Could needlephobia help us better understand anti-dopism?
By Bernat López, Department of Communication Studies, Universitat Rovira i Virgili, Tarragona, Spain
Three years ago, a new anti-doping initiative of the UCI caused a fuss in the media and among the cycling community: the “no-needle policy”, as the governing body called it, consisting in a prohibition of “injections of medicines or other substances, without a medical indication, that have the objective of artificially improving performance or recovery (vitamins, sugars, enzymes, amino acids, antioxidants, etc.)”.[1]
Although the initial controversy that surrounded this decision has since long faded out, the fact remains that the “no-needle policy” was enacted and incorporated into the UCI Regulations, the constitution of cycle sport, and is therefore enforceable at any moment and in any place. Section 13.1.062 of the Regulations reads as follows:
The injection of any substance to any site of a rider’s body is prohibited unless all of the following conditions are met: 1. The injection must be medically justified (...); 2. There is no alternative treatment without injection available; 3. The injection must respect the manufacturer-approved indication of the medication; 4. The injection must be administered by a certified medical professional; 5. Except when received during hospital treatment, clinical examination, or for vaccination, or for treatment with a valid TUE, the injection must be reported immediately and in writing not later than 24 hours afterwards to the UCI Doctor (...) [2]
Not only that. On June 2012, short before the London Olympics, the International Olympic Committee, having surely appreciated the UCI initiative, extended it to all competitions taking place during the Games: “The Olympic Games are ‘needle-free’. This shall not prevent the receiving of injections for necessary medical treatment”. Failure to comply with this prohibition of administering injections to athletes which are not “medically justified and necessary” was deemed to be “serious” and liable to exposing “the concerned athletes, to disciplinary action, additional testing and possible sanctions”. [3] For the Sochi winter Olympics almost the same rules were enacted, with the only (in?)significant change of calling them “Needle policy”, instead of “No-needle policy”. [4]
The main justification put forward by the UCI for this new curtailment of the athletes’ freedom was that it was “above all (...) designed to protect the riders' health”, and aimed at encouraging “natural physical recovery”. [5] The patent absurdity of this statement was made explicit by Verner Møller in his May 2011 INHDR editorial: “The rationale is flawed insofar as riders’ inject the legal substances vitamins, sugars, enzymes, amino acids, antioxidants, etc. in order to recuperate and thus protect their health (...) If the purpose indeed was to ‘encourage natural physical recovery’ the UCI should at the same time ban vitamin pills, energy drinks, and chocolate bars, which are all unnatural means that help athletes recover” (Møller, 2011: 2-3). I would add to this list of unnatural recovery means which should also be banned following the same logic: topical vasodilators, aminoacid tablets, massage, acupuncture, electrostimulation, taking baths of iced water, high-tech mattresses, et cetera.
It seems quite undeniable, indeed, that prohibiting recovery injections runs straight against the “protection of the health” principle, much quoted by anti-dopism[6] as one of its main rationales and goals of anti-doping. Either it is untrue that the no-needle policy was devised with this noble purpose in mind, or the UCI leaders were seriously misled if they believed in earnest that this would be the main benefit of its enactment. I would rather bet for the first option.
If the main rationale was therefore not health protection, what were the real motives of this extraordinary measure? Møller (2011) points at a much more pragmatic, though not less compelling, goal: protecting “cycling as a business” and “the reputation of the sport”. No independent commentator would indeed deny plausibility to this supposition. Given the hegemony of the prohibitionist anti-doping paradigm, the public visibility of doping (not doping in itself, by the way) has undeniably become the main challenge for the continued existence of elite cycling, and elite sport as a whole, on grounds of the damage it inflicts to the image of an activity fully dependent on sponsorship revenues, and therefore on good media reputation and coverage. Being needles and injections the main symbol of doping, it apparently makes sense targeting its eradication in the cycling milieu as a main policy objective.
