Sidney is is a professor of philosophy of law at Eastern Michigan University. He has taught philosophy for 36 years, specializing in philosophy of law. He has co-edited several books and authored about 20 articles appearing in leading philosophy journals.

More Steroids, Please!

IV - THE PROPAGANDA WAR

The fuss about Mark McGuire's use of androstenedione is particularly pathetic because androstenedione is probably worth less. In the first place, this so-called "drug" is not a drug according to the Food and Drug Administration but a naturally occurring hormone. It is readily available in health food stores and some supermarkets. Mr. McGuire did not sneak into ugly dope- saturated dungeons to buy his "drug". Androstenedione is marketed in hopelessly small units (50 or 100 mg) and consequently is cheaper than cashew nuts. The International Olympic Committee, now followed sheepishly by several other organizations, has banned androstenedione. The ban is arbitrary and capricious. (1) Arbitrary, because the IOC has not done the same with other supplements generally conceded to be much more effective than androstenedione. Creatine is the best example. (2) Capricious, because neither the IOC nor the others believes androstenedione gives the athlete who uses it any advantage. Their own tentative studies have led them to that conclusion. There you have it: a legally obtained over-the-counter substance is now banned by several sports federations who don't think it gives any advantage to those who use it. Here, then, is a clear-cut case of paternalism in action - you are deprived of a substance not because it is thought to give an undeserved advantage but because the banning gang is worrying about your health. Our "leaders" could simply send athletes notices that read: "WARNING! Current research suggests that androstenedione may be bad for your health and, in any case, probably won't improve your performance. Use at your own peril." (Last year, Javier Sotomayor, the world's number one high jumper was briefly banned for using cocaine. Obviously this was because he was considered a naughty boy. Nobody thought using cocaine helped him to jump higher. In fact, it probably made him worse.)

Steroid drugs could have somewhat similar notices: "WARNING! Although steroids may improve your performance, the dangers of taking them are well-established. Among these dangers are gynecomastia, liver diseases, cancer, baldness, severe acne, decreased sperm count, shrinking of the testicles, unbearable headaches, and undesirable voice changes." It might also mention the usual litany of side-effects that are found with every medicine including the contradictory ones meant to cover all bases such as insomnia and drowsiness, constipation and diarrhea. What else is new? Do we really need daily washings and scrubbings of our brain? There are, literally, dozens of steroids that athletes know about. They know which are injectable and which are taken orally. They know the possible and likely side effects of each. They know these things much better than 99% of all physicians for reasons to be explained shortly. We need a moratorium on brain washing just as we need one on control and power.

Athletes, no matter what their age, are treated disrespect fully because they too often act like children. Indeed, professional athletes readily accept contracts with clauses that bar them from criticizing officials even in the mildest manner and allow themselves to be fined for violating these clauses. In the past they permitted coaches to dictate the length and style of their hair. They are still told how to dress, especially when "on the road" for they swallow whole the unthinking presumption that they should be role-models - ostensibly for children but, in truth, for idolizing adults. Athletes may not fraternize with their opponents and baseball players may not bet on football games nor football players on baseball games. "Good reasons" are always given for these rigid rules but the fact remains that really good reasons work by the force of rationality. It is absurd that some person designated a "Commissioner" working at the behest of franchise owners is empowered to treat thirty-five year old men with families as children.

But athletes can be easily bullied only if they ARE what they are considered. Powerlifters, curiously enough, among the most easily bullied, now sign consent forms that go something like the following. (It is curious because, unlike professional athletes, they lose little by not surrendering to the bullies.) This particular example is found on all entry blanks of an organization called USA Powerlifting:

"In consideration of the acceptance of my entry blank...I agree that any testing method which the director of this meet uses to detect the presence of strength-inducing drugs SHALL BE CONCLUSIVE. Whether I think the results of the tests are right or wrong, I agree I have no right to challenge the results...I agree to pay any attorney fee and litigation expenses incurred by any person whom I may sue in an effort to challenge this release from liability. "

I doubt that this bizarre consent form would withstand legal challenge but I doubt, too, that powerlifters will offer a challenge. Officialdom counts on this meekness and its consent forms will, in time, grow bolder.

