AS THE 2009 baseball playoffs begin, the game continues to recover from disclosures earlier this year that some of its biggest stars were among 104 players who tested positive in 2003 for anabolic steroid use.
Major League Baseball formally banned steroids in 1991. At the heart of the steroid controversy is how an epidemic of such scale went without notice or response for so long. The players’ union, the commissioner’s office, owners and management, and the media have all shared blame for their silence and inaction. But that shouldn’t be the end of it.
As physicians and fans of the sport, we wonder whether the doctors who care for ballplayers share culpability. Baseball players are routinely subject to extensive examinations by a variety of physicians. The physical findings and behavioral changes associated with prolonged anabolic steroid use are not subtle. How was it that the doctors caring for the players never voiced any suspicions - in private or in public?
Baseball writer Joel Sherman has written that in his years following the New York Mets, he was always struck by the prominent acne on the back of a prominent player - noting that the acne had raised his suspicion that the player might be using steroids. Certainly the doctors who closely examined players with this and other symptoms such as rapid weight gain, uncharacteristic hair growth, shrinking testicles, and emotional swings had their own concerns about what was going on in the clubhouse besides card games.
Perhaps some of the physicians associated with teams brought the issue to the attention of players and management, but their voices went unheard; or they felt bound to silence by their relationship with their patients or the teams for which they worked.
More worrisome, however, is the notion that they were active conspirators. Ramon Scruggs, a California physician and self-described “anti-aging and performance’’ specialist, admits to having supplied several Major League baseball players with steroids. Former Red Sox player Lou Merloni stirred controversy in the spring for suggesting that a physician was present at a team meeting to “make sure [players] were taking steroids the right way,’’ with advice about timing of administration and sterile technique. Merloni notes that “The [Red Sox] organization acknowledged that there were likely players using steroids and basically ‘if you’re gonna use them, this is how you use them so you don’t abuse them.’ ’’ Former Red Sox general manager Dan Duquette vehemently denied that any such meeting had taken place.
All doctors have an obligation to protect the health of their patients. This obligation includes intervening if patients are using dangerous substances, educating patients who are at risk, and alerting public health authorities in the face of an epidemic.
The problem is, maybe physicians who work with celebrities - professional athletes among them - so enjoy the fame, privilege, and compensation of their roles that they don’t want to compromise their positions by serving as whistle-blowers. As the family of Michael Jackson learned, sometimes social prominence begets worse care - not better.
To be sure, it’s likely that doctors warned players about the risks of steroid use. In keeping publicly silent about the broader epidemic, however, doctors involved in the care of Major League players share some responsibility with players, management, and owners for the scourge that has befallen America’s pastime.
Dr. Sachin H. Jain, a research fellow at Harvard Business School, is a resident physician in internal medicine, and Dr. Michael E. Wechsler is an attending physician in pulmonary and critical care medicine at the Brigham and Women’s Hospital and Harvard Medical School. 
