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Current anti-doping in competitive sports is advocated for reasons of fair-play and …

Biology Articles » Bioethics » Current anti-doping policy: a critical appraisal » Special cases

Special cases
- Current anti-doping policy: a critical appraisal

Doping Control on Cannabinoid Use

There are additional inconsistencies in the foundation of the world-wide war on doping. If anti-doping were purely addressing the unfair advantage of an ergogenic intervention, anti-doping should be focussing on the control of the use of ergogenic substances only. Cannabis (marihuana, hashish) and its active substance THC are not performance enhancing; THC is probably merely deleterious for performance for any elite sport activity [51]. At present the WADA-AMA rules do not allow for traces of THC metabolites in urine, even though it is well known that these metabolites are found in urine well after the psychophysiological effects of the substance have subsided. Why then test for the substance? We believe that the inclusion of control on THC goes beyond the declared goal of anti-doping. Moreover, justification of their inclusion on the claim that athletes are role models is problematic, as this places an unreasonable burden on athletes, compared with other public figures like musicians, politicians or actors whom are not required to undergo such tests. Our point is that the intrusive monitoring of athletes actually undermines their status as role model, since it stigmatizes athletes as people who, without surveillance, will behave improperly. Thus, the burden is unreasonable not because it is unfair, but because it constitutes an attempt to orchestrate role model status which we consider to be deceptive and antithetical to what role models should be. In any case, there is no obvious reason for why testing for THC or similar drugs should be a matter of public concern, unless one also requests tests from other such public figures. If the response is that testing should be applied to other such people, then at least part of our claim would be redundant. However, we believe that there are good reasons for why such surveillance practices would be quite inappropriate in a liberal society. One might also raise questions about the role model status of most athletes. After all, while all competitive athletes are subject to anti-doping rules, only a few have a high public profile or a high salary. The majority have no greater public role than, say, a teacher or a parent. Yet, we do not hear pleas to test these and other people for illicit substances on account of their being role models.

Accepted technology

The use of recombinant erythropoietin for enhancing the oxygen carrying capacity of the blood is prohibited in competitive sports. The alleged reason is clear, since it is accompanied by higher oxygen uptakes and improved endurance performance. Altitude exposure has a similar effect and leads to a natural increase in hematocrit and an increase in oxygen carrying capacity. Nowadays, altitude training camps, often touted with the slogan "sleeping high and training low" are popular [52]. Modern technology allows for the simulation of altitude with the use of hypobaric and normobaric hypoxia. Costly adaptations of sleeping quarters allow sleeping at virtual altitudes and several federations now have these facilities. Even individual athletes who can afford it have altitude sleeping rooms at home [52]. Since it is the body itself that brings about the increase in hematocrit when exposed to hypoxia, athletes are for now allowed to use this technology even though its objective is to gain "undeserved" advantage, just as with erythropoietin doping, and there are no long term data on its alleged innocuousness. Again, this is a challenge to equity, since many athletes cannot afford nor have access to such technology. Probably in part in response to this, WADA-AMA recently considered whether such technology should be banned, though has concluded that it should not. This outcome reinforces the inadequacy of anti-doping measures, since the difference between using these techniques and happening to live in a high-altitude locality is ethically irrelevant.

Other permitted technologies reflect a similar hypocrisy in anti-doping rules. For example, electrical muscle stimulation is increasingly used, either in preparation before a competitive event, or after. German athlete Wojtek Czyz won three gold medals (100 and 200 metres, and the long jump) at the 2006 paralympics in Athens after having trained with a unique, commercially unavailable electrical muscle stimulator developed for international space station use [53]. Many sports involve high tech material from swim suits and running shoes to futuristic bicycles. There is certainly no equitable access to these technologies for rich and poor alike [54]. The usual response to this comparison is that these forms of performance enhancement provoke a physiological response while doping methods a pharmacological one. Yet, this is not the justification for distinctions made within anti-doping policy. Indeed, we suggest that it reveals a dubious essentialism about what it means to be human that relies on claims about what is 'normal' or 'natural' for people to exhibit physiologically. We argue that sports have never been a test of merely 'natural' capabilities, but that they have always been constitutively technological, whether this involves specific artefacts or simply the application of scientific knowledge. This interaction between potentiality and environment is consistent with critical views of human genetics. Moreover, the difficulty with a commitment to essentialist views about natural capacities is made more apparent through the application of genetic technologies to sport specifically.