Now it is true that not all adults are fully informed of the risks they run by using steroids, climbing mountains, and several other things. Our duty is to promulgate the risks but that is the extent of our duty and, more importantly, the extent of our right. We should not say, "This is no good for you, whether you understand or don't understand, and I/We won't permit it." This ugly way is a deep expression of arrogance but, worse, is born of a need to exult in power. There is great pleasure in telling people how to live their lives. As one who has spent most of his life exercising authority over students, I recognize, ironically, that it is a "drug". I struggle constantly to keep this vice in check. I personally have known members of important sports organizations who are fond of saying how overwhelming is the work they must do. They whine about how underappreciated they are but they will not quit. The work MUST be done. "Fine", I have replied, "I'll do it; go take a rest." They are wildly indignant. "You! Give up my post for you? It took me twenty years to reach this exalted position and you think I'd give it all up for a Johnny-come-lately like you? You must be crazy." Indeed, I must be, if I fail to understand how delicious it is to be in charge of other people's lives. The words of Lord Acton haunt the corridors of my mind whenever I hear these "good people" announce how heavy is the burden on their shoulders.

The National Institute of Drug Abuse (a division of the National Institutes of Health) is a particularly outrageous agent of propaganda. It puts out a series of childish, but very slick, glossy brochures called Mind Over Matter. The "heroine" of the series is a little girl named cutely "Sara Bellum". Get it? She's smart; you're not smart - at least not until she gets done with you. Nowhere in the series does the NIDA ever use the word "use". The implication is that if you have used drugs even once then you are an "abuser".

Inside her three feet by two feet brochure, Little Miss Bellum explains to "girls" and "guys" why it is better to do pushups than to abuse drugs. Nowhere does the good Sara ever use the words "men" or "women". She wants to be a regular guy, just like you and me. She wants to get "down to your level" so you'll be able to understand her and also know she is being straight and honest with you. Sara has other brochures, too, in which she has plenty to say against marijuana, opiates, drinking, you name it. No doubt NIH is working on other brochures featuring an army officer, Sir Ebrum, who will point out that hard studying before exams beats cheating and who concludes each of his brochures with that wise, old proverb, "Cheaters always lose". It isn't as if all this is wrong; rather it is awful drivel, so insulting that only persons crushed by power or in the habit of bowing to authority would not recognize it as such.

It is important to say why neither steroids nor marijuana are in any way comparable to cocaine or heroin. The use of heroin or cocaine should not be legal but the other two should be. Steroids and marijuana are neither habituating nor addictive. The distinction between habit and addiction is often missed, even by so-called "health professionals". A habit is a settled learned tendency to act in a certain way. "Habit" is a neutral term that does not give a clue as to whether the tendency is good or bad. Brushing one's teeth is for most people habitual, and a good thing, too, but it is not an addiction. Whereas a habit is a settled disposition to behave a certain way, an addiction is a physical dependency to a substance. Furthermore, we never use the term "addiction" neutrally but to condemn, and this is how it should be.

Bad habits are maintained because, although it isn't clear to those who don't have them, they are immensely pleasurable. In habits, unlike addictions, it is the doing, rather than some end result, that is the attraction. Cigarette smokers enjoy the inhaling, the very lighting of the cigarette, even drawing the cigarette out of the pack. All these are elements of the pleasurable habit. What is "craved" is the very doing, the smoking and not the nicotine. (Prior to 1819, nicotine was not known so people could not have craved it yet they craved smoking.)

Addictions are different. A person who injects heroin into his veins does this too infrequently to acquire a habit. He probably does this no more than once daily. Some addicts do it no more often than three or four times per week. The addict is not interested in the action of injection. He is after the experience the heroin delivers. If he could accomplish the same end-state by rubbing heroin into his skin that would satisfy him. If injecting were his goal he would take injections throughout the day even if he had nothing inside the syringe. I have never heard of a person who was habituated to injections. When we say heroin addicts "crave" heroin, we mean they crave the effects the heroin produces. When we say the heroin addict is addicted what we mean is that he is chemically dependent on heroin and suffers terribly if deprived of it. Physical agony is the nature of addiction, not habituation.

