Article on Beta Blockers in pistol competitions.


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lbmii
August 28, 2008, 12:35 AM
Here is an interesting article on the use of Beta Blocker drugs as performance enhancer drugs in olympic pistol competitions. A 13 percent increase in performance was shown by users of Beta Blockers because of a reduction of hand tremble.

http://www.theatlantic.com/doc/200808u/beta-blockers

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Zundfolge
August 28, 2008, 12:50 AM
Hmm ... I have a problem with an essential tremor that comes and goes ... maybe I should look into this (no, I don't shoot competitively either)

wadcutter45
August 28, 2008, 12:54 AM
In the world of biostatistics 13% is not a significant figure and is well within the expected range of variation.

It always sounds more credible to quote statistics even if the reporter doesn't understand statistics.

Fuzzy data fuzzy conclusions. Remember, this is being quoted in a popular magazine, not from a scientific peer-reviewed journal

Jim Watson
August 28, 2008, 01:10 AM
Tell that to the Korean who got disqualified at the Olympics.

I know a lot of shooters who would take a dose for a 13% improvement, +/- 12%.

lbmii
August 28, 2008, 01:12 AM
Indeed, "The Atlantic" is top rate as far as general readership type of magazines go. The 13% comes from a primary reseach medical journal.

"In a double-blind cross-over study of 33 marksmen (standard pistol, 25 m) the adrenergic beta 1-receptor blocker, metoprolol, was compared to placebo. Metoprolol obviously improved the pistol shooting performance compared with placebo. Shooting improved by 13.4% of possible improvement (i.e., 600 points minus actual points obtained) as an average (SE = 4%, 2P less than 0.002). The most skilled athletes demonstrated the clearest metoprolol improvement. We found no correlation between the shooting improvement and changes in the cardiovascular variables (i.e., changes of heart rate and systolic blood pressure) and no correlation to the estimated maximum O2 uptake. The shooting improvement is an effect of metoprolol on hand tremor. Emotional increase of heart rate and systolic blood pressure seem to be a beta 1-receptor phenomenon."

taprackbang
August 28, 2008, 01:15 AM
I would like to see if the great G. David Tubb uses Beta Blockers for perf. enhancement.

"Guns don't kill people... Brain drugs do!"

HIcarry
August 28, 2008, 01:16 AM
In the world of biostatistics 13% is not a significant figure and is well within the expected range of variation.

It always sounds more credible to quote statistics even if the reporter doesn't understand statistics.

Fuzzy data fuzzy conclusions. Remember, this is being quoted in a popular magazine, not from a scientific peer-reviewed journal

Not sure that I agree that a 13% improvement isn't significant. What I believe to be more significant in evaluating this is that the cohort size was small (33 shooters; since it was a double blind study, it means that about half, or 16 folks actually got the drug). Other issues that might affect the significance of the study is the Confidence Interval, P value, and other such statistical tools, as well as the overall construct of the study itself. It should be noted that the study quoted in the magazine article was done in a peer-reviewed journal (http://www.ncbi.nlm.nih.gov/pubmed/2875053) in 1986, but used metoprolol, not the propanalol found in the Korean athletes. They are related compounds, but not the same drug.
Still, for most folks the use of beta blockers to improve shooting accuracy is not worth the risk. Besides, personally, I want the flight/fight response to be as nature intended if I get into a situation, not blunted by drugs.

geophysicishooter
August 28, 2008, 01:24 AM
If you saw the documentary "Bigger, Stronger, Faster", you'll recall the segment in which several symphony/orchestra musicians talked about how beta blocker drugs helped keep their nerves under control. I know little about these drugs other than that they're supposed to be great for anxiety and keep the brain from freaking out in stressfull situations.. Given that, I wouldn't be surprised to find out competitive shooters would find that effect useful..

13% is about 1 in 8 which is hardly statistically insignificant. Of course that concept varies and I'm not a biostatistician but it would be hard to disregard a calming of the nerves in a shooting situation.

Isn't diazapam a drug that snipers use to calm their nerves and slow their heart rate??

Haemon
August 28, 2008, 01:33 AM
Wouldn't be surprised -- Diazepam is the generic name for Valium. It's used as an anticonvulsant, to treat muscle spasms, and much more. It's been around for ages and the docs know exactly how it works. This other drug is probably bring used in olympic competition instead because of more "refined" effects or becaouse it is harder to test for.

