Why we should allow performance enhancing drugs in sport
TL;DR: The use of performance enhancing drugs in the modern Olympics is on record as early as the games of the third Olympiad, when Thomas Hicks won the marathon after receiving an injection of strychnine in the middle of the race.
Abstract: The legalisation of drugs in sport may be fairer and safer
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, although outnumbered five to one, were victorious. Feidipides was sent to run back to Athens to report victory. On arrival, he screamed “We won” and dropped dead from exhaustion.
The marathon was run in the first modern Olympics in 1896, and in many ways the athletic ideal of modern athletes is inspired by the myth of the marathon. Their ideal is superhuman performance, at any cost.
The use of performance enhancing drugs in the modern Olympics is on record as early as the games of the third Olympiad, when Thomas Hicks won the marathon after receiving an injection of strychnine in the middle of the race.1 The first official ban on “stimulating substances” by a sporting organisation was introduced by the International Amateur Athletic Federation in 1928.2
Using drugs to cheat in sport is not new, but it is becoming more effective. In 1976, the East German swimming team won 11 out of 13 Olympic events, and later sued the government for giving them anabolic steroids.3 Yet despite the health risks, and despite the regulating bodies’ attempts to eliminate drugs from sport, the use of illegal substances is widely known to be rife. It hardly raises an eyebrow now when some famous athlete fails a dope test.
In 1992, Vicky Rabinowicz interviewed small groups of athletes. She found that Olympic athletes, in general, believed that most successful athletes were using banned substances.4
Much of the writing on the use of …
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TL;DR: This scientific statement synthesizes available information on the medical consequences of P ED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem.
Abstract: Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs. There is a widespread misperception that PED use is safe or that adverse effects are manageable. In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated. This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem. PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors. PED use has been linked to an increased risk of death and a wide variety of cardiova...
429 citations
TL;DR: This work uses Digital Twins as the hypothesis that one would be in the possession of very detailed bio-physical and lifestyle information of a person over time, and redefines the concept of ‘normality’ or ‘health’ as a set of patterns that are regular for a particular individual, against the backdrop of patterns observed in the population.
Abstract: Personalized medicine uses fine grained information on individual persons, to pinpoint deviations from the normal ‘Digital Twins’ in engineering provide a conceptual framework to analyze these emerging data-driven health care practices, as well as their conceptual and ethical implications for therapy, preventative care and human enhancement Digital Twins stand for a specific engineering paradigm, where individual physical artifacts are paired with digital models that dynamically reflects the status of those artifacts When applied to persons, Digital Twins are an emerging technology that builds on in silico representations of an individual that dynamically reflect molecular status, physiological status and life style over time We use Digital Twins as the hypothesis that one would be in the possession of very detailed bio-physical and lifestyle information of a person over time This perspective redefines the concept of ‘normality’ or ‘health,’ as a set of patterns that are regular for a particular individual, against the backdrop of patterns observed in the population This perspective also will impact what is considered therapy and what is enhancement, as can be illustrated with the cases of the ‘asymptomatic ill’ and life extension via anti-aging medicine These changes are the consequence of how meaning is derived, in case measurement data is available Moral distinctions namely may be based on patterns found in these data and the meanings that are grafted on these patterns Ethical and societal implications of Digital Twins are explored Digital Twins imply a data-driven approach to health care This approach has the potential to deliver significant societal benefits, and can function as a social equalizer, by allowing for effective equalizing enhancement interventions It can as well though be a driver for inequality, given the fact that a Digital Twin might not be an accessible technology for everyone, and given the fact that patterns identified across a population of Digital Twins can lead to segmentation and discrimination This duality calls for governance as this emerging technology matures, including measures that ensure transparency of data usage and derived benefits, and data privacy
262 citations
Cites background from "Why we should allow performance enh..."
...One therefore can argue that enhancers are potential social equalizers, counterbalancing the individual differences that are randomly assigned by the natural and social lottery (Savulescu et al., 2004)....
