What event preceded the rampant use of steroids in major league baseball?

What are steroids, and why might they be a problem? A steroid is a complex chemical substance consisting primarily of hormones. Anabolic steroids are the class of steroids taken by athletes to improve their performance.

Side-effects of steroids can be serious. WebMD, an Internet website providing health information, summarizes potential side-effects for one particular form of anabolic steroid—androstenedione, popularly known as “andro,” infamous because of its use by the great home-run hitter, Mark McGwire.

Q: Since AN [androstenedione] is widely available and the FDA hasn’t stopped stores from selling it, why is there so much concern about it, as reflected in the media?

A: Because AN is classified as a dietary supplement, it is not regulated by the FDA the way prescription drugs are (WebMD, 2002).

This same WebMD Web page catalogs the many serious risks associated with AN:

■ The quantity of AN in dietary supplements varies, ranging from none to excessive dosage. Product labels do not indicate the quantity of AN.

■ In high dosages typically used by athletes, AN may lead to numerous threats to the user’s health, including problems with the liver, behavioral problems, sexual dysfunction, infertility, increased risk of heart disease, reduced supply of HDL (the “good” cholesterol) and muscle disorders.

■ AN is likely to combine with other drugs users may be taking to produce still more medical complications.

Steroids in fairly high doses have been used to treat medical conditions and in scientific trials designed to assess their effects on performance and health (Yesalis, 2000, pp. 6–7). The risks cited by WebMD arise because steroids often are not taken with care, and users often lack accurate knowledge about correct dosage and the safe versions of steroids (there are dozens of variants of steroids).

There are at least two issues implied by the Sports Illustrated lead story: How widespread (prevalent) is the use of steroids in professional baseball? And how dangerous is their use to the health and welfare of the player?

Prevalence of Steroid use

The Sports Illustrated article makes strong claims. It says use of steroids and other performance enhancers are “rampant” in professional baseball. And steroid use in professional baseball has “grown to alarming proportions.” Sources for these claims include a baseball MVP and “other sources” (Verducci, 2002, p. 34).

Are these claims thorough and balanced, as science advocates? Neither the word- ing nor the content of the opening statement gives us much confidence that they are.

The evidence consists solely of a sequence of testimonials and lengthy quotes from ballplayers, both major and minor league. Ken Caminite, the MVP referred to in the excerpt, is quoted estimating that 50 percent of players do it, but he later retracted that estimate (New York Times, 2002). Jose Canseco is quoted as estimating that 85 percent use some kind of enhancer.

In short, the article doesn’t contain an accurate estimate of the prevalence of steroid use in baseball.

What does an accurate estimate of steroid use require? A survey of all professional baseball players or a probability sample combined with repeated medical tests for many drugs is needed. Since the tests aren’t always correct, they should be supplemented by anonymous self-reports from players. Careful development of a questionnaire or interview schedule combined with extraordinary efforts to gain the confidence of the players in the study also are required. Obviously, a popular magazine like Sports Illustrated isn’t going to conduct such a study—though it might have commissioned one from a reputable research institution.

How damaging to the main theme of the story is the absence of a good numerical estimate of the prevalence of steroid use? Knowledge about sampling and qualitative methods suggests that much useful information isn’t readily quantifiable and doesn’t necessarily derive from a scientific survey. However, an editorial in The New York Times judged the Sports Illustrated (SI) story to be credible, and calls for action based on it. The editorial says that ubiquitous use of steroids by baseball players is documented in “compelling detail” by the SI article (New York Times, 2002, p. A14).

Why was The New York Times editorial staff convinced? Of course, we don’t know, but we can assume that it’s because of extensive quotes from ballplayers and others in the sport. Some of the descriptions of how to obtain steroids and other drugs, based on interviews with players, contain so much detail that it’s not likely that they were concocted on the spot for the reporter. It appears that “something is going on out there,” even if we aren’t able to quantify it exactly.

Still, Sports Illustrated doesn’t describe its methods. How did it select the sample of players it interviewed? How many players refused to be interviewed? Were questions leading the respondent to an answer, producing biased information? Is the sample of interviewed players large enough to give an accurate estimate of the prevalence of steroid use in baseball?

We don’t know the answers to these questions. But we do know that Sports Illustrated and the journalist have their own interests for reporting spectacular findings. Maybe reporters selected players they already knew informally were steroid users. Given the high-pressure environment of the media, this is a plausible scenario—but, again, we don’t know.