HIcarry
August 28, 2008, 01:42 AM
Valium (diazepam) also causes drowiness, which, I imagine would not be a desired effect while waiting, hidden and still, for your target. Beta blockers do not generally cause drowiness.

wadcutter45
August 28, 2008, 01:46 AM
HIcarry said it better than I....I should have said in a small sample (cohort) 13% is not a significant number...if the cohort were , say 1,000 it would be a significant conclusion.

And Geophysicishooter is absolutely right one in eight is a significant number...significant in our world, my fellow geophysicist. But the world of biology and the life sciences is less precise than the world of physics.

HIcarry nailed it when he said 13% isn't worth the risk...health-wise or legal-wise. I guess that's how I should have phrased it.

Besides, everyone knows that 23.7% of all statistics are made up anyhow. <smile>

Good points, gentlemen...they don't call this forum "The High Road" for nothin. Any medical statisticans out there who care to comment on methodology and conclusions?

wadcutter45
August 28, 2008, 01:51 AM
Oh, and Ibmii...I didn't in any way mean to disparage your contribution...thank you for posting this article

KelVarnson
August 28, 2008, 01:52 AM
As I understand it, propranolol is an older drug, which acts on a larger group of receptors than metoprolol (Toprol). I currently take both. Not for competition shooting but for high blood pressure, and for something else, which I will get to in a moment.

My doctor and I have been experimenting with a number of different meds and combinations of meds to keep my B.P. under control. Just about anyone with hypertension would understand that trying a bunch of different drugs is fairly common; trying to find the perfect drug or combination.

Along the way, we tried propranolol. First of all, it did a remarkable job of controlling my BP, better than anything I had tried. But unlike all of the other drugs, it also had a profound effect on how I felt. Much like a tranquilizer, but without any intoxication, like the article said. It just made me calmer.

Unfortunately, because propranolol works on a wider range of receptors, it does open you up to more side effects than some of the newer, more targeted drugs. In my case, it caused a couple of nuisance side effects that I grew weary of, so I switched to metoprolol, which is more targeted specifically to the receptors that control BP (if I understand it correctly). The metoprolol works almost as well as the propranolol for my BP.

The more generalized effect of propranolol makes me believe that it would be more effective, likely much more effective at improving shooting skills under pressure than metoprolol would.

I said I take both drugs. Here's why: I play in a band that gigs on a very regular basis. When I started taking propranolol, all of a sudden stage fright became non-existant. This was not placebo effect, because at that point I was unaware of this application for the drug. Doing a little research showed me that I wasn't just imagining it.

But the since the side effects proved too much, I switched off of 24-hour time-release propranolol, and onto the time-release metoprolol for BP. But, my doctor prescribed a small dose of short-acting propranolol for gig days. He said it is very common for this application, and another doctor I spoke to echoed that. Both said they had a few of patients that took it for various forms of performance anxiety.

So, it works, it's dirt cheap, and it doesn't have any of the negatives of other "solutions", like alcohol or sedatives. I haven't tried it for shooting, but I am already convinced that it would help.

geophysicishooter
August 28, 2008, 02:10 AM
The cellists and oboeists popped 'em like m&m's in that film.. Maybe no one saw it but I highly recommend it. But they swore by them. Said they wouldn't stand a chance of beating out someone for a chair in a symphony if they weren't on blockers and the person they were competing against were. Of course, that's just annecdotal (I didn't spell that right), but the musicians interview for that film were convinced of the positive effects of beta blockers. One of the key interviewees said he pretty much took them all the time whether he was playing or not. Interesting film. people should check it out, "Bigger, Stronger Faster* the side effects of being American"

btw, good to know there's another phys on the high road.

HIcarry
August 28, 2008, 02:18 AM
Wadcutter: While I am not a medical statistician, I do have to spend a good deal of time reviewing medical journals and research. I tried to read the article referenced just to look at the study construct and results, but couldn't get it online. The abstract available online didn't offer enough relevant info to make any determinations about the study itself.

As to the cohort size, while important, it in and of itself is not necessarily the determining factor in evaluating studies either. A poorly constructed study that doesn't allow for confounding factors, doesn't screen or adequately blind the participants is "bad" regardless of the size of the cohort. Another issue is repeatability. As they say in medical research, your findings don't mean anything until someone else can recreate the study and obtain similar results.

