HS2002-03

THE NATION S NEWSPAPER

Collegiate Case Study

www.usatodaycollege.com

Injuries in major leagues skyrocket Steroid use could share blame for jump in trips to disabled list By Cesar Brioso

7

Angel says steroids 'aren't worth it'

Doctors talked Gil out of using them By Staff reports

8

Olympic-style drug testing is rigid By Dick Patrick

Steroids: Are they worth it? There are sports figures who use anabolic steroids to enhance their athletic prowess, but at what risk? Players acknowledge there is pressure to take steroids to compete. However, doctors caution that side effects from steroid use can include kidney failure, heart disease, brain tumors and impotency as well as behavioral changes. And yet, some contend that when used in lower doses there isn't a negative effect on liver function, the immune system or cardiac risk profile.

9

Build muscles, shrink careers

Using anabolic steroids means risking health and even life By Anita Manning

10

Kids, steroids don't mix

Yet many teenagers look up to ballplayers, do whatever it takes to get big(ger), strong(er) By Anita Manning

12

Case Study Expert Dr. Michael S. Bahrke Acquisitions Editor, Human Kinetics (Scientific, Technical, and Medical Division)

USA TODAY Snapshots® America’s pill takers More than 44% of Americans take prescription drugs daily. Number of prescriptions they take:

OPE

N

PU DO SH & T WN UR N CL

OS E

1 2 3 4

5 moror e

Source: American Society of HealthSystem Pharmacists

Should athletes be tested? The decision of whether or not players should be tested for steroids and how that would be implemented brings about questions of privacy, fairness and the politics of sports. This case study will review viewpoints and policies from Major League Baseball and other sports like the NFL , NBA, U.S. Olympic team, NCAA and high school sports.

Cover Story

USA TODAY poll: 79% of players want drug testing By Mel Antonen USA TODAY

Question hanging over baseball is whether players, union and owners can deal with steroids as well as economic challenges to the game

All-Star Derek Jeter is tired of the never-ending suspicions that baseball players are souped up with illegal muscle-building drugs called steroids. He knows about privacy issues but says he wants to be tested to clear the record. "I don't have a problem with getting tested because I have nothing to hide," says Jeter, shortstop for the New York Yankees. "Steroids are a big issue. If anything like a home run or any injury happens, people say it's steroids. That's not fair."

By Frank Pompa, USA TODAY

Reprinted with permission. All rights reser ved.

AS SEEN IN USA TODAY NEWS SECTION, MONDAY, JULY 8, 2002, PAGE 1A

Jeter isn't alone in his view. According to a USA TODAY poll conducted June 12-23, 79% of bigleague baseball players say they would agree to independent testing for steroids. Even though the players union has resisted testing, only 17% of the polled players back the union's stance. But 44% of players acknowledge there is some pressure to take steroids to compete in the majors.

manipulate careers with control over drug testing, voiding contracts of undesired players and looking the other way with stars.

A separate USA TODAY/CNN/ Gallup Poll shows that 86% of baseball fans say players should be tested for steroids. Almost 80% of fans say steroids have played a role in the recent rash of offensive records. Cynics note that the season home run record, which had stood for 37 years, has been broken twice in three seasons. (Last Tuesday, a record 62 home runs were hit in the majors.)

Players and owners are not getting any closer on thorny economic issues such as revenue sharing among teams, luxury taxes on high payrolls and salary caps. Baseball's competitive balance is in shambles. Ticket sales are plummeting.

There also has been an alarming increase in injuries. James Andrews, an or thopedist in Birmingham, Ala., who treats many professional athletes, says he has never seen such a rush of muscletendon injuries and thinks it could be related to steroid use. A USA TODAY database study shows that trips to the disabled list for major leaguers increased 32% from 1992 to 2001. So if players, fans and the league all want it, why does testing remain out of reach? The short answer is baseball politics. Years of battles over economic issues have created long-running distrust between owners and players. The two sides must agree on drug testing and how it is implemented in collective bargaining before it can become a reality. The relationship between the sides is so acrimonious that there have been few agreements -- and eight work stoppages -- since 1972. According to numerous interviews, players want to know before they agree to testing how the tests will be administered and by whom. They worry about privacy matters and what the punishment would be for players who test positive. And they worry that owners might

Baseball's Basic Agreement expired in November. The players are preparing for a strike in August, and union leaders are meeting in Chicago today, a day before the AllStar Game in Milwaukee, to set a strike date.

Drug testing could end up a bargaining chip, say players and union leaders. It certainly will be viewed as less important by both sides than the issues involving the basic financial underpinnings of the game. A testing solution won't happen if both sides are at each other's throats over money issues. "I don't know if steroids testing is going to be part of the agreement," says Yankees relief pitcher Mike Stanton, the team's player representative. "I don't want to belittle its importance, but there are a lot of issues on the table that USA TODAY will come before steroids. And the steroids issue is not as easy as saying yes or no. There is legal stuff." The players say they don't trust the major league office to administer the tests fairly. The issue of punishment for a positive result or refusal to take a test needs to be bargained. Players say they also have concerns over what is tested for and when they are tested. Colorado Rockies infielder Todd Zeile says the owners must prove they can do the tests fairly. Still, he wants a deal. "The sad part is that the issues I hear discussed are whether (using steroids) is taking away from the level playing field or whether there are long-term effects to this stuff," Zeile says. "I never hear anybody talking about the

Reprinted with permission. All rights reser ved.

Page 2

Steroids Case Study AS SEEN IN USA TODAY NEWS SECTION, MONDAY, JULY 8, 2002, PAGE 1A

Independent testing popular but would need approval of union, owners morality or the ethics or the integrity of the game. It's cheating in every sense." Anaheim Angels outfielder Garret Anderson is opposed to testing, calling it an invasion of privacy. Yet, because his home runs have doubled since he hit 16 his rookie season of 1995, Anderson says he gets falsely accused of using steroids. "You get into a situation of, 'Where's it going to end?' " he says. "It's an invasion of privacy. Once you start doing that, then you jump to other things." What if a testing program assured anonymity? "I wouldn't trust it," Anderson says. "Things come out. There is just no way you can have 100% anonymity unless you say you're going to sue somebody for a million dollars if they say something. Who knows? You may get released and don't even know why. . . . Whatever they may find in your blood. There's no way they can convince me that it's 100% that nobody's going to know." St. Louis Cardinals manager Tony La Russa scoffs at that notion. "I hear people talk about privacy issues. If you want privacy, go play semipro ball. (Drug use) hurts baseball. Why should we pay millions of dollars to these guys and have them go on the disabled list?"

