The case for PED's?

This blog post was originally written as a response to a discussion by Nicholas Thompson, Malcom Gladwell and Ben McGrath.   The conversation can be found here:

http://www.newyorker.com/online/blogs/culture/2013/09/out-loud-malcolm-gladwell-case-for-doping.html

If you do listen to the clip the discussion starts about 3 minutes in.  They are discussing David Epstein’s new book The Sports Gene, which I am currently reading, but my response is to the parts of the discussion related doping, not Epstein’s book specifically.  It is worth noting that Gladwell has written other pieces on doping, including Drugstore Athlete 

I applaud Gladwell’s thought experiment, envisioning a world where PED use is something we don’t have to hide.  I do agree that setting acceptable standards could make PED use safer, but not safe.  Gladwell and company failed to acknowledge that one of the main reasons we currently ban PED use is that there are a laundry list of side effects, ranging from abnormal growth, to ‘roid rage, to infertility, to heart attack or death.  Like most medications, PEDs have side effects, even in controlled amounts.  In medicine we weigh the risks and the benefits of each prescription we write.  A patient on warfarin might have an increased risk of internal bleeding after a car accident, but we acknowledge that as the lesser of two evils between having a heart attack.  PEDs fail to fall into this risk and benefit distinction from a medical perspective as the athletes have no legitimate medical need for these substances.  Their quality of life is not improved by taking PEDs. 

Along the lines of side effects of PEDs are injuries associated with PEDs.  Although substances like steroids allow you to recover faster, they also make athletes bigger, faster and stronger.  We have already seen a progression in this direction simply from tailored fitness and diet regimens for athletes, and PED use will only serve to make athletes more proficient.  This proficiency is of most concern in contact sports such as football or hockey.  Suddenly we have increased the speed and power with which collisions are occurring, but we haven’t changed things like the thickness of the skull, or the ability of the brain to withstand repeated trauma.  Head injuries in the NFL are a hotly debated topic, and beyond the scope of this discussion, but while PEDs may increase the strength and speed of muscles, they do not increase the ability of our organs to withstand the increase trauma load.  As such, an increase in traumatic brain injuries is not surprising.  

Additionally, Gladwell and co. fail to address the inequities of obtaining PEDs, even by legitimate means.  If we allowed PED use we intrinsically favor athletes with the financial means of obtaining them and monitoring their dosing.  I acknowledge that sports already favor athletes with financial resources in many ways, but PED use could greatly increase this disparity.  

Finally, I think this discussion has failed to address the main reason athletes dope: money.  Athletes are some of the highest paid people in the modern world, and the more successful they are, the more they are rewarded with both salaries and endorsements.  In 2005, Lance Armstrong received $28 million from awards and endorsements.  The second place finisher in the Tour de France that year?  Ivan Basso, (who was also found to have used PEDs, but) whose earnings aren’t even acknowledged by Forbes (presumably because they aren’t significant enough to mention).  The bottom line is that being good at sports is incredibly lucrative, and that creates incentive to cheat, and I use the word cheat here to include things like corking a bat, weighting a bobsled, a spitball, etc.  Armstrong gets to keep the money he earned from endorsements as a result of his success, despite the elicit means of obtaining that success.   Thus, the pressure to win will never go away whether PEDs are legal or not.  Athletes will always be looking for an advantage.  If that advantage isn’t using PEDs, maybe it will become how much they use.  Can they get away with higher does in the off season to build muscle that lasts during the season?  Or can they tailor their PED regimen so that it peaks during competition, but is also metabolized during that time, so that before and after levels fall within the normal range?  PEDs present a new challenge of regulation in athletics, however the consequences of allowing their use outweighs the benefits of permitting them, even in a controlled environment. 

References:

1. Buckman JF, Farris SG, Yusko D a. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug and alcohol dependence 131: 50–5, 2013.

2. Maravelias C, Dona a, Stefanidou M, Spiliopoulou C. Adverse effects of anabolic steroids in athletes. A constant threat. Toxicology letters 158: 167–75, 2005.

3. Overbye M, Knudsen ML, Pfister G. To dope or not to dope: Elite athletes’ perceptions of doping deterrents and incentives. Performance Enhancement & Health (August 2013). doi: 10.1016/j.peh.2013.07.001.