The Human Growth Hormone test: a war of words between the World Anti-Doping Agency and the NFL Players Association

NFL Quarterback
Monday, 27 May 2013

The World Anti-Doping Agency (“WADA”) and the National Football League Players’ Association (“NFLPA”) have been in a long running debate over the application of Human Growth Hormone (“HGH”) blood testing in the National Football League (“NFL”). Howard Jacobs (The Athletes Lawyer) reviews both sides of the debate in light of the recent the Court of Arbitration for Sport decision in the Veerpalu v. FIS case.

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Comments (1)

  • DrBenKoh

    • 28 May 2013 at 06:54
    • #

    It would appear that both sides may have muddled the idea of validity and reliability in parts of their statements. Both constructs are related but fundamentally different.

    Validity refers to how true is something you say is true. In other words, if a HGH test says it is positive, how true is it that there was an abnormal HGH level/ratio. It deals with "specificity".

    Reliability refers to how consistent the test is. In other words, if the test is repeated 100 times, how many times will the HGH test bring up a positive result in a person that did indeed have an abnormal high HGH level/ratio. It deals with "sensitivity".

    In general, a highly specific test tends to be low in sensitivity and the reverse is also true. If you have a very strict criteria (highly specific) then your pick up rate (sensitivity) will be low.

    Imagine that you have a very strict criteria for picking up only Green T-shirts. A T-shirt that is slightly more Yellow or slightly more Blue (although within the spectrum of Green; outliers) will be rejected (low sensitivity), but whatever you pick up will truly and undisputedly be Green (high specificity).

    One wonders, if the specificity is indeed 99.99% as WADA claims, then it will likely have a very low sensitivity. This will likely to be borne out in larger sample sizes in a well-controlled experimental condition.

    In addition, the stated comments also supports the above assertion: "...According to the Respondent, the decision limits do not lead to too many false positives but are in fact conservative that tend to result in false negatives..." at [199]

    A high false negative would mean a low sensitivity (some T-shirts deemed Green may not be picked up).

    This brings the question of whether the test should be done in the first place.

    In my opinion, there is a valid argument for the NFLPA to question the validity (specificity) of the test in athletes. From the athletes' perspective, reliability is not important for them per se and is more a WADA concern "of catching the cheats".

    Even if the stability of the ratio that is claimed is true, is it true for patients with pathological conditions of HGH, in healthy subjects but non-elite/ non-athletes only, or for all humans? Because of strict liability, most validation tests are conducted on non-elite/non-athletes or extrapolating data from patient with pathologies. Can these results still be valid in elite athletes?

    If as indicated (footnote 96 at [145]) that even with a small sample size, exercise does influence the ratio of 22 kDa/pitGH ratio then a much larger sample size needs to be established to determine how large a fluctuation of the ratio exists in a variety of: exercise conditions (endurance/resistance training; various duration) and individuals (cross-cultural, both gender, age groups).

    I think it is also appropriate to have the stability of the ratio criteria (rather than absolute values) using Kit 1 and Kit 2 be tested by an independent laboratory (not nominated by WADA to ensure no conflict of interest; at [161]). This can potentially be done under confidentiality agreements so that the details of the test are kept proprietary and only reporting to the NFLPA the end results of sensitivity/specificity.

    I think that reliance on scientific instruments demand that the transparency of the scientific process and the scientific tradition of falsifying of theories be adhered to. While WADA's concern of some athletes beating the system are noted, any policy should not be at the expense on all athletes.


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