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Doping

UN warns of dangers of drugs sold on internet

In March 2004, The British Medical Journal reported on the International Narcotics Control Board statement on the sale of drugs over the Internet. They highlight popular drugs such as sildenafil (viagra) and fluoxetine (Prozac) - who hasn't received email about these substances!? It is interesting that some of these drugs are associated with so-called 'lifestyle' enhancements. While the lack of regulation over online drugs is significant, I wonder how much of their concern is about how these drugs reflect a shift in the way people use and perceive medicine. One of the difficulties facing the medical profession is how to curb the tide on lifestyle medicine. There seem to be a number of legal and moral questions arising from the development of online pharmacies and, even if the current regulations offer a structure through which action could be taken against a dodgy company, we need to take into account how online pharmacies are different social spaces, compared with high-street retail outlets. For example, how does a physician take a history of their patient through the Internet? What relationship between the physician and patient is possible?

There also seem to be difficult boundary issues facing regulation. Even if the legal issues are similar to the importation of substances from one place to another, the manner in which people transcend these boundaries is radically different - it is much easier to click on a website of a company in a country far away, than it is to go there or connnect with a supplier in that country.

Sport, medicine, ethics, Sweden

Sport Medicine Ethics, 23-24 May, 2005
On Monday 23rd and Tuesday 24th of May 2005, the Stockholm Center for Bioethics, together with the Department of Philosophy at the University of Stockholm and the Oxford Centre for Applied Ethics will organize an international conference on sport medicine ethics, an area still undiscussed within the field of bioethics.

The conference site is Stockholm, and the title of the conference is

"Legitimate and illegitimate enhancements, where to draw the line?".

further details will be posted at the website of the Forum for the Analysis of Sport Technology

The Beam in Your Eye - LASIK

Here is an news article about the use of laser-eye surgery on athletes, in this case the golfer Tiger Woods. The basic premise of this piece is that laser eye surgery is also a performance enhancement for athletes, but it is not banned. why not? "A week ago, Tiger Woods was celebrated for winning golf's biggest tournament, the Masters, with the help of superior vision he acquired through laser surgery." (link)

Here is an extract from an article I have written on this theme, which will be published in a Dutch book on gene doping (edited by Bernike Pasveer and Ivo Van Hilvoorde):

"To articulate the differences between the various uses of medical technology for sport, one can draw three categories of human modification: therapy, non-therapy, and enhancement. To understand the conceptual differences between these categories, it is useful to consider an example of medical intervention where these boundaries appear to be blurred. Laser eye surgery is a medical intervention intended to relieve the deterioration of eyesight. If this technique is applied to someone who has severe or even mild eyesight problems, then it can be considered therapeutic, since it will rectify any imperfection that might inhibit vision. In this capacity, it is tempting (and usual) to describe this as a ‘therapeutic’ medical intervention. It also matters that the definition is underwritten by the existence of a physician’s authority here. Yet, what are the defining characteristics of this ‘therapeutic’ guise? Is it important that the individual’s eyesight is being restored to a previous level of vision? If this were true, then we might wonder about the relevance of this conclusion. How would we feel if the intervention were applied to a person who was born without eyesight? The surgery would not return the individual to any previous state and, in that sense, s(he) would not be restored. In this case, the person would be restored only in the sense that there exists some species-typical state of function, where the treatment is characterised as therapeutic based on some typical functionality that a given species should possess. It could be said that humans have evolved to utilise the capacity for vision. This could also account for an individual who is born with partial vision – for whom we might also argue that restoration to perfect human vision is justified on account of a species-typical level of functioning to which we are comparing the said capability.

Each of these methods of intervention is generally considered acceptable. While there is some disagreement about the legitimacy of interventions that appear to suggest certain ways of being human are preferable over others, let us assume for the moment that eliminating dysfunction, however troubling we might find its definition, is ideologically sound. So, the interest to ensure deafness is corrected is defended on account of it offering an ‘open future’ (Feinberg, 1980), where this entails maximising the possibilities any individual might encounter (for further elaboration see Savulescu, 2001 and Shakespeare, 2001). These examples can be contrasted with an intervention that would raise the level of capability beyond both an individual and species-typical level of normal or even perfect function. So, if laser eye surgery leads to better than perfect vision, we might have quite different concerns and feelings about it.

