Should use of performance-enhancing drugs be banned in sport?

Sigmund Loland, Professor, Norwegian School of Sport Sciences (Norges idrettshøgskole) and Visiting Professor, University of Southern California, 2014-2016

In the general public and the mass media, a primary concern with the use of performance-enhancing drugs (PED) seems to be on cheating and unfair advantages. Clearly, breaking rules to get an exclusive advantage is unfair. Yet the fairness argument does not entail whether use of PED should be banned or not. We cannot justify a ban merely by reference to the wrongness of rule breaking.

A second argument is that use of PED implies risk of harm to athletes. Indeed, this is true. Extensive use of anabolic steroids or EPO in non-therapeutic dosages implies risk of harm and, in worst cases, death. But again, the argument needs qualification. First, some banned drugs can probably be used without risk of harm, for example micro-dosages of EPO. Secondly, sport is not inherently free of risk. Hard training and intense competition brings with it the risk of injury. In sports such as downhill skiing athletes face risk of serious injury and even death. The health argument can be developed into the (to most of us) absurd argument of banning competitive sport as a whole.

My point here is that any stance on PED-use in sport necessarily requires a stand on the nature of sport itself. Anti-doping, as well as a liberal view on the use of PED, are normative positions based on more or less explicit references to the values of sport.

The spirit of sport

This is acknowledged by The World Anti-doping Agency (WADA). For substances and methods to be evaluated for the prohibited list, they must be potentially performance-enhancing, potentially harmful, and potentially a violation against what WADA refers to as ‘the spirit of sport’. The spirit of sport is defined as ‘… the celebration of the human spirit, body and mind’, and is further explained in reference to a series of ideal values, among them fair play and honesty, health, excellence, character and education, and fun and joy.^[1]

The two first criteria on performance-enhancement and health are matters of available scientific evidence and objective discussion. The ‘spirit of sport’-criterion is a normative criterion and has to be interpreted with critical ethical reflection.

WADA’s definition of ‘the spirit of sport’ has been exposed to criticism.^2] The values are general and provide little specific action guiding potential. This criticism is relevant but to a certain extent misplaced. The Code is a principled policy document. Criteria of performance-enhancement and health risk are not operationalized in detail, either. As in any other policy-guiding institution, sub committees, often with experts, are given the task of operationalizing or line drawing. Policymaking is a constant iterative process between principles and considered judgment in practical cases.

On the other hand, the critique hits the point. Whereas the science of performance-enhancement and health effects of PED is extensive, ethical and empirical studies on interpretations of  ‘the spirit of sport’ are given less emphasis. In what follows I will give a sketch of an argument developed by my colleague Hans Hoppeler and myself.^[3] We have used insights from the biology of training and drug use within a normative framework. The aim was to reach a more precise interpretation of ‘the spirit of sport’ with improved action-guiding potential.

The biology of training and drug use

From a biological point of view, training is systemic adaptation of the human organism to stress. Or, more precisely, training implies exposing the human organism to specific stress situations that produce a systemic multi-organ and multi-gene response. During the restitution phase, there is compensation for stress-induced damage. Upon regularity of stress-situations, super-compensation occurs in preparation for future stress. Put in plain language, with a good training regime, performance will improve.

The response capacity of the organism is a consequence of selection through evolution of organisms with a ‘built-in’ capacity to adapt to the environment. In the case of sport training this adaptation is targeted towards relevant performance phenotypes: basic bio-motor qualities such as strength and endurance and sport specific abilities and skills. In brief, training is utilization of the phenotypic plasticity of the human organism. Perhaps this is what is intuitively referred to as ‘natural’ performance enhancement in sport?

The use of PED impacts the organism in a different way. Drugs are intermediates, end products or modulators of biological processes. They are targeted directly to improve for instance muscle strength or endurance without invoking the systemic adaptation of the organism as with training. In our article we contrasted production of EPO as the result of adaptation to altitude with its production as a result of an injection. The EPO injection can be considered a shortcut to increase the number of red blood cells and the oxygen carrying capacity of the blood without invoking complex adaptation processes (which is also why it represents a health risk as the warning systems of the body are more or less out of play). Perhaps this is what we intuitively refer to as ‘artificial’ performance-enhancement?

