Tuesday, February 26, 2013

Addressing Performance Enhancing Drugs in Sports

The controversy surrounding the use of Performance Enhancing Drugs (PEDs) in sports continues to build with every passing year. Not surprisingly the controversy does not surround their effectiveness for clearly steroids and other PEDs increase a user’s ability to produce positive outcomes in athletics both for in tangible statistical elements (home runs, passing distance, throwing velocity, etc) and intangible elements (confidence or intimidation from physical appearance, higher probability for endorsement deals, etc). The most common point of contention in the debate over PED use involves the morality of their inclusion in sports both in the spirit of “fairness” and the nature of individual freedom. Note that for the purpose of this discussion the phrase “legalize PED use” and similar phrases will pertain to allowing their use in sports.

Most individuals who do not oppose PED use in sports (they either support it or have no option) frequently point out that non-athletes have the ability to freely assume risks that could result in detrimental health outcomes either in the short-term or the long-term, thus athletes should also have that same freedom. The “personal freedom” argument is commonly used as a hedge against almost any ability of an authoritative body to provide regulation. Unfortunately these arguments rarely appreciate how interconnected society is and how these connections weaken the so-called isolated nature of “personal freedom”.

One popular counter against the personal freedom argument is the seatbelt argument. All states with the exception of New Hampshire have laws that prohibit individuals from driving automobiles without having a buckled seatbelt. What allows a state to do such a thing for most individuals would regard such a regulation as a direct assault against one’s personal freedom. What is the rationality? Clearly the probability that after an accident with another vehicle an unbuckled driver is launched through the windshield of one car and through a second windshield of another vehicle killing a buckled passenger is so infinitesimal that using the personal safety of others as a rationality for seatbelt laws is not applicable. Instead a regulatory body can enforce such a rule as a means to ensure the safety of the driver in question by forcing the application of a remedial and simple task, especially if there is an associated societal cost.

To question why regulatory bodies would attempt to restrict the use of PEDs is foolish and/or ignorant. Stimulants like ephedrine and amphetamines have large histories of abuse in various sports and put users at risk for heart failure, high blood pressure and erratic behavior.1 Steroids induce numerous skin conditions, most notably acne, increases LDL cholesterol levels, increases blood pressure, increases probability of muscle injury and a significant increased probability of infertility.1 Based on these significant detrimental side effects it is understandable why regulatory bodies may want to protect individuals from themselves.

The final aspect of the seatbelt issue asks the question of safety in general. Why does an organization like the FDA exist? Should society allow a product that has not been proven safe or at least had its side effects properly understood be sold and consumed by the public or should society prohibit that product until a scientific majority has acknowledged the product as appropriately safe? One of the linchpin questions regarding the seatbelt issue is the moral appropriateness of allowing an ‘informed’ individual to engage in an action that significantly increases the probability of death solely to increase the probability of becoming more famous and/or rich? Do steroid users even understand the risks of taking steroids?2

Another element against the personal freedom argument is the confliction of freedoms. One common statement regarding the limitations of personal freedom is that an individual loses his right to swing his fist where another person’s face begins. This statement can be applied to sports and PED consumption in one of two ways. First, in direct contact sports like football, hockey, lacrosse, etc. PED consumption will increase the average velocity and force (through mass) of impact against other players, which will in turn increase the probability of injury both short-term and long-term. Some opponents of PED regulation argue that PED consumption could only have marginal effects on the ability of an individual to make contact with an opponent. However, such an argument is rather irrelevant because in these direct contact sports there will be contact and the issue is not the frequency of hitting, but what happens to the opposing individual after he is hit. Therefore, one could argue that an individual’s personal freedom to take PEDs is not applicable in an environment where threat to injure another person is a realistic aspect of the sport.

