health ethics

Feb 22, 2013

Do we need to change our expectations around the “chemical stockpile” of modern sport?

Given the unending stream of revelations about the use of performance enhancing drugs in sport, is it time to rethink the merits of the ban on doping? Paul Smith, po

Melissa Sweet — Health journalist and <a href=Croakey co-ordinator" class="author__portrait">

Melissa Sweet

Health journalist and Croakey co-ordinator

Given the unending stream of revelations about the use of performance enhancing drugs in sport, is it time to rethink the merits of the ban on doping?

Paul Smith, political editor for Australian Doctor magazine, investigates some of the scientific and ethical issues behind the recent horrified headlines.


If sport can’t clean up its act, what are the alternatives? 

Paul Smith writes:

Amid all the lies peddled by disgraced cyclist Lance Armstrong, there was one truth to which he remained faithful.

Yes, he told Oprah Winfrey, doping — the EPO, the blood transfusions, the testosterone, the cortisone, the human growth hormone — “levelled the playing field”.

It’s self-serving, of course. If everyone cheats, who is the cheated?

But during his days in the yellow jersey it was the truth, it is just a truth the rest of us find difficult to acknowledge, not just because of the way it clouds our condemnation of the man — it also clouds our sense of what modern sport is.

That is really the issue at the heart of this month’s shock-horror headlines about “Australian sport’s darkest day“.

Because, for many of those close to the Australian football codes, few of the Australian Crime Commission’s claims could be that surprising. (The report Organised Crime and Drugs in Sport is here).

Growth hormones, steroids and stimulants have been in the gyms for decades, a product of body building, that strange subculture of steroid-fuelled narcissism. These drugs are common, their use and abuse widespread – and not just among the hardcore gym junkies.

Given sport and society are not separate worlds, the culture leached into the football clubs.

The impression left by the ACC’s breathless report was that evolutionary forces of big money sport mutated into a world where Frankenstein doctors administer exotic, performance-enhancing cocktails apparently mixed in the laboratories of high science.

I suspect much of “science” is closer to the variety found in your average anti-ageing clinic.

On one level I understand why drugs get used – given the mundane physical brutality of a sport like rugby league. Outside the millionaire lifestyles of the game’s superstars, for the journeyman that crosses the line the use of steroids must feel less like cheating and more like a form of survival – survival in the struggle for the next game, the next season, the next contract and the world you have been a part of since you were a kid.

For all its glamour, professional sport is a precarious trade, the nature of which the rest of us are fortunate not to face.

Whether the crime commission’s allegations against the nameless leads to something more substantial than a well-intentioned PR stunt is a difficult question.

The doping agencies are launching their own inquiries into the football codes. Sadly the most powerful driver of doping — Armstrong’s “level playing field” philosophy and the doping culture it breeds — will be a harder case to crack.

When you have an endemic perception that doping is itself endemic, the problem self-perpetuates.

Sprinter Ben Johnson, one of history’s most notorious drug cheats, first took steroids at age 19. He was told by his coach Charlie Francis that without the kind of steroids being injected by his rivals, he was starting a metre behind in every race he ran.

Johnson said he struggled with the dilemma for three weeks before he made his Faustian pact. What is most depressing about the story is that we now know his coach was largely right.

Of the eight men who ran the 100m final at the Seoul Olympics in 1988 — described as the “dirtiest race in history” — five had tested (or would test later in their career) positive for banned drugs, including the winner, Carl Lewis.

And you don’t have to hang around the sporting elite to hear rumours about who dopes. The easy availability of performance enhancers means the suspicions cut right through to local club-level sport where cheating can not be passed off as mechanism for financial gain.

The question is whether the suspicion can ever be eradicated, now that participants and spectators have been fed so many broken promises of a new dawn of drug-free sport — in athletics post Ben Johnson, cycling post Festina, baseball post Barry Bonds.

It is worth stressing that the reliable test for anabolic steroids, used since the 1950s, only emerged in 1974. For blood doping it was 1986. The test for EPO came a decade after the drug was banned in 1990. For human growth hormone — a test still not widely used — it was 2004.

It is this that led to the arguments — articulated by medical ethicists like Julian Savulescu — that the ban on doping should go. The Oxford University professor describes anti-doping as a failed dogma.

Doping, no different from caffeine pills and altitude training, should be legal. Athletes would be monitored by doctors in this brave new world.

The only point at which they would be removed from an event would be if their health was at an unacceptable risk, such as when injected EPO reaches such concentrations it turns blood to a sticky, fatal glue.

The argument flounders on the difficulty of determining what an acceptable health risk is.

Is it when doping reduces your life expectancy, when it threatens imminent illness? And how imminent and how serious does it have to be?

Yes, you can use predefined biomarkers – but these are often proxy markers for health at the level of the individual – not health itself. In short there is no distinct line to be drawn.

Hopes for clean sport now lie with the widespread introduction of biological passports supplementing random drug tests. For all its dirty history, cycling seems to show a possible future.

You hope it works because doping controls, given the repeated wave of scandals, require acts of faith among the public.

If our suspicions cannot be assuaged, then competitive sport will become a “levelled” playing field, one where every kid with natural talent becomes, in the words of Dick Pound, former head of the World Anti-Doping Agency, a “chemical stockpile”.

• This article was first published in Australian Doctor on 22 February. 





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