Pumped-Up Hysteria

by Dayn Perry

This article originally appeared in the January 2003 issue of Reason magazine. It has been reprinted with permission. Visit www.reason.com.

[http://reason.com/0301/fe.dp.pumped.shtml]

Had Ken Caminiti been a less famous ballplayer, or had he merely confessed his own sins, then it would have been a transient controversy. But it wasn’t. Last May, Caminiti, in a cathartic sit-down with Tom Verducci of Sports Illustrated, became the first major league baseball player, current or retired, to admit to using anabolic steroids during his playing days. Specifically, he said he used them during the 1996 season, when he was named the National League’s Most Valuable Player. And his truth session didn’t stop there.

"It’s no secret what’s going on in baseball. At least half the guys are using [steroids]," Caminiti told SI. "They talk about it. They joke about it with each other....I don’t want to hurt fellow teammates or fellow friends. But I’ve got nothing to hide."

The suggestion that steroids are a systemic problem in professional athletics is hardly shocking, but such candor from players -- particularly baseball players, who until recently weren’t subject to league-mandated drug testing -- was virtually unheard of. Before the Caminiti flap had time to grow stale, Jose Canseco, another high-profile ex-ballplayer, upped the ante, declaring that a whopping 85 percent of current major league players were "juicing."

The estimates were unfounded, the sources unreliable, and the implications unclear. But a media orgy had begun. The questions that are being asked of the players -- Do you think it’s worth it? How many are using? Why did the players union wait so long to adopt random testing? Why won’t you take a test right now? -- are mostly of the "Have you stopped beating your wife?" variety. The accusation is ensconced in the question.

This approach may be satisfying to the self-appointed guardians of baseball’s virtue, but it leaves important questions unexplored. Indeed, before the sport can solve its steroid problem, it must determine whether it even has one.

From those sounding the clarion call for everything from stricter league policies to federal intervention, you’ll hear the same two-pronged concern repeated time and again: Ballplayers are endangering their health and tarnishing baseball’s competitive integrity. These are defensible, if dogmatic, positions, but the sporting media’s fealty to them obscures the fact that both points are dubious.

A more objective survey of steroids’ role in sports shows that their health risks, while real, have been grossly exaggerated; that the political response to steroids has been driven more by a moral panic over drug use than by the actual effects of the chemicals; and that the worst problems associated with steroids result from their black-market status rather than their inherent qualities. As for baseball’s competitive integrity, steroids pose no greater threat than did other historically contingent "enhancements," ranging from batting helmets to the color line. It is possible, in fact, that many players who use steroids are not noticeably improving their performance as a result.

There are more than 600 different types of steroids, but it’s testosterone, the male sex hormone, that’s most relevant to athletics. Testosterone has an androgenic, or masculinizing, function and an anabolic, or tissue-building, function. It’s the second set of effects that attracts athletes, who take testosterone to increase their muscle mass and strength and decrease their body fat. When testosterone is combined with a rigorous weight-training regimen, spectacular gains in size and power can result. The allure is obvious, but there are risks as well.

Anecdotal accounts of harrowing side effects are not hard to find -- everything from "’roid rage" to sketchy rumors of a female East German swimmer forced to undergo a sex change operation because of the irreversible effects of excess testosterone. But there are problems with the research that undergirds many of these claims. The media give the impression that there’s something inevitably Faustian about taking anabolics -- that gains in the present will undoubtedly exact a price in the future. Christopher Caldwell, writing recently in The Wall Street Journal, proclaimed, "Doctors are unanimous that [anabolic steroids] increase the risk of heart disease, and of liver, kidney, prostate and testicular cancer."

This is false. "We know steroids can be used with a reasonable measure of safety," says Charles Yesalis, a Penn State epidemiologist, steroid researcher for more than 25 years, and author of the 1998 book The Steroids Game. "We know this because they’re used in medicine all the time, just not to enhance body image or improve athletic performance." Yesalis notes that steroids were first used for medical purposes in the 1930s, some three decades before the current exacting standards of the Food and Drug Administration (FDA) were in place.

