Masters Swimming and Illegal Supplements

Originally posted by Sam Perry I also don't think age means anything, I'd be willing to bet if there were a test, you might find it more common among older swimmers. As you age the body begins to slow down, we all know this. If I could take something AGAINST THE RULES to slow that process, it would be enticing. If by "you might find it more common" you mean that drug use is more common among older swimmers, I fully agree. In fact, that is what I said. The reason why they are more likely to be using drugs is because they are more likely to have health problems. Let's take an actual example: Hypertension (high blood pressure) is a problem that affects people of all ages. But there is no question that it is more prevalant among older people. Only about 1 in 9 men aged 20-34 have hypertension, while only about 1 in 32 women aged 20-34 have the disease, and I suspect that the percentages are even lower than this for competitive swimmers in this age range who enter FINA, NCAA, and USA Swimming competitions. Yet more than half of both men and women aged 55-64 have the disease, and more than 70% of men and nearly 85% of women aged 75 and older suffer from it. (Note that these figures are based on the classic definition of hypertension, in which anyone with a systolic pressure of at least 140 and/or a diastolic pressure of at least 90 is considered to be hypertensive.) Diuretics are a class of anti-hypertensive drugs that have been in use for a long time, and which therefore have one of the best established records of safety and efficacy. And, in some circles, they are still considered to be the drugs of first choice when treating essential hypertension. But they are also on the list of banned substances that is used by FINA, NCAA, and USA Swimming. As I understand it, this is not because they actually enhance performance, but because their use may prevent other drugs that enhance performance from being detected by current testing procedures. So what if a competitive swimmer has hypertension and their doctor prescribes a diuretic to treat it? Well, if they want to continue competing in FINA/NCAA/USAS meets, the first thing they must do is disclose the fact that they intend to use the said drug. The rules are very clear on this: If an athlete uses a banned substance without disclosing it, they're disqualified even if there was a legitimate medical reason for the use. In fact, the use is ideally supposed to be approved before the athlete even starts using it, but the rules do recognize that there are emergency situations in which it may place the athlete at risk if use of the substance is delayed. But even then, immediate disclosure of the use is required. And, if the review board does not approve the use, the athlete must either stop using it or be barred from competition. Now, the first thing the review board would presumably examine is whether the health problem actually exists. I have no idea what sort of examination they do. In this case, would the athlete be required to temporarily stop using the drug so the board could verify that the athlete's blood pressure did, indeed, rise to dangerous levels? Another problem is what constitutes hypertension. In the statistics I cited above, "hypertension" was considered to exist if systolic pressure was at least 140 and/or if diastolic pressure was at least 90. But this standard is now considered to be questionable. In fact, "normal" blood pressure is considered to be 115/75, and every elevation of 10 points in the systolic pressure and 5 points in the diastolic pressure above this is known to double the risk of heart disease. Thus, a person with a blood pressure of 125/80 (once considered very normal) actually has twice as much risk of heart disease as a person with a blood pressure of 115/75, and a person with a blood pressure of 135/85 (once considered a high normal) has 4 times the risk. Obviously, these risks are nothing new - it's just that nobody knew about them until recently. And, when they were discovered, all doctors did not learn about it at the same time. But even if the board can (a) determine what the athlete's untreated blood pressure actually is, and (b) agree on how high it needs to be to warrant treatment, there is still the issue of what treatment should be used. The general policy is that use of a banned substance should not be allowed if there is an alternative treatment that could be used. Obviously, there are several classes of anti-hypertensives besides diuretics. But there are serious health concerns about some of these, some do not have as well established a track record as diuretics (meaning that there may be as-yet-undiscovered health risks associated with their use), and virtually all of them have side effects which may render them inappropriate for some patients, particularly if those patients also have other health problems. Moreover, some hypertension is so severe that it requires treatment with more than one anti-hypertensive. And there are questions about whether all anti-hypertensives are equally effective in reducing the health risks of essential hypertension. (Note that the term essential hypertension means that the cause of the hypertension is unknown. It is therefore possible that some anti-hypertensives may be treating the cause of the hypertension while others may only be treating the symptoms.) The bottom line is that the review boards are, in the end, in the position of second guessing the athlete's own doctors. A former doctor of mine wrote a diet book, and in the opening chapter, he included the following advice: "It is always prudent for your physician to approve and supervise your diet, and I always so advise, even if you know you are in good health. Your physician knows much more about you than a stranger writing a book . . ." If you substitute the words "review board" for "stranger writing a book", this statement is still valid. I suspect that the reason all of these things have not been a problem for FINA/NCAA/USAS is because hypertension is so rare among the athletes who compete in their events. But this is clearly not going to be the case for USMS. Unless USMS is prepared to have a full-time review board consisting of doctors who have the expertise needed to second guess the treatments of doctors all over the country, USMS would be well-advised to stay away from banning substances (except, perhaps, for those that are illegal even with a prescription). Bob

