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Elite Sports and the Enhancement Debate
Owen Nicholas   Jun 12, 2012   Ethical Technology  

With the Olympic Games fast approaching, in all of its ritualised pomp and ostentation, doping in sport has once again become a hot topic for social commentators and pundits to chew over in regards what is seen as acceptable forms of enhancement and the kind which is seen as warranting public condemnation.

Naturally the doping issue exists within the wider context of the debate over technological enhancement in sport and the cultural, political and ethical aspects surrounding it. Indeed the landscape of elite sport is changing so rapidly that it often makes an excellent arena for challenging preconceptions about enhancements that may have a genuine impact upon the real world. As the prospects for more radical technologies to influence athletic performance continue to grow, with progress in nanotechnology, stem cells and genetics, questions about the future direction of sport will become increasingly relevant. What will be the consequences of increased biotechnological involvement? Will this serve to reinforce elitist mechanisms and structures, or will it open the door to a radically democratized and egalitarian sporting environment?

An interesting aspect of this debate has been the publicity given to the use of Cheetah blades; the custom-built, high performance carbon fibre foot which is used by the South African sprinter Oscar Pistorius, aka ‘Blade Runner’. In 2009 a team of scientists concluded that Pistorius enjoyed a considerable advantage in running, specifically that his lighter carbon fibre prosthetic blades enabled him to accelerate his limbs so rapidly that he could do what no other runner could in terms of repositioning his limbs. Peter Weyland a leading expert on sprint mechanics described it in this manner:

“Reduced limb repositioning times allow Mr. Pistorius to spend less time in the air between steps. Shorter aerial periods, in turn, substantially reduce how hard Mr. Pistorius must hit the ground during each stance period to lift and move his body forward into the next step…. intact-limb competitors, with natural limb weights and swing times, lack this option, and therefore must achieve their speeds via exclusively biological means. Mr. Pistorius, in contrast, achieves these speeds through the use of technology (1).”

Assessments like this have sparked populist fears of voluntary surgeries to give athletes the latest prosthetic limb or designed hardware in order to remain competitive. To many this is simply indicative of the belief that widespread introduction of radical technology changes sport for the worse.  The implication is that, by allowing certain kinds of progress, the character of a sport is changed in a way that invalidates it or makes it worse. The essence of such an argument is that we are on a ‘slippery slope’ towards a point where sportsmen are more like robots or bizarre cyborgs. But is this a valid position? We could equally argue that we have been on exactly such a slope for a long time, advances in technology, in equipment, clothing and training have always taken place and this obsession with a static conception of sport ignores the fact that sporting endeavours have always changed over time. Furthermore the ‘naturalist’ ideal may become increasingly untenable as developments outside sport continue apace. 

Before examining some of the more radical forms of enhancement which may soon be on offer, let us first review the current anti-doping policy, its stated aims and the efficacy of enforcement.  This is important, as the present legal situation in sports offers a preview of the challenges of enforcing any ban on future genetic modifications. The use of performance-enhancing drugs is illegal in competitive sports, but policing is difficult despite a nearly ideal situation for effective action. The sanctions enjoy widespread public support, a straightforward penalty of immediate exclusion exists, and sporting authorities have incredibly large budgets at their disposal. Furthermore, athletes submit to intrusions on their privacy that the general population would never tolerate, all while being few in number, easily identifiable, and physically accessible at competitions. However, these advantages are nowhere near strong enough to overcome the ingenuity of athletes with strong incentives to cheat. Elite athletes can earn tens of millions of dollars every year in prize money alone, and millions more in sponsorships and endorsements. The lure of success is great. But the penalties for cheating are relatively small. A six month or one year ban from competition is a small penalty to pay for further years of multimillion dollar success.

This has led to a situation where 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. This is only too evident with the regular doping scandals that occur at major sporting events across the globe. One oft cited case study was done in 1992 by Vicky Rabinowicz who interviewed small groups of athletes. She found that Olympic athletes, in general, believed that most successful athletes were using banned substances (2).