Even so, anabolic steroids or their derivatives are commonly used to treat breast cancer and androgen deficiencies and to promote red blood cell production. They are also used in emerging anti-aging therapies and to treat surgical or cancer patients with damaged muscle tissue.

Caldwell cites one of the most common fears: that anabolics cause liver cancer. There is dubious evidence linking oral anabolics to liver tumors, but athletes rarely take steroids in liquid suspension form. Users almost uniformly opt for the injectable or topical alternatives, which have chemical structures that aren’t noxious to the liver. And as Yesalis observes, even oral steroids aren’t causally linked to cancer; instead, some evidence associates them with benign liver tumors.

More specifically, it’s C-17 alkylated oral steroids that are perhaps detrimental to liver function. But the evidence is equivocal at best. A 1990 computer-assisted study of all existing medical literature found but three cases of steroid-associated liver tumors. Of those three cases, one subject had been taking outrageously large doses of C-17 oral anabolics without cessation for five years, and a second case was more indicative of classic liver malignancy. It’s also C-17 orals, and not other forms of steroids, that are associated with decreased levels of HDL, or "good" cholesterol. But, again, C-17s are almost never used for athletic or cosmetic purposes.

Another commonly held belief is that steroid use causes aggressive or enraged behavior. Consider the case of San Francisco Giants outfielder Barry Bonds, whose impressive late-career home run hitting and built-up physique have long raised observers’ eyebrows. Last season, Bonds, long known for being irascible, had a dugout shoving match with teammate Jeff Kent. A few columnists, including Bill Lankhof of The Toronto Sun and Jacob Longan of the Stillwater News-Press, obliquely diagnosed "’roid rage" from afar. "There’s very inconsistent data on whether ’roid rage even exists," says Yesalis. "I’m more open to the possibility than I used to be, but its incidence is rare, and the studies that concluded it does exist largely haven’t accounted for underlying factors or the placebo effect."

Scientists are nearly unanimous that excessive testosterone causes aggression in animals, but this association begins to wither as you move up the evolutionary ladder. Diagnosing such behavior in athletes is especially tricky. "There’s a certain degree of aggression that’s not only acceptable but necessary in competitive sports," Yesalis says. "What’s perhaps just the intensity that’s common to many athletes gets perceived as steroid-linked outbursts."

Fears about steroid use also include other cancers, heart enlargement, increased blood pressure, elevated cholesterol levels, and musculoskeletal injuries. Upon closer examination, these too turn out to be overblown. Reports associating heart enlargement, or cardiomegaly, with steroid use often ignore the role of natural, nonthreatening enlargement brought on by prolonged physical exertion, not to mention the effects of alcohol abuse. The relationship is unclear at best. Evidence supporting a link between steroids and ligament and tendon damage is weak, since steroid-related injuries are virtually indistinguishable from those occurring normally. And blood pressure problems, according to Yesalis, have been exaggerated. There is some associative evidence that steroid use can increase the risk of prostate cancer, but this link has yet to be borne out in a laboratory setting. No studies of any kind link the use of anabolics to testicular cancer.

Addiction is a legitimate concern, and Yesalis says a quarter to a half of those who use steroids solely to improve their body image exhibit signs of psychological dependence. "But in all my years of research," Yesalis continues, "I’ve only known three professional athletes who were clinically addicted to steroids." The distinction, he explains, is that professional athletes see steroids as little more than a tool to help them do their job -- the way "an office worker views his computer." Once their playing days are over, almost all the athletes within Yesalis’ purview "terminate their use of the drug."

One reason the health effects of steroids are so uncertain is a dearth of research. In the almost 65 years that anabolic steroids have been in our midst, there has not been a single epidemiological study of the effects of long-term use. Instead, Yesalis explains, concerns about extended usage are extrapolated from what’s known about short-term effects. The problem is that those short-term research projects are often case studies, which Yesalis calls the "lowest life form of scientific studies." Case studies often draw conclusions from a single test subject and are especially prone to correlative errors.

"We’ve had thousands upon thousands [of long-term studies] done on tobacco, cocaine, you name it," Yesalis complains. "But for as much as you see and hear about anabolic steroids, they haven’t even taken that step."

