Performance Enhancing Drugs or Medicine?

The current performance enhancing drug scandal in major league baseball, which includes a number of players (most notably Alex Rodriguez) and the recent issue of Lance Armstrong Michael Rasmussen, Floyd Landis, and 20-30 other Tour de France riders, are sometimes not completely black and white issues, as they are usually portrayed in the media. Advances in medical technology are introducing new ethical questions as developments occur.

The prototypical very obvious case used in the media is of an athlete in any sport using medications, transfusions, erythropoetin, anabolic steroids, human growth hormone, etc. while participating in a sport and subsequently obtaining a competitive advantage in strength or cardiovascular endurance. Clearly, this is fundamentally unfair to the non-using participants.

However, the questions/answers get a little more murky when there is underlying disease or injury. An athlete with congenital anemia, asthma or hypogonadism may require the same medications that a non-athlete would be prescribed for their condition. In those cases, should they not be allowed to participate in athletics? It is an interesting question. Is exclusion fair to someone with a congenital disease beyond their control? Do we have a type of eugenics in sports? It is certainly simpler to take the “sucks to be you” approach. On the other hand, if athletes on legitimate prescriptions are allowed to compete, how do the governing bodies make sure there is no significant advantage? If they are allowed to participate, how far can the remedy go? Sometimes, ridiculous examples illustrate the problem. Should a person with a congenital bone deformity of the leg be allowed to ride a scooter in a track meet just so they can participate or do you set up separate categories (e.g., wheelchair marathons)?  It is a very difficult problem to solve (e.g., Oscar Pistorius, Casey Martin). Clearly, there has to be some set of acceptable medications/guidelines. The governing bodies have been attempting to establish and refine those for years. Additionally, how does the governing body ensure that the medical treatment is legitimate? Based on some of the recent Olympic games in women’s gymnastics, every athlete on the Chinese national team will have certified medical conditions requiring medications and will be the proper age to compete. There would have to be medical panels to resolve diagnosis/medication disputes in each sport. Some have even suggested that it would be easiest to just let anyone use anything and set up the “BCS” in a given sport where all’s fair. That would get rid of the testing cost and anyone who used medications or supplements just has to live with the medical consequences. It would be on the NCAA model with the steroid and non-steroid divisions.

I find the dilemma in injuries even more interesting. If an athlete uses a medication or supplement while recovering from injury during the time they are not participating in their sport in order to return faster, is that cheating? For example, if someone uses human growth hormone to heal faster but never plays while using it and does not use it when they return, is that acceptable? A professional athlete depends on participating to make a living. Some would argue that as long as there was no residual advantageous effect after recovery, there is no problem. Should remedies used on the average patient recovering from a severe injury be denied to an athlete just because they are an athlete? If someone develops a “Dr. Bones McCoy” pill that regrows the anterior cruciate ligament of the knee in two weeks, should the athlete still be required to rehab for 7-9 months if it isn’t available to everyone else?

History shows that technology often runs ahead its acceptable use. One good thing about an Alex Rodriguez or Lance Armstrong is that the situation forces the issues to be addressed. Major League Baseball rode the Mark McGwire/Sammy Sosa wave of attendance and profit and held its head in the sand. It didn’t take a scientist to detect steroid use in Mark McGwire, it only took eyes. While it is uncomfortable to expose these users/abusers, at least the playing field eventually becomes level… until the next breakthrough comes along.

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