The journey of humanity has been an unending search for an edge, an advantage, a performance enhancement that allows us to be stronger, smarter, faster and better than our fellow humans. Among man’s endeavors, sports have always been the easiest in which to observe those results. Perhaps that’s why, no matter how exalted or overpaid athletes become, we still identify with them and their search for the limits of human achievement. We understand they must go to great lengths for these achievements—rigorous training, severe diets, all manner of medical procedures and surgeries, and periodic abstention from sex, fluids, food and much of life as we know it. We seem to allow elite athletes every possible modification or enhancement save one: They may not take performance-enhancing substances described generally as steroids, a category that encompasses a wide range of chemicals, almost all of which occur naturally in the human body.
The two dominant arguments against steroids are that they are dangerous and that they are unfair. Neither stands up to much scrutiny. The first was made most famously by Lyle Alzado, the NFL defensive lineman who died of a brain tumor in 1992; in a 1991 Sports Illustrated cover story, he said he regretted his 15 years of steroid use and blamed them for his brain cancer. However, no scientific proof has ever linked the two. “To this day, he is the only person I know who used steroids and had brain cancer,” says Dr. Norman Fost of the University of Wisconsin, a specialist in medical ethics.
But steroids have become a symbol of a larger moral failing, stigmatized by, among other scandals, Alzado’s death, the Ben Johnson doping case at the Seoul Olympics and Major League Baseball’s loss of an entire era to inflationary statistics. However, steroids are classified as mere Schedule III substances, on par with the likes of Tylenol With Codeine. The New England Journal of Medicine concluded in a 1996 study that besides an increase in acne and breast tenderness in some subjects, “no other side effects were noted.” The National Institute on Drug Abuse echoes on its website that “the incidence of life-threatening effects [of steroid use] appears to be low.”
Thousands of athletes have used steroids safely—though surreptitiously—since the 1930s. John Romano is just one example, a 54-year-old former competitive bodybuilder who has been on and off anabolic steroids since 1982. “They have helped me retain muscle mass and recover from injuries,” he says. “My blood work has always been perfect; every marker I have is excellent.” By his own count he has coached thousands of bodybuilders over the past 25 years. “I have not encountered one negative effect in myself or my charges,” he says.
“The number of deaths in the world that we can attribute to anabolic steroids is really low,” says Charles E. Yesalis, professor of health policy and administration at Pennsylvania State University and author of Anabolic Steroids in Sport and Exercise. “Aspirin is dramatically more dangerous.” And nobody denies that steroids, like all drugs, have side effects, but they are certainly less dangerous for a healthy adult male than tobacco or alcohol—yet those plagues on public health are legal. Perhaps that’s why then senator Joseph Biden pivoted from citing health effects to invoking the “fairness” issue when he announced harsher penalties for steroid use in 2004. “It’s a values issue,” he said. “If kids think the best athletes are on the juice, what does that teach them? That cheating is okay.”
But the senator began with a false premise: that sports are fair. From the outset, as David Epstein makes clear in his best-selling book The Sports Gene, there is nothing fair about sports. Some athletes are born with inherited advantages due either to size, weight and muscle mass or to genetic mutations such as those that enabled Finnish cross-country skier Eero Mäntyranta to win seven Olympic medals over three Olympiads. Mäntyranta’s anomaly allows his bone marrow to produce an extraordinary number of red blood cells, which deliver oxygen to muscles. That translates to greater speed over greater distances. Wouldn’t a fairer race allow other athletes to increase their own red blood cells so each started with the same advantage? That is an effect of erythropoietin, or EPO, a substance banned by the International Olympic Committee but widely used by cross-country skiers and other endurance athletes, including Lance Armstrong, for precisely that purpose: to achieve the red blood cell production that Mäntyranta sees naturally.
Why then is Mäntyranta’s mutation legal while Armstrong has been banished from competition for pursuing the same effect? “It’s arbitrary,” says Peter Singer, professor of bioethics at Princeton University and author of The Most Good You Can Do. “These rules say what substances you can take, but in terms of procedures, surgeries or other performance enhancements, it’s capricious. Take an athlete living at high altitude so his lungs adapt to less oxygen. Why are these things legal and specific substances illegal?”
He points out that one third of MLB pitchers have undergone Tommy John surgery, in which a ligament in their elbow is replaced with a tendon from their own body or a cadaver, often resulting in improved performance. Similarly, many professional baseball prospects and golfers, including Tiger Woods, have undergone corrective surgery to improve their vision, an enhancement every bit as unfair as taking steroids to increase one’s strength—but no senators call for hearings to decry this form of “cheating.” “Inconsistency is the norm,” says Yesalis. “When it comes to drug testing, the NFL, Major League Baseball, the Olympics all spend a lot of time working on that false wall. It’s public relations.”
If athletes are aware of the few dangers of performance-enhancing drugs and are willing to take them anyway—under medical supervision, no less—shouldn’t that decision be theirs alone? After all, it was their decision to take on the dangers of professional sports in the first place. Concussion awareness has not diminished the number of athletes elbowing for a shot at the NFL, nor have the obvious dangers of extreme sports led to their being banned.
We have indeed drawn an arbitrary line, outlawing specific substances, from anabolic steroids and EPO to human growth hormone and even an athlete’s own transfused blood cells, while allowing or encouraging a host of other activities and procedures, each of which offers a competitive advantage to athletes who can afford them—which in international sports means athletes from wealthier, developed countries. Our testing regulations also result in an advantage for athletes from those countries—including totalitarian regimes—that have the resources and science to beat the tests.