The recent revelations that have emerged from the federal investigation against the Bay Area Lab Co-operative (BALCO) — that it has been supplying performance-enhancing drugs (PEDs) to several high profile athletes, including baseball players Barry Bonds, Jason Giambi and Gary Sheffield — has unleashed a public reaction that is startling in its proportions. The story has dominated the sports media, relegating every other news item to page 3. In newspapers, television broadcasts, and internet chat rooms, much has been said in the past few days concerning this scandal. Unfortunately, the discussion has generated much heat and little light; many of the claims being made in these reports about PEDs are factually wrong, irrelevant, or misguided.
What the authors in this report would like to do is walk the readers through the myriad of ethical, physiological, legal, and societal implications that the use of PEDs has on baseball. We would also like to suggest the best course of action. The ideas in this report are their own and have been developed and refined either independently or in consultation for the past three years.
Let us start at the beginning and consider each issue that this controversy has unleashed:
- What are PEDs and how do they work?
- Do they improve performance and, if so, by how much?
- What do baseball players in particular have to gain by using PEDs?
- Are the PEDs being used safely, and, if not, what type of pathologies can we expect to see develop in those using them?
- What are the legal issues involving PEDs, and have the athletes using them broken the rules of baseball? Have they broken any public statutes?
- Why do we care if athletes use these substances, and what will it do to the game?
- What should be done to the violators?
- What should be done about the records that have been achieved by those using PEDs illegally?
- What should Major League Baseball (MLB) do, and what can they do?
- What should the position of the fans be?
Let us walk through these issues and consider them one by one.
There are many natural and synthetic substances that could be broadly described as performance enhancing, and in many discussions, they are all treated as members of the genus “performance enhancing” without significant difference. A representative list is shown below:
- Stimulants (caffeine, amphetamines, cocaine)
- Muscle and bone stimulants (anabolic steroids, beta-2 agonists, hCG, LH, hGH, IGF-1, Insulin)
- PED masking agents (epitestosterone, diuretics, plasma expanders, secretion inhibitors)
- Relaxants (beta blockers, cannabinoids)
- Oxygen carrying agents (EPO, artificial hemoglobin)
- Anaestetics (narcotics, local anaestics, ACTH. cortisone)
We think the classification of all these substances as “performance enhancing” is an unfortunate mistake, and in some cases, a deliberate obfuscation of the issue. Most of these substances have legitimate and recognized medical uses, and nearly all of them are approved by MLB. The analgesic substances do not enhance performance per se; that is, they cannot make you a better player than you already are. Rather, they remove some of the barriers to optimal performance, such as pain from injuries and fatigue. Therefore, the muscle and bone building agents and the substances that increase oxygen-carrying efficiency are considered as a separate class of substances.
As medical breakthroughs advance, and the information learned from the human genome project is utilized for practical purposes, this list is sure to grow, both in the number of agents in each of the categories and substances that could be listed under new categories — such as nerve growth stimulants, artificial organs and limbs, drugs that enhance the five senses, drugs that induce rejuvenation of tissues and organs, and genetic engineering by gene transfer methods. It is this second class that appropriately goes by the name, “PEDs”.
The current controversy is over the use of a substance or substances in combination to produce an anabolic effect. These substances — some natural, some synthetic — stimulate the body to increase muscle mass and to metabolize fatty acids more quickly. A beneficial side effect is that the muscles bounce back from fatigue more quickly, allowing the user to engage in a more rigorous training regimen. A person using these substances can expect to gain strength more quickly than by traditional resistance training methods, without necessarily gaining weight. In fact, you can actually lose size and still gain substantial strength, since muscle weighs more than fat.
Once an athlete chooses to use PEDs, what can he expect to gain? According to the experimental and empirical data available — a whole lot. According to Erikson et al. of the Department of Integrative Medical Biology at Umea University in Sweden, the use of anabolic steroids “induce an increase in muscle size by both muscle hypertrophy and the formation of new muscle fibers”1. While less information is available for the effects of self-administered anabolic steroids on recovery time between training sessions, Rozenek et al. of the Department of Physical Education at the California State University-Long Beach report that anecdotal reports of shortened recovery times is supported by experimental evidence2.