Cigarette smoking is principally a very bad habit (although, possibly nicotine is addictive, even though, as I said above, it is never craved). The AMA and FDA and their allies in the "war" against smoking prefer the term "addiction" to describe the cigarette habit because "habit" is a neutral term and the propaganda war demands condemnation. Cigarette smokers rarely experience horrible withdrawal symptoms requiring hospitalization when they try to stop, but they do suffer considerable psychological distress. It is, surprising perhaps, how much harder it is to break a habit than to break from an addiction. An addict can be put into special surroundings to "dry out" and be made "clean". This can be accomplished sometimes in only a week or two. If he is lucky, as few addicts are, and the environment to which he re turns is very favorable to normal life, he will stay "off" drugs without battling cravings. The cigarette smoker who "goes clean" (say five years without a cigarette) may remain in danger of falling back and must ever be on guard. One puff and he may regress to his old ways. Alcohol use seems to be both habitual and addictive. In the early stages of withdrawal, the alcoholic suffers a great deal of physical torment. Much later - say, after five years - the addiction is gone but the habit still lurks in the background. The alcoholic faces temptation even then, and is always in danger of falling back. But the important point is that this is so because although the addiction is broken, the habit remains buried in those neural pathways.

Now marijuana smoking is a recreational activity and the use of heroin, crack and cocaine are not. The typical social setting for marijuana use is at a party. Conceivably heroin and cocaine are recreational at the beginning of their use but not after the addiction is present. At that point, the heroin user seeks relief, not pleasure. Its use is now a very grim business. If marijuana were legal it would not be consumed with the frequency that cigarettes are because its effects are so strong that even the Department of Health and Human Services concedes that people don't need to smoke it with the frequency that they consume cigarettes to achieve the desired effects. ("Marijuana and the Cannabinoids", 1991 Third Triennual Report to Congress from the Secretary.) As with all other things, diminished frequency, diminished habituation. As it now stands, with the exception of some persons living in Jamaica, I have never heard of someone habituated to marijuana. But suppose I am wrong. A habit that is so underground, so immune to observation, that I know of no cases is hardly worth our bothering with. What matters most about marijuana is that it does not turn people into dysfunction al beings. They get up and go to work just as cigarette smokers do. About 19.4 million Americans are recreational users according to the Department of Health and Human Services. Marijuana users blend in with the "normal" population invisibly.

What the propagandists tell us is that marijuana is a gateway to harder drugs. This claim is dishonest, not merely wrong. The propagandists claim that most persons who use the hard drugs begin with marijuana. That is the extent of the gateway. The claim may be true, but what of it? What needs to be proved for the "gateway" argument is that all or most persons who use marijuana recreationally end up using the hard drugs. Since everyone knows this is false, the "gateway" argument is dishonest. The Substance Abuse and Mental Health Administration estimates that 19.4 million Americans occasionally use marijuana and 4.2 million use cocaine. Perhaps 180,000 persons use heroin. One might as well say that buying an airline ticket is a gateway to death since nearly all people who die in airplane crashes bought air line tickets shortly before they died. Obviously the objection to buying airline tickets would have to depend on the "fact" (which it isn't) that nearly all persons who buy airline tickets die in airplane crashes. Since the argument against the use of marijuana is exactly parallel to the argument against buying airline tickets we must conclude that the propagandists are dishonest, not merely wrong. They count on the fact that people will not notice the parallel. Indeed, many people do not.