Originally posted by Sam Perry I also don't think age means anything, I'd be willing to bet if there were a test, you might find it more common among older swimmers. As you age the body begins to slow down, we all know this. If I could take something AGAINST THE RULES to slow that process, it would be enticing. If by "you might find it more common" you mean that drug use is more common among older swimmers, I fully agree. In fact, that is what I said. The reason why they are more likely to be using drugs is because they are more likely to have health problems. Let's take an actual example: Hypertension (high blood pressure) is a problem that affects people of all ages. But there is no question that it is more prevalant among older people. Only about 1 in 9 men aged 20-34 have hypertension, while only about 1 in 32 women aged 20-34 have the disease, and I suspect that the percentages are even lower than this for competitive swimmers in this age range who enter FINA, NCAA, and USA Swimming competitions. Yet more than half of both men and women aged 55-64 have the disease, and more than 70% of men and nearly 85% of women aged 75 and older suffer from it. (Note that these figures are based on the classic definition of hypertension, in which anyone with a systolic pressure of at least 140 and/or a diastolic pressure of at least 90 is considered to be hypertensive.) Diuretics are a class of anti-hypertensive drugs that have been in use for a long time, and which therefore have one of the best established records of safety and efficacy. And, in some circles, they are still considered to be the drugs of first choice when treating essential hypertension. But they are also on the list of banned substances that is used by FINA, NCAA, and USA Swimming. As I understand it, this is not because they actually enhance performance, but because their use may prevent other drugs that enhance performance from being detected by current testing procedures. So what if a competitive swimmer has hypertension and their doctor prescribes a diuretic to treat it? Well, if they want to continue competing in FINA/NCAA/USAS meets, the first thing they must do is disclose the fact that they intend to use the said drug. The rules are very clear on this: If an athlete uses a banned substance without disclosing it, they're disqualified even if there was a legitimate medical reason for the use. In fact, the use is ideally supposed to be approved before the athlete even starts using it, but the rules do recognize that there are emergency situations in which it may place the athlete at risk if use of the substance is delayed. But even then, immediate disclosure of the use is required. And, if the review board does not approve the use, the athlete must either stop using it or be barred from competition. Now, the first thing the review board would presumably examine is whether the health problem actually exists. I have no idea what sort of examination they do. In this case, would the athlete be required to temporarily stop using the drug so the board could verify that the athlete's blood pressure did, indeed, rise to dangerous levels? Another problem is what constitutes hypertension. In the statistics I cited above, "hypertension" was considered to exist if systolic pressure was at least 140 and/or if diastolic pressure was at least 90. But this standard is now considered to be questionable. In fact, "normal" blood pressure is considered to be 115/75, and every elevation of 10 points in the systolic pressure and 5 points in the diastolic pressure above this is known to double the risk of heart disease. Thus, a person with a blood pressure of 125/80 (once considered very normal) actually has twice as much risk of heart disease as a person with a blood pressure of 115/75, and a person with a blood pressure of 135/85 (once considered a high normal) has 4 times the risk. Obviously, these risks are nothing new - it's just that nobody knew about them until recently. And, when they were discovered, all doctors did not learn about it at the same time. But even if the board can (a) determine what the athlete's untreated blood pressure actually is, and (b) agree on how high it needs to be to warrant treatment, there is still the issue of what treatment should be used. The general policy is that use of a banned substance should not be allowed if there is an alternative treatment that could be used. Obviously, there are several classes of anti-hypertensives besides diuretics. But there are serious health concerns about some of these, some do not have as well established a track record as diuretics (meaning that there may be as-yet-undiscovered health risks associated with their use), and virtually all of them have side effects which may render them inappropriate for some patients, particularly if those patients also have other health problems. Moreover, some hypertension is so severe that it requires treatment with more than one anti-hypertensive. And there are questions about whether all anti-hypertensives are equally effective in reducing the health risks of essential hypertension. (Note that the term essential hypertension means that the cause of the hypertension is unknown. It is therefore possible that some anti-hypertensives may be treating the cause of the hypertension while others may only be treating the symptoms.) The bottom line is that the review boards are, in the end, in the position of second guessing the athlete's own doctors. A former doctor of mine wrote a diet book, and in the opening chapter, he included the following advice: "It is always prudent for your physician to approve and supervise your diet, and I always so advise, even if you know you are in good health. Your physician knows much more about you than a stranger writing a book . . ." If you substitute the words "review board" for "stranger writing a book", this statement is still valid. I suspect that the reason all of these things have not been a problem for FINA/NCAA/USAS is because hypertension is so rare among the athletes who compete in their events. But this is clearly not going to be the case for USMS. Unless USMS is prepared to have a full-time review board consisting of doctors who have the expertise needed to second guess the treatments of doctors all over the country, USMS would be well-advised to stay away from banning substances (except, perhaps, for those that are illegal even with a prescription). Bob