Some individuals would point out that injury is a part of certain sports and any participants should take such consequence into account, but there is a difference between historically trended injury potential and growth abnormality. Basically over time injury potential trends in a specific direction based on changes in training techniques, nutrition, player style, type of player, etc. However, these changes are slow enough the individuals are able to understand the changes in these risk profiles and respond accordingly. The introduction of PEDs on large scale will greatly hastened injury potential and continued consumption will create an abnormal potential that makes it difficult to classify the consequence in probability and magnitude of injury eliminating the “informed consent” aspect that is essential to the above objection by PED supporters.

Second, if prohibitions on the consumption of PEDs are eased or even eliminated there exists a high probability that a form of PED arms race will ensue in all major sports. This mentality is supported by survey information which demonstrates the highly competitive and short-sighted attitudes of athletes when majorities report that they would shorten their life spans and quality of life through the consumption of PEDs if it resulted in the highest tier of performance (1st Team Selections, Championships, undefeated, etc.) for some number of years in their athletic careers.3,4 The limited number of positions on sports teams creates a zero-sum competition between all potential participants, thus game theory also predicts widespread PED use.

Some try to explain this competitive nature through the career characteristics of the professional athlete in that most individuals have careers that extend into their 60s even 70s, whereas athletes typically see an end to their playing days at late 20s to late 30s. Therefore, some argue that these individuals need to be hyper-competitive to not only lengthen their careers, but also maximize their earning potential. Unfortunately this argument is not supported by logic or empirical evidence. First, there is nothing that prevents these individuals from seeking employment in another field and most individuals who participate in professional sports and have an education (one they should have received due to scholarship to a college) should have little trouble securing another form of employment, especially because who you know/how famous you are is more important in modern society than what you know.

Second, minimum salary in major sports leagues are (2012-2013 season): NFL = $390,000; MLB = $480,000; NBA = $473,604; NHL = $525,000 where these figures increase with both time (2013-2014 salaries will be larger than 2012-2013) and experience. Assume an average 5 year career, at even the minimum level of earning power and the professional athlete should still (barring radical changes to the tax codes) make more money than vast majority of people will make working for 30+ years (assuming all those years are at the same job). It is the athletes living beyond their financial means that typically creates their financial problems, not having too low a salary (especially for those who work in states without income taxes). Third, taking PEDs could actually be more detrimental by increasing the likelihood of injury and other deleterious health effects.

There is little rationality to the argument that the competitive nature of athletes is derived from the professional sports environment. It much more probable that most professional sports athletes are either inherently hyper-competitive or become hyper-competitive long before entering the pros because of the competition required to reach the pros. This attitude will drive the PED arms race, which will create an environment where individuals who do not take PEDs will be placed at a very significant disadvantage in performance versus those individuals taking PEDs. Basically this arms race environment would create an environment of coercion.

There is something to be said for athletes who do not want to endanger their long-term health by consuming certain substances in they should not be forced out of a particular career path because they are not willing to compromise that value. What type of moral message does that send to society: either take this substance that will shorten and/or reduce the quality of your life in the future and has nothing directly to do with the career or find a new career. Thus conflict of personal freedoms is between the ability of an individual to increase his/her capacity to play a particular sport versus the ability of an individual to compete at a particular sport without placing his/her health at risk beyond the intrinsic elements belonging to that sport.

The devious nature of this arms race is that it creates an environment of diminishing returns. If everyone is using there is no advantage to using beyond simply keeping pace with everyone else, yet one will still experience the negative side effects, which reduce current and future quality of life at a biological level. However, in such an environment to gain an advantage one must continue to take even more steroids or possibly riskier new versions that will further reduce quality of life. Thus in the end one significantly reduces quality of life for no more absolute money, fame or anything else.

The nature of “fairness” also ties into the above conflict of freedoms. Without the utilization of PEDs most individuals, outside the very small number that are genetically gifted, have natural biochemical ceilings that are placed on their potential to be a professional sports athlete due to those same genetics and the simple fact that only so many hours exist in a day. Basically one can only develop physical abilities to a certain point because of these boundary conditions. Due to the nature of these ceilings individuals who may have lower ceilings than others can increase their playing probability through other non-physical strategies.

