LET'S START WITH a simple statement that will clarify anything you might be confused about later in this book: I believe that any substance that gives any player an unfair advantage should be banned from use in baseball.
That's the last time we'll be able to say something so simple on this issue. Still, it's important to keep in mind. I believe that most people would agree with the position. It gives us a base for talking about the drug issue intelligently. Try, for a moment, to forget that we're talking about baseball at all. This discussion is equally relevant to any sport, from football to curling.
The issue has been trending down in our society, moving from athletes at the elite level to athletes at the high school level. The problems of Olympic-level competitors are high profile, but farther down the chain there is less knowledge and oversight all around. In other words, I wouldn't want an Olympic sprinter using steroids, but I sure wouldn't want Johnny Quarterback who lives down the street to have steroids that he bought off some guy at the gym.
We'll discuss the scientific definition of steroids in a later chapter, but for now let's look at how the term is used in the ongoing public discussion. The term "steroids" has become the generic. In discussing any drug use in baseball, the media and the general public most often use the simple "steroids" instead of the more accurate term, performance-enhancing drugs. But PEDs encompass far more than just steroids.
Performance-enhancing drugs include, but are not limited to, anabolic and androgenic agents. "Anabolic" refers to a process by which living cells convert simple substances into more complex compounds, especially into living matter. "Androgenic" means that the substance produces masculine characteristics. These agents include steroids, amphetamines, and other substances that create an artificial "up" effect, and drugs that change body processes in such a way as to alter performance positively. It's not just a stronger, faster, or higher response that defines a PED. It can also be enhanced recovery, reduced pain, or increased sensation. The term "ergogenic" is synonymous with PED.
PEDs, however, are not always what you may think. Take, for instance, a drug that for the past five years or so has become one of the most abused drugs in sports. Doctors, both of the medical and witch varieties, purport that it has miracle-healing abilities when injected into aching joints. They also use it to stimulate muscle growth. While you can't get this drug without a prescription, it's easy to come by it at "reasonable" street prices. Taken improperly, a person using this drug could be sent into shock, and deaths have been recorded due to misuse.
The simple solution would be to ban this drug: keep it out of circulation and away from athletes and anyone else who might use it. What is the drug? Insulin. Millions of diabetics lead a normal life because of its easy availability. It is also misused as an ergogenic aid or in a new, controversial healing technique called prolotherapy.
When does a lifesaving drug become an illegal performance-enhancing drug? That's a question for the ethicists, but I'll go as far as saying that the difference lies in intent. Many athletes are also diabetics, and barring them the use of insulin would severely damage their quality of life. Given a choice-their insulin or their sport-few if any would choose sport, certainly if they were given that choice early in life.
The term we should use, then, for drugs that have been determined to offer an unfair competitive advantage or have a deleterious effect on health, should be illegal performance-enhancing drug, or IPED for short. And a government or sport sanctioning body should confirm this illegal status.
Let's look at a couple of examples of IPEDs-androstendione and THG, two substances well known to baseball fans. Androstendione was the substance used by Mark McGwire during his 1998 season. Many believe that "andro," because it is something from which testosterone is formed, has anabolic properties-in other words, it helps grow muscle. While current scientific investigation is unclear, and its performance-enhancing properties are in question, there is no question that in 1998, at the time McGwire was using the substance, it was legal under the standards enforced by Major League Baseball. Andro was illegal in many other sports and in the Olympics, but for McGwire it was legal to use. (The recent change in baseball's drug policy now meshes more closely with the federal Anabolic Steroid Control Act, which makes any substance illegal that is "closely related to or with substantially similar effects to a known anabolic steroid.")
THG, on the other hand, was "legal" for a different reason. Because it was an unknown substance, it could not be placed on a list of banned substances. Perhaps a drug called ZZZ will be created and distributed in 2010. Until that drug exists, it cannot be banned.
While technically "legal," then, users of THG, known or unknown, were skirting the rules of the sport. The recent changes by sanctioning bodies and by governments have closed the loophole slightly, tightening the guidelines. Nonetheless this issue again falls to ethics rather than science. Cheaters will cheat; that's what distinguishes them.
By defining these drug terms, we risk painting ourselves into a corner. Just as insulin can be both lifesaving and performance enhancing, many can find grey areas in the use of almost any drug, forcing us back to the intent of the abuser rather than the potential of the drug itself. Insulin, to Jason Johnson, a diabetic pitcher for the Detroit Tigers, is performance enhancing only in that it allows him to be healthy enough to compete athletically. I have seen no one complain that he or any of the other diabetic athletes have a competitive advantage.
Another drug that lives in this PED grey area is Strattera. Manufactured by Eli Lilly and Company in Indianapolis, Strattera is used for attention deficit / hyperactivity disorders (ADHD). It is one of the first nonstimulant drugs used for this condition. Yes, that means that other ADHD drugs, such as Ritalin, have an amphetamine-like effect on abusers. While Strattera is reported to have no "upper" effect, many players feel it gives them better concentration. "They feel 'locked in' and ready to go," said one major league team physician.
While the actual effects of Strattera for non-ADHD sufferers are debatable, its use by athletes points up the fact that they will take almost anything if they think it can give them an advantage. Most will attempt to stay within the rules. Those who feel aided by such drugs will often try to obtain a legitimate prescription from an enabling physician. Major League Baseball has instituted procedures to reduce this practice, forcing players who use such drugs under a new, nonstanding prescription to get a second opinion from an ADHD specialist.