How other sports handle testing Minor league baseball Testing: All players are tested for amphetamines, cocaine, LSD, marijuana, opiates, PCP, Ecstasy, alcohol, steroids and androstenedione. Punishment: First-time offenders are subject to education, treatment and counseling and placed in a program where there is more random testing. Repeat offenders are subject to various actions; five positive tests require a suspension. NFL Testing: All players tested once during preseason for steroids, cocaine, marijuana, opiates, PCP, ephedrine. Testing continues year-round with seven or eight players picked randomly from each team every week. There also are random offseason tests. Punishment: A first-time offender is suspended for four games without pay. A second-time offender gets a six-game suspension without pay, and a third offense draws a year's suspension without pay. NBA Testing: Rookies get tested four times a year for amphetamines, cocaine, LSD, opiates, marijuana, PCP and steroids. Punishment: For steroids, the first offense brings a five-game suspension and placement in the league's drug treatment program. A second offense gets a 10-game suspension, and a third brings a 25-game suspension.

Money matters Fans polled by USA TODAY clearly voiced their support of testing. "I'm sure players take steroids," says Travis Hopkins, an accountant and a Baltimore Orioles fan from Woodbridge, Va. "I wish they wouldn't, but I understand they are taking them to make money and get into the history books." Penn State professor, author and drug testing expert Chuck Yesalis, says that money is the motivation for players using steroids and for owners not being genuinely interested in ending their use. Players stand to make millions if steroids improve their stats. Owners will make more money if attendance and TV revenue rise in response to a home run splurge or an improved team record. "People say, 'What are we going to do about (the drug problem)?' " Yesalis says. "The history of doping leads me to say, 'Nothing.' "Unless the fans turn off their television sets or stop going to stadia, nothing's going to happen. Sports aren't going to

U.S. Olympic team Testing: Steroids, diuretics, narcotics, peptide hormones (EPO), mimetics and analogues (HGH and IGF-1 fall into this category), stimulants, blood doping, plasma expanders. Also prohibited in certain circumstances (in competition, usually): alcohol, beta-blockers, marijuana, local anesthetics and glucocorticosteroids. Erythropotein (EPO) is tested for at certain events, including the most recent Olympics in Sydney and Salt Lake City. Punishment: Penalties vary by sport and by substance. First-time offenders can receive as little as a public warning or as much as a two-year suspension. In 2001 a diver received a two-month suspension for using ephedrine, a track athlete received a public warning for the same offense and a cyclist received a three-month suspension. All were first-time offenders who tested positive at events. NCAA Testing: A year-around, on-campus, random program tests for anabolic steroids in Division I football and track and field and Division II football and baseball. Every college player is tested at least once a year. Besides steroids and diuretics, testing at NCAA championships and bowl games includes stimulants and street drugs. A positive test results in loss of eligibility for one year.

do anything unless the multibillion-dollar sport industry is threatened. The only way it can be threatened is by diminished market share." Estimates vary on how many players use steroids. Earlier this summer, retired MVPs Ken Caminiti and Jose Canseco admitted they had used steroids and charged that steroids are rampant in baseball. Caminiti said that at least half of the players use steroids. Canseco said the number was closer to 85%. Players disputed these numbers, and even Caminiti backed away from his estimate. Still, as USA TODAY's poll indicates, players do believe a number of their ranks are using steroids. "I feel cheated if everyone's on steroids," Chicago White Sox first baseman Frank Thomas says. "Baseball needs to do something." The issue of performance-enhancing drugs became national news in 1998. That's when St. Louis slugger Mark McGwire admitted using androstenedione, a weight-lifting supplement that can be bought over the counter, when he hit a season record of 70 homers. "There's no doubt in my mind that Mark didn't do anything illegal," La Russa says. But, he adds, testing is

Reprinted with permission. All rights reser ved.

Page 3

Steroids Case Study AS SEEN IN USA TODAY NEWS SECTION, MONDAY, JULY 8, 2002, PAGE 1A

What major league players think Results of a poll of major league players taken between June 12 and June 23 with 556 of the 750 players on rosters answering at least one question. Most would accept independent tests Would you accept independent testing for steroids and performanceenhancing drugs? Yes

79%

4%

17%

Depends on if union gives OK

No

They think less than half of players use What portion of major league baseball players do you think use steroids or performanceenhancing drugs? All 0% More than half 10% Half 4% Fewer than half 75% None 3% Almost half feel pressure to use Do players feel pressured to take steroids and performance-enhancing drugs to compete at the major league level? Strongly agree

7% 37% 34%

Agree Disagree Strongly disagree

11%

Source:Sports Exchange By Adrienne Lewis, USA TODAY

needed "so that comparisons (of players) from generation to generation can be drawn as legitimately as possible. We're talking about the game's integrity." San Diego Padres general manager Kevin Towers says steroids are "prevalent" in the game and too many players are gaining 20-30 pounds over the winter, a surefire sign of someone on steroids. Most current players say steroids are used in the game but label claims by Caminiti and Canseco as outrageous. The USA TODAY poll showed that 75% of players believed less than half of major leaguers used steroids; only 3% believed no one used them. "Half the players? Come on," Oakland Athletics outfielder David Justice says. "I look around this clubhouse, and I don't see anybody with the signs of steroids use. I don't know of anyone who came to camp 20-30 pounds heavier."