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TL;DR: Rather than striving for eradication of doping in sports, which appears to be an unattainable goal, a more pragmatic approach aimed at controlled use and harm reduction may be a viable alternative to cope with doping and doping-like behaviour.
Abstract: Current anti-doping in competitive sports is advocated for reasons of fair-play and concern for the athlete's health. With the inception of the World Anti Doping Agency (WADA), anti-doping effort has been considerably intensified. Resources invested in anti-doping are rising steeply and increasingly involve public funding. Most of the effort concerns elite athletes with much less impact on amateur sports and the general public.
203 citations
Cites background from "Why we should allow performance enh..."
...Our inquiry draws on a developing body of literature within medical ethics that discusses sports related enhancement issues [3-6]....
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...As long as the rewards of competition remain high and the consequences of being caught are merely exclusion from competition, the likelihood of athletes using doping will remain high [5]....
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...Since testing techniques for these older substances are well established, their users run greater risk of discovery than those who have access to newer more sophisticated molecules [5]....
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...For instance, depending on their nationality and sports speciality, athletes may differ enormously with regard to their access to care, supervision, and a high quality medical and technological environment [5,13]....
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TL;DR: This review outlines the various methods that exist and presents the scarce data available in this area and concludes that a combination of questionnaires using the Randomised Response Technique and models of biological parameters is able to provide the statistical possibilities to reveal accurate estimates of this often undisclosed practice.
Abstract: The prevalence of doping in elite sports is relevant for all those involved in sports, particularly for evaluating anti-doping policy measures. Remarkably, few scientific articles have addressed this subject so far, and the last review dates back to 1997. As a consequence, the true prevalence of doping in elite sports is unknown. Even though it is virtually impossible to uncover the exact prevalence of a prohibited activity such as doping, various methods are available to uncover parts of this particular problem, which enables the circumvention (to a certain degree) of the issues of truthfulness, definition problems and the limits of pharmacological evidence. This review outlines the various methods that exist and presents the scarce data available in this area. It is concluded that a combination of questionnaires using the Randomised Response Technique and models of biological parameters is able to provide the statistical possibilities to reveal accurate estimates of this often undisclosed practice. Data gathered in this way yield an estimation of 14–39 % of current adult elite athletes who intentionally used doping. These period prevalences have been found in specific sub-groups of elite athletes, and the available data suggest that the prevalence of doping is considerably different between sub-groups with varying types of sport, levels and nationalities. The above-mentioned figure of 14–39 % is likely to be a more accurate reflection of the prevalence of intentional doping in elite sports than that provided by doping control test results (estimate of doping: 1–2 % annually) or questionnaire-based research (estimations between 1 and 70 % depending on sport, level and exact definitions of intent and doping). In the future, analytical science may play a more important role in this topic if it may become feasible to detect very low concentrations of prohibited substances in sewage systems downstream of major sporting events. However, it is clear that current doping control test results show a distinct underestimation of true doping prevalence. It does not seem feasible to distil better estimates of the prevalence of doping based on performance indicators or ego documents because of the various existing effects that influence athletic performance. Such information can only be used as extra information to augment the accuracy of prevalence rates that have been found by using other techniques. True doping prevalence studies have been scarce in elite sports so far. With the correct application of the available scientific methods, preferably using harmonised definitions of the terms ‘doping’ and ‘elite sports’, more information on this topic may be gathered in a relatively short time. This would assist anti-doping professionals in the future in order to evaluate the effects of possible anti-doping measures, and better anti-doping policies would serve athletes who compete without doping. The existing anti-doping measures seriously impact the lives of elite athletes and their immediate entourage, which imposes a moral burden to evaluate these measures in the best possible way.
199 citations
TL;DR: The ethical and pragmatic implications of nootropic use in academia are reviewed by drawing parallels with issues relevant to the drugs in sport debate by examining the use of methylphenidate, modafinil and piracetam among healthy students within academia.
