1 What is doping?
In view of the increased priority given to the fight against doping since 1999 both by governments and sporting authorities, one might be forgiven for believing that there exists a clear definition of what doping is. This is not, however, the case, as can be seen from the evident pragmatism of the (circular) definition used by the World Anti-Doping Agency (WADA): ‘Doping is defined as the occurrence of one or more of the anti-doping rule violations set out in Article 2.1 through Article 2.8 of the Code’ (WADA 2003: 8). Doping is simply defined as infringement of WADA’s doping regulations. In other words, doping is whatever WADA at any moment assesses it to be.
On the basis of a definition that is void of content, the rules of doping risk taking on an entirely random character. This WADA has accepted, presumably driven by the concern that any attempt to be more specific as regards the content of their definition of doping would either render it too narrow or too broad. If, for example, doping was defined as ‘the use of artificially produced performance-enhancing substances’, anabolic steroids, EPO and suchlike would be prohibited but not doping by using the performer’s own blood or by chewing the coca leaf. If, on the other hand, it was defined broadly as ‘all performance-enhancing substances’, then the definition would include blood-doping and coca leaf chewing – but to them would have to be added hitherto accepted energy boosters such as chocolate, cola and energy bars, which athletes consume to prevent them collapsing during long-term physical exertion.
There are perhaps those who will claim that an energy bar is not a performance-enhancing substance, since it simply contributes to the maintenance of blood sugar levels, or in other words keeps the body in balance. But the same argument could be used to defend giving athletes testosterone. For example, it could be argued that a sporting event such as the Tour de France is an activity that causes physical degeneration, and since strenuous branches of sport are not prohibited, the least those in charge can do is to keep an eye on the athlete’s health and if, for example, their testosterone level falls, offer them a compensatory dose that carries no risk.
WADA avoids having to take issue with this kind of reasoning by choosing a vacuous definition of doping. In so doing, they have forearmed themselves against such difficulties as the Council of Europe created for itself in its 1963 ruling that doping was:
the administration to or the use by, a competing athlete of any substance foreign to the body or any physiological substance taken in abnormal quantity or by an abnormal route of entry into the body, with the sole intention of increasing in an artificial and unfair manner his performance in competition.
(Houlihan 1999: 130)
This formulation contains glaring difficulties. It could, for example, never be proved that a substance was consumed with the sole purpose of increasing a level of performance; and it would take lengthy disputes to reach agreement as to how much of a substance could be consumed before it constituted an abnormal quantity. That the wording takes no account of this kind of objection is probably due to the fact that the author relied on common sense and trusted that the reader, whether it be policy-makers, administrators or athletes, would approach the text with the intention of understanding it. Read in the spirit in which it was intended, the wording is clear enough. Experience tells us, however, that if athletes can gain advantage by turning a blind eye to the spirit of the law and clinging to its letter, they will be inclined to do so. Nor was it many years before the council recognised the shortcomings of this wording. In 1967, there was an attempt to make it more precise. Some of the glaring ambiguities were removed, but others remained and new ones arose. For example, doping was now said to be ‘administration to or use by a healthy person, in any matter whatsoever, of agents foreign to the organism’ (ibid.: 130f). But what does it actually mean for a substance to be foreign to the organism? And is it acceptable for people who are not healthy to consume performance-enhancing substances? In that case many athletes will be ‘home safe’, if the WHO’s authoritative definition of health is used as the basis for a judgement, since it presents health as a state of complete physical, psychological and social well-being and not as simply absence of sickness (WHO [1946] 1948). On this basis, athletes unable to take part in competitions without medical aids would be able to invoke the right to take medication simply because they felt hard-done-by.
It looks as though Charles Dubin, who headed the Canadian investigation into doping in sport launched after the Ben Johnson case, was right when in his report he quoted Sir Arthur Porritt, chairman of the British Association of Sports Medicine for saying that ‘to define doping is, if not impossible, at best extremely difficult’ (Dubin 1990: 77f). Nevertheless, it is questionable whether he was right in quoting the rest of the sentence and the next: ‘and yet, everyone who takes part in competitive sport or who administers it knows exactly what it means. The definition lies not in words but in integrity of character’ (ibid.: 78).
