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What’s Wrong With Performance Enhancing Drugs?

What’s Wrong With Performance Enhancing Drugs?. Norman Fost MD MPH. Professor, Pediatrics and Bioethics, University of Wisconsin School of Medicine and Public Health . Preliminaries . Comments apply only to competent adults

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What’s Wrong With Performance Enhancing Drugs?

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  1. What’s Wrong With Performance Enhancing Drugs? Norman Fost MD MPH Professor, Pediatrics and Bioethics, University of Wisconsin School of Medicine and Public Health

  2. Preliminaries • Comments apply only to competent adults • Risks to young children may be permanent and their capacity to make informed choices is suspect • “Adolescents” are somewhere in between

  3. Moral Claims About Performance Enhancing Drugs • Unfair • Harmful • Coercive • Unnatural, violate “spirit of sport” • Rx OK, Enhancement bad • Integrity of records; loss of trust among fans

  4. The Unfairness Claim • Having an advantage is not usually considered unfair • Shaquille, Carl Lewis, Dream Team • Seeking an advantage is not unfair • Training, coaching • Using artificial externalities is not unfair • Shoes, poles, Nautilus equipment

  5. The Unfairness Claim • Changing internal body structure/function is not unfair • Carbo-loading, Gatorade, special diets • Unequal access is unfair • Greasy swimsuits, Bobby Knight, training facilities (eg, high altitude) • The usual solution to unfairness is to equalize access

  6. Taking fair competition seriously • Hypocrisy: Clear unfairness is tolerated • Bud Selig: “A level playing field” • Yankees vs Brewers payrolls • Taking fair competition seriously • Total weight limit for offensive line • Total height limit for basketball

  7. The Harm Claim • Harm of anabolic steroids is wildly exaggerated • Lyle Alzado, liver cancer, chronic heart disease, Heidi • Most harms are reversible or mild • infertility, hair gain/loss, voice changes • Serious harms (e.g. death) very rare • ? < 10 (maybe) Vs 100 from playing football • The concern is disingenuous • Get the quarterback; hockey fights • Criminalization makes risks more likely • Can’t do studies • No oversight of manufacturing process

  8. The Harm Claim • Paternalism is generally unjustified • The sport itself is far more dangerous than the drugs (Football: 90% disability in 3 years) • “Protection of others” claim is disingenuous; size/speed should be regulated, not their causes • Smoking, alcohol far more dangerous and aren’t regulated, even within sports

  9. The Coercion Claim • Definition: Use or threat of force or depriving of an entitlement • Distinguishing an offer from a threat: the chance to be better off vs worse off • Exploitation: Taking advantage of a person’s basic need by doing something that would otherwise be wrong

  10. The Coercion Claim • Withholding opportunities for wealth is not a satisfactory solution to poverty

  11. Lake water Bare feet Lifting rocks Marijuana Testosterone Gatorade Air Jordans Elliptical machine Albuterol Stanozolol Unnatural claim GOOD BAD

  12. Lake water Bare feet Lifting rocks Marijuana Testosterone Gatorade Nautilus machine Greasy swim suit Air Jordans Albuterol Unnatural claim GOOD BAD Testosterone is the most natural anabolic steroid and the most toxic

  13. A sport has no “nature” • A sport (eg., football) is not natural. It does not have an innate definition or an essence. • Tackling, passing, punting are not inherent to football • Gatorade, carbo-loading and steroids are neither inherent to track events, or inconsistent with them.

  14. Enhancement/Treatment Distinction • Rick DeMont (1972) • Ephedrine banned; aminophylline OK • Both taken with the intent of enhancing function and performance • Not a desire for normal function; His “disease” state was >3 SD’s above the mean.

  15. Enhancement/Treatment • Enhancement is common in medicine, pediatrics, and life • Vaccines, education, caffeine, Viagra • Sports training is generally about enhancement • So what? Enhancement as an end violates no apparent moral principle • The means used (e.g., drugs, genes) violate no apparent moral principle

  16. Integrity of records; loss of trust by fans • Empirically false • Bonds, McGwire were the biggest draws • Bigger, faster football -> increased popularity • “Three cheers for Keith” (Hernandez) • Concern about economic impact partly explains the hypocrisy

  17. What about adolescents? • Competence, not age, should be the boundary for autonomous choices • Over 18, competence is presumed • We allow older adolescents to make far riskier choices (driving, drinking, swimming, football, hockey) • Some risks may be linked with duration of exposure (prostate cancer)  need research  open policy

  18. Summary • Claims that performance enhancing drugs are immoral are based on incoherent or inconsistent arguments or bad facts. • These claims seem hypocritical or disingenuous in face of reluctance to address more serious problems

  19. Summary • Athletes may prefer to play without (or with) drugs, just as they may prefer to play with or without passing, tackling or helmets. These are preferences, not moral issues.

  20. “If all the ethicists in the world were laid end to end, it would be a good thing.” Anon.

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