San Francisco physician Prentice Steffen has a radical-fringe medical philosophy that has made him persona non grata in his chosen specialty.
"I believe it's my duty as a physician to do what I'm able to protect young athletes from a system that forces many into practices that are dangerous to their health; I believe that it would be negligent of me not to take that responsibility seriously and act accordingly," Steffen wrote in an e-mail distributed among friends. He sent the message last fall after he was compelled to resign from his part-time job as team doctor of Team TIAA-Cref, a bike racing team sponsored by the financial services company that is now contesting the Amgen Tour of California which began Sunday on the Embarcadero. "Also, I believe in the beauty and purity of sports and find doping offensive in every way," Steffen wrote.
Ordinarily a doctor taking a stand protecting patients' long-term health isn't controversial. But in the alternate universe of professional sports, where Steffen has been a team cycling doctor since 1993, it is different. There, Barry Bonds keeps his job after injecting "the clear." And in that ironic world, Amgen, manufacturer of cycling's most popular banned doping drugs, sponsors the Western Hemisphere's biggest-ever bicycle race. Amgen's main products are Epogen (commonly known as EPO) and Anaresp, forms of the hormone erythropoietin that are legitimate lifesavers for cancer and anemia patients and that also happen to have a blood-thickening, stamina-enhancing effect popular among cheating athletes.
There will be plenty of heroics during this week's seven-day, $20 million bike race from San Francisco to L.A. in the form of out-of-the-saddle attacks, 40-mph-plus sprints, and chesslike team strategy devised from inside team cars. But I'm going to be reserving some of my cheers for the St. Mary's Medical Center emergency room physician and moonlighting sports doctor Steffen. His own heroic behavior denouncing performance-enhancing drug use has earned him a roller-coaster ride from respected team doctor to outspoken pariah to top candidate for a job carrying out anti-drugs policy for international track and field. And I hope the ride leads back to a job as a pro cycling team doctor.
Along the way Steffen may have planted a seed in the international cycling community that has a narrow chance of blossoming into a full-blown purge of pro athletes who improperly use products such as those produced by Amgen. A year and a half ago Steffen sent out e-mails to cyclists he knew who had been members of Lance Armstrong's U.S. Postal Service cycling team, for which Steffen was team doctor in the mid-1990s. Steffen advised them that they might be in a legal position to sue the team's S.F.-based owner over the subject of performance-enhancing drug use. If such a suit were to be filed and prevail, it could help sever the link between sports and dope. That's because, for the first time, a company could stand accused of financial fraud if it profited from knowingly hiring doped athletes and lying about it.
From a sports-business point of view, Steffen's outspoken anti-drug posture makes him a risk. He was compelled to resign from the TIAA-Cref cycling team last October after a French newspaper quoted him repeating published assertions that the now-retired Armstrong had used banned drugs. There's a chance the team may take him back to aid riders beginning with this week's race.
From a medical point of view, and from the perspective of sports fans wishing to believe they're watching drama more authentic than pro wrestling, Steffen's return to the cycling fold would be the best possible outcome. During the seven days that Tour of California cyclists make their way from San Francisco to L.A., I'll be shouting a cheer for Team TIAA-Cref that goes something like this: "Allez, allez: Keep Prentice Steffen in cycling!"
Until he was compelled to resign from TIAA-Cref last fall, Steffen worked a steady sideline as a team doctor ever since he was hired in 1993 by Subaru-Montgomery, an outfit launched by San Francisco financier Thom Weisel as a precursor to Armstrong's U.S. Postal Service team. Steffen was U.S. Postal's team doctor in the mid-1990s before moving on to work with other top U.S. professional teams.
Steffen says he became truly concerned about the issue of doping when Tyler Hamilton and another rider for the U.S. Postal Service team approached him a decade ago with what he believed was a request to medically administer banned performance-boosting drugs.
"My first big go-round with Lance was when I first wanted to tell that story," says Steffen.
In 2001 British anti-doping journalist David Walsh quoted Steffen saying, "Two of my riders approached me saying they wanted to talk about the medical program."
Walsh then wrote, "Steffen is sure he was being asked to help two riders to dope."
Steffen says Armstrong read the story and was furious.
"I did catch heat, and got a call from Lance saying he would make my life miserable."
Hamilton, for his part, wrote to a cycling magazine that "the claim that I, along with another teammate, approached a team doctor and asked him questions about doping products back in 1996 is absolutely false. I swear on my wife's life and the grave of my dog that I never asked that man about anything of the sort."
Earlier this month Hamilton exhausted the last of his appeals against a two-year suspension for using banned injections of another person's red blood cells to boost his own stamina while on the Phonak cycling team.
The agency representing Lance Armstrong responded to a list of questions by saying it had no comment for our story.
Another go-round came when Steffen got the idea of using this information to sue a company formed by S.F. financier Weisel to manage the U.S. Postal Service team. Steffen believed that the U.S. Postal Service's sponsorship contracts with Weisel's Tailwind Sports included an anti-doping clause permitting the government agency to cancel the agreements if team officials looked the other way as riders doped. Steffen believed this had indeed happened, and he consulted a lawyer specializing in the False Claims Act, a 19th-century federal law that permits common citizens to sue individuals or companies they believe have defrauded the government.
