Tweet: Do you think that the medical literature about steroids and bodybuilding has been influenced by who paid for the studies?

A: There have been some people who’ve gotten sick or died from medical problems created or worsened by the abuse of steroids, but most of us also know of adults who’ve used steroids for decades with no apparent ill effects. It’s a mixed bag, and yet the reported literature on anabolic steroids and bodybuilders is overwhelmingly one-sided: negative. When information is so dramatically biased in one direction, there are usually reasons behind it. And when scientists have underlying reasons to reach particular conclusions, the credibility of their research is tarnished (remember when the sports medicine community tried to discourage usage by designing studies to “prove” that steroids don’t work?).

The mainstream medical establishment believes that giving healthy adult males more than natural “replacement” doses of testosterone is dangerous and ethically forbidden (only a handful of studies in the 1990s went up to 600 milligrams weekly). So, don’t expect placebo-controlled, double-blind studies with bodybuilding doses to be conducted any time soon.

Much of the medical literature on steroids and bodybuilding has been comprised of case reports. Case reports have an inherent selection bias because they involve catastrophic events— sudden death or serious liver, cardiac or psychiatric problems. There are no steroid case reports about non-events— reports about users who didn’t get sick or didn’t show up for treatment despite years of use. How many thousands of these “healthy” users are out there? Nobody knows. But the fact that only the adverse events and problems are reported has created the widespread public perception that steroids hurt or kill many or most users— a perception that is generally at odds with the anecdotal observations of those in the trenches of the hardcore training community.

Beyond a case report from an attending physician, actual steroid research can be costly in time and effort. Taking the time to organize a group of steroid users and put them through medical or psychiatric examinations, or to follow them over a course of time, isn’t something doctors or scientists are going to do for free. Who’s going to offer grants for such research? The community of steroid users is unorganized and has no funding. The pharmaceutical industry abandoned steroids (other than researching new methods of administering testosterone replacement without an injection) when Congress made them controlled substances. So the only practical sources of funding for steroid research are institutions dedicated to opposing their use— sports anti-doping agencies and government anti-drug bureaus.

Examples of the above: a review of the adverse effects on the “cardiovascular, metabolic and reproductive systems of anabolic substance abusers” was funded by the Finnish Antidoping Committee; a questionable Swedish study funded in part by grants from the World Anti-Doping Agency purportedly linked steroid use with opiate dependence (although the authors claim that “WADA had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication”).

The National Institute on Drug Abuse proudly displays some of the anti-steroid research it’s funded at https://www.nida.nih.gov/PDF/NNCollec...NNSteroids.pdf. The institutions I’ve mentioned have a direct self-interest in maintaining or increasing their own funding— and a great way to do that is to fund studies that will strengthen the justification to maintain or even escalate their mission to eradicate performance-enhancing drugs.

So, you have researchers seeking grant money— and institutions with grant money seeking researchers— to further their agenda. But since the institutions can choose where to put their grant dollars, who do you think gets the grants? Is it unreasonable for researchers to design studies, collect data and draw conclusions— and for peer reviewers in the same field to conduct their reviews— with a keen awareness that future grants may likely hinge on furthering the agenda of the bankrollers? Money shouldn’t influence science, of course, but how can it not?

The take-away message about bias goes beyond steroids. Just because an article is printed in a peer-reviewed scientific or medical journal doesn’t mean there wasn’t a financial incentive influencing its design, data and conclusions. The process of peer-review publication doesn’t necessarily exorcise the bias out of a study or article. Always be a critical reader, and one way to do that is to check out where the money came from.



Rick Collins, JD, CSCS [www.rickcollins.com] is the lawyer that members of the bodybuilding community and nutritional supplement industry turn to when they need legal help or representation. [© Rick Collins, 2017. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.

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