Peter Handrinos is a frequent
contributor to Scout.com and author of the upcoming ‘The Best New York
Sports Arguments: The 100 Most Controversial, Debatable Questions for
The following introduction has been altered from its original posting, which mischaracterized several of Dr. Fost’s views on the subject of steroids. The author regrets his initial errors.
Slowly and surely, the mainstream
media has formed a familiar consensus on the subject of
Experts have repeatedly claimed
that the drugs are physically harmful to users while being destructive to sports
integrity. Time and time again we’ve been told that the various revelations and
investigations of the last few years have soured the fans’ perceptions and the
game’s historical record, all while sending a uniquely destructive message to
All that has been part of the conventional wisdom on steroids, but Dr. Norman Fost has never been a part of it. In fact, he’s done his very best to present several alternative arguments.
Dr. Fost’s skeptical views, as passionately-held as they may be, would be relatively easy to dismiss if he didn’t possess such impeccable professional credentials. A 1960 graduate of Yale Medical School, he served a residency at Johns Hopkins Hospital before moving on to the University of Wisconsin Hospital, where he’s served as a tenured professor in pediatrics and the history of medicine for more than 20 years. He currently serves as the Chairman of UW’s Hospital Ethics Committee and has been a past Chairman of the American Academy of Pediatrics’ Committee on Bioethics.
Recently, one of the nation’s
leading ethics authorities discussed his skeptical take on steroids and
steroids help athletes perform better?
no question that they improve performance in some athletes in some settings. As
far back as World War II, steroids were known to enhance protein synthesis in
certain tissues of the body and help injured muscles and wounds heal more
quickly. There are good studies showing that weight lifters can improve their
strength and performance by using anabolic steroids.
theory about how they work is that they allow more vigorous weight training.
Without them, weight lifters suffer micro-tears in their muscles and need to
take time off to heal. Otherwise, they’ll be sore and, eventually, injured.
Steroids allows you to train harder and, thereby increase muscle size and
strength, and in time, to performance. I’m not aware of controlled studies that
prove you hit more home runs, or throw harder or more often, but I don’t think
there is much doubt that some baseball players have improved their performance
by adding steroids to a rigorous weight training program.
people may think you can just take a pill and suddenly hit more home runs. It’s
not like that. The best power hitters work very hard and steroids probably allow
them to work a little harder before stopping for recovery.
you know, a lot of media stories have emphasized the physical harm associated
with steroids. What’s your view?
are two problems with the media accounts.
playing the sport causes far more permanent disabilities than those associated
with steroid use. In football, far more players have died or become seriously
disabled from playing the sport than for reasons related to steroids. I would
guess more people have died playing baseball, versus taking steroids
- namely, one [the Indians’ Ray Chapman in 1920]. I’m not aware of any
major league baseball player whose death can be clearly attributed to steroids.
ethics start with good facts, and press accounts have been wildly exaggerated.
The majority of reporters have been repeating the same claims about risks
without checking the sources. This litany of claims - that steroids cause
cancer, heart attacks, strokes, and other serious medical problems in baseball
players - isn't supported by any reliable medical evidence.
steroid users like Lyle Alzado [of the NFL] or Ken Caminiti have died, the media
has simply assumed that the steroids played some significant part, but there
isn’t a shred of evidence that either one was a 'steroid-related death', as
Alzado’s cancer was described in the front page of the New York Times. The young
man in Texas, [Taylor] Hooton, was a very sad case, but reportedly had other
risk factors for his suicide, such as depression and was reportedly using
Lexapro, an anti-depressant medication called an SSRI, which have been shown to
be associated with suicidality.
of the problems with the prohibition policy is that everything is driven
underground, so we can’t do the kind of well designed studies that could produce
reliable information. I don’t belittle the non-life threatening risk associated
with steroids, in everything from male pattern baldness, infertility (usually
reversible), voice changes, mood changes, and acne. All those things are real. I
do object to the claims about the life-threatening effects from steroid usage in
the ways professional athletes use them.
