An open doping market: Julian Savulescu versus The Inner Ring

>zie hier voor de Nederlandstalige versie van dit artikel<

Although the Netherlands is known for its liberal attitude towards the use of soft drugs arguments for liberalization of doping are quickly rejected today. Recently, cycling magazine De Muur gave it a try. Beautiful articles by Bert Wagendorp and Tim Krabbé brought quite a few elaborate arguments together. However, reactions were blunt and dismissive. "There is nothing, absolutely nothing romantic or mirrorhally to breaking your own health with syringes," NRC journalist Thijs Zonneveld sneered also on behalf of an audience on a different mission.

How different is this in the English-speaking world, where a much more nuanced discussion takes place. On the one hand, Oxford professor of bioethics Julian Savulescu (@juliansavulescu) explains in a number of different articles and interviews why an open doping market is better for athletes, the public and the sport. On the other hand, the very popular and well-informed blogger and twitterer The Inner Ring (@inrng, >25k followers) seriously responds to the arguments Savulescu, albeit with a deeply felt aversion toward doping. It is worthwile to elaborate the discussion point by point, to weigh pros and cons and to collect remaining questions.

Health and Safety 

Savulescu: Many performance-enhancing drugs are not harmful in themselves. Lance Armstrong took drug cocktails in quantities that have improved performance without affecting his health. The risk lies in experimenting without medical supervision. In an open drug market, however, the use of performance enhancing drugs is supervisedand only agents that are safe are allowed. Regulated use of growth hormones, anabolic steroids and EPO should be allowed. Substances that corrupt the nature of a particular sport, such as analgesics and anxiolytics in boxing should be banned. The search for the safe dosage of admitted substances is exactly what will happen in an open drug market. Moreover, there will be more pressure to create safer drugs.

The Inner Ring: Most doping substances are banned for a reason. Take too many hormones and you run greater risk of cancer or heart disease. This type of risk is culturally accepted much less than for example the risk of descending an Alp. Growth hormones are regulated medicines that come with health warnings, even normal dosages for standard use are normally reserved for those with a clinical need. Moreover, there is no guarantee that doping will only be medically administered in an open market. Athletes will still break rules if they can gain an advantage, only are we no longer able to distinguish mega doses of EPO from regulated use, because everyone can say that he is under medical supervision. This way cortisone were abused with a medical prescription for saddle pain.

In Het Rood: Paradoxically, an open market seems to bring more gain than loss of health. Athletes will be medically assisted and doctors will consult their literature and peers. Substances that are harmful in themselves (eg because of their side effects) remain prohibited. Megadoses EPO are impossible if monitored on treshold values. Savulescu - Inner Ring 1-0

Tresholds

Savulescu: There is a limit: safety. There should be no deaths. But instead of testing for drugs, we should focus more on health and fitness. Not testing for EPO, but on hematocrit value. A level of, say 50%, is not a problem. Higher levels are dangerous. This is different from anabolic steroids, which are harmful in themselves (Note: Savulescu is more reserved about steroids in his earlier publications than in later).

The Inner Ring: The hematocrit test has never worked. Once the testers appeared, riders would infuse liquids to temporarily dilute the blood and thus score 49.9% in time for the blood test. 50% never was the ceiling for one's own health, it was a minimum for competition. Then it's just a highway: what is meant to be the maximum speed directly turns into the cruising speed.

In Het Rood: Enforceability of doping rules is one of the biggest problems in a number of contemporary sports. Even if one agrees on a hematocrit limit of 50%, then the problem remains that it is difficult to strictly control. So, Savulescu - Inner Ring 1-1. But there is a difference. Testing hematocrit can be much cheaper, so often, unexpectedly and prior to the course. Threshold policy is better to maintain. Savulescu - Inner Ring 2-1.

Availability

Savulescu: Whether physicians will be willing to prescribe performance-enhancing drugs to fit athletes depends on how much they are getting paid. Many teams have enough money. Physicians should also realize that they can protect athletes from shopping on the black market. They have a moral obligation to deliver doping services, even if they are personally opposed to it.

The Inner Ring: Medications are available for sick people and a doctor cannot prescribe to a healthy person. By the same token is the use of drugs more regulated than of any other type of product. Moreover, there are differences between countries. What if athletes in one country can buy products that are not permitted by the drug authorities in another?

In Het Rood: Medication for human enhancement is a controversial topic. Elite athletes are frontrunners. It is difficult to see that physicians now have a moral duty to doping services. Savulescu - Inner Ring 2-2. By the way, differences between country are smaller than Inner Ring represents. European countries have a joint Drug authority, the EMA, which collaborates a lot with the U.S. FDA. Furthermore, liberalisation obviously presupposes that doping authorities make arrangements with drug authorities on how and where permitted substances are  available for athletes.

Criminalization

Savulescu: The legalization of drugs is the most effective way to reduce the involvement of organized crime in the drug market. We should learn from experience with the prohibition of prostitution, alcohol, abortion or recreational drugs. The best way to handle it is legalization, supervision, regulation, monitoring and prevention and reduction of harm.

The Inner Ring: Doping is different than alcohol or soft drugs. It's not that you have a glass of beer or wine to drink, the point of doping in sport is that you want to be better than the other, so you use more than others. Therefore, some athletes will consult regular doctors, but others continue to seek shadowy ones who want to give them mega doses. If someone gets one syringe, another wants a double and in no time  you'll be back at the health risks, but now you have sacrificed the testing regime for detection.