For example an individual who is undersized can still be an effective linebacker through sheer ferocity, intelligence (predicting running paths and taking proper angles to reduce intercept times) or superior technique (either in pass coverage and/or tackling) to name a few strategies. However, these strategies work because of the pre-existing biochemical ceilings, which limit physical abilities. Artificially increasing those ceilings through the use of PEDs strips the usefulness of these additional stratagems, thus demanding that individuals who are not physically gifted either become physically gifted to neutralize the gains from the new artificial ceilings of their competitors (i.e. take drugs themselves) or lose their ability to maintain their position.

Ignoring the morality aspect of the conflicting personal freedom issue, some would claim that universal allotment of PED is fair because everyone could use them unlike genetic differences, which are not yet controllable. These individuals also argue that due to the legality of painkillers, caffeine and alcohol PEDs should be legal to consume as well. While there is difference in genetic makeup, the difference is limited enough that those differences do not eliminate non-physical strategies, as mentioned above, for compensating in competition between a vast majority of players. Painkillers and caffeine do not have long-term enhancement effects on users and low probability for detrimental side effects. Alcohol does not have significant enhancement effects (probably are more detrimental than beneficial) and has become so ubiquitous in society that prohibiting it is logistically irrational, thus to use its legality as a point of emphasis to legalize/allow something else currently prohibited is foolish because the something else does not have the cultural significance, good or bad, that alcohol has.

The issue of fairness is also broached in discussion of the inequality of training between rich/connected individuals and poor individuals. Some argue that if taking PEDs is prohibited why is specialized training, coaching, psychological analysis, etc. allowed? This argument is foolish because it whitewashes the unique characteristics associated with each of these training elements. Specialized trainers and nutrition programs may have given athlete A an advantage over athlete B a few decades ago when this information was still selectively known. However, with the advent of the Internet age it is difficult to argue the exclusivity of ‘secret’ information known to only a select few personal trainers or psychologists.

Also there is little correlative evidence that demonstrates training technique A to be superior to training technique B, most evidence is either anecdotal or psychological/placebo whereas there is no question that PEDs, especially steroids, increase endurance and/or muscle mass. Finally proponents of the above argument neglect the Prisoner’s Dilemma (game theory) detriment associated with the use of PEDs, a characteristic that is not present in using training technique A over training technique B. Overall the non-drug elements associated with training that could be viewed as an exclusive domain of the rich have lost significant value in modern times versus decades ago, thus ‘fairness’ is no longer an issue.

The final major point against the use of personal freedom to support PED use is that individual choices can significantly influence the well being of society as a whole. Simply looking at the current state of the ghosts of the NFL (former players) and the high profile analysis of the higher than normal rates of brain injury and mental disease that these players are suffering from correlates the association between personal freedom and societal cost. These players are suing for benefits and money because the risks of playing in the NFL were “undersold” or “unknown”. If PED use becomes widespread due to arms races and elimination of penalties from the removal of prohibitions it stands to reason that more individuals will require healthcare for long-term chronic detrimental health conditions.

So who pays for all of this healthcare… government under Medicare? The sad reality of personal freedom is that everyone wants government out of their lives until they need the protection and/or services of government. If players have private insurance based on previous behavior it stands to reason that private insurance including these individuals will raise premiums, with the rational of covering operating costs for these new chronic cases, for all customers. What happens if players cannot pay these new healthcare costs, do we as a society simply let them die after “thanking” them for sacrificing their life for our entertainment? This potential consequence is an aspect of personal freedom that most people do not want to address.

Another societal issue is what to do about the anticipated violence and aggression, which will arise out of increased PED use? Should society accept the increased assaults, domestic violence and possible gun deaths or does the potential overall increase in entertainment value offer too little value for these potential detriments? How would this increase in criminal behavior influence court dockets, prison populations and incarceration times?

