Performance Enhancing Drugs: Not Just Baseball

There are quite literally thousands of musical notes in a symphony—each of which must be played not only with near mechanical precision but infused with a passion that breathes life into the composer's vision. Replicating that passion and technical prowess to an audience every night is a tall order. But to many professional musicians, it's a prospect that reduces them to cold sweats, nearly incapacitating anxiety, even physical pain—what the rest of the world calls stage fright. "It got so bad that I would be sick for days before a performance," says Jeffrey Forden, 47, a French horn soloist and chamber musician in New York. "That was before I started taking pills."

As Congress prepares for another round of interrogation of major-league ballplayers about their use of steroids and human growth hormone next week, ignored is the starring role that so-called performance enhancing substances also play in myriad professions from the classroom to the orchestra pit. While pitchers Roger Clemens and Andy Pettitte and infielder Chuck Knoblauch will face questions about which, if any, drugs they took to improve their play on the field, professionals in other fields like classical music and academia are turning to a variety of drugs to tame their nerves or simply boost their production. Forden received his legally from a doctor, but many actors, dancers, public speakers, students, and musicians buy them without a prescription for a few dollars from their peers. Known as beta blockers, medication to lower blood pressure, they are the performance enhancing drug of the performing world. Beta blockers, in small doses, are far less harmful to the body than, say, steroids, yet there is a real risk that players can become psychologically dependent on a pill.

Probably dating back to mead-swilling troubadours, musicians have long turned to drugs to influence their playing. Alcohol and marijuana are the most common; jazz giants like Charlie Parker, Miles Davis, and John Coltrane used heroin. And pity the medic called to analyze blood samples from Jimi Hendrix, had the drug-addicted guitarist been subjected to the same investigatory regime that professional bicyclists now endure.

Musicians, classical ones in particular, argue that their profession is so difficult and stressful that drugs are a natural response to the demands placed on them. A survey in 1987 found that 27 percent of classical musicians used beta blockers, though many estimate that use is now far more widespread. Seventy percent of those taking the meds got them without a prescription, the study found. "Listen, if you get one note wrong the entire audience knows and your career can suffer—it's about a livelihood that demands perfection," says a flutist in midwestern orchestra who has used beta blockers (obtained from a colleague) before auditions and concerts. "It's the hardest job in the world."

That's a common sentiment among pill-popping tunesmiths and professional athletes alike, and one with which neurosurgeons and bomb disposal technicians might beg to differ. Yet it hints at a central question of the steroids era: Why is it OK to use drugs in some professions, but not others? Bioethicist Greg Kaebnick says the use of drugs to affect performance can only be assessed in ethical terms on a case-by-case basis. "There's no general ethical principle for enhancement—a performance that one group celebrates as a manifestation of natural talent and practice boosted by a drug, another group sees as cheating."

And just as there are musicians who insist that pieces be performed only with the instruments for which the music was composed (a harpsichord, for instance, instead of a piano), there are those who consider beta blockers cheating. "If you practice a piece a hundred times, then take a pill to minimize your chances of messing up during a single audition, is that cheating?" asks Forden. Drugs are acceptable to alleviate physical pain, but not to make life painless, ethicists contend. An oft-cited reason that Congress began looking at the steroids issue in the first place was the reported danger to teen athletes, though the actual number of teens using anabolic steroids is quite low. Beta blockers, as classical musicians describe using them, have less risk, according to a report by the Cleveland Clinic Foundation.

For students, the lines between appropriate and inappropriate use of performance enhancing drugs is even less clear. Speed in the form of diet pills was common in past decades, and caffeine is ubiquitous on campus. But is it cheating for a student to take Ritalin before the SAT or the GRE? And, if beta blockers ease nerves so easily, should nervous surgeons be using them too?

Many students, even those with dubious symptoms, are prescribed the drugs legitimately. Should their scores carry an asterisk, like the Barry Bonds home run baseball headed for Cooperstown? If not, should every student be able to take the pills to compete on an equal playing field? "Attention, just like the capacity for stage fright or home run hitting ability, is a natural human attribute. Some people have it more than others," says Barbara White, a professor at the University of New Hampshire who found that nearly 17 percent of college students were taking ADHD medication in ways not prescribed by a doctor.

But do such drugs, in fact, enhance performance? That depends on the definition of enhancement. "It has become an artistic dilemma: Do you settle for less passion in your playing by taking a pill to take the edge off your nerves?" asks Barry Green, a former bassist with the Cincinnati Symphony and author of The Inner Game of Music. Green contends that musicians who don't suffer from clinically diagnosed anxiety are turning to the drugs to compensate for poor preparation as much as for frazzled nerves. And it comes with a cost. "Subtracting adrenalin from the equation," he says, "is going to make your music suffer." That might not be cheating in an audition, but it surely cheats the audience.