PERFORMANCE enhancement is an obsession in professional sports given that there are considerable rewards on offer — monetary and otherwise — for athletes who outperform their opponents.
Indeed, some have described the pursuit of ever-higher athletic achievement as the “essence of sport” itself.
Facilitating performance enhancement is also a core component of modern sports medicine alongside injury prevention and treatment.
Sports doctors have been commonplace within elite professional sporting teams for years and a growing number of other experts — sports scientists, exercise physiologists, psychologists and dietitians — are also often employed to ensure that athletes are better than simply “fit and healthy”.
This mandate, and the desire to constantly have an edge on opponents, means that the number of performance-enhancing interventions, innovations and technologies introduced into elite sports has proliferated.
Although some of these methods may be more scientifically sound than others, how do athletes know if they are putting themselves in harm’s way without any reasonable prospect of benefit?
Take for example the use of Actovegin (calves’ blood) injections by athletes hoping to recover from injuries more rapidly. Former National Rugby League player Matt Orford described experimenting with the procedure for his injured groin in 2008 despite being unsure about the effects: “… I don't think there was any true fact or anything behind it. … They were searching for something just to help me get onto the park. … I didn’t know anything about it. That’s why I was always sceptical. And I’m sure the doctor would be along the same lines as me. There wasn’t enough info behind it to show it would have a positive result on injury-based causes and speed your recovery.”
In an article published in Philosophy, Ethics, and Humanities in Medicine, British bioethicist Silvia Camporesi and philosopher Michael McNamee argue that many athletes are essentially vulnerable research subjects and the growing translation of innovations directly into athletic environments for performance enhancement amounts to unregulated clinical research.
Widespread doping within professional cycling is, of course, an archetype but there are other examples closer to home that speak to the view of Camporesi and McNamee.
For instance, we know that many professional football teams in Australia across several codes have implemented elaborate supplementation programs for their players over several years, some more “elaborate” than others. The Switkowski report into the Essendon football club’s program found “a disturbing picture of a pharmacologically experimental environment never adequately controlled or challenged or documented”.
Much discussion has focused on whether any substances taken by these players were banned by the World Anti-Doping Agency (WADA) Code.
Regardless, this situation raises uncomfortable questions about whether the normal protections afforded to research subjects were in place for these athletes. As with those who make a living out of participating in Phase 1 pharmacology trials (so-called professional human guinea pigs), the use of performance enhancers in the sporting world raises issues of voluntariness, undue influence, full disclosure, equitable subject selection and conflicts of interest.
For athletes, there is actually very little transparency about the safety and effectiveness of many performance-enhancing drugs and methods (which may or may not be banned by the WADA) because they are untested for performance-enhancing purposes.
It’s not particularly sound science to infer that a drug or supplement may be a performance enhancer in elite athletes by simply translating its observed effects in clinical or non-athletic populations. Assessing the actual risks and benefits in athletes is complicated further if a cocktail of purported enhancers is being taken.
Camporesi and McNamee suggest the need for a framework to establish claims about performance enhancement and risks to health. Perhaps greater transparency and visibility will encourage more compliance with the WADA Code and reduce the incentive to treat athletes as guinea pigs.
This system could also serve to justify the inclusion of substances and methods on the WADA Prohibited List.
It would be impractical and costly to conduct controlled trials on all potential performance enhancers and unfair to require the WADA to have such data before passing judgement on a substance.
It is also not clear that “enhancement trials” can be ethically justified given that there is an inherent absence of any health-related goal. But there is still considerable scope for the WADA to provide clearer explanations for why it takes a precautionary approach by banning some substances.
Some professional athletes are certainly well compensated for their efforts but that doesn’t mean they can’t be vulnerable to exploitation.
Common problems encountered in research ethics may be exacerbated when translated into the sporting world where a “win at all costs” attitude provides a powerful motivation to take risks.
Dr Brad Partridge is an NHMRC Research Fellow in Public Health based at the University of Queensland, UQ Centre for Clinical Research. He has an interest in ethical issues related to sport.