There is presumably agreement among practitioners of sport that athletes’ use of potent substances such as amphetamine, anabolic steroids, growth hormones and EPO are to be regarded as doping. But in the absence of a definitive doping list as a reference point, there can scarcely be unanimous agreement as to the range of substances and methods that should constitute doping. The use of creatine has been debated for a long time, but has not been included in the doping list despite several studies indicating that it has a performance-enhancing effect (Jäger et al. 2008). Some will also continue to believe that caffeine is a doping substance, since it, too, has been proved to be performance-enhancing (Paluska 2003). The fact that it has been removed from the doping list can, however, only mean that other people must have provided sufficiently convincing arguments for it not being a doping substance. Perhaps it has been argued that although it can improve athletic performance, it has no harmful side-effects so long as the substance is not consumed in larger quantities than required to produce the desired effect. At first glance, this argument may appear convincing but it brings with it the problem that this goes for many of the substances on the prohibited list. A number of debatable substances and methods could be mentioned. There is no consensus, for example, as to whether the use of hypobaric chambers is an acceptable performance-enhancing practice. At the WADA Congress in Montreal in 2006, it was decided that their use should continue to be accepted but it is not obvious why. And nothing in the minutes of the executive committee meeting advances our understanding. On the contrary, at the meeting it was confirmed that the hypoxic devices are performance-enhancing. It was also stated ‘that such devices might be dangerous in the hands of unqualified people’. It is true, it was determined that ‘properly used under proper supervision’, there was no basis for saying that they induced health risks. But the same could also be said about the medicine, erythropoietin (EPO), which is used for the same purpose as hypobaric chambers. Furthermore, the matter had gone to WADA’s Ethical Issues Review Panel, which, it held, ‘had determined that these devices were against the spirit of sport’ (WADA 2006: 38). Despite this, WADA approved their use. This example is yet further evidence that Dubin’s claim that there exists unanimity on the subject of the concept of doping does not hold. But this is of no consequence, since the way WADA has chosen to address the question means that the organisation can adjust its rules at will.
WADA does have, however, a moral obligation to ensure that doping rules are reasonable. If the reasonableness of the organisation’s measures and methods is called into question, there is the danger that the support of athletes and the authorities will be eroded with serious consequences for the fight against doping. It makes sense then to consider whether WADA should operate with a more substantial definition than that presented in the anti-doping code, so that the fight against doping can be carried out more in accordance with good sense.
If, however, an adequate definition of doping cannot be formulated as an official basis for anti-doping work, there will not be much likelihood of providing a definition stringent enough to consolidate the efforts of those working within the sport. It is more probable that new initiatives will be coordinated according to the particular form of reasoning prevailing in the narrow community of anti-doping officialdom, reasoning that cannot avoid being coloured by the task that that particular community centres on and regards as being of importance or relevance. In other words, those working in the field of anti-doping develop a structure of relevance that is at variance with everyday common sense. It can be assumed that this has contributed to the fact that the offspring of the IOC, WADA, which in its infancy was the darling of all the forces for good, has found itself running into a number of ‘unfortunate’ cases (see Chapter 5).
The root of the difficulties that the anti-doping campaign has to wrestle with remains precisely because the concept of doping has not been sufficiently clarified. This becomes further apparent as soon as the concept is studied more closely.
Doping, medicine and health
Doping substances are primarily forms of medicine taken for their potential performance-enhancing effect. Athletes can legitimately take doping drugs without being guilty of a doping offence. Several, for example – especially in the field of endurance sports – suffer from exertion-induced asthma.1 They can be given dispensation to use medicine on the doping list. It is true that WADA tightened up the rules in 2005 so that the old medical certificate can no longer be used. Today a Therapeutic Use Exemption (TUE) certificate is needed. The stiffer rules mean that permission does not give carte blanche to use any medicine needed if it appears on the doping list. On the application form the athlete has to declare the dose of administration, the route of administration, the frequency of administration as well as the length of time the treatment is expected to continue. If an athlete with a TUE certificate tests positive for medicine that he or she has a dispensation to use, then tests are carried out to see whether the content of active substances in the blood corresponds to the dose required by the treatment. If the athlete has taken more than prescribed, then this is regarded as a contravention of the doping rules and is treated as such. Behind such decisions lies, of course, WADA’s desire not to discriminate against individuals who do suffer from an illness. Necessary medication is regarded as a means to compensate for a physical handicap in order that the ill person can compete on an equal footing. On the other hand, it should not be possible for athletes to exploit their legitimate need for treatment to acquire a competitive advantage. For that reason the quantity of active substances contained in the body is regulated. This appears to be logical. Nevertheless the very fact that an opportunity for dispensation exists raises at least one significant question.
