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Explaining Steroids: Interview with a PED expert

Everyone has an opinion on the steroid scandal. But do we know what we're talking about?

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Dr. Charles E. Yesalis has studied the non-medical use of anabolic-androgenic steroids and other performance-enhancing drugs for over thirty years. A professor at The Pennsylvania State University, he has served as a consultant to the Drug Enforcement Administration, the Food and Drug Administration, the NFL Players Association, the U.S. Olympic Committee, and the N.C.A.A., and has testified before Congress on three occasions. He is the author of The Steroids Game, about steroid use by adolescents, and he is the editor or co-editor of two medical reference texts on performance-enhancing substances in sports.

Last week, I spoke with Dr. Yesalis about performing-enhancing substances and their use in the game of baseball. Our conversation had to await the conclusion of a three-day motorcycle ride (on his part,) and the next time I reached out, he was busy shooting at a gun range. But eventually I did get a hold of the good doctor, and he spoke openly and passionately about his area of expertise. The transcript has been lightly edited for clarity.

Q: Let's start with MLB's list of banned substances. What criteria was used to decide what is banned and what is acceptable?

A: That's not clear for any sports organization. There are some drugs on the list where we don't have really hardcore evidence that they enhance performance. Some sports outlaw marijuana. Our data on growth hormone, even though I personally believe that it is a performance enhancer, you look at some of the studies they've done, and it's unclear. Then another factor is safety. Some drugs like anabolic steroids and growth hormone, especially steroids, I don't know if they're all that dangerous. They're clearly not a major killer drug like amphetamines can be, or cocaine, or heroine, or tobacco for that matter. So for a long time those of us who are observers of this scene, the rationale for putting a drug on there is often not that clear and consistent.

Q: Do you feel that those who are making these decisions are looking more at performance enhancement or more at safety risks?

A: It may have more to do with appearances; meaning, if that drug is in the public eye and they want to act like they're on top of things, "we'd better add this to the list." And then you add the other two in: what we know about it from a performance enhancement standpoint and how safe it is.

Q: So to follow up with that, a drug like cortisone, for instance, is obviously legal and commonly used in baseball, and it's also a steroid, I understand...

A: ...Well, it's not an anabolic steroid. The molecular structure appears similar but it's like saying gasoline and orange juice are similar, they're both liquids. They're very different.

Q: So what is the difference then? What makes anabolic steroids stand out?

A: We do have a lot of data that they increase strength, that they increase muscle mass, though to my knowledge there's never been a study that shows they help you catch a baseball or hit a baseball better unless you already have that hand-eye coordination... All else being equal, Bambi and Godzilla have the hand-eye coordination of a major league baseball player, who's going to hit the ball the farthest? If you have the pitches and control of a major league pitcher already, but you add 20 pounds of muscle, that would hurt you how? "Gosh darn my fastball would be faster. Oh jeez that's terrible."

Q: And is it that the substance itself adds muscle mass, or that it helps in recovery, or that it helps being able to work out for longer periods...?

A: ...All of the above. It helps you recover from one workout to another, therefore you can work out harder and recover. It has been demonstrated to build muscle mass and build strength.

Q: To talk about today's game, where there's now a testing protocol, what sort of banned substances does it appear that players are using, and what sort of effects might they have? Is it anabolic steroids that someone like Ryan Braun is using?

A: I don't know. First of all you're starting with an assumption that baseball is serious about this. I could make an argument that lately they've become more serious; they've hired the former head of the secret service to run their program and, maybe they're very serious, but it's private, it's in-house. It's not like you have a third party organization that is not answerable to baseball at arm's length conducting all this. It's in-house, so you only know what they allow you to know.

"[Testing] is in-house, so you only know what they allow you to know."

Putting on my conspiracy hat—well, not exactly a conspiracy hat—football arguably is being very much threatened by CTE, chronic traumatic encephalopathy, and the litigation that would go with that, and that parents won't allow their children to play football, and on and on. Football, it's been alleged, has been inundated with PEDs for at least fifty years. Baseball used to be the national pasttime and one may say, "Wait a second, people enjoyed baseball decades past without players using steroids—they used amphetamines, but not steroids—we don't need to have big hulking ballplayers to make baseball popular once more. So we can clean up the image of the game and see what happens to football and maybe slip back into number one." So if that's in the head of baseball, maybe they're very serious in dealing with this problem.

OK, if you do deal with it., well, do you test for growth hormone? If you've read anything about the testing, there are some experts who are very skeptical about the reliability and validity of that test, and frankly I have great sympathy with the players' union's questioning whether they want to be open to testing on that. Even if you were tested, there's a whole bunch of human growth hormone spinoffs that to my knowledge—I'm an epidemiologist not a biochemist—present loopholes. So, historically, looking at all types of testing, there are numerous loopholes available for stimulants and anabolics and blood-boosting agents, though this last probably isn't necessary for baseball since it's such a horribly slow-moving sport.

