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A fresh look at anti-doping

A fresh look at anti-doping

Last November, I was asked to give a talk for a legal summit examining the doping dilemma in sport. It was a chance to reflect on 15 years of immersing myself in this complex subject. You can download the entire book publication from this event here but here's my manuscript pasted below for ease. 


I.    Overview of a Current Ethical Challenge in Anti-Doping, by Professor Andy Miah
Thank you to the WADA commentary team for inviting me here to give a talk. It has been a long journey for me in anti-doping and, to some extent, I want to take you through that 15 years or so within which I have often found myself on, for many people, the wrong side of the argument, for want of a better phrase. I was asked to talk about a current ethical issue around anti-doping. I think there are many, but I want to give you a glimpse of one particular topic through that journey that I have had in this world and outside of it. I began in this field from a sports science background. My PhD was in bioethics and sport, where I looked at genetics in particular, and my work expanded into bioethics more broadly. It is that interface between sport’s use of performance enhancement and the wider societal  uses of technology that I want to address. 
Forgive me reading a bit of the manuscript. Often I give talks just by talking, but I sometimes also write a manuscript that I develop through the talk. With this one I'm going to read a bit and hopefully give you an insight into the challenge, I think, with identifying what constitutes a current issue  around ethical concerns in anti-doping.

Around 20 years ago I gave a talk at the first International Conference on Human Rights and Sport which took place in Sydney. I don't know if there was a second International Conference on Human Rights and Sport, but the issues were quite significant. My talk was titled, quite simply, “The Human Rights of the Genetically Modified  Athlete”. Most people, as you can imagine thought: “What the hell is that about?” Especially people in sport thought this must be something like doping  but just on a genetic level; that's how we should regard it and how we should think about the ethical issues around this topic. For most people in that world, this was simply another case of “bad hombres” using things they shouldn't be to compete  in sport. But it was much deeper for me than just that. I was interested in thinking about a world in which there were genetically modified people whose enhancements were decided for them by the genetic selection or enhancement decisions of their parents or ancestors and how the world of sport might deal with that kind of person.

I wanted to imagine athletes who had not, themselves, done anything to achieve their genetic advantage but whose parents, who had sought to optimise their child’s chances through genetic selection  or genetic enhancement, would have an impact on  their lives. Their existence would not violate any rule within anti-doping, even though their being permitted to take part in elite sport would certainly mean that anyone who was not genetically modified or selected would be less competitive.

This was a time of considerable change in the world more broadly. This talk found itself one year before the completion of the Human Genome Project. I want to take you back to that moment.
The Human Genome Project was nearing completion, and in fact was creating an incredibly challenging set of ethical issues for the world at large. It seemed to me particularly challenging for the world of sport. How will it deal with a world in which this technology was used? But all of a sudden the work of Crick, Watson and Franklin came to life. We found ourselves in the middle of a new era in human evolution. This was what was at stake at the time: this feeling that we are transcending those biological limits and remaking humanity in quite controversial and challenging ways. We hadn't figured out how this would operate. So I wondered how would the world of sport deal with an era where genetic information and even gene transfer found its way into sport.
Looking back, I suppose I also thought that this was a game-changer for the subject and that intrigued me, certainly. Gene doping was going to bring about the collapse of anti-doping, a system which I had studied and found to be left wanting philosophically and practically as a project interested in sustaining a moral framework to sport that I thought was unjustified, undesirable, and ineffective.

Now, some 20 years later, and also 20 years since New Scientist published its first article on performance genes, I'm left wondering: “Is this still a current issue?”

In 2001, in September that year, there was a conference scheduled at Cold Spring Harbor where the World Anti-Doping Agency would talk about gene doping and the prospects. 9/11 happened, that conference was cancelled and  postponed to the following year, but this was the time at which Professor Lee Sweeney began to say  that he was being contacted by athletes and their entourages with a view to them being enrolled into clinical trials using gene therapy. This brought the issue to life for the world. Lee Sweeney saying this made it a live issue, made it a current issue.

Lee's work on IGF-1 in particular revealed a proof of principle in the science and he spoke of an appetite among athletes to enroll within his trials. This was about as current as it got, or so I thought. Also at this time the IOC set up a gene therapy working group and soon after WADA did the same. We've now had a good 15 years of talking about this matter, but what has really changed? Well, we have research like this (indicating video of mouse on treadmill) coming out of Case Western Reserve University, which gives you a sense of how genetic interventions may have an impact on performance.

So over this 15 years or so there have been discoveries, findings, that suggest a proof of principle that could have applications for humans. And since every Olympic Games from Sydney onwards the media has published stories claiming that  gene doping is the next big threat for sports while many other threats have also come and gone. Tthink of THG, the ‘clear’ or designer steroids more generally. And there have been examples of how genetic interventions can dramatically affect performance capacity, at least within animal models.

So it has been current for at least 15 years. Fast forward now to 2016 and we see how this becomes manifest within public discourse.
I was in a meeting with our chief science adviser in the British government this week where we talked about trust and expertise, and I gather it came up a little bit yesterday. But here's how it happens. Scientists were asked about what's going on in the world of science, and they tell them. They are then asked about what's going to come next, and they tell them again.

“We don’t know yet whether this has been done anywhere, but…it will be used sometime”

This is a quote from Carl Johan Sundberg [WADA Gene Doping Panel] from just last year, before the Olympic Games began in Rio,        which tells you how this discourse is propagated within the media, how current issues are formed through the opinions of expertise but, crucially, through the requests of them to make predictions about what's coming next. So it is a discourse that's facilitated by experts. One of the predicaments, I think, of anti-doping not specifically, but it certainly is one that it needs to deal with, is the ethics of communication around emerging technology issues. It is a real challenge.

You can find quotes like these from every single Olympic Games period. Usually about a month before WADA puts out its big statements about the fact that no one is going to get away with it this time, we have some fancy new test that is going to catch everybody, which happened last year with a genetic test for EPO, and you  have these claims about whether in fact gene  doping is here and here to stay.

Personally I experienced this directly. In 2004, I published a book called Genetically Modified Athletes, and just before the Athens Olympic Games, the BBC asked me on to their flagship Newsnight programme to talk about these  implications and we had a good debate about where we were and where it might go. Eight years later, during the London 2012 Games, I had exactly the  same debate on the same television programme about gene doping. It was almost word for word. So there's a real challenge here in terms of how we think about what is current and how we deal with it.

If this is a current issue, what was it 20 years ago when I started writing about the subject, when New Scientist published its first article on the subject? What is the difference between an emerging technology and a current technology when thinking about what we should be doing within our ethical investigations and policy making?

Some of my learning in bioethics were shaped by time at the Hastings Center in New York, where conversations with Dr Thomas Murray, who was involved with WADA at various levels, led me to conclude that sport would not deal with this  matter head on since bioethics, it is often said, must deal only with the present-day reality of scientific possibilities, not what might be here in five or ten years' time. Genetic enhancements weren't possible scientifically, at least we didn't know that they would work and be safe, and so did not deserve our time, even if they were rich philosophical debates. Instead we focused on gene tests and selection, and soon after such tests were becoming available. Here's one screen shot of a genetic test that was made available commercially. You could buy this test over the Internet. It simply takes a mouth swab and gives you some data on whether you are more likely to be a power-based on endurance-based athlete. Every scientist in this field has criticised this test, but the point, I think, from a policy perspective and from an intervention perspective is that it has become a social reality. The test is out there. The language of genetic tests as being determining of capacities or likely life achievements became a reality. So this led WADA to focus on genetic tests, and it published the Stockholm declaration in 2005, based on our talks.

Now I may have an erroneous definition of the word current, but it does matter how we define this term. I consider it essential to the work of ethics that we do mid to long-term speculative work. Space, time, and money is required to undertake such enquiries or else we lose sight of the bigger problems and lose time to determine our resolve. Failing to dialogue with speculative matters also limits the duration of our convictions and undermines our capacity to avoid problems that we may face in the future. In any case it is critical to distinguish between different forms of that word current. And we can have quite simple distinction between what is happening right now, so for example cases that come up in the world of sport or actual gene doping that's taking place that we know about, this is one way of thinking about what's current. But a lot of the conversation around anti-doping  focuses on a second definition which talks about the sorts of things that preoccupy our time - the worries we have about the future. Certainly for nearly 20 years now, gene doping has been a "current" issue in that respect. 

While it makes sense that we focus our efforts on the first of these, focusing on: Well, if it's not here yet, let's focus on the stuff that's here and deal with that. We need to think about the second one to avoid having to deal with the first one. If we don't deal with these longer-term implications, then we have a harder time dealing with the stuff that comes at us at crisis points.

Here's an example of the problem. We are moving into a world where these technologies are talked about not as a means of distorting nature or corrupting some internal essence or jeopardising a moral framework to how we recognise talent or effort in sport, and the like. Rather, it  actually has something much deeper to do with how we are changing as a species and as individuals. This terribly long quote is a good indication of that. 

A quote from Lee Sweeney's work, who I mentioned earlier, who has been working with WADA trying to find ways of detecting gene doping. But he says, and I'll read it out:
1.    “From my own work with the mice, I also know that earlier you intervene, the better off you're going to be when you get old. So once you go down that path, I think it's unethical to withhold from someone something that would actually allow their muscles to be much healthier now and to the future. As long as there's no safety risk, I don't see why athletes should be punished because they're athletes. So I'm on the other side of the fence from Wada on this one, even though we're on the same team right now” 
2.    Lee Sweeney, Jan 2014
At the moment the direction of travel for genetics is that, for it to be an effective public health intervention, we need to intervene before  an athlete even becomes an athlete.
These technologies that, at the moment, are within the WADA Prohibited List and rejected by the sports community generally, are seen as kind of discrete doping problems, but they are part of a wider change in the  circumstances of our biological condition.

A lot has happened over 20 years or so. We have now an article that covers gene doping  within the WADA Code, even if our knowledge of what is taking place is limited. Over the years there have been indications of gene doping at Games but nothing confirmed. We've heard talk about specific genetic products being used at different Games; but, again, it is all very  unclear. My concern is that the present strategy doesn't really address the problem that I wanted to consider back in Sydney in 1999, which was to do with the way in which genetics enters the population in a much deeper sense, perhaps through germ-line transfer of enhancements.

