Why performance enhancing drugs belong in sport

From a purely scientific perspective, bans on performance-enhancing drugs are arbitrary and illogical.

Greg Stevens

Science Correspondent //http://www.kernelmag.com/features/report/7144/performance-enhancing-drugs-will-never-go-away-and-they-shouldnt/

Notorious drug cheat Lance Armstrong in the documentary The Armstrong Lie

Wednesday, 27 November 2013

Caffeine was fine for athletes to use until 1962. Then it was banned by the International Olympic Committee, and it suddenly became an illegal, shameful and disgusting way to gain an unnatural advantage. Then, in 1972, the ban was lifted, and caffeine was suddenly just something you got with your coffee or soda. Then, it was re-banned in 1984.

In 1988, Alex Watson was dismissed from competing in the Olympics. In his words: “As far as they were concerned… I’d tried to cheat, I’d failed a drug test, I was a disgrace.”
Then in 2004, the ban was lifted again. But, in 2010, a high-profile Australian Rules football player ended up in the hospital after having an adverse reaction to caffeine and sleeping pills, so the World Anti-Doping Authority (WADA) recommended adding caffeine back on the banned list again.
John Fahey, chairman of the WADA, said: “Having been taken back off the banned list, it can be put back on… It will be looked at again in light of what’s occurring at the moment” (emphasis added).
This mercurial “we will change the rules based on what’s in the news today” attitude is fueled, in part, by the way that the media reports on these issues. Shame. Betrayal. Disgust. The language is always damning and extreme.
From Alex “A-Rod” Rodriguez to Lance Armstrong, from the 2007 Mitchell Report to the current ongoing investigation of the Biogenesis of America clinic, the stories are always presented as tales of sleaze and moral decrepitude that inevitably lead to remorse and shattered dreams.
How could they not? When people think “steroids”, the image that comes to mind is those infamous East German female athletes, back when Soviet-controlled East Germany started giving their athletes testosterone, resulting in liver cancer, organ damage, infertility and… well, a very distinctive look.

Kornelia Ender, 1976. Photo Credit: Allsport UK/Allsport

But medicine and technology have come a long way since the 1970s. People know more about dosages and how to counteract the negative side-effects of substances like testosterone. Nonetheless, injecting your body with things that bodies naturally produce, such as human growth hormone (HGH), testosterone and blood, is still banned.

Taking synthetic antibiotics or pain killers, on the other hand, is not banned – despite the fact that both antibiotics and painkillers are performance-enhancing. They allow athletes to overcome the pain and damage caused by physical stress, and therefore improve performance. Moreover, they both can have harmful physical side effects if they are taken to the extreme or administered in an unsafe way.
Testosterone and HGH can both be prescribed as medical treatment for people whose bodies do not produce enough of these substances naturally. To account for this, the International Olympic Committee created Therapeutic Use Exemptions (TUE), which can be granted to an athlete if the three following criteria are met: 1) the athlete would have a significant impairment to health if the drug were withdrawn, 2) the drug will only increase the athlete’s performance to normal levels, and 3) the athlete could not use any permitted alternative.
Since neither “significant” nor “normal” are well-defined, these criteria essentially are reduced to a game of instinct and personal judgment on the part of the TUE commission. TUEs for testosterone use were approved in two prospective Olympic athletes in the 1990s because the applicants were men who did not have testicles (one because of a congenital defect, the other because of surgery).

Sticking to the spirit

On the other hand, an older Olympic athlete had been prescribed testosterone for the medical condition of low testosterone, but his application for a TUE was rejected because there was no “organic reason” to justify its use. Here “organic” presumably means “lack of testicles”.
Vague guidelines and arbitrary enforcement have always been the name of the game for drug enforcement in sports, however. The WADA defines three criteria for banning a substance for Olympic athletes, one of which is whether use of the drug is “against the spirit of the sport”.
You see, the reasons for banning performance enhancing drugs from athletic competitions have never really been about health or science. From a purely scientific perspective, the bans are arbitrary and illogical.

XKCD addresses the steroid scandal.

Serious athletes monitor, regulate and experiment with every aspect of their physical being. This includes their food and water intake, their sleep habits, and of course their exercise routines. They have rituals that they go through during training and leading up to competitions.

