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Athletes and steroids: the bad bargain.

ATHLETES AND STEROIDS: THE BAD BARGAIN

Many young athletes are makingwhat may prove to be a Faustian bargain with drugs, specifically anabolic steroids. They use steroids now to grow larger muscles, not knowing if, years later, the drugs may shorten their lives or cause chronic medical problems, such as heart disease, liver trouble, urinary-tract abnormalities, or sexual dysfunction.

There is not shortage of takers forthis bargain. Both amateur and professional athletes are using anabolic steroids, and many experts fear the number will increase because steroids are readily available from both legal (prescription) and illegal sources.

The Current Uproar; Its Background

Steroid use by college-age or youngerathletes was dramatically underscored last December, when mor e than 20 college football players--from at least seven universities--were barred from participating in postseason bowl games because tests showed they have used steroids. Best known among them was the all-American linebacker Brian Bosworth, of the University of Oklahoma. He was highly critical of the National Collegiate Athletic Association (NCAA), which had ordered testing. "Steroids are a legal drug," he said. "I'll continue to fight against the abuse of drugs--recreational drugs that are destroying society. Steroids aren't destroying society."

Many observers think steroid usedestroys fair competition, though, and thus is unethical. Nobody knows yet exactly how harmful the practice may be to healthy people.

Steroids, first used in sports competitionsin the 1950s, have led the list of chemical performance enhancers since that time. Steroids are especially prevalent in sports requiring strength and endurance, such as football and weight lifting. Because anabolic steroids cause fundamental derangements of body chemistry, the number of physicians who will prescribe them has declined sharply.

Steroid use in the United States isoften attributed to the late Dr. John B. Ziegler, the team physician for the U.S. weight lifters at the 1954 world championships. He became friends with a Russian physician, who confided that some members of his team were using testosterone. Ziegler looked at the Russians and he was impressed. Back home, he began conducting his own studies. He was later quoted as saying he would like to take that chapter out of his life, that he did not realize most of the weight lifters had obsessive personalities that mixed poorly with drug use; they loved what the pills did and ignored recommended doses.

There Are Steroids, and Then

There Are Steroids

The public, and perhaps someathletes, may be confused about steroids. There are two types of steroid hormones: 1) those produced by the adrenal glands, which control many of the body's biological processes; and 2) the sex hormones produced by female ovaries and male testes (estrogen, progesterone, and testosterone).

1) Corticosteroids became widelyavailable after cortisone, a steroid with anti-inflammatory properties, was first manufactured synthetically in 1948. Corticosteroids are used to treat a number of disorders, including asthma, arthritis, certain types of cancer, and injuries involving inflammation. Many athletes have had injections of corticosteroids to reduce inflammation acompanying injury .

2) Anabolic (a team meaning "constructivemetabolism") steroids were the result of an attempt to separate the androgenic, or masculinizing, aspects of steroids from their ability to add muscle. Although Bosworth and other football players' stated reason for taking the drugs was injury treatment, anabolic steroids do not have anti-inflammatory properties. They are not prescribed as a treatment for injuries.

Could athletes innocently be confusingthe corticosteroids with anabolic steroids? Dr. Bertram Zarins, a Harvard Medical School orthopedic surgeon and the team physician for both the New England Patriots football team and the Boston Bruins hockey team, disagreed. "I doubt they confuse the two," he said. "I think most people who take anabolic steroids know what they're taking." Of prescribing anabolic steroids for knee injuries, he said, "I have never done it or seen it done," and added, "I have never seen the need to prescribe anabolic steroids for any reason."

Bosworth said he took an injectedsteroid known as Deca-Durabolin, a favorite among weight lifters. Dr. Donald H. Catlin, director of the laboratory at the University of California at Los Angeles, which did the drug testing for the 1984 Olympics and some of the NCAA testing, said the type of preparation Bosworth took is the most dangerous of the steroids: "It's administered in an oil-based solution and releases its contents over weeks and months; consequently, the pituitary is suppressed for a long time. My clinical impression is that if one had to take them [steroids], oral agents are less dangerous than the oil-based, injected solutions."

Tests the Students Can't Study For

Dr. Catlin emphasizes that hislaboratory is very careful about testing procedures, which are the same procedures used for the 1984 Olympic Games. An Athlete must donate the specimen under observation. It is divided into two vials and placed in special cases. A wax seal is then attached by the athlete. Samples are identified only by number codes, not by athletes' names. There must be a clear chain of custody until they reach the laboratory. Only the A sample is tested; the B sample is not tested unless there is a positive result on the first test.

"My position," Dr. Catlin said,"is that we will work with any group willing to follow certain basic guidelines we think are necessary to defend the credibility of the testing. If the samples were not collected properly, they might as well not be analyzed. There is no way I could justify working on samples that could have come from anywhere."

Performance-enhancing drugs aretaken far in advance of competition and are metabolized so extensively that laboratories must look not for the drug itself but for metabolic products--as many as four or five different metabolic products for each drug. Besides the cost of the equipment, another reason for the expense of drug testing is that the laboratories must create metabolic pattern libraries.

Bosworth was critical of the NCAAfor both the testing and its timing. He claimed he hadn't been given enough notice to get the steroids--which he said were prescribed by a doctor to help him recover from shoulder and thigh injuries--out of his system.

"Everyone knew," said UrsulaWalsh, the NCAA's director of research and sports sciences, about the testing program passed by the NCAA January 10, 1986, and put into effect last August. Oklahoma football coach Barry Switzer said he warned Bosworth about testing the same January.

What Do Steroids Do?

