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: 1.6). 03/2007; 8:2. DOI: 10.1186/1472-6939-8-2
Source: PubMed

ABSTRACT 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, Aug 09, 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.
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    • "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.
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    • "produtos veterinários) comprados no chamado mercado negro que envolve o comércio de EAA (Melnik, Jansen, Grabbe, 2007), além da superdosagem e o compartilhamento de seringas, conforme indica o estudo de Santos (2010). Este quadro, como alguns autores argumentam, potencializa os fatores de vulnerabilidade e risco associados ao uso descontrolado da substância (Lust et al., 2011; Kayser, Mauron, Miah, 2007; Silva et al., 2007; Iriart, Andrade, 2002). Além disso, o próprio medo do estigma faz com que o consumo dos EAA seja ocultado pelos usuários (que não procuram a atenção médica), deixando seus efeitos sobre a saúde desconhecidos epidemiologicamente. "
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