Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market.
In a recent issue of this journal, Graham et al.reported on the analysis of 57 oral, injectable and percutaneous performance enhancing drugs (PEDs) obtained from the illicit market in the United Kingdom.
They found significant levels of adulteration and misbranding: some drug products contained different active pharmaceutical ingredients (APIs) from those listed on the labelling (for example, testosterone propionate was substituted for nandrolone decanoate, which exhibits significantly different pharmacokinetics and pharmacodynamics) whereas others had no detectable APIs as per the analyses undertaken.
To our knowledge, this is the first published piece of work from the UK providing analytical evidence of the high level of adulteration of a sample of PEDs for more than 14 years. It serves to advance the contemporary evidence base from a collection of anecdotes and informal observations. Further, it broadly supports the findings from convenience samples and case reports in other settings both temporally and spatially†.
Why is any of this important?
From our perspective the failure to better understand and quantify the issue of adulteration better could be one issue – of many – that confounds the analysis of the adverse events that have been ‘associated’ with PED use, leading to specious reasoning when undertaking causal inference.
Specifically, if the composition of the drug products cannot be assured and we do not quantify and assess the impact of this, then how can we know if we are examining the effects of a specific drug product?
Evans-Brown M, Kimergard A, McVeigh J. Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market. Drug Test Anal 2009;1(7):323-6. Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market - Evans-Brown - 2009 - Drug Testing and Analysis - Wiley Online Library
'All scientific work is incomplete-whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time.'
In a recent issue of this journal, Graham et al.reported on the analysis of 57 oral, injectable and percutaneous performance enhancing drugs (PEDs) obtained from the illicit market in the United Kingdom.
They found significant levels of adulteration and misbranding: some drug products contained different active pharmaceutical ingredients (APIs) from those listed on the labelling (for example, testosterone propionate was substituted for nandrolone decanoate, which exhibits significantly different pharmacokinetics and pharmacodynamics) whereas others had no detectable APIs as per the analyses undertaken.
To our knowledge, this is the first published piece of work from the UK providing analytical evidence of the high level of adulteration of a sample of PEDs for more than 14 years. It serves to advance the contemporary evidence base from a collection of anecdotes and informal observations. Further, it broadly supports the findings from convenience samples and case reports in other settings both temporally and spatially†.
Why is any of this important?
From our perspective the failure to better understand and quantify the issue of adulteration better could be one issue – of many – that confounds the analysis of the adverse events that have been ‘associated’ with PED use, leading to specious reasoning when undertaking causal inference.
Specifically, if the composition of the drug products cannot be assured and we do not quantify and assess the impact of this, then how can we know if we are examining the effects of a specific drug product?
Evans-Brown M, Kimergard A, McVeigh J. Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market. Drug Test Anal 2009;1(7):323-6. Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market - Evans-Brown - 2009 - Drug Testing and Analysis - Wiley Online Library
'All scientific work is incomplete-whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time.'
thanks for pointing that out.
