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Allow physiological doping in sport to focus on the unsafe variety
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Imagine you are training for February’s Sochi Winter Olympics when you sustain an injury. It is nothing serious – you will recover before the games. But your training schedule is delayed. You are unable to achieve your best times. Your coach offers a solution: testosterone. A patch overnight will bring your levels to the higher end of normal, speed up your recovery and assist your training. So, why not?According to John Fahey, head of the World Anti-Doping Agency, “more athletes will be tested at Sochi than ever before and anyone who ends up standing on a podium with a medal around their neck should know now they will be tested – no exceptions.”

Of course, testing is not 100 percent effective: “Using typical values of detectability of 48 hours, sensitivity of 40 percent and testing frequency once every three months, the probability of detecting a cheater who uses doping methods every week is only 2.9 percent per test,” Aaron Hermann and Maciej Henneberg of the University of Adelaide wrote.

Sufficient testing to catch all dopers is estimated to cost 21,000 euros per athlete per year. Even then, doping methods such as autologous blood transfusions, thought to be widely used in cross-country skiing, remain undetectable. Then there are variations in testing protocols: Questions have been raised about testing in ski racing, which has few blood tests, and individual countries have been accused of having lax testing regimes.

It isn’t right for an athlete to cheat in any circumstances. But, especially given the financial incentives, some will, and many have: A new steroid test implemented in Germany this year uncovered 266 positives from past samples.

In a world of limited resources, what should we do?

WADA prohibits the use of substances that enhance performance and either pose a health risk or violate the spirit of sport.

Because human beings have different levels of naturally occurring, physiological substances – such as testosterone, growth hormones and red blood cells – it is difficult to tell what levels are healthy for any given athlete.

Physiological doping is when athletes use naturally occurring compounds to enhance their normal physiology. Athletes who have higher levels of red blood cells, for instance, have an advantage over those with lower levels, so some take erythropoietin (EPO), a hormone that produces red blood cells, in order to enhance their performance.

Is it safe? It is difficult to get good data on illegal activities. However, we do have some figures with which to work. A red blood cell count of up to 50 percent is typically considered safe – kidney patients that are given EPO are brought up to this level. For some years before EPO was testable, this was the level set by the Union Cycliste Internationale for professional cyclists. In fact, despite an undeniable history of widespread doping, particularly EPO and drug transfusions, Tour de France riders have a significantly lower mortality rate than the general population.

It is difficult to know whether someone who has a red blood cell count of 50 percent doped or was born lucky. That is why WADA created biological passports: to look for changes specific to each athlete. But smart dopers set the parameters high and carefully monitor their trends. One cyclist described passports as a gift to the doping athlete.

Measuring levels of red blood cells, growth hormones, testosterone and so on is straightforward and cheap, but it is nearly impossible to determine whether one has supplemented natural hormones by doping. What we need to do is set a safe level and penalize only those who exceed it – for their own safety.

There is nothing wrong with aiming for sport that is free of performance-enhancing drugs. But there is also nothing intrinsically wrong with allowing certain kinds of performance enhancers. Legal performance enhancers such as caffeine, creatine, concentrated beetroot extract, hypoxic air chambers, analgesics and nonsteroidal anti-inflammatory drugs all enhance performance, yet are permitted. Many of these, like caffeine and analgesics, can be dangerous if taken in excess.

WADA’s 2015 code lists a number of values encapsulated in the spirit of sport: health, excellence in performance, character and education, fun and joy, teamwork, dedication and commitment, respect for rules and laws, respect for self and other participants, courage, and community and solidarity.

These are wonderful values, but they do not apply to professional sport. There is not much fun and joy in elite competition. Mostly, there is pain and heartbreak. In any case, it is hard to see how legal physiological doping compromises any of these values.

There is a valid concern that performance-enhancing drugs may take over sport and remove the essential human element. Archery, pistol shooting, biathlon and other precision sports are partly a test of human ability to aim and control anxiety. Beta blockers, which enhance performance by reducing tremor, should therefore be banned. But because they are not physiological and not natural, they are easy to detect.

Physiological doping does not remove the human element. What it does remove is one test of natural physiological inequality. But physiological differences will still exist, even if a few parameters are equalized. And the factors we really care about in sport – mental toughness, hard training, tactical genius and talent – will still apply. If anything, their importance will be boosted as genetic advantage is diminished.

Allowing physiological doping will not eliminate cheating, but it will free up resources to focus on catching doping that is unsafe and that undermines the purpose of sport. The challenge is not to enforce a set of immutable rules but to evolve our rules to maximally respect the values of health, spectacle and meaningful competition – and, of course, to test human spirit and talent.

Julian Savulescu is the director of the Uehiro Center for Practical Ethics at Oxford University. He is also the editor of the Journal of Medical Ethics. This commentary originally appeared at The Mark News (

A version of this article appeared in the print edition of The Daily Star on December 11, 2013, on page 7.
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