Aloha

AZAndy
August 28, 2008, 07:41 AM
Saw an article this morning that discussed the use of beta blockers and shooting:


In Defense of the Beta Blocker

Nobody seemed terribly surprised when two North Korean athletes tested positive for performance enhancing drugs at the Olympics last week. By now, stories of disgraced athletes sound familiar almost to the point of tedium. But if you had the patience to read beyond the headlines, you might have noticed something unusual about this particular scandal—namely, the nature of the banned drug the athletes were using. That drug was propranolol, and the athletes using it were pistol shooters. Propranolol is not exactly a cutting-edge performance enhancer. If you are familiar with propranolol, it is probably because you (or your parents) take it for high blood pressure. Its value as a performance enhancer comes from its ability to mask the effects of anxiety, such as the tremor that might cause one’s hand to shake when aiming a pistol. That propranolol can improve athletic performance is clear, and not just for pistol shooters. Whether it ought to be banned is a more complicated question.

Propranolol comes from a class of drugs known as beta blockers, which lower blood pressure by blocking particular sympathetic nervous system receptors. These receptors also happen to be the ones that get activated in times of fear or anxiety, which is why beta blockers are useful as performance enhancers. A beta blocker can keep a person’s hands from trembling, his heart from pounding, and his forehead from beading up with sweat. It can also keep his voice from quavering, which is why shy people sometimes sneak a beta blocker before giving a big speech or a public presentation. Beta blockers do not directly affect a person’s mental state; taking a beta blocker before firing a pistol is not like taking a Valium, or tossing back a shot of Jack Daniels, because beta blockers do not alleviate anxiety so much as block the outward signs of anxiety. A pistol shooter on beta blockers will still be nervous, but his nervousness will be less likely to make his hand tremble.

Beta blockers seem to be especially good performance enhancers when the performance in question involves an anxiety-producing public setting. This is because a large part of the anxiety of performing in public comes from the worry that one’s anxiety will become outwardly obvious. Most people who worry about public speaking, for example, aren't worried that they'll flub their lines, trip and fall as they approach the podium, or deliver an hour-long speech on television with their pants unzipped. They worry that their anxiety will become apparent to the audience. They're terrified that their hands will tremble, that their voices will become high-pitched and quivering, and that beads of sweat will appear on their foreheads and upper lip, like Richard Nixon trying to explain Watergate. This is why beta blockers are so useful; people who have taken a drug that blocks the outward effects of their anxiety become less anxious—not because the drug is affecting their brain, but because their worst fears are not being realized.

Beta blockers have been around since the 1960s, but it took a while before anyone noticed how useful they were for performance anxiety. Probably the first performers to start using them widely were musicians, especially classical musicians, whose hands can get clammy or tremble during a concert performance. In the mid-’70s, a team of British researchers tested the effects of a beta blocker on the performances of skilled violinists and other string musicians. They made sure that the musicians were playing under maximally stressful conditions by booking them in an impressive concert hall. They also invited the press to attend, and recorded all the sessions. The musicians were asked to perform four times each, twice on placebo and twice on beta blockers, and their performances were scored by professional judges. Not only did the musicians tremble less on the beta blocker, they also performed better. Usually the improvement was minimal, but for a handful of musicians it was dramatic.

From a competitive standpoint, this is what makes beta blockers so interesting : they seem to level the playing field for anxious and non-anxious performers, helping nervous performers much more than they help performers who are naturally relaxed. In the British study, for example, the musician who experienced the greatest benefit was the one with the worst nervous tremor. This player's score increased by a whopping 73%, whereas the musicians who were not nervous saw hardly any effect at all.

One of the most compelling arguments against performance enhancing drugs is that they produce an arms race among competitors, who feel compelled to use the drugs even when they would prefer not to, simply to stay competitive. But this argument falls away if the effects of the drug are distributed so unequally. If it's only the nervous performers who are helped by beta blockers, there's no reason for anyone other than nervous performers to use them. And even if everyone did feel compelled to use beta blockers, it's unlikely that anyone would experience untoward health effects, because beta blockers are safe, cheap, and their effects wear off in a few hours. So unlike users of human growth hormone and steroids, users of beta blockers don’t have to worry about their heads growing or their testicles shrinking. You don’t even have to take them regularly. All you have to do is take a small, 10 mg tablet about an hour before your performance.