Dr. Richard Strauss, an Ohio StateUniversity professor and an authority on steroids, said it was possible that a physician actually did prescribe the steroids for Bosworth. Dr. Strauss pointed out that the first medical interest in them was from surgeons who wondered if they could be used to build up debilitated patients. But he added that no good data suggest the effectiveness of such a treatment.

Researchers do know that anabolicsteroids cause derangement in pituitary function and changes in lipoprotein levels that may lead to hypertension. Other risks may include liver and kidney problems, sterility, masculinzation (for females), and skin problems.

Dr. William N. Taylor, A Floridaphysician who has been writing about steroids for several years, thinks a connection between the use of anabolic steroids and the increasingly violent personalities of athletes is likely. Dr. Taylor says steroids cause normal behavior to become "polarized," resulting in a more hostile, aggressive, and assertive nature.

Recently, Sports Illustratedcharged that steroids are a major part of weight-training programs of professional football players and that the increased player size seen over the years owes more to steroids than nutrition. It also suggested that some injuries occur because players have more weight on their bodies than the frames were intended to bear.

"I think it's true," Dr. Strauss saidof the Sports Illustrated charges, "but I don't have any data to support that. It may be that muscles get bigger and stronger more quickly than tendons can adjust, causing a higher risk of tendinous injuries."

Dr. Strauss' opinion is seconded byDr. Forest Tennant, the California physician who runs the National Football League's drug-education program. Tennant noted there have been some problems with slow healing in players known to use steroids and said, "If you get too much muscle, you don't heal well, because the muscle is too heavy for its support."

Drs. Catlin and Strauss have beenfollowing amateur athletes who use drugs during training and resist counsel on their dangers. Speaking of the long-range outlook for athletes who take steroids, Dr. Catlin said, "We really don't know. There is a pool of people who started on steroids in the 1960s. But nobody has scientifically studied this pool to try to find answers to the specific questions of interest." Thus, he says, it is not known whether steroids lead to cardiovascular problems, what the teratogenetic (embryo-deforming) effects in women may be, or whether steroids cause an increase in the number of tumors.

Even though steroids are known tobe growth promoters, Dr, Catlin said it is "a very long leap to go from what is known about basic pharmacology of steroids to speculating what may happen 20 years down the line to a weight lifter who started taking steroids in 1965."

Also unknown is whether the derangementsin chemistry that occur with steroid use are reversible. "When I look at the changes in high-density lipoprotein and low-density lipoprotein levels and pituitary function in steroid users, [I conclude] these people are sick," Dr. Catlin said. "We know, for example, that a male who takes high doses for a few months will lose production of sperm. But you may look at a man who has these changes, and he's 6'5", 250 pounds, and looks as healthy as a horse. It's almost a judgmental question.

"Physicians would look at this situationand conclude the use is harmful," Dr. Catlin continued, "but the counterargument from the athlete is that he understands the risk, and it is acceptable to him because of the benefit he hopes to obtain."

A Physician-Athlete Speaks

Dr. Craig Brigham, a Chicago physicianand twice an Olympic decathlon aspirant, said he understands that position very well. Dr. Brigham said most world-class athletes who use steroids do not associate value judgements--"right" or "wrong"--with that use. Steroids are as much a part of training as weight lifting, Dr. Brigham said, adding he reluctantly used steroids himself during one period of his training.

Appealing to a world-class athlete'sconcern for his health probably has little effect, Dr. Brigham pointed out, because most athletes don't perform for their health and because some would use methods or drugs they knew to be dangerous if it would help them win. "I'm for the athlete," Brigham said, "because, believe me, I know the pressure. Unless you've been in the position of being potentially the best in the world, you can't understand that pressure. An Olympic contender has one shot at it, and if he believes other athletes are taking something to give them an advantage and put him at a disadvantage, he will want it too."

On the other hand, Dr. Brigham isnot entirely convinced steroids do enhance performance. "No drug has ever been shown to enhance athletic performance. There are just drugs that athletes think enhance performance," he said. Anabolic steroids have a powerful placebo effect, Dr. Brigham explained, and because the user can see changes taking place in his body, they reinforce that effect.

Dr. Brigham believes taking pills toimprove performance is a natural step for many athletes who are part of a drug-oriented society and accustomed to taking vitamins and to making dietary manipulations as part of training.

He does not condone steroid use,primarily on ethical grounds, but he thinks some physicians overplay the actual dangers involved. In Dr. Brigham's opinion, the drugs might not be any more harmful than oral contraceptives.

Dr. Brigham suggested doctors willhave more influence with their athlete patients if they avoid condemning steroids and simply point out that, without proven benefits, they can't really justify the risk of steroid use.

Athletes have indicated the basicquestions about steroids to be addressed are: "Do they improve performance?" and "Are they harmful to healthy people?" If the answer to the first question is found to be yes, some won't care what the answer to the second question is.

Opponents of steroid use have beenmore successful in attacking it on ethical grounds, asking, "Is it fair?" Dr. Robert O. Voy, the sports-medicine and sports-sciences division director for the United States Olympic Committee, summed up this school of thought. He said he cannot understand why physicians would consider prescribing these drugs. "The U.S. Olympic Committee feels an obligation to the American public to demonstrate fair competition in amateur sports," he said. "That is very important to our charge. The American public does not want to support an athletic program that is the best chemistry can provide; that's an adulterated or perverted activity. What's the point of setting records on pills, not innate human ability?"
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Title Annotation:column
Author:Cowart, Virginia S.
Publication:Saturday Evening Post
Date:Apr 1, 1987
Words:2133
Previous Article:Catherine Marshall remembered.
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