In Het Rood: Production and trade of many doping products takes place in the criminal world and are uncontrollable. Liberalisation can significantly reduce that. Checks on threshold values should avoid that limits are exceeded. But even those who exceed limits will no longer be dependent on the criminal production and trade. Savulescu - Inner Ring 3-2.

Enforceability

Savulescu: The fight against doping will fail. The potential benefit to athletes is enormous and the chances of getting caught are quite small. You can demand from sports that they are free from doping, but that's just not realistic. The current rules may be perfect for angels, but they are not for human beings. I therefore call for the 'second best' option: an open market for doping.

The Inner Ring: Let's not pretend that we can eradicate doping, but control can help limit excesses. It reduces the margins for cheating, protects the health and contains scandals that undermine the sport. Instead of allowing doping one should probably test more and more often on more riders to protect the peloton.

In Het Rood: Lack of enforceability is the main premise of Savulescu, more tests will not solve the problem. Doping users will always be a step ahead of hunters in their inventiveness. Whether he is right remains to be seen. Penalties are higher now and many believe it is indeed hardly possible to take drugs. Are they right? This point remains undecided.

Fairness 

Savulescu: There is no difference between upgrading hematocrit by altitude, oxygen tent or EPO. Only the latter is prohibited. Some are lucky to have a high hematocrit value of themselves. Others can afford an oxygen tent or altitude training. Is that fair? Nature is unfair. Ian Thorpe had big feet. An open doping market actually decreases inequality because EPO is much cheaper.

The Inner Ring: No comments.

Natural values ​​

Savulescu: Fair play, health, competition, spectacle and testing physical and mental perfection are all values ​​that are consistent with the liberal approach to performance-enhancing drugs. The only obstacle is an outdated attachment to nature and worship of pure, natural talent. But should we, in the name of nature, continue ruining careers, health damage, cheating and organized crime, while in other areas we already permit ourselves to enhance our own nature with training, diets, supplements and equipment? Human enhancement is a project that we have already begun.

The Inner Ring: Take two people, one with a natural hematocrit of 37% and another with a higher value of 45% and a limit set at 50%. The first may use much more EPO. Genetic differences are not less, but rather greater.

In Het Rood: Due to liberalization of EPO up to a certain treshold unfair genetic differences are eliminated. Plenty of natural differences remain for an exciting race: body height, weight, explosiveness, nervousness, etc. But where we are capable of restoring the unfairness of nature, we have a duty to do so. As long as no one can tell why the value of nature is a decisive argument, it can be better put between parentheses. Savulescu - Inner Ring 4-2.

Money as a factor 

Savulescu: Especially in a closed market doping rich teams can buy the last non-detectable substances and escape positive controls. In 2004 an oxygen tent cost U.S. $ 7000, while an EPO treatment cost approximately U.S. $ 122 per month. Moreover, the cost of an EPO test multiplies the much simpler hematocrit test. The savings liberalization yields could be used for grants for poorer athletes.

The Inner Ring: Allowing supervised use of some substances and methods is not so simple. It can be a financial matter where to get the best advice and products. Consider the USADA report showing that U.S. Postal / Discovery had much more money to spend than other teams.

In Het Rood: If 100% doping free would be a realistic future, it would indeed be a costly one, but one in which no individual athlete had to spend a penny to doping. But because this future is not realistic, there are differences. These differences are very large as long as monopolists like Fuentes and Matschiner reign. They can ask what they want and that still does not include travel expenses to and from the labs. Liberalisation will level these differences. You will buy your products at the pharmacy around the corner. Savulescu - Inner Ring 5-2.

Spectators

Savulescu: With or without doping, sports performance remain dependent on human strength and weakness. Willpower, courage, determination and tactics remain decisive. To reach the top of a mountain just remains a huge physical challenge.

The Inner Ring: Until today the audience wonders how riders withstand rain, heat and long distances. But if it believes the answer can be found in a syringe with epo, then there is a good chance that they do not watch the race. The spectacle disappears when the riders change into characters in a computer game with many lives and endless energy re-ups.

In Het Rood: The problem of the past 10 years was not that we are watching characters in computer games, but whether we can assume that the person who first crosses the line is indeed the regular winner. Imagine two competitions, one without and one with doping. Which one would you watch? In my subjective opinion it would be a battle of preparation, character, willpower and tactics in both cases. Perhaps the doping competition would be more attacking, which pleas for liberalization. What is your opinion?

Amateurs and youth 

Savulescu: It is clear that children who are not able to reject potentially harmful agents should not get them from their coaches or parents. But according to the same principles children should not be allowed in elite sports in the first place. That raises the same ethical problem: the choice of a child restricts his/her options for a future career and lifestyle. Children who practice sports miss a lot of education and socialization and are subjected to great psychological pressure at an age when they cannot cope with that yet. But if children are still being allowed to train as professional athletes, then the same means should be allowed, provided that they are not more dangerous than the training itself is.

The Inner Ring: No comments.

Genetic doping 

Savulescu: Genetic doping must currently be prohibited because it fundamentally changes the balance and that makes sport uninteresting. Permitted substances enhance the qualities of an athlete, they do not change them.

The Inner Ring: No comments.

Doping confessions

Savulescu: We can never fully determine who has or has not used doping in the past. In those circumstances it is fairer to leave teh past behind.

The Inner Ring: No response.

Conclusion

The discussion brings quite a few arguments together. In the Dutch language this was not yet done, with the possible exception of the more prosaic The spirit of sport by Tim Krabbé. My conclusion is that there are more arguments pro liberalization than against, reflected by the score of 5-2 in favor of Savulescu. However, there is also a number of arguments which The Inner Ring has not responded to. 5-2 is a half time score.