(An aside: it is crazy to think that baseball’s “Steroids Era” began as late as 1994, and ended as early as 2004. Anabolic steroids were used in baseball long before 1994. As Craig Calcaterra recently reminded us, Congress first linked anabolic steroids to baseball back in 1973. U.S. weightlifters were using anabolic steroids in the 1950s; football players were using anabolic steroids in the early 1960s. It’s silly to imagine that baseball players took 30 years to catch up with performance-enhancing athletes in other sports. It’s equally silly to assume that anabolic steroids disappeared from baseball with the advent of drug testing in 2005. Rest assured, any baseball player who wants to use anabolic steroids can continue to do so, with little or no risk of failing a drug test. More on this in a later post.)
I include in the Tolerance Camp some of my favorite baseball writers, including Jayson Stark, Rob Neyer and Craig Calcaterra. The IIATMS staff include vocal supporters of the Tolerance Camp: see here and here and here, for example.
Most of the arguments of the Tolerance Camp make sense to me, but one does not. Tolerance Camp member Jim Caple wrote the following:
[H]ow can you reasonably justify withholding a [Hall of Fame] vote for steroid use but not amphetamine use? Amphetamines became illegal two decades before steroids did. That was also about when we learned amphetamine use was rampant in baseball, thanks to “Ball Four.” In other words, a whole lot more players used amphetamines and for a whole lot longer than ever took steroids… Don’t tell me amphetamines are a performance-enabler, not a performance-enhancer. That’s simply a convenient rationalization to excuse amphetamine use by your favorite players. If a substance helps a player perform in any way, it is a performance enhancer.
Rob Neyer has made a similar argument:
[T]he argument for using amphetamines is actually worse than the argument for using steroids … it’s probably true that some players, perhaps including [Mark] McGwire, were able to return to the lineup (or the rotation, or the bullpen) sooner than otherwise because they used [anabolic steroids] illegally. In those cases, the drugs really were performance enablers; the players literally wouldn’t have been able to perform, at all, without the drugs. Amphetamines, though? Those were, for a number of decades, purely performance enhancers ... Players used amphetamines so they could play better. And to be completely frank, anybody who tells you different is either lying or foolish.
Oh, boy. As we’ll discuss below, the people that Rob thinks are “either lying or foolish” include many experts on this subject.
Rob does not help the “Tolerance Camp” cause by making simple, sweeping and disputable statements about the nature of amphetamines. I do agree with Rob that amphetamines should be classified as “performance enhancing”, though for reasons that Rob might not anticipate, I’d prefer to classify amphetamines as “performance altering”. If given the opportunity, I’d ignore these categories altogether, because PEDs like amphetamines defy easy categorization. Drugs like amphetamines do not behave in ways that make for convenient arguments about who should (and should not) be Hall of Fame inductees.
For the moment, let’s toss the categories out the window, and look at the facts instead. With all of the facts in hand, it becomes impossible to compare amphetamine use to the use of anabolic steroids. These two drugs are not remotely similar. No good can be accomplished by blurring the important distinctions between these two drugs.
Anabolic steroids are drugs that mimic the effects of the male hormone testosterone. They increase protein synthesis within cells, which helps build larger muscles. It’s well accepted that use of anabolic steroids, in combination with adequate diet and high intensity exercise, can result in gains in muscle strength. Whether this increased strength enhances performance in a sport like baseball is an open question – most people assume that it does, but we have no scientific proof.
What about amphetamines?
While anabolic steroids enhance performance by helping an athlete build muscle, amphetamines (sometimes called “greenies” in baseball circles) affect performance by stimulating the athlete’s central nervous system. Amphetamines trigger increases in the user’s blood pressure, heart rate, cardiac output and breathing rate. As a result, athletes that take amphetamines experience increased alertness and wakefulness, and decreased sensation of muscle fatigue. Studies show that amphetamines can increase reaction time and cognitive function, and improve an athlete’s endurance (at least to the extent that the athlete is willing to work longer and harder without reporting exhaustion).