Proponents for the adoption of legalized PED use also frequently use the argument that the current testing and regulation methodology is a waste of money due to poor enforcement rates and little deterrence due to the short-term advantages associated with PED use in sports. This argument is reflective of a similar one used by proponents for marijuana legalization in that they focus on isolated short-term cost savings, but fail to neglect the costs associated with the health and societal detriments derived from marijuana use. In a legalized PED environment major sports leagues can save some money by no longer requiring testing, but such action will more than likely result in higher costs for society as a whole due to an overall decrease in mental health and increased overall healthcare costs. Also using a possible low enforcement rate as rational for lifting prohibition implies that all laws with low enforcement rates should be eliminated as well, thus no more speed limits, no more assault laws, no gun control laws, no larceny laws, etc. basically almost all laws should be rescinded. Such a belief is completely and entirely ridiculous.

More over most individuals presume that the poor PED enforcement rates are due to deceptive biochemical designs that seamlessly mimic natural components in the body masking them from detection. Unfortunately for this belief the truth is far more simplistic. The principle reason explaining the poor percentage of PED enforcement involves three parts: 1) some players unions and Olympic committees do nothing to discourse PED use or even support PED use increasing the number of individuals that take PEDs in the first place; 2) players unions fight protocols that would require blood testing instead of hair or urine testing. The difference between using blood versus other bodily fluids is quite significant as drug concentrations linger at much more detectable quantities in the blood versus these other mediums; 3) Random testing only includes a very small sample of competitors. For example in 2004 the International Amateur Athletic Federation estimated (in 2004) that only 10–15% of participating athletes are tested in each major competition and little has changed since.4,5 While it is true that there are some PED compounds that have effective mimicking properties, changing these above three elements should significantly increase the number of PED using athletes who fail drug screenings.

Some also attempt to argue that regulation of PEDs in a “more legal” environment will increase the safety for users. This belief is unusual because most athletes that use PEDs acquire their drugs from highly reputable and professional pharmaceutical companies or quality “underground” suppliers, not Jack the shady guy at the end of a particular alley. Therefore, there is no significant contamination probability of available PEDs, thus no meaningful increased safety through a mythical decrease in contamination rates is to be had through legalization. Dosing dangers are also rather rare because of this associated pharmaceutical connection. There is something to be said for a higher probability of seeking medical attention for suspected PED related health problems in a PED legalized environment over a prohibited one, but it is unclear how useful this aspect will be largely because it requires large ego males to recognize something is wrong and seek medical attention. Finally it is difficult to gauge the usefulness of legalized screening because most athletes probably will not wait for new PED x to be evaluated for safety by the FDA if it promises to be better than current PED y.

Some argue against the legalization of PEDs on the basis of sports athletes being viewed as role models to younger individuals. The concern with PED use then translates to younger individuals using these agents, like their “heroes”, without pertinent information pertaining to the negative risks associated with consuming these agents or without the biological maturity to take advantage of their benefits or minimize their risks. It is unfortunate that this argument has a small amount of supporting empirical evidence because it is not the responsibility of a sports athlete to live his/her life in a certain way to demonstrate a specific lifestyle to others. It is the responsibility of the parents of children and teenagers and athletic coaches to help provide the necessary information that may be lacking in a given situation so a means of informed consent exists when one makes decisions.

Some have argued that this role model aspect of the PED debate is mitigated due to survey information indicating that the most common reason teenagers take steroids is a poor physical self-image, which has little to do with professional athletes.4,6 This belief is somewhat inaccurate because poor physical self-images are frequently identified along the aspects of relative comparison rather than absolute comparison (i.e. a person looks at his body relative to another person’s body rather than simply defining his body in a standalone aspect). These comparisons are frequently made to those in the public eye like celebrates and sports athletes in addition to popular peers.