The use of marijuana does not cause dysfunctionality but the use of heroin and cocaine does (and so do hallucinogens like LSD and PCP, inhalants like amyl and butyl nitrates, sedatives such as barbiturates and methaqualone and tranquilizers of various sorts). Conjointly, these result in about 485,000 emergency admittances to hospitals in a single year. That makes these drugs a concern for public health. Every steroid user would have to be admitted five times per year to match this horror. Heroin and cocaine users are a drain on social resources. More over, this destructiveness is further complicated by the desperate measures heroin and cocaine addicts take to get hold of drugs. They will kill and rob their own family members. They are immediate threats to society, not merely to themselves. That is why objecting to them is not compromising my argument against paternalism. There is no serious analogy between marijuana use and heroin use. There is even less analogy between steroid use and heroin use. Steroids are not even mildly habituating. Typical steroid users "cycle" their steroids. For example, one might use one's favorite steroid for three weeks and then "go off" for two weeks. No cigarette smoker or heroin addict can adopt such a routine. Steroid users sometimes find their source has "dried up", in which case they simply are obliged to stop. End of story. No mad shakes, no terrible cramps, no bizarre hallucinatory episodes culminating in emergency room admissions, nothing other than some loss of muscular mass and a lot of psychological misery. If the user runs out of money he does not wait desperately in dark allies to attack rich, little old la dies. He is done. End of story.

Typically, the steroid user may be injecting only once per week (it all depends on the particular steroid) and this can hardly qualify as a habit. There really is nothing to debate despite what "medical authorities" say to the contrary. If any "authority" says otherwise, ask him to compare the habituating or addicting properties of Deca-Durabolin with Anavar. Or how about Dianabol, Nolvadex, Equipoise, Cytomel, Anadrol®, Clomid, Halotestin, Cyclofenil, or any of another couple dozen steroids he has never heard of? Will he know which are taken orally, which via injection? Will he be able say how many times one can "abuse" this drug or that drug before acquiring a habit? In short, does he know anything? It is very unlikely he will know a fraction as much as several steroid "gurus" who willingly share their knowledge via Internet.  

V - STEROIDS! JUST HOW DANGEROUS ARE THEY?

When you hear that steroids can cause this or that dread problem, what exactly do you know? We know aspirin can cause severe stomach distress. That tells you little and by itself doesn't give you a reason never to use it. "Airplanes can crash and kill you." is a worthless remark. What exactly is the risk? More information, please. Statistics, sir, if you'll be so kind.

Yes, steroid use is more dangerous than taking aspirin - a lot more dangerous. But what does "a lot more" mean? In the famous aspirin study done at Framingham, aspirin was found to be a "lot more" effective than a placebo for preventing heart at tacks. The researchers called off the study for fear that they were depriving the placebo group of a valuable therapy. "A lot more" in this celebrated example meant 5% more effective. In other words, if one hundred people out of one hundred thousand who used placebos got heart attacks during the research period (over several years), only ninety-five aspirin takers got heart attacks. Most physicians don't tell their patients the statistical story for fear that their patients won't appreciate the math. But let me be kinder. Heart disease is a public health problem and not merely a matter of individual concern. A reduction of 5% annually in the total number of heart attacks that the American population experiences would be an enormous public health gain. Taking a global view instead of an individual perspective, 5% is no joke. But it is a joke when it comes to steroids. The main risks of steroids are not lethal. Even in his tirade against steroids, "The Consequences of Anabolic Steroid Abuse", Dr. David Lamb, of Ohio State University, admits "Young people should be told that very few athletes are known to have become seriously ill or to have died from steroid abuse." [Published by the Gatorade Sports Science Institute, an avowed enemy of drugs.] More over, the number of people taking steroids is so few that if every steroid user discontinued the practice the resulting drop in lethality would be trivial and there could be no marvelous public health gain. (My personal guess is that there would be one life saved per two year period.) Again, because the numbers are so low, the very substantial drop of 50% in acne, a particularly common side effect, would not be a marvelous social gain. (Perhaps there would be a drop from 4000 cases to 2000 cases each year.) And, of course, acne, a grave concern to those who have it, presents no public health concern since it isn't contagious. The number of persons developing some form of cancer or heart disease because of steroids is not known but it certainly is too low to regard as a significant contributor to the public health problem. Cancer and heart disease are matters for public health because they put a tremendous strain on our resources. All of us chip in to maintain the insurance and hospital costs. Acne, shrunken testicles, baldness, and gynecomastia are not social diseases; they are matters of individual concern. Individuals need to know the statistics (which don't exist) so they can assess the risks they run for themselves. The aforementioned Dr. Lamb warns that orally administered steroids usually cause abnormal liver function but confesses these abnormalities are usually harmless. He says "some" deaths have been reported. He says that "many" athletes have high blood pressure and also claims that "many" athletes have shrunken testicles. "Many" have poor sperm production. Athletes "have been known" to purposely crash their cars into trees under a "steroid rage". Not a single statistic occurs anywhere in the article. Right now, government and medical policy is simply to alarm us about a risk that no one can quantify. Even if steroid use became legal it is doubtful that steroids would appeal to more than two million people. Marijuana appeals only to about fifteen to twenty million people and there is no reason to suspect that steroids could ever approach marijuana in popularity. So what is the danger to America from steroids?