People in the world of sport, when asked this question about that germline modification or these wider questions about society and how it  uses technology will shrug their shoulders and  say, well, what can we do? We have nothing to do as a sporting organisation to address this. We have to see how society changes its values and, if it does, we may respond to it. Others will talk about it as just complete nonsense, that germ-line genetic engineering is just pie in the sky and akin to science fiction, and it is then also quickly dismissed. But then I'm often reminded, and have often been reminded over these years, as to how quickly these things change, how technology is taking us into new realms of capability. And year after year I have seen examples of that.
For example, this is from the TED Conference happening this week in Vancouver.


Sports find themselves at a time of tremendous change in the sorts of things that people want to do with their lives. Numbers around many sports, traditional sports, are diminishing. People are inventing alternative forms of physical practice which have alternative values and relationships to this problem of anti-doping.

One of the big areas that I wasn't going to get into but just to mention it very briefly is the rise of E-sports - competitive computer game playing - which has risen in the last few years significantly. It has so many profound implications for the world of sport. I could give a whole presentation on just that. However, the key thing here is that sport is losing generations to other kinds of activities, where the approach to the questions of doping is very different. So, we need to look at these and understand really what is going on and where it leaves us with regard to the ethical dilemmas that sports face.

In that context, the second the act of this talk is to men tion a few examples. Just to give you a glimpse of some of these challenges that we face

The first one I want to talk about is CRISPR, this technology that will allow a much  more sophisticated approach to gene editing. CRISPR has been discussed at length in the press in the last couple of years, where there is concern that, in factk that era of gene transfer for  potential enhancements that was dismissed 15 years ago as pie in the sky, as not quite here yet, is around the corner. The quotes again from scientists working in this field will say that this is easy to do, it may not be safe, but this is something that is now within our grasp. We also have projects that are changing those capacities we have as people. One of the nicest examples, I think, is North Sense. Here's a quick glimpse of it.

Now, many nonhuman animals have a capacity to know which direction is north, and this project is giving humans this sensorial capacity, which can change the sorts of things we can do in our lives. My proposition to you is that, in fact, this describes the future of sport much more than the older problems of doping that we see played out in the world of sport today. Creating people with different functions, different capacities, will lead to the creation of different kinds of sports and we'll see how this will change that approach that we have to the doping problem.
We also have the rise of ingestible sensors. A patent was awarded for this for the first time a year ago in the US, and we now begin to see this technology being rolled out. Here is, again, a sense of how it works.

This is here now. You can see how athletes might wish to use something like this to fine-tune their doping to avoid detection and so on, but you can also see how, perhaps, it can be used in a much wider sense as well.

The next one is prosthetics. Prosthetics are changing the sense of what biology can do by transforming it into artificial apparatus. We saw this around the London 2012 Games with Oscar  Pistorius, who became the first person to complete in an Olympic Games with a prosthetic device. But it was really only the beginning of this and we see ourselves at the cusp of an era where prosthetic devices on both significant levels like an artificial limb, but also on nanoscale levels, can be transforming that boundary between nature and technology to the point where it makes no sense to think about these as separate things. 

So in different ways, each of these examples, I think is a problem for sport as they are not really covered by the Code not even its catch-all article which indicates the capacity to encompass other forms of enhancements that aren't listed specifically. But the Code fails the concern that medicine is slipping into the realm of enhancement rather than therapy, calling into  question the role of medicine. Many people who work in this field coming from the medical perspective are worried this enhancement era  transforms the act of providing medical care in a way that undermines it and so are pushing back against it. Yet, we exist in a world where we are increasingly comfortable with this slip and where some even argue that we have moved into a post-human era where the conventional assumptions about healthcare are no longer relevant.
I mentioned one example at breakfast this morning where, in the UK the NHS, our National Health Care Service, is beginning to experiment with artificial intelligence as a diagnostic tool  within primary care. So you can see how these technological changes are coming. The dilemma, I think, to go back to the task I was set today, which was to talk about a current dilemma, can be articulated thus. How can anti-doping protect its social mandate, when human enhancement is allowing the general public to      become more capable of performing acts of physical endeavour than the anti-doping compliant athlete?

The point at which the general public is more enhanced than the athlete is the point at which anti-doping becomes a failed project. As you will anticipate, I don't think that anti-doping can succeed, and what we will see steadily is an erosion of public interest in the unenhanced athlete and the expansion of alternative sports that will not operate by the same kinds of rules.
The answer, however, I think is found within the Code, which has a fundamental flaw  within it. The Code is somewhat tautologous; it is a very self-contained set of directives and principles, self-referential in many ways. It asks the signatories to protect doping-free sport because that is the rule. It does not allow the signatories to question the rule. Even more worrisome is that within Article 18 on Education, it does not seek to undertake education in any meaningful sense.
As an educator myself my role is to guide students in the pursuit of certain ideas but to  allow them to arrive at their own conclusions.

Anti-doping prescribes the end point of that    educative route and it is to be in the service of the Code's purpose. In my view that is far from being education.
Thank you very much.

PROFESSOR KAMBER: Thank you, Andy, for your talk. I always enjoy your talks very much. I remember the first talks about gene doping and then we were on the brink, everybody is telling gene doping is around the corner, but I don't think so. But I'm convinced that we have to discuss this technical enhancement, these products helping people. But I think it is not a problem because we already have it in sports. We have all the sports equipment, already you have the bobsleigh, you have the Formula One cars. And so I think this direction is not such a problem. But I guess the discussion about gene doping, changing your genes, is over. I'm not sure it's coming to the sport. Because if you look at medical enhancement, medical improvement, in the last years, it didn't exist. But I agree with you that we have to discuss these enhancements with the technique, with this equipment we have. Maybe we have mixed races, as we have shown. This we have to discuss but no longer gene doping.

PROFESSOR MIAH: Wow, I can't believe you said that, Matthias, really. I'm staggered! I am given, you know that this is something that experts from your position say at every Olympic Games: This is something we need to discuss. It seems it is part of maybe it is part of the rhetoric. Maybe I misunderstand this. Is it simply about generating a sense of the fact that  WADA is doing something, we're forward thinking, we're thinking about these problems and making clear to the public that this is what we're doing. But at every year over the last 15 years people  within WADA have said: This is a problem we have to deal with. And the funding going into from their side, but also our side of it, suggests this is a serious concern. So I am surprised that you would say this, but I accept what you have said about the fact that gene therapy hasn't been particularly effective or successful in any medical sense, and the assumption is that until it is at least effective in a medical sense we wouldn't even dream of using it in a non-therapeutic context. 
The caveat to that is there is no capacity to embrace its use within a non-therapeutic purpose because, as with other  medical devices or methods or treatments, the limits of their regulation is in the precise terms of that therapeutic application. So, by implication, anything used out with those terms is  considered to be unethical and unreasonable for  scientists to be involved with. But the reason to put Lee Sweeney's quote up there is to show that people working within this field regard that the effective use of these next-generation therapies requires stepping back from the idea that there is something called "the natural course of aging" and intervene much earlier in life to benefit from  those interventions later in life. When you get into that, for me that is a completely radical point for many people who think that, no, we get old and we die, and that's it. We might do some fixing along the way with some medicine, but the direction of travel for the project of western medicine [PAUSE] I was going to say "is immortality", but the less radical way to put that is this ongoing pursuit of interventions. And hopefully these interventions will be safer, but they need to happen earlier in life rather than later. You don't get to 70 and then start your gene therapy to deal with the problems you face, it has to be earlier on, and that is a big shift, I think, in how people will feel about it.
Sorry, that was a long response.

PROFESSOR SANDS: One more question and then we'll break to our panel. Right at the front over here.
JEAN-PIERRE MORAND: I must say that when we are listening to you it is like an abyss is opening in front of us. My reflection was the following. Sport is one aspect of life. What you are showing is touching on many, many, many more severe and more serious aspects, including who is going to be  mortal, etcetera, etcetera. Then you say the Code is a failure. But I say, looking at this, sport as a concept becomes a failure. Because sport is based on comparison of people who are more or less having an equal field, otherwise it loses completely its function and sense and a competition will like a technical fair: which is the best matching? Which was designed the best by the best genetician then, and this is our product. There I think therefore doping becomes a detail and irrelevant in such a big, vast array of ethical problems.
PROFESSOR MIAH: I'm more optimistic. 

I think that even with these technological interventions the human role in performance remains crucial and it is our task to decide which things are relevant to the test of competition and which things are not.

One of the central points of the presentation, and I was trying to draw attention to this mindful of the purpose of this event, is that there is no mechanism for that interface  between sport and society within the Code itself.

Now that might be straightforward to many people. The Code is supported by governments and other organisations and their support implies a kind of assumption that this is what we want to do. But there needs to be an interface where people are able to discuss the ideology and the values behind it. And this is especially concerning when, within the Article 18 that talks about education, there is no statement about creating or nurturing critically-engaged athletes who can defend their position and understand what it is that matters to them about doping. It is entirely, I mean, for want of a better word, propagandist in how it approaches the concept of education. Without that interface within the Code, without some provision for a dialogue interface within that Code, it is destined to  fail, I think. It doesn't fail, sport kind of happens and it takes place reasonably well, although we have these problems with it, but I do think the key point is that interface. At the moment the Code is pretty self-contained and it is about sport deciding what it wants to do and society accepting it. We need to look more broadly, I think.

PROFESSOR SANDS: Andy, a big thanks from the entire audience and from me. I think we take a moment to thank Andy for his very interesting and challenging outline of issues that we have faced and that we will face.
Andy, thanks a lot. 



Doping & the Tour De France [VIDEO]

This month, I have written an essay for Routledge publishers, introducing a theme for their journals focused on doping and cycling. Here's a video primer for the essay and the video's transcript, produced by Routledge:

Hello, my name is Andy Miah and I’m a Professor of Ethics and Emerging Technologies at the University of the West of Scotland, where I direct the Creative Futures Institute. This video is in relation to an essay I’ve written for Taylor & Francis the publishers, who this month are publishing an edition on sport that’s focused particularly on doping and cycling in line with the Tour de France that’s happening in the next few weeks.

