PEDs as Healing Agents

Expanded Playing Time

The Argument

Those who simply will not relinquish their cherished beliefs that PEDs just must be messing up baseball stats, when faced with the overwhelming number of studies that show it doesn't affect power, have one more card up their sleeves. Their case is that steroids and even more so hGH have healing effects, so that players can appear in more games than they otherwise would, thus pumping up their seasonal and career home-run totals. The numerate will instinctively see the gross implausibility, but let's examine the claim in some detail.

The biggest problem with an argument of this sort is that it is not a true scientific proposition, in that it is hard to see how it could be considered falsifiable. If someone says "I pray nightly for your well being, otherwise you'd be run over and killed by a bus within a week," that is falsifiable: you merely ask the person to stop for a week. But if someone says "The reason there are more home runs is that invisible, indetectible space ships from Mars are beaming down equally indetectible space-energy rays on some ballplayers", just how exactly is one supposed to disprove the proposition?

It may sound funny, but really, how could one? But if we cannot find a handle on the "invisible effects" argument itself (as we cannot possibly ever know in how many games a ballplayer might--or might not--play that he would otherwise skip from injury but which he is able to participate in because of invisible, oops, because of unknown substances of indeterminate effects), we can nonetheless approach the issue sideways, so to speak.

Approaches to Answers

The first question we might ask our Martians theorist, or our medical-miracles theorist, is "Whatever makes you think so?" On what ground, that is, do you--and should we--even consider the proposed idea as an answer? As to the "healing" effects of hGH and steroids--well "everybody knows it", don't they? Do they? Where and how did they learn of it? Was it not from someone else whose source was also "everybody knows it"? What is the likely original source of the belief that hGH heals injuries?

Medical Opinion

It certainly isn't medical science. The closest science has come is to note that certain selected anabolic steroids appear to have some minor healing benefit in rodents. The original 1997 study (about the only one typically cited by other studies touching on the subject), "The Effect of Anabolic Steroids and Corticosteroids on Healing of Muscle Contusion Injury" [The American Journal of Sports Medicine 27:2-9 (1999)] contains the remark that anabolic steroids "may have an ethical clinical application to aid healing in severe muscle contusion injury" [emphases added], which is a very long haul from saying that they do much for naggy muscle pains on a day-to-day basis.

Most medical references to anabolic steroids with respect to healing refer to its apparent ability to help skin cuts heal over (wound closure); that is very far from healing damages to muscles and tendons, which is the kind of "healing" that athletes would be concerned with. For example, when we read "the anabolic steroid oxandrolone significantly enhanced wound healing", we need to notice that the sub-title of the article is "Oxandrolone, an anabolic steroid, enhances the healing of a cutaneous wound in the rat" ("cutaneous" means of the skin) and that the study measured time to wound closure.

But most of the buzz about "healing" is in reference to hGH. The source of this rumor is not hard to trace: it flows from a now-famous (or notorious) 1990 article in the New England Journal of Medicine, in which a research team led by Daniel Rudman of the Medical College of Wisconsin gave hGH regularly to a dozen elderly (60+) men, who, according to the paper, were said to have apparently undergone a reversal of "10 to 20 years of aging." Needless to say, that finding is now wildly controversial. Those who believe it pay megabucks to get jabbed in the butt daily, and those who don't find the whole apparatus of expensive clinics, physicians, and treatments to be a glorified racket.

But, more to our point, none of that has to do with recovery from muscle or tendon injury--but the "magic" apparently spread its glamour over the vague idea of a connection between hGH and "improved health", even for those not yet geriatric.

So let's see what the medical profession has to say about such a connection:

• Dr. Mary Lee Vance, professor of internal medicine at the University of Virginia and author of a much-cited 2003 study of growth hormone, was interviewed by the Baltimore Sun in late 2007 about players' perceptions that hGH helps recovery: "I think the key word is perception," Vance said, "because there's no evidence at all that it helps anyone recover from injuries."

• A NIDA position paper states that Some athletes insist that these substances aid in recovery from injuries, but no hard data exists to support the claim.

• A letter, published in the Wall Street Journal, cosigned by Richard Landau, M.D., Emeritus Professor, and Louis H. Philipson, M.D., Ph.D., Professor, Department of Medicine, both of The University of Chicago, stated that The view of some athletes that a few injections of the hormone might have beneficial effects on sore arms has never been rigorously tested, but is very unlikely to be effective.

• Dr. Lawrence A. Frohman, Professor Emeritus of Medicine, University of Illinois, and a spokesman for the association of doctors who treat hormone imbalances has said that the growth hormone confers no advantage in healing.

