Current anti-doping policy: A critical appraisal

Professor, Institute of movement sciences and sports medicine, Faculty of medicine, University of Geneva, Switzerland. .
BMC Medical Ethics (Impact Factor: 1.5). 03/2007; 8(1):2. DOI: 10.1186/1472-6939-8-2
Source: PubMed


Current anti-doping in competitive sports is advocated for reasons of fair-play and concern for the athlete's health. With the inception of the World Anti Doping Agency (WADA), anti-doping effort has been considerably intensified. Resources invested in anti-doping are rising steeply and increasingly involve public funding. Most of the effort concerns elite athletes with much less impact on amateur sports and the general public.
We review this recent development of increasingly severe anti-doping control measures and find them based on questionable ethical grounds. The ethical foundation of the war on doping consists of largely unsubstantiated assumptions about fairness in sports and the concept of a "level playing field". Moreover, it relies on dubious claims about the protection of an athlete's health and the value of the essentialist view that sports achievements reflect natural capacities. In addition, costly antidoping efforts in elite competitive sports concern only a small fraction of the population. From a public health perspective this is problematic since the high prevalence of uncontrolled, medically unsupervised doping practiced in amateur sports and doping-like behaviour in the general population (substance use for performance enhancement outside sport) exposes greater numbers of people to potential harm. In addition, anti-doping has pushed doping and doping-like behaviour underground, thus fostering dangerous practices such as sharing needles for injection. Finally, we argue that the involvement of the medical profession in doping and anti-doping challenges the principles of non-maleficience and of privacy protection. As such, current anti-doping measures potentially introduce problems of greater impact than are solved, and place physicians working with athletes or in anti-doping settings in an ethically difficult position. In response, we argue on behalf of enhancement practices in sports within a framework of medical supervision.
Current anti-doping strategy is aimed at eradication of doping in elite sports by means of all-out repression, buttressed by a war-like ideology similar to the public discourse sustaining international efforts against illicit drugs. Rather than striving for eradication of doping in sports, which appears to be an unattainable goal, a more pragmatic approach aimed at controlled use and harm reduction may be a viable alternative to cope with doping and doping-like behaviour.

