The most controversial issue in sports medicine is performance enhancement beyond what can be achieved by proper nutrition and general conditioning. The publicity has focused on drugs: first amphetamines, now steroids, next human growth hormone and other genetic engineering products. The problems are not limited to drugs. Biomechanics and the use of direct muscle stimulation tools are changing the nature of training and allowing the selective overdevelopment of muscle groups. Improperly used, these techniques can increase the probability of injury and disability.

Taking drugs to improve athletic performance has been publicly deplored but privately practiced for years. It has become a risky practice for both the athlete and the physician. Most competitive athletic organizations have rules against any use of drugs or doping to enhance performance. Urine testing has become cheap, quick, and easy. The athlete who gets caught is likely to be excluded from participation for some time. Blood doping is less easily detected but may be more dangerous. Even the use of the patient’s own blood can be risky. Physicians should remember that it is unethical and usually illegal to prescribe for nontherapeutic purposes. As drug enforcement programs adopt zero- tolerance policies, physicians with questionable prescribing habits can expect to face investigation and prosecution.