Drugs in sport

A version of this article was printed in Humanism Ireland, March-April, Vol. 145 (2014) 

Should we legalise performance-enhancing drugs in sport?

In July this year, American Tyson Gay and Jamaican Asafa Powell (the second and fourth fastest men of all time over 100 meters respectively) tested positive for banned substances.  Other athletes, such as Jamaican sprinter Sherone Simpson and 31 Turkish athletes also failed drugs tests just prior to the Moscow World Championships in August. Further recent drug scandals include the conviction of the sports-doping doctor Eufemiano Fuentes, who claims to be associated with top Spanish football league clubs, a long list of professional cyclists, tennis players, and past London marathon winners. The ruling of the Spanish court to destroy evidence from the Fuentes trial, however, means that we may never ascertain who was involved with his clinic. Over the past few decades, there have been several doping scandals involving house-hold names: Ben Johnson and Marion Jones (athletics), Lance Armstrong (cycling), Barry Bonds (baseball), and Diego Maradona (football).

Ever since the day Canadian sprinter Ben Johnson demolished his opponents and the 100 meters world record—stopping the clock at an incredible 9.79 second—at the 1988 Seoul Olympics, sports like athletics, cycling and swimming have repeatedly grappled with two concerns: one against the dopers, who many consider are always one step ahead of the science of drug testing, and the other against an ascending public cynicism towards illegal enhancements in elite sports.

To validate this unease, a critical report was released earlier this year, that focused attention on failures within all parts of the anti-doping system, that includes a lack of independence among national anti-doping organisations, doping officers being bribed, harassed and, in some cases, threatened. Dick Pound, the former president of the World Anti-Doping Agency (Wada) who presided over the working group, said the report raises tough questions for all. The extensive use of drugs in sport, he said, has made him question "everything I see.”  Werner Franke, a leading expert on performance-enhancing drugs, seems to share Pound’s feelings: he reminded us, just before the London Games, that half of the men’s 100 meters finalists from the previous two Olympics were subsequently reported to have been involved with banned substances.

In spite of this, Wada and other sporting bodies continually evoke a code of zero-tolerance against drugs. Just prior to the World Championships, the International Association of Athletics Federations (IAAF), for instance, declared their “firm commitment to have tougher penalties,” by announcing plans to return to four-year bans, as opposed to the current two-years, for offenders from 2015. Former athletes also have endorsed tougher penalties: Sebastian Coe, a two-time Olympic gold medallist and current chairman of the British Olympic Association, supports the IAAF’s additional two-year ban; and former Olympic 100 meters champion Donovan Bailey went even further by suggesting that life bans for cheats should be considered.

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So, is a policy of zero-tolerance the best way to tackle the apparent widespread use of drugs in elite sport? Some believe Wada and others are fighting a losing battle—analogous, in many ways, to current western governments pointless “war on drugs” or the introduction of alcohol prohibition in the United States during the 1920s and early 1930s. Along these lines, there’s a list of reasons why the war on doping in sport is also failing.

Firstly, the pay-offs, in terms of money and glory, for athletes is too much and some will always be tempted by drugs to confer an added benefit. Secondly, new drugs are always being developed and many will be very difficult to detect: growth hormone, blood doping and, in the future, gene doping. As gene enhancement becomes more effective, it’s likely to be something that competitors will consider using and detection will be difficult—it would not require blood or urine samples, but unsafe muscle biopsies.  These considerations strongly suggest that current policies are not capable of being achieved and, in consequence, are unavailing.

In Plato’s Republic, Glaucon wants us to imagine what would happen to someone who had a mythical gold ring that makes her invisible at will. He maintained that we behave well only because we’re not invisible; we’re only virtuous because we fear the consequences of getting caught—in particular, the damage to our reputation. However, if we had the opportunity to wear the mythical gold ring and have one’s identity concealed, the temptation might be too much to resist. Glaucon’s conviction was revealed in a small 1995 survey of US Olympic athletes, where over 98 percent of participants said they would take banned substances if it were guaranteed they would win and not get caught.  Although the survey is too small in scale to declare decisively that most athletes would cheat if they got the chance, many studies in social psychology nonetheless give us strong grounds to suspect that people are often more concerned about looking good than really being good. 

A further reason to criticise current anti-doping policies is on account of the rules being confused, contradictory, and grounded on false assumptions. One of the reasons given for banning certain substances is due to the fact that it gives athletes an unfair advantage over competitors. If so, then perhaps it should be available to all competitors; if everyone has access, then no one is disadvantaged. 

