There was a time when Anthony Galea was on the front lines in the war against doping in sport.
When disgraced Olympic sprinter Ben Johnson made his comeback in 1991, Dr. Galea was there as a certified doping-control officer, watching over him while he peed into a vial. He once issued a public warning to Toronto parents about the torrent of steroids flowing through high-school locker rooms. He has railed against the win-at-all-costs attitude ruining sport, saying "that's why there is an increasing use of drugs to enhance performance."
Yet this week, Dr. Galea stood before a U.S. District Court judge and uttered "guilty" to the charge that he repeatedly carried misbranded drugs across the U.S.-Canada border, and admitted in an agreed statement of facts that he smuggled restricted drugs, including human growth hormone, to professional football and baseball players.
Now the 51-year-old father of seven could go to prison after acknowledging that he crisscrossed the United States, met athletes in their homes and in hotel rooms, and practised medicine without an American licence. It has threatened to ruin his career, the end of a remarkable arc that saw him go from a Toronto strip mall to the Toronto Argonauts clubhouse to making house calls for golfer Tiger Woods, former National Football League rushing leader Jamal Lewis and baseball slugger Alex Rodriguez.
His defence team insists that his injections of growth hormone, which are banned by most professional sports leagues, were strictly for healing and to encourage cartilage repair. "Any suggestion that he was involved in performance enhancement is clearly untrue," Toronto lawyer Brian Greenspan said after the hearing in Buffalo.
A close look at his past reveals a long and complex history with the world of steroids and growth hormone.
Dr. Galea is a man who resists categorization. He is drawn to the spiritual - he studies the Bible - but equally fixated with the superficial: his side business performing Botox injections and laser hair removal, for example. And while he courted a reputation as an ardent anti-doping advocate, steroid users lauded his willingness to help them manage their side effects. "Awesome," they called him.
Open door for bodybuilders
In 1992, Mario Carrier had won his first three amateur bodybuilding competitions on a steady diet of illegally obtained steroids, such as Winstrol and Durabolin. His "gear" came from one of two sources: connections at the gym or a horse-trainer associate who had access to veterinary supplies. But he had no one to turn to for sound medical advice in his quest to become Mr. Canada.
Then a co-worker told him about the Institute of Sports Medicine in Toronto and its founder Dr. Galea - a young physician with a near-constant smile and an open-door policy for bodybuilders. It took only one appointment for Mr. Carrier to know that he had found someone he could trust.
"He's not going to help me get the drugs, but he's going to help me monitor my body - the blood count, the liver count. There's a lot of guys who weren't doing that and I was right in with Tony," recalled Mr. Carrier, now a personal trainer in Toronto.
Not long after connecting with Dr. Galea, Mr. Carrier joined the professional bodybuilding circuit, competing in U.S. and Canadian cities. Mr. Carrier said he consulted Dr. Galea about when to start his next cycle - the intervals, which last around three months, when steroid users adhere to a strict schedule of injections.
"I'd go and see Tony and make sure when I was going back on … if my [blood]count was right, he'd say, 'Okay, you can go on your next cycle.' If it was too high, he'd say, 'Wait a while.' You know? So I benefited greatly from that guy."
Dr. Galea declined repeated requests for an interview but agreed to answer written questions through his lawyer. Mr. Greenspan described Dr. Galea's approach to bodybuilders as a classic harm-reduction strategy, treating them much like drug addicts or alcoholics, but denied that he'd ever advised anyone when to start or stop a steroid cycle.
"You don't throw them out of your office because they're a substance abuser…," he said. "You try to treat the medical issues that their substance abuse has created. That's the only reason they're in his practice, period."
The doctor carved out a niche treating the many side effects that afflict steroid users. When their testicles shut off - a consequence of excess testosterone during a cycle - and they developed male breasts, they would turn to him for estrogen blockers.
Nelson DaSilva, a former Mr. Canada, described Dr. Galea as "awesome," saying that as well as helping him with a torn tricep, the physician treated the "low testosterone, low sex drive" he developed once a cycle was completed.
"You go into your family doctor and say, 'I'm taking steroids. I'm off of them now. I'm feeling some nasty side effects,' and those doctors will say, 'Well, you did it to yourself. Go home. It will wear off.' He would actually tell you what to do."
He also provided other services. On one occasion, Mr. Carrier feared that a $2,500 vial of insulin-like growth factor - also a banned substance - he had purchased on the black market was counterfeit.