One of the central pillars of anti-doping work is consideration for the health of the athlete, and one reason for prohibiting the intake of performance-enhancing substances (and of substances that can mask their use) is to protect the athletes. Nevertheless, it is a feature of much sporting activity that it involves a relatively high risk for its practitioners. Torn ligaments, damage to muscles and menisci, broken fingers, arms, legs and backs, concussion and death are regular occurrences in the sporting arena. The only way to eliminate this risk would be to prohibit the great majority of sports, and that is not realistic. On the other hand, it is possible to tighten up the safety requirements. This has been done in a number of areas. Restrictions have been introduced in boxing over the course of time such as limits on the length of the fight, requirements to use gloves, gum-shields, and in amateur circles the obligatory use of a helmet – a precaution that, by the way, no evidence suggests has remedied the risk of brain damage (Zetterberg et al. 2007). Cyclists have also been required to wear helmets, and footballers have had to get used to playing with shin-guards. Rules of this kind have been introduced to limit the risk of athletes being subjected to physical damage. The prohibition of doping can be seen as yet one more rule added to the list of those whose purpose is to protect the health of the athlete. It is just not, however, quite that simple. For while it is easy enough to argue for the expediency of shin-guards, helmets, gum-shields and gloves as measures promoting health even though the outcome may be debatable, the same cannot be said to be true of the prohibition against doping. Anyone wanting to argue for doping prohibition on the grounds of health alone is only on firm ground as long as the premise holds that doping damages health. And this is not always the case. As a rule, the substances that athletes dope themselves with are forms of medicine developed to improve human health.
Athletes are, of course, gambling with health if they take courses of EPO that raise their haematocrit level to around 60 per cent, at which point their blood becomes so thick that they have to take supplementary anti-coagulant medicine to reduce the risk of blood clotting. It is less obvious why ephedrine should appear on the doping list. Ephedrine can be found in cough mixtures that doctors have been prescribing for runny-nosed children for years. It is hard to see the rationale on health grounds for allowing athletes to feed ephedrine to their children but not allowing them to take it themselves if they catch the same cold. The argument that ephedrine in exceptionally high doses can damage health immediately falls apart in the face of the fact that the same is true for permitted substances such as painkillers. And just as relatively few of them are needed to achieve the desired effect, so the doses of ephedrine needed to cause a positive doping test are not such that they constitute a significant danger to health (Ros et al. 1999). On the other hand and rather ironically, it seems that larger doses of ephedrine do not have a positive effect on exercise performance (Dekhuijzen et al. 1999).
Nor can the health argument be used to counter viewpoints along the lines that it is precisely in the interest of their health that athletes should be allowed to take supplements of those substances that sporting competitions have drained out of them. The argument that, faced with such a deficit, athletes should give up their competition and go home to recover in a natural manner is somewhat divorced from reality and is no real defence in terms of health-related counteractions. Ambitious sportspeople do not give up competing because they feel themselves to be drained physically. If they are law-abiding citizens, they try to recharge their batteries through legal means, by using energy bars, vitamin supplements, and so on. If that does not work, they keep on going anyway as long as they can. In the past, countless athletes have entered competitions despite physical discomfort or sickness. If there was a serious consensus that those who are not physically on top form should be excluded, then the necessary consequence would be to carry out obligatory health checks at regular intervals on all participants in tournaments and races of longer duration as a supplement to doping tests. Proposals for preventative health checks on a regular basis have, however, never been presented by sports organisations. The international cycling union (UCI) undertakes a health test prior to a major race, but in reality this is an indirect doping test, whose purpose is to check that every cyclist’s hematocrit is below 50 per cent. If it is not, then the cyclist involved is regarded as being ill and, as a means of protecting his or her health, is grounded for 15 days (UCI Cycling Regulations, Part 13, Sporting Safety and Conditions, {§}4, no. 13.1.086). As a rule, it is up to the individual athlete to assess whether they are in a fit state to take part in a competition or whether to continue if they have fallen, have been hit or are in crisis. One of the most grotesque examples seen in recent years of the degree to which the athlete’s ‘right to self-determination’ is respected was when the Swiss runner Gabriela Anderson-Schiess in a state of almost lethal dehydration teetered unconscious and crippled by exhaustion across the finishing line during the marathon at the Olympic Games in Los Angeles in 1984. Yet no one stepped in to stop this internationally televised madness.