It might be said that doping goes against the integrity of sport, since athletes on drugs will not just be applying their natural ability anymore; what we will see, by contrast, is competition between different pharmaceutical manufacturers.  But this explanation isn't altogether satisfactory either. Nobody really thinks elite athletes nowadays just rely on natural ability. There are, of course, intricate combinations of economic, social, political, environmental and technological factors that can determine—directly or indirectly—an individual’s or team’s outcome. Athletes have a much better chance of success, for instance, if the country they come from has better coaches, training facilities, climate, and so on, than someone from a place where these benefits are unavailable.

There are several different ways to gain an advantage over competitors and it’s difficult to see how a professional athlete could succeed without them. This is how Norman Fost, a professor of paediatrics and bioethics, expressed his astonishment to the frequent contradictory convictions of those who are vehemently anti-drugs: “It is remarkable how people brag about manifestly unfair advantages, such as better training facilities, greasy swimsuits, or even superior coaches, and then express outrage about a drug that is generally available to anyone who wants it.”  If we really believe the integrity of sport would be damaged by enhancement aids, Fost argues, then we should also consider banning coaching and training. 

To see how arbitrary anti-doping rules are, consider the example of producing more red blood cells and haemoglobin in the body, so as to carry more oxygen to muscles—this is something endurance athletes find advantageous. There are a number ways to achieve this.  Firstly, high altitude training can allow the body to adapt to the relative undersupply of oxygen, thus increasing the mass of red blood cells in the body and altering muscle metabolism. For many it’s not always possible to train at the top of a mountain. For this reason, several athletes use hypoxic tents—or altitude tents—instead to artificially simulate the effects of living at high altitude.  Thirdly, erythropoietin (EPO), a natural hormone that stimulates red blood production, can be injected into the body for the same effect. The fourth option is blood doping, where blood is extracted from the body, preserved and inserted again after the athlete’s blood has come back to its normal level. According to Wada, the first two options are perfectly legal, but the final two are not.  

Hypoxic tents are deemed legal because there isn't any significant difference between them and high altitude training. If hypoxic tents were to be banned, the argument deducts, we would also have to ban altitude training. Yet, if we follow this line of reasoning, it seems the same thing could be said about EPO and blood doping. The desired outcome, essentially, is the same with all. There doesn't appear to be any difference between elevating your blood count by means of altitude training, a hypoxic tent, EPO, or blood doping, only that the rules say the last two methods are illegal. Wada might say in response that hypoxic tents don’t give the same degree of stimulus as EPO. If this is the case, it could equally be an argument for regulating EPO dosages, instead of banning it completely. I will discuss this point in more detail below.     

It’s often said that drugs are a shortcut to success and that an athlete wouldn't really earn his achievement by taking drugs. This is a misunderstanding of how performance-enhancing substances work. Athletes take drugs because it allows them to train harder and to recover from injuries much faster. Without the hard training, drugs alone will bring no success. American professional cyclist Tyler Hamilton conveyed it like this in his 2012 book, The Secret Race: “EPO granted the ability to suffer more; to push yourself farther and harder than you’d ever imagined, in both training and racing. It rewarded precisely what I was good at: having a great work ethic, pushing myself to the limit and past it.” Similarly, a hypoxic tent or custom-made shoes, by itself, wouldn't be enough to win; even with the developed edge, an athlete still has to train hard in order to flourish.

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The Australian bioethics professor Julian Savulescu believes that current anti-doping legislation has proved to be expensive, unpoliceable and futile, and in its place he has offered a radical solution. In a 2004 paper, published in the British Journal of Sports Medicine, Savulescu and two others first suggested that we should give up the ban on enhancing drugs, and let athletes take whatever they want, on the condition that it's safe for them to do so. This would require testing for health rather than drugs.  According to Savulescu et al., “what matters is health and fitness to compete. Rather than testing for drugs, we should focus more on health and fitness to compete.” Quite consistently, the view holds that if health is screened, it doesn't matter how enhancement is achieved. Based on Savulescu’s suggestion, there seems to be a number of advantages with this approach.

If testing is done to monitor health and fitness rather that drugs, it should make things safer for athletes. At the moment, banned substances are traded underground—sometime by agents of international organised crime—and athletes that self-medicate may use higher quantities than what is safe. If enhancing drugs were permitted, however, it would be easier for athletes to obtain satisfactory medical advice and there would also be greater demand to develop safer drugs. Moreover, instead of investing several million dollars on drug detection, it would be better to devote resources to those substances that are harmful to athletes’ health, instead of wasting funds on those that don’t cause harm.