• Dr. Gary Gaffney, who maintains the "Steroid Nation" web site, states that Any physician using HGH for healing (unless it would be related to burn injuries, AIDS, and children with short stature) is practicing myth, heresy, chicanery, or quackery.

What in all that leads us to a tentative conclusion that hGH is going to put an injured athlete back on the field ahead of his normal recovery time? Nada, zip, nil, null, nought, blank, and whatever else Mr. Roget might have for nothing.

Statistical Analysis

OK, doctors and biologists are jerks: they know nothing about the wonderful advances discovered by athletes. Discount everything they say.

Are we then obliged to believe in the Martians healing effects of PEDs?

Well, let's consider. If PEDs get players out on the field when they would otherwise not be able to play, we should see some sort of cumulative or developing trend throughout the so-called "steroids era". What are we looking for? We want to see if there is evidence that, on the large scale--all of MLB--players are getting in more playing time per season. So let's do a thought experiment and then see how the data stack up.

On the one hand, the overall amount of playing time is obviously invariate: there are so many and so many plate appearances a team gets per season (which is a function of its on-base percentage, and does thus vary from team to team, though not drastically). On the other hand, we don't want to try just following a select few players; if nothing else, we might be missing a larger-scale effect. What we are really interested in is the playing time afforded to regulars, meaning batters who normally play the whole game in most games their team plays. If such men are fortunate enough to remain healthy, they can play in all 162 of a team's games.

How do we define a "regular"? I suggest that it is a player whose average number of plate appearances per game in which he appears is 3 or 4 or some figure in that region. Such a criterion identifies a man who is not a pinch hitter or defensive substitute; even though such men occasionally do get to start in a game, their seasonal average number of plate appearances per game they are in will not be that of a true regular.

We can reserve judgement on whether the exact criterion should be 3 or 3.5 or 4 appearances per game played--perhaps even try them all. But having identified such men by whichever criterion we use, what then? Well, we then look at their average number of plate appearances per seasonal team games. That is nearly the same as saying their total number of appearances in a season, which is to say their "playing time"; but we allow for the fact that different seasons over the history of the game have had different numbers of team games, mainly from expansion but also from work stoppages.

If the Martian healing-effects hypothesis is correct, what we should expect to see is a rise in the average plate appearances per team game datum for "regular" players: after all, the theory goes, those players, or some nontrivial number of them, are now healing faster and thereby reclaiming from history's dustbin games they would otherwise have missed.

The envelope, please:

Wait, wait, I'll type more when I can stop laughing.

Granted, the trend is not drastic. But very, very, very clearly average playing time per season for regulars has been decreasing over exactly the era in which the honorable ladies and gentlemen would want us to believe it had to be increasing.

Afterthoughts

The whole thing was a folly anyway. To begin with, just how many games a season does a first-rank player (the sort of man whose home-run totals matter to anyone) miss for which his being held out is marginal? That is, where there was a close decision--by him or his manager or the trainer or some combination of them--as to whether he could play? With the matter at issue being a still-healing injury (as opposed to, say, the flu)?

Or, if instead of players with a nagging, marginal almost-injury being kept available, we are talking about players with a serious, DL'ing injury coming back sooner, how many power hitters have how many such injuries in their careers? And how many "not-missed" extra days are we thus talking about adding on to those careers? Remember, we are talking about record-setters: such men necessarily have long careers. Even if the miracle juice worked as hyped, how many days would it add? Say one major injury per career, say a whole extra week added to the career--that might be a couple of long balls more over the whole career. Be still my heart. In fact, even adding a full week to some one season is only maybe two dingers for that season. I am still not in danger of swooning.

And there is yet another point about this miracle-juice-sends-marginal-men-out-to-play sophistry. As Dr. Arthur DeVany (who authored a paper cited elsewhere here on home-run hitting) has noted:

That is, since no PED really has literally magic total and instantaneous curative powers, the most a PED might do for a man who otherwise could not play in a given game is to allow him to go out there at well under 100% of his normal, healthy abilities. So even our generous assumption of a couple more dingers from a full extra week a season may well be far too generous; players playing on recovering muscles or tendons are not like men with the flu (or a hangover, for that matter). In the second case, it's hitting the ball at all that is going to be their main problem, but if they hit it squarely, they will probably hit it as hard as ever; the quasi-crippled athlete, on the other hand, is typically incapable of swinging with his full power, so that even if he hits the ball squarely, it's probably not going to be powered as his usual stroke would power it.

But that is all qualitative--just like the "arguments" of those who cling to their beliefs. When we look at hard numbers, well, the graph speaks for itself.