1. David Pinto on January 27, 2004 11:26 AM writes...

Great blog, Nick. Thanks for linking to Baseball Musings. The steroids and uncertainty post are excellent.

2. Welch Suggs on January 27, 2004 02:27 PM writes...

Nick,
Interesting stuff here. In the interest of shameless promotion I'm attaching a story I wrote last year about drugs and sport, with a few interesting comments from sports ethicists (who are as a rule pretty interesting folks).
The piece hardest for me to grapple with is where you draw the line between permissible and impermissible. You can't say that one has side effects and the other doesn't--steroids certainly have side effects, but so does tackling somebody or skiing down a hill at 80 miles an hour, and both of those are permissible. If I learn a particular technique that enables me to run faster, do I have an impermissible advantage over you?
Anyway, looking forward to reading this.
Best,
Welch Suggs
Chronicle of Higher Education

Copyright © 2003 by The Chronicle of Higher Education. All rights reserved.

From the issue dated March 14, 2003

http://chronicle.com/weekly/v49/i27/27a03601.htm

Deadly Fuel
As supplements and steroids tempt and endanger more athletes, what are colleges doing?

By WELCH SUGGS

Every athlete dreams about getting the extra edge. "We have a magic-bullet mentality," says Loren Seagrave, a former college track coach who now works with professional athletes. "In college, the big boys go out and buy whatever they think can make them into something different."

That includes legal supplements, some of which are banned in college sports, and illegal anabolics like steroids and growth hormones. Athletes the world over have been ingesting things to get bigger, faster, and stronger for more than two generations now, and college men and women are no exception. Rigorous drug testing and a few horror stories about the side effects forced most drug use underground during the 1980s, but the problem never went away.

That's been amply proven in recent months: College athletes in Maine and Texas have been arrested and punished by the courts for steroid possession. And in January, Northwestern University staff members admitted that they discovered pills and powder containing ephedrine, an illegal supplement known variously as ephedra and ma huang, in the lockers of several football players on the day in 2001 that one of them, Rashidi Wheeler, died following an off-season practice. Ephedrine also is being blamed in the death of a Baltimore Orioles pitcher last month.

The reason colleges and other sports federations ban stimulants, steroids, and other performance-enhancing supplements is simple: Athletes should never believe that they have to risk their health to win.

However, the risks -- suspensions, jail time, side effects, and even death -- are worth it to players who see drugs as their way to the top, whether that be the professional ranks, the Olympics, or just a conference title.

"It's hard. It's like you're addicted to [steroids]," says Vince Manuwai, who just finished his senior season as an offensive lineman at the University of Hawaii. He's never taken any kind of supplement, he says, but "you see it gives you the strength, and you can't stop. My teammate took them, and it was so hard to get off. You see what steroids do, and you get to where you don't know if it's you or the steroids."

Not Just the Stars

Athletes aren't just using drugs in the hopes of making money in the pros, says Thomas H. Murray, president of the Hastings Center, a bioethics research organization.

"Even if you're playing for a very small college in Division III, you want to play well, and if you think it's going to help, you might take something," says Mr. Murray, chairman of the education and ethics committee of the newly formed World Anti-Doping Agency. "It's not primarily about the money. It's about winning, and success. It's not surprising to see [drug use] in sports where people can get wealthy, but you're just as likely to see it in sports where athletes don't make a penny.

"It's more about the competition."

Mr. Manuwai says people get suspicious of football players. "It's frustrating," he says. "People look at you and if you're bench-pressing 500 pounds, they think you've got to be on something."

Other players say they've taken amino acids, creatine, and various other supplements to bulk up -- even things where side effects may not be known for some time.

"What's that store? The GNC, yeah, that's the one," says Alonzo Jackson, a former defensive end at Florida State University, referring to the General Nutrition Center, a ubiquitous national chain. "There were some guys that lived up in the GNC, trying to find something to make them big."