Within this thematic month, a range of articles are published that deal with the history and the politics, the sociology, the science and technology of doping, and it’s been an interesting process to read some of the backlog of articles within the publisher for the last four years. The research is just enormous in this area. Doping is perhaps one of the central issues for the world of sport today; it has been for quite a long time. But these essays reveal, really, just how far the research has come, and how much more there is left to do. Philosophers are still debating the definition of doping. We’re still figuring out what this means, and that becomes harder as the technology evolves too: would surgical implants constitute as doping, would laser eye surgery be included? What sorts of things are athletes likely to do that are going to change that definition? At the same time, how is society going to develop its relation to body modification and enhancement? In a way that changes that as well. So these are quite challenging issues, not just for sport but for society too. And yet doping’s still one of those topics where people aren’t sure how much is going on. How big a problem is this for the world of sport? How much of it is a public health problem too? So many of the articles grapple with the complexity of this, given the vast uncertainty of really what’s taking place, and there are considerable differences of opinions about how bad that is.

Now, the Tour de France has always been rife with discussions about doping. One of the essays reminds us of the 1998 sit down where riders protested the police raids on the Festina team by sitting down in the middle of the 17th leg just, I think, in complete dismay at the way cyclists are treated. For me one of the key issues has always been how athletes give up their privileges just for sport: freedom of movement, physical privacy is lost in the pursuit of drug testers and dopers, and one of the questions that arises from this is how far we’re prepared to go to test people for drugs and doping. Now you might say ‘we’ll go as far as we need to – we need to make sure there’s a level playing field and competitors are playing in the same sort of way’, but we’re already testing kids in high schools. How far do we test people before we start to think ‘this has just gone too far – we need another strategy’. So many of these articles do grapple with that complexity, and reveal to us just how far the anti-doping authorities still have to go to really address this issue.

They’ve got a tough job ahead of them. I think the biggest problem they face is that the world’s moving on too – it’s not just a question of what’s happening in sport anymore. We live in a world where, twenty years ago, people were up in arms about GM products - today people are less concerned about that – so there’s a sense in which technologies that are new, that are controversial, become accepted or more acceptable. In a world where we have genetic screening, pre-implantation genetic diagnosis, ways in which we are tampering with biology before day 1, before birth, then what sense will there really be of having a policy that tries to protect people from enhancement, or to ensure some natural playing field where athletes compete? I think this has really got to go back to basics and really think about what sports are all about. We care about seeing extraordinary performances, we put athletes in a position where they have to use technology to do this – in fact, many sports are constituted by technology; they wouldn’t make sense without them – so we can’t just quibble over the details as to which technologies we like and which we don’t. But aside from that, we get lost in the concerns about harm and the risk to health and so on, which have been part of the history of the doping debate and its broader contextualization within the doping war.

So I think when we consider where this might go, where all this research may take us, a number of the articles point to the fact that this intractable problem is only likely to get worse. So we need to rethink the problem. We need to rethink our approach to the problem, and consider what other strategies there might be to level the playing field, or create a kind of level playing field that we value. If that means allowing everyone access to everything, that might be a better solution. That doesn’t mean we need to encourage people to take ridiculous risks with their health, but we perhaps monitor the health risks of performance-enhancing technologies; we set up a world pro-doping agency as well as the world anti-doping agency, the responsibility of which will be to invest into safer technologies, allow athletes access to safer, more informed ways of performance-enhancing for their sports. If we do that, then yes, some athletes may get harmed anyway, but they may get harmed less, and that seems to be a better situation. So enjoy the articles, enjoy reading just how far this body of research has come in 40 years and how much more difficult the problem is today than it was back then. Thanks very much.

Why the doping problem is here to stay

Why the doping problem is here to stay


Yesterday’s doping news from the Australian Crime Commission raises three crucial questions for the world of sport.

First, why do athletes dope? Second, how prevalent is doping in elite and recreational sport. Finally, how far beyond sport does performance enhancement extend? You might have noticed a new acronym in their report – PIED – Performance and Imaging Enhancing Drugs. This is not the first time it has been used in anti-doping jargon, but it is a crucial signal to the broader culture of performance enhancement that confronts elite sport. Back in 2006, the American Academy of Pediatrics made clear that to just pursue elite athletes is not going to address the wider culture of doping in society and it is this part that the sport’s world still does not understand.


People dope because they want to win. They want to win because it brings rewards. Rewards increase one’s social status and capacity to live a good life. This is one version of what’s happening. Another is that athletes dope because they want to push their bodies even further and reach new limits. In this version, the reward is having transcended what others have achieved before, going beyond what we thought to have been humanly possible, and securing one’s place in history as a result.


One of the crucial omissions to yesterday’s news was precisely how prevalent doping is in elite sports. Admittedly, nobody knows, but they did say the report revealed it is more common than we were led to believe. Some figures on that claim are crucial, as is a better way of figuring out what’s really going on. It’s not easy to do, but the answer would dramatically shape the policy response, and so it should.


However, the really big problem facing elite sports is that they don’t operate in isolation from the rest of society, no matter what they might like to think. Certainly, in sports you can commit acts of violence that would be criminal outside of it, but I’m talking about the broader culture of performance enhancement that surrounds us in daily life. Whether it is a cup of coffee in the morning – or a few cups – or steroids, the so-called problem of performance enhancement in sport will never be solved without a shift in our values. However, I’m not sure that we need to change. We just need to protect people more effectively from taking excessive risks. Anti-doping goes well beyond this.


Being the best that has ever been is an aspiration that underpins people’s lives, especially when they are young and this can drive the desire to win at all costs.  This may be an argument to get rid of elite competitive sport specifically or to remove competition from society more generally, but WADA won’t do that all on its own. In any case, it would distinguish this kind of dangerous competition from healthy competition. I suspect you cannot have one without the other.



Why wasn't Lance Armstrong caught earlier?

I've had a few inquiries about LA this morning and I wanted to set out my stall on this topic once and for all.

In 1988, Ben Johnson shocked the world by testing positive for anabolic steroids. The outcome was the Canadian Dubin inquiry, which most importantly revealed that an athlete alone cannot build a culture of doping. It is systemic problem, it is a product of how athletes are set up to fail in sports by our pushing them towards transcending human limits with limited means. It is about the malleability of what we consider to be a fair competition, when people are not biologically born or nurtured in similar ways.

The press material from USADA is aggressively pursuing one individual, placing all the blame squarely on his shoulders for breeding a culture of secrecy of doping practices. It has sought to make this case against LA for many years. It operates within a nation that has placed the war on drugs in sport above many other social problems that exist. Yet, it is also a nation that breeds the pursuit of excess and champions sporting victories so greatly that it is little wonder athletes do all they can to advance the possibility of victory.

We live in a time when cheating is commonplace within many aspects of our society. Who can forget the recent banking scandals? Trying to get away with cheating is a high return, low risk activity in many complex professional practices. The World Anti-Doping Agency describe Armstrong has having developed a sophisticated programme of doping. Not really. If he is proven guilty, all he did was use things for which there are not tests. Not sophisticated at all. Quite sensible - the basic principle of doping done well. Using doping methods for which there are tests is idiotic.

If these allegations are upheld in a court, then the answer as to how he got away with it for so long is quite simple. Doping is commonplace within cycling. There is a culture of doping within the Tour and many athletes feel inclined to maintain this circle of secrecy because those are the values of their sport. For years, I've heard discussions about qualifying claims about doping within the Tour and figures from experts range from saying it is a minority to saying it is everybody.

Here's the problem. It's a problem that never goes away for elite sports. Athletes are smarter than anti-doping authorities. Actually, athletes have an unfair advantage over anti-doping authorities. An athlete can study what is being developed in the world of science, new designer steroids for example, pursue access to those that were never commercialised - even work with a lab to bring them to product stage. Anti-dopers will never know that the substance exists and so never seek to test for it.

Alternatively, the claims about LA are that he used substances and methods that were known, but for which they could not test. Autologous blood transfusions is one of the most challenging. If this is the predicament of the sport's world, then anyone who wins is potentially doping, so under the present system we can never feel proud of an athlete's achievement as the book will always be open on whether they doped or not.

This is why we need to rethink the entire situation. If LA is guilty, then another of the world's greatest heros has failed us, at least this is what they will say. In my view, it is the sport system that is failing us. It's time we set up a World Pro-Doping Agency so we can allow athletes the means to enhance themselves as safely as possible using medical technologies and we need to bring this all into the open. Some say this will turn people away from sports. I say it will inspire honesty about what makes a great athlete - the combination of nature and nurture, biology and science. These two have always worked together to win gold medals.

As it becomes harder and harder to detect doping practices, we need to find another approach to ensure that we can believe in what athletes have done when they win gold. It's a sorry state of affairs when someone like LA is brought down, after a life that has been incredibly challenging and hard. Even if he used performance enhancements, they didn't allow him to breeze through the door. There is a lot still left to admire about the doped athlete and compassion in understanding their circumstances will prove more productive than a witch hunt.




La lutte antidopage, un "dogme inquiétant" pour certains

La lutte antidopage, un "dogme inquiétant" pour certains


Interview for Stephanie Pertuiset @AFP on the Yannick Noah headlines around doping, published by a range of French newspapers, including Liberation & Le Temps. Here are some of the quotes from the raw invu in English:

1) Former tennis champion Yannick Noah said he is in favor legalizing doping to stop hyprocrisy. In France, every one shot at him, saying basically that doping is a really bad thing leading to Circus Games. Do you think it is a taboo nowadays to say something like that ?   Why antidoping has such be legitimated ? 

"Anti-doping is a worrying kind of dogma, which leaves little scope for serious ethical debates about elite sports practice. Anyone who speaks against it is quickly shunned by    the sports world, but enough people have made this kind of argument now. It's time people listened to what's being said - anti-doping is broken."
2)  I found you were quoted as saying the fight antidoping is at the opposite of its own objectives. Can you explain why ?
"Elite athletes are placed in a situation where they need to find a way of gaining an edge over their competitors. Inevitably this will involve using performance enhancing technologies and we have to act responsibly and recognize that this is a situation that the sports world has created. As such, it must take responsibility for developing more effective enhancements, which are available to all. As well, if the goal of anti-doping is to protect athletes from harm, then it fails. Instead, athletes pursue products on the black market and put themselves at even greater risk than if the doping technologies were legalized and under medical supervision"
3) WADA, national antidoping agencies and governments always put in front the so-called health issue. Do you think AD is a real health issue or led by others motivations ?
"All sports are a risk to health, with or without doping. Some doping technologies may increase that risk, but that increase could be moderated considerably if doping were out in the open. Health risk in itself is not a good enough reason to ban doping, there has to be something more too it - the moral dimension - and this is really not a robust reason to prohibit many doping forms"
4) The way the tests are done, all the wherabout system, the breach in intimacy… could all these things have an ethic justification according to you ?  
"Not at all. We find ourselves in a world where kids in high schools are being tested for sport related drugs. How far are we prepared to go in violating personal privacy to attempt to protect a level playing field? I think it's gone too far and, like Yannick Noah, sympathize with the idea that a change is necessary"
5) Do you think sport can keep living in its own square while the rest of society is taking substances to be better an more performant ?  
"Far from it. The world of sports is soon going to hit a massive road block with anti-doping. We live in a world where the use of human enhancement technologies - from laser eye surgery to cognitive enhancements  - are becoming features of 21st century living. What value will anti-doping have in an era where everyone has been genetically selected and optimized? None. Sports need to make changes soon, or risk being completely redundant activities"

The Ethics of Sports

The Ethics of Sports


Unknown to me, I have a chapter in this Reader published by Routledge. My chapter focuses on the doping debate, arguing that concerns about health risk still dominate the ethical debate.