The World Anti-Doping Agency (WADA) which defines which drugs will be banned in international athletics, bans a substance if it meets two of these three criteria;

1. It is a risk to the health of the athletes.

2. It has performance enhancing potential.

3. It is seen as contrary to the ‘spirit of sport’. 

The first condition is certainly one which carries much ethical weight, but the health argument alone is insufficient to warrant exclusion from participation, which tends to suggest that sporting authorities are not primarily concerned with issues of respective health. Not all harmful drugs are banned; the use of tobacco for instance has no effect upon enhancement and is therefore not tested for. It is worth remembering that elite sport without performance-enhancing drugs is not safe and that many impose chronic health risks upon elite performers. It will continue to get less safe as athlete wages go up and they push the limits of human performance. If we thought that health was of central importance the authorities would be testing athletes on the basis of health indicators rather than drugs.  Evaluating heart size and function, heart rhythm, other cardiac parameters and disqualifying athletes who were at risk, whether the cause was natural variation, training or use of steroids or growth hormone. There would also be more focus on assessing long term risks, possibilities of bone fractures, degeneration of joints and the potential for developing arthritis in the future.

On the other hand the use of performance enhancers which have negligible effects on health and apparently do not violate the spirit of sport, such as caffeine which can strongly improve performance, or dietary supplements for building stamina such as creatine, are not banned. If performance enhancement is not intrinsically wrong in relation to sporting competitions then what is the distinguishing factor for legitimacy? Why, for example, is adopting an innovation such as peizo-electric technology for tennis racquets, or undergoing Lasik eye surgery for 20/20 vision seen as a legitimate advantage, while building more muscle mass through chemical boosters is not?

This quandary is made more obvious when considering the third and seemingly arbitrary condition of the spirit of sport. Exactly what constitutes this spirit and how is it assessed? According to the WADA, the general features of the spirit of sport are a sense of honesty and fair-play, teamwork, dedication, commitment, respect for the rules, courage and solidarity (3). Needless to say these are fairly vague and unspecified points which do not iterate clearly exactly what kind of intervention is seen as constituting an unfair advantage or otherwise. Critics may claim that this very flexibility allows an opening for political agenda’s to influence the deliberative process, particularly as half of the organisation’s funding is entirely made from contributions by various national governments. With this in mind perhaps it would be naive to analyse the anti-doping policy without acknowledging the backdrop of the war on drugs.

As technology has advanced drugs have become harder to detect because they closely mimic natural biological processes. Certainly the arrival of designer drugs which are completely unknown, easy to alter, and near impossible to trace, have shocked anti-doping authorities into developing quite drastic responses. The challenge of proving doping cases has resulted in the emergence of non-analytical positives; doping infractions without the need for urine or blood tests. This means that athletes not only face disqualification but in some cases prosecution based on evidence other than scientific data. The willingness to criminalise doping infractions and to discuss doping as being underpinned by organised crime has transformed the issue of doping from a matter relating to ethics and fairness in sport to one of moral hysteria over drug use (4).

Because of this climate, it has been argued, that the present codes focus on cheating rather than harm, has created an environment which actually increases the risks for athletes. As doping is illegal, the pressure is to make performance enhancers undetectable instead of insuring safety. Enhancers are purchased on the black market and administered in a clandestine, often crude and uncontrolled way with no monitoring or safeguards for the athlete’s health. Pro-legalisation arguments revolve around the idea that allowing usage of performance enhancers would make sport safer as there would be less pressure to take unsafe enhancers with the development of safer and more effective options. Allowing performance enhancers would not eliminate risks to health, as some athletes will still choose to use unsafe, illegal enhancers in hazardous doses, but it would substantially reduce the risk. By narrowing the performance gap between those athletes who wish to avoid health risks and those who don’t, closer parity can be achieved resulting in less coercive pressure.