The rituals are different for different sports, of course, but they can include anything from manipulating their sleep cycles to radically modifying their salt intake in the days before they compete. For athletes, their bodies are finely-tuned machines. They are constantly testing the engine, seeing how it reacts and fine-tuning the parameters.
So what happens when an irresponsible overly enthusiastic young athlete voids himself of too much salt, and due to a medical condition ends up in the hospital? Will salt testing suddenly become mandatory, and salt a regulated substance: anyone with levels too low will not be allowed to compete?
Will new committees be formed to ensure that no athletes eat too many carbohydrates in a day, with the intent of “conferring an unfair advantage”? Will they regulate how much or how little sleep an athlete is allowed to get?

Vague guidelines and arbitrary enforcement have always been the name of the game for drug enforcement in sports.

When emotional levels are high, as they tend to be both in matters of sports and in matter of health, people easily slip into extreme and irrational arguments. This is how we end up with bans on caffeine, a substance that is almost difficult to avoid in today’s world.
This is how we end up with scare stories like the New York Times piece, “Muscular body image lures boys into gym, and obsession”, intended to terrify parents over the fear that their children might feel pressure to take performance enhancing drugs if they get involved in sports.
“90 percent of the 1,307 boys in the survey… said they exercised at least occasionally to add muscle,” the article ominously explains. “More than 40 percent of boys in middle school and high school said they regularly exercised with the goal of increasing muscle mass.”
Behold the horror of teenagers exercising! Obviously, parents should be very frightened.
The witch hunts and drum-beating surrounding steroid use – both for professional athletes and for teenagers – have been ramping up dramatically over the past 10 years. Everybody is told that they should be afraid of this terrible epidemic. Massive “outings” of athletes, like the ones currently in the news surrounding the Miami clinic Biogenesis of America, are lapped up by audiences with the same horror and fascination as car chases and airplane crashes.
Yet despite the best efforts of the fear-mongers, professional athletes are still doping. There is absolutely no evidence that all of the fear and bans and shaming have actually lead to any decrease in the use of performance enhancing substances.
How could it possibly be a deterrent, when the notion of “performance enhancing substances” isn’t even well-defined? How could an athlete possibly take the idea seriously, when he views his body as a complex and highly tuned machine for which all food is essentially a drug: a drug in the good sense, and one that allows the machine to function properly.

Inconsistent and arbitrary rules

There are times, although they seem rare, when the “anti-doping” crowd is pressed to admit their own inconsistent and arbitrary rules. This happened recently when HARDtalk’s Stephen Sackur interviewed Julian Savulescu, professor of Practical Ethics at University of Oxford and editor of the Journal of Medical Ethics.
Over and over again, Savulescu explains that the ban of performance enhancing drugs is arbitrary and illogical. Finally, Sackur was reduced to stating explicitly the real underlying argument against performance enhancing drugs: moralistic prejudice.

“You miss a human element,” Sackur blusters. “If you persist with this, you turn sport into a contest between scientists, rather than a contest between physical athletes.”

This kind of argument has been echoed by others, such as Eric Cohen, the editor of The New Atlantis. Cohen says, “steroids may help athletes break records, but that such feats cannot be considered valid athletic accomplishments because they are not, in themselves, solely human.”

With all due respect to journalists and philosophers, this is the type of observation that could only be made by a person who has never been a serious athlete.

There is nothing more human than being an athlete who is in tuned with his body. There is nothing more physically human than paying such close attention to your body that you know how every aspect of your diet and exercise routine impacts you, how your performance will change, and how you can improve that extra fraction that could ensure victory in the next competition. There is nothing more human than testing the limits of your physical self.

When you are an elite athlete, everything in life is chemistry. Your sleep, your diet, your activity, and even the amount and timing of the water you drink affect your body chemistry. Everything is a drug. And your one and only focus is finding out how to push your body to perform better.

There exists no drug that will simply place you on the scoreboard for any sport. All performance enhancing drugs interact with an athlete’s genetics, training, diet, and skill. Even if performance enhancing drugs were made universally legal, in a free-for-all with no restrictions – which is not something I’m advocating, by the way – it would still not be a “competition between scientists”.

At the end of the day, no matter how many drugs are involved, The Game will always be sweat and blood and skill and training. This is something that every athlete knows, and this is why the “problem” of athletes manipulating their own bodies, by any means necessary, will never go away.