Yesterday, Alex Rodriguez of the New York Yankees became the youngest Major League Baseball player to hit 600 home runs. Like so many recent feats in baseball this one comes with the ‘asterisk’ of steroid abuse, which got me thinking about the nature of performance enhancing drugs.
I’ve never taken care of any professional baseball players, but I have treated more than few musicians for performance anxiety, which manifests itself as a physiologic tremor. We all have a baseline tremor in our hands of about 10-12 Hz. Normally, it’s not apparent but many things can make the shakiness very noticeable: caffeine, nicotine, certain drugs, muscle fatigue and – most commonly – excitement, fear or stress.
For most of us, those shaky hands are just a mild annoyance. But for a violinist auditioning for a job with a major orchestra – or a spot in the music performance program – it can have an enormous impact on her life. Luckily there are cheap and relatively safe medications that can blunt those tremors and allow such people to perform to their maximum potential in those situations where their nervous system doesn’t.
In the minds of many sports fans, A-Rod’s use of performance enhancing drugs makes him a big, fat cheater. So am I helping my patients cheat?
Is a cellist taking a beta-blocker to keep from shaking uncontrollably during a concert the same thing as a pro baseball player juicing up with roids? It seems unfair to say that treating a medical condition is cheating; after all, you wouldn’t tell a diabetic shortstop that he couldn’t take his insulin before a game or a pitcher with poor vision that he can’t wear his glasses.
But one could argue that dealing with the pressure of being in front of an audience is an integral part of performing, and that using a chemical substance to enhance your ability to do so is cheating. After all, a lot of weekend duffers can sink a 12-foot putt on the practice green, but there’s only one Tiger Woods.
So what do you think? Is taking a medication for an anxiety-induced tremor simply a matter of leveling of the playing field for someone with a medical deficit; or is it giving an unfair edge to someone who can’t handle the heat?
John A. Vaughn, MD
Student Health Services
The Ohio State University