This point also seems to inappropriately marginalize the fact that there are individuals who do use steroids to look like and/or play like athlete A and body image is a secondary motivation. Thus it seems inappropriate to argue that increased PED use of professional athletes will not result in a meaningful increase in PED use in teenagers. However, one should not blame professional athletes for this increase instead blame the teenagers taking the PEDs, their parents and all relevant athletic coaches, just do not think that there will not be an increase. Interestingly enough one of the more overlooked points may be that the illicit nature of PEDs is keeping a number of individuals from using and eliminating this environment could be viewed as encouraging greater use through societal acceptance, especially in the competitive environment for college scholarships and the stress that competition brings. Unfortunately there does not appear to be significant amount information on this issue.

A small side question about PED legalization is the nature of sportsmanship. If one engages in inherently unnecessary actions that are permanently detrimental to long-term health how does that resonate with the nature of sport from a standpoint of competition? What about the message sent to teenagers and college athletes in that professionals can use PEDs, yet they will probably not be able to use them. Logically it seems like a difficult sell to kids and teenagers on the matter of sportsmanship that PED use for them is not condoned, but it is fine for professionals. However, one could argue the relevance of this issue in that does sport have a natural contradiction where on one hand individuals are to defeat an opponent, yet on another hand they are not expected to take advantage of all possible advantages. Does this ‘contradiction’ eliminate the point of sportsmanship or does it validate it?

When discussing future regulation of PEDs one point of contention is the potential difference between recovery agents and enhancement agents. Some argue that if a biochemical agent speeds recovery from a particular injury then it should be allowed. This argument is consistently tied into other medical advancements like “if Tommy John surgery or microfracture surgery is allowed why not biochemical agent x?” The problem with this argument is that agents that speed recovery do so by typically increasing muscle mass or muscle flexibility, thus these recovery agents could be viewed as enhancement agents. Therefore, recovery agents cannot be legitimized as long as enhancement agents remain prohibited. Surgery is different because, despite what some fictional movies tell us, surgery rarely enhances an individual’s abilities beyond the abilities possessed prior to the injury that lead to the surgery and any such enhancement is not by design.

The most controversial PED at the moment is human growth hormone (HGH or HG1), a peptide mitogenic hormone most commonly composed of 191 amino acids with a molecular weight of 22.1 kilodaltons.7 While gaining in popularity for its supposed anabolic effects on muscle, some believe that any enhancement associated with HGH is merely coincidental citing studies where HGH produced an increase in lean muscle mass, but no increase in overall muscle strength or muscle associated protein synthesis.7-9

So if HGH does not have a direct influence on muscle growth, why is it gaining popularity as a PED? One reason is individuals may view HGH as an anabolic agent is due to a general mischaracterization of its effect. Some look at the name HGH and incorrectly assume that it has something to do with muscle growth. In actuality HGH is largely responsible for increased height and bone mass in children and adolescents. A second reason may be the ongoing mischaracterization of HGH as an anti-aging element. While HGH does increase lean muscle mass by increasing fluid retention, thus increasing overall health for the elderly, it does not retard or reverse aging. However, HGH may actually possess PED characteristics. By itself HGH does not seem to increase muscle growth, but it does significantly increase sprint capacity.10

Sprint capacity is defined by a combination of power and anaerobic performance,11 thus HGH either positively influence muscle anabolism and/or energy supply. Based on previous research questioning HGH ability to increase muscle anabolism, it stands to reason that HGH positively influences anaerobic energy supply. This increase is theorized to occur from HGH driving a preference for glucose over fatty acids and suppression of oxidative mitochondrial energy production, which not only improves anaerobic energy metabolism, but also buffers against intracellular pH decline.12 This suggestion is supported by natural levels of HGH increasing relative to short-term workout intensity (largely anaerobic) before a biological ceiling.