Finding a testing solution The owners and players talked about steroids testing during a June 20 meeting in New York. In February the owners offered an 11-page proposal that calls for random testing three times a year. The union hasn't responded. "The ball is in their court," says Rob Manfred, Major League Baseball's vice president of labor relations. "This is a high-priority issue." The only man who doesn't seem to think there is much of a problem is Don Fehr, the head of the Major League Baseball Players Association. He says the current system allows for steroid testing of players, assuming a team has

"reasonable cause." No player has been tested for "reasonable cause." Manfred suggests that the steroid issue be settled separately from the economic issues so "we could have an agreement tomorrow." But Fehr, who will spend the next month traveling to update the 30 teams on the labor talks and get input on steroids, says removing the testing issue from the economics debate "is possible, but I am not sure how practical it would be."

What fans think How many players do you think use drugs? All 0% More than half

12% 24%

About half Less than half

56%

None 2% Should players be tested? Yes, should No, should not

86%

12%

Are drugs a major contributor to record performances in recent years? Major contributor Minor contributor

33% 45% 18%

Not a contributor Fehr says he will do his Source: Results of a USA TODAY/CNN/Gallup poll of 408 baseball fans conducted June 7-8, (Margin own research on players' of error ± 5%): concerns about testing By Adrienne Lewis, USA TODAY and will not discuss the issue publicly. Last month he told a U.S. Senate Consumer Affairs Subcommittee led by Byron Dorgan, D-N.D., that steroid testing will be a key part of negotiations.

The players support their union leaders but are serious about drug testing. "I think it's going to get done," Baltimore's Jeff Conine says. "They work for us." The steroid effect Anabolic steroids stimulate muscle growth, even without diet and activity, and help athletes recover from injury faster. It is against federal law to use steroids without a prescription. President Bush signed a bill into law in 1990 that put steroids in the same classification as amphetamines, methamphetamines, opium and morphine. Simple possession of steroids is punishable by one year in prison and/or a minimum fine of $1,000. Doctors can prescribe steroids for conditions such as AIDS. Studies shows that side effects of steroid use can include kidney failure, heart disease, brain tumors and impotency as well as behavioral changes such as violent rages, depression, even schizophrenia. In addition to the 20-to-30-pound offseason muscle-mass gain, signs of steroid use include a perfectly sculpted body, mood swings and acne on the back. Without steroids, a player on a vigorous weight program

Reprinted with permission. All rights reser ved.

Page 4

Steroids Case Study AS SEEN IN USA TODAY NEWS SECTION, MONDAY, JULY 8, 2002, PAGE 1A

for five months in the offseason would be doing "very good" to gain 10 pounds of muscle mass, says Tim Bishop, the Baltimore Orioles strength coach. And that would be if the athlete were lifting four times a week for two hours each session. "Anything more than that, it's a sure sign that something else is going on," Bishop says. Steroids also could lead to an increase in injuries, especially to joints that can't handle the unnatural growth in muscle. According to a USA TODAY database study, injuries to joints in the majors increased 58% in the last 10 years. All other injuries increased 5%. Yet ask the Yankees' Jason Giambi about steroids testing, and he gets angry. He doesn't like it when anyone links injuries to steroid use. "Baseball players have been getting hurt for a hundred years," Giambi says. "It's stupid for people to make the connection to steroids. "People should know that players are working hard. They have trainers. They have people helping them plan their diets, even cooking for them. You can't just take a pill and expect to hit home runs. You have to have talent. Steroids don't help you hit a baseball." But, as Bishop says, extra muscle helps: "Added strength behind a mis-hit fly ball to the warning track might send it over the fence." There are many players who have drawn whispers about their sudden burst in size, including the San Francisco Giants' Barry Bonds, who set a record with 73 home runs last season, as well as the Chicago Cubs' Sammy Sosa and the Seattle Mariners' Bret Boone. Bonds denies using steroids and says he can be tested at any time. The same for Sosa. Boone, 33, gained 25 pounds before the 2001 season, then had a career-high 37 homers and 141 RBI for the Mariners. His career high in homers had been 24. He denies using steroids, but he didn't condemn them last month during an interview with Playboy. "Who is to say someone's wrong for doing it?" Boone is quoted as saying. "I don't know if they're good or bad. If you abuse anything, there are going to be effects down the road. If steroids are done in moderation, done correctly and safely, it might be an option."

could go to independent testing, as the International Olympic Committee did in 2000 with the formation of the World Anti-Doping Agency. (The U.S. Olympic Committee established a similar organization.) Drug-testing experts hope baseball breaks the mold in domestic sports with independent testing. Both agencies want to talk to baseball officials about the possibilities. "This could be a seminal moment," says Gary Wadler, a physician and author of books on performance-enhancing drugs. "This may be the right time for independent testing in pro-sports." The main problem with in-house testing is that it is inherently a conflict of interest. Teams and the league have an interest in seeing their stars producing on the field and not suspended for using illegal substances. The temptation to cover up a positive result for a star or key player becomes too great. When the IOC and the USOC supervised testing, there was documented evidence of coverups. "Everyone knows steroids is going on in baseball," says Dick Pound, president of the world doping agency. "The problem for the owners is how do you keep the gladiators on the field for 160-some games a year. "If baseball does the test, you'll get the NFL version: 'Now, Moose, you understand we're very much against steroids. And we're going to have a surprise test Sept. 22. That shows you how serious we are and you're forewarned.' " One thing is certain: Until baseball has a steroids-testing policy, fans are going to speculate on who is and isn't using steroids. "The game should be steroids-free, but there are millions of dollars involved," says Vince Troisi, a telephone lineman from Philadelphia and a Phillies fan. Says his friend, Victor Hnatczenko, a security officer from Philadelphia: "Look at Barry Bonds. He never put up more than 35 to 40 home runs (a year) in his career." "And now he's breaking the home run records," Troisi interjects. "Isn't it funny how Roger Maris' (season) home run record stood for 37 years? Now it's been broken twice in three years." Contributing: Dick Patrick, David Leon Moore, Bob Nightengale

Conflicts of interest If baseball opts for testing, there are two choices. The sport could police itself, as the NFL and NBA do, or baseball

Reprinted with permission. All rights reser ved.

