If steroids are cheating, why isn't LASIK?

Science, technology, and life.
April 18 2005 12:36 AM

The Beam in Your Eye

If steroids are cheating, why isn't LASIK?

Illustration by Mark Stamaty.
Click image to expand.

And why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

A month ago, Mark McGwire was hauled before a congressional hearing and lambasted as a cheater for using a legal, performance-enhancing steroid precursor when he broke baseball's single-season home run record.

A week ago, Tiger Woods was celebrated for winning golf's biggest tournament, the Masters, with the help of superior vision he acquired through laser surgery.

What's the difference?

At the steroid hearing on March 17, numerous members of the House Committee on Government Reform, led by Chairman Tom Davis, R-Va., denounced performance-enhancing drugs. They offered three arguments: The drugs are illegal, they're harmful, and they're cheating. But illegality doesn't explain why a drug should be illegal, and the steroid precursor McGwire took, andro, was legal at the time. The director of the National Institute on Drug Abuse conceded at the hearing that steroid precursors weren't banned until last year, that steroids "do, in fact, enhance certain types of physical performance," that some are "prescribed to treat body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass," and that "not all anabolic steroid abusers experience the same deleterious outcomes."

Don't get me wrong. If you buy a steroid off the street or the Internet today just to bulk up, you're taking a stupid risk. But much of that risk comes from your ignorance and the dubious grade of steroid you're getting. A star player with access to the best stuff and the best medical supervision isn't taking the same degree of risk. Furthermore, steroids are a crude, early phase of enhancement technology. Chemists are trying every day to refine compounds and doses that might help pro athletes without bad side effects.

Already the medical objection to doping has holes. At the hearing, lawmakers displayed a supposedly damning list of "Performance Enhancing Substances Not Covered by Baseball's New Testing Program." The first item on the list was human growth hormone. But the Food and Drug Administration has approved human growth hormone for use in short, healthy children based on studies showing its safety and efficacy. The National Institutes of Health says it's "generally considered to be safe, with rare side effects" in children, and the American Association of Clinical Endocrinologists has found the same pattern in adults.

That leaves one comprehensive complaint: cheating. At the hearing, I heard six lawmakers apply this term to performance-enhancing drugs. They compared the drugs to corking bats, deadening baseballs, and sharpening spikes. "When I played with Hank Aaron and Willie Mays and Ted Williams, they didn't put on 40 pounds of bulk in their careers, and they didn't hit more homers in their late thirties than they did in their late twenties," said Sen. Jim Bunning, R-Ky. "What's happening now in baseball isn't natural, and it isn't right." Rep. Mark Souder, R-Ind., chairman of the House subcommittee on drug policy, recalled that baseball had harshly punished players who threw games. He asked why such punishment didn't apply to "players today who systematically cheat through steroids and performance-enhancing drugs to alter the games." Davis, who presided at the hearing, announced that he would co-chair "Zero Tolerance: The Advisory Committee on Ending the Use of Performance-Enhancing Drugs in Sports."

Zero tolerance? Wait a minute. If the andro that helped McGwire hit 70 home runs in 1998 was an unnatural, game-altering enhancement, what about his high-powered contact lenses? "Natural" vision is 20/20. McGwire's custom-designed lenses improved his vision to 20/10, which means he could see at a distance of 20 feet what a person with normal, healthy vision could see at 10 feet. Think what a difference that makes in hitting a fastball. Imagine how many games those lenses altered.

You could confiscate McGwire's lenses, but good luck confiscating Woods' lenses. They've been burned into his head. In the late 1990s, both guys wanted stronger muscles and better eyesight. Woods chose weight training and laser surgery on his eyes. McGwire decided eye surgery was too risky and went for andro instead. McGwire ended up with 70 homers and a rebuke from Congress for promoting risky behavior. Woods, who had lost 16 straight tournaments before his surgery, ended up with 20/15 vision and won seven of his next 10 events.

Since then, scores of pro athletes have had laser eye surgery, known as LASIK (Laser-Assisted In Situ Keratomileusis). Many, like Woods, have upgraded their vision to 20/15 or better. Golfers Scott Hoch, Hale Irwin, Tom Kite, and Mike Weir have hit the 20/15 mark. So have baseball players Jeff Bagwell, Jeff Cirillo, Jeff Conine, Jose Cruz Jr., Wally Joyner, Greg Maddux, Mark Redman, and Larry Walker. Amare Stoudemire and Rip Hamilton of the NBA have done it, along with NFL players Troy Aikman, Ray Buchanan, Tiki Barber, Wayne Chrebet, and Danny Kanell. These are just some of the athletes who have disclosed their results in the last five years. Nobody knows how many others have gotten the same result.

Does the upgrade help? Looks that way. Maddux, a pitcher for the Atlanta Braves, was 0-3 in six starts before his surgery. He won nine of his next 10 games. Kite had LASIK in 1998 and won six events on the Champions Tour over the next five years. Three months after his surgery, Irwin captured the Senior PGA Tour Nationwide Championship.