there does seem to be evidence of steroids’ harm to ball players, in that
disabled list stays increased 31% from 1990 to 1998. Players like Caminiti, Jose
Canseco, and Jason Giambi have all suffered severe injuries while they were
to Caminiti, Canseco, and Giambi, anecdotes don’t tell me much. Some steroid
users have had injuries and some haven’t. To attribute injuries to steroids,
you’d have to do a more scientific study of users and non-users, and show that
the incidence of injury was higher in one group. The fact that three famous
steroid users had injuries doesn’t tell me very much.
once told a reporter that there’s no evidence that steroids cause joint and knee
problems, as he had implied in an article. He responded, ‘Come on Doctor, don’t
you know that most weight lifters are on steroids, and most of them have chronic
knee problems?’ I said, ‘Yes, I know that, but how many of the injuries are due
to weight lifting and how many are due to steroids?’ He didn’t seem to
understand that simple distinction.
to your other point, yes, there do seem to be more injuries than decades ago.
For example, when I was young, I could name the starting pitchers for the
Dodgers, Giants and Yankees over a ten year period, because they basically
stayed uninjured over that span. Today, there seem to be a lot more pitchers who
are disabled early in their careers or burn out.
it’s because they throw harder and don’t pace themselves, since they are not
expected to pitch a complete game. Maybe it’s related to their training. I
wonder if increased weight training isn’t causing more of wear-and-tear on
muscle ligaments, with stretched and torn ligaments. I’d welcome more studies on
the connection between weight training, in itself, and baseball
suspect that steroids, in encouraging athletes to train harder and longer, may
be associated with the greater injury totals, but the problem is [that] we
just don’t know how much of the injury problem is due to steroids and how much
to other factors.
come out for legalization of steroid usage for adults. What substances would you
ought to be a serious risk-to-benefit ratio, one with a substantial harm
incidence with no compensating medical benefit. Ephedra, for example, has been
alleged to cause 100 or more deaths. I’m not sure about the number - it’s
hard to get a reliable number - but if that’s true, it would support the
argument for a ban. That’s a substantial number, and the drug has no known
it were the case that steroids caused a number of premature deaths, obviously,
that would count against them. It’s a powerful argument, one that’s brought up
by the steroid critics constantly, but, unfortunately, it’s not based on any
reliable data at this point. I’d advocate better scientific studies to get the
data. Jose Canseco claims that more than half of major league players use
steroids. Can you name one who has had a heart attack or a stroke or liver
you know, the issue isn’t just about medical science, but about ethics, and I
wonder if you’d speak to some of the most popular arguments against steroids.
For instance, it’s been said that ‘ball players are basically being forced to
use steroids in order to keep up with the competition’.
problem with that is, no one is forced to use steroids, any more than any one is
forced to play professional sports. If you don't want to play, don't play. It's
an offer, not a threat. It's an opportunity, not a requirement. No one's forcing
you to do it, so everyone I know takes the risk
argument - ‘We have to protect athletes from their own competitive
don’t know if you can really protect people from themselves. It’s a basic tenet
of American liberty that you don’t interfere with people who want to take risks
if they are not exposing others to risks.
to say - we allow people to do far more dangerous things than play football
or baseball while using steroids. We allow people to bungee-jump, to ski on
advanced slopes, to cliff dive. To eat marbled meat or ice cream pie every day
if they want. I don’t think we want to go down a path in which we restrict and
even criminalize behaviors just because they have health risks. And steroids are
so low on the list of drugs or diets that cause serious harm I don’t understand
why we would start there.
might not know if steroids are terrible, but we should always err on side of
a physician, I wouldn’t prescribe enhancing drugs that might be dangerous, just
so a patient can become a better athlete. However, forbidding the players from
taking them? That’s something different. Playing professional sports involves
substantial risks of harm with a high incidence of permanent disability, and I
haven’t heard anyone say that we should prohibit players from volunteering to
guess one of the reasons I don’t really respect football is the fact that it’s
based on crippling violence. Baseball has always had far more respect for its
athletes’ health and well-being.
don’t see Major League Baseball showing much concern about substances or
behaviors that cause much more harm than steroids, such as alcohol and chewing
tobacco. If the purported goal is to protect the athletes from harming
themselves, why are the penalties for tobacco and alcohol use not as harsh as
those for steroids? In the case of alcohol, they not only don’t discourage its
use to the same degree as steroids, they promote it to the fans.