"So he'd grab it and test it and then he'd turn around: 'Mario - it's garbage'… So then I'd go back to the guy and say, 'Give me my goddamned money back.'"
The argument posited by the bodybuilders, that it was better to supervise an athlete's steroid use than leave him vulnerable to amateur chemists, was also promoted by another visitor to Dr. Galea's clinic, the late Charlie Francis, Ben Johnson's former coach.
It was Mr. Francis's candid testimony during the Dubin Inquiry that pulled back the curtain on the extent of doping in track and field - and prompted his lifelong ban from coaching.
Mr. Francis's wife, former hurdler Angela Coon, was Dr. Galea's patient. But a former staffer at the Institute of Sports Medicine, who spoke on the condition of anonymity, said the sprint coach's ties to the clinic went deeper than that.
"I don't know what specifically he was doing. I just know he was bringing in a lot of athletes," said the staffer. Ms. Coon did not reply to a written request for comment.
Mr. Greenspan acknowledged that Mr. Francis attended the clinic with athletes, but said the two men were not close. "Charlie did refer some people to him when they had muscle and joint injuries. He was there very infrequently at the clinic."
As well as Mr. Francis, the once-prominent members of his former Scarborough track and field club - the team at the heart of Canada's biggest doping scandal - seemed to reunite at Dr. Galea's clinic.
Mark McKoy, the hurdler who admitted taking steroids under Mr. Francis's watch in the 1980s, went on to win an Olympic gold medal in 1992. He has since run a strength-training class out of the clinic's fitness area and is a partner with Dr. Galea in the numbered company that owns the building that houses the clinic. The two men are close friends.
Desai Williams, another sprinter who admitted to taking steroids under Mr. Francis's supervision, also trained athletes at the clinic. Around the same time Dr. Galea became a team doctor to the Argonauts in 2004, Mr. Williams was hired as the team's speed coach.
Even Ben Johnson made the occasional appearance at the Institute of Sports Medicine. In an interview, Mr. Johnson said he was drug tested at the clinic several times before his final positive test in 1993 spurred the International Amateur Athletics Federations to ban him for life.
Despite his frequent contact with athletes who use, or once used, banned substances, it wasn't until 2000 that Dr. Galea's conduct started to come under scrutiny. And just like the more recent U.S. probe that may send him to prison, it was customs agents who sounded the alarm.
Seizure at Sydney Olympics
Six days into the Sydney Olympics, Scott Anderson was peering out at the warm-up track when his cellphone lit up.
As the long-time physiotherapist for Canada's track team, he was accustomed to all sorts of requests but this one was new. An Australian customs official had some pointed questions about a man, just off the plane, who said he was a doctor and allegedly claimed he was a member of Canada's medical team.
"He has some drugs that really don't belong in Australia and we're wondering what his role is with the team," the official said.
Authorities said Dr. Galea was carrying ephedrine, a stimulant that is banned by the Olympics but common in over-the-counter cold medications. (Ironically, he'd appeared on TV five years earlier when rower Silken Laumann tested positive after inadvertently taking ephedrine. "It's the responsibility of the athlete to make sure they are not taking drugs on the banned list," he said.)
And, as it turned out, he had no role with the Canadian medical team. He was in Sydney at the invitation of several high-profile track stars, including Donovan Bailey, who were staying in what the sprinters referred to as a "safe house" - a residence far away from the distractions of the athletes' village.
The doctor was eventually allowed into the country, but his medical bag stayed with the authorities, at least temporarily. Mr. Greenspan called the seizure "much ado about nothing" and said that any uproar could be attributed to the "natural tension" between the doctors who volunteer for their country and those who are brought in by superstar athletes.
The incident, however, came during a turbulent period for Dr. Galea. Around the time he turned 40, he completely overhauled his life: leaving his wife for a teenager, connecting with God and seeking the secret to eternal youth.
Dr. Galea met his first wife, Maureen, as teenagers in Toronto's west end, where they were both gifted tennis players. They married shortly before Dr. Galea finished medical school at McMaster University in Hamilton in 1986. Their families, both from Malta, had close ties; her father was a family physician and Dr. Galea briefly worked in his clinic, later inheriting most of his Maltese patients.
Their marriage wasn't without bumps - she alleges he was unfaithful throughout the 1990s, a charge he denies - but his reaction to reaching midlife sealed the end. "His behaviour change dramatically," she wrote in her divorce filings.
"He became disinterested in family life. Instead, he socialized with friends who were mostly single … [and]would often not come home until early in the morning."