However, this increased energy metabolism through glucose preference also results in the increased build-up of lactic acid in muscles. Basically HGH helps athletes competing in short burst endurance sports and hurts athletes competing in long pace endurance sports. Unfortunately for PED use opponents almost every major sport, especially those at the professional level, are short burst endurance sports (football, baseball, basketball and hockey with soccer having short burst and long pace components). For those who think the difference is irrelevant, a 3.9% increase in sprint capacity equates to a 0.4 second improvement out of ten seconds in a 100-meter dash.10,13

In addition to increasing sprint capacity there is a belief, although the clinical evidence is exclusive to elderly men,14 that HGH taken in combination with anabolic steroids increases muscle growth and enhances HGH influence on body composition at a greater rate than steroids taken alone. Whether or not this PED combination treatment works on younger men is unclear largely because of the lack of well-conducted studies on HGH combination treatments, especially because dosage for most studies are concerned with safety thus experiments use doses significantly less then the currently estimated and wide range of 15 to 180 ug/kg per day used by athletes.15

There is reason to suspect that HGH/steroid combination treatment would produce benefits exceeding either isolated or staggered treatment because of the differing pathways in which these elements influence positive muscle change. HGH increases lean muscle mass through increased fluid retention and steroids increase lean muscle mass through increasing cell mass.10 Due to the fact that there are biological ceilings for both HGH and anabolic agents in the body, which appear to be synthesis limiting over receptor saturation limiting, supplementation of either should increase training efficiency and overall performance.

One of the biggest problems in HGH use is the aforementioned lack of quality studies at empirically realistic dosages, thus safety information for HGH use, most notably where it matters in healthy non-HGH deficient young men, is lacking. Some of the side effects of HGH use are known and involve increased probability of fluid homeostasis disruption leading to abnormal fluid retention resulting in swelling of the hands and feet and excessive sweating, increased risk for diabetes mellitus, hypertension, cardiomyopathy, osteoporosis, impotence and even Hodgkin's lymphoma along with decreased high density lipoprotein (HDL) cholesterol concentrations.16

Some individuals want to see high profile athletes take a stand and start routinely taking drug tests for PEDs as a means to basically coerce other athletes into taking the same tests thereby “cleaning up” sports. In this scenario those athletes who do not ‘volunteer’ for PED tests will be inherently suspect. The problem with this idea is it spits in the face of the notion of the burden of proof, i.e. innocent before proven guilty. It is of similar vein to the police tactic of asking a suspect for his/her DNA with the phrase, “If you didn’t rape the victim then you should have nothing to hide.” In this case the phrase simply changes to “If you are not taking PEDs then you should have nothing to hide and take multiple drug tests.” Never anything wrong with stomping all over individual rights, probable cause… what’s that?

Overall the idea that self-reporting and self-testing will bring about the purification of professional sports is unlikely. As long as playing professional sports affords the rewards of fame and money in current quantities these short-term positives will supercede the long-term negatives in the minds of some to most athletes, thus leading to and continuing PED use. Also as much as the public seems to believe in shaming, the willingness of the public to forgive and the lack of financial or other punitive damage from PED use being exposed basically eliminates shaming as a possible solution strategy. Therefore, the most probable strategy to eliminate PED use is simple zero tolerance. Create a transparent and clear rule structure when it comes to PED use and if an individual is caught violating that rule structure then that individual is banned from participating in that particular professional sports league for life.

Another argument commonly made by PED use proponents is that the history of PED use in sports is extensive,17 thus why is modern use of PEDs such a big deal? The difference is intent versus success. Much greater biochemical knowledge mitigates the utility of the comparison between ancient cheating and modern cheating. In “ancient” times individuals had little grasp of biochemistry thus any “perceived” benefits from potential PED use were more likely illusions or attributed to short-term placebo effects versus actual gains. It would be expected that most athletes made themselves sick with their attempts to cheat over actually enhancing their performance. In modern culture the advancement of biochemistry and organic chemistry has dramatically increased the probability of knowing whether or not compound x will aid in the enhancement of y. Thus while some ancient athletes had the intent to cheat, this intent more than likely did not result in successful cheating, while in modern times the intent to cheat will almost guarantee successful cheating (using drug enhancement).