A boxer in an equivalent state would not have been allowed to continue, though otherwise the individual boxer is also regarded to a considerable extent as responsible for his own health. If the referee steps in and stops the fight, it is on the basis of an assessment that the boxer who has been hit is punch-drunk, has momentarily lost his power of judgement and is therefore no longer in a position to take care of his own health. If, on the other hand, the boxer is only shaken, it is up to him to decide whether he wishes to continue regardless of the fact that experience indicates that this is a situation in which the risk of being knocked out is imminent, and his ability to decide what is best for him is disturbed.
Consideration for the health of athletes is compromised in any number of sports. It applies, for example, when athletes take a knock and let themselves be given a superficial treatment with pain-killing ice spray, so they can quickly get on with the game; or when because of an injury they are not entirely match-ready but agree to play an important game with the aid of a pain-killing injection; or when they reduce a high temperature by taking Paracetamol and so get to play a match, when other people would go to bed or take things easy. It cannot be denied that the use of ice spray, injections and Paracetamol in these contexts is intended to improve the athlete’s performance ability in situ. Nor that it overrides concerns about health. But it is nevertheless not regarded as doping.
Nor is it seen as such when an athlete suffers torments to lose weight, whether it be by sweating it out in a sauna or by following a strict diet, possibly using slimming medication not on the doping list. It is particularly true of endurance sports that athletes are often extremely concerned with getting their weight down as far as possible without it affecting their performance level, because every superfluous kilo that has to be carried reduces the chance of success. In his autobiography, the Danish cyclist, Brian Holm, writes that from having weighed 80 kg during his first years as a professional in the 1980s he ended up weighing 67 kg in the 1990s when he earned his way as a valued support rider and among other things contributed to the Tour de France victory of his countryman, Bjarne Riis, on Team Deutsche Telekom in 1996. With hindsight, Holm can see that his weight was too low during the final years of his career, but, as he writes:
Unfortunately I followed the trend in becoming extremely thin because I simply believed that that made me into a better cyclist. It became natural for me to go to bed hungry every evening and to wake in the night because my stomach rumbled with hunger. I got up and ate cornflakes without milk in order to get some more sleep. It almost became an obsession to be thin. When people told me that I looked like a concentration camp victim, I took it as a compliment and was almost proud of it. At one point I even had veins on my buttocks. But my body could not really function without a little layer of fat, and it began to deteriorate because its immune system was no longer on top form.
(Holm 2002: 98)
A body that has virtually no fat has less resistance than it would have with a normal weight. But being as lean as a racing greyhound gives a competitive advantage. Abnormal thinness, therefore, places an indirect pressure on competitors. If they do not want to take part with a handicap, then it is equally incumbent on them to reduce their amount of body fat to a competitive level.
If considerations of health were just as important for the integrity of sport as defenders of doping prohibitions like to maintain, we might expect the campaign against slimming to excess to have the same priority as the campaign against doping. In relation to WADA’s definition of doping, there is nothing to stop methods used for losing weight being included in anti-doping regulation. What is more, unhealthy forms of extreme dieting would be easier to put a stop to than other doping methods, since one could simply introduce a weight limit in the same way as we now operate with a blood density limit.
If, for instance, a Tour de France cyclist presents himself below a certain specified weight at the start of the race,2 he could be subject to a penalty weight, which would in one fell swoop eliminate any advantage accrued through unhealthy low weight. In spite of the fact that it is well known that extreme dieting leads in some cases to athletes developing anorexia, the practice remains unregulated. This is just another example of the fact that, although one of the mainstays of doping work is concern for health, it is not possible to formulate a consistent definition of doping by focusing on a phenomenon’s risk to health. On the one hand, to attempt to do so would create considerable problems in isolating the methods and substances that should be regarded as being harmful to health and therefore prohibited. On the other, it would pave the way for a whole range of marginal cases and disputes with athletes who had their doctor’s certification that their particular use of medication was in the interests of their health.
We can, then, conclude that a doping p...