Olympics + Doping

The Olympics, Doping and the Meaning of Sport: Performance enhancement technologies and the changing boundaries of human natureDate: Wednesday 5 October 2011, 6:30pm to 8:30pm Venue: The Millenium Room, The Carriageworks, Millennium Square, Leeds

Speakers: Dr David JamesProfessor Andy Miahand Professor Jim Parry


£5 waged/£3 unwaged on the door

With only a few months remaining before the London 2012 Olympic Games, British athletes are preparing hard in pursuit of a record haul of medals. To help them better the 47 won at the 2008 Beijing Olympics, an army of coaches, doctors and psychologists is at hand, along with a thriving sports technology industry, all backed by an unprecedented level of public and private investment.

National ambitions aside, we all want to see exceptional performances from the world's best athletes, such as Usain Bolt’s record-smashing sprints. Yet sometimes we are uneasy when athletes shatter old records, fearing it is artificial aids, and not the athlete’s individual effort, that accounts for the achievement. We seem to be hanging in a precarious balance between expecting a superhuman performance and fearing the crossing of nature’s boundaries.

When particular technologies have been 'too successful', such as Graeme Obree’s bicycle and riding position, or polyurethane-coated swimsuits, they have been banned for giving an unfair advantage. Some, like Rebecca Adlington refused to use the new swimsuits for ethical reasons even before they were banned, claiming they are a form of ‘technological doping’. And with such high stakes to play for and constant advances in medicine, the temptation of actual chemical doping looms as large as ever, and it is hard to demarcate precisely the line between legitimate medical treatment and unfair artificial advantage.

Many take such a hard line against doping, calling for life bans from the Olympics for athletes like Dwain Chambers, who has long served his sentence. Others point out that sport is a very unnatural pursuit, and the intensity of training and competition has become such that no doping techniques are as dangerous for the athlete’s body as the sport itself, many ‘doping’ techniques being necessary to restore the athletes’ body to a healthy state. Some argue that, as enhancement technologies become part of everyday life and the line between medicine and body enhancement is blurred, it will become increasingly difficult to keep them out of sport. They believe we should allow all sorts of enhancement technologies provided they are safe.

So where should we draw the line between the artificial and the natural in sport, between effective sports equipment and ‘technological doping’, between legitimate medical therapies and illegitimate, performance enhancement treatments, between the struggle to excel and the need to have fair and balanced competition, between the urge to go beyond the boundaries of human nature and the fear of losing our humanity?

London 2012: the first Transhuman Games?

On 24th January, 2011, at 630pm @UWScreative will be hosting an 'inspired by London 2012' event at the CCA in Glasgow, host city for ICSEMIS 2012.


The event is FREE to attend and open to all. It will bring together a scientist, an artist and a philosopher (me) in conversation about the way in which athletes bodies and minds are being transformed by technology.

Today, elite sports find themselves in increasingly unchartered waters. More than ever before, athletes are using technology to optimize their biology for performance and many of their methods are not even tested for by the authorities. From genetic tests for sport performance to the use of superhuman prosthetic enhancements, this subject reaches parts that present-day anti-doping rules cannot reach.  These technologies have changed elite sports, as we know them, but the next decade promises even more of an overhaul to what we think being good at sport means.  As we approach the London 2012 Games, this debate will consider the ethical implications of new technology in sport, asking what distinguishes the cheat from the innovator. We will ask whether the debate about the ethics of athletic performance is all but over, as the winners' podium makes space for the transhuman athlete.

Going beyond the familiar debate about doping and anti-doping, this debate will consider how far biology has been pushed by technical systems and what Jacques Ellul called the technological society. It will include Dr Yannis Pitsiladis, who works with the World Anti-Doping Agency on genetic technologies and live artist Francesca Steele (pictured here in an image by Simon Keitch, who became a body builder as part of her most recent performance work.  Along with me, we will consider how we ought to regard the future of sport and how it will function in an era of transhuman enhancements.

The event is presented by the University of the West of Scotland as part of 'Knowing Sport: The science behind the medals', a public engagement initiative of ICSEMIS 2012 (Glasgow) supported by PODIUM and Research Councils UK, Inspired by London 2012'.

Speaker Biographies

Dr Yannis Pitsiladis is a Reader in Exercise Physiology at the Institute of Cardiovascular & Medical Sciences in the College of Medicine, Veterinary & Life Sciences at the University of Glasgow and founding member of the “International Centre for East African Running Science” (ICEARS) set up to investigate the determinants of the phenomenal success of east African distance runners in international athletics. Recent projects also include the study of elite sprinters from Jamaica and the USA and the study of world class swimmers (e.g., why are there very few black swimmers?). He is a Visiting Professor in Medical Physiology at Moi University (Eldoret, Kenya) and Addis Ababa University (Addis Ababa, Ethiopia). He is a member of the Scientific Commission of the International Sports Medicine Federation (FIMS, and a member of the List Committee of the World Anti-Doping Agency (WADA). He is also a Fellow of the American College of Sports Medicine (ACSM).

Francesca Steele has performed and exhibited work nationally and internationally since graduating with a BA in Fine Art from Northumbria University. She was awarded the Belsay Hall Fellowship in 2006, and has spent time as an artist in residence in various sensitive research, medical and rehabilitation settings including The Centre for Life and PEALS, in Newcastle and Horticultural Healing (a rehabilitation project for clients with acquired brain injury) in Plymouth. Francesca has performed at Baltic Centre for Contemporary Art, Gateshead and Arnolfini, Bristol amongst other UK and international venues. Her work has been featured in a range of publications, most recently Marina Abramovic and the Future of Performance Art (Prestel 2010). Currently Francesca bodybuilds specifically as part of her arts practice. The preparation for her current work began in October of 2008, since that time Francesca has trained as a bodybuilder. She won the title of Miss Plymouth in September 2009 and Miss West Britain (Trained Figure) at the National Amateur Body Building Association (NABBA) competition in April 2010, in May of that year she placed in the top six at the British Finals. From these experiences she has continued to develop her arts practice, through video and live performance work. Notably Routine, which was performed at The Pigs of Today are the Hams of Tomorrow (January 2010) and then the National Review of Live Art in Glasgow (March 2010).

and here's my sport biography :)

Professor Andy Miah, PhD, is Chair of Ethics and Emerging Technologies in the Faculty of Business & Creative Industries at the University of the West of Scotland, Global Director for the Centre for Policy and Emerging Technologies, Fellow of the Institute for Ethics and Emerging Technologies, USA and Fellow at FACT, the Foundation for Art and Creative Technology, UK. He is co-editor of Sport Technology: History, Philosophy and Policy (2002), currently on sale in the IOC Museum. He is author of over 50 papers on technology and sport and is author of ‘Genetically Modified Athletes’ (2004 Routledge), the first book to address this new science of human enhancement. He often gives pro-enhancement arguments, the most enjoyable of which was giving one such address to the IOC President Jacques Rogge and the Queen of Sweden at the Nobel institute in Sweden.

Muscular monkeys prompt sports doping fears (2009, Nov 12)

Muscular monkeys prompt sports doping fearsLinda Geddes, reporter

A gene therapy that appears to bulk up muscle mass and strength in monkeys - reported today in Science Translational Medicine - will undoubtedly raise fresh concerns about the potential for gene doping in sport.

We already know that some athletes use drugs like erythropoietin to increase the amount of oxygen their blood delivers, and steroids to bulk up muscle mass.

The big advantage with gene doping is that it should be harder to detect. That's because it's difficult to test for a protein that the body already produces, especially when its levels naturally vary between individuals - which might explain why some people are inherently better at sports than others.

In the new study, Janaiah Kota and colleagues at Nationwide Children's Hospital in Columbus, Ohio, used gene therapy to add extra copies of the follistatin gene into the leg muscles of monkeys. Follistatin has been previously shown in mice to block myostatin, a protein that decreases muscle mass, resulting in bulked up "mighty mice". Monkeys injected with the gene also seemed to bulk up, and when Kota's team analyzed their leg muscles with a device that measures force, they found that the muscles injected with the follistatin gene were also stronger than normal muscles.

They hope the approach could eventually be used to treat the severe muscle weakness associated with neuromuscular disorders like muscular dystrophy and multiple sclerosis.

Indeed, the drugs companies Amgen and Wyeth are already experimenting with drugs called myostatin inhibitors in humans, with some promising early results.

Such studies have already prompted fears about the potential for myostatin inhibitors to be abused by athletes hoping to gain the competitive edge. If gene therapy can achieve similar outcomes in humans, such modifications will be even harder to detect.

The World Anti-Doping Authority has already prohibited the use of gene doping within their World Anti-Doping code, and while there is currently no hard evidence of athletes using gene doping to improve performance, there are strong suspicions that they will start doing so soon - unless someone figures out a reliable way of detecting it.

Human Enhancement

  The Brocher Foundation, and the Universities of Oxford and Geneva are pleased to announce the Symposium:

Human Enhancement: What should be permitted? 20-21 October 2009, Brocher Centre, Geneva, Switzerland _____________________________________________________________________________________________________


Biomedical science is increasingly yielding technologies that can be used to enhance the capacities of healthy people, as well as to treat disease. This two-day workshop will aim to advance the debate on the ethics of human enhancement by considering

(1) What enhancements are likely to become possible?

(2) What enhancements will be ethically permissible?

(3) What enhancements should be legally permitted?

(4) What criteria should be used to answer 2 and 3?


