SOLUTIONS/FOST: Handling pro athletes who use steroids

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By Dr. Norman Fost

All adults try to enhance their performance in a multitude of ways. We use cars and computers to make our work more efficient. We use caffeine, alcohol and Viagra to improve our performance. We send our children to schools and Suzuki lessons to improve their cognitive and performance skills. We inject them with vaccines to enhance their immune systems.

Athletes have used performance-enhancing drugs and devices since the beginning of recorded history. Babylonians and Romans used herbs to improve their performance in battle. Naked Greeks put on shoes to run faster. Kenyan runners trained at altitude, and runners everywhere have carbo-loaded to improve their endurance.

None of these activities has been considered immoral or illegal. Why, then, are we re-enacting the Salem Witch Trials with steroids as the witch's brew? Why are our greatest athletes being threatened with imprisonment for this universal quest to succeed and excel, whether by using drugs, devices or other means?

To be sure, we have rules, and those who break the rules must suffer the penalties. But this begs the question of why we have this rule, particularly about an activity that is so distinctly human. The answers to this question seem to me morally incoherent, hypocritical or based on ice-cold wrong information. Let's look at five of the most common reasons for banning one of the myriad of performance-enhancing technologies — anabolic steroids.

First, critics say they confer an unfair advantage. But advantages are only unfair if they are unequally distributed. The usual solution is to equalize access. When Bob Seagren showed up at the 1972 Munich Olympics with a fiberglass vaulting pole, the response was to delay its use until others had a chance to practice with it but not to prohibit it.

The unfair advantage argument is further undermined by the rampant hypocrisy. In the 1988 Seoul Olympics, where Ben Johnson lost his gold medal and world record because of steroid use, Janet Evans, the American swimmer, bragged about the special swimsuit that we had kept secret from the East Germans. Johnson used a drug that was available to everyone, virtually on the training room tables. Evans used secret technology, available to none of her competitors and bragged about it. The press cheered American ingenuity and made Johnson a pariah.

Bud Selig, the Major League Baseball commissioner, preaches about a level playing field, but he presides over a league in which the New York Yankees payroll is two to three times that of most of their competitors, including my beloved Milwaukee Brewers, and have failed to make the playoffs only once in 15 years.

Second, critics say that steroids are harmful, but they rely on information that is exaggerated or simply fabricated. We are told repeatedly that steroids cause heart disease, cancer and stroke. Oral testosterone was associated with liver cancer, but for decades the steroids of choice have been injectable versions of different molecules, which have not been associated with liver or any other cancer.

Lyle Alzado, the professional football player, became a poster child for the horrors of steroids. He died of a brain tumor. The New York Times and Sports Illustrated told us in cover stories that this was due to steroids without a single reference from an informed physician, because there is no evidence. Seventeen years after his death, the Alzado story is repeatedly cited without evidence of a connection.

Anabolic steroids do have undesirable side effects, such as acne, baldness, voice changes and usually transient infertility. But sport itself is far more dangerous and we don't prohibit it. The number of deaths from simply playing football is multiples of even the alleged deaths due to steroids.

Third, the critics say that their use is coercive, but there are no examples of American athletes being forced to use steroids. There is no entitlement to play a professional sport. It is an opportunity, with great rewards and often great risks, with or without steroids. Many walk away and choose not to play. No one is forced to compete. In the first year of universal testing in baseball, only 6 percent of players tested positive, suggesting that most were able to compete at the highest level without feeling forced to use them.

Fourth, critics claim that steroids undermine fan interest. This is empirically false. Baseball attendance rose steadily in the steroid era. Professional football is even more popular. Former Major League Baseball player Barry Bonds, widely assumed to use steroids, was the biggest draw in sports, adding 10,000 and more ticket sales everywhere he played. Chicks love the long ball. Guys love the long ball, and there is no evidence they like it less because of steroids.

Fifth, critics claim that steroids undermine the integrity of records. This is naive. Historical records are not comparable with or without steroids. Baseball fences are shorter, the ball is livelier, the pitching mound is lower, the season is longer and Coors Field is a mile above sea level. By one estimate, Babe Ruth playing in today's ballparks would have hit 1,000 home runs, far beyond those hit by Barry Bonds.

The leaders of sports should abandon the hypocritical condemnation and criminalization of steroids. This would allow better scientific studies to see if there are risks, prescribing by informed physicians, and oversight of the manufacturing process, so athletes could know they are putting into their bodies. Freed from this witch hunt, the sports police could turn their attention to the drug used much more widely by professional athletes, resulting in far more deaths — namely alcohol — and be more attentive to the common behaviors that cause far more harm, namely criminal and sexual assault.

• Dr. Norman Fost is a professor of pediatrics and medical history and bioethics at the University of Wisconsin School of Medicine and Public Health at Madison. This essay was adopted from remarks made by the author at a debate sponsored by the Rosenkranz Foundation/Intelligence Squared US at the Asia Foundation in New York City on Jan. 16, 2008.