Page 5

Behind the Story: A Reporter's Notebook The 2002 baseball season will be remembered in part as the season that brought steroids testing to the forefront.

Mel Antonen Reporter, Sports

Last February, baseball was without a program to test for performance-enhancing drugs as team owners pushed for a program that would allow random testing three times a year.

The issue of no drug-testing program in baseball became a national debate when former players Jose Canseco and Ken Caminiti, each of whom had won an MVP award, made allegations that baseball was overwhelmed with steroids. Caminiti said that 50% of the players took the illegal drug while Canseco said the number was closer to 80%. Owners were pushing the plan. The union's leaders were mum on the subject. There was really no way to accurately find out the amount of steroids use in baseball, but since the issue was part of the Basic Agreement - a legal contract between the owners and the players union - the USA TODAY plan was to poll players about whether steroids testing would be a good thing for baseball. We didn't know what to expect, but the results showed that 79% of the players wanted to be tested. And, the reasoning made sense: Players were tired of the accusations that they weren't playing an honest game.

"Every time, there's a home run or an injury, the discussion turns to steroids,'' said New York Yankees shortstop Derek Jeter. Of course, getting a drug-testing program isn't as easy as it sounds. Players were concerned about civil rights, and rightfully so. They were worried how the tests would be administered, who would do the work and the privacy and punishment issues. As the summer wore on, the owners and players eventually got together on a plan. Baseball's program works like this: In 2003, players will be tested and if 5% or more test positive, mandatory testing will take place the next two seasons. If less than 2.5% test positive in consecutive years, mandatory testing will be dropped. The program brings questions that are worth discussing: Does this agreement say that if there is small number of players using steroids, it is not a problem in baseball? In baseball, as it all sports, should independent testing be used? How much credibility does a program have if testing is done from within? Mel Antonen, 46, a native of Lake Norden, S.D., and a graduate of Augustana College in Sioux Falls, S.D., has covered baseball at USA TODAY for 16 years. Previously, he was a general-assignment reporter at the Argus Leader, a newspaper in Sioux Falls, covering politics, agriculture and sports.

Reprinted with permission. All rights reser ved.

Page 6

AS SEEN IN USA TODAY SPORTS SECTION, MONDAY, JULY 8, 2002, PAGE 1C

Injuries in major leagues skyrocket Take me out of the ballgame

Steroid use could share blame for jump in trips to disabled list

From 1994 to 2001, baseball injuries increased dramatically, especially joint injuries, which some experts associate as possible consequences of steroid use. +58% +55%

+32%

By Cesar Brioso USA TODAY

+15% +5%

Injuries in major league baseball are up, way up. USA TODAY's exclusive database research comparing the 1992 and 2001 seasons found that while major league roster spots increased 15% from 650 to 750 as the result of expansion in 1993 and '98, the number of trips to the disabled list increased 32%. Days missed because of injuries increased 55% in the same period. In 1992 major league players went on the disabled list 352 times. Last season there were 465 DL trips. In 1992 major leaguers spent 17,920 days on the DL. Last season injury days jumped to 27,779. "When you look at it, that's a significant increase," said Dr. Marc Galloway, associate director at the Cincinnati Sportsmedicine and Orthopaedic Center. "Seeing an increase like this would stimulate me to ask, 'Why is this occurring?' " In the wake of Ken Caminiti's recent pronouncement that half of major leaguers use steroids, national attention has focused on just how widespread the use of performanceenhancing drugs is in baseball. In a USA TODAY poll of major league players conducted last month, 89% said there was some steroid use in baseball.

Roster spots

Disabled list trips

Injury days

Large-joint injuries1

Other injuries2

1 – Includes ankle, elbow, hip, knee, shoulder and wrist 2 – Includes back, hand, foot, neck, ribcage, broken bones, fractures Source: USA TODAY research

By Julie Snider, USA TODAY

During the last 30 years, however, multiple cases associating steroid use with tendon and ligament damage have focused attention on steroids' role in large-joint injuries such as those to ankles, elbows, knees and shoulders. Comparing DL trips from 1992 to 2001, the number of large-joint injuries increased 58% (from 178 to 281), while DL visits for all other injuries, including head, neck, back, ribs, hand and foot, increased only 5% (from 174 to 182). "There seems to be a disproportionate increase in injuries one might expect to see in persons who are using large quantities of steroids," said Dr. Glen Hanson, acting director of the National Institute on Drug Abuse. "Although there are other potential explanations, this is one that should be considered."

Although doctors say steroid use could be a factor in baseball's increased disabled-list trips, they also point to aggressive, year-round weight training, improved injury diagnosis and increased caution with injuries because of the millions invested in player salaries. "Of all the potential health effects of anabolic steroids, if I were to rank the most difficult to deal with, it would be muscular-skeletal injuries," said Dr. Charles Yesalis, professor of health and human development at Penn State University. "It would be wrong in my judgment to say we know that part of (the increase in injuries in baseball) is due to anabolic steroids," Yesalis said. "You don't know what percent of people used them."

Reprinted with permission. All rights reser ved.

Page 7

AS SEEN IN USA TODAY SPORTS SECTION, MONDAY, JULY 8, 2002, PAGE 8C

Angel says steroids 'aren't worth it' Doctors talked Gil out of using them From staff reports With the recent rise in power numbers in baseball, many players are faced with a dilemma: Lose your job to a power hitter, or take a performanceenhancing drug to bulk yourself up and compete. A survey of 556 major league players conducted by USA TODAY between June 12-23 showed that 44% believe there is pressure to use steroids to compete at the major league level. Anaheim Angels infielder Benji Gil faced that pressure. He says he considered using steroids at the end of the 1999 season when he was stuck in Class AAA. After spending parts of four nondescript major league seasons with the Texas Rangers, he bounced around the minors for two years. He was worried his career was going nowhere. "It seemed like my last opportunity so I contemplated steroid use," he says. "There didn't seem to be any interest in bringing me to spring training so I was like, 'Well, what do I need to do?' "I talked to people about steroids. They just said, 'You know what? It's not worth the risk.' " He says he didn't approach players for advice. "To be honest, I've never witnessed anyone doing it, so I would never go and ask someone, even if people think that they are using steroids," he says. "I would feel too

