University of Wisconsin medical ethicist talks about science and morals as applied to sports.

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    Jan 16, 2008 5:30 PM GMT
    [url]http://www.chicagotribune.com/features/lifestyle/chi-0115steroids_fostjan15,0,7051905,full.story[/url]
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    Jan 16, 2008 5:31 PM GMT
    This guy really comes across as a voice of sound reason, to me.
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    Jan 16, 2008 9:32 PM GMT
    LINK
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    Jan 16, 2008 11:10 PM GMT
    The man making the case for steroids
    As controversy swirls, medical ethicist remains a center of calm and certainty

    By Charles Leroux | Tribune senior correspondent
    January 15, 2008

    How can the accomplishments of Bonds, McGwire, Sosa and others of the "steroid era" of baseball be compared to those of Aaron or Ruth? Can Major League Baseball and the National Football League and the others ever get drugs out of their systems? Will the athletes named as users in the Mitchell report face futures threatened by cancer, heart attack, stroke? What will come of the House committee hearings, now postponed until February? Is there any tarnish remover strong enough to put the shine back on sports in America?

    As the controversy over use of anabolic steroids by athletes swirls like a wind-whipped snowstorm, Norman Fost, professor of pediatric medicine and director of the Program in Bioethics at the University of Wisconsin, is a center of calm and certainty. He says, as he has for many years and virtually alone, that the maelstrom is nothing more than "the hypocrisy, bad facts, inconsistency and moral incoherence of anti-drug hysteria."

    To him, athletes who take banned performance-enhancing drugs are as morally and ethically blameless as the pole vaulters who quickly converted from bamboo poles to fiberglass when they saw a competitive edge. Rather than being banned, he insists, steroids should be available, under a doctor's supervision, to any pro or amateur adult athlete who wants them.

    For his contrarian stance, the soft-spoken, 68-year-old tennis- and basketball-playing sports junkie who will, he said, "watch anything that moves," has been roundly vilified.

    "NPR called me 'the loneliest man in America,'" he said. "The president of the university has forwarded letters from alumni saying they are withdrawing their financial support because of me. I've had sportswriters tell me to wake up to the modern world. I've been called 'the wacko in Wisconsin.'"

    If Fost is a wacko, he likely has the most stellar resume in the wacko world. His bachelor's degree is from Princeton, his M.D. from Yale. His residency was at Johns Hopkins and his master's in public health came from Harvard. At Wisconsin in 1973, he founded one of the earliest and most highly regarded and copied bioethics programs in the nation.

    "Norm has always been provocative and controversial," said Dr. Mark Siegler, director of MacLean Center for Clinical Medical Ethics at the University of Chicago and a friend and colleague of Fost's since the '70s. "But his views are always presented in a careful, thoughtful way, and come from a depth of insight and clear thinking."

    New Jersey-born Fost recalled that his father, also a pediatrician, was "skeptical when it came to conventional wisdom. He was smart, funny and a pit bull about honesty."

    Those genes kicked in vis-a-vis sports for Fost when, in the 1972 Munich summer Olympics, an American swimmer, Rick DuMont, was stripped of a gold medal for taking a banned substance, ephedrine. It was contained in an over-the-counter cold medicine that he took, with the permission of his team doctor, to relieve asthma symptoms.

    'Superficial reporting'

    "I started thinking about the line between treatment and enhancement," recalled Fost, who takes even aspirin reluctantly. "As time went by, I kept reading more and more superficial reporting about how taking enhancing drugs was immoral."

    In 1983, he wrote an editorial for The New York Times titled "Let 'em Take Steroids," an attack on the growing body of conventional and, he thought, bogus wisdom.

    At the 1988 Seoul Olympics, Canadian sprinter Ben Johnson would leave in disgrace, portrayed as, Fost said, "a combination of Charles Manson and Adolph Hitler. But the American swimmer Janet Evans was hailed as representing everything good and great."

    The difference was that Johnson tested positive for the use of an anabolic steroid while Evans, after her 5,000-meter gold medal win, was lauded for keeping secret from other teams the newly developed, high-tech fabric swimsuit she said helped her to victory.

    Watching this morality play of good and evil on his TV, Fost wondered, "Why was Johnson condemned for taking a performance-enhancing drug while Evans' use of a performance-enhancing suit was praised?"

    Fost then wrote another New York Times op-ed piece, this one titled "Ben Johnson: World's Fastest Scapegoat."

    Just as he found hypocrisy in the stance that one form of enhancement is immoral while another is OK, he found it as well in the hue and cry concerning the health horrors associated with steroid use. He read medical journals from around the world and found no deaths tied to anabolic steroid use, no side effects for adults beyond acne, hair loss, infertility, lowered voices in women -- mostly cosmetic and reversible effects. He allows that, during use, bad lipids in the blood rise while the good decline but said: "This gets translated by the press into statements that there is an increased incidence of heart disease or stroke. I don't know of any evidence of that."

    As to so-called "'roid rage," out-of-control anger associated with steroid use, he says there are statistically so few cases that conclusions about cause and effect are hard to make. Fost is more interested in controlling the behavior than the steroids. "If people are worried about physical or sexual assault by athletes on steroids, they should be equally worried about them by athletes who are not on steroids."

    Charles Yesalis, a steroids expert and epidemiologist at Penn State, has expressed doubts about "'roid rage" as well and has been quoted in media reports as saying, "You take a state college on any given weekend and you will see as many cases of alcohol-induced rage as you will see in a hundred years with anabolic steroids."