What about the research that has been done? At least some of it seems to yield engineered results. "The studies linking steroid use to cancer were performed by and large on geriatric patients," notes Rick Collins, attorney, former bodybuilder, and author of the book Legal Muscle, which offers an exhaustive look at anabolic steroid use under U.S. law. The hazard of such research is that side effects observed in an older patient could be the result of any number of physiological problems unrelated to steroid intake. Moreover, the elderly body is probably more susceptible to adverse reactions than the body of a competitive athlete.

Collins believes that some studies were performed with a conclusion in mind at the outset. "Their hearts were in the right place," says Collins. "Curtailing nonessential steroid use is a good and noble goal, but they undermined their efforts by exaggerating the dangers." Call it the cry-wolf effect.

For instance, it’s long been dogma that use of anabolic steroids interferes with proper hepatic (liver) function and causes thickening of the heart muscle. However, a 1999 study at the University of North Texas found that it’s not steroid use that causes these medical phenomena; rather, it’s intense resistance training. Weight-lifting causes tissue damage, and, at high extremes, can elevate liver counts and thicken the left ventricular wall of the heart. Both disorders were observed in high-intensity weightlifters irrespective of steroid use. The researchers concluded that previous studies had "misled the medical community" into embellishing the side effects of use.

The cry-wolf effect may have as much to do with the boom in steroid use as anything else. Athletes were inclined to be skeptical of warnings about steroids because their own experience contradicted what critics were saying. When use of Dianabol and other anabolics began to surge in the 1960s and ’70s, opponents decried them as ineffective. The message was: They don’t work, so don’t take the risk. But steroids did work, and users knew it. Once weightlifters, bodybuilders, and other athletes realized they were being lied to about the efficacy of steroids, they were less likely to believe warnings about health hazards, especially when the evidence backing them up was vague or anecdotal.

One of the chief drumbeaters for the steroids-don’t-work movement was Bob Goldman, author of the hysterical anti-steroids polemic Death in the Locker Room. Goldman, a former competitive power-lifter turned physician and sports medicine specialist, was an early, and shrill, critic of performance pharmacology. In his 1984 exposé, Goldman attributes steroids’ tissue-building qualities almost entirely to the placebo effect. His agenda may have been morally sound, but his conclusions ran counter to the preponderance of scientific evidence at the time.

Today, his claims are even less supportable. Goldman is working on a new edition of the book, one that he says will better crystallize current scientific thought on the subject. Of his 1984 edition and its seeming histrionics, Goldman says the book was intended "as an educational tool to warn high school students of the possible hazards of drug use, but then it became something else."

Whatever his intentions at the time, Goldman’s views played well in the media, which cast the book as a sobering empirical assault on performance-enhancing drugs. Its warnings soon gained traction with lawmakers. Although the Anti-Drug Abuse Act of 1988 had already made it illegal to dispense steroids for nonmedical reasons, Congress, ostensibly out of concern over reports of increasing steroid use among high school athletes, revisited the matter in 1989.

Congressional hearings convened to determine whether steroids should become the first hormone placed on Schedule III of the Controlled Substances Act, reserved for drugs with substantial abuse potential. Such legislation, if passed, would make possession of anabolic steroids without a prescription a federal offense punishable by up to a year in prison. Distributing steroids for use, already prohibited by the 1988 law, would be a felony punishable by up to five years in prison. What’s usually forgotten about these hearings, or perhaps simply ignored, is the zeal with which many regulatory agencies, research organizations, and professional groups objected to the proposed changes. The American Medical Association (AMA), the FDA, the National Institute on Drug Abuse, and even the Drug Enforcement Administration all opposed the reclassification. Particularly adamant was the AMA, whose spokespersons argued that steroid users did not exhibit the physical or psychological dependence necessary to justify a change in policy.

Nevertheless, Congress voted into law the 1990 Anabolic Steroids Control Act, which reclassified steroids as Schedule III controlled substances, placing them on legal par with barbiturates and narcotic painkillers such as Vicodin, just one step down from amphetamines, cocaine, and morphine. Now even first-time steroid users faced possible jail time.

Prohibition naturally produced a black market, and unintended consequences followed. Besides creating yet another economic niche for the criminal underworld, the legislation scuttled any hope of using steroids as a legitimate and professionally administered performance enhancer.