Enhancement in sport

Life extension


Enhancement in general

The full list of speakers/respondents is: Eric Juengst, Paul Root Wolpe, Hank Greely, John Harris, Tom Murray, Gaia Barazzetti, Aubrey de Grey, Mike McNamee, Andy Miah, Stella Reiter-Theil, Ilina Singh, Astrid Stuckelberger, Sigmund Loland, Nicole Vincent, Massimo Reichlin, Ingmar Persson, Margareta Baddeley, Julian Savulescu, Alex Mauron, Bengt Kayser, Verner Moller, Tom Douglas, Norm Fost (TBC).


Julian Savulescu, Alexandre Mauron, Bengt Kayser, Verner Moller, Tom Douglas


you are kindly requested to fill in the registration form and to send it back to the Brocher Foundation by mail, e-mail or fax before 5 October 2009. Places are limited and will be allocated on a first come first served basis.

Fondation Brocher 471 rte d’Hermance, 1248 Hermance, Switzerland E-mail: Fax: 0041 22 751 93 91

Here are some notes from the day:

Enhancement in sport (chaired by Julian Savulescu, Oxford)

0930 – 1020: Anti-doping: Not the only matter of concern for elite sport

Bengt Kayser (Director, Institut des Sciences du Mouvement et de la Médecine du Sport, University of Geneva)

Discuses cases of enhancement use throughout life

-       21 med student uses ritalin

-       75 retired athlète

anti-doping leading to excessive surveillance in sport

more harm to society than it prevents

slippery slope

arg against doping – against rules

doping-like behaviour – conduite dopante

why anti-doping rule ?

-       fair play, health, rôle model, spirit of sport

thèse reasons for anti-doping are flawed

what is the objective ?

-       eradication?

  • no

-       decrease prevalence?

-       decrease prevalence in mass sport ?

-       decrease in society ?

talk about GPS tracking

-       to identify athlete’s whereabouts

for 2012 Olympic Games – condition of entry to search athletes

false negatives

false positives

why do people transges

new law in france (2008) – 5 yrs in prison and €75,000 for possession for trade

strict liability – presumption of guilt as reversal of justice

Article 6 (2) ECHR – presumed innocent until proven

Can anti-doping be successful?

-       illusion

-       shows signs of fantacism

side effects

-       public belief that doping works

-       hidden because illegal

-       criminalization

-       dangerous behaviour

increase in prevalence

other problems

-       other collateral damage

Respondent: Mike McNamee (Professor of Applied Ethics, Swansea University, Wales)

Privacy – public and private distinction – with internet now, why should this worry us particularly?

Why does cost of strict liability rule matter so much?

If someone forcibly injected with steroid, would not have been their fault.

If different syste and don't test, but only advise, is sports world culpable?

Clean sport and doped society

-       if likely, then still sport could claim desire to maintain freedom from these technologies

ME: if society accepts medicalization of enhancement, can sports prevent such freedoms?

Strict liability – not an attribution of guilt, but of negligence

Can never prove intentionality of doping behaviour

John harris: this debate is bedevilled by confusion about the debate – rules can be whatever people want them to be – prob comes when dress up anti-doping as if is an ethical issue – not an ethical issue, is a matter of the sport’s rules –

Julian Savulescu – test only for health thresholds – rules also often about making better spectacle – what makes sport more exciting?

1020 – 1110:                                     The Ethics of Sport Enhancement and the Meaning of Sport

Tom Murray (President of The Hastings Center)

Why baseball is the best game – john rawls

-       perfectly adjusted to human skills

Rawls – virtuous perfection of natural talents

Excellence in sports – 1) natural talents 2) virtuous perfection of those talents (that would be admirable for a variety of reasons)

ME: is it necessary for athletes to originate those things that they do as admirable? Of course, they replicate established knowledge

Are vaccines an enhancement – can protect against H1N1 but make us more

Enhanced interrogation – bush administration – ie. Torture – most would not regard as a morally valuable pursuit

Enhancement for what ends?

Implications for flourishing?

Individual and society concerns

Powerlifting (non-olympic) vs weight lifting (Olympic)

-       Jan Todd

Powerlifting as case study

-       use of drugs and shirts

fracturing of powerlifting movement

-       19 organizations in USA

Ernie Frantz – advert for the sport – no testing – but some countries do want to test

In drug free powerlifting association – likely that drug use is evident

Longhorn Open Championships  - award 109 trophies to 98 lifters competing

By 1985 – concerns that powerlifting had degenerated

Powerlifting – the shirts

-       assist in bench press – many layers of denim, Kevlar, etc

-       600pound benchpress in superheavyweight would be great in a raw event, but in powerlifting would not be competitive – shirts make the difference

system of justice – should be to accommodate whole system not just the athletes

claims of incoherency

line drawing problem – is any line going to be defensible

baseball 60ft and 6 inches

athletes we spoke to wanted effective doping control – reasonable assurance, not guarantee

non-trembling surgeon – point is not to demonstrate technical skill of surgeon

sport – point of practice?

reflective equilibrium

not the means

sport vs society

-       use of drugs in sport different from society

‘when you come to a fork in the road, take it’

-       if health is cited, isn’t it unjustified paternalism

-       would you ban low harm drugs?

-       Or permit all drugs?

Mehlman 2009 – handicapping of pure ability

-       but what about unearned adv due to pain tolerance?

How handicap?

-       how do you handicap for height?

In what spheres of practice do we insist that only unearned virtue prevail?

Far poorer world if we handicap people because they unfairly possess unearned advantages.

Respondent: Bennett Foddy (Postdoctoral Fellow in Bioethics, Princeton University)

If permit doping not right to say that choice to use harms other substances, when prefer to not use, cf. training hours

Coercive pressure in itself not a harm

If sport is about identifying most genetically talented performance, then why not count gender for eg?

-       ME: this isn’t what tom says

Admirable activities

-       why are enhancements less admirable comparing technologies?

Standardize equipment? Or remove it?

If about effort – then gender segregation can make sense.

Why not allow evening out of genetic differences

If about a close comp, why not handicap hard workers too?

Or award prize to biggest personal improvement?

Swimsuit – changed to floating and paddling, rather than slicing through the water

Lasik for tiger woods

Tommy john’s surgery

1110 – 1140:                                    COFFEE

1140 – 1220:                    Genetics and Ethics in Sport

Sigmund Loland (Professor of Sport Philosophy, Norwegian University for Sport and Physical Education)

Genetic predisposition can be necessary, but not sufficient

In short, embrace value of phenotypic superiority

-       more reliable than genetic test

agree that crude fairness argument won’t work

we are interested in justification for breaking rules

no problem that different systems of justice in medicine and in sports

-       ME: but what about their intersection? The purpose of medicine is to support individuals in undertaking activity that will be detrimental to their health.

Relevant vs irrelevant risk

Sport not about equality, but perhaps equal opportunity

It is meritocratic and interested in inequality – but not any kind

Thin interpretations – do not link to thick ethical concepts

-       Fairness - prosthetics vs ordinary legs’ body ‘in tact’

-       Sociologically naïve – not grown up people entering sports, but are reliant on sport systems to protect – coerciveness is a concern too – don’t see what it adds to sport

ME: sports competitions measure natural talent, virtuous perfection and technological competition

Don’t want to measure inequality of equipment but skill of athlete

-       ME: skill is not separate from the use of technological means

ME: you develop your natural talent in combination with what Jacque Ellul would call ‘la technique’ the combined ways in which science imparts knowledge to create technological systems which remove performance inhibitors or

Scepticism to expert-administred biotechnological enhancements

-       ME: imagine a world where all athletes go through an educational system while competing – many do, many do sport science degrees – in what sense are they not experts in their own administration?

If enhancement becomes the norm, how can sport deal with this?

Father of serena Williams actively looked for partner who could produce optimal genetic composition for athletic performance

Germline no role in sport – ME: so what?

Question: since we are advancing claims about what sports are, I would want to add to your and tom’s natural talent and virtuous perfection through the exploration of a relationship with technology.

Psychological enhancements more important – ME: but the swim suit is the psychological

Empowered athlete

Respondent: Ingmar Persson (Professor of Practical Philosophy, Gothenburg University, Sweden)

1220 – 1300: Who Guard the Guardians? – A Critical Reflection on Recent  Developments in the Fight against Doping

Verner Moller (Professor, Department of Sport Science, University of Aarhus, Denmark)

if anti doping is corrupt, then debates about what should be permitted are irrelevant

anti-doping officials have sacrified prnciples upon which anti-doping was founded and have lost credibility

Michael Rasmussen case 2007-9 – was overall leader of the Tour de France – alleged that he received warnings for whereabouts  - presented by press as doping possibility – pressure built up around him –

Marshall mcluhan – government by news leak

Danish Cycling Federation – has code it thinks is higher than WADA Code

Tom Boonen – also removed from Tour because of cocaine positive test – which is not an out of competition substance – why was this leaked to the press?!

1300 – 1400:                                    LUNCH

Life-extension (chaired by Verner Moller, Geneva)

1400 – 1450: The Foreseeability of Real Anti-Aging Medicine: Focusing the Debate

Aubrey de Grey (Chief Science Officer, « SENS » Strategies for Engineered Negligible Senescence)

Gerontology approach not sufficient – ie. To clean up metabolism

Instead, maintenance approach better

Do not interfere with metabolism

Longevity escape velocity (LEV)

-       rate at which rejuvenation

rate of progress

2 types of breakthroughs

radical vs incremental

e.g flight – 1903 aeroplanes, then rapid progress

Phonex and de Grey

Therapies double efficacy only every 42 years


-       would extending life widen the divide between haves and have nots?

-       Unlikely to be a problem – already v expensive to keep elderly alive

-       Correct precedent is not existing medicine, but basic education

-       Economically suicidal to not make available to everybody

Respondent: Gaia Barrazetti (Researcher, EPFL, University of Lausanne)

Translational process from research to implementation

Idea of life extension as ‘personal benefit’

Time for making a decision about reversing ageing process – as early as possible is ideal

-       ME: pre-embryonic?


-       It’s a question of too late, rather than too early – no point applying at age 20 or 30 as will not have accumulated much damage – better at around age of 60 when begun but not pathological

-       Distinguish between sociological and ethical

  • Sociologically, particularly difficult to implement.

