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Should athletes be allowed to use performance enhancing drugs?

BMJ 2013; 347 doi: (Published 22 October 2013) Cite this as: BMJ 2013;347:f6150

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Re: Should athletes be allowed to use performance enhancing drugs?

“He that covereth his transgressions shall not prosper, but whoso confesseth and forsaketh them shall obtain mercy”, or not ?

I vividly remember as a college student noticing the widespread use of amphetamine-like substances among my fellow students during the examination period, this to enable them to make it through a night of studying without losing too much mental focus due to fatigue or sleepiness. I wondered “Gee, if ever someone would come up with the idea to submit university students to random testing for performance-enhancing drugs and tie the validity of their examination results to the outcome of such testing, it would be pandemonium”. However, the idea was never brought into practice and now, decades later, still is not; neither do exam regulations typically contain any stipulations that prohibit the use of performance-enhancing drugs even though the term ethics is one of the most fashionable words in the contemporary academic world.

Somehow the situation is quite different in sports, where WADA today follows a zero-tolerance policy towards performance-enhancing drugs.1 2 Sport philosophers tend to argue that such strong opposition against doping exists because the essence of the ethos of sport and fairness itself is at issue.3 In more pragmatic terms this means that the performance of one athlete only makes sense when it can be compared to the performance of others. To achieve such a valid comparison between competing athletes would therefore require that the parties involved battle with equal arms. Apart from striving to achieve this objective and demonstrate that one is better, stronger, faster or more skilled than similarly equipped athletes, there is no further substance to competitive sports, whereas there is to the results of a drugged student passing his examinations. After all, the student still proves he or she masters the topic and has obtained the knowledge, skills and abilities. If the student did not already have the knowledge, it certainly would not suddenly arrive due to taking some magic pill.

A favorite argument among doping hunters is that allowing performance-enhancing drugs violates the equality of arms principle.4 In reality it is not that simple though, and the equality of arms principle really is violated only if some athletes are allowed to use or have access to such drugs while others do not. In that respect it is, no doubt, naive to think that equality is achieved by either banning or allowing performance-enhancing drugs. In case one prohibits doping, then some athletes still will use and the challenge is to not get caught;5 6 on the other hand, if one allows doping, then equality among athletes is still prevented by the magnitude of drugs each individual chooses and is willing to take. Besides, inequality exists in many other forms in sport, in particular, financial and material. In practical terms this leads to differences in what is available to the athlete in terms of training facilities and equipment, nutrition, overall skill and commitment of the coaches. The inequality also applies to dietary supplements that are not on the list of prohibited substances, but which too might exert an effect on performance or recovery.5 So, weeding out extrinsic differences between athletes by banning performance-enhancing drugs is at best illusionary.

Inequality among athletes is a reality. Athletes start off being unequal and by attempting to excel in their sports discipline, they try, in fact, to be as unequal as possible. Or to use the words of Savulescu et al.: “our capacity to improve ourselves using reason and judgment that may involve biological manipulation, and in this way cause that the winner in a sports event is not merely the person who was born with the best genetic potential to be the strongest, but someone who successfully has combined genetic potential with training, psychology, judgment, creativity and choice.”7

This example perfectly illustrates the nature of this debate, a debate which, yes, is interesting, but unlikely to get resolved. The reason is simple: many of the arguments of both those in favor and those against hold true, rather than one side being correct and the other side wrong.3 This is not any different with regard to the arguments provided by colleagues Savulescu, Creaney or Vodi2: neither of them is “wrong”. If one fully realizes that and accepts that, then perhaps it would make more sense to focus on what can be done to limit the major flaws of the current WADA approach and to increase its fairness. One of the major flaws is the inconsistency in mitigation, specifically with regard to the athlete who is being framed.8 While a likely excuse there certainly have been cases where scientific evidence suggests either contamination through accidental ingestion or having been framed by a third party, are more likely explanations than the athlete willingly or knowingly having committed a doping offence. Both the Contador and the current Van Snick case come to mind.9

The consequences for an athlete who finds him-/herself in such a situation are devastating in terms of participation, reputation, and potential loss of financial contracts. “He that covereth his transgressions shall not prosper: But whoso confesseth and forsaketh them shall obtain mercy”, the saying goes. Not so for WADA; WADA goes more than just one step further, with sometimes doubtful consequences for the sports community, the athlete him-/herself, and the essence of truth itself.8 Expressed in moral terms, the injustice of any such false accusation is at least as great as the unfairness caused by an athlete winning an event due to performance-enhancing drugs when none of his/her adversaries made use of doping.

1 Renström P. Arne Ljungqvist: the great fighter against doping. Br J Sports Med 2013 Sep 24. doi: 10.1136/bjsports-2013-093029.

2 Savulescu J, Creaney L, Vondi A. Should athletes be allowed to use performance enhancing drugs? BMJ 2013; 347:f6150. doi:

3 De Wachter F. De sportdroom bedreigd: doping als filosofische kwestie [The sporting dream under threat: doping as a philosophical issue]. Ethische perspectieven (Bel.) 2000; 10 (3): 157-62. [cited 2013 Oct 30]. Available from: Dutch.

4 Hoberman J. Sports physicians and the doping crisis in elite sport. Clin J Sport Med 2002; 12 (4): 203-8.

5 De Crée C. Groeihormoon [Growth hormone]. Geneeskd Sport (Hol.) 1994; 27 (5): 146. Dutch.

6 Morente-Sánchez J, Zabala M. Doping in sport: a review of elite athletes’ attitudes, beliefs, and knowledge. Sports Med 2013; 43 (6): 395-411. doi: 10.1007/s40279-013-0037-x.

7 Savulescu J, Foddy B, Clayton M. Why we should allow performance enhancing drugs in sport. Br J Sports Med 2004; 38 (6): 666-70. doi: 10.1136/bjsm.2003.005249

8 McNamee MJ, Tarasti L. Juridical and ethical peculiarities in doping policy. J Med Ethics 2010; 36 (3): 165-9. doi: 10.1136/jme.2009.030023.

9 D.P.C., V.W. Ph. Une analyse toxicologique innocente Charline Van Snick. Le Soir, 29 October 2013. Available from: Retrieved: 29 October 2013. French

Competing interests: I was a(n unpaid) member of the Flemish Anti-doping Commission 1991-1993 and a former student (1983-1984) of the late Dr. Albert Dirix (1914-1999), at the time Secretary-General of the IOC Medical Committee.

04 November 2013
Carl De Crée
Professor of Exercise Science, Sports Medicine & Reproductive Endocrinology
Center for Sports Medicine
B-2800 Mechelen, Belgium