Societal Alternatives to Anabolic Steroid Use

In 1991, Robert Voy, MD, former Chief Medical Officer of the United States Olympic Committee, commented: If we will have reached a point of no return with this win at all costs attitude, the gold medals won't shine as brightly, the flags won't wave as boldly, the torch will flicker dimly, and we will have lost one of the greatest treasures ever known.1 It appears that Dr. Voy's predictions have already come to pass. In 1998 and 1999 alone, the public was bombarded with a constant stream of drug scandals that included, among others: • Chinese swimmers being ejected from the World Championships in Australia after having tested positive for banned substances; • former East German coaches and physicians tried and fined for their roles in the systematic doping of East German athletes over three decades; • a Canadian snowboarder, Ross Rebagliati, testing positive for marijuana after having won a gold medal at the Winter Olympics in Nagano, Japan; • Olympic gold medalist swimmer Michelle Smith deBruin being accused and found guilty of manipulating her urine sample in an out-of-competition drug test; • cyclists, coaches, physicians, and trainers participating in the Tour de France implicated in a widespread, systematic doping scheme; • Olympic champion shot putter Randy Barnes testing positive for androstenedione; • baseball home run king Mark McGwire admitting using androstenedione; • Olympic sprint champion Florence Griffith-Joyner dying at age 38, and rumors of prior performance-enhancing drug use that surrounded her victories at the Seoul Olympic Games being resurrected; • Uta Pippig, three-time winner of the Boston Marathon, testing positive for a high level of testosterone; and • Australian Open tennis champion Petr Korda testing positive for an anabolic steroid. When discussing the problem of performance-enhancing drug use, it is important to remember that sport is a microcosm of our society, and that the problems surrounding sport are by no means limited to drug use. During the 1980s, 57 of 106 universities in National Collegiate Athletic Association (NCAA) Division I-A were punished by the NCAA via sanctions, censure, or probation for rule violations. 2 These offenses did not involve illicit drug use by athletes, but rather unethical behavior of coaches, athletic administrators, staff, and faculty, the very men and women who should be setting the example for those athletes. More recently, United States collegiate athletes have been convicted of criminal offenses related to sports gambling. In addition, an NCAA survey of 2,000 Division I male football and basketball players found that 72% had gambled in some form and that 25% reported gambling on collegiate sports; 4% had even bet on games in which they played. 3 Among members of the International Olympic Committee (IOC), bribery, graft, and other corruption appear to be entrenched in the culture of the organization (Swift E, “Breaking point,”Sports Illustrated, February 1, 1999, pp. 34–35). 4 A common factor among all of these scandals is money. In the 1990s, there is no doubt that sport has become a multinational industry of huge proportions. The IOC, NCAA, National Football League (NFL), National Basketball Association (NBA), and Major League Baseball (MLB), among others, are all billion-dollar businesses (“A survey of sport: not just a game,”Economist, June 6, 1998, pp. 2–23; Hiestand M, “The B word—billion—no longer out of bounds,”USA Today, January 12, 1999, pp. 1A–2A). A free society often relies on the news media to inform the populace regarding the incidence and magnitude of problems, such as doping in sport. Even though the epidemic of drug use in sport has been common knowledge among insiders, the news media, especially in the United States, does not appear to have engaged in a widespread, concerted effort to chronicle this issue. Unfortunately, the media, particularly television news programs, are often influenced by conflicts of interest within their parent companies between those reporting the news and those responsible for the broadcast of major sporting events. Few would argue that an in-depth exposé of drug use, for example in the NFL or the Olympics, would enhance the marketing of these highly lucrative sporting events. Before any effort can be made to address the issue of doping in sport, it is critical that all of the stakeholders acknowledge that a problem exists. In this regard, we need to fully appreciate the high entertainment value placed on sport by society. Some go so far as to argue that sport is the “opiate of the masses,” a contention made by Karl Marx regarding religion. If sport has become the opiate of the masses, then we must be prepared for indifference on the part of the public regarding drug use in sport, at least at the elite level. Moreover, it could be argued that if substantial inroads are made regarding the epidemic of doping, fans may express anger rather than appreciation toward those fighting drug use. Many people view competitive sport as an escape from the problems of daily life, and do not wish to be confronted with the moral and ethical aspects of doping. Further, if antidoping efforts are successful, once bigger-than-life idols could begin to appear all too human in stature, and breaking of records at national, Olympic, and world levels could become so rare that the fervor of fans will wane and the sport business will suffer. In the United States, even high school sport appears to be expanding as a source of entertainment for adults, as shown by the increasing level of television coverage of high school football and basketball games. Consequently, it can be argued that the growth of the high school sport entertainment business is contributing to the increase in anabolic steroid use among adolescents that has been observed during the 1990s. Sport has also been used by governments as a tool to control the masses or as justification for their social, political, and economic systems. “Bread and circuses” (panem et circenses) were used in this fashion by the emperors of Rome. 5 Nazi Germany, the Soviet Union, East Germany, and Communist China all have used sport for political advantage. 