uncomfortable to go up to somebody that you don't know for a fact is using and ask them such a personal question." Gil says he spoke to two doctors and a trainer outside of baseball. "The doctors told me it's not smart," he says. "There are long-term effects that we don't know about. And there's no way we can know. Unless we have humans to study long-term effects, there's no way to know." "The trainer said if you eat well and don't consume a lot of alcohol and try to keep your body pure and work out hard, it may not give you the same results (as steroids), but it's pretty similar." "I just figured it wasn't worth it. At the time, I was married and hadn't started a family. The doctors said they don't know if any problems might be passed on to my children." Gil supports testing personally but sees it as an issue that the players' union should deal with. "It's a touchy subject with players," he says. "I wouldn't mind being tested. But we (the union) have to be as one. If some people have a problem with it, maybe there shouldn't be." The Angels invited Gil to spring training in 2000. He's in his third season with them and is batting .324 with two home runs and 11 RBI in 26 games.

On the rise Of the 352 trips major leaguers made to the disabled list in 1992, 178 (51%) were for injuries to large joints. Of the 465 trips to the DL last season, 281 (61%) were for large-joint injuries. 1992 DL visits 70 51 24 11 18 4 174

Injury Shoulder Elbow Knee Ankle Wrist Hip Others

2001 DL visits 129 71 45 18 14 4 184

The number of injuries identifies as tendonor ligament-related also jumped from 1992 to 2001. Injury Tendon/ligament

1992 45

2001 146

From 1992 to 2001, visits to the disabled list and says missed because of injuries have increased steadily. Injury DL trips Injury days

1992 352 17,920

1997 414 22,341

2001 465 27,779

Slowing down? Through the All-Star break this season, there have been fewer visits to the disabled list compared with the same time last season. But the number of injuries identified as tendons or ligaments has increased. Injury DL visits Large-joint injuries Injury days Tendon/ligament

1992 367 281 24,734 76

2001 306 174 14,166 101

Contributing: David Leon Moore

Reprinted with permission. All rights reser ved.

Page 8

AS SEEN IN USA TODAY SPORTS SECTION, MONDAY, JULY 8, 2002, PAGE 8C

Olympic-style drug testing is rigid By Dick Patrick USA TODAY If Major League Baseball were to adopt Olympicstyle drug testing for performance-enhancing substances, players could encounter a shocking change. There is no random testing in the majors for steroids or other performance-enhancing drugs. In contrast, athletes in Olympic sports are subject to year-round, no-notice testing. Athletes call it "knock and pee." Testers arrive at a residence with their kits, and athletes have to provide a urine sample immediately. The U.S. Anti-Doping Agency, founded in October 2000, conducted about 1,450 out-of-competition tests last year and plans to increase the number to 4,000 by 2004. Out-of-competition testing started in the late 1980s and early '90s after Canadian sprinter Ben Johnson's positive steroid test at the 1988 Olympics cost him the gold medal in the 100 meters. A Canadian hearing revealed a fall-winter-spring steroid program that allowed him to pass dozens of in-competition tests during the summer.

Testers can arrive at inconvenient times. A couple of years ago miler Jim Spivey was preparing to take his son, Sebastian, to preschool when testers for the international track federation knocked on the door of his Chicago home. "Three people are at the door," Spivey says. "I'm thinking 'Arrrr.' It was 8:53 (a.m.) and Sebastian was due at school at 9:15. So I said, 'Sebastian, this is a day you don't go to preschool.' " Major leaguers might also complain about perceived loss of freedom. Athletes in USADA's out-ofcompetition pool are required to inform the agency if they are leaving their main residence for more than three days at a time. If testers can't locate a selected athlete at his/her main residence and the athlete has failed to notify USADA of a departure, the athlete can be charged with a missed test. Three missed tests within 18 months, and an athlete is suspended for two years. Deena Drossin, the U.S. record holder for 10,000 meters on the track, spends "hours" each year filling out forms where she can be located. "It's monotonous, tedious," says Drossin, who once had to give a urine specimen during a graduation party she hosted. "But being a drug-free, professional athlete, it's your responsibility. You want your sport to be seen as pure. "It can be inconvenient and embarrassing. But it's worth it, even if they catch only a couple of people a year to keep the playing field more level. That's still beneficial and better than catching no one."

Reprinted with permission. All rights reser ved.

Page 9

AS SEEN IN USA TODAY SPORTS SECTION, MONDAY, JULY 8, 2002, PAGE 3C

Build muscles, shrink careers Using anabolic steroids means risking health and even life By Anita Manning USA TODAY Sports figures who use anabolic steroids to enhance their athletic prowess might build bigger muscles, but they also might be heading for health problems that could shorten their careers, and maybe their lives, experts say.

The effects of steroids on the body Anabolic steroids are synthetic derivatives of testosterone, the male sex hormone. Taken in conjunction with a high-protein diet and a high-level exercise regimen, anabolics can improve an athlete’s strength, power and endurance. By themselves steroids don’t increase muscle mass. But used by someone lifting heavily, steroids can produce larger and more powerful muscles. Taken orally, by injection, or by patch, the drugs enable an athlete to work harder and longer than normal because of the increase of testosterone in the system. But abuse can lead to serious health issues.

Ability to train longer and harder (with a shorter recovery rate)

Thinning hair (women)

Aggression Acne Deepened voice (women)

Breast development (men) Decreased breast size (women)

Anabolic steroids -- synthetic versions of male hormones -- are prescription drugs developed to Early end to teenagers’ treat a condition in which the bone growth testes don't produce enough testosterone, resulting in delayed puberty or impotence. They are also used to treat wasting away in patients who have AIDS or other conditions. They are entirely different from corticosteroids, drugs used to treat swelling and inflammation in diseases such as arthritis.