Beta blockers are banned in certain sports, like archery and pistol shooting, because they're seen as unfairly improving a user’s skills. But there is another way to see beta blockers—not as improving someone’s skills, but as preventing the effects of anxiety from interfering with their skills. Taking a beta blocker, in other words, won’t turn you into a better violinist, but it will prevent your anxiety from interfering with your public performance. In a music competition, then, a beta blocker can arguably help the best player win.

Does the same hold true for pistol shooting? That beta blockers generally help pistol shooters seems clear. It's even been demonstrated in a controlled study. A group of Swedish researchers found that the performance of a group of shooters was improved by an average of about 13% upon the administration of beta blockers. The improvement was deemed to be the result of the effect of the beta blocker on hand tremor. (What was unclear from the study is whether the beta blocker helped nervous shooters more than calm ones, and whether its effect would have been any different if the shooters had performed in a stress-inducing public competition, like the London musicians.)

Even assuming that the effect was the same for the Swedish shooters as it was for the London violinists, however, it’s not obvious whether or not the drug should be banned. The question is whether the ability to perform the activity in public is integral to the activity itself. For some sports, being able to perform under stress in front of a crowd is clearly a crucial part of the game. Back in March, when the Davidson College basketball team was making its amazing run through the NCAA tournament, for example, the real thrill came from the ice-water-in-the-veins performance by shooting guard Steph Curry. The Davidson games were so unbearably intense that I thought my head would explode just from watching, yet it was always at the point of maximum tension that Curry’s 3-pointers would start dropping miraculously through the net. In a sport like basketball, where a player’s performance in public under pressure is critical to the game, taking a drug that improves public performance under pressure would feel like cheating. So the question for pistol shooting is this: should we reward the shooter who can hit the target most accurately, or the one who can hit it most accurately under pressure in public?

Given that we’ve turned big-time sports into a spectator activity, we might well conclude that the answer is the second—it is the athlete who performs best in front of a crowd who should be rewarded. But that doesn’t necessarily mean that that athlete is really the best. Nor does it mean that using beta blockers is necessarily a disgrace in other situations. If Barack Obama decides to take a beta blocker before his big stadium speech at the Democratic Convention next week, I doubt his audience will feel cheated. And if my neurosurgeon were to use beta blockers before performing a delicate operation on my spine, I am certain that I would feel grateful.

Carl Elliott teaches at the Center for Bioethics at the University of Minnesota and is the author of several books, including Better Than Well: American Medicine Meets the American Dream (2003), and the co-editor of The Last Physician: Walker Percy and the Moral Life of Medicine (1999).

Here's the link to the article. (http://www.theatlantic.com/doc/200808u/beta-blockers)

Henry Bowman
August 28, 2008, 10:09 AM
So the question for pistol shooting is this: should we reward the shooter who can hit the target most accurately, or the one who can hit it most accurately under pressure in public?

Given that we’ve turned big-time sports into a spectator activity, we might well conclude that the answer is the second—it is the athlete who performs best in front of a crowd who should be rewarded. But that doesn’t necessarily mean that that athlete is really the best.It depends on how you define "best." In the Olympics, it's the latter, as the author noted.

In sports (and performing arts), its about performance. It doesn't matter how well I sing in the shower, if I can't sing in public, I won't be a star musician. I may be able to make a living in the recording studio, but it's performance that is rewarded.

ETA: Threads merged for convenience

makarovnik
August 28, 2008, 02:24 PM
I take beta blockers for my blood pressure not anxiety. It is sometimes prescribed after a heart attack. I would be in big trouble without it.

svtruth
August 28, 2008, 02:51 PM
IIRC, negative inotropes, they make your heart contract less forcefully, which should also help accuracy. The idea of taking them in an aerobic sport like basketball is crazy.
Those beta receptors they block are the ones that are stimulated by beta agonist inhalers used by asthmatics to keep from dying.
But this raises an interesting, related, point. Can any one shed light on the use of relaxation or meditation techniques in shooting?

