Performance Enhancement in Sport

1
Performance Enhancement in Sport

• Professor Julian Savulescu

2
Possibility of biological enhancement

• Longevity
• Stem cell science
• Quality of life
• Behavioural genetics
• dogs
• Hard working monkey
• Monogamous meadow vole
• Sex selection

3
Non-Disease Genes and the Best Life

• Impulse control
• Memory
• Temper
• Shyness blushing
• Empathy
• Good humour
• Looking on the bright side
• anxiety

4
Reality of enhancement

• Sport EPO, anabolic steroids, growth hormone
• Identification of athletes on the basis of
  genetic potential ACTN3
• Cognitive enhancement nicotine, ritalin,
  modavigil, caffeine
• Mood enhancement prozac, recreational drugs,
  alcohol
• Sexual performance viagra
• Communication mobile phones
• Travel air travel
• Present pharmacological and external technology
• Future
• Genetic engineering artificial chromosomes
• Internal technology nanotechnology, AI

5
Arguments in Favour of Enhancement

• Consistency
• environmental manipulations
• Treatment and prevention of disease
• Goal of procreation and parenting child with
  the best opportunity
• Nature as a rational parent
• Family interest parent and child
• Public Interest cost/benefit to society,
  rational biological/social progress
• Responsibility for choosing to not enhance
  responsibility for child being worse off that
  could otherwise have been (harm)\

6
Choosing not to enhance is harming

• Dietary neglect results in a child with a
  stunning intellect becoming normal
• Wrong
• Failure to institute some diet means a normal
  child fails to achieve a stunning intellect
• Equally wrong

7
Consistency

• There is no difference between environmental and
  genetic intervention
• Environmental manipulations affect biology rats
  who were mothered showed genetic changes
• Stimulating environment protects against HD in
  rats
• Train children to be well behaved, co-operative
  and intelligent
• so couples should maximise the genetic
  opportunity of their children to lead a
  productive, cooperative social existence
• Geneticism and genophobia

8
What matters no difference to disease

• Goodness of health is what drives a moral
  obligation to treat or prevent disease
• Health is not what matters
• But how well our lives goes
• Drives a moral obligation to enhance

9
Asthma

• Asthma reduces quality of life.
• Attacks cause
• severe breathlessness
• death
• steroids required to treat it are among the most
  dangerous drugs which you can take.
• It can be life long and require lifelong drug
  treatment.
• Ultimately it can leave you wheel chair bound
  with chronic obstructive airways disease.

10
Morally relevant properties

• The morally relevant property of asthma it is
  a state which reduces the well-being a person
  experiences.
• could substitute cystic fibrosis, osteogenesis
  imperfecta, Down syndrome, dwarfism, blindness,
  etc

11
What is the Best Life?

• Life with the most well-being
• There are various theories of well-being
  hedonistic, desire-fulfilment, objective list.
• Not just absence of disease.

12
Non-Disease Genes and the Best Life

• It is not asthma (or disease) which is important,
  
• it is its impact on my life in ways that matter
  which is important.
• Imagine there is a tablet to completely suppress
  its effects
• People trade length of life for non-health
  related well-being- smoking, alcohol, risk
• Non-disease genes may contribute significantly to
  well-being as much as disease genes

13
Goal of Reproduction Person who has a Good Life

• Evolution
• Genes selected according to environment
• survival and reproduction
• Medical
• Health
• Rational
• Good life

14
Summary Arguments in Favour

• What matters is human well-being
• Essence of humanity is to choose to be better
• Parents/society interests
• Liberty to make own life
• Take seriously responsibility for outcome

15
Objections

• Personal harmful
• Spiritual - against the spirit of human activity
  or unnatural
• Social-unfair/unjust

16
1.Harmful

• Precautionary principle
• But also benefit to the child
• We have to weigh risks and benefits to the child
• Enhancements should be predicted to be in the
  childs best interests

17
Gamble

• Heads you win 50 tails you lose 60
• Heads you win 50 tails you lose 25
• Heads you win 50 tails you lose 1
• Change for
• years of extra life,
• Units of future well-being
• Gambling for your child

18
Objections

• Can be delayedBut in many cases enhancement will
  have to be performed at embryonic stage to be
  effectiveArgument applies to non-delayable
  enhancements
• Children are gifts
• Nature or God
• Applies to disease
• Alternative is rational choice