Criminalization of steroids created dangers more serious than any that had prompted the ban. Once steroids became contraband, many athletes bought black-market anabolics that, unbeknownst to them, were spiked or cut with other drugs or intended solely for veterinary use. Physicians were forbidden to prescribe steroids for promoting muscle growth and thus were not able to provide steroid users with responsible, professionally informed oversight. New league policies even ban the use of steroids for recovery from injuries.

Combine the lack of medical supervision with the mind-set of the garden-variety steroid user, and you have a potentially perilous situation. "Many of those using anabolic steroids," says Penn State’s Yesalis, "have the attitude that if one [dose] works, then five or 10 will work even better. That’s dangerous."

Athletes who acquire steroids on the black market are loath to consult with their physician after they begin using regularly. If they do disclose their habit and ask for guidance, the physician, for fear of professional discipline or even criminal charges, may refuse to continue seeing the patient. For professional athletes, another deterrent to proper use is that all responsible doctors keep rigorously accurate records of their dealings with patients. The fear that those records might be leaked or even subpoenaed makes pro athletes even less likely to seek medical guidance.

Since many of the observed side effects of steroids -- anecdotal, apocryphal, or otherwise -- most likely result from excessive or improper use of the drug, one wonders: Can steroids be used for muscle building with a reasonable degree of safety? "The candid answer is yes, but with caveats," says Collins, the attorney who specializes in steroid law. "It would need to be under the strict direction of a physician and administered only after a thorough physical examination, and it would need to be taken at reasonable and responsible dosages."

It’s a statement that even Goldman, once the bellwether scaremonger, says is "something I could probably agree with."

Herbert Haupt, a private orthopedist and sports medicine specialist in St. Louis, is "absolutely, unequivocally, positively opposed" to steroid use as a training or cosmetic tool. But he concedes that properly supervised use of the drug for those purposes can be reasonably safe. "The adverse side effects of steroids typically subside upon cessation of use," says Haupt, "and use over a short span, say a six-week duration, probably carries nominal risk."

Moreover, the official attitude toward steroid use seems anomalous when compared to the treatment of other methods that people use to improve their bodies. "People die from botched liposuctions," Collins notes. "We’re also allowed to inject botulism into people’s faces [in botox therapy], but no one is allowed to use steroids for similar cosmetic reasons."

Collins is quick to add that adolescents, whose bodies are already steeped in hormones, cannot use steroids safely. But the fact remains that the illegality of steroids makes responsible professional oversight virtually impossible.

Another puzzling distinction is the one made between steroids and other training supplements. Many baseball players have openly used androstenedione, a muscle-building compound that major league baseball hasn’t banned even though it’s merely a molecular puddle-jump from anabolic steroids.

Androstenedione is a chemical precursor that is converted to testosterone by the liver. Creatine monohydrate, another effective supplement, is far more widely used than androstenedione and is virtually free of stigma. Creatine is chemically unrelated to anabolic steroids or androstenedione and also differs in that it does not manipulate hormone levels; rather, creatine allows muscle cells to recover from fatigue more quickly. But all three substances -- creatine, androstenedione, and anabolic steroids -- increase a naturally occurring substance in the body to promote the building of muscle tissue. Anabolic steroids simply accomplish this end more quickly and dramatically.

The list of "artificial" enhancements doesn’t stop there. Indeed, the boundaries of what constitutes a "natural" modern athlete are increasingly arbitrary. Pitchers benefit from computer modeling of their throwing motions. Medical and pharmacological technologies help players to prevent and recover from injuries better than ever before. Even laboratory-engineered protein shakes, nutrition bars, and vitamin C tablets should theoretically violate notions of "natural" training. Yet no one claims these tools are tarnishing the competitive integrity of the game.

Rangers pitcher Kenny Rogers has said, in a bizarre admission, that he doesn’t throw as hard as he can because he fears that the line drives hit by today’s players, if properly placed, could kill him on the mound. And you need not read the sports pages for long to find someone complaining that today’s "juiced" ballplayers are toppling the game’s sacrosanct records by the shadiest of means.