Human growth hormone (hGH) is often used in combination with anabolic steroids. The effects of supraclinical doses of hGH were studied by Crist et al. at the Department of Medicine at the University of New Mexico School of Medicine in Albuquerque. Crist et al. found that hGH in normal adults “alters body composition and muscle protein metabolism, and decreases stored and circulating lipids in fit adults with a pre-existing supranormal body composition”3. While it is difficult to gauge the true effects that self-administered, poorly controlled doses are currently having on athletes, it is clear that clinical and experimental data support the empirical observations that these substances are having a profound effect on athletic performance.
Weight training has long been recognized to have a beneficial effect on baseball performance. Honus Wagner was one of the first to recognize its usefulness and had a spectacularly long and successful career. For some reason, due mostly to ignorance and superstition, resistance training fell out of favor during the years between the wars and beyond. Its use gained favor again after Carl Yastrzemski adopted a rigorous off-season regimen prior to his remarkable 1967 season.
Resistance training was also becoming more popular in other sports. It was used to best effect when coupled with a demanding stretching protocol, since improper form or overtraining with weights can lead to muscle tightness and fatigue. Since the 1970’s, weight training is both common and encouraged in almost all major sports and the weight room is a common sight in stadiums and arenas. The obliteration of Roger Maris’ HR record in the late 90’s and the marked increase in HR/AB rates to record levels by some players has heightened awareness of the benefits of resistance training on power categories. However, since resistance training had been quite common since the 70’s, many suspected that other factors contributed to the remarkable power upsurges by the likes of Mark McGwire, Bonds, and Sammy Sosa, among others. The revelation of the surreptitious PED use by some of these players is sufficient to explain the bulk of this sea-change in human performance.
It has been asked why PEDs — like anabolic steroids and the off-label use of hGH — are not permitted, or why their efficacy for improved athletic performance has not been tested by the clinical trial process. The answer is quite simple, and there are at least two reasons. The distribution and use of PEDs is illegal, and the side effects of their use are either harmful, poorly understood, or both. Individual athletes do not have the authority to circumvent laws that have evolved and been refined since the beginning of the Food and Drug Administration (FDA) in 1862 as a single chemist working for the Department of Agriculture.
Today, the FDA oversees the vast and complex process of approving product safety and efficacy of food products (other than meat and poultry), human and animal drugs, therapeutic agents of biological origin, medical devices, radiation-emitting products for consumer, medical, and occupational use, cosmetics, and animal feed. There are approximately 9,100 highly trained employees of the FDA that are experts in the fields of chemistry, pharmacology, medicine, microbiology, veterinary science, and the law. Nobody claims perfection on the part of the FDA, but the current process of experimentation, study, and approval seems effective, especially given the demands placed on the FDA personnel to expedite the approval or rejection of an enormous number of drugs and other products.
The administration of PEDs runs counter to the dominant ethos of the medical science profession. The following is a direct quote from the Hippocratic Oath: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” Among the harmful side effects attributed to the use and the abuse of anabolic steroids include liver disease (including cancer and cystic hemorrhaging), anemia, renal dysfunction, impotence, pituitary gland dysfunction (including hypertrophy), and dysfunction of both the male and female reproduction system4. The off-label use of hGH in normal adults has some equally undesirable side effects, such as acromegaly (which is associated with cardiac disease), diabetes, osteoarthritis, and liver cancer. Additionally, there have been documented cases of athletes using hGH illegally produced from cadavers, risking the frightening transmission of Creutszfeld-Jakob syndrome, a uniformly fatal neurodegenerative disease for which there is no treatment5.
Any of these side effects would be a non-starter with any FDA review panel considering the merits of an Investigational New Drug (IND). All of them together should condemn these drugs, in the way in which they are being used, to the list of controlled substances. Manufacturers and physicians face stiff sanctions for developing, supplying, or prescribing any substance that is ingested as a drug and that has not gained FDA approval. In addition, individuals are not permitted to use these substances (although there is no law against possessing them). Since the players named in the BALCO investigation did not willingly reveal that they were using these substances, and confessed only under the threat of perjury, it has to be assumed that they knew what they were doing, that they knew it was wrong, and that it was against the law.
