Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

The study of movement skills in sports: toward an integrative approach.

The article commences with a fundamental objective: to comprehend movement skills in sports in a manner that can bridge the dualist gap between experiential qualities observed in practice and theoretical and mechanistic explanations. Drawing inspiration from Kuhn's concept of scientific paradigms, practical examples from skiing research, and innovative insights into the integration of phenomenology and mechanistic explanation in cognitive science, we have outlined a three-step integrative approach. The first step entails the development of phenomenological descriptions of the primary experiential qualities inherent in the execution of the skills being investigated. In the second step, phenomenological descriptions play a pivotal role by setting constraints and delineating a space for the elaboration of multilevel mechanistic analyses. These analyses draw upon insights from various fields, encompassing biomechanics, motor control approaches, expertise studies, and cognitive science. The third step involves the systematization of findings and the formulation of sport-specific movement skills theories. We contend that such theories hold substantial significance as they serve as valuable supplements to skill studies conducted within rigid, nomological frameworks. Sport-specific theories include descriptions of first-person experiential qualities and can contribute to bridging the theory-practice gap effectively.

Personality and willingness towards performance enhancement and body modification: A cross-sectional survey of a nationally representative sample of Norwegians.

We conducted an exploratory investigation of the relationship between personality and willingness towards performance enhancement and body modification in Norway. The study is based on Norwegian Monitor data from a cross-sectional survey of a nationally representative sample of 4,233 (females: 49.9%) persons aged 15 to 96 (45.92 ± 18.02) years. Data were collected using a questionnaire containing demographic questions and measures of physical appearance satisfaction, physical activity level, personality (five-factor model), and willingness towards performance enhancement (e.g., substances that improve creative thinking) and body modification (e.g., use of muscle-building substances). Data were analyzed using descriptive statistics and multiple regression analyses. We found that 62.2% and 50.1% of our sample were either willing to use or contemplating using substances that reduce memory failure and enhance physical fitness respectively. Our sample was most willing or contemplating tattooing (30.0%) and generally skeptical of the other body modification methods with willingness to use or contemplating using substances to enhance muscularity least accepted (3.9%). Higher fantasy/openness and lower agreeableness were associated with higher willingness towards both performance enhancement and body modification. Additionally, higher extraversion and lower control/conscientiousness predicted higher willingness towards body modification. Our findings corroborate previous indications that performance enhancement and body modification are now mainstream. They also underline the importance of personality traits in willingness towards these practices.

Classification in sport: A question of fairness.

Competitor classification schemes have been a part of sport since its origins. Eligibility criteria have developed towards inclusion and increasing diversity. The pool of competitors has expanded from the ancient Olympic Games, eligible only to free Greek men, via nineteenth-century English sport favouring primarily the upper class of so-called gentlemen amateurs, to the current global and diverse pool of men, women, children, and able-bodied as well as disabled persons. Hence, the challenge of sound classification schemes has increased. This article examines the principles of fair classification of athletes. With the help of normative theory as well as practical examples, a fair equality of opportunity principle for sport (FEOPs) is formulated. It is demonstrated how sound classification schemes combine the normative backing from FEOPs with relevant scientific insights. Current classification challenges and possibilities for change are discussed. It is suggested that in several sports, biological sex classes can be abandoned, and that in some sports, sex classes can be replaced by body size classes. It is argued, too, that sports in which body height exerts a significant and systematic impact on performance should classify accordingly. In the final part, classification is discussed in light of new techno-scientific possibilities, among them the possibility of innovative performance-enhancing prosthetics.

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

'Clean athlete status' cannot be certified: Calling for caution, evidence and transparency in 'alternative' anti-doping systems.

Athletes, sponsors and sport organisations all have a vested interest in upholding the values of clean sport. Despite the considerable and concerted efforts of the global anti-doping system over two decades, the present system is imperfect. Capitalising upon consequent frustrations of athletes, event organisers and sponsors, alternative anti-doping systems have emerged outside the global regulatory framework. The operating principles of these systems raise several concerns, notably including accountability, legitimacy and fairness to athletes. In this paper, we scrutinise the Clean Protocol™, which is the most comprehensive alternative system, for its shortcomings through detailed analysis of its alleged logical and scientific merits. Specifically, we draw the attention of the anti-doping community - including researchers and practitioners - to the potential pitfalls of using assessment tools beyond the scope for which they have been validated, and implementing new approaches without validation. Further, we argue that whilst protecting clean sport is critically important to all stakeholders, protocols that put athletes in disadvantageous positions and/or pose risks to their professional and personal lives lack legitimacy. We criticise the use of anti-doping data and scientific research out of context, and highlight unintended harms that are likely to arise from the widespread implementation of such protocols in parallel with - or in place of - the existing global anti-doping framework.

Caster Semenya, athlete classification, and fair equality of opportunity in sport.

According to the Differences of Sex Development (DSD) Regulations of the International Association of Athletics Federations (IAAF), Caster Semenya and other athletes with heightened testosterone levels are considered non-eligible for middle distance running races in the women's class. Based on an analysis of fair equality of opportunity in sport, I take a critical look at the Semenya case and at IAAF's DSD Regulations. I distinguish between what I call stable and dynamic inequalities between athletes. Stable inequalities are those that athletes cannot impact or control in any significant way such as inequalities in biological sex, body size and chronological age. Dynamic inequalities, such as inequalities in strength, speed and endurance, or in technical and tactical skills, can be impacted and to a certain extent controlled by athletes. If stable inequalities exert significant and systematic impact on performance, they provide a rationale for classification. If high testosterone level is an inborn, strong and systemic driver of performance development, inequalities in such levels can provide a rationale for classification. As is emphasised by the Court of Arbitration for Sport (CAS), this leads to a dilemma of rights: the right of Semenya to compete in sport according to her legal sex and gender identity, and the right of other athletes within the average female testosterone range to compete under fair conditions. I conclude with providing conditional support of the CAS decision in the Semenya case and of IAAF's DSD Regulations.