Fost and Savulescu both claim that the risks of performance-enhancing drugs have been vastly overstated and that there is no strong evidence to suggest serious health effects for many substances—nandrolone, for instance, can be taken safely in small dosages.  Furthermore, the International Cycling Union allows athletes to have a packed cell volume (PCV) no greater than 0.5. Anything above that level can lead to health problems, like the risk of a stroke. If EPO is taken in a quantity that doesn't cause adverse health effects (under 0.5), it is difficult to find a convincing reason to ban it.  If one’s PCV is higher than 0.5 due to high altitude training, on the other hand, he should not be allowed compete. To put it another way, the issue is the PVC safety level, not whether its source is natural or artificial. Substances like anabolic steroids, of course, may be dangerous in themselves, but, as Savulescu argues, we should concentrate on banning them because they are harmful not because they improve performance.

Some might object to this situation because they see it as unfair to honest athletes, namely, by forcing them to take drugs that might have health risks, despite what best medical practice considers safe. This is a legitimate concern, as no drug in the world has zero risk. At the same time, nearly everything we do has some degree of risk involved; drinking too much water, for example, can also be harmful. Professional sport, in particular, contains a high degree of risk—like American football, rugby and motor sport—and indeed they can be much greater than doping. If we think drugs are bad for sports because they threaten the welfare of athletes, the same argument, it seems, could be invoked to ban some sports as well. We may just have to accept that sports contests, like doping, also pose a degree of risk to participants.               

By allowing athletes to take safe enhancing drugs may also result in fairer competition. It will allow genetically less gifted athletes to compete against more naturally gifted ones who just happened to be dealt a better genetic hand. If we think it’s unfair that someone can take drugs to narrow the genetic gap between himself and Usain Bolt, why is this any different than narrowing the gap by way of a better coach or a healthier diet? As far as I know, nobody called for Tiger Woods to be banned from golf after he received eye laser surgery to enhance his vision and performance. Safe enhancing drugs may also reward athletes from lower socioeconomic backgrounds. Only rich athletes can afford to train at high altitude or buy a hypoxic tent; EPO is much more affordable and, if legal, would allow poorer athletes the same benefits as everyone else. In this way, rather than making things more unfair, performance-enhancing drugs actually level the playing field. With safe legal drugs, we must still assume that some athletes would still try to gain an advantage by taking excessive dosages that are harmful. Nevertheless by permitting safe drugs, we narrow the gap between the honest athletes and the cheats.    

     

I don’t believe there’s anything proposed here to suggest that performance-enhancing drugs would radically damage the integrity of sport and result in fans losing interest. In 2002 the French philosopher Robert Redeker expressed concern about the way sports like cycling are becoming steadily more like video games. Of course, enhancement already exists in sport and several have changed drastically over the decades: superior training techniques, starting blocks, superfast Mondo track surfaces, and sophisticated running spikes have all contributed to sprinters recording much faster times. After Mo Farrah won two gold medals at the London Olympics, nobody thought his achievement was tarnished by revelations of him sleeping inside an hypoxic tent beforehand, and it certainly didn't diminish the level of public interest he received either. The introduction of fibreglass poles has allowed pole vaulters to reach much greater heights than before, and it certainly hasn't damaged the integrity or public interest of the event. There are some things that would endanger the integrity of sport: replacing manual racing boats with motor boats, for instance, would obviously be something that would go against the integrity of rowing.  Whereas a substance that grants swift recovery from training, or from injury, would not hamper the integrity of sport. Performance-enhancing substances do not turn athletes into robots, they just simulate natural processes.  

Ever since the time of the Ancient Olympics, the virtue of sport has been more that just a demonstration of inborn physical ability: creativity, innovation and skill have always been synonymous with sporting excellence. By virtue of these qualities, athletes and coaches have forever given thought to different ways to boost performance; using drugs for improvement is not really any difference than other means. Past high profile drug scandals, along with highly probable future ones, has the potential to seriously damage the reputation of sport. Zero-tolerance on doping is likely to fail and thus further jeopardize the future integrity of sport.  Perhaps it’s time to challenge the dogma of anti-doping and, in its place, consider the feasibility of implementing a fair enforceable policy that centres on the health and fitness of athletes.