Illegal use of steroids to add muscle mass can cause serious, irreversible effects, but doctors disagree on how to treat patients who choose to take them.
Yes. Monitoring does not mean prescribing. In terms of steroids, it does not mean recommending drug regimens or devising ways to escape detection. Certainly, it doesn't mean condoning or encouraging steroid use.
I'm not denying that use of steroids in sports is unethical, illegal and risky. But a physician confronted by an athlete who uses steroids has two choices: care for the patient or refuse. Taking care of the person includes checking for damage from drug use and providing treatment advice.
Of course, doctors should advise against using dangerous drugs. But a physician who decides not to monitor steroid use is in actuality deciding not to care for the athlete -- who may then receive less conscientious care or none at all.
We're kidding ourselves if we think athletes will stop using the drugs if we refuse to treat them. They feel they're invulnerable. Besides, it's hard to influence someone you're not talking to.
Lifestyles and personal decisions aren't a reason to deny care. I don't condone smoking, but I take care of smokers. I take care of people who use cocaine and amphetamines. I take care of alcohol abusers, prostitutes and people who practice unsafe sex. -- Paul D. Thompson Associate professor of medicine, Brown University; director of preventive cardiology, Miriam Hospital, Providence, R.I.; NBC sportsmedicine analyst, 1988 Olympics No. I have had experience with athletes at all levels, and many of them try to take advantage of the system -- or of physicians -- to gain a competitive edge.
When athletes ask me to monitor their use of steroids, I make it clear that I will not aid or abet such use. I make every effort to intervene and help the athlete discontinue it.
Experience has shown that "monitoring" athletes' use of steroids is a failure. For instance, after the 1983 Pan American Games in Caracas, Venezuela, the U.S. Olympic Committee decided to implement a drug-testing program. To show good faith, a nonpunitive system provided reports on anonymous urine specimens.
The athletes used this information to manipulate their doses. They were able to figure out exactly how much they could use and when they needed to stop so they'd test negative.
A physician who has an alcoholic patient doesn't say, "Go ahead and use alcohol as you please, and come in every so often so I can see whether it's doing you any harm." We know alcohol has deleterious effects, so we intervene. We confront the patient and steer him or her into a rehabilitation program.
We know now that the behavior of people who use steroids parallels that of people addicted to other drugs. Many have tried to stop using steroids but continue despite problems caused by the drugs. Some have withdrawal symptoms that they may use the drugs to relieve.
Steroids work. Athletes who use them are cheating. There is a significant potential for abuse, so if you identify a steroid user, you must treat him as you would any other abuser: intervene and rehabilitate.
James C. Puffer
Chief of family medicine and associate team physician, UCLA; head team physician, 1988 U.S. Summer Olympic Team