I am raising plenty of questions about risks but I can't give many answers. That is because the precise nature of the risks is not known. This is not remediable. The federal government has classified drugs into what it calls "schedules". Altogether there are five of these. Schedules I and II are reserved for hard drugs with no medical use. I and II are differentiated by reference to power of addiction. Steroids are Schedule III because they have recognized medical purposes and are grudgingly conceded not to be addictive. As Schedule III drugs, steroids are not permitted to be researched for performance-enhancing effects. Such a purpose is not deemed medical. Moreover, not much research is any longer being conducted for their medical value. Recent studies have used very small sample sizes, precluding stratification by age, race, or gender. Some of them have not incorporated control groups thanks to the fact that legal reasons make it hard to randomly assign subjects to treatment or placebo when one is dealing with Schedule III drugs. [For details, consult recent issues of the journal, SPORTS MEDICINE, 1997 or 1998.]

A much more important problem in assessing the dangers of steroids is that more than half of "steroids" may not be steroids. They are obtained on the black market, most commonly entering the U.S. from Mexico. Impurities are the rule. Some times plain junk altogether replaces the steroid. Even if the steroid is pure there are dozens of them with very different chemical compositions and routes of action. So, when we learn steroids are dangerous, we need to ask, "Which ones?" And are we talking about pure steroids or "steroids" (either impure or altogether fake)? Moreover, the dangers of oral drugs far exceed the dangers of those that need to be injected because they must be processed in the liver before reaching the blood. Injectables bypass that route. Some users stay away from injectables because they are painful. They knowingly prefer the risk of the orals, which can be toxic to the liver. When we are told that steroids "can" be very dangerous, we are NEVER informed of the relative dangers of the orals vis-a-vis the injectables. Commonsense alone tells us that even among the orals, the dangers must be different - different with respect to what they can do and different with respect to the frequency of their adverse effects. Neither the medical world nor the government ever bothers to differentiate these - if, in fact, they have a clue about these differences. Every steroid user, however, knows something about these differences but his choice of drugs is not easy. First, given that he obtains his drugs illegally he takes what is available. Second, prices vary widely. Steroid users are not the wealthiest segment of society. Steroid users prefer drugs that cost under $250 per month to those that cost over $400. The steroid user knowingly runs the risk that the cheaper product may have something wrong with it. NO ONE has attempted to stratify the dangers of drug use according to price. Furthermore, different steroids serve different purposes. Some are intended to make muscles more massive; some are meant to make them harder; some to create a "vascular" look; others are de signed to enhance strength without necessarily increasing size. NO ONE has attempted to stratify the dangers of drugs according to their purposes. Some steroids are "stacked" with others to produce a multiple effect. NO ONE knows the extent, if any, to which the interactions multiply the risks. Another complicating factor is that competitive athletes may have to limit their choice of steroids to those that are hard to detect. NO ONE knows whether risks can vary with that. (Although it is known that one drug, at least, nandrolone, is very mild in toxicity but very easy to detect.)