Question: Life span vs expectancy

-       interventions have increase expectancy, but not span

suicide rate in elderly popuation highest

cell phone used to cost a lot, now available

ME: evidence that least affluent pay for the cutting edge technology

1450 – 1530: Anti-ageing: Results of a Swiss study

Astrid Stuckelberger (Institut de Médecine Sociale et Préventive, University of Geneva)

1950s – ageing as natural decline

1980s successful ageing


aging – failure of the

1530 – 1600:                                    COFFEE

1600 – 1650: Prevention and Life Extension

Eric Juengst (Professor of Medical Ethics, Oncology, and Philosophy of Science, Center for Biomedical Ethics, Case Western Reserve University)

Chloroplasties to prevent malnutrition

What doe ‘aging’ mean for us?

-       not simply getting older or wearing out

-       maturation  - growing older – progressing through developmental life cycle

case of my department chair at 65 – ‘I have the cv of a much younger man’

intervene in 11 yr old – freeze body in development so puberty postponed to allow cognitive development – would this view of promoting maturation fit in honouring life cycle – I think not

Beyond Therapy – cheating ourselves

The stages of life –

Dan Callahan – life cycle traditionalism

Respondent: Massimo Reichlin (Professor of Moral Philosophy, Università Vita-Salute San Raffaele, Milano)

World Anti-Doping Agency World Congress

WADA World Congress Jacque Rogge

Not just about elite sport

‘it is a public health problem -    ‘high school and university sports programmes’

‘hundreds of thousands of teenagers’

‘general sporting public’ – recreational

EU report doping risen from 5% to more than 20%

Raw Deal

Richard W. Pound

Joining of sport and government


Minister of Education, Spain

New Spanish law this year


Craig Reedie

Wada history

1998 – festina scandal at tour 1999 – world conference, Lausanne

Foundation under Swiss Law Foundation board of 38 Executive of 12

Healh, Medical and Research (Ljunqvist) -    List -    LAB -    TUE -    Gene Doping

ME: where is Ethical Issues Review Panel??






Arne Ljunqvist

Key outcomes of research programme

Anabolic Steroids -    disocery of desoxyMethylTestosterone -    detection of 6 oxo compounds -    method of detect aromatase inhibitors -    devel of CRMs for steroids -    proof of conversion of supplements into nanrolone -    detection of new long lasting metabolities -    genetic and ethnic differences in adrogen excretion -    devel of in vitro syst to identify AS

Blood Doping

Third gene doping symposium in 2008

Food supplements -    if needed, why? If irregular food intake, should correct.

Even within same bottle, some pills have banned substances and others not.

David Howman

160 tests of Marion Jones – not one adverse finding

Operation Gear Grinder 2005 – mexico

Doping and Public Health (2007, Aug 15-16, Aarhus)

Doping & Public HealthArhus, Denmark, 15-16 August, 2007.

15 August 2007 10.15 - 10.45 John Bale and Richard Peel (Chairing sections)

Prof. Jens Evald, Chairman of Anti Doping Denmark – Introduction: Anti Doping Denmark’s Action to Protect Public Health

Prof of Legal Philosophy at Arhus.

background doping and fitness public health fitness-doping anti-doping denmark 3-year project

Background Anti-doping denmark – independent Act of Promotion of Doping-Free Sport (2005) -    ADD is self-governing -    12 member board -    7 secretariat -    ministry of cult = 1/3 of budget

Act 2005 -    doping control -    info -    research and development -    international collaboration on fight against doping -    provision of advice

Section 9 -    fight against fitness-doping (ie. doping use outside of sport. -    requires implementation of WADA code in gyms.

Gov argument for fighting doping -    public health -    illegal trafficking -    risk fo drugs spreading to organized sport

Public Health Issue

night-life violence increases by doping

effects of doping: loss of interest in surroundings social isolation suspicion and jealously new friends with own language dress code and social code can’t see anything wrong with own behaviour

big confidence agrresion depression alarm change in personality lack of empathy increase sexual self-orientation

how do users see these changes - problem is that they do not see the side effects (ME: AS PROBLEMATIC)

ADD a ‘natural born’ protector? - was never asked to form. - today, have 70 of 450 centres in system - working towards new model where commercial centres part of org

ME: is not talking to the political economy of doping (in Denmark). Like the dopers, is unaware of the context of own behaviour.

Is fitness doping a big problem?

Alesandro Donati wrote the WADA report, estimating doping on global scale - the report mentions 15,000 abusers, the newspaper says 31,000

84% of sold growth hormone is used in sport ME: but I thought many people believe most athletes are not using hgh, so where is this being used across sport?

also test for doping in prison – the prisoners trust us.

of tests: 0.6% positive in DIF 10% positive in DGI 20% positive in commercial fitness centers

number of positive tests has increased, but could be because of more effective testing. (testing for steroids/, not social drugs)

some people talk about 60,000 abusers in denmark. we don’t know.

ME: what could improve knowledge. WADA talks about intelligence. it’s interesting for me to hear you throw out the 60,000 figure, given your own estimates. are there formal mechanisms for gathering intelligence and are they different from WADAs? come to think of it, what are WADA’s mechaniss?

Questions: -    is ADD the right body? -    Is fitness-doping a real problem to society? -    which drugs should it test for? -    can we accept social isolation of doping users? -    what is lacking the most in fight against doping?

ME: what is worrying about isolationism of dopers? There has got to be at least two more premises to the argument.

ME: the fact that he is asking whether we test for social drugs is v problematic.

Questions and Answers

J: problem is that we cannot register the names of people.

Changes in WADA code allows making separate rules for fitness centres.

10.45 - 11.15

Asst. Prof. Paul Dimeo - The Public Health Origins of Anti-Doping

Key historical moments - 1948: Dr Christopher Woodward raises concerns about cyclists’ use of drugs - Late 1940s/early 1950s – returning war verterans and wide availability of amphetamines contribute to rising usage at all levels of American sport - 1952 – WHO conference - 1957 – AMAconference - 1960 – death of Knud Enemark Jensen at Rome Olympics, attributed to amphetamine abuse through later investigations dispute this claim; Avery Brundage raises issue with IOC; British anti-doping expert Arnold Beckett claimed later that IOC knew about t widening use of steroids by 1960 - 1961 – British athlete Gordon Pirie publishers a book ‘Running Wild’ in which he claims some British, many American and many society athletes use doping drugs - 1963 – CoE meetings - 1964 – International Congress of Sport Sciences meets during Tokyo Games and prob of doping is raises, also exptl testing conducted on cyclists during Games - 1967 – British Association of Sports Medicine conf on doping held in London - 1968 – first testing at Olympics for amphetamines; test for steroids  would arrive in 1076.

(Dimeo, P. 2007. A History of Drug Use in Sport, 1876-1976: Beyond Good and Evil (Routledge))

between 1950s and 1960s, change in anti-doping postwar period public health movement questions about how sport played a role in public health by late 1960s as sports orgs took control, tone of anti-doping changed to defensive of sportin culture and assumption of sport ethics. doping not defined as prob of too much intensity, but as a bleamish on utopia of sport. consequently, for public health officials who were more objective on health, had been lost. chance for moderation had been replaced by fanatic approach to the problem. beginnings of shift from 1952 Februrary. IOC had announced in 1933 that it did not like doping, but did nothing until early 1960s. were not many instances at this time. 1948 Woodward 1949 italian ctyclist died allegedly of amphetamine in US groupwing prob first major statements on doping came from health not sport – WHO 1952 - 2 speakers talked: Carl Evan – Norway health – oppressive system – said ‘use of dope….popping up here and there in the amateur sports world….will be a disaster for sports’ - American colleague at the conf: Milton Lomer – Social and occupational health secretary for WHO, didn’t like look of sport – athletes pressured into taking health risks for national prestige. he saw sports in critical terms. he thought sports were to blame.  not clear how these speakers reflected view of WHO. no further action was taken. June 1957 – AMA initited research studies on the subject. beginning of surveillance process. Herbert Berger narcotics expert – claimed dubious success of 4 minutemilers, but also critical of amphetamine use in college and high school in usa – widespread pattern of drug use ‘shocking and visious’ – saw it asa  public health issue. ‘drug addicts might get their start taking amphetamines in high school and college’. also said users displayed violent and criminal behaviour.

anti-doping among officials at this time AMA projects on use of amphetamines another was a clinical study about effectiveness of amphetamines for performance.

this affected publich health stratgies of surveillance. clinical studies were sign of honesty – though sports authorities discourages research on doping in 1960s.

in public health cntext, concept of fairness not visible if anti-doping had remained focused on public health, then nature of antidoping would have been v different.

early 1960s, in UK Austria, BASM and itlian counterpart established positions CoE defined doping as an evil, such a view had become routine like a religious doctrine eg. IOC anti-doping Arthur Poierot, also Sec of BASM, in 1965: ‘doping is an evil. it is morally wrong…legally indefensible’. – at this time, no evidence to support any of these points eg. XXXX immoral act of doping  ‘keep the ideal of sports pure for the welfare fo all mankind’

testing in Olympics by 1968. guardians disliked modernity in sport – eg. training technology.

no interest to dialogue values problem in their view was fringe element of sport ‘cancer’ on utopia of sport. IOC wanted elitism, but with amateur values. constructed a sense of sport that focused on excellence, but values that ddi not reflect reality of elite sports – inspired by indiv and national glory

how ddi early public health experts compare with later sports colleagues

similarities both disliked drugs in sport, though for different reasons both thought monitoring important

differences if about health , not ethics, then must consider broader public eg. alcohol – all allowed to drink alcohol and excessive can do, but if drive drunk can be prosecuted since affects others health. other crossovers – approach to alcohol has been realistic pragmatic and yet allowed freedom.

if sports doping had been seen purely as public health, would it  have emerged

ME: hmmm, medical intervention of doping might be a difference?

11.15 - 11.45 Prof. Barrie Houlihan - Doping, public health and the generalisation of interests

how politics is changing and how it might change.

theoretical presentation

theory of policy change

generalizing interests – building alliances with sympathetic policy areas

domestic and international policy making is hotly contested – many polic leaders are under constant pressure to give prominence to their issue and to protect it from others

2 questions: - how can momentum and commitment to resources at domestic and intenational be maintained? - to what extent can domestic and international sport interest control discoures….

