For a decade after his reign as the premier American marathoner of the early 1980s, Alberto Salazar failed to win a major race, and no one could figure out why. His years-long quest for medical advice that might salvage a distinguished career became well known among those who follow the running scene. Finally, the long-awaited breakthrough came with a victory in the 56-mile Comrades Marathon in South Africa in June 1994. But this personal triumph was accompanied by an odd and, for some observers, unsettling piece of news. After consulting with a sports physician and an endocrinologist, Salazar had concluded that years of intensive training had “suppressed [his] body’s endocrine system.” The treatment that he and his advisers chose was a drug that had no previous association with athletic performance and did not violate international rules: the now-legendary antidepressant Prozac.

No one familiar with the history of drug use in sports will be surprised by an athlete’s innovative use of a medication, especially one that is prescribed to create courage and self-confidence in timid, lethargic, or demoralized people. Over the past century there have always been athletes willing to ingest substances, including potential poisons such as heroin and strychnine, to boost their performance. That many of them have been assisted by physicians and pharmaceutical companies reminds us that sports medicine has always been part of what one German sports scientist has called “a gigantic experiment on the human organism.” At the same time, we must not overlook the quasi-scientific or pseud­o­sci­en­tif­ic character of most experimentation. Consider, for example, the fuzzy medical logic employed by Alberto Salazar and his counselors. While Dr. Peter D. Kramer’s phenomenal best seller Listening to Prozac (1993) makes many claims for the drug, the treatment of endocrinological disorders is not one of them. Equally revealing is the vagueness of the self-diagnosis that pointed Salazar toward the world’s most popular antidepressant: “It wasn’t that I was depressed or sad,” he told an interviewer. “I just never had any energy or zest. I knew there was something wrong with my whole system.”