Given the assumption that the athletes involved in the BALCO case knew what they were doing, was it cheating? There are two elements to cheating: intentionality and deception. The athletes appear to know that what they were doing was illegal (indeed, by clinging to the very edge of legality, Bonds’ testimony indicates awareness that candid admission would imply legal guilt) and that a significant percentage of their peers were unwilling to break the law as they were. They knew (or at minimum, believed) that they would gain an unfair advantage by circumventing federal statutes. This establishes intentionality.
So, were the athletes also deceptive? And whom did they intend to deceive? These questions are also answered easily. The issue is not why they tried to deceive, but whether they did. Clearly, the very names of the PEDs involved (e.g., the “Clear”) indicate a desire to deceive. The drugs were designed to produce false negatives on steroids tests so that Bonds et al. could boldly challenge sportswriters and the rest of us that they were ready and willing to take any available tests, should the Players’ Association only permit them. They actually hid behind the other players, implying that the silly Union prevented them from proving their innocence! Instead, of course, it turned out that the victims of these players’ deception included their peers — those players who choose to compete fairly, including perhaps those players whose performances suffered by comparison with their less scrupulous peers.
The youngest children able to compete know already what we as adults know. Competition serves to show us who is best at something, and competition succeeds in doing this only if the playing field is as level as possible. Thus, for instance, children will know when they have cheated, just as they will know when their competition is no competition at all. Two children toe a line to see who is fastest. Should one leave early and be accused of cheating, he typically does not deny the validity of the rule (the starting point and time must be uniform). He will deny instead that he broke the rule. Likewise, should the neighborhood’s best sprinter find his friend’s fat little brother toeing the line beside him, he is likely to claim, “He’s no competition for me,” thus expressing what we all know: competition presupposes a level playing field.
The current wrangle over steroids provides us adults an opportunity to reflect on the meaning of sport and the competition that sport entails. PEDs tilt the playing field in the direction of those willing to break the law and take risks with their bodies that exceed the standards risks of the game. Make no mistake about it — excellence at the level of professional sports requires risks most of us are unwilling (even if able) to take. PEDs involve added risk; they are unnecessary to the achievement of excellence in any sport. Rather, PEDs pervert excellence and distort achievement in much the same manner as the child who starts the race early or who dares to race his friend’s fat little brother. The excellence they provide is a sham excellence, and the achievement that results from them is a sham achievement. A player who excels because of steroids is likely to receive from his peers what the playground cheater receives from his: much disdain and little respect.
It is right and correct that we, the paying public, be outraged and indignant at this travesty of fair play. We are among the victims of their deception. When we buy our ticket, it is presupposed the competition will be played honorably and by the rules. It is right for us to demand these things, and it is our right to demand that MLB give us the product we want, because it is our interest and dollars that ultimately sustain the enterprise. If we stopped watching and going to games, MLB would soon go away because they could not pay the players and support personnel for their services.
There is also an aesthetic component that must be considered. Baseball is an ancient game, probably as old as the nation itself. We, as fans, have certain expectations as to how the environment of play should be. We demand natural grass because we don’t like the way artificial turf looks or how it affects play. We demand the use of wooden bats because the sound of the ball hitting an aluminum or graphite bat doesn’t sound right. It isn’t the sound that our fathers used to hear, or the father of our fathers. And the ball doesn’t react to aluminum the same way it reacts to wood. We demand that brick and mortar and wrought iron be the stuff that surrounds the field of play, and we are willing to pay more for these things because that is how we want it.
In the same way, if the use of steroids was unregulated and all players were free to use them, it would distort the game in the same way that aluminum bats and artificial turf distort it. It would render the records and achievements of former times irrelevant or meaningless. And the records are one of the things about baseball that we cherish most. We want to experience the game the way we remember we played it as children, and how our father and the fathers before them played it. It is natural and good that we feel this way. It is what separated baseball from the other sports, and why it resonates in a way that other games do not. And the records of those times can transport us to a time and place that we could not experience in any other way. It is up to us to nurture our game, to cherish it and protect it from those who wish to corrupt it against our will.
References & Resources
This manuscript is a collaboration of ideas and arguments that have been developed and refined for over a year between Kevin Gilligan, Ph.D., Joseph Capizzi, Ph.D., “John Smith” Esq., Andrew Moursund and Josh “Anonymous”, who are regular posters at Baseball Think Factory.
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4New England Journal of Medicine, Aug 26, 2004 (Vol 9) 351:847-849
5Br J Sports Med 2003;37:100-105