In April, 1999, he announced he was leaving her for rising tennis star Nela Bogdanovich. At the time, she was 18 and a patient at Dr. Galea's clinic, but being seen, his lawyer insists, by another doctor. (Mr. Greenspan says Dr. Galea saw her just once, for "a foot wart," when she was 13.) The couple married in 2003 and now have three children.
But Dr. Galea's midlife roller-coaster did not end there. In various media interviews that he gave long before his guilty plea, he has described how, over three nights, he tossed and turned in bed with the same message blaring in the recesses of his mind: "Go to Jerusalem."
So he did, and while wandering the Old City, he came upon a stone church that is shaped like a tear and called Dominus Flevit - Latin for "the Lord wept."
"It felt like someone had put an intravenous in my veins and poured in a combination of fire and love," he told a publication for the Canada-Israel Committee.
After repeated trips to Jerusalem, he began volunteering at the Sheba Medical Center, a hospital in central Israel that has since erected, in Dr. Galea's honour, an eight-foot metal sculpture - a smiling, multi-coloured clown wearing a bowtie. The artwork, which was created by a Brazilian pop star, was donated by former Toronto Argonauts owner, and Dr. Galea's close friend, David Cynamon.
This religious awakening came as a shock to staffers at the Institute of Sports Medicine. His athletic therapists, accustomed to weekend road trips to track meets and tennis tournaments, were now asked to ship out for stays in Tel Aviv. Occasionally, the clinic's boardroom played host to a Bible study led by Ralph Rutledge, a former televangelist from the show 100 Huntley Street. (Property records also show that Mr. Rutledge sold his home on Oakville's waterfront to Dr. Galea and his wife, Nela, in 2005.)
"All of a sudden, out of the blue, he changed," the former staffer said of Dr. Galea.
But during this period the doctor made another discovery that he believed might help him, and others, truly stymie old age.
Mystique of growth hormone
The power of hormones, real or imagined, has inspired throughout history many treatments designed to counter the inevitable process of aging.
In 1889, a 72-year-old French physiologist named Charles Édouard Brown-Séquard announced that he had started injecting himself with a mixture of semen and "juice" from the crushed testicles of dogs and guinea pigs. He insisted it had helped him regain "at least all the strength" he possessed as a younger man. In the 1920s, an American doctor named John Brinkley transplanted goat testicles into senior citizens in a doomed effort to restore their virility.
Growth hormone, in particular, has a mystique that stems from its essential role in developing the bones and muscles of children. But as people grow older, their pituitary gland produces less of it. Some say this is mother nature's way of discouraging the growth of tumours, while others have dreamed of tapping all of that power for a lifetime.
In 1990, true believers appeared to get the answer they had been waiting for from one of the world's most prestigious scientific journals, the New England Journal of Medicine. Twelve men, all older than 61, received regular injections of growth hormone for six months. The results were encouraging - increased muscle mass and reduced fat - but lead researcher endocrinologist Daniel Rudman drew few conclusions and was explicit about the need for further inquiry. Even so, he included a sentence in his report that was to haunt him and his entire field: "The effects of six months of human growth hormone on lean body mass and adipose-tissue mass were equivalent in magnitude to the changes incurred during 10 to 20 years of aging."
And with that, a $35-billion anti-aging industry was born. That sentence is now scattered across the far corners of the Internet. Numerous fly-by-night on-line pharmacies make all sorts of claims while invoking Dr. Rudman's name: "Medical proof that HGH is the secret to anti-aging" and "HGH - Significant Health Benefits!"
The timing couldn't have been better for Dr. Galea, still waging his own battle against aging. In 2001, he started injecting himself with HGH and spread the gospel to his middle-aged patients, doling out prescriptions, often through the pharmacy in his clinic, at about $500 per kit - enough for roughly 30 days. Sources close to the clinic say Dr. Galea ensured his patients were tumour-free before issuing a prescription.
Like all of those Internet marketers, Dr. Galea latched onto Dr. Rudman's 1990 study to buttress his fervent belief in the power of HGH. In his 2007 book, Dr. Galea's Secrets to Optimal Health, he wrote that the results in the New England Journal of Medicine couldn't have been more clear: "The conclusion to this study was that growth hormone could reverse the aging process."
That interpretation of the study is not shared by Dr. Rudman nor the publication that printed his research.