This is hardly an unheard of suggestion, in 1998 Juan-Antonio Samaranch, the president of the international Olympic committee made similar arguments when he called for permitting performing enhancing drugs (5). The conception of doping as cheating is therefore only a problem of legal restrictions. Instead of wasting valuable resources on enforcing failed regulations far easier to simply change the existing laws. Or as Oxford ethicist Julian Savulescu puts it:

“I positively support certain kinds of performance enhancement. When you look at the objections, one of the principal ones is its unsafe. I agree that this is a valid objection to some kinds of performance enhancers. But it doesn’t, for example, apply to moderate levels of growth hormones or even moderate levels of anabolic steroids. It all depends on what you class as ‘safe enough’...... the permitted and controlled administration of performance-enhancing agents will make sport fairer and, indeed, in the long term safer by getting rid of backyard illegal enhancements. What you’ll see instead is the expression of human choice about not just how you are going to run the race, but what sort of competitor you want to be.(6)”

There are places where we allow drugs to improve performance without attaching stigma or condemnation. Elite classical musicians, who work in similar competitive environments, commonly use hormone blockers to control stage fright.  These drugs lower heart rate and blood pressure, reducing the physical effects of stress, and it has been shown that the quality of a musical performance is improved if the musician takes these drugs (7). Audiences do not think any less of a cello player or pianist who makes use of such blockers if it provides an improved performance. Of course there are limits to competitive creativeness in any field. While chemical enhancements are accepted, musical competition has rules forbidding the miming of playing to a pre-recorded backing track, and similar laws can also be understood in sport. For instance the wearing of roller-skates at a sprinting race would be a clear violation of the concept of running, yet athletes doing everything in their power to run faster is not nearly so clear cut.

The dimension of fairness is one in which most people find the strongest arguments against the permissiveness of doping as it appeals intuitively to our sense of equality. Doping cannot be right because it provides an ‘unearned’ advantage to some players over the honest hard work of others. Yet it is worth remembering that elite sport epitomises the success of the genetically privileged that were gifted the wining hand by Mother Nature. Larger feet give a greater advantage in swimming, long legs make for a better sprinter, increased height is invaluable for basketball, in any field possession of certain genes is a crucial factor in providing potential for physical activities. One of the most obvious examples is the Finnish skier Eero Maentyranta. In 1964, he won three 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 (8). Was it fair that he possessed an advantage provided for by blind genetic roulette? 

Increasing the body’s capacity to deliver oxygen to the muscles is a vital means of improving an athlete’s performance in aerobic exercise. There are a number of ways athletes have traditionally done this such as intensive altitude training. More recently however the use of hypoxia chambers has become a contentious issue for some members of the WADA who see it as yet another violation of the sporting spirit. The science of hypoxia involves changes in the partial pressure of oxygen within an environment, which increases the body’s hematocrit level. These changes reduce the partial pressure of oxygen in the pulmonary capillaries, which leads to an increased need to breathe. In turn, the body senses the changes and increases the production of red blood cells, which are rich in oxygen carrying protein (hemoglobin). This enhanced production leads to greater aerobic potential for the individual (9). This technique was decried by the ethics review panel of the WADA as a ‘passive’ form of enhancement by athletes that required no skill on their part and was therefore antithetical to the ‘virtuous perfection of natural talents’. To date the use of such chambers remains legal. Needless to say this framing of the issue in moral terms can be quite problematic. Is it ‘virtuous’ for athletes to make use of any specialised equipment, training facility, or engage the services of experienced coaches? 

