Medical arguments for and against the liberalization of doping / Argumentos médicos a favor y en contra de la liberalización del dopaje

The use of doping has been banned for almost a century due to the risk involved to the athlete's health. Since then, the criterion of prohibiting substances has been reinforced to improve performance, becoming a rarely controversial issue nowadays. However, opinions defending the liberalization of doping has been sometimes given based on various arguments. One of the most common is the impossibility of completely eradicating doping and that this can be safe, from the point of view of health, if it is done by qualified doctors. This paper presents the arguments against the liberalization of doping from a medical point of view, contemplating various aspects. Those related to the use of substances such as: lack of clear criteria for inclusion in the list of prohibited substances and the unclear margin between the use of medication for treatment and for doping. Arguments related to health protection such as: the risk of sport for the athlete, the healthy sport, doping substances have few health risks, the use of medications, allow genetic doping because it is inevitable, risks of self-medication or use of medication without a prescription. Arguments related to sports performance such as: Doping products do not improve performance, doping is comparable to other performance improvement techniques, match genetic differences among athletes. And other arguments such as: prohibition favours doping, the control of doping increases the risks of doping itself, the high cost of anti-doping fight or the few anti-doping resources. The proposal for liberalization of doping under medical control is analyzed and discussed as well as the effects of liberalization on children and adolescents. At the end the medical ethical aspects related to doping are presented to conclude with the opposition of the medical profession against doping and its liberalization

El dopaje está prohibido desde hace casi un siglo debido al riesgo que implica para la salud del deportista. Desde entonces, el criterio de prohibición de sustancias se ha reforzado para mejorar el rendimiento, convirtiéndose en un tema poco controvertido en la actualidad. Sin embargo, a veces se han emitido opiniones en defensa de la liberalización del dopaje basadas en diversos argumentos. Uno de los más habituales es la imposibilidad de erradicar por completo el dopaje y que éste puede ser seguro, desde el punto de vista de la salud, si lo practica médicos titulados. Este artículo presenta los argumentos en contra de la liberalización del dopaje desde el punto de vista médico, contemplando diversos aspectos. Los relacionados con el uso de sustancias tales como: falta de criterios claros para su inclusión en la lista de sustancias prohibidas y el margen poco claro entre el uso de medicamentos para tratamiento y dopaje. Argumentos relacionados con la protección de la salud como: el riesgo del deporte para el deportista, el deporte sano, las sustancias dopantes tienen pocos riesgos para la salud, el uso de medicamentos, permitir el dopaje genético porque es inevitable, los riesgos de automedicación o uso de medicación sin prescripción. Argumentos relacionados con el rendimiento deportivo tales como: los productos antidopaje no mejoran el rendimiento, el dopaje es comparable a otras técnicas de mejora del rendimiento, diferencias genéticas entre los deportistas. Y otros argumentos como: la prohibición favorece el dopaje, el control del dopaje aumenta los riesgos del dopaje, el alto coste de la lucha antidopaje o los escasos recursos antidopaje. Se analiza y discute la propuesta de liberalización del dopaje bajo control médico y los efectos de la liberalización en niños y adolescentes. Al final se presentan los aspectos éticos médicos relacionados con el dopaje para concluir con la oposición de la profesión médica al dopaje y su liberalización

Basic values predict doping likelihood.

Basic values, defined as trans-situational goals that vary in importance and act as guiding principles in life, have been linked with unethical cognitions, emotions and actions. Their roles in doping, a form of cheating in sport, have yet to established. College athletes reported doping likelihood in hypothetical scenario-based situations and completed measures of basic values, moral disengagement, and anticipated guilt. Correlation analysis showed that doping likelihood was positively associated with self-enhancement values but negatively associated with self-transcendence values and conservation values. Moral disengagement correlated positively with self-enhancement values and negatively with self-transcendence values, whereas guilt correlated positively conservation values and negatively with self-enhancement values and openness to change values. Regression analyses showed that self-enhancement values positively predicted doping likelihood directly, self-transcendence values negatively predicted doping likelihood indirectly via moral disengagement and guilt, and conservation values negatively predicted doping likelihood indirectly via guilt. In line with theory and evidence concerning the relationship between basic value systems and moral thought and action, we found that the values of athletes are directly (self-enhancement) and indirectly (self-transcendence, conservation) linked with likely use of banned performance enhancing substances, an expression of cheating in sport.