Even if they were serious, you look at the Olympics, you really think the Olympics are drug free? You look at the NFL, you think they're drug free? So even if you had an ideal based on current standards, do you really think your sport is going to be drug free? And the force driving all that is the huge amount of money involved that athletes and even owners have to gain by making the sport more attractive, meaning (and this applies to all sports) presenting the public with bigger-than-life athletes capable of doing bigger-than-life feats, and that's what causes the multi-million dollar contracts, the huge TV contracts, filling the stadiums at high-price ticket values.

Q: So is it your opinion that it's difficult to tell—or impossible to tell—how the landscape has changed post-2005, when the testing regiment was introduced?

A: After the testing came into play, just like when it came into football, the athletes, rather than doing cowboy chemistry, they had to hire consultants like me (I've turned down every such offer) to make sure they wouldn't get caught, what to use, what not to use, regarding testing. I think it's still very, very premature to see how serious baseball really is. A skeptic like me—and I've been doing this over 30 years so I've earned my skepticism, whereas virtually none of the optimists have earned their right to be optimistic—I think it's going to take another year or two to see how many big name stars get pulled in, how they handle A-Rod and the like, if we see more harsh punishment of real stars then I would start to conclude they are serious. Which doesn't mean they're going to totally clean up, but the athletes will have to hire better consultants and be more careful. What's driving all of this is the money.

"I've earned my skepticism, whereas virtually none of the optimists have earned their right to be optimistic."

Q: Now, steroid-testing and the attempt to eradicate it from the game, is this a worthwhile and noble pursuit? Are there serious health risks we're talking about?

A: Look, you have never taken a drug that's going to be perfectly safe to all users, whether it's an over-the-counter medication or a prescription drug. They don't exist, and they probably won't exist in our lifetime. And then you say, "Well, it's relative." Are anabolic steroids a major killer drug? No they are not. I would not as an epidemiologist come even close to putting them in the same category as tobacco, cocaine, amphetamines, or heroin. No, they're not in that class. Can you hurt yourself with them? Yes, you can hurt yourself with aspirin, with ibuprofen; with sudamenafin you can kill yourself. If you take anabolic steroids in high doses for protracted periods of time it's difficult to think you could fool mother nature, that some adverse effects will not befall you. But they're not what I'd call major killer drugs. We use them in medicine, and I'd hope we're not purposefully killing our patients.

Q: Would there be a logic to changing the drug policy to allow use of certain drugs in a more responsible fashion?

A: Well, that's been proposed by some medical people over the last several decades; "controlled usage." The trouble is the innate human instinct to gain an edge. So if you and I are running this program and we say, "Well, you can use steroids but only so much a week," players will say, "Well, yeah, but if I use double that amount that'll give me my advantage again." So I'm very pessimistic about any positive impact of drug testing. I hate to see business as usual because we just use this facade, which is increasingly seen as a facade. Drug testing is used to convince low information fans that they're watching a clean sport. Well that facade is looking increasingly threadbare.

Q: So you would say that the recent evidence has shown you that testing has not been successful, not been effective?

A: No, not the recent evidence, the evidence of fifty years of testing!

Q: I know that everything on the banned list isn't a steroid, for instance; there are many kinds of substances.

A: Right.

Q: Is there a way that, to your mind, the banned list could be improved? That some things should be allowed, or that some that are allowed should be disallowed?

"I think drug testing has been a failure because of the money involved."

A: Look, that's an intelligent question, but the way I interpret it given my background is like, "How do you want to arrange the deck chairs on the Titanic?" I think drug testing has been a failure because of the money involved. The fact that the customers do not care will make it continue to be a flop, and it probably should be done away with. I think we've really reached the point where the dishonesty associated with it, this false sense of security, the odor of that is getting pretty intense.

Q: If it were done away with altogether, would you see a risk of extreme behavior? Is there an extent to which testing has a moderating effect, makes athletes tamp it down a bit?

A: Oh yeah, exactly, it tamps it down a bit. There's some limit to how much drugs they can use, what kind of drugs they can use... But what irritates me, is you have these various sports federations using drug testing decade after decade where, against evidence to the contrary, they say "We drug test, our athletes are clean." Well the hypocrisy of that makes me retch.

Q: Is there something on the horizon, either technologically or in terms of change of policy, that you foresee? What are athletes getting up to that's new?

A: If they get to the point of genetic manipulation, it's all over anyway. How close or far away that is... I'm not a geneticist. It'll eventually happen someday. You know, the trouble is, you have a lot of unscrupulous scientists sitting like vultures looking at what's falling off the medical advancement truck, seeing what could be applied to enhance human capacities and therefore used in professional or collegiate or Olympic sport; sport where there's money involved. And for every breakthrough there might be in drug testing there are seemingly way more medical breakthroughs that are being bastardized for use in sport. We take two steps up the ladder in drug testing and seemingly four steps down again.

Q: Would you say that your view represents, not a consensus, but a common feeling in the field?

[Laughs.] That's your job, not mine.

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