Voice of Dissent in Drug Wars

MADISON, Wis. —  Dr. Norman Fost recently appeared on a national radio program in which the host referred to him as “the loneliest man in America.” The doctor insists this is not true.

But it might not be far off the mark.

Amid the outrage over steroid abuse in sport -- a whirlwind of drug tests, federal investigations and Congressional hearings -- Fost offers an unpopular, if not unthinkable, suggestion: Athletes should be allowed to use performance-enhancing drugs.

While this opinion prompted one anti-doping official to call him “the wacko in Wisconsin,” Fost has gained a modicum of support from colleagues, researchers and legal experts across the nation. More and more often, the media call on him for a dissenting point of view.

Even some of those pitted against him acknowledge his pedigree as a Yale-trained physician and director of the medical ethics program at the University of Wisconsin.

“It’s good to have someone who has thought enough about this to take the contrarian side,” said Dr. Alan Rogol, a University of Virginia professor who has studied anabolic steroids and opposes their use outside of medicinal applications. “Norm is a wonderful contrarian. So bright. So funny.”

This role is not a new one.

The 65-year-old Fost has questioned standard medical procedure in numerous areas during his career as a bioethicist.

The quiet measure of his words masks an utter conviction that he is right in this matter.

“I’ve never been a person who saw much value in restating conventional wisdom,” he said, adding that on the steroids issue, “everything is against me.”

The past few years have seen the establishment of national and international anti-doping agencies. More recently, in a case involving the Bay Area Laboratory Co-Operative in Burlingame, Calif., federal prosecutors charged four men with distributing performance-enhancing drugs to professional baseball and football players and Olympic athletes.

News reports have linked Barry Bonds, Gary Sheffield and Jason Giambi to BALCO. Marion Jones and Tim Montgomery have been drawn into the controversy. All have denied taking steroids.

President Bush spoke about the issue during his State of the Union address. When the Justice Department brought charges in the BALCO case, U.S. Atty. Gen. John Ashcroft appeared at a televised news conference.

“It’s important to recognize these people have an agenda,” said Rick Collins, a New York attorney who represents bodybuilders and health enthusiasts arrested for possession of steroids. “This is the new face in the war on drugs. When was the last time you saw a major press conference on a cocaine or heroin case?”

Amid the hue and cry, Fost has a request: Step back, take a breath and think.

With silver hair clipped short, a shirt and tie, gray slacks, he works from an unapologetically messy office in his university’s medical center. Boxes clutter the floor, papers are heaped upon the desk and bookcases.

His primary complaint about the anti-doping argument is that health risks associated with the newer, injectable steroids have been, in his words, wildly exaggerated.

Many of the side effects, infertility and changes in voice and hair distribution, are cosmetic or reversible, he says. To date, he says, no one has conducted the necessary long-range studies to verify more serious claims that steroid abuse leads to increased incidence of cancer and liver damage.

Fost often cites the example of football player Lyle Alzado, whose death from a brain tumor was widely attributed to steroid use. “There’s not a shred of evidence” to prove that, he said.

Anti-doping crusaders concede a lack of research but insist they have studied how anabolic steroids affect the body and have cause to fear long-term risks. Fost demands more.

“If you’re going to interfere with someone’s liberty to take drugs, you need to have a reason,” he said. “Good ethics start with good facts.”

Nor is he swayed by the argument that steroid use by sports celebrities will encourage use among young athletes, for whom the drugs can cause developmental harm. Keep them away from teenagers, he says simply.

Fost wonders why there is such concern about performance-enhancing drugs when no one seems opposed to athletes’ facing debilitating injury in everyday competition.

“We allow them to box and go down ski slopes,” he said. “We allow them to play professional football where the risk of disability is hundreds of times greater than even the wildest risks associated with steroids.”

But health concerns are only part of the steroids debate.

Under law, it is illegal to distribute or possess steroids without a doctor’s prescription, and such prescriptions are allowed only for medicinal reasons.

Almost as important to both sides are issues of merit and fairness. As social commentator George Will once 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.”

At the USC law school, professor Michael Shapiro takes Fost’s side of the argument in writing about steroid use and what he believes to be common misconceptions.

Sports have long promoted achievement through sweat and perseverance, he notes. Performance-enhancing drugs seem like an easy way out, getting something for nothing.

But Shapiro argues that steroids help augment strength and speed only when accompanied by hard work in the weight room or on the track.

“Maybe decades down the line, they will come up with a pill that will make you instantly stronger,” he said. “But right now, all of these supplements still require exceptional effort.”

Furthermore, he says, the gains are slight and in no way a substitute for natural talent. As Fost put it: “You and I could take steroids till the cows come home and we wouldn’t hit home runs.”

Anti-doping experts point out that in track and swimming, a gain of .01 seconds can mean the difference between winning and losing.

Fost and Shapiro respond by suggesting performance-enhancing drugs are part of an evolutionary process that has seen athletes take advantage of increasingly advanced equipment, nutrition and training techniques.

Fans accept the use of fiberglass vaulting poles and sleek swimsuits, Fost says. They don’t blink an eye at runners who train at high altitude to increase their hemoglobin levels.

Anyone who complains about fairness is asked why the New York Yankees are allowed to have such a big payroll or why U.S. Olympic athletes get better training facilities than competitors in poor countries.

As for records broken by athletes using steroids? Well, Fost says, records are meant to be broken.

“If Jason Giambi and Gary Sheffield both hit 25 home runs this year, is that good for sports?” he said.

So what do the bioethicist and his colleagues recommend?

They are in favor of allowing athletes to take steroids under physician’s care. Doses could be monitored. Limits could be set for allowable blood content levels.

This arrangement would be safer, they say, than the current situation in which young men and women turn to the black market and use steroids without medical supervision.

A formalized program might solve another problem.

“You wouldn’t have this constant spectacle of people trying to evade the law and law enforcement being largely incompetent,” Shapiro said. “To me, that’s an intolerable spectacle.”

While Collins, the New York attorney, does not necessarily agree that athletes should be allowed to take steroids, he does criticize sports officials for their current stance.

The overreaction, as he describes it, dates to the 1988 Seoul Olympics when 100-meter winner Ben Johnson tested positive.

“The powers that be became very frightened that the principles that underlie sport ... would be eroded or destroyed if the public were to view sports as a chemistry contest,” he said. “Sports are great but, ultimately, I guess it’s big business.”

As confident as they are of their position, those in favor of a new way of looking at steroids do not expect to change any minds. At least not in the foreseeable future.

“People go with their initial reactions and don’t think things through,” Shapiro said. “What they see is a picture in which the word ‘drugs’ pops out and when they think of drugs, they think of heroin, speed, whatever. So nobody will listen to what I’m saying. Nobody will listen to Dr. Fost.”

Sitting in his cluttered office at the hospital, Fost recalls an incident several years ago when he received an angry call from then-White House drug czar Gen. Barry R. McCaffrey.

“Talk about intimidation,” he said.

Fost says he is reluctant to take so much as a common aspirin and would never use steroids or allow his children to use them. But that does not stop him from fighting for the right to take steroids. It does not stop him from criticizing what he sees as a knee-jerk reaction.

Such is the function of a contrarian.

“I’ve always seen my role as trying to bring rational discourse to the issue,” he said. “We’re trying to think clearly here.”