To assess the risk of steroids in a fair way one would have to compare the effects of a drug used in an appropriate dosage with the effects of wild overdosing. I know of no such study and doubt there has been any. I know of only one recent case of a world class bodybuilder who died from steroid overdose - Andreas Munzer, who died in the spring of 1996, three years prior to the time of this writing. Moreover, it is a fact that Munzer used all kinds of drugs, not just steroids, in incredible dosages. Munzer's case is well known in the steroid-using community. He had been on a death-defying track for about one year, stuffing his body to the tune of $6000 per month with common and exotic ergonomic aids of which steroids were hardly the mainstay. During these three years there have been many more deaths in several noncontact sports (basketball, for example) than have been caused by steroids. Contact sports have had many more. If steroids were legal, physicians would gradually grow more savvy about their use for performance-enhancement and, combining that knowledge with their knowledge of steroids for medical purposes, could be better guides than they now are. Undeniably, the risk of steroid use would be even lower than it already is. Everyone knows that any over-the-counter drug can be more dangerous than it has to be when taken to excess. Even vitamins taken indiscriminately can be very toxic. Why, then, should we be surprised if unmonitored, black market-obtained steroids are?

Before turning to the final section in which I discuss the argument from unfairness, I want to say a bit more about the ideological warfare. If the government wanted to allow us to make informed judgments it would present all the statistics it could marshal. It would not hide behind the idea that we poor "laymen" would only misunderstand. Thus, the first thing we need to know are base rates. Without base rates, all talk of "you are one hundred times more likely to die if..." is meaningless. Consider this purely hypothetical example. Suppose people who climb mountains are dying at the rate of ten per one hundred thousand every year while people who refrain from that activity die at the rate of only one per one hundred thousand every year. That is an enormous, statistically significant difference. But what is it really? Would you, if you were a mountain climbing enthusiast, consider for one moment giving the sport up now that you have learned the facts? To the contrary, you would take heart. You might have thought it was one hundred times more dangerous, not ten, and you are gladdened by the news. When you learn that doing something is ten times more dangerous than not doing it, this can be bad news or good news, depending on what your previous estimate was. You must first know the base rate for the general population before you can make sense of departures from the rate. In the case of steroids, since no one has base rates for many things we are being warned about, we are totally in the dark. Just how often do ordinary people get dizzy or get acne? So when we are told that steroid users suffer from acne, what exactly does that mean? Is it happening only to them? Is the increase 1000%? Not likely. 100%? I doubt it. 50%? Perhaps. And, what of it? Is the resulting incidence enough for us to declare, ""Wow! That's too often for me"? Now some steroid worries are peculiar to steroids - that's true. For example, gynecomastia (a swelling and feminizing of the breasts) and testicle shrinking. These are pretty much unheard of in the general population. Still, we don't know their incidence in the steroid population. No one does. We have nothing to go on but anecdotes. We all tend to suffer from Addiction To The Dramatic Instance. In other words, we make too much of the cases we hear about. ("I know somebody who once fell out of an airplane and didn't get hurt", etc. We report the anecdote tacked on to a "You never know what can happen" with the implication that it happens more than you might imagine.) As it happens, gynecomastia is one of the most common unwanted side-effects and it occurs in up to 50% of the athletes taking certain steroids (but not most) but only in the unregulated climate of god-knows-what-is-really-inside-that-syringe.

Our government is not one that puts its faith in the public's wisdom. It believes that secrecy is necessary in a wide variety of matters. Witness the fact that there are six million classified documents! Government maintains that national security would be compromised if most of these were made public. It does not allow impartial judges to make that assessment because it says that these judges, themselves, lack security clearance. Government is judge and jury of what we should know.

Given the hopelessness of cooperation from government sources, steroid users must, like critics of government secrecy, declare their competence in the face of astonishing resistance. STEROID USERS ARE KNOWLEDGEABLE. They have little to learn from physicians who are, for the most part, amateur dabblers in steroid chemistry. The very idea of a national institute on abuse is, to my way of thinking, an abomination. The very idea that a bunch of orthopedists should issue a Position Statement calling for harsh penalties is a disgraceful abuse of power and authority. That a bunch of bush league sports federations tries to court favor with major federations whose expertise is even less than theirs is depressing in the extreme.

Androstenedione has now been banned by most of these bush league organizations wishing to impress their betters. A team of Harvard biochemists is only now beginning to do research on the effects of androstenedione but the apple-polishers cannot wait for the results. Why bother? In their view jocks are just a bunch of jocks.

Next Installment: The Argument from Unfairness