You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Monday, August 23, 2010

When Performance Enhancing Health is not Enough

This week America’s pastime was sullied yet again as pitching superstar Roger Clemens was indicted for lying to Congress about his use of performance enhancing drugs (PEDs). “The Rocket” joins a growing clubhouse of superstars similarly accused: Lance Armstrong, Barry Bonds, Marion Jones, Floyd Landis, Mark McGwire, Alex Rodriguez, Sammy Sosa, and many others less well known. Some of these have admitted use while others are contesting the charges. In all cases, the infraction of actual use is compounded by lying to the government, sports officials, and the public.

There is a bigger context in which to place all these individual cases, and it is the way we think about drugs in our society. We are decidedly ambivalent. Our better angels are opposed to non-medical or recreational drug use, with the exception of tobacco and alcohol. Our evil twins use illicit drugs by the millions. We are mildly pleased that schools and the government are trying to keep drugs away from kids, but we want our own drugs when we want them, or we remember when we used to use drugs, and it just didn’t seem like such a big deal.

It is interesting that the ramparts against drug use, while still standing, look far less imposing than they once did. Many states are reconsidering marijuana laws and the idea of drug decriminalization is not dismissed as beyond the pale. In contrast, drug use in the sports world seems to be as forbidden as ever. The sports leagues and regulatory bodies like the International Olympic Committee have consistently drawn a line on the playing field. Though testing and detection are not perfect, there have been no signs of giving up this part of the war on drugs.

The addictive properties of illicit drugs are that they either provide a high of energetic stimulation, lifting the user above daily doldrums, or they cover up emotional pain, shame, and broken dreams. It is an axiom that drugs having a quicker onset of effects and also a more rapid wearing off of effects tend to be more addictive than drugs more slow to act and dissipate. All of this is an interaction between specific drug effects, individual vulnerability, and social circumstances around users. For some people, the compelling reinforcement of drug effects will swamp all the normal values of mainstream life: family, employment, caring for health, building wealth, morality, and so forth.

Sports drugs usually are about promoting strength, power, and speed, not any fleeting mood change. It is not correct to use the word addiction with the PEDs. Saying that the guilty players are addicted to winning and crowd adulation doesn’t seem plausible. Players who are not competitive would not reach professional or the highest levels of amateur sports. The drive to win at all costs is a social pathology almost universal, if not for all individuals, in every nation and culture.

The case can be made that drugs are just another type of technology. New technologies, such as shoe construction, athletic clothing fabrics, and the weight and balance of baseball bats all help players perform better and set records unthinkable in the past. However, people oppose PEDs because they give players an unfair advantage and make record-breaking performances suspect. Mark McGwire’s 70 home run season, and Barry Bonds 73 home run season will never be given Hall of Fame merit because there is the suspicion that they were only possible with help from drugs. But, the same can be said about golfers driving a ball 400 yards. Would that be possible without the latest technologies of ball design and club construction? Of course, the drug-enhanced athletes knowingly break the rules: they cheat, and therefore deserve sanctions. However, the basis for those rules is not clear.

We say drugs are bad, but the medical hazards of PEDs are not well established. There are lots of unsubstantiated anecdotes about cancer and other health problems, but research ethics will never approve a clinical trial in which athletes are randomly placed in either a treatment group receiving PEDs or a control group doing just normal diet and training. The only real medical reason for the anti-PED rules is that they might be harmful. With at least hundreds if not thousands of athletes using PEDs, there is no apparent epidemic of sickness among them. Although professional athletes are adults, and therefore should be free to make an informed choice for themselves, a competitive sports environment requires either all or none will use. Furthermore, we would not expect that children and youth are able to make an informed choice based on the evidence, and because the athletes are so high profile, their drug use would be a role model society is not ready to accept.

Given society’s reverence for sports “heroes,” this problem is not likely to go away. The attitudes among spectators and athletes are so basic to who we are that change is not going to be influenced by a prevention program. The cat and mouse game between hungry athletes, unscrupulous trainers and sports officials must therefore continue, trying to minimize cheating as much as possible.


Rob 1448 said...

Vitamin, mineral and enzyme supplements, it could be argued, enhance performance. And some of them are said, by certain research studies, to be detrimental if taken to excess. Does that mean that their use, as well, should be forbidden by competing athletes?

It seems to me that in the realm of sports, limits will someday be reached which unenhanced human bodies are incapable of surpassing. As a matter of scientific enquiry, why not investigate how far we could go with "help"? How much supplementing can be used without incurring permanent damage?

Anonymous said...

The legal distinction is that the substances you mention are normal, even if they are taken in abnormal doses.

The experiment you describe would never be approved on human subjects protection grounds.