While opposition to hypoxia chambers is characterised by claims of ‘passiveness’ or a lack of skill, the prohibition of gene-transfer technologies is largely due to its experimental nature. The increase of muscle mass and stamina is likely to be an important application for gene-transfer in sports. For example, inhibition of the growth factor myostatin, which controls muscle building, causes the growth of extraordinarily strong and developed muscles. The administration of myostatin blockers in mice causes significant increase in muscle mass, earning them the nickname Schwarzenegger mice (10).  Genetic manipulation to block myostation production would be expected to significantly increase strength in athletes and is likely to offer real potential for doping in the future.  Direct injection of insulin-like growth factors into the muscles of athletes would be simple and very hard to detect as recombinant DNA would be taken into muscle DNA, requiring risky muscle biopsies to detect it. As gene doping becomes more efficient, it is likely to offer great opportunities for doping in sport and ‘for all intents and purposes, gene doping will be undetectable’ (11).

With this kind of development on the horizon would it not be prudent for authorities to reassess the relationship between sports and technology or risk being left behind in an era when extensive body modification is soon to become a reality. Bioethicist Andy Miah opines: 

“I envisage a future for humanity where gene transfer, and many other forms of human enhancement, is sufficiently safe for its widespread use and where it becomes an integral part of our pursuit of good health. Indeed, undertaking such modifications would be considered as normal as body piercing or cosmetic surgery. Such attempts to promote our health will become increasingly important in an ever more toxic world and will create a scenario where the population is, as a whole, more capable of performing in extreme conditions – such as elite sports competition. They will still train, struggle and achieve as athletes do today. The only difference will be that their edge over each other will be determined by chosen genetic differences, rather than those wrought by the genetic lottery. On this basis, gene doping should not be seen as a threat to sport, but an opportunity for it to redefine its boundaries and, potentially, work towards the development of safer forms of performance enhancement….The critical point here is that, if we are able to develop the technology under controlled conditions, then there’s a greater chance of ending up with a safer form of enhancement since, unlike synthetic products, genetic augmentation will be more closely aligned to our individual biochemistry (12).”

One of the most common arguments against the premise of enhancement ‘levelling the playing field’ is that the best biotechnology will only be available to the richest athletes thereby introducing socio-economic inequality into the game. However this state of affairs already exists with the wealthier teams having access to better expertise, training, equipment, facilities and health care. In this regard illegal enhancements actually level the playing field as performance enhancing drugs like EPO (erythropoietin) are more affordable for third world athletes than legal hypoxic training chambers or indeed expeditions to high-altitude locals. The idea that sport would essentially turn into a competition between expensive technologies also largely ignores present realities. Professional sport, the Olympics being a perfect example, is primarily a business. Money buys success and those nations which spend more win the most games and the most medals. The top competitors have already embraced strategies and technologies that are inaccessible to the poor. Differences in capabilities, genetic endowments and financial backing are facts that cannot be changed. They can however be made less important by making elite sports ‘fair’. Fair in the sense that the rules are applied equally to everyone, and that means giving athletes the freedom to explore the full range of options at their disposal.

But what exactly would be the effects of decriminalisation and how should it be implemented? In a number of sports it would be hard to imagine much of a change. Would professional cycling, for example, show any noticeable effects? In a sport like boxing, the system of rigidly defined weight classes would make it impossible for fighters to use steroids to bulk up beyond a certain point. They might use drugs to train harder, enhance their endurance in the ring, or recover more quickly from injuries. But this would only contribute to a greater spectacle for fans. In sports like American football and baseball perhaps you would see larger impacts as the current effects of doping clearly demonstrate. Lincoln Allison the Founding Director of the Centre for the Study of Sport in Society at Warwick University asks:

“Do spectators believe that the number of US football players weighing 300lb, which has risen from 10 in 1986 to more than 300 today, is solely through muscle build-up achieved by eating the concentrated protein contained in egg whites? The estimate of a former professional is that at least 30% of US major-league football players are taking steroids; most people say that the figure is much higher. Fans are not put off by this….The fascination of watching Mark McGwire break the home-run record in 1998 was undiminished by his overt use of nandrolone (not a banned substance in baseball), which stimulates the body to produce more of its own steroids (13).”