The logic and spirit of sport

What is the relevance of these insights to the normative discussion on sport? To respond we need to return to the idea of ‘the spirit of sport’. Let me attempt an interpretation departing from some core characteristics of sport. The social logic of competitions implies measuring, comparing, and finally ranking participants according to relevant athletic performance. The rule systems of sport define what is to count as performance. In soccer, players cannot touch the ball with their hands. In tennis, the ball is allowed only one bounce on each court half. Athletic performances are composed of individual and team abilities and skills and are the results of both natural talent and hard training and efforts.

The global spread of sport indicates a fascination with these practices both in terms of participation and spectatorship. How, more specifically, can this fascination be understood?

A closer look at classification and standardization efforts gives leads to an answer. Most sports classify according to chronological age and biological sex, in addition combat sports and strength sports such as weight lifting have weight classes. Many sports have requirements on equipment and technology. In the throwing events in athletics, all participants use similar objects, in most sailing events there are strict standardization rules on boats and sails. Inequalities in age, or biological sex, or body size, or technology are considered irrelevant. These are inequalities upon which athletes can exert little or no impact. The test is about specific abilities and skills requiring own efforts and based on own talent.

A reasonable interpretation is that sporting rule systems are designed for evaluation of individual and team expressions of performance for which athletes and teams can be given responsibility. A strong performance, then, is indeed a source of fascination and admiration.^[4] Tom Murray pinpoints this idea of the spirit of sport as the pursuit of human excellence through ‘the virtuous perfection of natural talents’.^[5] This, I believe, is a reasonable interpretation of ‘the spirit of sport’.

Training versus drug use

What is the status of PED in this picture? Imagine a thought experiment of a four-week session with a daily training program (TP) versus daily use of a particular drug X. Imagine that both means provide a 5% performance-enhancing effect. How do the two means relate to ‘the spirit of sport’?

Performance-enhancement due to drug X is a ‘shortcut’ as X aims at a specific enhancement without systemic adaptation. Usually, the use of PED is administered with the help of external expertise. In a therapeutic setting this may save lives. We can admire the medical expertise involved. Within a non-therapeutic ‘spirit of sport’ setting, however, it is difficult to see anything admirable on the athlete side about using X to enhance performance.

Completing TP on the other hand requires athlete effort, persistence and motivation and implies the rational and specific utilization of the phenotypic plasticity of the human organism. Assistance from external expertise in terms of coaches usually takes the character of mutual interaction and requires the main work to be done by the athlete. The athlete can be held responsible for the performance as an expression of individuality and an admirable development of his or her natural talent.

If the use of X implies risk of harm, X is an obvious candidate for WADAs prohibited list. Within our interpretation of the spirit of sport, the risk is non-relevant. But even if X does not represent any significant risk of harm, its use will still be controversial. If it is allowed, it has to be provided for all athletes in order to address concerns of fairness. But what would this actually add to sport values? How can the additional administrative and financial cost and a pharmacologically improved performance be justified within the ideal of the spirit of sport?

Cultural diversity and the spirit of sport

There are several counterarguments to my position. This is as it should be. There is no Archimedean point from which normative questions can be determined once and for all. Criticism is a sign of healthy ethical discourse.

One basic opposition is that this interpretation of ‘the spirit of sport’ is marked by the historical, social and cultural situation in which we find ourselves.[6] It is ethnocentric. Obviously, in a sense this is true. The interpretation has a flavor of Western individualism and ideas of progress and responsibility. This is hardly surprising. The position is inspired by the logic of sport, and competitive sport is a typical product of Western culture.

A further response could point to the global spread of and fascination with sport. The idea of competition and performance is attractive in different cultures. Although phrased and contextualized in different ways most cultures have ideals of virtuous game playing and of responsibility for performance. Many cultures might share important elements of ‘the spirit of sport’ ideal. Further studies could provide important background knowledge in WADA’s quest for global consensus on PED policies in sport. 