    Aggressive behavior

    Last February's issue of Behavioral Neuroscience reported on research conducted at Northeastern University by a group headed by Richard Melloni Jr., associate professor of psychology. The group injected a cocktail of various steroids into adolescent hamsters and found the animals becoming aggressive and remaining that way weeks after their last injection.

    "After tearing apart thousands upon thousands of animal brains," Melloni said in a telephone interview, "I've concluded that these [anabolic steroids] are dangerous substances and should continue to be banned. They produce dramatic effects on developing systems in adolescents and on already developed systems. Some of the effects seem to reverse when the steroids are no longer used. Some don't."

    Melloni's is one of the few labs doing such research and has looked only at animals, though he says research on human brains may become possible with improved neuro-imaging technology.

    Fost absolutely opposes giving steroids to adolescents because steroid use can stunt growth. He urges stringent testing of young athletes, and, for those distributing steroids to children: "Hanging followed by a fair trial."

    In all the health and morality questions about steroids, Fost said: "It's as though the drug hysteria serves as a distraction from more serious issues. You'd be hard-pressed to find a single death associated with steroid use, yet the TV cameras keep showing [Red Sox manager] Terry Francona drooling disgusting spit from something [chewing tobacco] that has a very high cancer rate associated with it.

    "You have 400,000 deaths a year due to tobacco and tens of thousands of alcohol-related deaths, a substance heavily promoted by Major League Baseball, yet the president and Congress and the press have virtually nothing to say about tobacco and alcohol in athletics, but lots to say about steroids. A football player spending more than three years in the NFL has an 80 to 90 percent chance, according to one study, of some permanent disability, but the NFL produces films focusing on the most vicious hits.
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    Jan 16, 2008 11:11 PM GMT
    Is the tide turning?

    The governing bodies of national and international sports and groups such as the International Anti-Doping Agency still hold firm in banning steroids. The federal government continues to sponsor public-service announcements warning of the dangers associated with use. But lately, some scientists, lawyers and writers have come around to Fost's stance.

    "I'm not so much the loneliest guy anymore," Fost said.

    Nonetheless, he has no illusions that the boogeyman will go away any time soon. He likens the persistent myths on steroids to those concerning the Iraq weapons of mass destruction.

    "Even when it came out that there were no such weapons," he said, "having heard over and over that they existed, 40 percent of the public still believed it."

    - - -

    Counterpoints to some common arguments

    Dr. Norman Fost has ticked through his arguments against the objections to steroid use often enough that he can do it by rote, stopping only when his listener says something that indicates he gets Fost's point. Then he stops, smiles, points an index finger and says, "Bingo."

    Steroids give an unfair advantage. "There are a lot of things in sports that are unfair. In some football games, my beloved Badgers offensive line may outweigh opponents by 60 pounds. That's unfair. It is hypocritical for leaders in Major League Baseball to trumpet their concern about fair competition when one team [the Yankees] is allowed to have a payroll three times larger than most of its competitors.

    "Steroids are unfair only if there's unequal access. Removing the ban would give equal access, Also, as long as they are banned, steroids will come from people making them in their bathtubs, no clinical trials as to safety, no oversight of manufacturing process, no long-term studies. If steroids are harmful over the long term, that would be good to know, but under the current conditions, we may never find out."

    Athletes are coerced into using steroids. "That would mean there's the use of force or a threat of deprivation. Steroids are an offer to be better off than you are, just as signing up with a professional team is an opportunity to be better off than you are. In the first year of testing in 2003, with the results anonymous and with no penalties, about 6 percent were found to be using steroids but 94 percent were not. If there was coercion, it wasn't working."

    Steroids are unnatural. "Testosterone is made by the body. It's the most natural of all steroids. The rest are synthetic. Yet testosterone is the one steroid that we know does cause cancer and therefore is no longer used. Sport hasn't been 'natural' since the first naked Olympian put on sandals. A Nautilus machine isn't natural. Should athletes train only by lifting rocks?"

    Steroid use undermines the integrity of the sport. "That's the Bob Costas argument about the validity of records. There already is no validity in comparing athletes era to era. In baseball, the mound is lower, the ball livelier, the fences lower, the sizes of the fields and the rules of play are different. And what do you do about Coors Field?"

    Columnist George Will wrote: "Sport -- and a society that takes it seriously -- would be debased if it did not strictly forbid things that blur the distinction between the triumph of character and the triumph of pharmacology."

    "Did Barry Bonds undermine the integrity of baseball?" Fost asked rhetorically. "Well, the fans didn't seem to think so." And, a listener noted, the home run race between McGuire and Sosa is widely credited with bringing fans back after the strike.

    "Bingo," Fost said.

    Steroid users are bad role models for kids. "I'm more concerned about sexual assault, drunk driving and other things kids see some athletes doing."

    What about Lyle Alzado? "That question seems to come up every time I do an interview," Fost said. Lyle Alzado, a star defensive end in the NFL, became the poster boy for the dangers of taking steroids because of his death from brain cancer at age 42, a cancer he claimed was brought on by steroid use. So compelling was his story that, now, 16 years after his death, many Web sites about him conclude by saying: "Cause of death: Brain cancer brought on by excessive steroid use." "But there's not a shred of evidence to prove that connection," Fost said. "He was the poster boy for the wrong thing."

    -- Charles Leroux

    - - -

    Debating the subject

    On Tuesday, Norman Fost will take part in a debate in New York sponsored by a group called Intelligence Squared (IQ2). Moderated by Bob Costas, the motion put forth will be, "We should accept performance enhancing drugs in competitive sports."

    The debate can be heard, or read, beginning Jan. 23 by going to npr.org/intelligencesquaredFor more information, go to intelligencesquaredus.org.

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