Would the desire for a distinction between anti-doping and open sport be assuaged by the creation of separate circuits for ‘clean’ or ‘free’ leagues as in weightlifting. One can imagine strict codes of conduct and personal lifestyle applying to the former in order to bolster the league’s wholesome image. Some fans would gravitate toward the traditional games, with their moderate-sized players and conservative approach to sport. Many others would keep tuning in for the colossal spectacle of radically enhanced players performing feats that regularly push the boundaries of human ability.

Fundamentally the issue hinges on whether we should spend our limited resources on attempts to detect undetectable enhancers or evaluate health and fitness to compete. There are good reasons to allow performance enhancement, to make sport fairer, and to narrow the gap between the dopers and the clean athletes. Competition can be unfair if there is unequal access to particular enhancements, but equal access can be achieved more predictably by deregulation than by prohibition. It would provide a better spectacle, be safer and less coercive. Legalisation advocates argue that performance enhancement is not against the spirit of sport; rather it is the spirit of sport. To choose to be better is to be human. Athletes should be the given this choice and their welfare should be paramount. As further human enhancement technologies continue to emerge in sport, restrictive approaches to their usage will be put under increasing strain.

Human enhancement will likely become an important component for future society, especially as enhanced parents start having enhanced children, in such a context ideas about enhancement versus natural humans will become increasingly unrealistic. The question is will sports authorities choose to reflect such structural changes in society or will they persist in promoting a conception of sport which may have declining relevancy.

 

 


Notes

 


1. http://blog.smu.edu/research/2012/01/13/science-of-sport-oscar-pistorius-controversy-continues-to-bubble/

2. Rabinowicz V . Athletes and drugs: a separate pace? Psychol Today1992;25:52–

3.  HTML Tutorial http://www.wada-ama.org/Documents/Education_Awareness/Toolkits/WADA_TTK_Youth_2009_EN.pdf

4. http://www.andymiah.net/wp-content/uploads/2009/Miah2006RethinkingenhancementSportConvergence.pdf

5. http://news.bbc.co.uk/1/hi/sport/140315.stm

6. http://www.guardian.co.uk/science/2005/oct/10/genetics.research

7. Brantigan CO, Brantigan TA, Joseph N. Effect of beta blockade and beta stimulation on stage fright. Am J Med1982;72:88–94.

8. Booth F , Tseng B, Flück M, et al. Molecular and cellular adaptation of muscle in response to physical training. Acta Physiol Scand 1998;162:343–50.

9. http://www.andymiah.net/wp-content/uploads/2009/Miah2006RethinkingenhancementSportConvergence.pdf

10. Lee SJ. Regulation of muscle mass by myostatin. Annu Rev Cell Dev Biol 2004; 20: 61–86.

11. Andersen JL, Schjerling P, Saltin B. Muscle, genes and athletic performance. Sci Am 2000; 283: 48–55.

12. http://www.andymiah.net/2010/02/05/is-gene-doping-a-threat-to-sport/

13. http://sportsanddrugs.procon.org/view.resource.php?resourceID=002352

 




COMMENTS

I agree that legalization seems to make much more sense than the continuation of intrusive and ineffective and sometime inaccurate tests for doping. The key ethical question for me is the effect on the athlete’s health. Making enhancement legal would allow better monitoring. It would also increase the ability of the athlete to make informed consent since they would be able to get a broader opinion of the safety of a given enhancement.

The other reality is that enhancement by itself will not produce a gold medal athlete. They would still have to train and improve their technique and perform at their peak ability the day of the competition. Thus enhancement does not mean automatic achievement, it is just one piece and not even the most important.

It would be interesting to look at more radical enhancement. Would the Six Million Dollar Man be a legitimate competitor at the Olympics?

At some point, we’re probably going to run out of unenhanced people who want to become athletes.  The Olympic Games have been running for 2879 years, and I doubt they’ll last that long to come if we don’t start thinking about the finite supply of athletes we will face when the germline starts accumulating enhancements, and parents start dabbling in safe, reliable prenatal and neonatal surgical interventions.

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