Others trying to make themselves big included Stephen Cooper of the University of Maine at Orono, last year's football player of the year in Division I-AA of the National Collegiate Athletic Association. On November 1, during a routine traffic stop, a police officer found 1,200 pills in Mr. Cooper's possession, and the player admitted they were steroids.

A university report says that Mr. Cooper told his coaches about the situation, and that he had never tested positive for drugs while playing for the Black Bears. Instead, he told them, he planned to use them after the season to get ready for the NFL draft. He pleaded guilty in December on federal charges of drug possession.

Andy Slocum was a backup center on Texas A&M's basketball team who had played sparingly this season while recuperating from injuries. During the off-season, one columnist noted, his physique "went from James Gandolfini to Vin Diesel."

In January, police officers arrested him at a fraternity party in College Station after receiving a report that someone at the party was selling Ecstasy. In Mr. Slocum's possession were steroids including stanozolol, syringes, and prescription-drug bottles. He pleaded no contest in February and is awaiting sentencing. Meanwhile, he has returned to competition with the team.

Texas A&M's sports-information department would not permit him to be interviewed, but a spokesman said that Mr. Slocum has been tested often for steroids and other drugs, before and after his suspension. He has passed every test.

New Choices

Experts are mildly surprised that in this day and age, college kids would be using steroids. It's easy for drug tests to find stanozolol and its "chemical country cousins," as Charles E. Yesalis calls them, and there are other supplements that are cheaper and easier to get, as well as being less detectable.

"It's outmoded, and anybody who's drug-tested would be foolhardy to take that," says Mr. Yesalis, an epidemiologist at Pennsylvania State University at University Park. "Elite athletes stay away from traditional anabolic steroids. They use testosterone creams or gels, which dramatically reduce the chance of getting caught, in conjunction with insulin or insulinlike growth factor, and we don't even have a test for those."

The side effects of steroid usage have been well known for decades. In the 1980s, Tommy Chaikin, a former University of South Carolina football player, wrote in Sports Illustrated about the "roid rage" that engulfed him when he confronted a pizza deliveryman with a gun. Shrinking of the testes, baldness, and acne are also common. Lyle Alzado, the former Oakland Raider, believed that the brain cancer that eventually killed him was linked to his use of steroids over the years.

However, few know what the effects of other supplements might be, and they're getting easier and easier to obtain. Anyone can buy substances like testosterone, human-growth hormone (HGH), and insulin-like growth factor over the Internet. One site requires a doctor's prescription, but will sell one to any customer for $100.

Or someone can just walk down to the local GNC, like Mr. Jackson's teammates at Florida State. There, one can buy muscle-building steroid "precursors" like androstenedione and creatine monohydrate. "Andro" is banned by the National Collegiate Athletic Association and other sports governing bodies, but it's legal to buy. They're not as effective as older anabolic steroids, but they do provide some benefits.

The supplement industry has exploded since the passage of the Dietary Supplement Health and Education Act in 1994. The law allows stores to sell vitamins, herbal remedies, and other supplements over-the-counter. Gary I. Wadler, a professor at the New York University School of Medicine, says there are two problems with the law: First, manufacturers are not required to verify safety and quality control in production, meaning that labels might be wrong or misleading. Supplements might contain banned substances along with legal ones. Second, the law treats supposedly natural supplements in the same way as artificial drugs that have very similar effects and chemical structures.

"If you think about nandrolone, when it's taken as Deca-Durabolin, it's one of the most controlled substances in the country," says Dr. Wadler, a medical adviser to the White House Office of National Drug Control Policy and to the World Anti-Doping Agency. "But 19-norandrosterone taken as a supplement is one of the least-controlled products out there. But they produce the same effect. They're the same thing."

Most of the nutritional supplements on the market -- a market worth $17-billion annually, according to the latest estimates -- are fairly innocuous, Dr. Wadler says. But steroid precursors have the same potential for harm, as do stimulants like ephedrine.

