Steroids, Sports and the Ethics of Winning

By Michael Dillingham, team physician for the San Francisco 49ers and Santa Clara University

Why, ethically, does the use of steroids in sports bother us? The medical issues are fairly straightforward. The use of anabolic steroids increases the athlete's chance of getting liver cancer. Heavy or prolonged use can cause psychological and emotional problems—so-called "steroid rage."

Men will have testicular atrophy and libido problems, and women will have abnormal periods and changes in their normal hormonal balance.

Because steroids enable heavy lifting, tendon tears and osteoarthritis are common ailments. I could tell you about guys who do what their bodies weren't designed to do—such as benching 400 pounds—and by the time they are 35, they cannot lift their arms.

So, why do people use them? The answer to that question is also straightforward. They make you bigger, faster, and stronger. And they work perfectly well in anybody who's training heavily.

Should athletes be allowed to make this trade-off? Many say, "It hurts only me, so why does society care?"

Society cares because steroid use is a form of cheating. Since steroids work so well, they create an unfair advantage for those who take them, and this breaks the social contract athletes have implicitly agreed to: We are going to have a fair contest. There are things we can and cannot do. Even if there were a safe performance-enhancing substance, if it weren't available to everybody, using it would still be cheating.

Unfortunately, steroids are still ubiquitous, and one of the problems is that we let people use them. Society loves sports and tends to look the other way when they become dangerous. We tolerate boxing, where you have two guys beating each other's brains out; we tolerate sports that have severe lifetime side effects like some elements of track and field.

The conspirators in this are everywhere—coaches, institutions, even some parents. We see parents who are in complete denial when their kids—college athletes with eating disorders—have stress fractures of their tibias or patellas because their bones are fragile from anorexia. The parents are living through the children's achievements, so it's very difficult to break this pattern.

Steroid use is part of this whole youthful delusion that says, "If I just do this for a period of my life, I'll be fine. I'll smoke until I'm older; I'll only binge drink in college; I'll be anorexic or bulimic so I can run, and then I'll stop being that way and I'll go on and have a wonderful life."

That's playing Russian roulette, which is not a game I think we want to encourage.

The only things that work to discourage doping are testing and penalties. You can talk about personal responsibility until you're blue in the face, but to stop steroid use, testing is necessary. Cocaine and steroids have ceased to be big problems in professional football because of testing.

In most other professional sports, the inmates are running the asylum. There is no effective testing, and the penalties are pitiful. If Congress pushes this issue, and if professional sports and unions stop obstructing, and if some of the professionals get busted, we may get somewhere. I'm hopeful.

Wednesday, August 25, 2004