Liver damage

The National Institute on Drug Abuse says the drugs interfere with normal hormone production, causing a kind of drug-induced sex change -- men can become feminized, with shrunken testicles and growth of breasts, while women might grow body hair and develop lower voices. Both genders can experience male-pattern baldness and acne. Some studies suggest high doses of steroids also can affect the personality, leading to what the institute calls "homicidal rage, mania and delusion." And those are just the noticeable problems, says Gary Wadler, assistant professor of clinical medicine at New York University School of Medicine. "Many side effects may not be evident for weeks, months, years, decades."

Facial and body hair (women)

Heart disease and stroke Better muscle definition Increased muscle mass and weight

Increased sex drive Shrunken testicles and reduced sperm production (men) Enlarged clitoris (women)

Source: National Institute on Drug Abuse

Like the male hormone testosterone, anabolic steroids promote muscle growth in both men and women, and it is because of this that they have been used, legally or illegally, by athletes around the world for decades.

Balding (men)

By Bob Laird, USA TODAY

Long-term consequences may include stroke, heart attack, high cholesterol and liver tumors, says Wadler, who notes there are reports in medical literature of 15-20 premature deaths and a similar number of heart attacks in people in their 20s and 30s who used steroids. When used by adolescents, steroids can permanently stunt growth. But there are no definitive studies to confirm those fears, and some sports medicine experts say steroids used by adults in moderation might not be so risky after all. Miami Research Associates' Douglas Kalman, who has published papers on performance-enhancing supplements and counsels athletes about nutrition, says studies appear to show that when 300 milligrams or less a week are used, "there does not seem to be any negative effect on liver function, the immune system or cardiac risk profile." While high doses might be harmful, he says, the data show "more conservative uses of steroids might be not as unhealthy as once thought." While all drugs carry risks, says exercise physiologist Jose Antonio, author of Sports Supplements, "millions of athletes have used anabolic steroids regularly

Reprinted with permission. All rights reser ved.

Page 10

Steroids Case Study AS SEEN IN USA TODAY SPORTS SECTION, MONDAY, JULY 8, 2002, PAGE 3C

since the 1950s. At this point there is no evidence athletes are dying of all these maladies people have claimed." Moderate use for a couple of months increases muscle mass with "minimal side effects," he says. "Now, if you do it every day of the year, yeah, that's stupid. . . . You've just got to be smart." Many unknowns But athletes are aware of the risks. "Everybody knows the consequences," Seattle Mariners outfielder Mike Cameron says. "I've got two little kids who want to see their father grow up." Any discussion of risks and benefits of steroid use is clouded by a lack of data. Because the drugs are illegal, scientists don't know who is using them, what the effects of different doses are, how long they can be taken before causing side effects or what happens when they're taken with other drugs. "Steroid use is like a black box," says orthopedic surgeon James Andrews of Birmingham, Ala. "When athletes come in with injuries, we don't know the true history, because it's secret. I don't think we've done a good job as sports medicine physicians to delve into this black box to see how common it is and how it relates to the injuries we see."

Andrews, who treats many professional athletes, says he is seeing an increase in the number and severity of joint injuries involving tendons and ligaments. He can't attribute these to steroid use but notes that enlarged muscles put extra stress on the tendons and ligaments that hold them in place. "We see four to five times increased incidence in tendon and muscle ruptures in my practice compared to what we saw 10 years ago," he says. Hamstring pulls, once a relatively minor problem, have become more severe. "Not only do they pull them, but they tear them in two," he says. Achilles' tendon ruptures are more common, as are ruptures of biceps and triceps tendons. "It may be there's better recognition now or more athletes," he says. "There could be a lot of factors, but (steroid use) could be one of the risk factors." Many players say they don't want to take that risk. "Guys do them, but I don't," says New York Yankees outfielder Shane Spencer. "I think, 'Do I want to be crippled when I am done with baseball?' I make good money now. I don't need to risk my health to make more."

Reprinted with permission. All rights reser ved.

Page 11

AS SEEN IN USA TODAY SPORTS SECTION, TUESDAY, JULY 9, 2002, PAGE 1C

Illustration by Sam Ward, USA TODAY

Kids, steroids don't mix Yet many teenagers look up to ballplayers, do whatever it takes to get big(ger), strong(er) By Anita Manning USA TODAY Teenagers, looking up to those elite athletes whose muscles ripple with steroid-enhanced power, are picking up some dangerous training tips, health experts warn. Several national youth surveys estimate steroid use by high school boys at 4%-6%, up to 12% in one study, and about 2% for girls. And the numbers are rising. "I'd say 500,000 to 600,000 kids in the U.S. have used these drugs at

some time," says researcher Charles Yesalis, professor of exercise and sport science at Penn State. "Right now steroid use is at an all-time high." One reason, experts say, is the example set by professional and elite athletes. After Mark McGwire set a record for homers in a season in 1998 and admitted using the legal supplement androstenedione, a steroid substitute, sales jumped 1,000% and steroid use by teens of high school age crept upward. Among high school seniors, disapproval of steroids dropped from

Reprinted with permission. All rights reser ved.

Page 12

Steroids Case Study AS SEEN IN USA TODAY SPORTS SECTION, TUESDAY, JULY 9, 2002, PAGE 1C

