Kate Zernike, “The Difference Between Steroids and Ritalin Is . . .” New York Times, March 20, 2005.
T the Congressional hearings last week investigating steroids and baseball, players were scolded not just for taking substances that are unsafe, but for doing something immoral. Those who use performance enhancing substances were called cheaters, cowards, bad examples for the nation's children.
But if baseball players are cheating, is everyone else, too?
After all, Americans are relying more and more on a growing array of performance enhancing drugs. Lawyers take the anti-sleep drug Provigil to finish that all-night brief, in hopes of concentrating better. Classical musicians take beta blockers, which banish jitters, before a big recital.Is the student who swallows a Ritalin before taking the SAT unethical if the pill gives her an unfair advantage over other students? If a golfer pops a beta blocker before a tournament, is he eliminating a crucial part of competition - battling nerves and a chance of choking?
Beyond baseball and steroids, where do you draw the line on the use of performance-enhancing drugs? President Bush said in his 2004 State of the Union speech that steroid use in baseball "sends the wrong message: that there are shortcuts to accomplishment, and that performance is more important than character."
That is easy to say about steroids. After all, the mystique of the major leagues requires that home run records be set without the help of artificial enhancements. And major league players have some responsibility not to encourage teenagers to use a harmful substance.
When it comes to other drugs, and other kinds of endeavors, the lines aren't so clear. Bioethicists, who don't even all agree about whether taking steroids is wrong, are even less clear about everything else.
Some say the use of performance-enhanced drugs simply reflects progress - better living through chemistry - and to be human is to strive to be better.
"We've gotten very used to already assisting ourselves in other ways," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "No one's going to say, 'Don't drink coffee before the SAT.' No one's going to say, 'Don't smoke cigarettes before the SAT.' And most of the drugs we're talking about are far less harmful than nicotine."
But others lament that a performance-enhanced society is giving in to a culture that prizes the achievement over the journey. Many Americans already get that message from a young age, said Denise Clark Pope, author of "Doing School: How We Are Creating a Generation of Stressed Out, Materialistic and Miseducated Students."
When surveys ask students which is more important, to be honorable and get a low grade or to cheat and get a high grade, she said, more students choose the A. "The parents will say 'no, no, no,' but the message they're sending says the opposite."
The use of performance enhancing drugs reflects a society where stress and striving have become the national pastime. Ms. Pope calls it the "credentialism society," exemplified in her book through a high school student who describes life as a quest to get the best grades, so you can get into the best college, so you can get into the best graduate school, so you can get the highest-paying job, which brings you happiness.
So where people once took illegal drugs like cocaine to escape or stimulate creativity, they now take legal drugs to focus better and achieve more.
The danger in that, said Carl Elliott, the author of "Better than Well: American Medicine Meets the American Dream," is that not performing well will be seen as a medical condition - one that needs to be treated.
"The lines between treating an illness and enhancing a performance are so blurry," said Dr. Elliott, an associate professor at the center for bioethics at the University of Minnesota. "Most people don't conceptualize it as performance enhancement; most people conceptualize it as a treatment for an illness."
But others think there's no problem. Norman Fost, the director of the medical ethics program at the University of Wisconsin who has long said that the danger of steroids are overstated, similarly sees nothing wrong with taking drugs like Ritalin or Provigil solely to enhance performance.
"We all would like to do better at what we're doing, whether athletic or intellectual or musical," he said. "There's nothing inherently immoral about performance enhancement. It's what everyone does, or would try to do, for their children. We shouldn't be obsessed with the fact that it's a drug, as if it's a drug like cocaine or heroin."
Dr. Caplan mocks the handwringing over self-enhancement drugs. To him, it is all technology: "The lawyer who's taking a pill to stay up is also carrying a computer or P.D.A. to help his brain remember things. Are we going to throw away our calculators?"
Certainly, there is no guarantee that performance enhancement delivers happiness.
As Ms. Pope notes, at the same time stimulants like Ritalin are becoming more popular among high school students, college campuses are reporting a new drug of choice. It used to be marijuana. Now it's Prozac.
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