HIcarry
August 28, 2008, 04:27 PM
IIRC, negative inotropes, they make your heart contract less forcefully, which should also help accuracy. The idea of taking them in an aerobic sport like basketball is crazy.
Those beta receptors they block are the ones that are stimulated by beta agonist inhalers used by asthmatics to keep from dying.
But this raises an interesting, related, point. Can any one shed light on the use of relaxation or meditation techniques in shooting?
Beta blockers are negative inotropes (reduce contractile force) and negative chronotropes (reduce heart rate), which in part is why they work for things like performance anxiety. But, as you mention, in some situations, say aerobic sports or a real fight or flight situation, you might not want that effect.
There are actually three types of beta receptors, denoted as beta 1, beta 2, and beta 3, and the different beta blockers target the various receptors in different combinations and selectivity. That's why some folks get better results from one type of beta blocker than another. However, in general beta blockers are avoided in asthmatics for exactly the reasons you mention. They tend to close the small airways (bronchioles) via beta 2 blockade and inhibit the bronchodilation of emergency asthma medication, such as inhalers.
Aloha

Zundfolge
August 28, 2008, 04:36 PM
In the world of biostatistics 13% is not a significant figure...
No, but in the world of Olympic shooting 13% is the difference between Gold and never making it to the Olympics in the first place.

Even if the gain is little (or only placebo) many athletes on that level will take whatever sliver of advantage they can get.

KelVarnson
August 28, 2008, 05:06 PM
The idea of taking them in an aerobic sport like basketball is crazy.

Very true. I mountain bike, and the beta blockers slow me down significantly on that. But it's way better than the alternative!

wadcutter45
August 28, 2008, 07:35 PM
<Sigh>....I'm sorry i even commented. I was critiqueing the statistical methods...not an actual score improvement. Of Course 13% SCORE IMPROVEMENT is significant. And some say math skills aren't important....<sigh> :banghead:

Math skills help you interpret what is meaningful and what is not.

To put it very, very simply...the STUDY itself is not meaningful enough to encourage anyone to take beta blockers to improve their score.

mec
August 28, 2008, 07:50 PM
better living through chemistry

Propanolol is a definate aide. About 35 years ago, I was on the stuff for blood pressure. At that time, I was getting some astounding results in indoor pistol matches. I was also working as a security guard and had to handle drunks on a regular basis. It was simple. Clamp the drunk's whrists so he couldn't move, put on the cuffs and take care of business. Heart beat stayed steady at 72 bpm or thereabout.
when I started an aerobics program, my blood pressure dropped out and I experienced some mental dullness. The doctor took me off the stuff without advising that I taper off and pretty soon my pulse was racing with a good bit of ventricular fibrilation. That calmed down and a couple of nights later, I handled another drunk.
This time my pulse speeded up and I got a tremor in my voice and was fairly excited by what had been a low stress process on the drug.

antsi
August 28, 2008, 07:55 PM
HIcarry said it better than I....I should have said in a small sample (cohort) 13% is not a significant number...if the cohort were , say 1,000 it would be a significant conclusion.


You're misunderstanding statistical power. Large samples allow one to detect statistically significant but small magnitude effects. According to the quote above, the p-value was less than 0.002. This certainly achieves statistical significance by any meaningful standard. It does not make sense to criticize this study for its small sample size when statistical significance was achieved. If statistical significance was achieved, then by definition, the sample size was large enough. The value of large samples lies in detecting small, subtle effects. P of 0.002 in a small sample is not a small, subtle effect: it is a dramatic effect.

In the world of biostatistics 13% is not a significant figure and is well within the expected range of variation.

This depends on the distribution of the value in the population. In a population that is heterogenous for the variable in question, you're right, 13% might not be much of a difference. If, however, we are talking about the pistol shooting scores of Olympic-level marksmen, this is going to be a relatively homogenous population and 13% could be huge in such a group.

HIcarry
August 28, 2008, 09:26 PM
You're misunderstanding statistical power. Large samples allow one to detect statistically significant but small magnitude effects. According to the quote above, the p-value was less than 0.002....

Ahhh, sounds like you are familar with statistics, at least more so than I. I actually looked at the P value and noted it was written as "2P" which is a term I am not familar with. It also listed the standard error as opposed to a CI. Care to explain those and why they might have used them in this instance in terms even I can understand :)

And, to Wadcutter45 (and many others out there): the difficulty in making decisions about the validity and significance of medical studies stems from the fact that it frequently involves many interrelated and interdependent factors, as well as the statistics stuff. I frequently speak to physicians that readily admit to having difficulty making those decisions.

GigaBuist
August 28, 2008, 10:07 PM
So... are these things all prescription only or is there anything in this category that's OTC?

HIcarry
August 29, 2008, 03:35 PM
So... are these things all prescription only or is there anything in this category that's OTC?
Only available by prescription...

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