Is Drug Emphasis in Wrong Place? : Medicine: USOC doctor says too much attention is being paid to over-the-counter medications, rather than steroids.

A U.S. Olympic Committee doctor has admitted that mistakes have been made in the drug testing of American athletes.

James C. Puffer, chief of family practice at UCLA and the head physician for the U.S. team in the 1988 Olympic Games, said this week at the American College of Sports Medicine’s convention that too much emphasis is being placed on over-the-counter cold medications by The Athletics Congress, the national governing body for track and field.

Although Puffer said there is evidence that athletes use cold medications to enhance performance, he believes that the thrust of TAC’s program should center on anabolic steroid abuse.

“It doesn’t make a lot of sense to be chasing after people who inadvertently used cold preparations,” he said.

Track and field officials recently suspended elite athletes Larry Myricks, Antonio McKay and Greg Foster for three months. The athletes allegedly tested positive for a banned substance called phenylpropanolamine, commonly known as PPA. Myricks said he had taken Alka-Seltzer, which contains the substance; Foster said he took vitamin pills that contained PPA, and McKay has not commented on his case.

Puffer helped U.S. Olympic Committee officials develop their initial drug-testing program in the fall of 1983 after the Pan American Games at Caracas, Venezuela.

There, 17 athletes--some from the United States--tested positive for steroids, and many others suddenly left the competition once they realized that sophisticated testing was being used.

Now, Puffer calls the USOC’s original war on drugs “an absolute disaster.”

He said the program was organized to monitor athletes without punitive results. The idea was to educate athletes on the potential problems associated with steroids, such as liver cancer and heart disease.

Athletes, however, used the medical information to determine when to stop using the drugs to avoid detection.

“We didn’t get anybody off steroids,” Puffer said. “We allowed them to feel much more comfortable with their use.

“We grossly underestimated the extent of the problem. I don’t think there is any doubt our initial efforts failed because we were naive. The athletes did a very good job of duping us. We had no real handle on how extensive the problem was.”

Before the Pan American Games, most of the international testing was shoddy, said Puffer, a member of the U.S. Olympic Committee’s Sports Medicine and Science Committee. He said urine samples often were poured out after collection, a process cynics call the sink test.

Puffer said random, unannounced testing will help eradicate steroid use, but he is no longer naive and does not believe that the problem is going to disappear quickly.

Puffer engaged in a debate with Paul D. Thompson, a cardiologist from Brown University, on the ethics of physicians monitoring the use of steroids by athletes.

Thompson, who has researched the effects of steroid use, said physicians have a moral obligation to care for patients even when disagreeing with the patients’ lifestyles.

Puffer said that by caring for steroid users, doctors are aiding and abetting use. He said physicians should persuade steroid users to seek rehabilitation.

Thompson said the controversy over steroid use is overstated because medical literature is inconclusive. “We don’t know as much as we pretend to know,” he said.

He also said it is unfair to paint a broad-brush picture of steroid side effects. In a study of 11 Rhode Island weightlifters, he found that stanozolol had a different effect than testosterone on cholesterol levels. Canadian sprinter Ben Johnson tested positive for stanozolol after winning the 100 meters at the 1988 Seoul Games.

“I think the side-effects are overstated,” Thompson said, adding that stanozolol helped reduce the risk of heart disease by reducing cholesterol levels.

Puffer said working with Olympic-caliber athletes leads him to believe that the side-effects are real.

Eric Heiden, formerly a gold-medal winning speed skater and professional cyclist, is studying medicine at Stanford and coaching the 7-Eleven professional cycling team that will compete in next month’s Tour de France.

During a symposium on the medical and scientific aspects of the tour Friday, Heiden presented a slide show highlighting his team.

“You’ll have to excuse me, this looks like a Slurpee commercial,” he said after three consecutive slides prominently displayed the 7-Eleven logo.

Heiden, who competed in the Tour de France, said the race’s second week is psychologically the toughest on riders.

“You are into the mountains but you have another week to go,” he said. “It seems like they’re never going to end.”

Although cycling is popular in Europe, Heiden said he does not expect the sport to gain a foothold in the United States.

“The riders go by so fast there’s not a lot to see,” he said.