So, amphetamines are performance enhancers? Not everyone thinks so. For example:
“Ironically, the majority of research indicates that amphetamines do not enhance physical performance.” McArdle, Katch and Katch, Essentials of Exercise Physiology.
Athletes use amphetamines “despite the lack of evidence regarding any ergogenic or real performance benefit.” Central Nervous System Stimulants and Sport Practice, British Journal of Sports Medicine (available for viewing with free 30 day subscription).
A review of the literature on amphetamine use in sport can be a confusing experience! In the same piece, you can read that studies of the performance-enhancing effects of stimulants have yielded “primarily positive” and “somewhat equivocal” results. The British Journal of Sports Medicine piece I mentioned above – the one that cited the lack of evidence showing performance benefits from using amphetamines – itself mentions a number of such benefits, such as improved reaction time, muscular strength and acceleration. In fact, confusion seems to rule both sides of this debate. One of the strongest advocates of banning amphetamines from baseball – WADA advisor Dr. Gary Wadler – has stated that amphetamines “do not create extra physical and mental energy” and “are notable for distorting the user’s perception of reality and impairing judgment.”
I’m only a well-traveled non-expert in the field of PEDs, but I think a few different factors combine to confuse the issue of whether amphetamines are performance-enhancing.
First: different people react to drugs in different ways. One example: stimulants can tend to make users nervous and jittery (think of the classic stereotype of a person who’s had too many cups of coffee). But if you give certain central nervous stimulants to people suffering from an attention deficit disorder (either ADD or ADHD), the stimulants actually have a calming effect. Differences in the results reported by these studies may reflect differences in the subjects studied: these subjects may (or may not) be athletically active, or well-rested, or well-adjusted. Stuff that might enhance performance under certain circumstances may have a different effect in other circumstances.
Second: as we’ve pointed out, the primary effect of amphetamines is on the central nervous system. This might permit a user’s body to function better (for example, increased reaction time), but it’s also clear that amphetamines affect the user’s brain. Amphetamines affect an athlete’s sense of things: the athlete feels better, more alert, more wakeful. The user may not be any faster or stronger, but he is willing to push his body harder, for longer, with a more positive attitude. Is a drug performance-enhancing simply because it changes an athlete’s feelings? Is a drug performance-enhancing if it does not improve the athletes’ speed or strength, but simply causes the athlete to use his existing body harder? It all depends on your definition of performance-enhancing.
But there’s a third reason why amphetamines may not be performance-enhancing: we have not described all of the effects that amphetamines can have on athletes that use them. Amphetamines can make users irritable. They can impair judgment. They can interfere with the user’s ability to sleep. They can result in an inability to focus, inattention, increased reaction time, depressed reflexes, poor balance and coordination and an inability to follow directions.
But wait a minute! We said above that amphetamines increase alertness, reaction time and cognitive function. How can the same drug produce opposite effects?
Good luck trying to get a cogent and expert answer to this question! As best as I can tell from the available studies, amphetamines tend to have positive effects when they’re first used, in relatively small doses. But over time, the user grows resistant to the drug’s effects: the user builds up tolerance. Larger doses of the drug are required to produce an effect … but those larger doses seem to be the doses that are more likely to produce negative effects. I can’t find an expert who will say this … but it appears that if amphetamines are performance-enhancing, they may be performance-enhancing only for a short time, or only for the occasional user.
Another fact to consider: amphetamines obscure pain, and while this is commonly listed as a performance-enhancing benefit, masking pain may be more performance-impairing than performance-enhancing. Amphetamines can encourage athletes to ignore injuries, thus compounding the severity of these injuries.
