MONDAY, July 22, 2002 (HealthDayNews) -- Performance-enhancing drugs are a blight on sports perpetrated by a few bad seeds looking for a shortcut around the competition, right?
That's mostly true, but it's not the whole score, says one expert who argues that doctors have played a "significant, and largely unacknowledged" role in the doping of athletes.
"The stereotype is that the sport medicine establishment is 100 percent on the side of cleaning drugs out of sports. The fact is that's just not true," says John Hoberman, a professor of Germanic studies at the University of Texas in Austin who has made a second career out of exploring the doping problem in athletics.
Hoberman, author of Mortal Engines: The Science of Performance and the Dehumanization of Sport, explores the historical role of physicians in prescribing performance-enhancing drugs in an article in the July issue of the Clinical Journal of Sport Medicine.
His study, one of several in the issue that deal with the theme of drug use in sports, reveals a thin but persistent trickle of ambivalence in medicine toward steroids and other doping chemicals.
There have been spectacular examples, Hoberman says. After East Germany's Olympic triumph in 1976, thanks largely to steroids, a cadre of West German doctors began to question whether their nation shouldn't adopt its neighbor's strategy, he contends.
More subtly, while the mainstream has spoken out clearly and forcefully against physician involvement in doping, a small minority of doctors has argued over the years that drugs may have a place, Hoberman says.
Anabolic steroids mimic the muscle-building hormone testosterone, and they're strictly regulated in the United States by the Anabolic Steroid Control Act of 1990.
Yet, it's estimated that roughly 1 million Americans use anabolic steroids outside their intended purposes, which include helping people with wasting diseases like AIDS keep weight on, and in breast cancer and certain anemias.
Most abusers are body builders, Hoberman says, though police officers have been known to take the drugs, too.
Another drug commonly used by athletes looking for an edge is erythropoietin. EPO, as it's better known, is a hormone that stimulates red blood cell production. By doing so, it lets the blood carry more oxygen, a key factor in endurance.
Some athletes have also become fond of human growth hormone, often as a way to juice up steroids. However, in one study in the journal, Canadian endocrinologist Dr. Heather Dean, of the University of Manitoba in Winnipeg, reports the medical literature has shown no benefit of growth hormone for building strength.
Hoberman says the international sports community is entering a critical period. Never before has there been as much momentum to crack down on doping, both from athletic bodies and politicians. Yet at the same time, cultures are enthusiastically embracing enhancement in other realms -- for their sagging physiques, fading minds and falling faces.
Some doctors may be tempted to view athletic doping in the same light as a nose job. "The line that is increasingly blurred, and this is not necessarily the fault of the physician, is it is just not possible to make a clear distinction between therapy and enhancement" in some cases, Hoberman contends.
Some doctors rationalize giving performance-enhancing drugs to athletes by considering them to be patients. Administering these substances becomes simply another way of looking out for their patient's welfare, he says.
"As soon as the athlete is defined as a patient, you've opened up all sorts of possibilities, including their use of hormones that the sports federations [like the International Olympic Committee or the National Collegiate Athletic Association] have got on their banned lists," Hoberman says.
Hoberman believes few physicians are willing to break the law or, when not dealing with a banned substance, fudge medical ethics by prescribing and administering performance-enhancing drugs. However, he says, professional athletics is a seductive arena and some of the doctors who attach themselves to teams or individual competitors may sacrifice that integrity for the chance of victory.
Just how many, however, is impossible to tell.
Will Glaspy, a spokesman for the U.S. Drug Enforcement Agency, says that in the early years following passage of the steroid control act, there was a flurry of charges against doctors who broke that law. Now, Glaspy says, those prosecutions have tapered off.
"After that initial surge, [misprescribing of steroids] really has not been much of an issue," Glaspy says. Instead, officials have been trying to stanch the smuggling of steroids into the United States from Mexico and, to a lesser degree, Europe.
Dr. Jerry Hizon, a sports medicine physician in California and team doctor for the National Football League's San Diego Chargers, says the situation is simple in professional football. The league bans a sweeping array of substances, from steroids -- which Major League Baseball doesn't test for -- to even the chemicals in cold medicine if they haven't been cleared by a doctor. The league tests its players, too, says Hizon, which is a significant disincentive for trying to skirt the rules.
"It's relatively straightforward and, I think, relatively harsh," Hizon says.
Still, he adds, "It's true that the athletes will do just about anything [for an advantage] because it is such a competitive situation." Of the 150,000-odd college football players, only about 100 are offered professional contracts each year, he says.
Dr. Gary Wadler, a sports medicine specialist and an expert on doping, says he believes the "overwhelming majority" of doctors involved in sports don't condone the practice. While he has known two physicians who went to prison for illegal trafficking in steroids, they're not the main problem.
The larger issue, says Wadler, is that most doctors aren't trained to recognize doping when they see it.
"This is not part of the usual core curriculum in medical school or pharmacology school," says Wadler, medical advisor on performance-enhancing drugs to the White House Office of National Drug Policy and a spokesman for the American College of Sports Medicine.
Medical training needs to do a better job of educating doctors about how to spot the difference between a normal surge of hormones in an adolescent, for example, and one sparked by steroids. Between 2 percent and 4 percent of teenagers use anabolic steroids, he says.
What To Do
To learn more about performance-enhancing drugs, see the World Anti-Doping Code. For more on steroids, visit the U.S. Drug Enforcement Agency.
