Treuman Katz Center for Pediatric Bioethics - 2009 Conference What’s Wrong With Performance Enhancing Drugs? Norman Fost MD MPH Professor, Pediatrics

Treuman Katz Center for Pediatric Bioethics - 2009 Conference

What’s Wrong With Performance Enhancing Drugs?

What’s Wrong With Performance Enhancing Drugs?

Norman Fost MD MPHNorman Fost MD MPH

Professor, Pediatrics and Bioethics,University of Wisconsin School of

Medicine and Public Health

Professor, Pediatrics and Bioethics,University of Wisconsin School of

Medicine and Public Health


PreliminariesPreliminaries• Comments apply only to competent

adults

• Risks to young children may be permanent and their capacity to make informed choices is suspect

• “Adolescents” are somewhere in between

• Comments apply only to competent adults

• Risks to young children may be permanent and their capacity to make informed choices is suspect

• “Adolescents” are somewhere in between


Moral Claims About Performance Enhancing

Drugs

Moral Claims About Performance Enhancing

Drugs• Unfair• Harmful• Coercive• Unnatural, violate “spirit of sport”• Rx OK, Enhancement bad• Integrity of records; loss of trust among fans

• Unfair• Harmful• Coercive• Unnatural, violate “spirit of sport”• Rx OK, Enhancement bad• Integrity of records; loss of trust among fans


The Unfairness ClaimThe Unfairness Claim• Having an advantage is not usually

considered unfair– Shaquille, Carl Lewis, Dream Team

• Seeking an advantage is not unfair– Training, coaching

• Using artificial externalities is not unfair– Shoes, poles, Nautilus equipment

• Having an advantage is not usually considered unfair– Shaquille, Carl Lewis, Dream Team

• Seeking an advantage is not unfair– Training, coaching

• Using artificial externalities is not unfair– Shoes, poles, Nautilus equipment


The Unfairness ClaimThe Unfairness Claim• Changing internal body

structure/function is not unfair– Carbo-loading, Gatorade, special diets

• Unequal access is unfair– Greasy swimsuits, Bobby Knight,

training facilities (eg, high altitude)

• The usual solution to unfairness is to equalize access

• Changing internal body structure/function is not unfair– Carbo-loading, Gatorade, special diets

• Unequal access is unfair– Greasy swimsuits, Bobby Knight,

training facilities (eg, high altitude)

• The usual solution to unfairness is to equalize access


Taking fair competition seriously

Taking fair competition seriously

• Hypocrisy: Clear unfairness is tolerated– Bud Selig: “A level playing field”– Yankees vs Brewers payrolls

• Taking fair competition seriously – Total weight limit for offensive line– Total height limit for basketball

• Hypocrisy: Clear unfairness is tolerated– Bud Selig: “A level playing field”– Yankees vs Brewers payrolls

• Taking fair competition seriously – Total weight limit for offensive line– Total height limit for basketball


The Harm ClaimThe Harm Claim• Harm of anabolic steroids is wildly exaggerated

– Lyle Alzado, liver cancer, chronic heart disease, Heidi– Most harms are reversible or mild

• infertility, hair gain/loss, voice changes

– Serious harms (e.g. death) very rare• ? < 10 (maybe) Vs 100 from playing football

– The concern is disingenuous• Get the quarterback; hockey fights

• Criminalization makes risks more likely– Can’t do studies– No oversight of manufacturing process

• Harm of anabolic steroids is wildly exaggerated– Lyle Alzado, liver cancer, chronic heart disease, Heidi– Most harms are reversible or mild

• infertility, hair gain/loss, voice changes

– Serious harms (e.g. death) very rare• ? < 10 (maybe) Vs 100 from playing football

– The concern is disingenuous• Get the quarterback; hockey fights

• Criminalization makes risks more likely– Can’t do studies– No oversight of manufacturing process


The Harm ClaimThe Harm Claim• Paternalism is generally unjustified

– The sport itself is far more dangerous than the drugs (Football: 90% disability in 3 years)

– “Protection of others” claim is disingenuous; size/speed should be regulated, not their causes

– Smoking, alcohol far more dangerous and aren’t regulated, even within sports

• Paternalism is generally unjustified– The sport itself is far more dangerous than the

drugs (Football: 90% disability in 3 years)– “Protection of others” claim is disingenuous;

size/speed should be regulated, not their causes

– Smoking, alcohol far more dangerous and aren’t regulated, even within sports


The Coercion ClaimThe Coercion Claim• Definition: Use or threat of force or

depriving of an entitlement• Distinguishing an offer from a threat:

the chance to be better off vs worse off

• Exploitation: Taking advantage of a person’s basic need by doing something that would otherwise be wrong

