At least one baseball tradition will continue with the announcement two weeks ago of Major League Baseball's new drug testing program -- the use of amphetamine to enhance the ball players' performance.

While many are applauding the MLB and players' union agreement for more stringent testing of anabolic steroids in players, many long term critics of baseball's drug testing program are wondering why amphetamines (brand names like Adderall and Dexedrine but also very similar drugs like Ritalin or Concerta) have been left off the list. News reports say baseball's leadership wasn't certain if amphetamines truly improve performance. Also they were concerned that athletes with attention deficity/hyperactivity disorder (ADHD) would be denied treatment if their main drug, the amphetamines, were included as banned substances.

As a doctor who has evaluated and treated ADHD in children and adults for twenty-seven years and wrote a book on stimulants and their meaning in our society, I am baffled by the decision not to include these performance enhancing drugs. A little history is necessary. Few know that the German General Rommel started the ball rolling when he gave amphetamine to his German troops in North Africa during World War II. The Allies in turn widely distributed the drug to their troops and many GI's returned from WWII addicted to speed.

After the war, the American military wanted to explore amphetamine's effects more thoroughly and performed many studies on GI's and others groups in the 1950s. Among the others was the Stanford varsity swim team. All the members of the team were given amphetamine and placebo. The times for both short and long events were compared. On amphetamine the team's overall performance improved by four per cent which doesn't sound like much but that difference, say in a four minute mile, calculates to over nine seconds -- an enormous advantage for supreme athletes when hundredths of a second represent the difference between glory and oblivion.

The military in the end decided against the routine distribution of amphetamine during war time mostly because of occasional erratic behavior (not a good idea for guys with guns). There are relatively minor health risks in taking amphetamine. There is the rare possibility of a cardiac arrrythmia and sudden death (usually only if the drug is snorted or injected). Of more concern is a much higher risk to develop tolerance and addiction to the drug. The recent problems of getting hooked on Ritalin for one of the Desperate Houswives on ABC's hit show was no exaggeration. But virtually all professional and amateur sports have banned amphetamine in any case, primarily over issues of fairness in performance (achievement based on hard work and practice is different than taking a pill) and to avoid "free will under pressure" (if one athlete is permitted to use a performance enhancing substance then other athletes feel forced to take the drug if only to keep up). Major league baseball is the only exception and one must conclude that "tradition" has kept amphetamine off the list.

Admittedly, adult ADHD has become a popular diagnosis in the last five years. Notwithstanding some severely afflicted individuals (most of whom are incarcerated), the symptoms of ADHD can be quite ambiguous. A book popularizing the adult condition listed 100 symptoms that could represent ADHD which ran the whole gamut of the human negative human experience (including "Do you frequent change radio stations?"). Virtually every large metropolitan-suburban area has at least one clinic or doctor where it's well known that both the diagnosis and the pills are easily obtainable. I already envision major league baseball being struck with a sudden epidemic of ADHD. I hope my cynicism is clear without trivializing the disorder for others.

Indeed, only in America may athletes participate in track and field on amphetamine with a doctor's note certifying their ADHD. The NCAA, citing potential disability lawsuits, permits such exceptions. The U.S. Olympic Committee governed by international rules provides no exceptions. There are cases of athletes who've had to switch to non-stimulant medications to address their ADHD. However, I wonder how significantly impaired some of these athletes are, at least when engaged in their sport. It is well known that except for the most affected, even children with ADHD are able to focus well on endeavors for which they have interest and motivation. I would hope someone engaged in serious or professional sports at least likes what they do.

Growth hormone's effects on athletic performance are not as clear as those for stimulants but decision to only test the urine of baseball players also effectively precludes checking for that substance also. It is a shame that the MLB and players' union are not willing to fully address issues of drug enhancement in their sport. Short of players dropping dead or becoming addicted to the drug, the amphetamine tradition will continue in baseball. Their flimsy explanations not withstanding, the message from baseball to all of us including the youth of America is clear, "Cheat, if you can get away with it (and make some poor excuses too)."