Genetic Technology

Thus, one further challenge that lies ahead for the world of doping exacerbates the need for reform in anti-doping ethics: gene transfer. Also known as 'gene doping', this new form of potential performance enhancement has received considerable attention in recent years. While there is much scientific dispute about the science and current feasibility of gene doping [55,56], its prospect does alert us to the inadequacy of current strategies on doping control. Since some gene doping techniques might be undetectable in urine or blood in principle, one may wonder whether current approaches to doping are at all practical in an era where there can be no realistic expectation of catching all cheats. This might also move the war on doping to a stage of technical sophistication that might make it financially difficult to sustain. In addition, the broader social interest at stake with respect to gene transfer technology would give a new perspective to the question of what kinds of performances are legitimate in sport and how this ties in to concepts of equity, fair-play and deserved merit.

What are the Risks of Leaving Doping Choices to the Athlete?

Even though it is presently unrealistic to abolish anti-doping in sport, let us briefly discuss what the hypothetical consequences would be if the use of doping were allowed. Would there be an important increase in death rate among athletes? Would there be many (more) athletes willing to take deadly risks? Would there be more chronic illness and shorter life span after cessation of an athletic career? If doping were allowed under the conditions we discuss, including an ethical framework based on the principle of non-maleficience, we would probably see an increase in the use of ergogenic drugs, but this need not to lead to an increase in morbidity and mortality. The example of the widespread use of doping in the former East-German republic [57,58] reflects the secret and coercive nature of state mandated doping, a framework widely different from the one we propose. Our proposal for monitored performance enhancement would ensure that athletes are better informed about the risks they take and transparency of these practices would limit the possibilities for a given nation from taking advantage of their athletes. Furthermore, taking doping out of hiding may have positive effects beyond the restricted world of elite sports. Indeed, the practices in the amateur sports world might become less hazardous and thus overall incidence of health problems from doping use might actually decrease. Unfortunately, it seems impossible to test this hypothesis in the current political climate, since there is hardly any interest in re-evaluating the ethical foundation of doping. Moreover, as Houlihan demonstrates [48], there has been no sustained open discussion of the ethical foundations of anti-doping since it began in the 1960s. If one were to compare this with other policy debates in science, medicine and technology, the situation is radically inadequate.

What should the Physician's Role in Elite Sports be?

Suggestions about anti-doping reform have specific implications for medical professionals working with athletes. Yet, even within the present framework of anti-doping, problems arise that invite critical scrutiny of the established model. The current ethical framework of competitive sports is not without problems for the sports physician. As early as 1983, Thomas H. Murray, president of The Hastings Center (a leading institute for ethics), former United States Olympic Committee adviser, and present Chair of WADA-AMA's Ethical Issues Review Panel, argued that the conditions surrounding the physician's involvement with elite sport place undue pressure on their decision making capacities [59]. Often, the coach's or sponsor's interests take precedence over the physician's professional judgement about what is best for the athlete. On this basis, Murray argues that standards of best practice are often unclear or non-existent.

We believe that, in agreement with prevailing ethics of the medical profession, the role of the physician involved in the athlete's health supervision should be one of preserving the athlete's autonomy, which entails a balance between ensuring that treatment leads to the highest degree of present and future health, while acknowledging the athlete's interest to maintain a chosen style of life. Inevitably, there will be situations in which performance optimisation will conflict with the preservation of health just as it is already present today when therapeutic measures are applied to keep an athlete in the game despite an existing injury. Ethical reasoning should be based on proportionality, assessing the benefits and risks as objectively as possible. Admittedly, this is not an easy task, since it requires a process of negotiation to face the difficult question about what kinds of health risks are acceptable for an athlete to take. While further elaboration on this is beyond the scope of this paper, we would suggest that the solution lies partly in the structures of sport that permit such risk taking. Nevertheless, we believe that by carefully helping an athlete enhance her performance (by utilising currently banned methods), in keeping with the principle of autonomy, using any safe technology available, the physician should again become the direct partner of the athlete in pursuit of ever increasing performance. As a result, a physician in the role of caring performance enhancer should be accountable for ill effects from the use of any medical technology. This would be analogous to the usual role of physicians. They are free in their choice of intervention, pharmacologic or other, as long as these are in agreement with current medical knowledge and without disproportionate iatrogenic ill effects. Rather than speculate on anti-doping test procedures, resources should be invested into protecting the integrity of physicians who make such judgements. Without clear regulation, it is possible that coaches could appoint 'performance inclined' physicians to ensure maximum competitiveness in their athletes. Waddington [60] recognises that much more thought is needed to establish principles of good practice concerning the role of sports physicians. Perhaps independent physicians whose status is comparable to other sports officials, is the most suitable strategy through which to develop this more ethically rigorous requirement.

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