The attorney told Steffen his theory was sound. If team officials had kept the Postal Service's $10 million-per-year checks coming in by hiding a doping problem, it might constitute fraud. And whistle-blowers who sue to expose fraud against the government are allowed by law to get part of the proceeds. Given that the Postal Service sponsored the team for several years, such a cut could amount to millions of dollars. (Steffen went to attorneys about a year before I wrote about this legal theory last year.)
But Steffen didn't have a case. For one thing, his account of possibly being asked to dope two riders wasn't evidence of team-official-endorsed doping. For another, Postal Service contracts didn't contain anti-doping clauses until 2001, four years after Steffen had left the team. But Steffen believed there were other insiders who might have such information and would be in a financial position in which lawsuit winnings might come in handy.
Last fall Spanish bike racer Roberto Heras, who had been Armstrong's top lieutenant on U.S. Postal, was suspended after testing positive for erythropoietin, a year after his U.S. Postal predecessor Hamilton tested positive for blood doping. Both of these riders are in their mid-30s, and near the end of their careers, and potentially in need of money.
Steffen e-mailed a half-dozen cyclists he knew who had been on the U.S. Postal Service team advising them that, if they had insider doping information, along with information that team officials knew about it but did nothing, they might be in a position to approach an attorney specializing in False Claims Act cases.
If doping did go on at U.S. Postal with team officials' knowledge -- and the types of medications and procedures now used to illegally boost performance are so sophisticated and dangerous that they usually involve help of one kind or another -- Steffen's e-mails could prove a time bomb waiting for an ex-Postal rider to follow his suggestion. Nobody seems to have taken Steffen up on his call to arms -- yet.
Steffen's next go-round with the anti-doping cause came last September, in an interview he gave a reporter with the French newspaper L'Equipe. The interviewer asked Steffen if there was such a thing as a typical "profile" of a bike racer who boosts performance with dope, and Steffen, who speaks French, said no, that all sorts of athletes cheat with drugs.
"Unpleasant people like Lance Armstrong dope and nice people like Tyler Hamilton also dope. There's a moment when they waver. As if they don't have a choice. The only other solution would be to stop cycling. But they see themselves without a future, without a job," Steffen was quoted as saying.
Armstrong placed a personal call to the TIAA-Cref cycling team director. Soon TIAA-Cref team officials were editing Steffen's resignation letter and sending it to Armstrong's assistants for approval.
"Lance spoke with me about it, yeah. He did. He wasn't terribly happy," says Jonathan Vaughters, director of Team TIAA-Cref.
He says Armstrong "has a history of taking legal action against people saying things he didn't like. You can call that a legal implication. But he didn't say, 'We're going to come after you.'"
Steffen's L'Equipe quotes and subsequent resignation spawned newspaper stories all over the world. Steffen quickly found that his outspoken posture had gained him fans across the globe, some of them in high places.
"In the aftermath of the L'Equipe interview in October I got a bunch of e-mails from all over," says Steffen, "and I got one e-mail from the International Association of Athletics Federations," the world governing body of track and field.
Steffen was invited to apply for a position implementing the IAAF's anti-doping programs worldwide.
Harmon Brown, a UCSF physician who is a member of the IAAF's Medical and Anti-Doping Commission, says he believed Steffen would make a good fit with international track and field's efforts to banish doping.
"He was very much opposed to any form of doping, and he had a pretty strict attitude about the use of any illegal means to enhance performance," Brown says.
The association flew Steffen to Monaco for an interview. He was thrilled.
"I thought, 'Man, this is destiny.' Talk about landing on your feet after the Lance affair," Steffen says. "The problem was the pay was so low."
In Europe physicians don't occupy the same elite economic status that they do here. And administering the IAAF's global anti-doping programs paid a paltry $50,000 per year, less than half Steffen's income as an emergency room physician.
So for now, Steffen is left working nights at St. Mary's with hopes of returning to his sideline ensuring the health and fitness of elite international cyclists.
"Our sponsors have a say in whether that happens. Prentice himself has a say in whether that happens. But Lance doesn't have any interest or say in that decision," Team TIAA-Cref's Vaughters says.
While I had him on the line, Vaughters, himself a former top professional cyclist who raced with the U.S. Postal Service team in 1999, reminded me that cycling gets a lot of flak for banned drug use when the problem is at least as acute in sports such as football and baseball. Those sports don't have anything near the rigorous urine and blood analysis that cyclists must endure all year long.
Vaughters said he believes stricter testing has reduced the use of banned substances by cyclists since 1998, when Tour de France police raids revealed systematic doping programs implemented by European teams. In 2000, Vaughters moved from Postal to a French team sponsored by the bank Credit Agricole, which had insisted team directors take an absolutist anti-doping stance. He's brought that philosophy to TIAA-Cref, which he has staffed with young riders unversed in old cycling ways. And he hired Steffen, who is well known for his opposition to doping.
"After the 1998 Tour scandal, the French teams really said, 'Whether the test is positive or not is not the point. We want to be clean, period.' When it came to a team like Credit Agricole, it was just like the doctors were literally checking to make sure you weren't doping," Vaughters said. "It was a refreshing attitude."
I asked him if he meant refreshing when compared with his previous team, U.S. Postal.
"Ah. Uh. Heh, heh," Vaughters said and then paused a moment. "It was refreshing compared with the general attitude of the cycling world that I have seen in my life," he said.
In the world of professional sports, Vaughters' anti-doping attitude has the potential to create controversy. For that reason Vaughters' team, its erstwhile doctor, and the young riders under their charge deserve some loud shouts of "Allez, allez! Andale! Andale! Keep it clean!"