This sentiment began percolating when Roger Maris’ single-season home run record tottered and fell to Mark McGwire in 1998. Since the Caminiti and Canseco stories broke, sportswriters have been resorting to preposterous rhetorical flourishes in dismissing the accomplishments of the modern hitter. Bill Conlin of the Philadelphia Daily News, for example, writes: "To all the freaks, geeks and ’roid zombies who have turned major league baseball into a Muscle Beach version of the Medellin Cartel: Take your records and get lost."

Yet baseball statistics have never existed in a vacuum. Babe Ruth became the sport’s chief pantheon dweller without ever competing against a dark-skinned ballplayer. Chuck Klein of the Philadelphia Phillies posted some eye-popping numbers in the 1930s, but he did it in an era when runs were scored in bundles, and he took outrageous advantage of the Baker Bowl’s right field fence, which was a mere 280 feet from home plate. Detroit pitcher Hal Newhouser won two most valuable player awards and a plaque in Cooperstown in part by dominating competition that had been thinned out by World War II’s conscription. Sandy Koufax crafted his run of success in the ’60s with the help of a swollen strike zone. Also a boon to Koufax was the helpfully designed Dodger Stadium, which included, according to many, an illegally heightened mound. Gaylord Perry succored his Hall of Fame career by often calling upon an illegal spitball pitch. Take any baseball statistic, and something is either inflating or depressing it to some degree.

Beginning in the mid-’90s in the American League and the late ’90s in the National League, home runs reached unseen levels. This fact has encouraged much of the present steroids conjecture. But correlation does not imply causation, as the deductive reasoning platitude goes, and there are more likely explanations for the recent increase in homers.

Home runs are up, in large part, because several hitter-friendly ballparks have opened in recent years. Coors Field, home of the Colorado Rockies since 1995, is the greatest run-scoring environment in major league history. Until the 2000 season, the Houston Astros played in the Astrodome, a cavernous, run-suppressing monstrosity with remarkably poor visuals for hitters. They replaced it with Enron Field (now renamed Minute Maid Park), which is second only to Coors Field in terms of helping hitters and boasts a left field line that’s so short it’s in violation of major league rules. The Pittsburgh Pirates, Milwaukee Brewers, and Texas Rangers also have recently replaced their old ballparks with stadiums far more accommodating to hitters. The Arizona Diamondbacks came into being in 1998; they too play in a park that significantly inflates offensive statistics. The St. Louis Cardinals, Baltimore Orioles, and Chicago White Sox have all moved in their outfield fences in the last few years. Add to all that the contemporary strike zone, which plainly benefits hitters, and it’s little wonder that home runs are at heretofore unimaginable levels.

And then there is Barry Bonds and the momentous season he had in 2001. In the midst of Bonds’ siege on McGwire’s still freshly minted single-season home run record, Bob Klapisch of the Bergen County, New Jersey, Record made a transparent observation-cum-accusation by writing, "No one has directly accused Bonds of cheating -- whether it be a corked bat or steroids...."

Bonds is plainly bigger than he was early in his career. That fact, considered in tandem with his almost unimaginable statistical achievements, has led many to doubt the purity of his training habits. But Bonds had bulked up to his current size by the late ’90s, and from then until 2001 his home run totals were in line with his previous yearly levels. So there’s obviously a disconnect between his body size and his home runs. Last season, bulky as ever, Bonds hit "only" 46 homers, which isn’t out of step with his pre-2001 performance. More than likely, Bonds had an aberrant season in 2001 -- not unlike Roger Maris in 1961.

This is not to suggest that no ballplayers are taking advantage of modern pharmacology. Rick Collins says he knows some major league ballplayers are using steroids but can’t hazard a guess as to how many. And Yesalis believes that at least 30 percent of major league ballplayers are on steroids.

But then there are skeptics like Tony Cooper of the San Francisco Chronicle, a longtime sportswriter and 20-year veteran of the weightlifting and bodybuilding culture. During the 2001 season, as Bonds was assailing McGwire’s freshly minted home run record, Cooper responded to the groundswell of steroid speculation by writing that he saw no evidence of steroid use in baseball. Cooper had seen plenty of steroid users and plenty of "naked baseball players," and he couldn’t name one obvious juicer in the entire sport. As for Bonds, Cooper called the accusations "ludicrous," writing that the Giants’ slugger "merely looks like a man who keeps himself in condition."