6 Consequently, such governments arguably would be less than enthusiastic participants in the fight against doping, or for that matter, even publicly acknowledging the existence of widespread doping. On the contrary, there is a reasonable amount of evidence that the governments of the Soviet Union, East Germany, and Communist China all played significant roles in the systematic doping of their athletes. With many societal problems, identifying potential solutions is easy, but agreeing on a proper course of action and successfully completing it are difficult. The following are our alternative suggestions for dealing with the use of anabolic steroids and other performance-enhancing drugs: legalization, interdiction, education, and alteration of societal values and attitudes related to physical appearance and winning in sport. Legalization: An End to Hypocrisy? The legalization of illicit drugs has for some time been the subject of heated debate: comments range from “morally reprehensible” to “accepting reality.” Legalization would reduce the law enforcement costs associated with illicit anabolic steroid use and the substantial cost of drug testing. Even some opponents of legalization must concede that such an action would lessen the level of hypocrisy in sport. It can be argued that society and sport federations have turned a blind eye or have subtly encouraged drug use in sport as long as the athletes have not been caught or spoken publicly about their use of anabolic steroids. 1,7,8 In the United States, legalization of anabolic steroid use in sport would involve two levels of authority. At one level, federal and state laws related to the possession, distribution, and prescription of anabolic steroids would have to be changed. If in the future anabolic steroids become an accepted means of contraception or as treatment for “andropause,” it is difficult to understand how anabolic steroids could remain a Schedule III controlled substance in the United States. At the second level, bans on anabolic steroids now in place in virtually every sport would have to be rescinded. Legalization would bring cries that the traditional ideals of sport and competition were being further eroded. However, given the continued litany of drug and other sport scandals that have taken place in full public view, in this jaundiced age it is hard to imagine that many people believe the so-called traditional ideals even exist in elite sports. It has long been asserted that legalization of anabolic steroids would force athletes to further expose themselves to the potential for physical harm or to compete at a disadvantage. Some have even questioned the basic premise that banning drugs in sport benefits the health of athletes and have argued that “the ban has in fact increased health risks by denying users access to medical advice and caused users to turn to high-risk black market sources.” 9 Legalization would allow athletes to use pharmaceutical-grade steroids while being monitored by a physician. It can also be argued that the dangers of steroid use are not, in itself, a realistic deterrent, given the existing levels of use of tobacco, alcohol, and other illicit drugs that pose similar risks. In 1999, it seems that legalization of anabolic steroid use in sport is not acceptable. However, if the impotence of drug testing, which is now in full public view, persists for much longer, it is easy to imagine the IOC or other sport federations throwing up their hands in frustration and allowing the athlete with the best chemist to prevail. Interdiction: A Question of Cost-Effectiveness The United States federal government and all state governments currently have laws regarding distribution, possession, or prescription of anabolic steroids. 10 The Federal Food, Drug, and Cosmetic Act (FFDCA) was amended as part of the Anti-Drug Abuse Act of 1988, such that distribution of steroids or possession of steroids with intent to distribute without a valid prescription became a felony. This legislation not only increased the penalties for illicit distribution of steroids but also facilitated prosecution of these crimes under the FFDCA. In 1990, the Anabolic Steroids Control Act was signed into law by President Bush and added anabolic steroids to Schedule III of the Controlled Substances Act. This law institutes a regulatory and criminal enforcement system whereby the United States Drug Enforcement Administration (DEA) controls the manufacture, importation, exportation, distribution, and dispensing of anabolic steroids. However, the act did not provide extra resources to the DEA for shouldering the added responsibility. As the use of anabolic steroids is increasingly criminalized, drug use will likely be driven further underground, and the source of the drugs will increasingly be clandestine laboratories, the products of which are of questionable quality. It also appears that in some areas criminalization has already altered the distribution network for anabolic steroids; athletes used to sell to other athletes, but sellers of street drugs are now becoming a major source of anabolic steroids. 11 Even though the legal apparatus to control steroid trafficking exists, enforcement agents already are struggling to handle the problems of importation, distribution, sales, and use of other illicit drugs such as cocaine and heroin. 11 Based on what we know about the physical, psychological, and social effects of steroids, it is neither realistic nor prudent that enforcement efforts for steroids should take precedent over those for more harmful drugs. This line of reasoning should not be used as a rationale for a lack of effective action against steroids; nevertheless, the outlook that limited resources can be stretched to cover yet another class of drugs is not optimistic, 11 especially given recent increases in recreational drug use among adolescents. 