Dr. Norman Fost speaks softly, like he's unaware that half the world might think he's off his rocker. He has been called the loneliest man in America, the wacko from Wisconsin and the world's most visible steroid skeptic.

Yet he speaks with quiet confidence, remaining steadfast in his conviction that he sees something everybody else is either unable to see or unwilling to admit. He wants one study that shows "modern steroids cause heart disease or strokes or anything." He wants proof.

He's also not the only one debating whether sports are taking the correct route — centering arguments on ethics, scaring sans the scientific evidence — to cure what he calls their "perceived" performance-enhancing problems.

"You just can't make it up," says Fost, director of the program in medical ethics at Wisconsin. "They need some basis for it. And there is none. Show me the articles. Show me the studies. The bodies, if you will. People that make these claims have no references. And no one challenges them on that."

So we asked 25 experts one question: where's the definitive study that using performance-enhancing drugs are bad for athletes? Where is, in Fost's words, the proof? All 25 respond in chorus.

There is none.

Well, that's not exactly true. There was a study published in the New England Journal of Medicine in 1996. In it, one group of athletes was administered high doses of anabolic steroids (about 600 milligrams per week) and compared with a control group. Researchers found increases in muscle size and strength, but no adverse effects.

Since it lasted for six weeks — and most experts say that long-term effects of steroids will not be known for decades — it told us, well, absolutely nothing we didn't know already.

This leads Fost and others to ask what they deem a fair and simple question. What is it about drugs that differentiates them from other avenues — equipment, coaching, genetics, just to name a few — that enhance performance?

The ethics of sports, that's what. The belief that sports are a noble pursuit, that they are ultimately one person's ability against another person's ability, mano a mano if you will, that they are inherently fair.

"I fall back on the notion, for wont of a better word, of the yuck factor," says Maxwell Mehlman, law and bioethics professor at Case Western Reserve University. "It's a matter of taste. It's a matter of aesthetics. When it's all said and done, ultimately it's arbitrary.

"My concern is with the general growth of this. We're adding a war on performance-enhancement to the existing war on drugs."

What concerns Mehlman is that the anti-performance-enhancement attitude will "drift" outside of sports and into soon-to-boom fields like anti-aging. He calls it a "carry-over effect."

He points to drugs banned in sports such as human growth hormone (HGH), which he says racked up more than a million dollars in sales in Florida last year.

"The rules of what sports allow and disallow are arbitrary," Mehlman says. "That's fine. If sports wants to ban everything, that's its privilege. My concern is the general notion that it should be criminalized. Then all those folks in Florida, technically, are felons. We need proof."

The problem is that none is on the way. Because almost, if not all, performance-enhancing drugs are legal only by prescription, those used by athletes are illegal. And, more often than not, abused. They're taken at dosages doctors wouldn't recommend, purchased in black markets and cut with different drugs, and consumed by those who have no idea what the long-term effects are.

Doctors say we'll know more about long-term effects soon enough. That's because heavy steroid use didn't become popular among athletes until the 1970s, says Dr. Harrison Pope, director of the biological psychiatry laboratory at Harvard Medical School's McLean Hospital, and they aren't old enough to have entered the age of risk.

"You can't ethically do a study of 100 guys, feed 50 of them high doses of drugs and then sit back and see who drops dead," Pope says. "But you've heard the old saying, 'The absence of evidence is not the evidence of absence.' "

Possible steroid side effects are well-known and well-publicized — liver damage, heart disease, impotence, shrunken testicles for men, enlarged prostate, deepening of voice and other male attributes in females, among others.

The rest of the evidence is anecdotal. Like the late NFL star Lyle Alzado, who said he developed a brain tumor from taking steroids. To which Fost replies, "That's like saying, 'I ate a lot of hot dogs, which is why I got brain cancer.' You can't claim serious adverse effects based on anecdotes or ethics."

Fost knows his line of reasoning is not the popular one. But that hasn't stopped him from debating experts such as Dr. Gary Wadler, who isn't pleased when Fost's name is mentioned once during a 30-minute interview that stretches over several topics.

"I've debated Dr. Fost so many times, I'm not going to dignify his argument with further balance," Wadler snaps, shortly before dignifying. "His feelings are well known. And so are mine."

Wadler then outlines two reasons he believes Fost is wrong. The first is that "use and prescription of anabolic steroids other than for the treatment of a legitimate disease is a violation under federal law." The second is "we have reason to believe it's a serious health risk. Prospective studies done over the long term would never be approved by a review board. It would take 20 years to see the outcomes."

Even then, the study wouldn't take care of abuse. Dr. Mark Webber is the chiropractor for the Seattle Thunderbirds hockey team and has run drug testing for several international bodybuilding federations.

Would it be healthier if steroids could be monitored and managed, if bodybuilders could be educated? He answers yes.

"In an ideal world," Webber says. "But this is not an ideal world. You're always going to have people abusing it, and then you'll have more serious problems."

The debate is picking up steam. Fost and the like-minded on one side. Wadler and the like-minded on another. The problem, according to Will Carroll, author of the book "The Juice: The Real Story of Baseball's Drug Problems," is there's so little information in the middle.

"On one side, there are pro-steroid people, I mean the really true believers," Carroll says. "On the other side, there are guys like Wadler, and this is war to them. It's so difficult to have a factual, objective discussion about a serious problem.

"So how's anybody going to solve anything?"

Greg Bishop: 206-464-3191 or gbishop@seattletimes.com