Should doping be legalized?  A tired debate renewed

Last week in the British Medical Journal, a “Head to Head” was published between two opposing viewpoints around the question of legal doping in sport.  The protagonists were Julian Savelescu, a philosopher from Oxford, who pops up with about the same frequency as a leap year to raise pretty much the same points arguing that doping should be legal, and Leon Cready and Anna Vondy, who took the opposing view.

This is not a new debate at all.  We’ve discussed it many times, and earlier this year, I was involved in a radio debate with a local philospher, Jacques Rousseau, on the same question.   That was a very constructive discussion, actually, leading to something of a ‘compromise’ (gasp, what is that?), which I’ll end off with below.

First, some brief thoughts on the legalization issue – I’m somewhat snowed under with work this week, so I’ll keep it short.

Savelescu, as mentioned, is not new to the debate.  He argues pretty much the same thing every time, and I believe he makes two  incorrect assumptions.

[ribbon toplink=true]1.  The all-or-nothing assumption[/ribbon]

He assumes that anti doping doesn’t work because there is still doping. That’s like saying that crime laws don’t work and should be scrapped because there is still crime. Or that speeding cameras don’t work because people still speed.

It need not be all or nothing.  For instance, it’s not difficult to appreciate that speeding cameras work because they reduce the number of people speeding – every single one of you reading this will have a “known location” camera which forces you to slow down as you approach it, before you bomb off once you pass it!  Imagine there was a camera every mile – you’d be forced into not speeding.  But some would continue to speed.  That is not sufficient grounds to disregard the entire system.

For example, Savelescu makes the following statement in his argument: “Again, the current ban fails this test. Amateur doping is already happening in an unsupervised manner. There is doping at college, and it is estimated that 3-5% of school athletes use doping”.  3-5%?  Is that all?  If that is the “proof” that the current system is broken beyond repair and needs to be scrapped, then heaven help other laws (however arbitrary they may be) where the incidence they are designed to catch and punish is even higher.

Furthermore, it is critical appreciate that a speeding camera is effective even though it may never actually produce a “positive case” and resultant punishment.  That is, the deterrent is effective not because it catches people, but because it prevents the behavior in the first place.  Applied to anti-doping, the system is effective if if reduces the prevalence and the severity of doping to the point where it becomes possible to compete, and even win, while clean.

If anti-doping procedures can change behavior, then the system cannot be judged solely on delivering athletes to tribunals and sanctioning them.  It must be judged also on its impact on behavior.  This is obviously much more difficult to measure, but there is some evidence that it happens.  A paper published after the introduction of the biological passport showed that when the EPO test was introduced, the predominant method of doping changed from EPO use to blood transfusions.  A few years later, when the passport was rolled out, the incidence of both EPO use and blood transfusions dropped, as the graph below shows (from this article I wrote on the biological passport in 2011)

Were the illegal practices eliminated?  No.  Did the new tests catch significantly more people?  Not necessarily.  But the margins within which doping could be done were suddenly narrowed, and even those who doped were forced into less of it, less often.  That’s a victory that has to be acknowledged.  Further, any time the testing gets more sensitive, it means that the doping has to become more sophisticated.  That introduces costs – time and money – that also deter the doping practice.  So not only does anti-doping exist to provide a moral disincentive to dope, it also disincentivizes it in practical, meaningful ways.

The net result is a more equal playing field, and I can’t agree that it must be all-or-nothing.

[ribbon toplink=true]2. The clean athlete is the purpose[/ribbon]

The second point of disagreement with Savelescu is that he argues from the perspective of the doping athlete or the system, and neglects to realize that the important person is the clean athlete who does not wish to dope.  Anti-doping’s primary purpose is not to catch dopers.  That’s the means by which it achieves its primary purpose, which is to protect the right of the athlete who wants to compete cleanly without a disadvantage.

So the object of anti-doping is ensure that doping does not skew the performances so much that a clean athlete has zero chance of competing without it.  Referring to my previous point, it can do this without necessarily eliminating doping altogether.

Let’s assume that unregulated, the effect of doping on performance is 5%.  In a sport where 1-2% is the difference between a champion and making up the numbers, that’s insurmountable.  It would mean, quite literally, that the sport is instantly filtered to exclude anyone not willing to dope.  However, if the effect of doping can be reduced to say 1% by better testing, harsher punishments, greater costs to dopers, then suddenly the field is level enough to allow that athlete a reasonable chance.  Obviously, the desired outcome is to eliminate doping altogether, but the failures to do this should not force one into the extreme view that anti-doping fails.

The biggest loser were that to happen would be the clean athlete – precisely the person that should be protected.  And how can one argue that the greatest punishment should exist for the clean athlete?

[ribbon toplink=true]The compromise[/ribbon]

So, if not legalization of doping, then where is the compromise.  This is also a topic covered before, including in this interview with Prof Bengt Kayser, but one of the big issues facing anti-doping today is the inefficiency of pursuing doping products that may not provide any benefit or be harmful.

Too many ‘innocuous’ products exist on what has become a vast list, and these products, particularly as contaminants in supplements, help create a perception that doping is out of control.  And perhaps it is, but the pursuit of what I would describe as “important, harmful and serious” doping is compromised by the volume of cases involving these “lesser” products.

The challenge is to identify which are serious and which are not.  Caffeine is an example of one that was on the list, then was removed, and it simplified life for a lot of people.  There are arguably others that can be removed. Similarly, however there are drugs that should be added, and one of anti-doping’s biggest challenges is sorting through the list and identifying which substances should truly be banned on account of being performance-enhancing AND potentially harmful.  Note that this may differ from sport to sport, and one way of implementing this is not necessarily to remove the substance from the list, but rather to change the punishment for an offence.

For instance, a very mild stimulant might receive six months.  EPO or blood-doping? Six years.  The ban for a first-time offence may soon be changed to four years, but a blanket ban for substances that are arguably vastly different in effect and risk doesn’t seem logical to me, not least of all because athletes are doing other things that are legal, but may be more detrimental than doping with some of the substances on the list.

So that’s the compromise – a stream-lining of the list, and adjustments to the sanction so that we can come down harder than ever on the serious doping like steroid use, blood doping, EPO, powerful stimulants and growth hormone.  There are practical challenges, and I appreciate those.  But if there is the will, then it would be possible to work towards this simplicity, for the benefit of the athletes and the public.

Ross