Need performance-enhancing drugs? Claim ADHD.

Science, technology, and life.
Jan. 12 2009 12:13 PM

Doping Deficit Disorder

Need performance-enhancing drugs? Claim ADHD.

Would you like to take performance-enhancing drugs to boost your pro sports career? Are the drugs banned as a form of cheating? No problem. Just find a doctor willing to certify that you have a "deficit" of the performance factor in question.

That's what seems to be happening in Major League Baseball. Three years ago, the league belatedly banned stimulants on the grounds that they unfairly aided players' performance. At the time, 28 players had "therapeutic use exemptions" allowing them to take drugs such as Ritalin or Adderall. "Therapeutic use" means you can justifiably use the drug because you need it for a medical condition. If you didn't have the condition, you'd just be a normal pro baseball player, and the attention-focusing benefits of Ritalin would be a form of "enhancement," i.e., cheating.

William Saletan William Saletan

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

When the league banned these drugs, an amazing thing happened. The number of players claiming and obtaining "therapeutic use" exemptions for stimulants nearly quadrupled from 28 to 103. The basis of their claims? They all had attention "deficit" disorder. Accordingly, they were entitled to attention-boosting drugs.

Among children, the prevalence of ADHD is estimated at 3 percent to 5 percent. Among adults, the rate of diagnosis is between 1 percent and 3.5 percent. But among pro baseball players, the disease seems epidemic. The league has just announced that the number of "therapeutic use" exemptions based on ADHD increased again  last year from 103 to 106. That means 8 percent of major-league players have ADHD—twice the rate among children and three to eight times the rate among adults.

Advertisement

How can ADHD multiply fourfold in a sport in a single year? How can it become three times as prevalent in that sport as in the adult population? Is it contagious? Of course not. ADHD is a psychological diagnosis. Like post-traumatic stress disorder, which we talked about Friday, it's open to interpretation in any given patient. Three doctors may say you don't have it. A fourth may say you do.

In the case of PTSD, critics object that such a fuzzy diagnosis shouldn't entitle a combat veteran to a Purple Heart. In baseball, the objection is similar: A fuzzy diagnosis of ADHD shouldn't entitle a player to drugs that will improve his performance, and presumably his livelihood, relative to players who don't claim a deficit and don't take drugs.

Rob Manfred, MLB's executive vice president, spins the latest increase in therapeutic use exemptions as a crackdown on ADHD. "We made progress this year; we granted fewer new T.U.E.'s than the prior year," he says. That's pretty funny. The number of exemptions increased, and it's now three to eight times the rate in the adult population. But because the increase is smaller than it was in the previous year, with fewer "new" approvals, we're supposed to applaud the league's vigilance.

Manfred says it's unfair to compare the rate of ADHD claims in baseball with the rate of diagnosis among adults generally. "We are far younger than the general population, and we have far better access to medical care," he argues. But baseball players aren't far younger than children, who are half as likely to obtain ADHD diagnoses. And even the rate of diagnosis among children is widely regarded as inflated.

The crucial factor, as Manfred notes, is that pro baseball players have "far better access to medical care." Charitably, you could say this means that ADHD is underdiagnosed in children and adults and that if the rest of us had access to as many doctors as pro baseball players have, they'd discover our hidden ADHD. Uncharitably, you could say that ADHD is accurately diagnosed in adults and overdiagnosed in children so we can put them on Ritalin. And if the rest of us had access to as many doctors as pro baseball players have, we could shop around, as they do, until more of us found a doctor willing to give the diagnosis and write a prescription for attention-enhancing drugs.

If you've ever listened to Garrison Keillor's Prairie Home Companion, you're probably familiar with his fictional Lake Wobegon, Minn., where all the women are strong, all the men are good-looking, and all the children are above average. But that was before the age of performance-enhancing drugs. Now it's the other way around: In order to get the drugs that will help your child become above average, you need him to be diagnosed as below average. You need the certificate of a "deficit" disorder.

I wonder what spins Major League Baseball will come up with when more than half its players, prescriptions in hand, are officially below average.

(Now playing at the Human Nature blog: 1. The beauty of adjustable glasses. 2. Texting while driving should be regulated like drinking. 3. Is PTSD worth a Purple Heart?)

TODAY IN SLATE

The World

How Canada’s Shooting Tragedies Have Shaped Its Gun Control Politics

Where Ebola Lives Between Outbreaks

Gunman Killed Inside Canadian Parliament; Soldier Shot at National Monument Dies

Sleater-Kinney Was Once America’s Best Rock Band

Can it be again?

Paul Farmer: Up to 90 Percent of Ebola Patients Should Survive

Is he right?

Science

“I’m Not a Scientist” Is No Excuse

Politicians brag about their ignorance while making ignorant decisions.

Technology

Driving in Circles

The autonomous Google car may never actually happen.

In Praise of 13th Grade: Why a Fifth Year of High School Is a Great Idea 

PowerPoint Is the Worst, and Now It’s the Latest Way to Hack Into Your Computer

  News & Politics
The World
Oct. 22 2014 6:30 PM The Tragedies That Have Shaped Canada's Gun Politics
  Business
Continuously Operating
Oct. 22 2014 2:38 PM Crack Open an Old One A highly unscientific evaluation of Germany’s oldest breweries.
  Life
Gentleman Scholar
Oct. 22 2014 5:54 PM May I Offer to Sharpen My Friends’ Knives? Or would that be rude?
  Double X
The XX Factor
Oct. 22 2014 4:27 PM Three Ways Your Text Messages Change After You Get Married
  Slate Plus
Tv Club
Oct. 22 2014 5:27 PM The Slate Walking Dead Podcast A spoiler-filled discussion of Episodes 1 and 2.
  Arts
Brow Beat
Oct. 22 2014 4:10 PM Skinny Mark Wahlberg Goes for an Oscar: The First Trailer for The Gambler
  Technology
Future Tense
Oct. 22 2014 5:33 PM One More Reason Not to Use PowerPoint: It’s The Gateway for a Serious Windows Vulnerability
  Health & Science
Wild Things
Oct. 22 2014 2:42 PM Orcas, Via Drone, for the First Time Ever
  Sports
Sports Nut
Oct. 20 2014 5:09 PM Keepaway, on Three. Ready—Break! On his record-breaking touchdown pass, Peyton Manning couldn’t even leave the celebration to chance.