hypocrisy of a steroids ban is even more obvious, in sports like football and
hockey, where there is an even higher risk of permanent
argument against legalizing steroids is in ‘the yuck factor’- it’s simply
offensive to have star players inject themselves with syringes in bathroom
stalls and come out on the field as these over-inflated muscle
couple of things.
think, first, you can’t elevate repugnance - the yuck factor - to a moral
principle. That’s not a reason for prohibiting something. Many people felt yucky
about integrating schools and drinking fountains or having homosexuals teach in
schools or having female airplane pilots. Different people can feel yucky about
all sorts of things in life for different reasons - that’s not, in itself, a
sufficient basis for prohibiting them or regulating them.
part of that repugnance, to the extent that it exists at all, is manufactured by
the the relentless, one-sided reporting in the press, and more recently, in
Congressional hearings that were carefully staged to humiliate certain players.
the public really repelled by steroid use? Major League attendance has been
booming during the so-called steroid era. Suspected steroid users are huge box
office draws. The notion that fans wouldn’t come to see stars hitting home runs
isn’t plausible. Fans didn’t stop coming to see [Mark McGwire] after he admitted
taking andro [in 1998] and they didn’t stop coming to see [Barry] Bonds after he
admitted taking steroids inadvertently [in 2004].
isn’t any evidence that the public’s trust and love and affection for baseball
has been lessened in recent years, despite the media’s best efforts to hype the
steroids situation. People love [the game] for the same reasons they’ve always
loved it, steroid scandals or not. And it’s not just chicks who love the long
President, speaking in the State of the Union address, commented on the
situation, as you know. He said that the chemicals ‘send the wrong message
- that there are shortcuts to accomplishment, that performance is more
important than character.’
not sure the President is in any place to talk about sending the wrong message.
He found 15 seconds to talk about steroids in the State of the Union address,
but not one second to talk about tobacco and alcohol, which are proven to kill
hundreds of thousands of Americans, year-in and year-out . . . The
administration has no serious initiatives on any of that.
is called hypocrisy. You have 400,000 deaths a year due to tobacco
- 400,000 a year! You have tens of thousands of alcohol-related deaths, a
substance heavily promoted by Major League Baseball. And you have virtually no
deaths linked to steroids - maybe one, maybe two. The President and
Congress and the press have virtually nothing to say about tobacco and alcohol,
but lots to say about steroids. You can’t take it seriously in terms of
relevance to kids’ health.
not make the situation better through a ban?
you’re not going to make it any better. It’s hard to reduce to zero [steroid]
deaths - it’s somewhere close to zero already - but it’s relatively easy to
reduce thousands of the 400,000 tobacco-related deaths. There’s only so much air
time, and I’d recommend politicians talk about the things that really do affect
kids’ values and kids’ health.
you know, I’m in favor of a complete prohibition on steroid use by kids. There
are adverse health effects there that don’t apply to adults, and kids can’t make
informed choices. However, if baseball’s worried about sending a message to
kids, I’m 100 times more concerned about a place called
where they sell beer in industrial quantities. The League takes little notice of
it, nor do they have penalties for players who abuse alcohol comparable to the
penalties for steroid use.
you have to admit worry about a ‘something for nothing’ message with steroids.
One of the reasons ball players are admired is because they have to work so hard
for so long at the craft of the game. Steroids take away from that.
there’s still no ‘something for nothing’. Athletes reach the highest level,
because of physical and psychological qualities that allow them to perform under
pressure. That is, Michael Jordan and Larry Bird became superstars because they
worked harder than many others, and had extraordinary ability to concentrate and
relax in pressure situations. I don’t know how drugs affect that. I wouldn’t
imagine that they affect it at all.