Canseco, of course, claims 85 percent of players are on steroids. Caminiti initially said half, then backpedaled to 15 percent. Other players have dotted the points in between with guesses of their own. Whatever the actual figure, such widely divergent estimates suggest that not even the ballplayers themselves know the extent of the problem. And if they don’t know, the pundits assuredly don’t either.

A more reasonable (and answerable) question is: If players are on steroids, how much of a difference is it making?

Not much of one, according to Chris Yeager, a human performance specialist, private hitting instructor, and longtime weightlifter. Yeager’s argument is not a replay of Bob Goldman’s assertion that steroids function merely as placebos. Yeager posits that the engorged arms, chests, and shoulders of today’s ballplayers could well be the result of steroid use -- but that they aren’t helping them hit home runs.

"Upper body strength doesn’t increase bat speed," he explains, "and bat speed is vital to hitting home runs. The upper body is used in a ballistic manner. It contributes very little in terms of power generation." Yeager likens the arms, in the context of a hitter’s swing, to the bat itself: simply a means to transfer energy. A batter’s pectoral muscles, says Yeager, "are even less useful."

Yeager isn’t saying steroid use couldn’t increase a batter’s power. He’s saying most ballplayers don’t train properly. "There’s a difference between training for strength and training for power," he says, "and most baseball players train for strength." If hitters carefully and specifically trained their legs and hips to deliver sudden blasts of power, then steroids could be useful to them, but by and large that’s not what they do. "Mark McGwire hit 49 home runs as a 23-year-old rookie," Yeager says. "And, while I think he probably used steroids at some point in his career, he hit home runs primarily because of his excellent technique, his knowledge of the strike zone, and the length of his arms. Barry Bonds could be on steroids, but his power comes from the fact that he has the closest thing to a perfect swing that I’ve ever seen."

In what at first blush seems counterintuitive, Yeager asserts that steroid use may have decreased home run levels in certain instances. Specifically, he points to Canseco. "I’m almost positive Canseco used steroids, and I think it hurt his career," says Yeager. "He became an overmuscled, one-dimensional player who couldn’t stay healthy. Without steroids, he might have hit 600, 700 home runs in his career."

In short, steroids are a significant threat to neither the health of the players nor the health of the game. Yet the country has returned to panic mode, with both private and public authorities declaring war on tissue-building drugs.

The chief instrument in that war is random drug testing, which major league baseball adopted in September 2002 with the ratification of the most recent collective bargaining agreement. Players can be tested for drugs at any time, for any rea son whatsoever. Leaving aside what this implies for players’ privacy, testing is easily skirted by users who know what they’re doing.

Sprinter Ben Johnson tested positive for steroids at the 1988 Summer Olympics and forfeited his gold medal, but subsequent investigation revealed that he’d passed 19 drug tests prior to failing the final one at the Seoul games. Yesalis says most professional athletes who use steroids know how to pass a drug test. Whether by using masking agents, undetectable proxies like human growth hormone, or water-based testosterone, they can avoid a positive reading. At the higher levels of sports, Yesalis believes, drug testing is done mostly "for public relations." Image protection is a sensible goal for any business, but no one should be deluded into thinking it eliminates drug use.

Nevertheless, lawmakers are lining up to push the process along. California state Sen. Don Perata (D-East Bay) has introduced a bill that would require all professional athletes playing in his state to submit to random drug testing. Federal legislation could be forthcoming from Sen. Byron Dorgan (D-N.D.). It’s unlikely that any bill calling for this level of government intrusion will pass. But the fact that such legislation is even being considered suggests how entrenched the steroid taboo is. Meanwhile, baseball’s new collective bargaining agreement has firmly established drug testing in the sport. The Major League Baseball Players Association, contrary to what some expected, agreed to the testing program with little resistance.

The measure won’t do much to prevent the use of performance-enhancing drugs in baseball, but it may serve as a palliative for the media. At least until the next cause célèbre comes along.