Anthony Downs – policy ‘life cycle’ -    pre-problem stage -    alarmed discouvery and euphoric enthusiasm -    realizing cost of signif progress -    post-problem stage

much of history of anti-doping follows this pattern

first stage -    death of Tommie Simpson -    withdrawal from 1983 Pan-American Games -    1988 ben Johnson -    1998 tour -    2007 tour

each began with enthusiasm which rapidly dissipated

look at discourse that surround doping

3 dominant discourses - fairness, health of the ATHLETE (not public health), image of sport (role model, etc)

these are generally self-serving, inward looking and politically naïve

WADA Code reflects mixed rationale -    concern limited to athlete’s community

however, wada needs governmental allies examine how these other orgs discuss doping – they use broader, social terms eg. CoE – sport important role in protection of health, moral education, international understanding; EU – competence in area of public health; UNESCO Convention – education, health, development and peace many govs have publich health emphasis on sport – France, Norway, Sweden, Denmark

Dick Pound – ‘unviversal recognitioj…doping serious threat to public health’

whether it’s being exploited, I’m not sure

but not only discourse

competing discourses: -    constitutional: sport should be self-governing -    criminal: doping is big criminal business -    workers rights: right to eran leaving -    moral/ethical: fairness: -    medical: health of athletes, treatement -    public health: doping spills into non-sport

constitutional, moral medical are most promiinant international, others vary between countries

WADA’s response? -    is WADA aware that it is competing?

public health not exploited by sport

1998 – watershed - showed weakness of ‘constitutional discourse’ - French gov intervention (and criminal discourse)

Continued discuss about criminanlization need for sport to build a defensive ‘generalisation of interest’?

criminalization – ljunqvist – advocates criminalisation of sports related drugs

strategies for generalisation of interests -    sectional interests (like elite sport) aim to further interest by linking to public good o o    ‘one has to hrase one’s argument in impartial terms, as if one were arghing for the public good and not fornes own self interest’ (John Elster)

is linking elite doping with public health going to strengthen elite anti-doping?

back to initial 2 questions

discussions -    what is existing relationship between antidoping and external interests? o    what evidence is there of alliance building? o    the evidence suggests that they are not. -    are we seeking generalisstion of interests by sport to link with supportive external interests or the incorporation of sport by eternal interests.. – rather public health sees sport as valuable to them.

ME: is this because it would diminish the autonom yof WADA

parallel discourses? -    internaitonl, still focus on athlete’s health, modest concern on public health and broader pro-social discourse on sport -    domestically: increasing number of countries a crime/law and order discourse (encouraged by WADA?) but in others an increasing concern with public helaht and sport for al not just elite)

evidence of a changing discourse? sport still claiming tis privileges status (overplaying its hand) sport/elite soprt has lways been linked with other non-sport interest

ME: how does this function with doping technologies that are not clearly linked to public health issues – e.g. blood doping or hypoxic training? Is there a challenge over boundaries – ie. doping more than drugs. difficult to excite public health policy makers about hypoxia?

ME: would a public health approach require the separation of some doping technologies from others? – ie. some have a clearly larger spill over than others.

what will keep doping on the front burner? rely on continual succession of crises? criminalization is easier than public health. links to either run risk of loss of control by WADA and NADOs. but criminalization makes more difficult harm minimization.

Verner: don’t know if prob of doping, but we’ll solve it in 1960s don’t know if was a big prob, but begin to solve how politicians trying to solve. problem generated by political ambition.

ME:mobiilisation fo anti-doping is often

Barrie: different to identify public health dimension of some doping technologies, but for others, it is clearly the case

11.45 - 13.00 Lunch 13.00 - 13.30 Prof. Claudio Tamburrini - Postponing motherhood: an unfair advantage?

follow up project on genetic technology and gender

trying to ascertain how genetics impact on gender equity in elite sports

from time to time here that women give birth after menopause.

none of the techniques to assist this are genetic, but is conceivable.

whether athletes who postpone motherhood gain advantage over those who don’t? is this adv unfair?

when we speak of motherhood, not suggesting htat elite sports are not compatible with motherhood. some argue that it eventually enhances sports participation. (IRSS 2001).

but still the case that natural difference between mean and women still exists – women bear children and men don’t. so possibilitiy to equalise ability will remedy natural disadvantage.

do not take a stance on whether interventions aimed at delaying menopause should be considered treatement or enhancement.

does postmenopausal….

assume that gender equity is desirable, though this is contested by some.

possible that technology could create more gender equity. -    eg. resistance to ART – reinforces idea that women should become mothers and limits value of fulfilment without children

Laura Purdy

even if decision makers accept homosexual families, better heterosexual since discrim, but this is not a good argument.

develop a ‘happy child’ criteria – but no reason why could not meet standard

reasonable happiness

postmenopausal motherhood discourse shows resistance.

lets assume many women will do this. impact?

change of family. but no harm in that.

assume that once mothers, will shortly die. need to ensure provision within the community.

no reason to oppose postponing motherhood.

perhaps the children might resent older mother.

sport obvious eg where having children is a disadvantage. -    those who do not can remain productive during  their peak years.

is genetically postponing motherhood unfair in elite sports?

a substance or method will be considered if 2 of 3 conditions.

assume that the technology will become safe.

is it an unfair competitive adv?

if open to all, then how unfair?

perhaps expensive will create greater unfairness?

not suff reason to label it as unfair, according to anti-doping policy.

trying to underline sport governance of such mattes, when the become a scientific reality.

must search somewhere else to discern whether is unfair or not.

might argue that is unfair adv since put colleagues under tpoo heavy burden – renouncing to motherhood for the same of competitiveness

but all sports persons forfeit plans and put pressure on competitors to do the same.

perhaps the too heavier burden objection could substitute the current criteria, combined with some other form of consideration. eg. ethos of sport – rules out improper manipulation of the body.

ME: What sorts of things are able to become proper manipulations of the body?

hypoxic chamber might be risky if stay in too long, are directly enhancing, but unlike trad doping re ot seen as artificial.

prob is how the competitive adv might be seen by sports bodies.

given that men are fertile for longer than women,

ban on gene doping – what is the non-therapeutic use? possible to treat muscle disorders that might improve muscle strength.? gene encoded epo to boost bone marrow, might also increase for sport.

must be more accuratey specify unapproved aplpictions of genetic technologies.

need increased insight on potential conflicts between socially desirable goals and ethos of sport.

need for open and critical debate on how governing bodies should deal with people who are already modified.

the greater the possibility of other genetic technologies to equalise different, more reason to accept

13.30 - 14.00 Prof. John Hoberman – Is testosterone a supplement or a drug?

20 years ago. West German scientists Manfred Donicker said steroids should not become a popular nutritional supplement

2 months ago in Las Vegas – Intenrational Society for Sports Nutrition - middle aged man on testosterone on prescription. - he said, any man over 50 who is not on a testosterone product is crazy. - ie. donicker’s fear hass come true.

we are talking about a contest between testosterone status

what is difference?


assume fewer regulations, since assume fewer risks

I will argue that, in order to understand this, must look at history of synthetic tesosterone and realise that campaign to market to the masses

ME: big deal.

Time Magazine sept 23, 1935 “german and swiss chemical laboratories are already prepared said Dr Ruzicka [one nobel later] last week, to manufacture from sheep’s wool all the testosterone t world needs to cure homosexuals, revitalize old men”

our society has imagined testosterone being put to public health use from the beginning

Newsweek Sept 25, 1996? ‘ Super-hormone hterapy’ ‘tesosterone’ (Uses same cover as john’s book)

Time Magazine – tesosterone again in Time Magazine

The Early Androgens Market: How testosterone did not become a ‘tonic’

there is no critical distinction

Androgen Ointment for careful dosing (1939) - testosterone drugs being tested.

[see presentation from September 2006 in Newcastle]

Testosterone for Women: the new era of sex as a lifstyle entitlement

Hormones as ‘antiageing therapy’: the medicalization of the ageing process.

dopers in uniform. - police officers on steroids - brain doping by students Chronicle of Higher Education ‘the other performance-enhancing drugs’(2004, Dec 17.)

Does a lifestyle transform a drug into a stimulant?

“I sincerely believe he didn’t see steroids as a drug, none of these kids do’

Tesosterone magazine - if there is one, it’s probably a lifestyle, not a drug

NEJM – Aging and foundation-of-0youth hormones, paul m stewart. (Editorial)

new york times 1851

ME: treatment of syllvester stallone’s steroid episode in Australia a stunt?

ME:P If I told you that the Sylvester Stallone steroid story earlier this year was a publicity stunt to promote his film, would that change the way in which you would use it as part of your analysis?

what is medical treatment for?

‘if it gives real happiness, that is the most tha  any sufegon or medicine can giv e Dr Harold Gillies, poionieering British plastic surgeon specializing in the cosmetic repair of burned an maimed soldiers.

line between therapy and enhancement more blurred, but in sports it remains distinct.

outside of sport, enhanceemtn becoming part of acceptable lifestle goals.

Questions and Answers

Barrie: impc of context of supplement use. parallel with alcohol use – not supplement, but ubiquitous except in certain contexts, eg driving. so maintain distinction by defining context in which is seen. Also, bigger problem of maintaining definition of what a drug is – performance enhancement. athletes will not take supplements unless performance enhancing.

John: alcohol comparison important, but works one way but not another. focuses on volume of social harm that arses from use – anti-doping can make some analogies. compare social impact of steroid abuse with alcohol. but does not work in following way: putting police officer on alcohol improves performance, but if look hard enough can reconstruct dialogue of police officers on steroids – legit doping to assist in overpowering physically violent criminals. other trade ofd. chief of police of Miami said: we really should think about whether approp to put police on steroids. he was not saying it was wrong, but should think about it. now is v politically incorrect thing to say. but he identified a real dilemma. more common as something like modafinil becomes acceptable as a productivity stimulant. how are our feelings and values going to deal with this? popular wisdom in us that caffeine runs some industries.

Rob Beamish: enhancement as part of popular culture; postmodernist remaking of self; now, we remake self as part of regular way of lif. but also saw enhancement as violation of ethics. but in high performance sport, not anone who says high performance sport is a character building practice. so, enhancement not violation of ethics, but only certain types. where decide that enhancement is no longer ethical. at what point will we see steroids as non-ethical?

John: in 1990,k WHO said in Lancet that small doses of anabolic steroid were safe. research still being churned out in endocriminology. one part of the dilemma is that still in process of deciding how dangerous the drugs are. we know what anti-doping says. but, these are not the only opinions of relative risks. this remains undecided.

