by Leonid on 10 Dec 2004, 08:48
The Wall Street Journal
BY SCOTT GOTTLIEB
Friday, December 10, 2004
I knew of a doctor who injected a steroid-like drug into his skin upon landing at London's Heathrow Airport. He said it re-created nature's sleep-wake cycle. He wanted to foil jet lag on his frequent trans-Atlantic trips. The drug was supposed to trick his body's internal clock into thinking he was still in New York.
Everyone is looking for ways to give himself a boost. Television anchors extend their tube time well beyond what wrinkles allow with a nip, a tuck and a spritz of Botox. Professional musicians are known to use low doses of a certain high blood-pressure medicine, propranolol, to treat stage fright. How many reporters who dutifully decry the current steroid abuse "scandal" in baseball have used their brother's Ritalin to stay awake at the computer keyboard a little longer, or antidepressants like Paxil to fight "social phobia" or smooth over the self-loathing inside America's news rooms?
The U.S. Air Force has adopted Provigil, the alertness drug sold by the biotech company Cephalon, as one of its official "go pills" for some pilots whose missions stretch out more than 12 hours. (American sprinter Kelli White, who won the 100-meter and 200-meter world titles in Paris last year, lost after failing tests for the same stimulant.) Around the same time that Alan Greenspan decried Wall Street's "irrational exuberance," Barron's blew the cover off the real source of the Street's untamed euphoria, noting how rising sales of Prozac and similar drugs tracked the Dow's rise and playfully reporting how Wall Streeters enjoyed a higher-than-average use of antidepressants.
People's instinct to misuse powerful prescriptions to get an edge is dumb medicine but not surprising. Americans medicate every ache, opportunity and phobia. Drugs such as steroids and their analogues, illegally used by professional athletes to boost performance, are in the news after baseball star Barry Bonds confirmed in leaked testimony what everyone suspected: that he had used, among other things, a cream that contained steroids. Mr. Bonds claimed he didn't know what was in the cream, that he said he used to soothe his arthritis pain.
Mr. Bonds's testimony was part of a case being built against the founders of the Bay Area Laboratory Cooperative, or Balco, which is accused of supplying the illegal drugs to athletes. Balco's founders have pleaded not guilty. Dozens of elite athletes have been paraded before the grand jury to discuss the cooperative's steroid program, and suddenly one of the most open secrets in the sport is out. Every recent power hitter is under suspicion. Sports writers think they have uncovered the juice behind baseball's home-run spike. Of course, there is nothing new about such a strategy. Athletes routinely take established drugs, ones with legitimate medical purposes, and use them as performance-enhancers.
At the 2002 Winter Olympics in Salt Lake City, for example, cross-country skiers were caught using darbepoetin, a drug taken by cancer patients to combat anemia. The biotech company Genentech worked nearly a decade to create Protropin, the first recombinant human growth hormone to help children with hormone deficiencies reach normal adult heights. It became a wildly popular performance enhancer. Uzbekistan track and field coach Sergei Voynov was caught trying to smuggle 15 vials of Protropin into Sydney for the Olympics, claiming he used it to help reverse his baldness. Because these products are similar to hormones produced naturally in the body, they are difficult to identify in drug tests.
The Balco story reveals that there are chemists willing to work specifically on helping athletes cheat. Even athletes opposed to doping can be inadvertently tainted by dirty dietary supplements. A recent study conducted by the U.S. Anti-Doping Agency found that 41% of 624 legal supplements tested contained a steroid precursor or banned substance not listed on the label. Some contamination is from simple sloppiness--machinery that was not properly cleaned. In other cases, the contaminants are found at very high levels, and it is likely they are being added to the products to make them more effective.
When it comes to professional sports, tougher testing standards may catch more cheats. But what the Balco case also reveals is that technology for concocting designer drugs that evade detection is ahead of technology for spotting them. The big drug companies probably wish they were this good at pharmaceutical innovation.
But if everyone is using drugs to give himself a boost at work, why shouldn't baseball players? After all, many of the side effects of these drugs could probably be managed by medical supervision or mitigated by other drugs in the future. The reason is that athletics are supposed to teach us the benefits of hard work and a devotion to excellence. They are a meritocracy, with clear winners and losers at the end of the day and a second sort of competition going on, especially in baseball, with the dead heroes of the past. (That is one reason we still make players use wooden bats.) Drugs subtract from that tradition of devotion and cheapen the claims to current accomplishment.
Better than thinking that baseball can ever have perfect testing is imagining a regime of mandatory testing and zero tolerance. Players can try to outsmart the testing, but it should be game over if they get caught deliberately using banned substances. Think about the calculation you go through every time you get on the interstate. If the fine for speeding is $150 and there is a 25% chance of being nabbed, many will speed. If the chance of being caught is only 2% but the penalty is a lost license, many people will slow down.
If the baseball union will not acquiesce to that approach, baseball owners can demand that players stipulate in their contracts that they will remain drug free, a noose ready to be tightened if they are caught out. Let the union muster the gall to fight it. Right now, the Yankees would probably love to unload confessed steroid infuser Jason Giambi if they could prove that he violated his contract. Aside from the taint of his drug abuse, he is a richly paid but rotten first baseman.
As for the politicians who turned out for the Sunday talk shows--e.g., John McCain recently suggested that the government step in to require more stringent testing if baseball owners do not quickly come around to that position themselves--they should at least acknowledge that there is a fair amount of hypocrisy behind all the righteousness. With everyone else relying on biotech to improve what nature has decreed for us, do not expect Mr. Giambi to be any different. As long as there are pills to boost performance, there will be consumers ready to take them. In a culture where we medicate every opportunity, the real surprise in the wake of baseball's steroid mess may be not how many players used the drugs to gain an edge, but how few.
Dr. Gottlieb is a practicing physician and a fellow at the American Enterprise Institute.