It was a cool Monday morning in December, twenty year-old Marcus Jones was found dead in his college dorm room. Marcus was the star running back for a division I college football team with dreams of making it to the NFL. He had received high praise from all of his coaches, had never been in any sort of disciplinary trouble, and was widely regarded as one of the best running backs in the country. His death sent shock waves throughout the college campus and local community, and the ensuing hysteria left local community members demanding an explanation for his death. The problem, however, was that even the doctors and coroners were puzzled by Marcus’s cause of death, because much of the evidence that they were confronted with just didn’t seem to add up.
For starters, Marcus had just undergone a routine physical examination one week prior to his death, and his doctor reported that Marcus had “no existing medical conditions,” and was in “peak physical condition.” Furthermore, Marcus had been randomly drug tested by the NCAA just two days before his death, and all test results were negative, indicating that Marcus had no illegal drugs in his system at the time of the test. However, despite his seemingly impeccable health, Marcus was reported to have died from “sudden cardiac arrest,” the cause of which was still unclear[1].
An autopsy of Marcus’s body later revealed cardiac hypertrophy (thickening of the heart muscle), cerebral edema (brain swelling due to excess water accumulation), high levels of collagen, sodium, and potassium, dilation of the right ventricle, and softness and fragility of the liver[2]. Further postmortem lab tests also found trace amounts of drugs such as amphetamine salts (Adderall), methandienone, clomifene (also known as clomiphene), and clenbuterol in Marcus’s urine[3], suggesting that Marcus had somehow “tricked” or otherwise tampered with the drug test that he had taken two days before his death.
The presence of the anabolic steroids methandienone, clomifene, and clenbuterol, explained Marcus’s liver problems, enlarged heart, and high levels of collagen, sodium, and potassium (as these are all common side effects associated with anabolic steroid abuse), but they certainly didn’t explain the whole story[4]. Doctors were still uncertain as to how significant a role (if any) the amphetamine salts played in Marcus’s death, and they still could not make sense of the swelling in Marcus’s brain. In other words, it was clear that anabolic steroids played a significant role in Marcus’s death, but whether they alone were the cause of death remained unclear.
After thoroughly examining the evidence, the doctors and coroners were unable to make any definitive conclusions, so they decided to do an additional autopsy to see if they might uncover some important information. The results of the second autopsy confirmed the results of the first autopsy, but they also revealed a crucial detail that had initially gone unnoticed: there was severe mitochondrial damage in Marcus’s muscle cells—a relatively common side effect of combining intense physical exercise with anabolic steroid use[5]. This mitochondrial damage suggested to the doctors that anabolic steroids were likely the main cause of Marcus’s death, as an individual cannot stay alive for long without functioning mitochondria (the location of cellular respiration). However, this information still did not help explain the swelling in Marcus’s brain, or whether the amphetamine salts found in Marcus’s urine were at all connected to his death. So, in a last effort to fully uncover the mystery behind Marcus’s death, the doctors decided to team up with a group of medical researchers to perform some experiments on lab animals to see if they could discover exactly what caused Marcus’s death.
After numerous unsuccessful experiments on laboratory rats and mice, the doctors finally had a breakthrough. During an experiment with mice, the doctors noted that the combination of the anabolic steroids methandienone and clomifene (the same combination used by Marcus) resulted in severe brain swelling in almost all of the observed mice. Additionally, the doctors noted a substantial increase in the heart rate of all mice who had been injected with the anabolic steroid clenbuterol[6]. These results allowed the doctor’s to fill in the missing pieces of Marcus’s mysterious death.
Following this long and thorough investigation, Marcus’s doctors and coroners were finally able to come up with an explanation for Marcus’s death: He had been abusing steroids for at least six months (long enough for substantial liver, spleen, and kidney problems to take place), he had not been taking proper precautions with regards to his steroid dosages, he had been using drug detox kits to avoid detection on drug tests, and on the tragic night of his death, Marcus had decided to take Adderall to study for an exam, which elevated his heart rate to a lethal level, resulting in cardiac arrest that prematurely ended his life.
[1] Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 261. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
[2] Ibid. 262
[3] Ibid.
