Should All Performance Enhancing Drugs Be Banned?

Russia's athletics chief announced Monday that four more Russian athletes have tested positive for the performance enhancing substance meldonium. Meldonium is the same substance that made headlines worldwide two weeks ago when Maria Sharapova announced that she had tested positive for the drug at the Australian Open.

As World Anti-Doping Agency president Craig Reedie argues for increased funding to his organization to better investigate these kinds of violations, it’s worth examining the reasons we have for banning meldonium and substances like it.

After all, why do we ban performance enhancing drugs?

Since Sharapova says she took meldonium for health reasons, she might have been eligible for a “Therapeutic Use Exemption.” Had she applied for an exemption prior to being caught, she might have received permission to use the substance by WADA and the International Tennis Federation. But as it stands, Sharapova broke the rules of WADA and the ITF.

Breaking the rules by using a banned substance is a form of cheating, which is certainly bad. But is using performance enhancers worse than, say, using deflated footballs? Is it wrong to use performance enhancers, over and above the fact that it violates the rules?

Do performance enhancing drugs undermine the spirit of sport? Let us know what you think in the comments.

Here's another way to think about it: Meldonium was only just added to the list of banned substances this year. Is this just an arbitrary rule change, comparable to deciding to operate on a four strikes rule in baseball rather than the traditional three strikes rule? Or are there good reasons for banning meldonium?

A representative for WADA explained that when considering whether or not a substance should be banned they ask three questions:

• Does the substance enhance performance?
• Does it pose a danger to athletes?
• Does it violate the spirit of sport?

If the answer is yes to two of the three questions, then the substance will be banned.

In a public comment on the Sharapova case, however, WADA listed only one reason for meldonium to be banned: the fact that athletes were using it to enhance performance. WADA did not respond to inquires regarding this discrepancy.

The racket supplier Head, one of Sharapova's sponsors, has publicly questioned the decision to ban meldonium.

Protecting the health of athletes

The most obvious objection to doping is that it endangers the health of the user. And it is clearly true that some performance enhancers have negative health consequences that we should be concerned about. No one should take drugs without the advice of medical health professionals.

But it’s not clear what dangers are associated with meldonium (it has not been approved by the FDA). At least according to Sharapova, the amount of meldonium she’s been taking for ten years has made her more healthy, not less.

And even if there are some risks associated with the drug, the avoidance of risk itself is certainly not central to the spirit of sport. Sharapova herself has suffered repeated shoulder injuries playing tennis, and most competitive sports carry a non-trivial risk of injury.

Perhaps the overuse of any particular performance enhancer would in fact be unacceptably dangerous. But if that’s true, this consideration alone only justifies restricting the amount of doping, rather than banning the practice entirely. Too much physical training can be dangerous as well, but we don’t prevent athletes from training.

The spirit of the sport

WADA’s World Anti-Doping Code declares, “Doping is fundamentally contrary to the spirit of sport.” This is certainly a common belief, but it’s hard to understand exactly what it means.

According to the Code, the spirit of sport celebrates values including, fair play, honesty, excellence in performance, character, fun, courage, and community.

As long as performance enhancers are banned, it’s clear how their use violates at least "honesty" and "fair play." But this doesn’t explain why they should be banned.

Some of the values, like excellence in performance, might even be promoted by some performance enhancers.

Yet there’s a widespread belief that performance enhancing drugs undermine the value of excellence in performance, rather than promote it. One reason for this worry is that introducing new drugs distorts the historical record, because previous generations of athletes didn’t have access to contemporary performance enhancers.

This appears to be a strong argument, but there are several flaws. First, it’s not clear how “clean” the historical record is; we can’t really know which athletes did or didn’t get away with illicit substance use.

And all other sorts of advancements also distort the historical record, including rule changes, technology developments in sports gear, advancements in the science of athletic training, and medical progress generally. If we improve our ability to treat common sports injuries, this could give contemporary athletes longer careers than were previously possible. This would distort the historical record, but this hardly seems to make the progress objectionable.

Comparing historical sports figures to contemporary standards will always be a fraught endeavor, whether or not drugs like meldonium are banned.

But don’t performance enhancers undermine the training and discipline that sports is supposed to be about? Writing for Philosophy Now magazine, Darrin Belousek argued that allowing performance enhancers “substitutes designer pharmaceuticals for disciplined practice as the honored means of success in that sport.”

This seems to get at one of the central worries surrounding doping, that it introduces an artificial element that is completely disconnected from the purpose of sport. But as discussed, new training methods and sports equipment technologies already introduce “artificial” advancements into sports. And none of these advancements replace effort and practice; in a competitive environment, an athlete’s level of drive and devotion to the sport will always matter.

Natural vs. artificial enhancers

Julian Savulescu, a professor with the Oxford Uehiro Centre for Practical Ethics, argues that at The Conversation that it is a bias for the “natural” that leads us to ban some performance enhancing substances rather than others.

There are plenty of substances, Savulescu points out, that improve sports performance that are allowed, like caffeine, beetroot extract, and creatine. All of these substances are naturally occurring. But meldonium, which was developed in pharmaceutical labs, is banned.

“Injecting the hormone erythropoietin (more commonly known as EPO) unnaturally increases haematocrit and so is banned,” he points out. “But hypoxic air tents and altitude training both stimulate the body to naturally produce haematocrit, yet they are allowed.”

Too much meldonium may well be detrimental to human health and so excessive use should be discouraged. But the same can be said about caffeine. And while the high levels of haematocrit caused by EPO can be dangerous, there are also risks associated with altitude training.

As Savulescu has argued elsewhere, athletes might be better off if instead of testing for particular substances, we tested for signs of risk to the athlete’s health. Dangerously high levels of haematocrit, for instance, should be disqualifying, whether they were achieved with EPO or any other means.

We need some rules to keep athletes reasonably healthy and to preserve what we love about sport.

This way, we would incentivize athletes to use those techniques and substances that promote health as well as performance, rather than those that haven’t been banned yet. And athletes like Sharapova, if meldonium was indeed keeping her healthy, wouldn’t have to worry that they might end up with a tarnished record when the rules change.

Savulescu does agree that some substances should be banned to preserve integrity of tests for particular skills. For example, beta-blockers, which reduce blood pressure and are used by musicians to reduce performance anxiety, may directly undermine the skills tested in archery or pistol shooting.

But overall, he argues that the WADA should drastically shorten its list of banned substances.

“We need some rules to keep athletes reasonably healthy and to preserve what we love about sport,” he writes. “But that doesn’t require a Stasi-like approach to performance enhancement in sport.”

“Let the athletes get on with [sport] and let’s get back to enjoying it, rather than placing every athlete under a cloud of suspicion.”

Photo Credit: Justin Smith via Flickr