Facial features and unethical behavior - Doped athletes show higher facial width-to-height ratios than non-doping sanctioned athletes.

Past research has emphasized the role of facial structures in predicting social behavior. In particular the facial width-to-height ratio (fWHR) was found to be a reliable predictor for antisocial and unethical behavior. The current study was aimed at examining this association in the field of sports: FWHRs of 146 doping sanctioned athletes in athletics (37 male/38 female) and weightlifting (44 male/27 female) were compared to the fWHRs of randomly chosen non-doping sanctioned athletes of the Top Ten at the World Championship 2017 and Olympic Games 2016 in both sports (146 athletes). The results showed that doping sanctioned athletes due to the use of anabolic steroids had larger fWHRs than non-doping sanctioned athletes. However, doping sanctioned athletes due to other doping rule violations than the use of anabolic steroids, did not show this effect. The study provides empirical evidence for the relation between fWHR and unethical behavior in a real-world setting and contributes to the discussion about fWHR's biological origin, emphasizing the role of anabolic steroids. A mutual interaction between fWHR and doping behavior is discussed, at which a larger fWHR might signify a higher tendency to behave unethically, whereas the consequential intake of anabolic steroids might also shape individuals' faces.

The Landscape of the "Spirit of Sport" : A Systematic Review.

The World Anti-Doping Agency (WADA) sets out a detailed description of what its own conception of the "spirit of sport" as employed in the World Anti-Doping Code (WADC) entails. However, controversies as to the significance and meaning to be ascribed to the term abound in the literature. In order to unravel the core of the debates and to move discussions forward, the authors aimed at reviewing understandings of the spirit of sport in the conceptual literature. The main databases were searched using relevant keywords. After the inclusion and exclusion criteria were applied, eighteen publications were included in the review. The most striking result to emerge from the data is the multivalence of the concept of spirit of sport. Our thematic analysis generated the contestability of the spirit of sport as the predominant theme in the conceptual literature. There is a need for empirical research to generate data about perspectives on the spirit of sport from other stakeholders especially those of the athletes themselves.

Perceptions of coach doping confrontation efficacy and athlete susceptibility to intentional and inadvertent doping.

OBJECTIVES: We tested a conceptually grounded model linking athlete perceptions of strength and conditioning and technical coach doping confrontation efficacy (DCE) with athletes' doping self-regulatory efficacy (SRE), doping moral disengagement (MD), and susceptibility to intentional and inadvertent doping. DESIGN: Cross-sectional, correlational. METHODS: Participants were high-level athletes (nmale  = 532; nfemale  = 290) recruited in Australia (n = 261), the UK (n = 300), and the USA (n = 261). All participants completed questionnaires assessing the variables alongside a variant of the randomized response technique to estimate the prevalence of doping. RESULTS: The estimated prevalence of intentional doping in the sample was 13.9%. Structural equation modeling established: (a) perceptions of technical and strength and conditioning coaches' DCE positively predicted doping SRE; (b) doping SRE negatively predicted doping MD; (c) doping MD positively predicted susceptibility to intentional and inadvertent doping; and (d) the predictive effects of coach perceptions on susceptibility to doping were mediated by doping SRE and doping MD. Multisample analyses demonstrated these predictive effects were invariant between males and females and across the three countries represented. CONCLUSIONS: The findings show the conceptually grounded model to offer extended understanding of how multiple individuals within the athlete support personnel network may influence athlete doping.

The unethicality of doping in sports.

