Doping

Why We Should Allow Drugs in the Olympics
By Prof Julian Savulescu, Bennett Foddy. University of Oxford and Murdoch Childrens Research Institute.
-
This is a very controversial article on the war on Doping in Sport. I wanted to include it as it raises some interesting views regarding the way in which people think about the issues. Education is about understanding all aspects of a subject matter – Jamie

In 490 BC, the Persian Army landed on the plain of Marathon, 25 miles from Athens. The Athenians sent a messenger named Feidipides to Sparta to ask for help. He ran the 150 miles in two days. The Spartans were late. The Athenians attacked and, though outnumbered five to one, were victorious. Feidipides was sent back to run back to Athens to report victory. On arrival, he screamed ’We won’ and dropped dead from exhaustion.

The ancient Olympics ran every four years between 776 B.C. and 394 A.D., when they were banned by the Romans. The first new games were held in Athens in 1896. Now in 2004 the Olympics returns to its home. But this time it will be very different. Many athletes now compete on a drug cocktail. Scandals are already rocking the Olympics. Long gone is the ideal of Feidipides running barefoot from Marathon, a test of brute human endurance, courage and spirit.

Drugs in Sport
Performance enhancing drugs, however, have been around a long time. Early Olympians used extracts of mushrooms and plant seeds. From the 50s, amphetamines caused several deaths. East German swimmers won 11 out of 13 Olympic events in 1976 on steroids. In the 1988 Seoul Olympics, Ben Johnson was stripped of his 100m gold medal after testing positive for steroids. It hardly raises an eyebrow now when some famous athlete fails a dope test.

Attempts to eliminate drugs from sport have patently failed. And will fail. The drive to perfect performance is too great. Sports Illustrated surveyed past and aspiring Olympians. They were offered an imaginary banned drug with the guarantee that they would not be caught and that they would win. 195 said they would take it. 3 said they would not. [US physician Michel Karsten, who prescribed steroids to hundreds of world class athletes, stated, "There may be some sportsmen who can win gold medals without taking drugs, but they are very few. If you are especially gifted, you may win once, but from my experience you can’t continue to win without drugs, the field is just too filled with drug users."

Drugs like EPO and growth hormone are natural chemicals in the body. As technology advances, drugs have become harder to detect because they mimic natural processes. In a few years, there will be many undetectable drugs. The goal of “cleaning” up the sport is hopeless. Further down the track the spectre of genetic enhancement looms dark and large.

Condemned to Cheating?
So is cheating here to stay? Drugs are against the rules. But we define the rules of sport. If we made drugs legal and freely available, there would be no cheating. But would it be against the “spirit of sport”, as Raelene Boyle has said?

Human sport is different to sports involving other animals, like horse or dog racing. The goal of a horse race is to find the fastest horse. Horses are lined up and flogged. The winner is the one with the best combination of biology, training and rider. Basically, this is a test of biological potential. This was the old naturalistic Athenian vision of sport – find the strongest, fastest or most skilled man. Training aims to bring out this potential. Drugs which improve our natural potential are against the spirit of this model of sport. But this is not the only view of sport.

Humans are not horses or dogs. We make choices and exercise our own judgement. We choose what kind of training and how to run our race. We can display courage, determination and wisdom. We are not flogged by a jockey on our back but drive ourselves. It is this judgement that competitors exercise when they choose diet, training and whether to take drugs. We can choose what kind of competitor to be, not just through training, but through biological manipulation. Human sport is different to animal sport because it is creative. Far from being against the spirit of sport, biological manipulation embodies the human spirit – the capacity to change ourselves on the basis of reasons and judgement.

When we exercise our reason, we do what only humans do. The result will be that the winner is not the person who was born the best genetic potential to be strongest. Sport would be less of a genetic lottery. The winner will be the person with a combination of the genetic potential, training, psychology and judgement. Olympic performance would be the result of human creativity and choice, not a very expensive horse race.

Unfair?
Carl Lewis once said, “ To be the best, work the hardest.” Wouldn’t it be wonderful if the fairy tale were true? Sadly, it is not. People do well at sport as result of the genetic lottery that happened to dish them up a good hand. Genetic tests are available to identify those with the greatest potential. If you have one version of the ACE gene, you will be better at long distance events. If you have another, you will be better at short distance events. Black Africans do better at short distance events because of biologically superior muscle type and bone structure. Sport discriminates against the genetically unfit. Sport is the province of the genetic elite (or freak).

The starkest example is the Finnish skier Eoro Maentyranta. In 1964, he won 2 gold medals. Subsequently it was found he had a genetic mutation that meant that he “ naturally” had 40-50% more red blood cells than average. Was it fair that he had significant advantage given to him by chance?

The ability to perform well in sporting events is determined by the ability to deliver oxygen to muscles. Oxygen is carried by red blood cells. The more red blood cells, the more oxygen you can carry. Erythropoietin (EPO) is a natural hormone that stimulates red blood cell production, raising the haematocrit (HCT) – the percentage of the blood comprised by red blood cells. EPO is produced in response to anaemia, haemorrhage, pregnancy, or living at altitude. At sea level, the average person has an HCT of 40-50%.

HCT naturally varies. 5% of people have a HCT above 50%. Raising the HCT too high can cause health problems. Your risk of harm rapidly rises as HCT gets above 50%, especially if you also have high blood pressure. In the late 80s, several Dutch cyclists died because too much EPO made their blood too thick. When your HCT is over 70%, you are at high risk of stroke, heart and lung failure.