Barry Bonds does not hit home runs because he uses steroids. He hits home runs because
he’s a marvelous athlete with unbelievable hand-eye coordination and an
extraordinary work ethic. He was a Hall of Fame player long before he allegedly
started using steroids. Steroids may have increased his numbers over the last
few years, but they didn’t make him a Hall of Fame player.
you know, fan polls indicate strong public disapproval on the steroid issue. How
would you explain that?
as you know, are driven by the information available to those polled, and the
information out there isn’t very good. When you tell people there are weapons of
mass destruction in Iraq,
50% of the people will believe it. Even when you find out that they don’t exist,
40% still believe it!
when the press tells the American people, over and over and over again, that
steroids cause heart disease, cancer, and strokes and constitute a serious
example of unfairness in sports, what are they going to believe? Of course the
polls will reflect what they read and hear - there has been virtually no
one telling them anything to the contrary.
you believe steroids undermine the continuity of baseball
are all sorts of reasons why Bonds’ home runs aren’t really comparable to
[Roger] Maris’ home runs, and why Maris’ home runs weren’t comparable to Babe
Ruth. So many things have changed, including the height of the pitching pound,
the ball park dimensions, the number of games, nutrition, videotape, computers
- and they’re accepted in the course of things.
told the average number of home runs rose 50% when the Indians moved from old
Municipal Stadium to Jacobs Fields [in 1994]. Why wasn’t there a hue and a cry
to add asterisks to those records? Because you’d have to put asterisks on
everything - because nothing is truly comparable. Steroids undoubtedly have
affected the number of home runs, but so have many other factors. The records
would not be comparable even if there had been no steroids.
another argument - ‘baseball should be based on natural ability and hard
work, but steroids are unnatural’.
one escapes me completely.
sports are unnatural, to the extent that they're all made-up games. It's
impossible to imagine modern sports without unnatural enhancements, be they
shoes and equipment to hundreds of legal dietary supplements and drugs.
No one plays in a natural state without any unnatural assists.
are plenty of things that are enhancing, and they aren’t necessarily immoral
because they’re enhancing. The claim that doctors shouldn’t give people
enhancing therapies is not sustainable. Pediatricians give vaccines to children
to enhance their immune system. Other physicians try to enhance the “normal”
life span in other ways.
an advantage in sports would be unfair if it's unequally available, and the fact
is that steroids have been ubiquitously available despite being illegal. The
fairness argument doesn’t require prohibition. It could just as logically lead
are many things in sports that are unfair, but they aren't prohibited for the
fact that they're not available to all. To take a simple example, the
offensive linemen sometimes have an advantage of 50 pounds per person over their
opponents. Plenty of other Division I-A schools have bigger budgets and training
facilities and physicians and so on, in order to recruit superior athletes.
baseball, Bud Selig says he wants to ban steroids because they're anathema to
fair competition. This is a sport where the New York Yankees, with a $200
million payroll, compete against teams with $40 million payrolls. That’s
manifestly unfair and not only is little done to correct the imbalance; they
just agreed to retrench on the luxury tax.
hypocrisy there on several levels. It calls to mind an incident from the 1988
Olympics. Ben Johnson, everyone remembers, had his gold medal taken away due to
steroid use. On the same day, [gold medal-winning American swimmer] Janet Evans
held a press conference in which she bragged about her access to a special,
greasy type of swimsuit and said she was quite sure that it gave her an
advantage in her race.
use of steroids was considered a great moral scandal, but Evans ended up as
sweetheart. She had American ingenuity in action, and the fact she kept it
secret was even better. The hypocrisy was so thick; it amazed me that none
of the thousand reporters on hand picked up on it, then or
you see Major League Baseball’s tough new testing regime reducing steroid use in
it will almost definitely reduce usage for steroids that are testable. It will
almost definitely divert users to steroids that aren’t testable, or non-steroid
enhancers like human growth hormone. When you have a sport offering tens of
millions of dollars to its stars, I think athletes will do whatever’s necessary
to succeed at that level, and I suspect many players have already found
something that isn’t detectable by the current testing.
the long term, history indicates that the users and the chemists stay ahead of
the testers, with more and more new substances. To me, that’s all the better
reason to keep steroids legal and above ground, with effective lab testing for
efficacy and safety. Driving something underground makes it almost impossible to
you know, your skeptical views are in the minority. Do you think that will ever
Public Radio once called me ‘the loneliest man in America’ (laughs), but the
most prestigious medical journal in England recently had an entire issue
dedicated to sports and drugs, and several of the authors agreed with my views.
That was encouraging. I do think views can change.
The complete Table of Contents for
the ‘Baseball Men’ interview series can be found here.