19
Other Objections

• Coercive
• Coercion does not exist where the status quo is
  available
• Conflict child parental and societal interests
• Expanding circle child, parent, society rules
  against enhancement
• Radical Skepticism about Value
• Relative to environment

20
Social consequences

• Positional vs non-positional goods
• Non-positional happy disposition
• Positional height
• But nothing is pure
• Argument does not apply to predominantly
  non-positional goods

21
Strongest objection Positional Goods

• The example of performance enhancement in sport
• Not purely positional excellence of performance

22
Enhancement in Sport

• In 1976, the East German swimming team won 11 out
  of 13 Olympic events.
• In the late 1990s Sports Illustrated reported a
  survey by Dr Robert Goldman of past and aspiring
  Olympians.
• Goldman asked athletes if they would take an
  imaginary banned drug if it was guaranteed that
  they would not be caught and that they could win.
  
• 195 said they would take it and only three said
  they would not.
• 50 even if fatal

23
Enhancement in sport

• In 1997 Dutch physician Michel Karsten, who
  claims to have prescribed anabolic steroids to
  hundreds of world-class athletes,
• "If you are especially gifted, you may win once,
  but from my experience you can't continue to win
  without drugs. The field is just too filled with
  drug users."

24
Enhancement in Sport

• Studies involving the anabolic steroid androgen
  showed that even in doses much lower than those
  used by athletes, muscular strength could be
  improved by 5-20
• Most athletes are also relatively unlikely to
  ever undergo testing. The International
  Association of Athletics Federations (IAAF)
  estimates that only 10-15 of participating
  athletes are tested in each major competition.

25
Undetectability

• EPO and growth hormone are natural chemicals in
  the body

26
Enhancement in Sport

• Obvious what the advantage is
• Irresistible
• Prohibition will fail alcohol, drugs,
  prostitution
• Ritalin, nicotine and caffeine in exams
• Value skepticism
• wrong

27
Enhancement in Sport

• Against the spirit of sport?
• Spirit of sport
• Test of ability/talent in a rule governed
  activity
• Change the spirit
• Human race vs animal race
• Musicians and beta blockers
• Human spirit
• To be better
• To lead better lives

28
Respect the Natural

• Nature machines for reproduction and
  reproductive survival
• What is so special about that?
• Image of God
• Should not alter what God has given us
• But what about those who do not believe in that
  God

29
Enhancement and the Human Spirit

• Enhancement does not necessarily involve cheating
  or failing to respect the spirit of fair
  competition
• If there is a spirit of humanity or human
  activity, whatever it is, some enhancements are
  compatible with this

30
Ethos of Sport

• Test of natural/genetic/biological variation
  (naturalistic)
• Plus environmental enhancement of biological
• High tech training
• Plus a human component of direct biological
  modification

31
Unfair?

• Nature is random and inegalitarian. Applies to
  diseases
• EPO
• Capacity of blood to carry oxygen
• The starkest example is the Finnish skier Eero
  Maentyranta. In 1964, he won 3 gold medals.
  Subsequently it was found he had a genetic
  mutation that meant that he naturally had
  40-50 more red blood cells than average.
• Physiology Safe level of 50
• 5 have a natural level higher than 50

32
Prevalence

• In 1998, the Festina team was expelled from the
  Tour de France after trainer Willy Voet was
  caught with 400 vials of performance-enhancing
  drugs
• The following year, the World Anti-Doping Agency
  (WADA) was established as a result of the
  scandal.
• However, EPO is extremely hard to detect and its
  use has continued.
• Italys Olympic anti-doping director observed in
  2003 that the amount of EPO sold in Italy
  outweighed the amount needed for sick people by a
  factor of six.

33
What Matters

• What matters is the level, not its origin
• Natural pregnancy, haemorrhage, disease
• Altitude training
• Autoinfusion
• Hypoxic air machine
• Enhancement corrects natural inequality in
  haematocrit
• More fair

34
Unfair Two tier World?

• The enhanced vs unenhanced
• Happened in evolution
• neanderthal
• Happens now US vs Bangladesh environ economics
  tech knowledge
• Response is not to prevent or lower dev but make
  it more avail
• Make global enhancement possible

35
Just for Rich?

• The cost of a hypoxic air machine and tent is
  around US7000.
• Epogen costs the athlete about US122 per month.
• Biological enhancement may be cheaper

36
Social justice

• Is an objection to enhancement just as it is an
  objection to maximally pursuing our interests in
  other ways, e.g private health care, private
  education
• It is not an objection special to enhancement
• Applies to training

37
Safety

• Only basic objection
• Taking GH and EPO to a certain level is safe (eg
  EPO at 50)
• Concentrate on testing for that level, not
  whether exogenous or endogenous
• Far from harming athletes, paradoxically such a
  proposal may protect our athletes.
• There would be more rigorous and regular
  evaluation of athletes health and fitness to
  perform.
• Moreover, the current incentive is to develop
  undetectable drugs, with little concern for
  safety.
• If safe performance enhancement drugs were
  permitted, there would be greater pressure to
  develop safe drugs.

