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Performance-Enhancing Drugs and How They Affect Today’s Athlete Views from a Medical Doctor Julian Bailes* I. Introduction T his article focuses on some of the deleterious effects of performance-enhancing drugs on athletes. I have thirty years of on-the-field experience: ten years as a player and twenty years in a sideline position, including ten with the Pittsburgh Steelers and ten at the NCAA level. For the past ten years, I have been saying that WVU has the best medical care at the NCAA level. This is in part a result of our strong research into athletes’ injuries. I always think that as a sideline physician it is so important not only to watch the game as a fan, but also to watch it to see the mechanism of injury to better understand the injury and perhaps make suggestions about how to play the game in a safer manner. This article summarizes some of that research and puts it in its historical context. In part II, I briefly discuss the history of performance-enhancing substances, including such innocuous substances as Gatorade. In part III, I summarize the early history of athletes’ use of steroids to enhance athletic performance. In part IV, I focus on the beneficial and deleterious effects of steroid use on the athlete who uses that drug. And finally, in part V, I discuss some of the extreme long-term deleterious effects of steroid use on athletes, with particular focus on the possibility of brain damage akin to the type of damage seen in Alzheimer patients. II. Athletes, Heat Stroke, and Performance-Enhancing Drugs One of the things in which my colleagues and I were very interested was the correlation of performance -enhancing drugs and the rise of heat stroke deaths that occurred several years ago.1 Although intermediate heat exhaustion—with symptoms including nausea, vomiting, intense fatigue, and hyperventilation—is a reversible condition, full-scale heat stroke is significantly more severe and is 137 Performance-Enhancing Drugs and How They Affect Today’s Athlete generally irreversible.2 Symptoms of heat stroke include elevated body temperature, central nervous system dysfunction, and hot, dry skin; additional symptoms frequently include headache, confusion, disorientation, incoherent speech, seizure, delirium, and/or progression to deep coma.3 Sports-related heat stroke deaths are not a new occurrence. From the 1940s through the 1970s, coaches strongly discouraged athletes from drinking water while sweating or practicing because of fears they would become “waterlogged.”4 Since the advent of Gatorade in 1965 at the University of Florida,5 sports drinks have become widely accepted.6 As science progressed, the incidence of heat stroke deaths correspondingly decreased.7 In recent years, however, NFL trainers and others around the league have stated that the ingestion of foreign substances, particularly legal ones that are available over the counter at vitamin and supplement outlets, is one of the biggest concerns they are facing.8 Unfortunately, the death of Minnesota Vikings offensive tackle Korey Stringer due to heat stroke sadly echoes this concern.9 Despite a few allegations of possible mismanagement,10 numerous others linked his death with amphetamine-type substances.11 The death of Baltimore Orioles pitcher Steve Bechler may have been similarly caused by his use of banned substances obtained over-the-counter; when studying his case, I was primarily concerned with, of course, ephedrine-containing compounds.12 These unfortunate incidents led to the study my colleagues and I anchored here at West Virginia University. That study examined the correlation between increased risk of heat stroke and legal dietary supplements such as amphetamine derivatives.13 Our work and the work of other investigators influenced Congress when it decided to try to outlaw ephedrine and remove it from the market. Because of the attention this brought, manufacturers became worried about liability issues and removed it from their products. 14 Today, experts are primarily concerned with what stimulants and other supplements players can obtain legally. In a famous and relatively recent Sports Illustrated cover story, Ken Caminiti—the successful third (and later first) baseman for the Houston Astros, San Diego Padres, Texas Rangers, and Atlanta Braves—became the first professional baseball player to publicly admit steroid use.15 Amongst other revelations, Caminiti admitted that he won the National League’s 1996 Most Valuable Player award while on steroids purchased in Tijuana, Mexico, and that his steroid use continued over five seasons.16 Remorseless, Caminiti defended his steroid use as necessary for competitive success and financial security in a...

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