inneapolis — JACQUES BARZUN famously said that to understand America, one must first understand baseball. Never has his remark been more accurate. Professional baseball players may be the most vilified Americans using performance-enhancing drugs, but they are by no means alone. Performance-enhancing drugs have become a part of ordinary American life.
College students take Ritalin to improve their academic performance. Musicians take beta blockers to improve their onstage performance. Middle-aged men take Viagra to improve their sexual performance. Shy people take Paxil to improve their social performance. The difference is that if athletes want to get performance-enhancing drugs they go to the black
market. If the rest of us want performance-enhancing drugs, we go to our family doctors.
The athletes get no sympathy, of course. This is understandable. A scandal makes headlines only when it involves a star, and professional athletes are stars whose income and status most people can only envy. Many people secretly want to see stars fail - and when they do, these fans revel in it. In the case of baseball, they can revel guiltlessly, because the players have cheated. They have broken the rules of the game. In the rest of America, of course, we have simply changed the rules.
Don't steroids carry dangers? Of course they do. But so do the enhancement drugs we get from our doctors. Fen-Phen, the popular weight-loss drug that was linked to pulmonary hypertension and heart disease, has killed and harmed so many people that Wyeth, its manufacturer, has put aside more than $16
billion to compensate victims. Hormone replacement therapy, promoted in the 1960's as an anti-aging drug for women, has been linked to an increased risk of heart disease, strokes, pulmonary emboli and breast cancer. Antidepressants like Prozac, Paxil and Zoloft were described as "cosmetic psychopharmacology" a decade ago; today they are embroiled in a public controversy over their links to suicide and homicide.
Perhaps this is the inevitable result of turning our medical system over to the market, where making sick people well is often less profitable than making well people better than well. Procter & Gamble, for example, has decided that the profit margins of its ordinary consumer items like Crest toothpaste and Tide laundry detergent are not nearly as appealing as the enormous profit margins of prescription drugs.
So the same week that newspapers reported that Barry Bonds
of the San Francisco Giants and Jason Giambi of the Yankees used testosterone supplements, P&G was asking an advisory committee of the Food and Drug Administration for permission to market its new testosterone patch for women. (The panel later said no.) The medical problem it was being used to treat? Decreased libido. Laboratories like Balco, where Bonds and Giambi were clients, market testosterone to underperforming men; P&G hopes to market it to underperforming women.
The rest of the world often marvels at the enthusiasm with which Americans consume drugs and procedures for medical enhancement. Antidepressants are one of America's most profitable classes of drugs. America has turned cosmetic surgery into a multibillion dollar industry. The United States produces and consumes more than 85 percent of the world's supply of Ritalin.
Perhaps only in the United States is Botox a brand name as familiar as Kleenex or Pampers.
Yet enthusiasm may not be the right word. Working up the requisite outrage over Barry Bonds and Jason Giambi may be easy enough. But what about all the other, less gifted athletes who have turned to steroids in fear and desperation? Like the rest of us, athletes are caught up in a pharmaceutical arms race where to refuse to take drugs is to risk being left behind. This may be less about the desire to succeed than the desire to avoid shame and humiliation.
America's appetite for stimulants, antidepressants and Botox injections looks less like enthusiasm and more like fear. It is the look of a Little Leaguer stepping up to the plate in the bottom of the ninth with two outs and the bases loaded, terrified that he is going to strike out.
Carl Elliott, an associate professor at the Center for Bioethics at the University of Minnesota, is the author of "Better Than Well: American Medicine Meets the American Dream."