Yet, it is also possible to think of circumstances where there is not much resistance to such super-human capacities. For example, there do not seem to be particularly strong moral convictions about the use of binoculars, telescopes, magnifying glasses, or even satellites and cameras, which radically re-define our capacity to see beyond our physical constraints. Yet, how would we feel about super-human vision? What if laser eye surgery could enable humans to enjoy the vision of, say, birds of prey. Alternatively, what if it enabled some additional functionality, such as a zoom capability? What should be our moral stance to such modifications and would such modifications be accepted in competitive sporting cultures? (FN: while not specifically tied to a sporting example, ‘super vision’ has been discussed in the context of sport recently (Alderson, 2001))

In the world of sport, the ethical reaction to such innovations would be clearly expressed by a certain moral community, which argues that the ‘natural’ athlete must prevail in sports contests. Where a modification places an athlete over and above their natural level of functioning or some species-typical level of functioning, this constitutes doping and is considered to be unacceptable because it provides an enhancement of the natural. On one level, it is possible to understand why anti-doping exists and why some would seek to justify such rules on the basis of naturalness. In some sports, an athlete with the capacity to ‘zoom’ their vision would be at a considerable advantage to an athlete who does not have such capacity (though in others it might actually be an inconvenience and a skill to be able to modify one’s eyesight to optimise performance). In one very important sense, a contest between two athletes would not be of much interest where one of them has super-vision, since the enhanced athlete will be more successful. However, from another perspective, sport intends to reveal the most capable human. An athlete born with some ‘zoom’ capability is, in one very important sense, the most capable human. Why should an athlete not receive their gold medal, if they are the most capable? These matters raise questions about what is just in sport and the legitimacy of enhanced capabilities."

LifeWaves - Not Doping?

One of the questions at the Harvard symposium was about the ethical status of LifeWaves, the new technology that is designed to boost energy. There is no official WADA position on this one yet, but it is unlikely that it will be considered a method of doping. However ,it is performance enhancing and does offer a 'short-cut' to better performances. To that extent, one might argue (mistakenly) that is compromises the 'spirit of sport'. Here we have a further indication that there is a need for more joined-up thinking in the world of sport, about performance. In a paper I am due to have published in the Journal of Sport Sciences, I argue that it is necessary to ditch the anti-doping framework and replace it with a 'Performance Policy', which makes clear the connections between a range of technologies and how they challenge the ethical status of performance in sport. Here are some details about the LifeWave patches from The California Aggie:

"The product consists of two patches, which the company claims will boost energy by 20 to 40 percent, and contains a vague list of ingredients known as 'orthomolecular compounds.' The NCAA and the U.S. Anti-Doping Agency tested the patches and found no illegal substances. The NCAA went a step further by announcing that the patches do not fall under the category of nutritional substances because nothing is ingested.

While LifeWave's patent is still pending, and no details can be given about the composition of the patches, it is important to note the overall trend that is taking place in sports: an increase in cases of performance-enhancing products or supplements on the market. The fact that athletes at the collegiate and professional levels are looking for any advantages they can gain over their opponents is a distressing sign.

Gone are the days when athletes gained their advantage by just working harder than their competitors. In today's era of sports, money and results are what matter and some athletes seem to be willing to accomplish their goals by any means necessary.

While very few collegiate athletes gain the notoriety that often accompanies professional sports, it is important to note that Davis youths admire UCD athletes. Youngsters often emulate what they see performers doing and it is not far-fetched to believe kids will start using supplements in their adolescent years when given their favorite athletes as examples of a product's success.

LifeWave seems to be the latest in a string of performance-enhancing products. With the rise of such products, athletes are often faced with the tough decision: losing the competitive edge or compromising their athletic integrity."

Of course, I totally reject the stance of this paper, but what's new!?

From BALCO to Bioethics, Harvard

Details of a meeting where I will give a presentation on gene doping: Venue: Boston, USA: E.LaB Event Description

The Harvard Law School Ethics, Law & Biotechnology Society (E.LaB) in conjunction with the Harvard Committee on Sports and Entertainment Law (CSEL) & HL Central are proud to present “From BALCO to Bioethics: The Present and Future of Performance Enhancement in Sport.” The ongoing and highly publicized BALCO controversy has made the topic of performance enhancement among athletes one of substantial current interest and debate. While BALCO controls the headlines of today, and poses difficult questions for professional and amateur sports, we pause to speculate about what the future of performance enhancement in athletics may hold.

This panel discussion will feature Dr. Olivier Rabin, Director of Science for the World Anti-Doping Agency, Dr. Dan Brock, Director of the Division of Medical Ethics at Harvard Medical School, and Dr. Andy Miah, Lecturer in Media, Bioethics and Cyberculture at the University of Paisley, Scotland. The panel will be moderated by Dr. Gil Siegal, visiting professor and Medical Ethics Fellow at Harvard Medical School.

Please join us for an open dialogue about the present and future state of performance enhancement in sport.

Where: Harvard Law School, Langdell South Classroom

When: Monday April 11, 2005. 7-9pm.

Contact: Dan Vorhaus (dvorhaus@law.harvard.edu) for more information.

American Academy of Pediatrics on Doping

Today, the AAP published a Policy Statement on the Use of Performance-Enhancing Substances. It dismisses 'scare tactics' of health care professionals, suggesting that denying the performance-enhancing effects of substances to the young athlete is ineffective, as a means of prevention. The pediatrician must 'have an understanding of the incentives for use' and they define the problem as due to the drive for success in our contemporary society.

Of particular interest is that they identify 'limitations of current definitions' of doping, calling for a more restrictive definition that takes into account the possible different kinds of users. Specifically, they want a definitin that protects the most vulnerable kinds of users, in their case, a concern for minors.

