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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    • "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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    • "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: 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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