What, then, can be said to the fact that some (sub)cultures seem to rationalize doping and hold it as a necessary part of elite sport. This would require a critical inquiry in to its principled basis and its implication in practice. In current sport one implication is the very unfortunate position of athletes who, in such a system, are more or less forced into PED use. The history of PED-accepting sport systems is not a pleasant one and marked by a ‘dehumanization of sport’, to borrow a phrase from John Hoberman.^[7]

Respect for cultural differences needs not imply ethical relativism. All sport cultures can develop destructive practices that need critical scrutiny and adjustment.

A future society of enhanced individuals?

A further point is that interpretations of ‘the spirit of sport’ vary not only culturally, but philosophically too. There are ethical and philosophical arguments in support of lifting the ban on PED in sport. To Julian Savulescu, human enhancement via innovative biotechnology is not just a possibility but a genuine expression of the human spirit, and elite sport stands in the forefront of this enterprise.^[8] In a recent editorial, Savulescu accepts a PED-ban but argues for a reduction of the list of banned substances to those that are clearly unsafe, and to those that ‘corrupt’ the spirit of a particular sport.^[9]

My brief response to the liberal position goes as follows: The ‘spirit of sport’ interpretation proposed here is a ‘thicker’ one. Moreover, I do not believe in the idea of equalizing genetic inequalities with what is believed to be safe dosages of drugs. I notice however that Savulescu’s current position includes an idea of banning some kinds of PED, and an idea of the spirit of particular sports. Critical reasoning on PED use helps locating substantial disagreement between standpoints and opens for rational discussion among scholars, decision makers, and in the larger sporting communities. This is a good thing.

My other comment is that elite sport has developed rapidly over the last decades and will be different for sure in two or three decades from now. Perhaps we are about to enter societies in which enhancement of various kinds become the rule rather than the exception? Can anti-doping survive in such a system?

My honest answer is that I do not know. If, in a future society, we find individuals whose enhancement is based on informed consent and who are living more healthy, more fulfilling and more productive lives than what we find today, who would protest? And why should we not allow these individuals into sport?

Skeptics see these visions as biotechnological utopianism, others are technological optimists. In any case, these questions go above and beyond discussions of the spirit of sport and belong the ethics of enhancement and actually to grand philosophical questions about what is means to be human.

As of today, however, and based on a biologically informed interpretation of the spirit of sport and knowledge of the vulnerable position of athletes in the elite sport system, the principled position of anti-doping has my definitive support. 

^[1] See https://wada-main-prod.s3.amazonaws.com/resources/files/wada-2015-world-anti-doping-code.pdf, p. 14. Accessed June 3, 2016.

^[2] See, for examples, Savulescu J., Foddy B. and Clayton M. Why we should allow performance-enhancing drugs in sport. British Journal of Sport Medicine, 38, 6 (2004): 666–670; and McNamee M. J. Spirit of Sport and the medicalization of anti-doping: empirical and normative ethics. Asian Bioethics Review, 4 (4) (2012): 374-92.

^[3] Loland S. and Hoppeler H. Justifying anti-doping: the fair opportunity principle and the biology of performance-enhancement. European Journal of Sport Science 12, 4 (2012): 347-353.

^[4] For an extensive argument on this point, see Simon, R. Deserving to be lucky: Reflections on the role of luck and desert in sports. Journal of the Philosophy of Sport, 34 (2007): 13-25.

^[5] Murray, T. H. Doping and anti-doping. An inquiry into the meaning of sport. In McNamee M. and Morgan W. J. (eds.) Routledge Handbook of the Philosophy of Sport. London: Routledge 2015: 315-332.

[6] For an overview of the development of the idea of anti-doping in sport, see Gleaves J. and Llewellyn M. Sport, drugs, and amateurism: Tracing the real cultural origins of anti-doping rules in international sport. The International Journal for the History of Sport, 31 (8) (2014): 839-853.

^[7] Hoberman, J. Mortal Engines. The Science of Performance and the Dehumanization of Sport. New York: The Free Press, 2002.

^[8] Savulescu J., Foddy B. and Clayton M. Why we should allow performance-enhancing drugs in sport. British Journal of Sport Medicine, 38, 6 (2004): 666–670

^[9] Savulescu, J. Doping scandals, Rio and the future of human enhancement. Bioethics, 30 (5) (2016): 300-303.