for more than twenty years, states, "You find psychopaths in all professions. . . the shyster lawyer, the physician always on the verge of losing his license, the businessman with a string of deals where his partners always lost out." Hare describes psychopaths as lacking a capacity to feel compassion or pangs of conscience, and as exhibiting glibness, superficial charm, grandiosity, pathological lying, conning/manipulative behavior, lack of guilt, proneness to boredom, lack of empathy, and other traits often seen in quacks. According to Hare, such people suffer from a cognitive defect that prevents them from experiencing sympathy or remorse.

The conversion phenomenon. ["brainwashing"] ... Many individuals who become quacks undergo a midlife crisis, painful divorce, life-threatening disease, or another severely stressful experience. The conversion theory is supported by a study of why physicians had taken up "holistic" practices. By far the greatest reason given (51.7%) was "spiritual or religious experiences."

There is literature on studies which suggest that HGH mitigates some of the effects of aging and that it promotes more rapid healing of injuries/surgery. What I've read indicates the majority of medical professionals don't accept those studies as being definitive. However, there is enough "evidence" to nurture the faith among patients who are desperate and support a very lucrative side stream of medicine.

[Migrant Redbird]

Mr. Redbird. A simple question. Do you believe Ankiel took HGH to help him recover from his injury or do you believe he took it to enhance his performance as a baseball player? I'm talking about opinion, not a court of law.

I don't know. The prescription was filled during the period he was recuperating, slowly, from the TJ surgery and he subsequently announced his retirement from baseball in 2005 before the Cardinals convinced him to take a shot at becoming an outfielder. Simple logic would suggest that he hoped it would help with the recovery and was disappointed with the results enough to hang it up. However, we're still talking about a player who went outside the Cardinals medical system and consulted an independent orthopedic surgeon to get the HGH treatment.

What I've read is that TJ surgery has a success rate of 85-90 percent, and apparently Rick was in the other 10-15 percent. His arm did recover enough to give him a plus outfield arm, but not to restore him to the level he'd been pitching at before the injury.

But knowing that he received the HGH during that time frame, before it was banned, doesn't ensure that he didn't take it later.

Bernie Miklasz brought up a few good points in the St. Louis Post Dispatch, which even a lot of fans in St. Louis don't know or remember. Miklasz Column

Let's remember a few things beyond the obvious dissertation on the rules of the game, circa 2004.

— Ankiel's power is nothing new. As a 17-year-old in 1997, he hit a 450-foot homer in his final high school game, then was one of the top hitters for the U.S. Junior National team that summer. He played left field when not pitching and batted .387 with three homers, four doubles and 16 RBIs in a dozen games. Ankiel hit a three-run homer into the upper deck of the Toronto SkyDome.

— There is a difference between steroids and HGH. Author Will Carroll, who wrote "The Juice: The Real Story of Baseball's Drug Problems," summed it up in an interview Friday.

"In 2004, Ankiel was rebounding from Tommy John reconstructive elbow surgery," Carroll said. "And HGH really helps with recovery and healing. But HGH has absolutely no proven application in strength gain of the type that would help a baseball player."

— If Ankiel wanted to muscle up for a raw power grab, he could have juiced without hesitation in 2004, because steroids weren't officially outlawed by MLB back then. This meshes with Carroll's theory that Ankiel could have tapped into HGH as a healing agent.

Will Carroll probably knows a lot more about sports medicine than I do, but his assertion that "HGH really helps with recovery and healing" seems a little strong, given what I've read. Kind of like my wife believes taking echinacea helps her ward off colds. I'm skeptical, but the NIH does say that it "may help the body defend itself from the viruses that cause colds, sore throats and the flu," and maybe it does. I see taking HGH for staving off aging or aiding recovery from surgery as being similar to taking echinacea -- I'm skeptical of its efficacy but it might work anyhow due to the placebo effect. I don't know why anyone would want to hang a patient for taking echinacea or HGH though.

Some people follow doctor's recommendations when they're sick. Some don't. Cardinals doctors didn't prescribe the HGH for Rick; he went outside the team medical channels. Was that out of frustration because his recovery wasn't going as rapidly as he'd hoped, or did he hope that HGH would help him compensate for what the injury and TJ surgery took out of his arm? Maybe a little bit of both?

The off label usage of HGH for recovery from injuries doesn't seem to me to be any worse than taking it to stave off the effects of aging, but it's the anti-aging application that's apparently bringing in the big bucks. Old geezers often have lots of money and are desperate to hang onto whatever semblance of youth they have remaining. Were it not for the anti-aging market, athletes might not even be able to find anyone to write HGH prescriptions for them.