According to Golf Digest, Woods aimed for 20/15 when he signed up for LASIK. This probably didn't strike Woods as enhancement, since he was already using contacts that put him at 20/15. Now ads and quotes offering 20/15 are everywhere. One LASIK practice takes credit for giving  Irwin 20/15 vision. Another boasts of raising Barber to 20/15 and calls the result "better than perfect." Other sellers promise the same thing and offer evidence to back it up. Last year, they report, 69 percent of traditional LASIK patients in a study had 20/16 vision six months after their surgery, and new "wavefront" technology raised the percentage to 85. Odds are, if you're getting LASIK, you're getting enhanced.

The medical spin for LASIK, as opposed to the entrepreneurial spin, is that it's corrective. Your eyesight sucks, you go in for surgery, you hope for 20/20. Maybe you get it, maybe you don't, and that's that. But it isn't that simple. If you don't like the results, your doctor might fire up the laser for a second pass. In the business, this is literally called an "enhancement." Hoch, the golfer, got four enhancements in 2002 and 2003. He ended up 20/15 in one eye, 20/10 in the other.

Nor do you need poor vision to find a willing doctor. Most states think you're fine to drive a car without corrective lenses as long as your eyesight is better than 20/40. Cirillo, then a third baseman for the Seattle Mariners, was 20/35 in one eye and 20/30 in the other when he went in for LASIK two years ago. He came out 20/20 and 20/12. Cruz, an outfielder for the Toronto Blue Jays, was 20/30 when he went for an eye exam. Five days later, he was under the beam. "The doctor kind of talked me into it," Cruz told the Toronto Star. He came out 20/15. According to the Orange County Register, Gary Sheffield, then an outfielder for the Los Angeles Dodgers, had eyesight better than 20/20 when he asked for laser surgery to raise his batting average. His doctor talked him out of it.

Why risk surgery for such small increments? "Every little half-centimeter counts," Cruz told the Star. Last year, the Seattle Times reported that Troy Glaus, a power hitter for the Anaheim Angels, had gotten LASIK because he "felt his contacts were sufficient, just not always ideal. A windy day or a wave of dust could tip the advantage back to the pitcher." Often, coaches play a role. The Minnesota Twins training staff successfully encouraged several players to get LASIK. Maddux told the Atlanta Journal and Constitution that the Braves gave him "a little push" to get LASIK in 2000. Meanwhile, the Braves' manager, having talked to the same doctor about getting LASIK, in his own words "chickened out."

This is the difference between therapy and enhancement. You don't need bad vision to get the surgery. Wavefront, if you've got the bucks for it, reliably gives you 20/16 or better. If your vision ends up corrected but not enhanced, you can go back for a second pass. Players calculate every increment. Pro golfers seek "to optimize any competitive advantage," a LASIK surgeon told the Los Angeles Times. "They're already tuned in to the best clubs, the best putter, the best ball. ... Clearly having great vision is one of the best competitive advantages you can have." Eyes are just another piece of equipment. If you don't like 'em, change 'em.

The sports establishment is obtuse to this revolution. Leagues worry about how you might doctor bats, balls, or clubs. They don't focus on how you might doctor yourself. Look at the official rules of Major League Baseball: A pitcher can't put rosin on his glove, but he can put it on his hand. A batter can't alter the bat "to improve the distance factor," but the rules don't bar him from altering his body to get the same result. Baseball now has a dope-testing policy, but it isn't in the rules; the players negotiate it. That's why it's weak.

At last month's hearing, baseball commissioner Bud Selig testified that in 1998 and 1999 he sent his executive vice president to Costa Rica to check out reports that juiced-up baseballs were causing an epidemic of home runs. Selig was looking for the wrong kind of juice. The U.S. Golf Association's Rules of Golf share the same blind spot: You can't use a device to warm the ball, but you can use it to warm your hands. You can't use a device to measure distance or "gauge the slope of the green," but you can get the same powers through LASIK. In the age of biotechnology, you are the device.

Read the testimonials. At 20/15, Kanell can read the eyes of defensive backs. Tom Lehman, who will lead the U.S. golf team in next year's Ryder Cup, says Lasik improved his ability to "judge distances"—a common benefit, according to the technology's purveyors. Woods says he's "able to see slopes in greens a lot clearer." Woods' eye surgeon told the Los Angeles Times, "Golfers get a different three-dimensional view of the green after LASIK." They "can see the grain" and "small indentations. It's different. Lasik actually produces, instead of a spherical cornea, an aspherical cornea. It may be better than normal vision."

Just ask Tom Davis. "I was in and out in less than one hour," the congressman reports in a testimonial for the Eye Center, a Northern Virginia LASIK practice. "I was reading and watching television that evening. My reading was not impaired and my distance vision was excellent."

Good for you, Tom. Now, about that committee you've established for zero tolerance of performance enhancement. Are you sure you're the right guy to chair it?