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Available from: Bengt Kayser, Oct 04, 2015
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    • "Rather, a zero tolerance drug policy has led to geographical displacement (drug/consumers), the stigmatization and marginalization of users, a large criminal market, high levels of incarceration and death and disease (Beckett 1997; Costa 2008; Jensen et al. 2004). While the " war on doping " has yet to reach the extent of the " war on drugs " , a similar policy trend can be noted; a shift to law enforcement mechanisms at the expense of public health (Fincoeur et al. 2014; Mulrooney and Van de Ven 2013), the displacement of criminal activities to other countries with a lax regulation (Koert and Van Kleij 1998; Paoli and Donati 2014), the presence of more dangerous experimental PIEDs (Kayser et al. 2007; Smith and Stewart 2008), the exclusion and marginalization of PIED users (Coomber 2013) and evidence of a growing criminal " black market " (Paoli and Donati 2014). "
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    ABSTRACT: Doping in sport has been explored predominantly from a user-perspective, widely neglecting an analysis of the supply-side of the market for doping products. In this article, we aim to fill a gap in the existing literature by demonstrating that the supply chains of doping substances have evolved over the course of the past two decades, not least due to the zero tolerance approach of anti-doping policy. Specifically, adopting the case studies of (elite) cycling and recreational weight-training (RWT) and bodybuilding (BB), we outline how the supply chains for performance and image enhancing drugs (PIEDs) have shifted away from “culturally embedded dealers” and into new organizational structures independent from these sub-cultures. We maintain that the evolution of doping supply mirrors the evolution of doping use; whereas doping was previously the result of a socialization process, and PIED suppliers were a cultural product, consumption is now often a secretive practice and “social suppliers” are no longer prepared to take risks in (openly) supplying doping products. Consequently, the increased clandestineness of doping practices has led consumers to increasingly consider the “black market” as a potential source for PIEDs. Most importantly, this shift in doping supply chains has led to greater inequality among athletes, increased health risks and the rise of suppliers devoid of socio-cultural characteristics. We suggest that as the current anti-doping regime, focused predominantly on punishment and control, continues unabated these unintended negative consequences are likely to increase. As several countries have begun to rethink their position on the criminalization of drugs and drug users, it is time to rethink our approach to curbing the problem of doping in sports.
    Trends in Organized Crime 01/2014; 18(3). DOI:10.1007/s12117-014-9235-7
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    • "In this sense nutritional doping has passed beyond the “one-size-fits-it-all” first generation doping in which the same dopant was used by many athletes in a not effective way to the second-generation nutritional doping with the introduction and promises of postgenomics biotechnologies. Moreover, this could make the detection of doping even more tricky and challenging, increasing the cost and the burden of anti-doping policy [42]. The peculiar aspect of this nutritional doping is that it is a personalized doping, since it is tailored according to the specific needs of an athlete and not just generic as the first generation or classical doping. "
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    ABSTRACT: Food has societal, economic, medical and ethical implications, being fundamental for life. It plays an important role also in sports medicine, since a healthy diet is an important part of an athlete's training. Nutrigenomics and nutriproteomics are emerging as a result of a convergence of nutritional, genomics and proteomics knowledge strands in the postgenomics era. These fields of inquiry present an opportunity for the design of customized diets potentially able to counterbalance the extant obesity epidemic and remedy metabolic diseases, among others. They are noteworthy for sport medicine as well since they could provide athletes with crucial information for personalized training and nutrition, in order to achieve the best results possible and express one's own potential. But they could also be used as a form of personalized doping, thus constituting an advancement of “classical nutrition-based doping” (i.e., the use of nutraceuticals, stimulants and supplements). However, nutrigenomics (or nutriproteomics)-based nutritional doping is different from the first-generation doping because it is specifically tailored to the genomics and proteomics makeup of the athlete, although their effectiveness remain to be discerned in future systematic studies. Against this scientific background, ethical issues of nutrigenomics and nutriproteomics are discussed in the present paper with emphasis on the current limitations and the dizzying potentials of the omics data-intensive research for science and society. Additionally, I discuss the need to communicate uncertainty as a fundamental construct and intrinsic part of postgenomics personalized medicine, not to forget the gaps regarding the lack of adequate governance, and issues over providing a proper nutritional education to athletes as onus of the international sports organizations. “Let food be your medicine, and medicine be your food” Hippocrates
    Current Pharmacogenomics and Personalized Medicine (Formerly Current Pharmacogenomics) 06/2013; 11(2):162-166. DOI:10.2174/1875692111311020008
    • "Still, it has already been suggested that this indirect method of doping detection might be unreliable and produce false-positive results due to analytical variability and outlying individual patterns resulting from the effects of behaviour (training, altitude training) and genetics (Lippi and Plebani 2011; Sanchis-Gomar et al. 2011; Banfi 2011). Furthermore, anti-doping has a non-negligible cost (Kayser et al. 2007; D'Angelo and Tamburrini 2010). The IOC finances half the budget of the WADA, while the other half comes from national governments. "
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    ABSTRACT: In this chapter we suggest an alternative way of dealing with the problem of doping in sports. We find that today’s anti-doping policies are excessive, mostly driven by ideology and political convenience, ethically problematic, insufficiently effective, costly, and are possibly leading to more harm to society than they prevent. Anti-doping cannot achieve its declared objective (eradication of doping) since it cannot overcome the strong pressure towards winning at all cost and the limited effectiveness of surveillance. We think that the discussions on doping and anti-doping should not ignore the imperfect practical outcomes of current anti-doping policies, in elite, amateur and outside sports. Today’s anti-doping is not a solution, but an increasingly costly imperfection. We do not claim to know a way to an ultimate solution, simply because none exists, but we propose to consider a pragmatic utilitarian alternative respecting public health and ethical principles. We do this by drawing parallels between current anti-doping efforts and the ‘war on drugs’. Instead of an increasingly repressive anti-doping policy based on zero-tolerance with negative side effects, we propose to discuss another imperfection, one that might come with a reduced cost to the individual and society as compared to today’s imperfection, and that is based on regulation and harm minimisation.
    01/2013: pages 271-289;
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