Ethics, Economics, and Performance Enhancing Drugs

It is easy to slip into binary judgements of good or bad. Real life is rarely that simple. It operates along multiple dimensions, traverses through diverse agendas, and evolves across various nuanced gradients. In his book In Defense of Doping – Reassessing the level Playing Field, Alexander Hutchison , PhD, Editor-in-Chief of Wiley’s Current Protocols, whose own research encompasses exercise physiology and kinesiology, takes a deep dive into the complex science, ethics and economics of performance enhancement drugs.

The book’s central thesis revolves around the notion that the use of performance enhancing therapies and techniques is understandable if not reasonable and is “rarely a clear-cut issue”. Before delving into the chemical categorization and economic underpinnings of doping in sports, Hutchison endears himself to the reader with an engaging travelogue in the introduction where he narrates his Tour de France experiences in Alpe d’Huez in 2022, a trip he took with his wife and daughter partly to gather material for the book.

At the very outset, Hutchison manages to establish a conversational tone with literary elegance and a dollop of American humor thrown in for good measure. Despite detailed narratives of sports history and a medical data-backed analysis of doping in the context of a range of sports—cycling, track and field, baseball, tennis—the personal anecdotes scattered throughout the book cast the illusion of a memoir.

Hutchison moves seamlessly from his own eyewitness account of doping at the international cycling event to the history of doping in cycling, particularly his obvious resentment at the disdain with which Lance Armstrong has been treated compared with the veneration still reserved for European cycling champions who also used performance enhancement drugs (PEDs). In fact, one of his motivations for writing the book is to parse out his own struggle in understanding the world’s disproportionate response to athletes who have used PEDs.

Some of the factors, Hutchison says, that compound the complexities of doping in sports are:

(i) doping and prohibited substances are not strictly defined across different sports

(ii) athletes who had no intention to cheat can test positive for doping due to contaminated food or legally prescribed drugs

(iii) tests can conclude positive doping even when the amount of the drug in the body is too small to provide any competitive benefit

(iv) designing studies on humans that ascertain whether a substance or method can enhance specific performance attributes and at what dosage is inherently problematic and unethical due to the associated risks and difficulty in zeroing in on the relevant measurable element of performance.

Hutchison argues, most substances, including water, can be potentially dangerous based on the dosage and frequency of taking them.

However, a further level of complexity arises when Hutchison calls upon the reader to consider the justification of doping in sports where athletes must deliver their optimal performance under extreme physiological, social, and economic conditions. Sports, an arena often representative of the gestalt of life, requires athletes to invest a lifetime of rigorous training. Spectators pay good money to watch these extraordinary feats. Underlying the athletes own drive for excellence and the audience’s expectations, are other stakes that cannot be ignored, such as the pride of a state or nation whose political pendulum may sway with outcomes in the sports arena.

One of the myths that Hutchison tackles head on in the book is that doping makes it easier for athletes to perform. Hutchison argues that the most effective PEDs (anabolic steroids, human growth hormone) are not taken during the competition but during training to reduce physiological recovery time, which enables athletes to increase the intensity, duration and frequency of their workouts. Therefore, doping is not the easy way out for athletes and does not reflect laziness because athletes taking PEDs work more over the course of their training than other athletes.

What it boils down to are two contradictory perspectives – one holds that PEDs reflect an athlete’s willingness to adopt all means available to deliver their best performance for professional fulfillment, multimillion-dollar contracts, and personal and national pride, while the other holds sports performance to a rigorous, and Hutchison claims unrealistic, moral standard that considers the spirit of sports to be tarnished if synthetically bolstered. The World Anti-Doping Agency, Hutchison reminds us, defines a prohibited substance or method as one: (i) with the potential to enhance performance, (ii) that poses risk for the athlete’s health, or (iii) that violates of the spirit of sport. Hutchison parses all three criteria to reveal their ambiguity.

Hutchison does not condone or promote the unregulated used of PEDs in sports. Instead, he makes the nuanced case for the permissible use of some key substances and methods, moderation in punishments for doping, and leveling the playing field when it comes to our skewed judgement of sports compared to the rest of society. Overall, Hutchison’s defense of doping puts forth four arguments. First, prohibited PEDs that have legitimate medical value or can hasten recovery from injury should be regulated uniformly across all sports. Second, athletes who test positive in doping tests but either have tiny amounts of PEDs in their body or can prove accidental intake should not be punished or barred from competing. Third, substances that do not enhance performance should not be banned. And finally, even the intentional use of PEDs should be viewed leniently considering the socially accepted use of performance enhancing supplements beyond sports.

Hutchison’s controversial treatise will engage both the avid sports lover and the pedestrian philosopher who looks upon sports as a test tube for life and its complexities. Throughout the book, Hutchison himself professes sports is a metaphor for life. One cannot therefore help being left with the haunting thought that an ultra-competitive mindset in life, mirrored in sports, and its inherent doctrine of pushing beyond biological limits at all costs, undermines the foundation of both: health.