Should We Consider Creating a “Drugged” Sports Category?

If you’re willing to document the sh!t out of what you’re taking and why, we might learn something about human performance

One of the sports I follow (professional bicycling) has a long and sordid history of “doping” — athletes choosing to subject themselves to (or being pressured into subjecting themselves to) chemical and medical procedures for the explicit purpose of winning prestigious (and lucrative) prizes for winning a major event in that sport. As the world learns about new chemical and medical methods of manipulating hormone levels, blood oxygen levels, and muscular growth to improve human performance, outrage grows about how these athletes are gaining an “unfair” advantage over those athletes who have not been subjected to similar biochemical manipulation, and the rules of sporting are rewritten to forbid the use of those manipulations.

The agencies which regulate the use of drugs and performance-enhancing medical procedures, both therapeutic and non-therapeutic, in competitive sports include the United States Anti-Doping Administration (USADA) and the World Anti-Doping Administration (WADA). It’s their job to determine what drugs can unfairly enhance an athlete’s performance, restrict or ban them, and routinely test athletes to make sure they’re obeying these rules.

A little bit about doping in general. Most doping refers to an individual taking “performance enhancing drugs (PEDs)” — real drugs, most of which have real therapeutical uses, but which are administered to a person who does not need them therapeutically, for the explicit intent of improving athletic performance. Testosterone-enhancing drugs, beta blockers, steroids, and so on don’t not work on someone just because they don’t have a bona fide medical need. They increase muscle mass, lower heart rate, improve lung capaity, and so on to the point that they can make a mediocre athlete into one who can compete at world-class (“elite”) level.

[Note: Athletes who require drugs for bona fide medical conditions may be restricted to particular classes of drugs for their conditions (there are, for example, at least five separate classes of drug to treat hypertension), or if this is not a medical option (for example, athletes with Type 1 diabetes who require the regular use of insulin — which is a WADA-restricted drug), they can get Therapeutic Use Exemptions (TUEs) that allow them to use those restricted drugs under tightly-controlled conditions. (There are ongoing arguments about whether these exemptions are, on the one hand, sufficient, or on the other, too easily obtained under false pretenses.)]

But doping doesn’t stop with drugs. Athletes have done things like storing their own blood for the purpose of transfusing it back to themselves just before a major competition (autologous blood tranfusion). This procedure is done therapeutically when someone expecting an elective surgical procedure stockpiles his own blood weeks in advance of the surgery, in case of need during that surgery. When used as a method of doping, the increased amount of red blood cells improves the athlete’s ability to get oxygen into his muscle cells, improving his performance.

There are other, “legal” methods of increasing one’s oxygen-carrying capacity (most notably, training at altitude or living in “altitude tents” for some time in advance of an event), and there are tons of specialized training methods and data collection types which make Quantified Selfers (people who track many of their biometric data types, either for health reasons or just to understand how their bodies work) look downright lazy.

To put it bluntly, elite sports are a laboratory for human experimentation.

I don’t need to recount the history of sports doping scandals to remind my readers that this experimentation comes with a price. Some Major League Baseball stars testified before Congress about the adverse effects of their steroid use after they retired from (or were retired from) active play. PBS’s series Secrets of the Dead ran an episode exploring the notes left by East German sports physicians and former (mostly AFAB) East German Olympic athletes whose puberty was delayed or denied, or who were given male hormones to improve their sporting performance, and what that did to these athletes.

The flip side is, we can learn a lot about human physiology by examining the notes of people who experimented on other people, regardless of how ethical those experiments were. How (or whether) to publish that information, and how (or whether) to use it, is an ongoing ethical quandry. My intention in this thought experiment is to reframe the ethical issues in order to explore ways in which willing, fully-informed participants can contribute to these extremes of medical knowledge.

This brings me to the premise of my title. What if some athletes (and others), with fully informed consent, chose to take PEDs, and others (again, fully informed) chose not to take them, and we were able to both compare performance (and pre-doping performance and after-effects of doping) and not penalize the “undoped” from the prizes and remunerations of their chosen sport? What if we had two sets of prizes (or two sets of competitions): one for those who experiment with chemicals (and medical procedures), and those who don’t? The key here is, what we would be rewarding wouldn’t be “cheating” as much as it would be “contributing to medical science”: the “doped” athletes would need to disclose what they were taking (substances, procedures, length of time, regimen) and agree to being followed up medically for years after they stopped doping, to understand what the drugs might have done to them physically.

I’m not quite sure how this would be set up, or if it would even be “fair” to compare athletes on Team 1 on Doping Regimen 1 to athletes on Team 2 on Doping Regimen 2 (for anything other than a purely medical-science reason of comparing Doping Regimen 1 to Doping Regimen 2). I’m not sure how much of the sport-wide doping in cycling (and other sports) is (or was) voluntary and with full consent, and how much was “if you want to compete on this team, or with this coaching staff, you will submit to this doping”. (I’m pretty sure the East German athletes either had no idea of what they were getting into or had no choice in the matter — or both.) Pressure to dope, or naivete about being doped are both antitheses of informed consent.

A side effect — pun intended, though I’m not sure whether or not the effects themselves would be considered “intended” or not — would be greater understanding of biochemistry, including (but not limited to) sexual biochemistry. While accusations of sports doping, and the use of hormones for gender transition, have run mostly separate paths, the acccumulated data from one path can inform the other. (One result of this are international sports-regulating bodies’ guidelines for transwomen’s participation in women’s sports.) Similarly, one might suspect that manipulations originally intended to improve sports performance might find bona fide therapeutic medical use, with the doped athletes’ data providing baseline (probably Phase 2) activity and safety information.

Obviously, there are more questions than answers — but until that first “What if?” question is asked, the others are unlikely to follow.