Performance-Enhancing Drugs, Sport, and the Ideal of Natural Athletic Performance.

The use of certain performance-enhancing drugs (PED) is banned in sport. I discuss critically standard justifications of the ban based on arguments from two widely used criteria: fairness and harms to health. I argue that these arguments on their own are inadequate, and only make sense within a normative understanding of athletic performance and the value of sport. In the discourse over PED, the distinction between "natural" and "artificial" performance has exerted significant impact. I examine whether the distinction makes sense from a moral point of view. I propose an understanding of "natural" athletic performance by combining biological knowledge of training with an interpretation of the normative structure of sport. I conclude that this understanding can serve as moral justification of the PED ban and enable critical and analytically based line drawing between acceptable and nonacceptable performance-enhancing means in sport.

Anabolic-androgenic steroid use and correlates in Norwegian adolescents.

This paper surveys the prevalence and correlates of anabolic androgenic steroids (AAS) use among Norwegian adolescents, and examines the degree to which sports participation is a mediating or moderating factor to well-known correlations between AAS use and problem behaviour. The data come from the "Ungdata" study, a cross-national youth survey system offered to all municipalities in Norway (response rate: 74%, N = 77,572). The study demonstrates a lifetime prevalence of AAS use of 1.27% and a higher prevalence among boys (1.81%) than girls (0.76%). The analyses show that AAS use is clearly related to problem behaviour such as violence and other substance use. When controlling for problem behaviour, there are no correlations between AAS use and exercising in a sports club or on one's own, whilst there is a weak positive correlation between AAS use and exercising in a gym or engaging in other forms of physical exercise such as dancing or martial arts. These patterns are more or less the same for boys and for girls. We conclude that adolescent AAS use is a low-prevalence phenomenon that primarily takes place in smaller subgroups of individuals who engage in other forms of problem behaviour as well.

Geolocalisation of athletes for out-of-competition drug testing: ethical considerations. Position statement by the WADA Ethics Panel.

Through the widespread availability of location-identifying devices, geolocalisation could potentially be used to place athletes during out-of-competition testing. In light of this debate, the WADA Ethics Panel formulated the following questions: (1) should WADA and/or other sponsors consider funding such geolocalisation research projects?, (2) if successful, could they be proposed to athletes as a complementary device to Anti-Doping Administration and Management System to help geolocalisation and reduce the risk of missed tests? and (3) should such devices be offered on a voluntary basis, or is it conceivable that they would be made mandatory for all athletes in registered testing pools? In this position paper, the WADA Ethics Panel concludes that the use of geolocalisation could be useful in a research setting with the goal of understanding associations between genotype, phenotype and environment; however, it recognises that the use of geolocalisation as part of or as replacement of whereabouts rules is replete with ethical concerns. While benefits remain largely hypothetical and minimal, the potential invasion of privacy and the data security threats are real. Considering the impact on privacy, data security issues, the societal ramifications of offering such services and various pragmatic considerations, the WADA Ethics Panel concludes that at this time, the use of geolocalisation should neither be mandated as a tool for disclosing whereabouts nor implemented on a voluntary basis.

Education in Anti-Doping: The Art of Self-Imposed Constraints.

The pillars of anti-doping are detection, deterrence, and prevention. Detection takes the form of testing for banned substances. Deterrence builds on testing and gathering evidence. Athletes who test positive are exposed to penalties. The main tool of prevention is education. Education takes many forms and can be implemented in many ways. This chapter addresses the nature and challenges of current anti-doping education. Firstly, general goals of education and their connection to sport are discussed. Secondly, three normative interpretations of sport are presented, and their implications for anti-doping education are examined. Instrumentalist interpretations and interpretations with emphasis on performance and enhancement challenge the anti-doping campaign. A human excellence interpretation is advocated in which anti-doping is considered a consistent and integral part of sport. Thirdly, future challenges for anti-doping education are reflected upon.

Against Genetic Tests for Athletic Talent: The Primacy of the Phenotype.

New insights into the genetics of sport performance lead to new areas of application. One area is the use of genetic tests to identify athletic talent. Athletic performances involve a high number of complex phenotypical traits. Based on the ACCE model (review of Analytic and Clinical validity, Clinical utility, and Ethical, legal and social implications), a critique is offered of the lack of validity and predictive power of genetic tests for talent. Based on the ideal of children's right to an open future, a moral argument is given against such tests on children and young athletes. A possible role of genetic tests in sport is proposed in terms of identifying predisposition for injury. In meeting ACCE requirements, such tests could improve individualised injury prevention and increase athlete health. More generally, limitations of science are discussed in the identification of talent and in the understanding of complex human performance phenotypes. An alternative approach to talent identification is proposed in terms of ethically sensitive, systematic and evidence-based holistic observation over time of relevant phenotypical traits by experienced observers. Talent identification in sport should be based on the primacy of the phenotype.