They also dismiss the strategy of testing, as a method of prevention, identifying the need for education and evaluation of education programmes, which rarely happens.

Is blood spinning ethical?

WADA President Richard Pound recently commented on 'blood spinning', the technique of removing platelets from the blood (the cells that assist the process of healing) and reinjecting them into an injured part of the body to speed up the process of recovery. The English football team Chelsea is using this practice, but it seems likely that they will for much longer. UK Sport has already raised questions about whether it should be considered a form of doping. Yet, it is precisely this kind of application that is tricky for WADA and for the medical profession. Certainly, it could be construed as the application of a medical intervention for a performance purpose, but this purpose is perhaps not obvious, nor can it be taken in isolation, since the technique promotes recovery.

Quoted in AFP: "It sounds like blood manipulation of some sort to me. But I would need to talk to our scientific department to get all the background," said Richard Pound."

Link to article in This Sporting Life

Lotions & Potions: The Quest for Performance Enhancement

A symposium at DeSales University in the USA takes place today discussing the use of steroids in sport. It is hosted by the Bioethics Society and offers the following outline. Bioethics Society to discuss steroid use, Tuesday, March 29

"With opening day just around the corner, the U.S. House of Representatives recently took a mighty swing at Major League Baseball's efforts to eradicate steroid use. Another pitch now comes from the Baranzano Society on bioethics. This regional association will sponsor the forum, "Lotions & Potions: The Quest for Performance Enhancement" from 7:30 p.m. to 9:00 p.m. on Tuesday, March 29, in the Labuda Center for the Performing Arts at DeSales. The program will feature a panel of experts in health, science and business, who will discuss the facts and fictions of performance enhancing drugs. The event is open to the public free of charge.

The Congressional hearings shone a national spotlight on baseball players and the prevalence of steroid use in record-breaking performances. Yet use of steroids appears to be rampant, even among amateur athletes and young people, in general. A report from the Centers for Disease Control and Prevention points to a 300 percent increase in the last ten years, with more than 500,000 high school students claiming to have tried steroids.

In addition, according to Rep. Tom Davis, a survey by the National Institute on Drug Abuse and the University of Michigan found that "the perception among high school students that steroids are harmful has dropped from 71 percent in 1992, to 56 percent in 2004." Yet, anabolic steroids are regulated as illegal controlled substances.

During the round table discussion at DeSales, the panel of experts will address the health ramifications, ethical dilemmas, and social consequences of using pharmacological advances to enhance personal performance. The panelists include: Dr. Jay Hoffman, professor of health at The College of New Jersey and vice-president of the National Strength and Conditioning Association, who will report on his meetings with professional baseball coaches during spring training. Also, Richard Bartolacci, founder and president of JBN Enterprises, who will address the issue from the viewpoint of the sports and nutrition supplement industry, and Father Douglas Burns, OSFS, director of the Sport & Exercise Science program at DeSales, who will speak on the subject in terms of sport ethics."

link to site

Modafinil and cognitive enhancements

Kaufman, K. R. and R. Gerner (2005). "Modafinil in sports: ethical considerations." Br J Sports Med 39(4): 241-244. Kaufman and Gerner discuss the case of modafinil, asking whether athletes should be sanctioned for this use. The article provides a clear exposition of how the rules of anti-doping apply to the case of Kelli White, who claimed her use of modafinil was therapeutic for narcolepsy. However, due to her failing to file this condition when submitting her doping tests, exemption could not be granted. The authors consider whether this substance is an indication of further doping in sport, since it is unlikely that many cases of athletes with narcolepsy should arise in elite sports, due to the rarity of the condition.

Questions concerning cognitive enhnacements in sports have not been given much attention in the literature. There is considerable scope to question the way in which enhancement is defined in sports by examining these issues. The role of cognitive function in sport is not so easily quantified for performances, since it is not possible to connect specific movements with specific cognitive capacities.

Nevertheless, it is possible to identify a range of activities for which cognitive enhancements are essential and, thus, there WADA believes that there are good reasons to require the World Chess Federation to develop an anti-doping policy.

'Altitude Chambers' in the JME

This month, the JME includes 3 articles on the ethics of hypoxic training chambers for sport. The lead article by Spriggs disusses the Australian Football League's investigation into the ethical parameters of these 'altitude chambers'. A commentary is then offered by Torbjorn Tannsjo, Claudio Tamburrini and finally by Peter Fricker. Generally, the articles favour enhancement and changing the rules of sport to make enhancement more commonplace.

The Hastings Center and Sport

The renowned bioethics institute 'The Hastings Center' has been awarded a grant to research 'Ethical, Conceptual & Scientific Issues in the Use of Performance-Enhancing Technologies in Sports'. The funding is provided by the US Anti-Doping Agency and is, to my knowledge, the first study of this kind. Rarely has funding been provided for critical inquiries into the ethical foundation of performance enhancement and sport. The project runs until the end of 2003 and is led by Thomas H. Murray, Erik Parens & Angela Wasunna. link to details