Nonetheless at the time the article was published, the public seemed convinced that there was some problem with steroid use in baseball, but it was unclear how serious it was. Since that time, substantial additional evidence has surfaced supporting the original opinion. But there also may be reason to be skeptical of all the hype associated with the issue. The question is: Is strict prohibition of performance-enhancing drugs, along with severe punishment for their use, the best policy?

dangers of Steroid use

The SI article mentions two types of health risks associated with steroid use: (1) injury and, (2) impaired body functions. The evidence of these risks comes primarily from (a) anecdotal (personal story) cases of specific players, (b) interviews with doctors who specialize in sports medicine, (c) informal references to research findings and (d) league statistics showing an increase in time and money spent on disability.

Caminiti, for example, won the MVP award in 1996, the year he started taking steroids. In the years after 1996, he was injured a high percentage of the time and never approached the MVP level of performance again. A lengthy, graphic quote from Caminiti recounts the problems he encountered because his body virtually shut down production of natural testosterone.

More generally, SI cites medical research that indicates steroid consumption damages the heart and liver, leads to hormone imbalance, is associated with strokes and aggressive behavior, increases cholesterol levels and diminishes sexual function (Verducci, 2002, p. 36).

But most of the article is devoted to the informal information and doesn’t convey a good indication of how widespread these problems likely will be, given the usual dosages taken by ballplayers.

The article also attributes increased player injuries and days on the disabled list to steroid use. It cites four types of evidence: (1) opinions of a couple of sports managers and an orthopedic physician, (2) an increase in the number of players on the disabled list, (3) a 20 percent increase in the average number of days on the disabled list comparing the 2001–2002 season to 1997 and (4) a 130 percent increase over 4 years in the cost to owners for pay to players who were unable to play due to injuries (Verducci, 20002, p. 44).

How useful is this evidence of health risks? Each piece of evidence, taken separately, is not very convincing. The medical evidence cited in the article is weak and does not match what is known in the scientific and medical literature, which is not nearly as extensive as you might expect. Research published in academic sources before the SI article (2002) and later do not lend strong support to the claim that steroid use has major impact on any of these aspects of health (Friedl, 2000; Hoffman & Ratamess, 2006; Yesalis, 2000).

It also is important to recognize that the findings depend on the type of steroid and how it is measured (operational definition). Generally, the type of steroid taken orally (17-alkylated) does increase the risk of liver cancer. There is little debate about this effect. But no serious short-term health effects of injected steroids are documented. The scientific literature as of 2000 had not conducted research into long-term effects (Friedl, 2000).

The evidence in the SI article about sports injuries is especially inconsistent, and could be due to many variables not under physical control or statistical control. Only one comparison year is used in each mention of a percentage

increase, generating some suspicion that the comparison year might have been picked deliberately to emphasize the main point (selection bias). In particular, it would be useful to know the natural variation in these rates from year to year and to see trend lines over several years. Is the trend markedly up, despite yearly fluctuations? We also need to scrutinize carefully other events that might account for sharp changes in the trend line (history).

Even with a marked increasing time-trend line, attributing it to steroid use would be difficult. Many variables might affect such a trend, and it would be difficult to identify and measure them. This is the problem of a history effect (as an intervening variable).

Convincing evidence requires comparisons of the injury rate of individual players who do and do not take steroids. Except in randomized experimental designs, variables such as age, position, playing time, number of at bats, injury rate prior to starting to take steroids and race/ethnicity must be controlled.

In an extensive review of the scientific and medical literature, Friedl (2000) concluded that effects of steroid use on tendon ruptures was not established. In a similar review, Hoffman and Ratamess (2006) report the same conclusion. However, animal studies do suggest that very high doses may deteriorate ligament tissues. We conclude, however, that the SI evidence about injuries is not very convincing.

Sizing It all up

So what are we to make of the question of steroids in baseball and, more generally, in any competitive sport? Should they be banned, allowed but regulated or allowed without regulations?

There are two aspects to these questions: facts and ethics. Questions of scientific fact include the effects of steroids on the health and injuries of users, and knowing how much steroid use contributes to improving athletic performance. Questions of ethics (and opinion) have a different vantage point: Do you believe threats to athletes’ health and well-being are acceptable or unacceptable, and do you believe any performance advantages steroid users might gain is fair or unfair competition?

It is not easy to determine the facts about effects of steroid use. There are many varieties of steroids and they do not all have the same effects. There are many potential effects. Effects are not the same for men as for women; nor are they same for adults as for teens and preteens. Good scientific study of steroid effects in humans is difficult to carry out. The following list attempts to summarize current findings:

■ It is fairly well established that steroid use by men increases secondary male features such as baldness, hair growth except on the scalp, and deep voice.

■ It is well established that steroid use increases upper body strength, particularly when combined with weight lifting. Effects on other muscle groups are not documented and appear to be small, or none.