Incensed by Internet marketers and self-proclaimed anti-aging specialists who were misrepresenting the results of the study, the NEJM's editor-in-chief, Jeffrey Drazen, took the unprecedented step of issuing two disclaimers. One was an editorial written by Dr. Drazen himself, where he described the "unnerving" misuse of the study and decried the profit-seekers ruining the journal's reputation. Regarding Dr. Rudman's conclusions, the editor-in-chief was emphatic: "It was clear that the results were not sufficient to serve as a basis for treatment recommendations."
The other warning was written by Mary Lee Vance, an endocrinologist at the University of Virginia, who said "there is no current 'magic-bullet' medication that retards or reverses aging." Even Dr. Rudman's widow tried to fight back against the tidal wave of false advertising. "In a way I am glad he didn't live to see how his work is being used," Inge Rudman told the Kansas City Star. "He would be very miserable."
All of these warnings were issued in 2003, four years before Dr. Galea published his book - yet he makes no mention of them.
His book also quotes a team of researchers at Stanford University who, he says, also determined that growth hormone could reverse aging: "It is possible that physiologic growth hormone replacement might reverse or prevent some of the inevitable sequalae of aging."
That particular quote comes from a 1991 paper by Andrew Hoffman, a Stanford endocrinologist - though Dr. Galea doesn't identify him by name. Had he identified Dr. Hoffman, it might have allowed curious readers to look up Dr. Hoffman on the Internet, where they would clearly see that his research shows the exact opposite. In fact, the same year Dr. Galea published his book, Dr. Hoffman co-authored a Stanford paper that found there isn't a single scientific study that has shown any evidence of growth hormone reversing the aging process. However, it has been shown to reduce fat and tighten skin slightly.
In an interview, Dr. Hoffman said he could barely remember writing the 20-year-old paper cited by Dr. Galea. The passage quoted in the book was clearly posed as a hypothesis, he said.
"God only knows where he found this. I have one tattered old copy that I found in my files," Dr. Hoffman said.
His research into growth hormone led a Nevada prosecutor to enlist the professor in his efforts to shut down a doctor who was doling out the drug for anti-aging purposes. The work Dr. Hoffman did provided a rare insight into the commercial side of the operation.
"It's all a cash business. They mostly have worried, middle-aged guys, some women, and they give them all kinds of supplements," he said. "It's remarkable quackery, but it's very lucrative, I think."
This week in Buffalo, the world got a taste of just how lucrative.
U.S. prosecutors revealed that, over a year and a half, Dr. Galea billed his professional athlete patients nearly $800,000 - including travel expenses - for his cross-border house calls. He made more than 70 trips to the U.S., visiting athletes as far afield as Hawaii, Phoenix, Miami and Denver.
Prosecutors say it was a lone athlete that served as Dr. Galea's breakthrough to the U.S. market and helped spread the word about his treatments. Staffers from Dr. Galea's clinic identified that athlete as Jamal Lewis, a one-time Super Bowl champion who was introduced to the doctor by a former college teammate who went on to play for the Toronto Argonauts.
But the growth-hormone injections his athlete patients received weren't for anti-aging purposes; Dr. Galea believes that HGH is something of a multipurpose drug, and his plea agreement indicates that he gave them shots of the hormone to help with inflammation in their knees.
He is not the only person who believes that these sorts of injections work, but it is an extremely small group. When defending Dr. Galea, his lawyers have repeatedly invoked the work of Allan Dunn, an orthopedic surgeon in Miami who has, for years, been injecting growth hormone into the knees of patients, and even has a patent on the procedure. (For his part, Dr. Dunn dismissed Dr. Galea's treatments as unscientific and described him as "putzing around.")
But experts in cartilage are skeptical of the technique altogether, saying that no one has done enough research to say whether or not it works. Dr. Dunn has published a paper in a relatively obscure journal, Microvascular Research, but critics say he hasn't published nearly enough follow-up research for anyone to form firm conclusions.
"Just to give you a bit of perspective, the one paper that Dr. Dunn has published wouldn't even suffice for a PhD degree, or it may be half of a Master's thesis. That's kind of the quantity and the quality of work that he has produced," said Michael Buschmann, the Canada Research Chair in Cartilage Tissue Engineering at the École Polytechnique de Montréal.
So where does that leave Dr. Galea? Why is he injecting a drug, banned as a performance enhancer, into the knees of professional athletes when there is no proof that it does anything?
Investigators will finally have an opportunity to pin him down on this in the coming months. As part of his plea agreement, he is required to co-operate fully with the U.S. authorities and will be subjected to a lengthy interrogation. If he has any hope of skirting a possible two-year prison sentence, he will have to spill everything he has done with his patients and why he did it.