• Definition: Use or threat of force or depriving of an entitlement

• Distinguishing an offer from a threat: the chance to be better off vs worse off

• Exploitation: Taking advantage of a person’s basic need by doing something that would otherwise be wrong


The Coercion ClaimThe Coercion Claim• Withholding opportunities for wealth

is not a satisfactory solution to poverty

• Withholding opportunities for wealth is not a satisfactory solution to poverty


Unnatural claimUnnatural claim

• Lake water• Bare feet• Lifting rocks• Marijuana• Testosterone


• Gatorade• Air Jordans• Elliptical machine• Albuterol

• Stanozolol

• Gatorade• Air Jordans• Elliptical machine• Albuterol

• Stanozolol

GOOD BAD


Unnatural claimUnnatural claim



• Gatorade• Nautilus machine• Greasy swim suit• Air Jordans• Albuterol

• Gatorade• Nautilus machine• Greasy swim suit• Air Jordans• Albuterol

GOOD BAD

Testosterone is the most natural anabolic steroid and the most toxic


A sport has no “nature”A sport has no “nature”• A sport (eg., football) is not natural. It

does not have an innate definition or an essence. – Tackling, passing, punting are not

inherent to football– Gatorade, carbo-loading and steroids

are neither inherent to track events, or inconsistent with them.

• A sport (eg., football) is not natural. It does not have an innate definition or an essence. – Tackling, passing, punting are not

inherent to football– Gatorade, carbo-loading and steroids

are neither inherent to track events, or inconsistent with them.


Enhancement/Treatment Distinction

Enhancement/Treatment Distinction

• Rick DeMont (1972)– Ephedrine banned; aminophylline OK

• Both taken with the intent of enhancing function and performance

• Not a desire for normal function; His “disease” state was >3 SD’s above the mean.

• Rick DeMont (1972)– Ephedrine banned; aminophylline OK

• Both taken with the intent of enhancing function and performance

• Not a desire for normal function; His “disease” state was >3 SD’s above the mean.


Enhancement/TreatmentEnhancement/Treatment• Enhancement is common in medicine,

pediatrics, and life– Vaccines, education, caffeine, Viagra

• Sports training is generally about enhancement– So what? Enhancement as an end violates no

apparent moral principle – The means used (e.g., drugs, genes) violate no

apparent moral principle

• Enhancement is common in medicine, pediatrics, and life– Vaccines, education, caffeine, Viagra

• Sports training is generally about enhancement– So what? Enhancement as an end violates no

apparent moral principle – The means used (e.g., drugs, genes) violate no

apparent moral principle


Integrity of records; loss of trust by fans

Integrity of records; loss of trust by fans

• Empirically false– Bonds, McGwire were the biggest draws– Bigger, faster football -> increased

popularity– “Three cheers for Keith” (Hernandez)

• Concern about economic impact partly explains the hypocrisy

• Empirically false– Bonds, McGwire were the biggest draws– Bigger, faster football -> increased

popularity– “Three cheers for Keith” (Hernandez)

• Concern about economic impact partly explains the hypocrisy


What about adolescents?What about adolescents?

• Competence, not age, should be the boundary for autonomous choices– Over 18, competence is presumed

• We allow older adolescents to make far riskier choices (driving, drinking, swimming, football, hockey)

• Some risks may be linked with duration of exposure (prostate cancer) need research open policy

• Competence, not age, should be the boundary for autonomous choices– Over 18, competence is presumed

• We allow older adolescents to make far riskier choices (driving, drinking, swimming, football, hockey)

• Some risks may be linked with duration of exposure (prostate cancer) need research open policy


SummarySummary• Claims that performance enhancing

drugs are immoral are based on incoherent or inconsistent arguments or bad facts.

• These claims seem hypocritical or disingenuous in face of reluctance to address more serious problems

• Claims that performance enhancing drugs are immoral are based on incoherent or inconsistent arguments or bad facts.

• These claims seem hypocritical or disingenuous in face of reluctance to address more serious problems


SummarySummary• Athletes may prefer to play without

(or with) drugs, just as they may prefer to play with or without passing, tackling or helmets. These are preferences, not moral issues.

• Athletes may prefer to play without (or with) drugs, just as they may prefer to play with or without passing, tackling or helmets. These are preferences, not moral issues.


“If all the ethicists in the world were laid end to end, it would be a good thing.”

Anon.

Documents

Treuman Katz Center for Pediatric Bioethics - 2009 Conference What’s Wrong With Performance Enhancing Drugs? Norman Fost MD MPH Professor, Pediatrics