Actually, the full description of the effects of amphetamines is far more negative than I’ve painted so far. The medical risks of taking amphetamines include hypertension, stroke, glucose intolerance, paranoia, hallucinations, convulsions, heart rhythm abnormalities, heatstroke, cardiac arrest and sudden death. Amphetamines have contributed to the deaths of numbers of athletes, including cyclist Tom Simpson. (The death of Orioles pitcher Steve Bechler was linked to use of Ephedra, which can have an effect on athletes similar to that of amphetamines.) The risks of using amphetamines are compounded if the user combines amphetamine use with barbiturate use (amphetamines to amp up, barbiturates to calm down sufficiently to get a night’s sleep). Amphetamines act “abnormally” after barbiturate intake.
What’s worse, amphetamines are potentially addictive – much like more infamous but related central nervous system stimulants such as cocaine and methamphetamines (crystal meth). In scientific studies, most animals allowed to self-administer amphetamines will do so until the drug finally kills them.
We’ve all read about the dangers of the non-prescription use of anabolic steroids, and as a rule I hate to play the game of which drug is the more dangerous. But in this case there’s no question or controversy: amphetamines are far more dangerous than anabolic steroids. One author calls amphetamines the most dangerous illegal drug in the United States. Charles Yesalis, a Penn State professor and leading expert on PEDs, put it this way:
Amphetamines can stone-cold kill you immediately. They’re highly addictive and you can overdose on them. They can cause psychotic episodes. They can lead to stroke and heart attack. In my judgment, they dwarf anabolic steroids as potentially dangerous drugs.
This is the biggest problem I have with the argument that anabolic steroid use in baseball is “just like” amphetamine use. An athlete who uses anabolic steroids is taking a health risk in exchange for a possible benefit in terms of enhanced athletic performance. Such use is cheating, it is against the rules, but if you put issues of morality to the side, it might be argued that the benefits of anabolic steroid use are worth the risk. No such argument can be made in favor of amphetamine use. Not only are the benefits of using amphetamines less clear, but the risk inherent in such use is way, WAY too high. No sensible athlete has any business going anywhere NEAR this stuff.
This is why the question of whether amphetamines are performance-enhancing is the wrong question to ask. Given the dangers of using amphetamines, we need to ban their use in sport even if athletes wrongly believe that they are performance-enhancing. It’s not a question of fair play. It’s a question of public health.
So, let’s return to the question of baseball’s Hall of Fame. If we have dozens of current Hall of Fame members who were amphetamine users, does that justify the election of dozens of additional Hall of Fame members who were users of anabolic steroids? To borrow a phrase from Rob Neyer, I hope it’s obvious by now how foolish it is to ask questions like this. Some players who used amphetamines may have received a benefit of performance-enhancement, and some probably did not, but all of them used amphetamines at a risk to their personal health that dwarfs all other considerations. Asking about the performance-enhancing benefit of amphetamines is like asking about the nutritional value of arsenic, or asking if playing Russian Roulette is an effective way of learning about statistical probability. To ask such a question is to demonstrate that the questioner is missing a larger and more important point.
If the guardians of the baseball Hall of Fame feel that it’s part of their job to measure the potential value of amphetamine use, then I’d suggest that something has gone horribly wrong somewhere. Perhaps someone is taking this job too seriously. Or perhaps the job is no longer worth performing.
Let me add a post-script to address three matters that I expect may come up in the comments.
First: if amphetamines are so dangerous, then how is it that generations of baseball players survived their encounter with amphetamines without frequent hospitalization, institutionalization and interment? I don’t have a good answer to this question. The use of “greenies” by baseball players was first mentioned prominently in the book “Ball Four” by Jim Bouton, and Bouton has said (famously) that in his day “greenies” were “handed out like candy.” It’s hard to believe that baseball players gobbled amphetamines as if they were M&Ms, without obvious and catastrophic consequences. Perhaps Bouton exaggerated, or perhaps these “greenies” consisted of “No-Doz” or something else milder than amphetamines. We have little hard evidence on this subject.