Performance enhancing drug use in sport arguably constitutes a crisis, and as such, targeted measures are needed in order to stem it. Substance abuse in professional sports and competitions has besmirched many world-class athletes' reputations and standing, in addition to jeopardizing their health. Furthermore, there are many instances of amateur athletes and school-aged competitors who have taken to using such substances as well, significantly exacerbating the overall picture. The widespread acknowledgement of the potentially life-threatening consequences of performance-enhancing drug use has prodded sports organizations and governments into cooperating on many different levels to preserve the ethical grounding and soundness of sport competitions; unlawful substance abuse is in fact liable to undermine the very core of fairness in competition. Doping, along with various forms of cheating, has been recorded throughout the history of sport: prohibition in itself is all but ineffective without reliable and systematic detection strategies and enforcement of sanctions.

Doped and disclosed Anatomopolitics, biopower, and sovereignty in the Russian sports industry.

In this article, we scrutinize a policy area in which the Russian government has had to react to negative publicity in the last few years, namely, the doping scandal surrounding the 2014 Sochi Winter Olympics. This scandal uncovered important aspects of Russia's vulnerability in the global sports milieu, yet so far, it has remained almost unnoticed in the literature on mega sports events in Russia. Our analysis is premised on the convergence of two types and techniques of control and regulation: anatomopolitics, which presupposes, in Michel Foucault's interpretation of the term, measures of control over individual bodies, and biopolitics, which refers to policy practices that target and concern the entire population. Their conflation in the Russian context results in a controversial effect: it strengthens relations of hegemony yet also exposes the sovereign power to the regulations of global sports organizations.

Gene Doping-in Animals? Ethical Issues at the Intersection of Animal Use, Gene Editing, and Sports Ethics.

Gene editors such as CRISPR could be used to create stronger, faster, or more resilient nonhuman animals. This is of keen interest to people who breed, train, race, and profit off the millions of animals used in sport that contribute billions of dollars to legal and illegal economies across the globe. People have tried for millennia to perfect sport animals; CRISPR proposes to do in one generation what might have taken decades previously. Moreover, gene editing may facilitate enhancing animals' capacities beyond their typical limits. This paper describes the state of animal use and engineering for sport, examines the moral status of animals, and analyzes current and future ethical issues at the intersection of animal use, gene editing, and sports. We argue that animal sport enthusiasts and animal welfarists alike should be concerned about the inevitable use of CRISPR in sport animals. Though in principle CRISPR could be used to improve sport animals' well-being, we think it is unlikely in practice to do so.

Trastornos de bipolares y comorbilidades - consideraciones éticas en deportes / Bipolar disorders and comorbid conditions - Ethical considerations in sports

Introducción: El objetivo de la intervención farmacológica es el resultado terapéutico: máxima eficacia con mínimos efectos adversos. Esto resulta difícil a la hora de tratar el trastorno bipolar, debido a las comorbilidades y/o fármacos complementarios necesarios para abordar los efectos adversos. La polifarmacia racional óptima puede maximizar el resultado terapéutico, aunque podría crear cuestiones éticas en los deportes competitivos. El Código Mundial Antidopaje (WADC) y la Lista de Sustancias Prohibidas de la Agencia Mundial Antidopaje, publicada anualmente, tienen como objetivo disuadir y sancionar a los atletas que utilicen agentes para mejorar el rendimiento, y promover un marco de igualdad para todos los competidores. Este documento presenta tres ejemplos hipotéticos (TDAH/temblor secundario al litio/dolor) en los que la contravención no deliberada de la Lista de Sustancias Prohibidas derivaría en descalificación por violación de la norma antidopaje sin aprobación de las Exenciones por Uso Terapéutico (TUEs). Método: Análisis de caso hipotético con revisión de la literatura. Resultados: TDAH Comórbido: la Lista de Sustancias Prohibidas excluye los psicoestimulantes (metilfenidato/anfetaminas) en la competición (S6) pero permite guanfacina/atomoxetina. En los casos en que los psicoestimulantes constituyeran un tratamiento eficaz para el TDAH en los atletas con trastorno bipolar, a diferencia de guanfacina/atomoxetina, estos pacientes-atletas deberán presentar TUEs, junto con la certificación y documentación de respaldo del clínico. Temblor secundario al Litio: a menudo se prescriben beta-bloqueantes para controlar el temblor secundario al litio, pero que no están autorizados para deportes específicos (P2). En caso de que los fármacos alternativos (primidona) resulten ineficaces, serán necesarias las TUEs. Dolor: el manejo del dolor crónico es difícil en atletas, ya que los analgésicos narcóticos (S7) y cannabinoides (S8) están prohibidos en la competición. Cuando el dolor comórbido no se controla con fármacos autorizados, son necesarias las TUEs. Conclusión: Los pacientes-atletas con trastorno bipolar y comorbilidades precisan enfoques holísticos, con reconocimiento tanto del WADC como de la Lista de Sustancias Prohibidas. Los atletas deberían realizar un listado de todos los fármacos incluyendo diagnósticos/obtener TUEs/verificar el estado de la medicación propuesta (prohibido/restringido/permitido) con las Federaciones Internacionales adecuadas y/u Organizaciones Olímpicas. Los clínicos deberán ser conocedores de estas cuestiones a la hora de tratar a los pacientes-atletas