Athletes take supplements containing ephedrine to boost their metabolism, either to enable them to train harder or to lose weight. But ephedrine can interfere with the body's ability to process heat, triggering heatstroke in a handful of cases. This is how Korey Stringer of the Minnesota Vikings is thought to have died two years ago, and ephedrine is suspected in the deaths of Steve Bechler of the Baltimore Orioles and, in 2001, Northwestern University's Rashidi Wheeler.

Mr. Wheeler was doing a series of wind sprints during summer conditioning when he collapsed. He suffered from asthma, and his family sued Northwestern for wrongful death, saying that the university was negligent in failing to have the proper personnel and equipment on hand to treat him.

Northwestern, however, blames supplements containing ephedrine that Mr. Wheeler and several of his teammates appear to have taken on the day of his death. Wildcat players had canisters of "Ultimate Orange" and "Ultimate Punch," powders designed to be mixed with water, in their possession, along with tablets of Xenadrine RFA-1. All three have ephedrine in them -- which has been banned by the NCAA since 1997 -- and Northwestern has sued the products' manufacturers, claiming that the ephedrine caused Mr. Wheeler's heart to lose its rhythm irrevocably and then stop.

"Our contention is that Rashidi and several other football players took ephedra-containing supplements prior to participating in conditioning drills," said Alan F. Cubbage, a university spokesman. "Of those players who had trouble during the drill, almost all of them had taken supplements."

A Florida coroner also blamed the ephedrine in Xenadrine RFA-1 for Mr. Bechler's death, a claim rejected by the product's manufacturer, Cytodyne Technologies of New Jersey.

A 2001 NCAA survey found that usage of stimulants, including ephedrine and amphetamines, and anabolic steroids had risen slightly since 1997. Between 3 and 4 percent of athletes surveyed admitted using stimulants, and 1.4 percent admitted using steroids. More male water-polo players admitted to using steroids than did football players.

Experts put little stock in these numbers, saying most users wouldn't admit to doing drugs.

"I'm not trying to be a wise guy, but the only more secretive thing is pedophelia," Mr. Yesalis says. "An athlete would tell you he hit his girlfriend or he had a drinking problem before he'd tell you he's using performance-enhancing drugs. I'm very skeptical of any so-called anonymous surveys, as far as the veracity of those comments."

"We don't know [what usage rates are] at the elite level, whether you define elite as college, professional, or Olympic," he continues. "Do I think it's an epidemic? Yeah. My rationale for reaching that conclusion is that when you look, there are changes in the bodies of men and women athletes than I cannot reasonably explain by strength training and conditioning alone. You look at the fact that only careless and stupid people get caught in drug tests."

Inadequate Tests?

Taking and possessing steroids without a prescription is illegal. Taking other substances, like ephedrine, is legal but banned under NCAA rules. But the only way an athlete can be punished is by testing positive for a banned substance -- so Mr. Cooper was eligible and played for Maine for two games after his arrest.

The association's handbook says nothing about athletes who are caught with steroids in their possession, except to say that athletics administrators who know about athletes using drugs can be punished if they do not follow their institutions' own rules on drug possession or use.

The rules are so tortured that a shot-putter at the University of Nebraska at Lincoln, Carl Myerscough, is competing after serving a two-year ban for testing positive for banned drugs in an international competition. He was suspended by the International Association of Athletics Federations, the world governing body for track and field, in 2000, after admitting that metabolites of three banned substances -- methandienone, oxymetholone, both steroids, and testosterone -- had been found during his test.

The NCAA does not abide by IAAF suspensions, however, and Mr. Myerscough competed in three meets for the Huskers before Nebraska decided independently to honor the ban, which ran from the date of his last competition there until February 2002. Now the 6-10, 330-pound junior is the defending champion in the NCAA indoor shot-put, and will defend his title later this month.

