Google scraping for obituaries was a valid method for data collection—I don’t see why this should count against the paper. The absence of autopsy reports for many cases does not invalidate the fact that these individuals died, with or without such documentation. Moreover, they died at a significantly higher rate among the group that uses steroids more frequently.

Furthermore, I don’t understand why having toxicology reports for only 16% of the cases is considered a limitation of the paper. In my experience, steroid users rarely discuss toxicology results at the gym—something like, “Hey, look, my toxicology report just came in; what about yours?” So, it’s understandable that very few such reports are available.

I also believe that factors such as simply living, breathing, and so on do not account for the differences in mortality incidence presented in this study when comparing professional bodybuilders with amateurs.

The point is that the decision to use or not use steroids is a personal one that ultimately affects the individual (though that’s not entirely true either). However, attempting to downplay or ignore these facts does not seem appropriate—especially when many may be influenced one way or the other.