This oversight does not come cheap. Teams are forced to expend both monetary and personnel resources to combat the use of both PEDs and IPEDs. Some teams have gone as far as to bring in psychologists and employee assistance (EAP) counselors. One team actually issued a uniform to its EAP counselor, allowing him to walk on the field and talk with players without drawing attention to that conversation.
The misuse of the term "steroid" extends even to the now-famous BALCO case. Two substances in that case have become all too commonly referred to by the media as the "cream" and the "clear." Yet few if any reporters have described these substances. According to most press reports, BALCO distributed these two substances to athletes, and some also received modanifil, a prescription drug more commonly known as Provigil. Modanifil is a powerful drug that allows some people to stay awake for thirty hours or more without the side effects of amphetamines.
BALCO's "cream" is in fact not a steroid. It is a concentrated version of a prescription testosterone gel. Marketed as Androgel, this cream in its normal version is intended for people with low testosterone counts. Since testosterone is the "gold standard" for steroids, this gel, especially the altered version used by BALCO, can be very effective. It soaks into the skin in the same way nicotine does from a patch. Reports that some users were rubbing it on joints rather than muscles indicate that they may not have fully understood what they were taking or how to use it.
The "clear" is THG, the designer steroid that has caused so much consternation across the sports world. Again, we'll get into the chemistry and politics of THG later, but there is little doubt that it was in fact a steroid. What's more, it was specifically designed to be undetectable by modern testing techniques. For those who wanted to use a steroid but were concerned about drug tests, the "clear" was the ultimate. Oddly, the "clear" isn't clear; it's a medium-brown liquid that looks more like watered-down maple syrup. It also surprised many people that it is not injected. THG is taken orally. BALCO was noted to use flaxseed oil as a delivery agent.
Why flaxseed oil? According to several studies, and as widely reported in the steroid underground, flaxseed oil can counteract some of the estrogenic effects of steroid use, such as the growth of breasts in men. A suspension of THG in flaxseed oil would not only not raise any suspicions (it's sold in health-food stores as a cure-all), it would actually have a purpose. The one concern is that, according to many researchers, the dosing would be problematic since THG is difficult to distribute in the flaxseed oil. This means that even "shaken well," the THG could come in "clumps" or not at all in any given swig.
Advocates of steroid use-yes, there are some-prefer the term AAS (anabolic-androgenic steroid) to PED. It differentiates drugs such as Winstrol, Dianabol, and others that do meet the strict definition of drugs with chemical similarities to testosterone (AAS drugs) from those without such similarities. In the case of supplements, prohormones (substances from which hormones are formed), and so-called designer drugs, this is an important distinction.
Having defined PEDs and IPEDs, we must now consider two other categories: prescription drugs and supplements. Both are legal and controlled under various rules and regulations. Prescription drugs are, obviously, limited by their accessibility, prescribed by physicians and a few other affiliated health professionals for certain approved conditions. Supplements also fall under the FDA but tend to be less regulated, being sold over the counter in health-food and even grocery stores.
Both prescription drugs and supplements have legitimate purposes. Many prescription drugs save lives or raise the quality of life for millions. This $235 billion industry does research and marketing of basic and advanced medical compounds for thousands of conditions. But precription drugs can be as easily abused as any others. It's not always as simple as, say, a radio host getting multiple doctors to write prescriptions for hundreds of opiate pills. In 2003, for instance, Oakland A's pitcher Mark Mulder suffered a hip fracture. In efforts to get him back on the mound in time for the playoffs, the A's are reported to have used the drug Forteo to speed his healing. Forteo is approved for the treatment of osteoporosis in older women. Mulder meets none of these criteria, yet he was reported to have taken the drug with good results. Recently Forteo was also reportedly used with excellent results by the football player Terrell Owens, who was able to play in the Super Bowl only weeks after fracturing his ankle.
Other prescription drugs include growth hormones (used for helping underheight adolescents), insulin (for diabetics), steroids (for cancer patients and AIDS sufferers, among many other uses), and erythropoietin (for anemic chemotherapy patients). All have legitimate medical uses, and all are easily abused when taken for nonmedical, performance-enhancing purposes.
This so-called debate over performance-enhancing drugs has not been much of a debate at all. Most times it has been an emotional plea or political grandstanding. What has been missing is the real information, the facts, that will allow us to have a substantive debate.
I don't start out to belittle anyone's views. I often have to make my position on performance enhancers very clear, as I did at the beginning of this chapter, because I'm willing to listen to all sides and present their ideas, even as something of a devil's advocate.
Framing a debate is often a matter of language. Entire books have been written about choosing words carefully, and most of the terms in this particular debate are loaded (no pun intended). "Drugs" alone carries a massive negative connotation in our society, despite the widespread use of prescription drugs. "Steroids" are bad (and often misused as a word) in sports, yet hormone replacement and anti-aging therapies are a growth field in medicine.
Now that we have common language and an open mind, it's time to dig into the issues.
Excerpted from THE JUICE by WILL CARROLL WILLIAM L. CARROLL Copyright © 2005 by Will Carroll. Excerpted by permission.
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