Testing, traditionally, has been the only deterrent colleges use to stop athletes from using drugs. The NCAA itself does urine tests for steroids, hormones, and now ephedrine at its championships, while football players and track athletes are subject to random urinalysis year-round.

One of the most prominent testing laboratories used by the NCAA, and the International Olympic Committee is run by Don H. Catlin at the University of California at Los Angeles. The volume of positive drug tests has remained very low and very stable for the last few years, Dr. Catlin says, although nandrolone usage has been on the increase, thanks to doses that manufacturers sneak into supplements.

However, it isn't all that hard to evade drug testing on the college level, he says. "The total volume of testing isn't all that much, so it's not hard to play roulette and hope you won't get caught," he says. "The college population [of athletes] is huge, and the NCAA doesn't get the resources to get around and test everybody."

A majority of Division I colleges and some lower-division institutions conduct their own testing programs, as does the Big 12 Conference. Protocols can vary from predictable, scheduled drug tests -- which athletes can evade easily by stopping their drug use in enough time to let banned substances pass through their systems -- to the no-notice "pee on the spot" drug testing required by Olympic sport organizations.

Short Notice

That's relatively rare, however. The NCAA requires that administrators at a college be notified two days in advance of a random test, which could give athletes a loophole to exploit.

"With the NCAA program, the group running it is really quite good, but as long as there are ways to circumvent the testing, either by knowing when it's coming or just because your number doesn't come up that often, there's still a way [for drug users] to proceed," Dr. Catlin says.

Smart people know how to wind down their drug usage before being tested, Mr. Yesalis says. And athletes might simply choose to use drugs during a time period when they're fairly sure they won't be tested. And smart people also take supplements like human-growth hormone and insulinlike growth factor, for which no tests exist.

The NCAA uses the National Center for Drug Free Sport to coordinate both its championship and year-round tests. Frank D. Uryasz, president of the center, says athletes are still testing positive for banned steroids, although many of them claim innocence.

"What we see is that in a lot of steroid positives, athletes claim that all they're taking are over-the-counter supplement products," says Mr. Uryasz. "That may or may not be true, but it's become kind of the excuse du jour on the part of athletes. We can't tell from a positive drug test whether an athlete is taking injectable nandrolone, which is an anabolic steroid, or over-the-counter norandrostenedione."

It doesn't especially matter, he says, because both substances are banned. But some athletes say that norandrostenedione or other ste-roid precursors have been added to supplements but don't appear on the label. That's not an excuse, Mr. Uryasz says.

Mr. Uryasz discounts the problem of people "beating" drug tests. Athletes subject to year-round testing are given 24 hours' notice, he says, and testers stay with athletes throughout the drug-testing process to prevent them from spiking their samples. But, he admits, there are plenty of things athletes could take for which they'll never be caught.

Distance runners and swimmers, for example, could be using erythropoietin, or EPO, which causes the body to produce more red blood cells than usual.

Deterring Athletes

Mr. Murray, of the Hastings Center, says that convincing an athlete not to use performancing-enhancing drugs because of their side effects doesn't work -- not even when athletes have been dying.

"An intelligent football player or downhill skier will say, 'You're telling me that I can't take some drug that has a small probability of long-term damage to me, but I can careen down a mountain slope at 80 miles an hour, or I can run downfield 40 yards and crash into somebody who weights 350 pounds at full speed, and that's OK?'" he says. "Most athletes scoff at the safety argument. It doesn't mean to me that the safety argument has no traction, but it's not enough."

Instead, the goal ought to be developing an atmosphere where athletes don't believe they have to take drugs to be successful, he says.

"Why, in the end, we want to prohibit some forms of performance enhancement is because they devalue what is meaningful about sport," says Mr. Murray, using the analogy of a runner showing up for the Boston Marathon wearing Rollerblades -- it would make the competition meaningless. "It does resonate to many athletes. Give an athlete a choice between competing without anabolic steroids, knowing you're at no disadvantage, as opposed to having to take steroids, they'll choose the former."