■ The competitive advantage of steroid use to weight lifters and body builders is well established. But it is not clear that much advantage is gained in other sports, including baseball. Apparently, the main muscles controlling hitting power and pitch speed are in the legs. The arms and torso serve primarily as connectors. For example, the extensive Web page about steroids in baseball authored by Eric Walker contains data that show each of the eras of increased hitting power in baseball is preceded by an event such as increased liveliness of the ball. The scientific literature does not find any advantage of steroid use in endurance sports such as distance running (Walker, 2011, http://steroids-and- baseball.com/).

■ Steroid use may lead to acne in both sexes, but this effect is reversible after steroid use ends.

■ In men, steroid use may cause female-appearing breasts to develop. This happens in a minority of men but is not reversible except by delicate surgery.

■ Steroid use by men reduces sperm count and shrinks the testicles. Steroids have been experimented with as a male contraceptive, with mixed success. This effect is reversible with cessation of steroid use.

■ It is often claimed that heart and cardiovascular disease is a consequence of steroid use, but the evidence for this claim is very weak.

■ Several documented effects occur in women: Emergence of secondary male sex characteristics including deepening voice, muscle growth, hair growth, shrinking breasts and enlargement of the clitoris. These effects are not reversible.

■ An increased risk of liver cancer is associated with oral ingestion of steroids but not with injected steroids. The reason is that the types of steroids taken orally are modified to prevent the liver from removing them before they enter the blood stream. The modification is the causative agent.

■ Very little is known about the long-term effects of steroid use on humans. Several studies with animals report very harmful effects of high doses, including shortened lives.

■ Teenage steroid users, particularly boys, are at risk of stunting their growth. The steroids cause an increase of testosterone in the body. When a threshold is reached, it triggers the bone growth plates to close prematurely.

Ethical concerns also are complex. The arguments in favor of banning steroids are that we should protect the health and well-being of members of society, including athletes, users gain an unfair advantage in competitions, use by some athletes prompts other athletes to become users and use by athletes encourages youth also to become users. And, steroid effects on youth are more serious than effects on adults (see above).

Those opposed to banning steroids pose several arguments.

■ Steroids, when used sensibly, pose less threat to individual health and well-being than other substances that are not banned, particularly tobacco and alcohol.

■ Adults must be given the right to decide for themselves whether the risks are worth the benefits, just as they are in many other risky activities, such as tobacco use, alcohol use, parachute jumping, mountain climbing and so on.

■ Many circumstances give some athletes an “unfair” advantage over others. Access to the best coaches, best equipment, best training methods all give those with access an advantage over those without access. What is the difference between these inequalities and those resulting from steroid use by some, but not all, athletes?

■ Steroid use may be “unnatural” but so is most of athletics. The rules of all competitions were manufactured by people and are not natural. Fiberglass poles for pole vaulting, high-tech materials such as body suits worn by swimmers and high-tech tennis rackets are all unnatural.

■ It is impossible to exercise effective control over steroid use. The attempt to do so has prompted athletes to try all manner of unregulated substances, often in very high doses. It has stimulated an ever-growing list of new substances designed to avoid tests. A resulting black market is flourishing. Also, athletes use a number of tricks to avoid detection.

The arguments against rules and legislation to make steroids a “controlled substance” (make non-prescription steroid use illegal) tend to be drowned out by media (e.g., the SI article) and politics. For example, the Mitchell Report (2007) was commissioned by the Commissioner of Baseball to assess the use of steroids in major league baseball. By this time, steroid use in baseball had become something of a scandal. But the report does not contain a balanced assessment of the problem. Much of the report simply presumes steroid use must be prevented and offers many recommendations about how to do it. The NPR (National Public Radio) report on baseball titled “The Tenth Inning” contains some coverage of steroid use. It simply assumes that the scandal surrounding steroid use is based on strong science and makes no mention that there is an opposing viewpoint.

Also, there is a long history of mistrust of mainstream medicine by athletes. This mistrust apparently is due in part to early claims by prominent medical people that steroids do not help build strength—a claim that many athletes knew very well from experience is not true. Few, if any, argue that steroids should be entirely unregulated. But to do effective regulation, steroid use would have to be supervised by physicians or other trained medical personnel, and for this to work, athletes would have to be persuaded to trust medical people.

The issues related to steroid use in baseball and other sports are complex, and it is not clear just what the best policy is. The purpose of this section you’ve just read is to demonstrate the interplay between science and ethics, show the importance of separating the two domains and illustrate how hype and conventional “wisdom” can obscure important facts and ethical considerations.

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