But this rationale is also flawed. If the main problem with needles, syringes and injections is indeed one of bad image and public relations, it would suffice to focus on concealing them from the public’s sight instead of trying to enforce a prohibition which is damaging for the athlete’s health and very difficult to enforce. This would in fact be quite an unnecessary effort, since nobody in the pro peloton injects himself or gets injected under public scrutiny, but it could be argued that, despite injections being administered away from public’s sight, you can always get a picky investigative journalist searching the garbage bags and wastepaper baskets of hotel rooms were riders have been treated, and therefore special care is needed when manipulating medical material to properly conceal its waste. Let’s accept that this could somehow justify the ban on injections altogether. But then, why is the focus on the riders as the EXCLUSIVE target of sanctions?[7] The logical target for prosecution and punishment for failure to avoid public exposure of injection practices would rather be team doctors, soigneurs and managers, not only nor mainly the riders themselves.
It seems therefore that we need to look elsewhere to try and find a more convincing explanation of why such an absurd regulation as the no-needle policy was enacted in the first place. I propose resorting to psychoanalysis for this purpose. My next academic paper will be devoted to exploring needlephobia as its possible deep cause, and in fact as a potentially powerful explanation of many inconsistencies and irrationalities of anti-doping as a whole. Or, to put it in Hoberman’s words, of the “essentially intuitive”, that is, irrational, nature of anti-dopism (Hoberman, 2004: 15).
Needlephobia is a condition included in the fifth edition of the American Psychiatrical Association’s Diagnostic and Statistical Manual of Mental Disorders under the category of blood-injection-injury specific phobias, and described as a “marked fear or anxiety about a specific object or situation”, injections and needles for the occurrence (APA, 2013: 197). “In some sufferers the phobias extend to fear of associated stimuli such as syringes, doctors, nurses, dentists, hospitals, and even white laboratory coats” (Puri, 2007: 358). According to the American Psychiatric Association, the prevalence rate of this condition would be between 7% and 9% of the US and European population (APA, 2013: 199), although empirical studies conducted in specific countries/areas rather suggest prevalence rates of up to 20-25% of the population (Kose and Mandiracioglu, 2007; Nir et al., 2003).
Needlephobia, or unreasonable fear of needles and injections, is therefore not uncommon among the general population; rather the opposite. I would dare to say that almost everybody could report on more or less acute cases of this fear in his/her close entourage and everyday life. Møller himself confesses in his editorial article that injections give him “the creeps”, and I personally would not be too far from this feeling either. What is even more significant for my hypothesis: a broad search in autobiographic accounts of retired cyclists demonstrates that fear of injections (and/or blood) is also quite common among the riders themselves. Significantly enough, some of these public confessions of phobia to needles/injections/blood correspond to some of the ex-pros which have become more vocal against doping after their retirement: Paul Kimmage (2007), Christophe Bassons (2000), Laurent Fignon (2009), Cyrille Guimard (2012), Jean Bobet (Bastide, 1970), and even Bjarne Riis (2012).
It could be safely argued that the history of anti-doping somehow parallels the evolution of the dominant way of administration of performance-enhancing techniques and substances (PETS). The rise of anti-doping in the sixties is coincident with the time when injections became the preferred administration technique, leaving as secondary the oral way (drinking liquids and/or swallowing pills and tablets), due to the advantages of the former in terms of improving and speeding up the effects of the administered substances, including blood and blood derivatives. In this context, I do not think it is going too far to suppose that the widespread and essentially irrational rejection of needles, syringes and injections did heavily interfere with the perception of doping, both popular and inside the cycling milieu itself. In other words, when PETS were consumed orally, it did not meet with a staunch opposition, since eating and drinking are seen as “natural” activities, essentially beneficial and not harmless in themselves. Instead, the idea or the actual experience of piercing one’s skin with a needle “gives the creeps” to many people (possibly to one in every four or five human beings, if we are to believe some surveys published in academic papers), inside and outside of the cycling milieu alike. This irrational feeling would easily turn into a rejection of the practice altogether, which would evolve into a (moral) condemnation of those who would inject themselves without a compelling medical reason for doing it.
