If retired baseball great David Ortiz did not use performance-enhancing substances (PES) while playing, in a book released this week, then the former All-Star is a good role model for young athletes.
But Ortiz's revelation, which many have found hard to believe, is not nearly as surprising as another aspect of PES use in sports: Providers are often operating in the dark with young athletes, particularly adolescents and most particularly treating adolescent athletes using anabolic steroids.
"There is no established treatment protocol," said sports medicine specialist Michelle LaBotz, MD, who co-authored an American Academy of Pediatrics 2016 on PES use, adding that evidence is "sorely lacking."
"Science doesn't know a lot about that," said Harrison Pope, MD, a psychiatrist at McLean Hospital who has authored several articles on PES use. "There are no systematic studies of treatments for steroid users or interventions. There's just practically no literature out there."
Indeed, my own unscientific review yielded mostly a few aging advocacy group statements and -- as well as articles what LaBotz, Pope have said recently.
To somebody who vividly remembers the endless reports from the 2005 congressional hearing in which Major League stars were grilled about their PES use ("I'm not here to talk about the past") and live games featuring the in the late 1980s, this lack of evidence is far more shocking than Ortiz's narrative: a designated hitter cut by the Minnesota Twins at 27 morphing into a Hall-of-Famer with the Boston Red Sox without taking any PES.
Around the time that Mark McGwire and Jose Canseco were smashing records, Washington Post columnist Thomas Boswell Canseco of using steroids. Boswell was largely ignored, PES use in sports increased and a generation of young athletes grew up thinking PES use was either not a big deal or necessary to chase their dreams. One-quarter of young males believed "taking PEDs is critical to enhancing one's athletic performance," according to a (i.e., eight years after the congressional hearing). Many suffered; at least two died of complications from PES use.
The point: Science, government and sports organizations have had a long time and ample opportunities to tackle this issue, and tackle it they have not. Can't blame the media for this one; we were all over it earlier this century (even if -- Boswell aside -- we were late to recognize the problem, and have largely ignored it over the last decade).
Providers and other advocates gathered at the National Press Club a few weeks ago to remind the public that PES use remains a problem, and that it is now a "major unrecognized public health problem," as Shalender Bhasin, MD, an endocrinologist with Brigham and Women's Hospital, put it. They spoke of PES use broadly, but that's not to say athletes have jettisoned or even curtailed their PES use. (A column this week argues MLB players certainly have not, for example.)
It's difficult to gauge how many young athletes use PES; that's one factor for the limited evidence around treating anabolic steroid users. They rarely die of steroid use, and don't visit emergency departments or tell providers about PES use because they fear the repercussions, LaBotz said. The data then are limited.
The consequences of lacking tested treatment plans can be dreadful, such as the suicide deaths of and , two young baseball players who used steroids earlier this century. Hooton's psychiatrist asked him to quit using cold turkey, his father said at the Press Club, worsening his depression just before he killed himself. Garibaldi refused his psychiatrist's advice to stop doping and was taking a mixture of prescriptions drugs on top of the steroids, according to a new, by historian and author William Kashatus subtitled: "Taylor Hooton, Rob Garibaldi, and the fight against teenage steroid abuse."
Garibaldi's mother is a psychologist and both players were the youngest siblings in well-resourced, two-parent homes. Yet their parents and multiple providers missed warning signs when they started using PESs, and were unable to ultimately treat them successfully.
Yes, that was more than a decade ago, but it's still difficult to recognize when adolescents are using PESs and still tough to decipher how to treat them.
"It can be hard to sort out because a lot of these (symptoms), to some degree, their bodies are producing on their own," LaBotz said, citing acne and mood swings.
"Our goal now is to develop a treatment protocol," she said.
Researchers need more federal funding, LaBotz said, and advocates have started nudging Congress. Former Olympian Lauryn Williams before a Senate committee and Tom Hildebrandt, PsyD, of New York's Mount Sinai Hospital, challenged the body at the Press Club: "Congress has not done a damn thing since the 2005 hearings."
"We still do not have the medical protocols in place" to aid the Hootons and Garibaldis of today, public health consultant Neil Romano said. "And we have to change that."
Amen. And it isn't solely up to Congress. Consider:
- Scholars have published plenty about PES use over the last dozen years yet little about treating or identifying adolescent steroid use in sports
- The American Medical Society for Sports Medicine a statement about PES use (for any age group) posted on its website
- The most recent American College of Sports Medicine position on steroids in sports was published 30 years ago
- ACSM's most recent statement on blood doping was published in 1996, according to
- Pro sports leagues and other sports organizations are bathing in money and other resources, but have paid little recent attention to youth PES use
Perhaps it's time to shift some priorities regarding research and social responsibility. Or we may be as skeptical about true motives as New York Yankees fans are of Big Papi.