Introduction: The goal of pharmacologic intervention is therapeutic outcome: maximal efficacy with minimal adverse effects. In treating bipolar disorder, this may be complicated by comorbidities and/or adjunctive medications required to address adverse effects. Optimal rational polypharmacy may maximize therapeutic outcome yet could create ethical issues in competitive sports. The World Anti-Doping Code (WADC) and yearly published World Anti-Doping Agency Prohibited List are intended to deter and sanction athletes using performance-enhancing agents while promoting an even playing field for all competitors. This paper presents three hypothetical examples (ADHD/lithium-tremor/pain) wherein unintended Prohibited List contravention would result in doping violation disqualifications without approved Therapeutic Use Exemptions (TUEs). Method: Hypothetical case analyses with literature review. Results: Comorbid ADHD: the Prohibited List precludes psychostimulants (methylphenidate/amphetamines) in competition (S6) but permits guanfacine/atomoxetine. When psychostimulants effectively treat ADHD in athletes with bipolar disorder but guanfacine/atomoxetine do not, these patient-athletes, with clinician’s certification and supportive documentation, should file TUEs. Lithium-tremor: beta-blockers are frequently prescribed to control lithium-tremor but are not permitted for specific sports (P2). If alternatives (primidone) are ineffective, TUEs are indicated. Pain: chronic pain management is difficult in athletes as narcotic analgesics (S7) and cannabinoids (S8) are prohibited in competition. When comorbid pain is not controlled with approved medications, TUEs are required. Conclusion: Patient-athletes with bipolar disorder and comorbidities require holistic approaches with appreciation of both the WADC and Prohibited List. Athletes should list all medications with diagnoses/obtain TUEs/verify proposed medication status (banned/restricted/permitted) with appropriate International Federations and/or Olympic organizations. Clinicians should be cognizant of these issues when treating patient-athletes

Do athletes have a right to access data in their Athlete Biological Passport?

The Athlete Biological Passport (ABP) refers to the collection of data related to an individual athlete. The ABP contains the Haematological Module and the Steroidal Module, which are used for the longitudinal monitoring of variables in blood and urine, respectively. Based on changes in these variables, a statistical model detects outliers which indicate doping use and guide further targeted testing of the athlete. Presently, athletes can access their data of the Haematological Module in the Anti-Doping Administration and Management System (ADAMS). However, granting athletes access to this data has been a matter of debate within the anti-doping community. This article investigates whether an athlete has a right to access the contents of their ABP profile. We approached this discussion by comparing the nature of ABP data with that of forensic and medical data and touched on important concerns with ABP data disclosure to athletes such as potentially allowing for the development of alternative doping techniques to circumvent detection; and making athletes vulnerable to pressure by the media to publicly release their data. Furthermore, given that ABP data may contain medically relevant information that can be used to diagnose disease, athletes may over-interpret its medical significance and wrongly see it as a free health check. We argue that safeguarding the integrity of the ABP system must be seen as the most essential element and thus a departure from immediate data disclosure is necessary. Two different strategies for delayed data disclosure are proposed which diminish the chances of ABP data being misused to refine doping techniques.