To sum up: the no-needle policy recently adopted by the UCI and the IOC cannot be satisfactorily explained by the rationale stated by these bodies themselves (protecting the health of athletes), nor by image and PR considerations. It could, at least in part, actually be the expression of a deeply embedded and broadly prevalent phobia to needles and injections, which would in fact help us explain anti-dopism in general, at least in part. The widespread and irrational hostility to these practices would transform themselves, through a transference process, into hostility to those who dare to have injections not enforced by the medial authority: these people should be stopped from getting such “gratuitous” injections, and should be punished for accepting them.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington: American Psychiatric Publishing.
Bassons, Christophe (2000). Positif. Paris: Éditions Stock.
Bastide, Roger (1970). Doping: les surhommes du vélo. Paris: Solar.
Fignon, Laurent and Jean-Emmanuel Ducoin (2009). Nous étions jeunes et insouciants. Paris: Grasset.
Guimard, Cyrille and Jean-Emmanuel Ducoin (2012). Dans les secrets du Tour de France. Paris: Grasset.
Hoberman, John (2004). “Introduction – Doping and public policy”. John Hoberman and Verner Møller (eds.). Doping and public policy. Odense: University Press of Southern Denmark.
Kimmage, Paul (2007). Rough ride. London: Yellow Jersey Press.
Kose, S. and A. Mandiracioglu (2007). “Fear of blood/injection in healthy and unhealthy adults who are admitted to a teaching hospital”. International Journal of Clinical Practice 61: 453-7.
López, Bernat (2014). “‘The Good, Pure Old Days’: Cyclist's Switching Appraisals of Doping before and after Retirement as Claims Making in the Construction of Doping as a Social Problem”. International Journal of the History of Sport, DOI: 10.1080/09523367.2014.911731
Møller, Verner (2011). “Editorial – UCI no needle policy”. http://ph.au.dk/fileadmin/ph/Idraet/INHDR/Resources/Verner_Moeller_-_May_2011_-_INHDR_editorial.pdf, Accessed August 2014.
Nir, Yael; Alona Paz, Edmond Sabo, and Israel Potasman (2003). “Fear of injections in young adults: prevalence and associations”. American Journal of Tropical Medicine and Hygiene 68, 3: 341-344.
Puri, Basant K. (2007). “Blood-injection-injury phobias”. International Journal of Clinical Practice 61, 3: 358-359.
[1] “No Needle Policy: The UCI prohibits injections without medical indication”. UCI press release, 4 May 2011. http://femede.es/documentos/5-UCI%20Communique%20de%20presse%20No%20Needle%20Policy%20(eng%20)%202011_05_04.pdf, accessed August 2014.
[2] http://www.uci.ch/mm/Document/News/Rulesandregulation/16/26/69/13con-E_English.PDF, accessed August 2014.
[3] “IOC ‘No-Needle’ Policy – Games of the XXX Olympiad in London, 2012”. http://www.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/2012-06-07-IOC-No-Needle-Policy-Games-of-the-XXX-Olympiad-in-London-2012.pdf, accessed August 2014.
[4] “IOC Needle Policy – XXII Olympic Winter Games in Sochi in 2014”.
http://www.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/IOC-Needle-Policy-Sochi-2014.pdf, accessed August 2014.
[5] “No Needle Policy: The UCI prohibits injections without medical indication”. UCI press release, 4 May 2011. http://femede.es/documentos/5-UCI%20Communique%20de%20presse%20No%20Needle%20Policy%20(eng%20)%202011_05_04.pdf, accessed August 2014.
[6] “the ideology that supports anti-doping as a set of regulations, institutions and practices and the groups and individuals promoting them” (López, 2014: 3).
[7] Paragraph 13.1.67 of the UCI regulations: “The following penalties shall be imposed in the event of an infringement of article 13.1.062: suspension from eight days to six months and/or a fine of CHF 1,000 to CHF 100,000; in the case of a second offence within two years of the first: a suspension of at least six months or lifetime suspension and a fine of CHF 10,000 to CHF 200,000”.