Or perhaps we should not discount the amount of abuse that an athlete’s body can tolerate without completely falling to pieces. I’m reminded of a famous cyclist named Jacques Anquetil, who reportedly perfected the so-called “Anquetil cocktail” consisting of a painkiller and morphine or palfium. Anquetil would inject this cocktail directly into a painful muscle – reportedly, he’d do this in the middle of a race, while riding his bicycle. Then he’d take amphetamines to counteract the effects of the morphine and a sleeping tablet at the end of the day to counteract the effects of the amphetamines. I’d expect that anyone engaging in this practice would end up in a rubber room, or a crypt. Instead, Anquetil ended up on the top podium step for the most prestigious bicycle race in the world, the Tour de France. In fact, he won the Tour five times.
We can’t learn much from the fact that athletes can try something dangerous and get away with it. As they say on TV, “don’t try this at home.”
Second: in my usual fashion, I’ve addressed questions about a supposed performance-enhancing drug by looking at the best science I can find on the subject. But many folks are of the opinion that when it comes to PEDs, the athletes know better than the scientists. For these folks, amphetamines are clearly performance-enhancing, because if they weren’t performance-enhancing, athletes would not have used them.
If you read or write about PEDs, you’re often going to confront the question of who knows best, the scientists or the athletes. This question comes up in debates about human growth hormone, or HGH: the scientists cannot find an HGH performance-enhancing benefit, but athletes (and others) keep using HGH anyway.
There are probably things we can learn from both the science and the practice of PED-using athletes, but I personally believe in the science. The “common wisdom” about what’s good for athletes is commonly wrong, whether you look at the advice Burgess Meredith famously gave to Rocky in the first “Rocky” movie (“women weaken legs!”) or more tragically, the long standing practice of some coaches denying water to football players in training camp.
I particularly doubt any ballplayer’s expertise on the subject of amphetamines. As I pointed out above, amphetamines are known to impair judgment, so I’m more likely to believe the evidence provided by the men and women in the white lab coats and less likely to believe the testimony of potentially judgment-impaired amphetamine users.
Third: in my main piece above, I put all baseball writers into two camps: the Zero-Tolerance Camp and the Tolerance Camp. It’s probably unfair of me to jam hundreds of writers into two camps – there is an ongoing debate about anabolic steroids and the Hall of Fame, but I’ve probably taken some liberties in forcing everyone into one of two Camps.
There are two writers worth mentioning who have managed to resist even my effort to polarize this debate. There’s Ken Rosenthal, who won’t vote for any Steroids Era player the first time they appear on a Hall of Fame ballot. This particular stance makes no sense to me. I understand that there’s prestige attached to election to the Hall of Fame on the first ballot. But as Rosenthal himself admits, if every writer adopted Rosenthal’s position, no reputed steroids user would get enough votes to appear on a second ballot.
Ken Davidoff makes a good argument for distinguishing between steroids use prior to and after baseball’s formal adoption of drug testing in 2005. I give Davidoff credit for taking a nuanced stand on what I consider to be a complex issue, and for successfully resisting my instinct to paint everyone as either a steroids hawk or a steroids dove. But I don’t agree with Davidoff’s selection of 2005 as a cutoff date. Baseball first explicitly banned steroids in its 2002 Collective Bargaining Agreement. Moreover, the non-prescription use of prescription drugs has been banned by baseball since 1971 . Davidoff correctly argues that we have only “haphazard” knowledge of who was and was not using anabolic steroids prior to the commencement of baseball’s drug testing program in 2005. But our post-2005 knowledge remains haphazard – all experts acknowledge that drug testing catches a small percentage of users, and at least some experts point to the likelihood that drug testing will yield some false positive results. In fairness to Davidoff, I don’t believe he has adopted a hard and fast rule on this subject – for example, he’s willing to reconsider voting for Rafael Palmeiro on his 2012 Hall of Fame ballot. But if Davidoff is looking for a bright line date to distinguish between tolerable and intolerable use of anabolic steroids, I’d suggest that he use the date February 27, 1991 – that’s the date that federal law placed anabolic steroids in Schedule III of the Controlled Substances Act, making non-prescription possession of anabolic steroids a federal crime.