91% in 1997 to 86% in 2001 while the belief that steroids pose a great risk fell from 67% in 1997 to 59% in 2001, according to the 2001 Monitoring the Future Survey conducted by the University of Michigan's Institute for Social Research and sponsored by the National Institute on Drug Abuse. "Athletes are cultural icons, and some have great influence," says orthopedic surgeon Nicholas DiNubile, team doctor for the NBA's Philadelphia 76ers. "They can use it in a positive or negative way, but it's not neutral. They're more than athletes." The topic became front-page news again this year when retired MVPs Jose Canseco and Ken Caminiti admitted using steroids. A poll of 556 big-leaguers conducted by USA TODAY in June found 89% believe there is some steroid use in the game, 10% believe more than half of their peers are users and 44% feel pressure to use steroids to compete. A separate USA TODAY/CNN/Gallup poll of baseball fans found 78% believe steroids contribute to the recent glut of offensive records. The season homer record, which stood for 37 years, has been surpassed six times in the last four seasons. A record 62 homers were hit last Tuesday in one day of games. "I'll never hear that kind of number without wondering" whether performance-enhancing drugs made it possible, DiNubile says. In USA TODAY's poll of players, 79% support independent steroids testing. Others have less concern. "If guys are doing it, they're grown men," Anaheim outfielder Garret Anderson says. "Everybody is entitled to make their own decisions." Colorado outfielder Larry Walker agrees: "I don't worry about what guys are doing. We've got better things to worry about in this game than that. This isn't the Olympics. If guys want to use andro and creatine and all that stuff, it's all right." But noted orthopedic surgeon James Andrews, who treats pro and amateur athletes in Birmingham, Ala., believes young players model themselves after their grown-up sports heroes. "Whatever is being done at the professional level is being handed down rapidly to the collegiate level, the high school level and the prehigh school level." Some players agree. Chicago White Sox shortstop Royce Clayton favors testing: "It sends a message that steroids are a substance you don't want to mess around with and that there is no place for them in the game. . . . We are role models, and that's the most

important thing a player has to understand. As soon as we test and the game is clean, the better it will be for everybody." As kids use steroids, adults look other way While some doctors and researchers believe moderate steroid use in adults can have positive results with few side effects, almost all doctors agree steroids are dangerous for children and teens. But steroid use continues to rise among youngsters. Yesalis, author of Performance Enhancing Substances in Sport and Exercise, cites a study published in 2000 that found prevalent use among eighth-graders similar to that of high school seniors. "We've shown use down to seventh-grade level," he says. "It's scary for anybody to use these drugs, but in particular women and children." A 1999 Youth Risk Behavior Surveillance study by the Centers for Disease Control and the 2001 Monitoring the Future survey both show steady growth in steroid use by eighth- to 12th-graders. It is not only young athletes who use them, Yesalis says. Because steroids can help turn a 100-pound weakling into a buff beach stud, they "make a young person feel more popular, more sexually attractive," he says. But there is a price to pay. Anabolic steroids are synthetic drugs related to male hormones. They're used medically to help AIDS patients improve strength and appetite and to treat men for delayed puberty, impotence and hypogonadism, a condition in which the testes are underactive. For young athletes, steroids increase muscle mass and strength and shorten the time for muscles to recover from a workout. They also have the psychological effect of boosting assertiveness, giving a "pumped-up mental attitude," DiNubile says. The downside is that they can cause hair loss, severe acne, infertility, masculinization of women (deepening of voice, growth of body hair, smaller breasts) and feminization of men (shrunken testicles, enlarged breasts). Steroids also are thought to increase the risk of stroke, heart disease and liver cancer. The drugs also can permanently stunt growth. "Seniors in high school have, on average, grown to 95% of their adult height," Yesalis says, "but in seventh grade, they could permanently shut down their growth plates. So if God had intended them to be 6-2, they could end up a muscular 5-4." To counteract the negative effects, steroid users combine drugs, a practice that could increase risks for

Reprinted with permission. All rights reser ved.

Page 13

Steroids Case Study AS SEEN IN USA TODAY SPORTS SECTION, TUESDAY, JULY 9, 2002, PAGE 1C

Medical experts strongly oppose use by teenagers young people, says DiNubile, a spokesman for the American Orthopaedic Society for Sports Medicine. "The ones who are good at this take diuretics to get rid of fluid retention, they take anti-estrogens, they become very sophisticated."

doses," he says. "So when we came out and said yes, it works but it's not safe, they didn't believe us." Adding to that is the universal belief of teenagers in their indestructibility, he says. "They really don't believe these things can harm them."

But they can. Andrews says he has noticed an Top athletes have access to steroids through physialarming increase in the instance and severity of ligacians, but "kids buy black-market stuff whose purity ment and tendon injuries. While he can't prove is questionable," Yesalis says. "They're more prone to steroid use is a factor, he says these kinds of injuries cowboy chemistry," getting information from friends can result from stress or the Internet, increasRapid changes are signs to watch on tendons caused by ing the risk of misuse. overdeveloped muscles. Some signs of steroid use can be mistaken for normal teenage develop"In baseball players, we Yet the demand contin- ment, so it might be hard for parents, coaches and physicians to detect. Nicholas DiNubile, assistant professor of orthopedic surgery at the see an increase in the ues unabated, driven by incidence of rotator cuff the desire to win and for University of Pennsylvania Hospital in Philadelphia, says parents can look for rapid changes such as: injuries, a large increase the money that brings. in (injuries to elbow lig"I see the kids in the * Improbable gains in lean body mass, muscle bulk and definition. aments) related to the office," DiNubile says. * Increased aggressiveness or emotional ups and downs. stress of throwing," he "The coaches look the * Advanced acne on chest and back. says. The "real distressother way; their parents * Early male-pattern baldness. * Breast enlargement in boys. ing aspect," he says, "is want them getting that we're seeing these scholarship. A lot of peoParents should be aware that when young people try to go off steroids, career-threatening ple look away when it there can be a sudden weight loss that can lead to depression in young peoinjuries in the shoulders comes to steroids." ple whose body image is skewed, DiNubile says. "They think they've shrunk and elbows of baseball like air let out of a balloon." players in younger and In a competitive socieyounger age groups." ty where "moral stanInstead of resorting to steroids or other performance-enhancing subdards are being swept stances, he says, parents can help their kids work on sports skill training and capitalize on their natural abilities. "Try to make your great athlete that A USA TODAY dataunder the rug," Yesalis base study showed a says, the temptation is to way," he says. "For many centuries, that's how great athletes were built." 32% increase in stints reach the goal by any on the major league dismeans. abled list in the last 10 years. Injuries to large joints increased 58%, while all other injuries increased only "If you really believe in winning at all costs, and 5%. The number of injuries identified as tendon or ligthat's how you raise your kids, drug use is not illogiament injuries in baseball jumped 224% between cal," he says. "I get about one call a year from one or 1992 and 2001. two idiot parents who want my blessing to their use of growth hormone or anabolic steroids for a kid who Andrews has completed a study, not yet published, is otherwise normal, but they want Johnny or Mary to that looks at sports injuries in athletes under 18 and be a superstar. The conversations are very short, and found elbow ligament injuries and shoulder injuries in I'm not very polite. young athletes have increased dramatically. He doesn't know why. "We don't have the statistics to tell us "Use of these drugs by kids in sports is wrong. No what's going on, but we're all worried," he says. discussion." Severity and frequency of injuries rise Unfortunately, DiNubile says, young people often don't believe that, in part because the medical community erred in the 1970s and '80s by claiming steroids did not increase strength or muscle mass. "But the athletes knew, they realized they were getting gains and started experimenting with different