38
Safety

• For many athletes, sport is not safe enough
  without drugs.
• Between 1985 and 1995, at least 121 U.S. athletes
  collapsed and died directly after or during a
  training session or competition most often
  because they had hypertrophic cardiomyopathy or
  heart malformations.
• The relatively high incidence of sudden cardiac
  death in young athletes has prompted the American
  Heart Association to recommend that all athletes
  undergo cardiac screening before being allowed to
  train or compete.

39
Test health not drugs

• In 1998, the president of the International
  Olympic Committee, Juan-Antonio Samaranch,
  suggested that athletes be allowed to use
  non-harmful performance-enhancing drugs
• Caffeine is now allowed in the olympics

40
Performance Enhancement in Sport

• Performance enhancement is not against the spirit
  of sport it is the spirit of sport.
• To choose to be better is to be human.
• Welfare should be paramount.
• But taking drugs is not necessarily cheating.
• The legalization of drugs in sport may be fairer
  and safer
• There is nothing wrong with an enhanced
  competition

41
Limits

• Safety
• Nature of activity
• Webbed feet or flippers in swimming
• Natural webbing
• Our choice

42
Advantages

• Clearer conception of the nature of the activity
  and consistency
• Environmental enhancement vs Biological
• Swimming skins
• Cf biological alteration of skin
• Body Shaving

43
Advantages

• Health of the athlete
• Require independent body that tests health of
  athletes and educates them
• Different as today
• Sports medicine doctors are committed to
  performance
• Independent bodies test for performance
  enhancement
• Coaches have strong incentive to enhance
  performance

44
Advantages

• Reduces harm of social construction of sport
• At least makes options safer and so better
• Cant choose to be an unenhanced athlete but
• Not clear you can choose that now
• The nature of sport is arbitrary
• Reducing freedom is a perilous way of improving
  peoples choices
• To be truly free we will make you unfree
• Other ways of improving option set
• Reward the unenhanced
• Respect, prize money
• Reduces cheating

45
Examples

• Food (e.g. glutamine), Caffeine, salbutamol
  already permitted
• Safe so tolerated
• Salbutamol would be a nightmare to regulate
• How would we prove someone did not have mild
  asthma
• Beta blockers, Growth hormone, EPO yes
• Steroids - no

46
Talent Prediction ACTN3

• AUD110
• Australian company Genetic Technologies will test
  a cheek swab for the R577X variant of the ACTN3
  gene.
• protein alpha-actinin-3, which helps to produce
  the fast-twitch muscles used in sprint and power
  sports.
• R577X variant is a common version of this gene
  which produces less of this protein.
• People with this variant therefore will grow less
  fast-twitch muscle tissue in their body.

47
ACTN3

• no copies of the R577X variant gene - sprints and
  power sports such as judo.
• two copies of this gene - long-distance or
  endurance sports.
• one copy of each variant will be positioned
  between these two extremes.

48
Reason

• Knowledge is power
• Selection of activity if performance is desired

49
Objections

• Skepticism about predictive value and abuse
• Unfair
• But already employ talent selection
• Closing childs future
• Punish child for parents faults
• Social construction of harm

50
The Future

• Will it be better or just disease-free?
• We need to shift our frame of reference from
  health to life enhancement
• What matters is how we live
• Technology can now improve that

51
Two options

• Intervention
• Treating disease
• Preventing disease
• Supraprevention of disease
• Protection of well-being
• Enhancement of well-being
• State of nature - no treatment or prevention of
  disease, no technological enhancement
• To be human is to strive to be better
• There is nothing intrinsically wrong with
  performance enhancement in sport
• The limits are up to us to choose

52
Reference

• J Savulescu, B Foddy, and M ClaytonWhy we should
  allow performance enhancing drugs in sportBr. J.
  Sports Med., Dec 2004 38 666 - 670.