Antidoping program: an important factor in the promotion and protection of the integrity of sport and athlete's health.

Using performance-enhancing drugs concerns not only elite Olympic and Paralympic Games' athletes but also amateur athletes, who are making increasing use of substances and/or methods. Furthermore, a new frontier reached by the doping is the use of genes. World Anti-Doping Agency expressly prohibited the participation in competitive sports by the athlete in case of taking banned substances to treat disease in the event that the above assumption implies an excessive improvement of performance. This study aims to analyze and show the doping control as an essential part of the antidoping program to promote and protect the integrity of sport and athlete's health. Testing is carried out in accordance with the World Anti-Doping Code (WADC) and several international standards (ISs). The ISs were developed for laboratories, testing, the prohibited list, and for therapeutic use exemptions. It seems that the 2009 version of the WADC obliges all the healthcare professionals not to assist athletes engaged in doping behaviours; they can be removed from working with athletes. Many people do not know doping's dangerous effects on health. It is necessary, therefore, to implement the knowledge on this issue through public and sports institutions information and awareness campaigns. For this reason, local institutions and the National Olympic Committee shall give tools, in particular economic, to carry out the work of education, training, and control.

A Moral Foundation for Anti-Doping: How Far Have We Progressed? Where Are the Limits?

Clarity about the ethical justification of anti-doping is essential. In its absence, critics multiply and confusion abounds. Three broad reasons are typically offered in anti-doping's defense: to protect athletes' health; to promote fairness; and to preserve meaning and values in sport - what the World Anti-Doping Agency (WADA) Code refers to as the spirit of sport. Protecting health is itself an important value, but many sports encourage athletes to take significant risks. The case against doping is buttressed by concern for athletes' health, but it cannot be the sole foundation. Promoting fairness is vital in all sports as the metaphor of the level playing field attests. But playing fields can be leveled by providing performance-enhancing drugs to all competitors. When doping is prohibited, fairness is aided by effective anti-doping. But the fundamental justification for anti-doping is found in the meanings and values we pursue in and through sport.

Sport, Society, and Anti-Doping Policy: An Ethical Overview.

The purpose of this chapter is to provide an overview of the philosophical and ethical underpinnings of anti-doping policy. The nature of sport and its gratuitous logic is explored. The doping rules in sport, such as the Prohibited List, are ways of drawing a line to facilitate a certain sort of competition. Sports can be understood as a means of testing the natural physical abilities of the athlete, combined with the hard work they put into improving their performance. A test promoted by the anti-doping laws. Permitting certain forms of performance enhancement would threaten the special nature of such a test. Doping can be seen as a threat to the integrity of sport, not just because of the rule breaking doping currently entails. The chapter explores the ethical issues that arise with such forms of enhancement, such as fairness, harms to health, and indeed a refusal to accept human limitations. Finally, the criteria upon which a substance or method may be prohibited by the World Anti-Doping Agency (WADA) is addressed. The 3-part criteria, concerning (1) enhancement, (2) health, and (3) the spirit of sport are described, and literature that takes a critical line is addressed. Particular reference is made to the public health agenda explicit within anti-doping policy.

Health, integrity, and doping in sports for children and young adults. A resolution of the European Academy of Paediatrics.