One critical issue that must be addressed in the discussion of PEDs is why some view their consumption as “cheating” in the first place beyond consumption being prohibited by sports leagues. The reason that immediately jumps to mind is that consumption of PEDs is an action that is not routine to sport or life and has significant negative consequences in normal consumption quantities. An athlete sleeping in a hyperbaric oxygen chamber is certainly not routine in sport or life, but under an appropriate methodology there are no significant negative consequences whereas the consumption of steroids, EPO or even HGH do have significant negative biological consequences.

This non-common negative risk combination lead to the characterization of PED consumption as sneaky or shady, a common element associated with cheating. This feeling is why people hope someone like Usain Bolt does not take PEDs, that his achievements are ‘natural’. If PEDs were legalized one could argue that their use would become more common, similar to protein shakes, but legalization would not eliminate the negative consequence to their consumption and the enduring characteristic of those consequences returns the debate back to the moral coercion element.

These “cheating” characteristics are also a prime rationality for why consumption of PEDs are not allowed in professional sports. Some argue that leagues should not be allowed to prohibit PEDs, an argument that makes little sense. Leagues are not dictating whether or not their athletes can be healthy because restriction of PEDs fails to eliminate an agent that is required for health. Basically if someone does not take PEDs that person will not fall into poor health. Overall PED proponents seem to presume that the league has to have some form of scientific dictum to support banning the consumption/injection of certain agents, they don’t. Leagues can make arbitrary conditions on what can be used and what cannot as long as it is not completely unreasonable, which is appropriate for agents that cause significant long-term damage and increase risk of injury to other players.

In this light another side element that has yet to be addressed by all sports leagues is the use of PEDs to augment genetic conditions that place certain individuals at a biological disadvantage. This issue/problem (depending on one’s perspective) is becoming rampant in mixed martial arts where certain competitors are receiving testosterone replacement therapy because they claim to have low natural testosterone. Should individuals with naturally low levels of agent x be allowed to supplement that agent with drugs when other competitors with normal levels are not and how does one control and measure that the low level individuals are only augmenting to ‘normal’ levels instead of higher than normal levels?

To this point there has been little discussion about an important element of PED policy, the motivation of use and how the motivation corresponds or conflicts with the nature of sport. Earlier it was stated that most professional athletes tend to be hyper-competitive with an obvious desire to be the best. However, there appears to be a psychological disconnect between this hyper-competitive nature and PED use. How can one identify him/herself as “the best” if one takes PEDs? Clearly one must resolve that consuming PEDs is not cheating, but if taking an action that is prohibited by the rules of a particular sport is not cheating then what is? If John runs 18 miles of a marathon in 1 hour and 31 minutes and then decides to stop and leave the course can he declare himself the fasted marathon runner ever?

Not surprisingly most would regard such a statement as preposterous, but what is the symbolic difference between that and someone who takes PEDs declaring him/herself to be a superior success as an athlete over others who do not take PEDs? Both declarations involve clear unambiguous violations of the rules of the particular sport. Some would try to counter that the difference is in the “level” of cheating, that prohibiting PED use is some arbitrary policy created by sports leagues. The problem with that counter is that the prohibition IS part of the policy outlining the boundaries of what is allowed for how that sport is conducted in the particular league, its rationality is generally irrelevant.

The nature of this “all that matters is I’m the best” attitude that motivates PED use is impacted by the perceived nature of sport. Are sports just another form of entertainment like movies and television shows or it is something different, something more? Based on the existence and sheer influence of institutions like ESPN and the rigor of the relationship between society and sports, there are no riots when Taylor Swift wins a Grammy or the Daily Show wins an Emmy, it is difficult to suggest that sports are simply entertainment. Note that this behavior is not isolated to the U.S. recall how the rest of the world acts regarding soccer, cricket and rugby.