12 The availability of anabolic steroids in this country suggests that there is reason to believe that the United States simply may not have the law enforcement manpower to deal with apprehending and punishing sellers of anabolic steroids and other performance-enhancing drugs. Nonetheless, between February 1991 and February 1995, 355 anabolic steroid investigations were initiated by the United States DEA. 13 There have been more than 400 arrests, and more than 200 defendants have been convicted. However, because of the way criminal penalties were developed for steroid infractions, an individual brought to court on charges of distribution or selling must be a national-level dealer to receive more than a “slap on the wrist” and/or a short visit to a “country club” prison. For this reason, United States law enforcement agents often do not bother pursuing small cases because the costs of prosecution vastly outweigh any penalties that will be assessed. Drug testing by sport federations is yet another form of interdiction. Such testing has been partially successful when directed at performance-enhancing drugs that, to be effective, must be in the body at the time of competition, such as stimulants and narcotics. Drug testing has been even less effective against anabolic steroids, which are used during training or used to enhance an athlete's capacity to train. Testing can be circumvented by the steroid user in several ways. Generally, to avoid a positive test result, athletes can determine when to discontinue use before a scheduled test or, in the case of an unannounced test, titrate their dose using transdermal patches or skin creams containing testosterone so as to remain below the maximum allowable level. Further confounding the issue are other drugs used by athletes, such as human growth hormone and erythropoietin, for which no effective tests currently exist. Moreover, testing for anabolic steroids is expensive (∼$120.00/test), and although the IOC, or NCAA may be to such the cost is for the of Consequently, only a of school in the United States test for anabolic steroid use. law enforcement and drug testing has on the use of anabolic steroids and other performance-enhancing drugs is to the of at the state and levels regarding control of the manufacture, distribution, and possession of steroids in the and the 1990s, use among adolescents in the United States has increased As to the future of testing, it is difficult to be over the drug users have the drug In addition, one can only as to the future by in we be to enhance and the 1980s, the United States the United States of and many state state and medical and sports federations have been in efforts related to steroid For the these have on and distribution of and such as and For the Athletic Association has developed an that on the effects of steroid use but also to steroids and The United States of and other have developed a of at high school to provide about steroids, their to their use, and their now have a range of on steroid use and body provide and to and high the United States. Major television have at to the of steroid use “The and the United States health have made some inroads in several high-risk such as and However, are with of regarding the of these Further, these are on which society has increasingly In athletes who use anabolic steroids have significant in physical and and society is much less likely to these of the media, and is a as are and in the is the that anabolic steroids taken in to may have only a on at least in the short In several at the National that to the existing these drugs more of an ethical than a public health there is evidence regarding the health effects of anabolic steroids, many or potential anabolic steroid users of evidence for evidence of Even more is the fact that in two a of the anabolic steroid users no to using anabolic steroids if health effects were the of has the of effective health more than that, the of health effects made by some in sports and by the news media have further between athletes and However, even if effects were for use of anabolic steroids, with and suggests that substantial would of these problems and in and effective and could in part the significant increase in anabolic steroid use among adolescents a behavior that has in major benefits to the such as appearance and athletic a and to tobacco, alcohol, and drug have not been In there is evidence that a that to adolescents from becoming with anabolic steroids may to increased because their This to a and to Steroids in part on positive related to and The also on increasing of the of social they are likely to to use anabolic steroids and to against these are for and media to use anabolic steroids. and reporting of anabolic steroid use among adolescents was in an effort to the widespread use of anabolic steroids among as is an This has been successful in attitudes and related to steroid use and effective over several Unfortunately, the of the is to The on male high school football players and was not to address anabolic steroid use among among of steroid use have In addition, the of this is and the has yet to be in other Moreover, there are two important and as yet regarding the are school in an age of to time and to this it would be far and to to only to this problem and efforts to an by the and the use of and The second is even more to school In an when some believe that the at all is the will some to will some to a that could reduce steroid use at the cost of an to an who to a no on the use of performance-enhancing This is given some by of high school coaches the use and in some so-called such as and to their athletes. athletes about the health risks and ethical associated with anabolic steroid use to some this be as a with legalization, interdiction, and education, our social appears to receive far less in many the social a more on drug use in sport than do the more A of performance-enhancing anabolic steroids, are not or after the for these drugs was by our societal on winning and physical An does not believe that a is our society games for but society the of at and is a culture that on competition, in business and in sport. 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