Today’s news, first reported by San Francisco Chronicle investigative reporters Mark Fainaru-Wada and Lance Williams, about the use of human growth hormone (hGH) by Indians pitcher Paul Byrd had all the looks of a scandal. Yet the initial story was not the whole story. A later report from Ken Rosenthal of Fox let us know that Paul Byrd’s use might not be as sinister. I’ll try to break down, if not answer, some of the important questions that I’ve seen in the media and in my in-box:
Why was Byrd using hGH?
Byrd was using hGH under doctor’s orders after the discovery of a small, non-secreting pituitary tumor that may have resulted in lower-than-normal levels of hGH. This is far from a common situation, but neither is it rare. Byrd was examined by multiple doctors and, according to sources, the information was passed from team to team in Byrd’s standard medical record when he changed teams during the period of his usage. According to an endocrinologist who refused to be named because he did not examine Byrd or his records, hGH is a standard treatment for such a condition.
Was Byrd’s use illegal?
First, we must note the difference between the terms “illegal” and “banned.” Illegal denotes a use contrary to governmental laws or regulations. Byrd’s use, by prescription and for an FDA-approved condition, was not illegal.
Why did Byrd use a questionable pharmacy and have a prescription from a dentist?
Byrd has not commented on this issue. Many people use internet pharmacies to reduce costs. As for the dentist, Byrd appears to have never had actual contact with this person. It is all too common for refill prescriptions and even initial prescriptions to be done “on consult” with a doctor. This means that a patient fills out a questionnaire or, in some cases, speaks with a doctor by phone. This is a very common practice for erectile dysfunction drugs. I used Google to find one and included the top listed link here as an example. The dentist should not have been writing prescriptions and has been punished under the law as part of the ongoing case. Byrd likely had no idea who was prescribing the drug on most of his refills.
Was Byrd’s use in violation of MLB rules?
It does not appear that Byrd used hGH after January 13, 2005. That is the date that the second revision of the Joint Drug Policy went into effect, including a number of new substances in addition to the original list of anabolic/androgenic steroids. Since MLB had not banned the use of hGH prior to this date, Byrd’s use as reported does not appear in controvention of the ban on hGH.
Did Byrd have a Therapeutic Use Exemption?
It does not appear that he did. Byrd’s use, prior to the placement of hGH on MLB’s banned substance list, would not have required a waiver since it was not banned. It does not appear, as reported, that Byrd would have required one, though he did not hide his use from the team or league. It does not appear that he continued use beyond the date of the ban and would not then require a TUE. (For more information on therapeutic use waivers, listen to the BP Conversation with Dr. Olivier Rabin.)
Was Byrd’s usage of hGH connected to his elbow injury?
It appears that Byrd’s use pre-dates his elbow injury and subsequent surgery. Using hGH as part of a rehabilitation program for Tommy John surgery is highly questionable, though we do know that Jason Grimsley has stated that he took hGH as part of his recovery from surgery. The dates appear to be coincidental. Byrd admits that he feels the hGH helped with recovery time and fatigue levels, though both of these could be considered more related to his medical condition than supplementation.
Did Byrd’s use of HGH help him as a pitcher?
It didn’t help his fastball, if that’s what you’re asking. Byrd’s use of hGH does not appear to have any measureable effect on his pitching. Scouting reports do not appear to have had any significant change despite some variations in his effectiveness. If there was any effect of the hormone, it was less noticeable than the tutelage of Leo Mazzone.
Why did this story break and who’s next?
The full list of people involved in the Signature scandal has been leaked to at least two sources - the team at the San Francisco Chronicle and the team at Sports Illustrated. In an interview with Jon Wertheim of SI, he indicated that the list was extensive and being entered into a database. The story broke because Byrd’s name is noticeable and the timing was good to sell newspapers. That’s the job of any writer in the employ of a newspaper or magazine, so I’m not faulting anyone. Who’s next is tougher to say. If there’s any Indians, Red Sox, or Rockies on the list, they’d be a good bet.
When is the Mitchell Report coming?
The best guess is sometime between awards season and the Winter Meetings. I wouldn’t be surprised if it came out just before Thanksgiving, though Mitchell has given no indication of when he’d give his report to MLB or when it will be published.
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