The European Academy of Paediatrics (EAP) is dedicated to promoting healthy lifestyles for children from birth into young adulthood. Physical exercise and leisure are essential to the development of healthy bodies, strong minds, and social skills. All children, without regard to their physical or mental capacities, should be provided with the time, the leadership, the facilities, and the equipment needed to exercise through sports while enjoying playing, even competing, in an environment appropriate to their capacities and aspirations. During exercise and sports, children should be assured of a safe and an appropriate environment that protects and promotes their human rights. Top sports that engage the best competitive athletes in an age group, in a region, in a country, or in the world should provide role models and even dreams for all children. These top sports, however, are also most usually surrounded by large political, economic, and/or business interests where only the best can compete while at times exacting a too high physical and/or psychological cost for those who have survived the cut, made the grade. Alongside this more and more children are being raised in environments with fewer open spaces as well as inside a media and digital culture making significantly less room for the enjoyment of physical exercise and leisure. Children's diets have also been changed dramatically by a significant intake of calorierich foods, which often have little nutritional value and which even a child's high metabolism rates not able to burn off efficiently. Conclusion With this Resolution, the EAP is calling for a renewed look at the role of sports and leisure in the lives of children and, by implication, at the way we structure, finance, and promote sports in Europe. The EAP is also asking that this Resolution be adopted by all organizers of sports involving children and young adults in Europe (and beyond), be that on the playground, in schools, in clubs, or in professional sporting organizations. The EAP would like that every child, throughout his or her childhood years and into young adulthood, can fully participate in sports in a safe environment where winning is playing and playing is winning.

Ethics of a relaxed antidoping rule accompanied by harm-reduction measures.

Harm-reduction approaches are used to reduce the burden of risky human behaviour without necessarily aiming to stop the behaviour. We discuss what an introduction of harm reduction for doping in sports would mean in parallel with a relaxation of the antidoping rule. We analyse what is ethically at stake in the following five levels: (1) What would it mean for the athlete (the self)? (2) How would it impact other athletes (the other)? (3) How would it affect the phenomenon of sport as a game and its fair play basis (the play)? (4) What would be the consequences for the spectator and the role of sports in society (the display)? and (5) What would it mean for what some consider as essential to being human (humanity)? For each level, we present arguments for and against doping and then discuss what a harm-reduction approach, within a dynamic regime of a partially relaxed antidoping rule, could imply. We find that a harm-reduction approach is morally defensible and potentially provides a viable escape out of the impasse resulting from the impossibility of attaining the eradication of doping. The following question remains to be answered: Would a more relaxed position, when combined with harm-reduction measures, indeed have less negative consequences for society than today's all-out antidoping efforts that aim for abstinence? We provide an outline of an alternative policy, allowing a cautious step-wise change to answer this question and then discuss the ethical aspects of such a policy change.

Tracking U.S. Professional Athletes: The Ethics of Biometric Technologies.

Professional sport in the United States has widely adopted biometric technologies, dramatically expanding the monitoring of players' biodata. These technologies have the potential to prevent injuries, improve performance, and extend athletes' careers; they also risk compromising players' privacy and autonomy, the confidentiality of their data, and their careers. The use of these technologies in professional sport and the consumer sector remains largely unregulated and unexamined. We seek to provide guidance for their adoption by examining five areas of concern: (1) validity and interpretation of data; (2) increased surveillance and threats to privacy; (3) risks to confidentiality and concerns regarding data security; (4) conflicts of interest; and (5) coercion. Our analysis uses professional sport as a case study; however, these concerns extend to other domains where their use is expanding, including the consumer sector, collegiate and high school sport, the military, and commercial sectors where monitoring employees is viewed as useful for safety or to maximize labor potential.

How to Restore Fairness After Doping Infringement?

This article addresses the question how to restore the biggest possible amount of fairness after a discovery of doping infringement. I will analyse eight actions that could be taken: (1) disqualification and re-ranking, (2) change in official result, (3) medal stripping and medal re-awarding, (4) ban, (5) rematch, (6) legal action, (7) apology and (8) forgiveness. I conclude that the best way to restore the biggest possible amount of fairness seems to be a selected combination of actions. I also propose that re-ranking and medal re-awarding should be accompanied by a ceremony in which the new winners are celebrated because they typically did not have the possibility of enjoying their success in front of the original audience.