Thinking About Performance-Enhancing Drugs

Mark Sisson is a Malibu-based former elite marathoner and triathlete who became well-known in athletic circles as an expert on drug testing for athletes while serving for 13 years as the anti-doping and drug-testing chairman of the International Triathlon Union and as the union’s liaison to the International Olympic Committee.

In a provocative letter to his friend Art DeVany, Sisson talks about drug-testing for athletes and makes some interesting observations:

At the risk of sounding a bit brazen, I would suggest to you and your audience that sport would be better off allowing athletes to make their own personal decisions regarding the use of so-called “banned substances” and leaving the federations and the IOC out of it entirely. (Even the term “banned substance” has a negative connotation, since most of these substances are actually drugs that were developed to enhance health in the general population). Bottom line: the whole notion of drug-testing in sports is far more complex than even the media make it out to be. [. . .]

The performance requirements set by the federations at the elite level of sport almost demand access to certain “banned substances” in order to assure the health and vitality of the athlete throughout his or her career and – more importantly – into his or her life after competition. . . . World class athletes tend to die significantly younger than you would predict from heart disease, cancer, diabetes and early-onset dementia. They also typically suffer premature joint deterioration from the years of pounding, and most endurance athletes look like hell from the years of oxidative damage that has overwhelmed their feeble antioxidant systems.

Most people don’t realize it, but training at the elite level is actually the antithesis of a healthy lifestyle. The definition of peak fitness means that you are constantly at or near a state of physical breakdown. As a peak performer on a world stage, you have done more work than anyone else, but you have paid a price.

It is again ironic that the professional leagues and the IOC — the ones who dangle that carrot of millions of dollars in salary or gold-medalist endorsements — are the same ones who actually created this overtrained, injured and beat-up army of young people. They don’t care. These organizations then deny the athletes the very same drugs and even some natural “health-enhancing” substances that the rest of society can easily receive whenever they feel the least bit uncomfortable. [. . .]

I believe that with proper supervision, athletes could be healthier and have longer careers (not to mention longer and more productive post-competition lives) using many of these “banned substances.” And perhaps the biggest assumption I will make here is that the public just doesn’t care. Professional sport has become theater. All the public wants is a good show and an occasional world record.

As I noted earlier with regard to Barry Bonds’ use of steroids, management of professional sports has not done a good job of drawing the line with regard to what should constitute illegal use of drugs, on one hand, and legal performance-enhancing substances that are beneficial to the health of the athletes, on the other.

As a result, the league rules (as well as our nation’s laws) governing which substances are legal and illegal are often arbitrary and hypocritical.

Indeed, professional sports teams (as well as their fans) often encourage their players to risk their health. Players who “play with pain” are the subject of adulation in all levels of sport, as are players who risk injury by running into walls, taking cortisone shots to be able to perform with reduced pain and undergoing risky surgeries to lessen pain in order to play in a big game (remember Curt Schilling in the 2004 World Series?).

The difference between a professional athlete taking pain-reducing drugs to get through a season and another athlete using performance-enhancing drugs in an attempt to be more productive during a season is not as wide as it may appear at first glance.

4 thoughts on “Thinking About Performance-Enhancing Drugs

  1. Tom you state that the rules are hypocritical and arbitrary. Almost all rules are arbitrary by nature. There have to be cut off lines. As far as hypocritical ñ I donít see the falseness of the banned substance rules. There may be problems with enforcement, but I donít see a conscious pattern of deception by the administrators.
    I also believe there is a HUGE distinction between drugs for pain relief and the use of illegal anabolics for enhanced performance. There is a difference between using morphine to relieve the pain of a myocardial infarction and the recreational use of morphine on the street. There is a huge difference between my prescriptions for dextroamphetamine for ADHD children, and the use of speed in professional athletes.
    The difference is basic ñ medical use, and street abuse.
    It is true the use of a pain killer or a corticosteroid can reduce pain and inflammation, thus enhancing performance in an athlete. That is an accepted and traditional medical use, prescribed by a professional (a physician), who has successfully completed a high level of training, has experience in the use of these drugs and treatments, and is monitored in the professional use of them.
    The use of a performance enhancing anabolic substance by an athlete is not at all clinical. Ascertainment of the drug is by statute, illegal. Street venders, drug dealers, and people who buy these in Mexico are not trained professionals. Their use is to generally enhance the contractile efficiency or power of skeletal muscle thus producing more power or speed, and not the relief of pain or disability. Other drugs can increase stamina, concentration, oxygen carrying capacity of the blood, or other physiological alterations to give the cheater AN EDGE over the competition.
    To say the medical use of a substance is close to the anabolic (performance enhancing) use is like saying vigilante justice is equal to the legal system in settling disputes and meting out justice. Although both aim for justice, it just aint so.
    🙂

  2. Gary, the point is not that illegal drug use is the same as the club’s legal use of medicine to treat injuries legitimately. The point is that the clubs’ use of certain drugs on players to allow them to perform for the club’s benefit — while preventing the players access to other drugs that might help the player perform for the club’s benefit — is hypocritical and leads to poor policy decisions.
    You attempt to paint bright lines between legal and illegal drug use when those lines are, at best, blurred. You state that there is a “huge difference” between prescribing cortisone to allow an injured player to perform and prescribing a steroid so that the player might not break down in the first place. In reality, the difference is far less than you suggest.
    Similarly, the history of professional sports is rife with examples of teams giving injured players “legal” drugs for the purpose of allowing the player to perform despite the injury. Not infrequently, the result has been that a player’s career has been shortened by the expectation that the player should “play through the pain” rather than allow the injury to heal properly.
    Finally, your argument regarding the difference between prescription of legal drugs and use of steet drugs is a canard. Of course, use of legal drugs prescribed by a professional is superior policy, but the street use of drugs is simply the inevitable black market result of regulation. As you know, many steroids are perfectly legal when prescribed by a professional for a legitimate use, such as treating an injury or — heaven bid — attempting to prevent one.

  3. Thanks for clarifying the point, Tom.
    Tom, you are correct in saying that I am painting bright lines when the lines are blurred. Every day I inform families about blurred lines. Every day millions of medical decisions are ‘judgements’ are based on the preponderence of the data, rather than clear cut data. However, the aim is to make crystal clear policy, benefits, and risks of drugs.
    I also agree with you on the blur between management’s use of some drugs (and proceedures) that are dangerous to an athletes health, and the athletes use of dangerous anabolics.
    However, my overall point would be to continue to use the medical profession in these issues. Wheras an individual physician may not be right, at least records are kept, and the physician is using the drugs (or proceedures) in the bright light of scientific and public scrutany, unlike the shadowy world of illicit drug dealers, and ‘street trainers’.
    I have thought about a world where these drugs would be legal for enhancement of performance. Then the medical community would be able to monitor the effects and the side effects.
    Of course there is always going to be a black market for these drugs. Even if legal, some athletes are going to use much higher doses than ‘approved’.

  4. BTW, For those reading this, Tom and I agree on 97% of issues, and he is wrong on the other 3% 🙂 I like the word ‘canard’ but I don’t think my position is a canard (or a false position).
    Street use is always present based on a multitude of factors (cost, access, legality, even convience). Street use of steroids is dangerous…these are drugs that penetrate into the nucleus of the cell, effecting changes at a DNA level. Oiy Vey!

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