Problems In A Turned-on World

Dr. Dooley is a wiry, excitable, even a pugnacious man, and also a very busy one. His Wood Memorial Clinic is usually crowded with halt, lame and worried athletes who have come for treatment, information or reassurance. He treats professional, college, high school and even grade school athletes. The majority come from the Los Angeles area, but not a few are from other parts of the country, Dooley perhaps being better known among participants than physicians.

"I don't pretend to be a researcher or a scientist," says Dooley. "I'm a practicing physician who is interested in athletes. A lot of physicians are stuffed shirts when it comes to sports. Athletes do want to perform better, that is what it is all about. If I know of something which may improve performance, a training or rehabilitation technique, a drug that is legal and which I don't believe involves any serious health risk, I see no reason not to make it available to an athlete. I can't see any ethical difference between giving a drug to improve performance and wrapping an ankle or handing out a salt pill for the same purpose. Athletes hear about these things and they are going to get them one way or another."

Between the opposed views of the two West Coast doctors—Dr. Kerlan's that drug abuse constitutes a growing athletic crisis and Dr. Dooley's that the use of drugs is the sporting wave of the future—there are all shades of opinion and all kinds of fancy hedging and dodging. But there is also one thing that is agreed upon—a greater quantity and variety of drugs are being used now than were used a generation, a decade or even a year ago.

Setting aside ethical considerations for the moment, there are obvious reasons why athletes should use so many drugs. The most obvious is that there are more drugs available these days for everyone than ever before. Furthermore, we have all been sold on the efficacy of drugs. We believe that the overflowing pharmacopoeia is one of the unquestioned triumphs of the age. We have been sold on drugs empirically because we have tried them and enjoy the results. We have been sold by countless magazine and newspaper stories about wonder drugs—many of which later turned out to be less than wondrous—by massive pro-drug propaganda campaigns mounted by pharmaceutical manufacturers, by TV actors dressed in doctors' coats and by real doctors, many of whom are very quick with the prescription pad. Generally, we have accepted rather uncritically the central message of this persuasive pitch—drugs are good for you. These days it is a cultural reflex to reach for a vial, an atomizer, a capsule or a needle if you suffer from fever, chills, aches, pains, nausea, nasal congestion, irritability, the doldrums, sluggishness, body odor, obesity, emaciation, too many kids, not enough kids, nagging backache or tired blood.

It would be surprising if athletes were not influenced by the same trends and tendencies that have the rest of us so high on drugs. A Pepper Martin, if plunked in the ribs by a Schoolboy Rowe fastball in 1934, would have trotted down to first base without doing anything about his injury because 1) there was nothing he or anyone else knew to do about it, and 2) he would have thought it a little sissified to have taken medicine for a bruise. In 1969 when a hitter catches one in the side, the game is likely to be stopped while he is sprayed with ethyl chloride to freeze the area, takes an enzyme or (if his medical attendant has come by some on the black market) has some DMSO slathered on the bruise. If he is a particularly sensitive jock he might even take a sedative or a painkilling pill. All this is done, and even demanded, because such aids are available and the consensus is that it is the smart, scientific, modern thing to use them.

On the other hand, if you fell down the front steps and bruised your ribs, you would not use ethyl chloride, an enzyme or DMSO. Athletes do because they have far more access to drugs than most of us. They do not have to stand around in waiting rooms, at pharmacy counters or on street corners for their fixes. Drugs are brought to them, and usually provided free of charge. The athlete gets free professional advice from physicians and assisting trainers as to what drugs to take, and when and how. Of all vocational groups, athletes are probably under the closest medical supervision. While physicians and trainers will often bridle at the suggestion (drug has become a four-letter word for them as well as others), the general pattern seems to be that the more closely one is associated with the medical profession the larger one's drug consumption is likely to be. Increasingly a major role of athletic medicine men is to keep the athletic Establishment informed about what drugs can be used to what advantage, and to serve as drug dispensers. Most drugs—good and bad, safe and risky, effective and ineffective, legal and illegal—used by athletes are supplied directly by physicians or indirectly by physicians through trainers. If drug usage in sport is a developing scandal, then it is a scandal that involves the medical Establishment as well as the sporting one.

"Exuberance, our own exuberance, is something we physicians in sports have to guard against," says Dr John Finley, a team physician for the Detroit Red Wings. "Most of us work with teams as sort of a labor of love, because we are fans. I know I am. I root hard for the Wings. I'm trying to think of what I can do to help them win. Maybe there is a drug that will help, I try to watch myself, not let my emotions influence my medical judgment, but it is something to keep in mind."

"I obviously don't care to be quoted," says a New York physician close to the sporting scene. "However, as a generality, team physicians tend to be men of action, not scholarly, speculative types. They are interested in immediate problems: making somebody strong, relaxed, mean or quick and in getting a player back in the game as soon as possible. If somebody tells them there is a drug that might do the trick, they are apt to try it They are not likely to wait around for a double-blind control study to find out if the drug is effective or what it will do to the liver three years later They are interested in today."

"Quackery. That is the bane of sports medicine," says Dr Daniel F. Hanley of Bowdoin College, Me., who has been a physician for three U.S. Olympic teams. "We've rid ourselves of some of the worst, but there are still too many people handing out get-good-quick pills, touting machines that send out blue sparks and make big muscles or advising athletes to drink superduper seaweed extracts. There is a time and place for certain drugs in sports, but each situation has to be evaluated individually. For example, I was with the Pan American team in 1967. One of our wrestlers, Wayne Baughman, a middleweight, severely pulled a muscle in his chest during a semifinal bout, which he won. He was in a lot of pain, virtually incapacitated. Before the finals I injected Novocain and taped him, and he won the gold medal. I am normally opposed to this type of treatment. I would never use it in high school or college competition. But this was a special case. The injury did not involve a weight-bearing area, such as a knee or ankle There was little risk of aggravating the injury. And Baughman was a grown man competing for an international gold medal, an opportunity he might never have again. You balance risk against reward."

"Could he have wrestled without the shot?"