So what reason do people have for placing sports at some hallowed level above other forms of entertainment? Two explanations immediately jump to mind: first, the historical nature of sport defined it as something beyond entertainment due to its nationalistic elements. Long before organized sport leagues, tribes in Africa had wrestling competitions between themselves to demonstrate which tribe was superior. In that context sports provided a non-violent method to measure superiority. This nationalistic/tribalistic association has never really left sports instead having just branched out to different environments. In contrast few people standup and shout, “Harvard forever baby!” when Tommy Lee Jones wins an award.

Second, the design of sports creates one of two mindsets. For most sports there is a tiered development where teams first play a set number of games (the regular season) after which a certain number of teams based on some form of scoring system (normally number of victories) move on to a second tier of competition that determines the champion for the given year. Overall numerous games are played and those watching a particular team get to see the “journey” that the athletes take and through watching this journey fans develop a closer kinship with the players. Other sporting events have a smaller tiered event structure with a much lower frequency of occurrence (one event per four years instead of one annual event). This reduced frequency increases the intensity of the emotion and fervor for both the players and the fans realizing that there is only a certain window of opportunity to achieve success before skills and talents are no longer adequate for competition.

The reason for this closer kinship is that during the journey players and teams struggle and it is through the frustrations of that struggle and, if applicable for a given season, overcoming those struggles that fans form stronger emotional relationships with the players and team even if they have never met the players. While most people may see movie x with actor y they do not see casting, rehearsal and the numerous other elements that go into creating the film, which create joy, frustration and other emotions. Unfortunately the rise of PEDs and the “all that matters is I’m the best” attitude compromises this methodology eliminating the struggle in effort to only produce positive results. This attitude exists because it is allowed to exist due to little short-term punitive punishment and because society does not typically tangibly reward the struggle only the results, so if one can create shortcuts to produce the same or better results people typically do. It reminds one of the famous G. Gordon Liddy line, “If crime didn’t pay, there would be no crime.”

If one believes that sports are nothing but another medium of entertainment then one can understand a “legalize PEDs” mindset. With that mindset there is a threat that sport loses nuance, strategy, elegance and even possibly its spirituality. It would be like playing a video game with ten different types of weapons, yet with one weapon superior to the other nine, thus the player would only use that weapon. If one cares about strategy and diversity this would be a horrible situation for one would have to self-handicap making the game more difficult than it should be and more then likely less enjoyable. However, if one simply plays for the ability to blow-up artificial buildings and mow down other artificial characters one superior piece of firepower removing the “unnecessary” nuance increases the enjoyment produced by the game. The issue is that in the video game it does not matter if by the end of the game the gun of choice is overheating, broken and nearly out of ammunition, does it matter if the player is such?

Citations –

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2. Nilsson, S, et Al. “Attitudes and behaviors with regards to androgenic anabolic steroids among male adolescents in a county of Sweden.” Substance Use & Misuse. 2004. 39(8):1183-1197.

3. Bird, E, and Wagner, G. “Sport as a common property resource.” Journal of Conflict Resolution. 1997. 41. 749-766.

4. Lombardo, J, Bowers, L, Chu, J, and Cowan D. “The quest for clean competition in sports: are the testers catching the dopers?” Clinical Chemistry. 2011. 57(7):943-947.

5. IAAF, 2004. http://www.iaaf.org/antidoping/index.html.

6. Morrison, T, Kalin, R, and Morrison, M. “Body-image evaluation and body- image investment among adolescents: A test of sociocultural and social comparison theories.” Adolescence. 2004. 39(155):571-592.

7. Deyssig, R, et Al. “Effect of growth hormone treatment on hormonal parameters, body composition and strength in athletes.” Acta. Endocrinol. 1993. 128:313-318.

8. Yarasheski, K, et Al. “Effect of growth hormone and resistance exercise on muscle growth in young men.” Am. J. Physiol. 1992. 262:E261-267.

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