Use of EPO is endemic in cycling and many other sports. In 1998, the Festina team was expelled from the Tour de France after trainer Willy Voet was caught with 400 vials of performance-enhancing drugs. The following year, the World Anti-Doping Agency (WADA) was established as a result of the scandal. However, EPO is extremely hard to detect and its use has continued. Members of the Chinese swim team, which won four swimming gold medals at the 1992 Barcelona Olympics and then took 12 of 16 women’s titles at the 1994 world championships, have used EPO (along with testosterone, anabolic steroids and growth hormone).

In addition to trying to detect EPO directly, the International Cycling Union requires athletes to have a HCT no higher than 50%. But five per cent of people have a HCT greater than 50%. Athletes with a naturally elevated level of HCT cannot race unless doctors do a number of tests to show that their HCT is natural. Charles Wegelius was a British rider who was banned and then cleared in 2003. He had had his spleen removed in 1998 following an accident - since the spleen removes red blood cells, this increased his HCT.

There are other ways to increase the number of red blood cells which are legal. Altitude training can push the haematocrit to dangerous, even fatal, levels. More recently, hypoxic air machines simulate altitude training. The body responds by releasing natural EPO and growing more blood cells, so that the body may absorb more oxygen with every breath. According to Tim Seaman, a US athlete, the hypoxic air tent has “ given my blood the legal ‘boost’ that it needs to be competitive at the world level.”

There is no difference between elevating your blood count by altitude training, by using a hypoxic air machine or by taking EPO. But the last is illegal. Some competitors have high HCTs and an advantage by luck. Some can afford hypoxic air machines. Is this fair? Nature is not fair. Ian Thorpe has enormous feet which give him an advantage which no other swimmer can get, no matter how much they exercise. Some gymnasts are more flexible, and some basketball players are seven feet tall. By allowing everyone to take performance enhancing drugs, we level the playing field. We remove the effects of genetic inequality. Far from being unfair, allowing performance enhancement promotes equality.

Unsafe?
Should there be any limits to drugs in sport? There is one limit: safety. We do not want an Olympics in which people die before, during or after competition. What matters is health and fitness to compete. Rather than testing for drugs, we should focus more on health and fitness to compete. Forget testing for EPO; test for haematocrit. We need to set a safe level of HCT. Currently that is 50%. Anyone above that level, whether through the use of drugs, training or natural mutation, should be prevented from participating on safety grounds. If someone naturally has a HCT of 60% and is allowed to compete, then that risk is reasonable and everyone should be allowed to increase HCT to 60%. What matters is what is a safe level of growth hormone – not whether that is natural or artificial.

We need to take safety more seriously. In the Sports Illustrated survey, athletes were also asked whether they would take a banned drug if it was guaranteed that they would not be caught and that they would win every competition they entered for the next five years, but then die from the side-effects of the substance. More than 50% of the athletes said yes. We should permit drugs that are safe, and continue to ban and monitor drugs that are unsafe. There is another argument for this policy based on fairness: provided a drug is safe, it is unfair to the honest athletes that they have to miss out on an advantage that the cheaters enjoy.

Taking EPO up to the safe level, say 50%, is not a problem. This allows athletes to correct for natural inequality. There will of course be some drugs which are harmful in themselves (anabolic steroids)– we should focus on detecting these because they are harmful not because they enhance performance.

Far from harming athletes, paradoxically such a proposal may protect our athletes. There would be more rigorous and regular evaluation of athlete’s health and fitness to perform. Moreover, the current incentive is to develop undetectable drugs, with little concern for safety. If safe performance enhancement drugs were permitted, there would be greater pressure to develop safe drugs. Drugs would tend to become safer.

Just for the rich?
Would this turn the Olympics into a competition of expensive technology? Forget the romantic ancient Greek ideal. The Olympics is a business. In the 4 years prior to the Sydney Olympics, Australia spent $545 million on its athletes. On the basis of that expenditure, economists predicted that Australia would win 14 gold, 15 silver and 33 bronze. The final medal tally was close: 16 Gold 25 Silver 17 Bronze. A gold medal costs about $40 million. Australia came 4th in the medal tally in Sydney despite having the 52nd highest population. Neither our multicultural genetic heritage, nor our flat landscape and desert could have endowed us with any special advantage. We won because we spent more. Money buys success. We have already gone down the road of embracing expensive technology.

Paradoxically, permitting drugs in sport could reduce economic discrimination. The cost of EPO is around $150 month. The cost of a hypoxic air machine is around $10 000. Drugs are going to be more accessible than expensive technology and training facilities.

Test for health, not drugs
The welfare of the athlete must be our primary concern. But if drugs do not expose an athlete to an excessive risk, we should allow them even if they enhance performance. We have two choices: to vainly try to turn the clock back. Or to rethink who we are and what sport is, and to make a new 21st Century Olympics. Not a superolympics but a more human Olympics. Our crusade against drugs in sport has failed. Rather than fearing drugs in sport, we should embrace them.

Performance enhancement is not against the spirit of sport; it is the spirit of sport. To choose to be better is to be human. Athletes should be the given this choice. Their welfare should be paramount. But taking drugs is not necessarily cheating. The legalization of drugs in sport may be fairer and safer.