Colleges, professional leagues, and Olympic agencies, have tried to produce a drug-free atmosphere through testing. The World Anti-Doping Agency bans substances if they meet two of three tests:

They enhance performance.

They present a significant health risk.

They violate the spirit of sport.

Despite his doubts about tests, Mr. Yesalis says that governments and sports organizations still haven't put enough resources into developing state-of-the-art and foolproof drug-detection systems.

"Sports federations ought to give $50- to $100-million to chemists to come up with drug tests that would stand up in a court of law," he says. "If you don't see progress after that, we ought to throw up our hands. But I'm willing to give it one last legitimate shot."

Familiar Voices

Athletes say they get most of their information about drugs and supplements from their strength and conditioning coaches. Until 2000, those coaches were allowed to provide nutritional supplements, like creatine and even ephedrine, to players, until the NCAA decided to ban the practice. Athletes are still allowed to take creatine and other supplements, but must buy them themselves.

"At Florida State, they educated us about what to take and what not to take," says Mr. Jackson. If any of his teammates went out and bought supplements, they were supposed to bring them to the trainers to examine for possible banned substances.

But enforcement is rarely more than the occasional and often-predicted urine tests and admonitions from colleges and the NCAA. After all, colleges with big-time athletes have a great deal of financial incentive to protect athletes from positive tests, and fewer reasons to look too deeply into their medicine cabinets.

Until the health consequences get too grave, as they have with ephedrine. One of Mr. Jackson's teammates, Devaughn Darling, died two years ago with the stimulant in his system.

But athletes will always be looking for a leg up.

"Everybody's trying to bulk up," says Tony Romo, a National Football League prospect from Eastern Illinois University. "If someone puts something like that in front of you, you're going to think about it."

3. Vic on January 27, 2004 03:52 PM writes...

I think it is a question of what testing is really trying to accomplish, or why. If it was strictly about competitive balance then just opening the door to full use would certainly solve the problem.

I've had a conversation or two about this, usually revolving around baseball and Barry Bonds and Mark McGwire. So, this is probably a baseball-centric argument. As a baseball fan, the issue for me comes down to history, as it does for many others. I want to know that when Bonds hits 73 homers, that record means something. When no one hits .400, it is because Ted Williams was an amazing hitter who did something really hard, not because the testing technology kept a player from getting that little bit of something extra.

4. Barry on January 28, 2004 09:34 AM writes...

I believe one important problem with legalization is that those athletes who don't want to take steroids could be virtually forced to if they want to reamin competetive. The pressures to take them now are quite strong. If legalized for sports, how is an athlete supposed to say no while teammates and competitors are loading up? In fact the entire steroid argument might get turned on its head. Those athletes who choose not to will be seen as the "weird" ones and the "weak" ones. They will also lose precious seconds for contests which rely on speed and be at a comptetive disadvatnage in strength, etc.

5. Stephen on January 28, 2004 10:53 AM writes...

Something I remember from the days when I followed professional bodybuilding (don't ask why): there was a big movement in the early 90s to have "clean" meets and "other" (presumptively non-clean) meets. I remember that the difference between the competitors was truly staggering. Also, guess which kinds of meets the bodybuilding magazines covered.

6. Steve Sailer on January 30, 2004 02:49 AM writes...

The conventional libertarian argument made by Sullum -- Got rulebreakers? Legalize them! -- doesn't make much sense for sports because sports are meaningless without rules.

Further, his idea that, if legalized, athletes would just take a moderate level of doctor-approved steroids is silly. If everybody took exactly the same moderate level of steroids, nobody would get any advantage from taking them. No, the whole point of taking steroids is to take _more_ steroids than the other guys.

Sullum simply doesn't understand the logic of competitive drug taking. He's fixated on drugs that people take for pleasure, not as part of an arms race.