Abstract: Reports in the popular press suggest that smart drugs or "nootropics" such as methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia. This article reviews the ethical and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that "unfair" advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally champion the rights of the individual in deciding if these risks are acceptable. Finally, whether the prohibition of nootropics can be effectively enforced is doubtful. As nootropics use becomes widespread among students in the future, discussion of this issue will become more pressing in the years to come.
189 citations
References
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Book•
13 Jun 1985
TL;DR: 1. Oxygen is a toxic gas - an introduction to oxygen toxicity and reactive species, and the chemistry of free radicals and related 'reactive species'
Abstract: 1. Oxygen is a toxic gas - an introductionto oxygen toxicity and reactive species 2. The chemistry of free radicals and related 'reactive species' 3. Antioxidant defences Endogenous and Diet Derived 4. Cellular responses to oxidative stress: adaptation, damage, repair, senescence and death 5. Measurement of reactive species 6. Reactive species can pose special problems needing special solutions. Some examples. 7. Reactive species can be useful some more examples 8. Reactive species can be poisonous: their role in toxicology 9. Reactive species and disease: fact, fiction or filibuster? 10. Ageing, nutrition, disease, and therapy: A role for antioxidants?
21,528 citations
TL;DR: The results suggest that H2O2 may act as a signal-transducing molecule, and they suggest a potential mechanism for the cardioprotective effects of antioxidants.
Abstract: Stimulation of rat vascular smooth muscle cells (VSMCs) by platelet-derived growth factor (PDGF) transiently increased the intracellular concentration of hydrogen peroxide (H2O2). This increase could be blunted by increasing the intracellular concentration of the scavenging enzyme catalase or by the chemical antioxidant N-acetylcysteine. The response of VSMCs to PDGF, which includes tyrosine phosphorylation, mitogen-activated protein kinase stimulation, DNA synthesis, and chemotaxis, was inhibited when the growth factor-stimulated rise in H2O2 concentration was blocked. These results suggest that H2O2 may act as a signal-transducing molecule, and they suggest a potential mechanism for the cardioprotective effects of antioxidants.
2,575 citations
TL;DR: Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy.
Abstract: Objective. —To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly. Design. —Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data. Participants and Setting. —A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. Main Outcome Measures. —Characteristics and probable cause of death. Results. —Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3PMand 9PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P =.01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%). Conclusions. —Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.
1,633 citations
"Why we should allow performance enh..." refers background in this paper
...For many athletes, sport is not safe enough without drugs. If they suffer from asthma, high blood pressure, or cardiac arrhythmia, sport places their bodies under unique stresses, which raise the likelihood of a chronic or catastrophic harm. For example, between 1985 and 1995, at least 121 US athletes collapsed and died directly after or during a training session or competition—most often because they had hypertrophic cardiomyopathy or heart malformations....
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TL;DR: Evidence shows that the cell's fate is determined by cross talk between the cellular signalling pathways and the cellular redox state through a complicated regulation mechanism.
1,119 citations
TL;DR: Although the risk of primary cardiac arrest is transiently increased during vigorous exercise, habitual vigorous exercise is associated with an overall decreased risk ofPrimary cardiac arrest.
Abstract: To examine the risk of primary cardiac arrest during vigorous exercise, we interviewed the wives of 133 men without known prior heart disease who had had primary cardiac arrest. Cases were classified according to their activity at the time of cardiac arrest and the amount of their habitual vigorous activity. From interviews with wives of a random sample of healthy men, we estimated the amount of time members of the community spent in vigorous activity. Among men with low levels of habitual activity, the relative risk of cardiac arrest during exercise compared with that at other times was 56 (95 per cent confidence limits, 23 to 131). The risk during exercise among men at the highest level of habitual activity was also elevated, but only by a factor of 5 (95 per cent confidence limits, 2 to 14). However, among the habitually vigorous men, the overall risk of cardiac arrest--i.e., during and not during vigorous activity--was only 40 per cent that of the sedentary men (95 per cent confidence limits, 0.23 to 0.67). Although the risk of primary cardiac arrest is transiently increased during vigorous exercise, habitual vigorous exercise is associated with an overall decreased risk of primary cardiac arrest.
812 citations