TRT Mania wrote:
Mr. Obvious wrote:An athlete receiving prescription medication from a doctor, whether a testosterone patch, EPO, or other substances, for the purposes of enhancing athletic performance, would be perfectly in compliance with current law. This is pretty easily done by going to an anti-aging clinic.
No M.D. is going to be able to legally prescribe EPO for the purpose of enhancing athletic performance. Only in cases where the athlete is clinically diagnosed with severe anemia as treatment for an underlying disease pathology (e.g., renal failure, sickle-cell anemia, chemo treatment) would EPO legally be prescribed to an patient/athlete.
I'm afraid this does not explore the complexity of performance enhancing drugs and prescriptions, perhaps due to poor initial statements on my part.
Doctors can legally prescribe just about any drug they want, for just about any condition they want (HGH being one notable exception, with prescribing outside of a narrow set of diagnoses being forbidden by law). That includes EPO. I agree with you that the doctor is likely not going to put down "enhancement of athletic performance" as the reason for the prescription.
I believe that the FDA indicated uses of EPO include only chronic kidney disease, chemotherapy, certain treatments for Human Immunodeficiency Virus (HIV), and also to reduce the number of blood transfusions during and after certain major surgeries. Just under half of EPO prescriptions are written for conditions for which it is approved as an indicated treatment by the FDA according to a recent study of prescribing practices.
The indicated uses really only serve as a regulatory requirement for the drug manufacturers and restrain the way they can market their drugs to doctors.
Doctors remain free to legally prescribe just about any drug they want for just about any condition they choose, including EPO. Doctors generally may prescribe a drug any time they would deem it medically appropriate for their patient. This is not without hurdles, but most of those are reactive hurdles and would not qualify in any way as making such a prescription "illegal."
There are some practical limits to this freedom. The first is getting the drugs paid for. In all but a few cases most patients are going to need an insurance company to pay for their drugs, and the insurance company is not going to pay for just any diagnosis. This may not apply to high performance athletes. Regardless of whether an insurance company would pay for the prescription or not, this does nothing to make such a prescription illegal.
The second hurdle would be the increased malpractice risk associated with prescribing off label. This is slightly increased by the fact that EPO has a black-box warning on it. However this does not prevent massive off label and contraindicated prescriptions in other drugs classes, such as the use of SSRIs in people younger than 24 due to increased risk of suicidality or the use of atypical antipsychotics to treat senile dementia despite a contraindication. Again such a limitation may in practice prevent some doctors from prescribing some drugs for off label usage, but this does nothing to make those prescriptions illegal.
The third limitation that I am award of on physicians freedom to prescribe off label would be the ability of the regulatory authorities to challenge such prescriptions as not being within the standard of care required for a practicing physician. This can be done by the FDA (which looks at prescribing practices and often monitors prescriptions of certain drugs especially heavily such as opiates and ADHD stimulants) as well as by the state medical boards, sometimes in conjunction. These mechanism are generally weak and reactive. The FDA is only going to pick up prescribing practices that are wildly out of the norm and state medical boards are usually only going to respond to complaints. In any case, in the vast, vast majority of these cases, the remedy is corrective action or suspension or revocation of the medical license of the practitioner (the exception to this would normally be where the physician is part of a drug selling/distribution ring or there is outright fraud). There is really no sense in which this would render previous prescriptions to be illegal and there would really be no remedy against individuals who had received prescriptions (they would have to find a new doctor).
In practice, even these mechanisms are unlikely to prevent any athlete who wanted to from obtaining EPO from a physician. There are a wide variety of conditions where there is at least some indication that EPO might be effective that a physician would have a very plausible case that he could prescribe. There is some indication in the literature that EPO is effective in addressing cognitive deficits associated with schizophrenia and bipolar disorder, that it is effective in treating treatment resistent depression. These have been through phase 2 clinical trials. EPO use has been used to treat anemia in all forms (including from hemolysis) in addition to anemia just from renal disease and chemo and HIV).
So, under the current regulatory scheme the doctor really only has to have a plausible reason to prescribe EPO to an athlete. Then the doctor and the athlete are legally able to prescribe and receive the medication. I suspect that not many athletes receive their PEDs this way but if they did, again, the issue is only jeopardy of exposure to USADA.
Simmons would like to change this and have both the doctor and the athlete face jail time. Again this would require some pretty radical restructuring of the current regulatory regime.