[4] Hartgens, Fred, and Harm Kuipers. "Effects of Androgenic-Anabolic Steroids in Athletes." Sports Med 34.8 (2004): 539-40. Afboard.com. 2004. Web. 22 Nov. 2012. <http://www.afboard.com/library/Effects%20of%20Androgenic-Anabolic%20Steroids%20in%20Athletes.pdf>.
[5] Laghi, Franco, W. E. Langbein, Andreea Antonescu-Turcu, Amal Jubran, Christine Bammert, and Martin J. Tobin. "Respiratory and Skeletal Muscles in
Hypogonadal Men with Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine 171.6 (2004): 601. Ajrccm.atsjournals.org. 10 Dec. 2004. Web. 22 Nov. 2012. <http://ajrccm.atsjournals.org/content/171/6/598.full.pdf html>.
[6] Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 263. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
For starters, Marcus had just undergone a routine physical examination one week prior to his death, and his doctor reported that Marcus had “no existing medical conditions,” and was in “peak physical condition.” Furthermore, Marcus had been randomly drug tested by the NCAA just two days before his death, and all test results were negative, indicating that Marcus had no illegal drugs in his system at the time of the test. However, despite his seemingly impeccable health, Marcus was reported to have died from “sudden cardiac arrest,” the cause of which was still unclear[1].
An autopsy of Marcus’s body later revealed cardiac hypertrophy (thickening of the heart muscle), cerebral edema (brain swelling due to excess water accumulation), high levels of collagen, sodium, and potassium, dilation of the right ventricle, and softness and fragility of the liver[2]. Further postmortem lab tests also found trace amounts of drugs such as amphetamine salts (Adderall), methandienone, clomifene (also known as clomiphene), and clenbuterol in Marcus’s urine[3], suggesting that Marcus had somehow “tricked” or otherwise tampered with the drug test that he had taken two days before his death.
The presence of the anabolic steroids methandienone, clomifene, and clenbuterol, explained Marcus’s liver problems, enlarged heart, and high levels of collagen, sodium, and potassium (as these are all common side effects associated with anabolic steroid abuse), but they certainly didn’t explain the whole story[4]. Doctors were still uncertain as to how significant a role (if any) the amphetamine salts played in Marcus’s death, and they still could not make sense of the swelling in Marcus’s brain. In other words, it was clear that anabolic steroids played a significant role in Marcus’s death, but whether they alone were the cause of death remained unclear.
After thoroughly examining the evidence, the doctors and coroners were unable to make any definitive conclusions, so they decided to do an additional autopsy to see if they might uncover some important information. The results of the second autopsy confirmed the results of the first autopsy, but they also revealed a crucial detail that had initially gone unnoticed: there was severe mitochondrial damage in Marcus’s muscle cells—a relatively common side effect of combining intense physical exercise with anabolic steroid use[5]. This mitochondrial damage suggested to the doctors that anabolic steroids were likely the main cause of Marcus’s death, as an individual cannot stay alive for long without functioning mitochondria (the location of cellular respiration). However, this information still did not help explain the swelling in Marcus’s brain, or whether the amphetamine salts found in Marcus’s urine were at all connected to his death. So, in a last effort to fully uncover the mystery behind Marcus’s death, the doctors decided to team up with a group of medical researchers to perform some experiments on lab animals to see if they could discover exactly what caused Marcus’s death.
After numerous unsuccessful experiments on laboratory rats and mice, the doctors finally had a breakthrough. During an experiment with mice, the doctors noted that the combination of the anabolic steroids methandienone and clomifene (the same combination used by Marcus) resulted in severe brain swelling in almost all of the observed mice. Additionally, the doctors noted a substantial increase in the heart rate of all mice who had been injected with the anabolic steroid clenbuterol[6]. These results allowed the doctor’s to fill in the missing pieces of Marcus’s mysterious death.
Following this long and thorough investigation, Marcus’s doctors and coroners were finally able to come up with an explanation for Marcus’s death: He had been abusing steroids for at least six months (long enough for substantial liver, spleen, and kidney problems to take place), he had not been taking proper precautions with regards to his steroid dosages, he had been using drug detox kits to avoid detection on drug tests, and on the tragic night of his death, Marcus had decided to take Adderall to study for an exam, which elevated his heart rate to a lethal level, resulting in cardiac arrest that prematurely ended his life.
[1] Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 261. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
[2] Ibid. 262
[3] Ibid.
