In early June, Julian Edelman, wide receiver for the New England Patriots, tested positive for an “unrecognizable substance” during an NFL performance-enhancing drug test. As a result he was issued a 4 game suspension. He subsequently appealed the suspension to an independent arbitrator who upheld the suspension. On the medical side of things, there are two big questions that are left unanswered. First, how can scientists not be able to recognize the exact substance for which he has tested positive (ie. is this mistaken identity)? Secondly, how can an athlete be suspended for a substance that the league and its scientist are not actually able to recognize. I thought these two questions would be a great start to a review of the NFL banned substance policy.
Banned Substance List
The NFLPA Drug Resource website has a list of banned substance in appendix A that is dated from 2016. The list includes approximately 200 banned substances which are divided into several different groups. The anabolic agents group is what gets the most attention and includes several different substances such as anabolic steroids, growth hormones, and a newer product called selective androgen receptor modulators (SARMs). SARMs have been popular due to their proposed ability to be more specific in their action, and cause fewer side effects than synthetic testosterone derivatives. Additionally, the banned list includes masking agents such as diuretics and stimulants such as amphetamines or pseudoephedrine. As one might imagine there are thousands of products on the market that may contain products on the banned list that the athlete may not be aware of as a banned substance. Due to a lack of regulation on nutritional supplements many products can be contaminated or mislabeled resulting in an athlete's unintentional consumption of a banned substance.
How can scientists not recognize the exact substance?
What many people don’t understand is how can the scientists not recognize the exact substance for which Edelman has tested positive. Well, the majority of substances on the banned list are synthetic products created in a lab. Therefore, scientists can only test for the substances that are known performance-enhancing drugs. There are labs all over the world that are working on creating new performance enhancing drugs that are undetectable by current testing standards. Take for example the BALCO scandal that involved Barry Bonds and Jason Giambi, in their alleged use of a cocktail of banned substances that when used in a cycle could go undetected by drug testing at the time. On one hand, unscrupulous labs need only slightly adjust the chemical structure of the substance to potentially avoid detection, on the other, labs may create an entirely new class of drugs to aid in performance. Many times these substances are created legitimately for medical purposes but then adapted to fit the needs of the athlete.
If It couldn’t be recognized, how is it a positive test?
The key to answering this question is a notation in the Appendix A document referenced above. The document states that the list of banned substances includes “other substances with a similar chemical structure and similar biological effect(s)”. We don’t know exactly which category Edelman’s positive test falls under, however, it likely fits into this category. For example, with anabolic steroids, the pharmacologic benefit is to stimulate tissues that respond to testosterone to help build muscle. These synthetic steroids all share a similar biochemical structure in order to potentiate this effect. Therefore if NFL league scientists detected a substance with a similar structure and function to an anabolic steroid, then that would be considered a positive test. Again, this is just an example, but my guess is that this is why he did not focus on the “unrecognizable substance in his appeal” and the subsequent confirmation of his suspension.