That's a concern, because prolonged use of steroids is likely to increase the chance of side effects, including those that might be life threatening, he says. "I don't want to say it's causing these things all over the place . . . but we know there are side effects and they're being minimized by athletes. They think they're invincible. But until we test for it and know (who is using the drugs), we'll be sitting here guessing.

Reprinted with permission. All rights reser ved.

Page 14

Steroids Case Study AS SEEN IN USA TODAY SPORTS SECTION, TUESDAY, JULY 9, 2002, PAGE 1C

"The problem is the almighty dollar. Parents are doing whatever they can to make professional athletes out of their children. Some start planning at 2 years of age. There's a lot of enticement to do what is necessary to enhance performance." Cincinnati outfielder Ken Griffey Jr. sees the same problem at the major league level. "All you can do is live your life the right way and not worry about the other guys. You see things and you hear things, but what can you do? Guys know the risks, but they also know there's big money out there." Messages from pros carry weight The lure of big muscles, an athletic scholarship or a pro career is irresistible to many youngsters, DiNubile says. "We need real vigilance here and for more parents and coaches to be aware." Doctors can issue warnings, but they might not have much impact, he says. Kids might need to hear it from more influential sources. "It would be tremendously helpful," DiNubile says, "if some sports heroes would be more visible on this

issue, be willing to stand up, speak to our kids and educate them. Because kids listen to their heroes." But Los Angeles first baseman Eric Karros says he's disturbed by the suggestion that steroid use by major leaguers will create a cause-and-effect spike in use by younger athletes. "If people make decisions based on something they've read or what a sports figure says, if that's solely how they make decisions, then there's obviously a lack of parenting," he says. But others in baseball see a responsibility. "Our sport is a microcosm of society," Houston general manager Gerry Hunsicker says. "We know that substance abuse, including steroids, is certainly a problem throughout our society. To have our head in the sand and convince ourselves that it's not a problem is probably a bit naive and irresponsible. There's growing evidence steroids are dangerous and can even be life threatening. It certainly behooves all of us to come up with a meaningful education and control policy." Contributing: Mel Antonen, David Leon Moore and Bob Nightengale

Reprinted with permission. All rights reser ved.

Page 15

Future implications

For discussion 1. There are many adverse effects associated with the use of performance-enhancing substances. Develop a list of the physical, mental, and legal risks associated with the various substances such as anabolic steroids, creatine, and ephedrine. 2. As a teacher, coach, or parent, what strategies would you use to prevent performance-enhancing substance abuse by your students, athletes, or children? In addition to promoting healthy nutrition and strength training programs, what other alternatives exist for preventing drug use in sports? 3. While some performance-enhancing substances such as anabolic steroids and amphetamines are illegal and banned by sports federations, other performance-enhancing substances such as dietary supplements are not. How can consumers assure themselves of the purity, content, and efficacy of nutritional supplements? 4. The U.S. Supreme Court ruled recently that the drug testing of students participating in extracurricular activities is not a violation of their constitutional rights. To what extent do you feel testing deters students' drug use? 5. Develop a list of resources where you can obtain additional information on performance-enhancing substance use in sports.

1. The number of new performanceenhancing substances, including those used to boost the production of oxygen-carrying red blood cells, and technologies such as new drug delivery systems and gene transfer therapy that have become available recently, is simply amazing. As a society, how will we deal with these new substances and techniques as they relate to the integrity of competitive sports and the health of athletes? 2. Some experts believe we will never be able to completely eliminate doping in sport. Should we go so far as to hold separate competitions for those using drugs and those competing drug-free? Would legalizing drug use in professional sports serve only to confirm reality, help level the playing field, or compound existing problems?

About The Expert Dr. Michael S. Bahrke is an acquisitions editor in the Scientific, Technical, and Medical Division of Human Kinetics, Champaign, Illinois. He has been an assistant professor at the University of Kansas, director of research for the U.S. Army Physical Fitness School, fitness area coordinator at the University of Wisconsin, and project director for a National Institute of Drug Abuse-funded research grant designed to investigate performanceenhancing substance use in the Chicago area. Dr. Bahrke has authored more than 60 scientific articles, chapters, and books, including the recently published, Performance-Enhancing Substances in Sport and Exercise. Dr. Bahrke completed his undergraduate degree in Physical Education at the University of Wisconsin - La Crosse and received his Master's Degree in Exercise Physiology and Doctorate in Sport Psychology from the University of Wisconsin - Madison. He is a fellow of the American College of Sports Medicine.

Additional resources Performance-Enhancing Substances in Sport and Exercise edited by Michael S. Bahrke and Charles E. Yesalis. Champaign, IL: Human Kinetics, 2002. DRUGSTORY.ORG: Sponsored by the Office of National Drug Control Policy http://www.drugstory.org/ (An informational resource for entertainment writers and feature journalists.) STEROIDABUSE.ORG: A service of the National Institute on Drug Abuse http://www.steroidabuse.org/ (A NIDA-sponsored web site featuring comprehensive information on steroids.)

THE NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE AT COLUMBIA UNIVERSITY http://www.casacolumbia.org/ (Provides statistical information and commentary on drug-related issues.) NATIONAL INSTITUTES OF HEALTH OFFICE OF DIETARY SUPPLEMENTS http://dietary-supplements.info.nih.gov/ (Provides information on programs, activities, and scientific resources concerning dietary supplements.)

For more information, log on to www.usatodaycollege.com

Page 16