[4] Hartgens, Fred, and Harm Kuipers. "Effects of Androgenic-Anabolic Steroids in Athletes." Sports Med 34.8 (2004): 539-40. Afboard.com. 2004. Web. 22 Nov. 2012. <http://www.afboard.com/library/Effects%20of%20Androgenic-Anabolic%20Steroids%20in%20Athletes.pdf>.
[5] Laghi, Franco, W. E. Langbein, Andreea Antonescu-Turcu, Amal Jubran, Christine Bammert, and Martin J. Tobin. "Respiratory and Skeletal Muscles in
Hypogonadal Men with Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine 171.6 (2004): 601. Ajrccm.atsjournals.org. 10 Dec. 2004. Web. 22 Nov. 2012. <http://ajrccm.atsjournals.org/content/171/6/598.full.pdf html>.
[6] Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 263. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
Critical Thinking Questions:
1. Do you think the doctors investigated Marcus’s death in the most efficient way? Would you have investigated this case differently?
2. Based on the postmortem test results, do you think the doctor who gave Marcus his routine physical exam was incorrect in saying that Marcus was in “peak physical condition?” What specific evidence might suggest that Marcus was not in perfect health at the time of his exam?
3. Could this case have been solved without animal experimentation? Was the animal experimentation in this case ethical? Why or why not?
4. How do you think the NCAA could do a better job of preventing illegal drug use among athletes? Do you think performance enhancing drugs could ever be completely eliminated from sports? Why or why not?
5. Do you think drug detox kits should be made illegal? Why might it be difficult to pass such legislation?
1. Do you think the doctors investigated Marcus’s death in the most efficient way? Would you have investigated this case differently?
2. Based on the postmortem test results, do you think the doctor who gave Marcus his routine physical exam was incorrect in saying that Marcus was in “peak physical condition?” What specific evidence might suggest that Marcus was not in perfect health at the time of his exam?
3. Could this case have been solved without animal experimentation? Was the animal experimentation in this case ethical? Why or why not?
4. How do you think the NCAA could do a better job of preventing illegal drug use among athletes? Do you think performance enhancing drugs could ever be completely eliminated from sports? Why or why not?
5. Do you think drug detox kits should be made illegal? Why might it be difficult to pass such legislation?
Sources:
Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 261-64. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
Hartgens, Fred, and Harm Kuipers. "Effects of Androgenic-Anabolic Steroids in Athletes." Sports Med 34.8 (2004): 539-40. Afboard.com. 2004. Web. 22 Nov. 2012. <http://www.afboard.com/library/Effects%20of%20Androgenic-Anabolic%20Steroids%20in%20Athletes.pdf>.
Laghi, Franco, W. E. Langbein, Andreea Antonescu-Turcu, Amal Jubran, Christine Bammert, and Martin J. Tobin. "Respiratory and Skeletal Muscles in
Hypogonadal Men with Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine 171.6 (2004): 598-605. Ajrccm.atsjournals.org. 10 Dec. 2004. Web. 22 Nov. 2012. <http://ajrccm.atsjournals.org/content/171/6/598.full.pdf html>.
Hausmann, R., S. Hammer, and P. Betz. "Performance Enhancing Drugs (Doping Agents) and Sudden Death." International Journal of Legal Medicine 111.5 (1998): 261-64. SpringerLink.com. International Journal of Legal Medicine, 3 Mar. 1998. Web. 22 Nov. 2012. <http://www.springerlink.com/content/1gjkvmvk21ydqa51/>.
Hartgens, Fred, and Harm Kuipers. "Effects of Androgenic-Anabolic Steroids in Athletes." Sports Med 34.8 (2004): 539-40. Afboard.com. 2004. Web. 22 Nov. 2012. <http://www.afboard.com/library/Effects%20of%20Androgenic-Anabolic%20Steroids%20in%20Athletes.pdf>.
Laghi, Franco, W. E. Langbein, Andreea Antonescu-Turcu, Amal Jubran, Christine Bammert, and Martin J. Tobin. "Respiratory and Skeletal Muscles in
Hypogonadal Men with Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine 171.6 (2004): 598-605. Ajrccm.atsjournals.org. 10 Dec. 2004. Web. 22 Nov. 2012. <http://ajrccm.atsjournals.org/content/171/6/598.full.pdf html>.