14.00 - 14.30 Prof. Bengt Kayser - Current anti-doping policy: harm induction or harm reduction?

doping-like behaviour

Randall, Zimmerman And Crook prohibited from Olympic strat

kikkan randall – also natural epo peak

spirit of sport – mal defined concept

ME: deliberately so, like many ethical concepts.

repression vs potential gain

consequences of being caught - exclusion for life

consequences of a medal - fame and money for life

difficult to punish much more

does anti-doping work in the sense of their being less doping? - not clear.

transport of doping drugs easier than cocaine, etc

2006 Blood, false-positive detection of recombinant human ep in urine following strenuous physical exercise - criticised by different groups.

ME: Should WADA institute policies to protect vulnerable perspectives on anti-doping?

mike: people who disagree with your prognosis will agree with our diagnosis. disagree with ethical analysis, but agree with analysis.

14.30 - 15.00 Coffee break 15.00 - 15.30 Privat-Dozent Dr. Giselher Spitzer - Body and mind – biographical and health studies about doping victims in East German elite sport

15 years shift – what you see in doping procedures today was ‘state of the art’ before 1989

when did it start with steroids? - blue pill oral-turinabol was 14-15yrs median - half of sample doped before, first estimated 10 yeraas up to 14

why taking bills? - no true answer - others: vitamins, help traiing,  therapy

important damage and disease in sample -    negative developments -    damae of skeleton and muscle make normal jobs impossible (eg. longer standing, sitting, holding things). typical decision to find work was to find freelance. -    no control group, so used brothers and sisters and offspring of each. most of the conditions are not present in these relations.

change of genotype – genetic damage -    virilisation of foets or mandartory abortion because of pregnancy while training or a half year after competition -    premature death while pregnancy or death birth (6 of 46 died from premature death); 3 parents have death birth -    risk of premature death of children of doped athletes 32 times higher than normal popn; risk of death birth 10 times -    important when considering that athletes were strong and medically well controlled -    even control group did not have these figures

side effects on children born to athlete sing drugs -    most of 69 surviving children also damaged -    children of mothers who ere drugged, typically handicapped o    37 children 54% suffer from 2 illneses o    17 ids multiple damage -    Dsisease represented more than 2 times: o    every fourth child has allerges o    one of 4 has skin illness o    one of 4 asthmatic o    one of 10 crippled o    nearly one of ten metaboligc o    1 of 7 psychic o    1 of 17 mental disability

change of phenotype

1.    side effects: skin a.    skin disease 12% b.    allergies 12%

Liver -    disease 17%

organsof body -    damage to skeleton 92% -    operations 67% -    knee shoulder ankle joint 22%

25% of doped athletes have cancer or had cancer 35% sudden inflammations 17% migraine 15% metabolic stomach 15% epilepsy 10% kidney 6%

disturbance of psyche and behav -    attempts to suicide  38% -    psychic illness 62% -    health nutrition 25% -    social drug -    addiction to alcohol 13% -    addiction to drugs 6%

side effects on male -    testicle-atrophy or loss ability to produce sperm, 4 athletes -    operation of testicles 3 athletes -    enlarged prostate and treament 1 athlete -    gynacomeastia 3 athletes (11%) (pre-cancer) -    8 andrological diseases (29%) o    more often than was thought

side effects on women -    virilisation in general (breast reduction, facial hair, lowering of voice) 42% -    injectins after maenorrhoea 4 women -    hypertrophy of clitoris (not asked!) 0 in literature biggest size is 12cm -    atrophy of uterus and underveloped 2 women -    changes to ovaries – 3 women -    generally o    12 women gynaecological disease (50%) o    probs with sexualidentification and identity, resulting from virilisation

no case of transexualism

7 secondary side effects as a result of higher dosese (‘overload) - new type of damage of connecting tissue - 7 athletes took drugs against feeling of being hungry or pills to lose water - german masters or Olympic medallists or candidates were anxious because some gram of body mass. they stopped after reaching goal

The Value of the Results - what we learn first: give help to victims of mandatory oping as a humanistic need second: knowledge to prevent re-emergence of simlar systems based on drugs eg china third: enhancement of future policy

ME: Why do we have no good answers about what is happening in China?

other values - value of health motor for anti doping - boy capital is concrete guide for athletes who have to decide if they want to dope - beyond ethical arguments, must protect own health.

Caston Lundby – rHuEPO treatment in humans: new findings and considerations for anti-doping work in the future

function of rHuEPO on blood

red cell mass ncerase, decrease plasma – total amount remains similliar

function of rHuEPO on performance

invasive studies – 6 catheters

new: epo also works at altitude. if take epo and ex at altitude, have use until 4100m approx.

so epo works for max ex intensively, but since most comps not held at max capacity, wanted to know at more suitable ex level. – how long could cycle of 80% of max to exhaustion -    VO2max inc, but sub maximal intensities, much greater effect of epo doping. -    not that using epo will lead to 54% increase, but that, in cycling, if break away from pack, could go for same velocity for 54% more time.

does epo have other functions than increasing oxygen content? -    we’ve found receptor for epo in skeletal muscle (Lundby et al, AJP. -    we’ve found no other physiological function with our model. -    if develop more capabilities, could inc ex capacities.

to determine whether other effects,  gave subjects epo. -    cycling exercise. o    removed new blood from epo inducaed athletes. result showed presccie correspondence with pre-induced performance •    suggests that effects of epo on performance related to arterial oxygen content

conclusion 1 -    rHuEPO increase arterial oxygen content by inc red cel mass decaeasing plasma vol -    if arterial o2 inc aerobic also increase -    m

is it dangeros to take rHuEPO.

transgenic mouse – tg6 mouse – born with 80 hematocrit. lives for 12 moths. wild type lives 24 months. -    dies ofmulti-organ failure.

Mean Arterial Blood Pressure -0 in our substances, increased by 5-6ml of mercury – if you have this throughout your life, it is of course hazardous, but if increase to 50 and inc mercury for a few months per year for a cycling career, my guess is that it’s not so bad.

also investigated heart itself. found no dangers.

detection strategies and other

are the detection methods good? -    abolish hematocrit level? because easily manipulated (plasma expanded, or blame sauna) -    so, think about quantifying total haemoglobin mass, since this is constant measure usually

Hb increases with altitude exposure Hb increases with training Daily variation in htc daily variation in plasma epo

so, to know whether is stable, measured in subjects – breath carbon monoxide

not clear that rapid increases in htc is blood doping

wide variation

so, this method is worthless

the on/off model

future (now) ?

epo receptor activating peptides (ERAPs) -    do job of epo, but are not epo

when not neede, broken down immediately by -    prolyl hydroxylase inhibitors

group in oxford has made inhibitors (DETECT FOR INHIBITOR?)

Machines to use? -    Radiometer OSM3

Conclusion 2 -    difficult ot get htc or hb mass measure -    machines don’t always tell the truth -    future (and this is now…) is scary with regard to detecting endogenous epo enhancing agents

15.30 - 17.00 INHDR network meeting

19.00 Dinner in Aarhus 4 International Network of Humanistic Doping Research 16 August 2007 8.45 - 9.15 Coffee 9.15 - 9.45 Asst. Prof. Rob Beamish – The Policy Implications of the Current Social Construction of Steroids as a “Moral Panic”

I try to never use the word doping, since implicit illegality

Umah Bartov ‘Distorted Mirrors’ - perceptions are fundamentally important - holocaust portrayed through series of mirrors

march 17, 2005 – committee on government reform

social constructionism - moral panics - claims makers - build moral consensus

eg. house committee is one process of claims making

coubertin’s objectives have become the IOC brand

1972 munich – separate GDR - east german successes embarrassment to west

Wade 1972 raises concern about steroids

‘the first of male steroids to improve performance is said to have been in world war II when….

1988 – 48 strides under 9.8 seconds

Trevor Graham turns in syringe with THG to USADA BALCO 2004 State of the Union

San Francisco chronicle links Greg Anderson to BALCO who is linked to

bigorexia – young men trying to bulk up. – associated with Viagra, and other enhancements – ‘cult of the body’ within a context where drug/supplement use is widespread.

comic book masculinity

use of steroids part of postmodern world of changing faces.

Questions and Answers

John H: how long did victor conte serve in prison for balco – 3 months. grotesque disproportion of moral panic vs judicial system.

Rob: game of shadows – clear that there are thousands of BALCOs throughout America.

Paul D: mythmaking vs actual fact? how distinguish?

9.45 - 10.15 Dag Vidar Hanstad (Norwegian School of Sport Sciences) – Where on Earth was Michael Rasmussen? Elite Level Athletes and their Whereabouts

aim -    survey of athletes attitudes on doping -    292 subjects, 80 responses (or was it 80?)

findings -    80% said they trusted the online system -    1 out of 4 felt it reduces the joy of being an elite athlete -    signif percentage felt that 3 warnings in 18months should lead to sanction -    many athletes felt part of a ‘big brother’ system? -    few felt that info collected would be misused.

does tracking whereabouts violate self-determination? need to regulate can get out of control

everyday surveillance is extensive

10.15 - 10.45 Asst. Prof. Andy Miah - Human Enhancement Technologies and Sport: The New Language of Doping? 10.45 - 11.00 Coffee break 11.00 - 11.30 Prof. Mike McNamee - Ethical issues regarding human enhancement technologies: Therapy, Enhancement and the traditional goals of medicine in sport

against doping - performance enhancement - allows more training – coercion - unnatural - harmful - unfair advantage - cheating

idea of enhancement - valorization of autonomy - are athletes generally autonomous. if not, cannot make autonomous choices - athletes are not autonomous, do not understand sports medicine, are passive.

ME: their reliance on expert knowledge is no different from your own knowledge of medicine.

medicine is essentially therapeutic

ME: but a wide range of therapies are context driven. imagine a 70 year old man who can no longer enjoy a sex life. is the prescription of Viagra therapy or enhancement? Alternatively, an individual who has a known late onset genetic condition for which there is an ongoing treatment – you are likely to get Parkinson’s, we should start treating you now’ your characterisaton of these as peripheral to your concerns is mistaken. they are the business of all medicine.

doesn’t follow that what happens within a hospital is all therapy

night and day, cannot tell you when one begins. – ME: yes you can mike, it’s when you wake up

‘there will be cases which are not therapy/enhancement, I don’t have a problem with that’ - ME: that’s precisely the problem you have

demarcate unacceptable enhancement use of prosthetics in elite disability sport

how desirable is the fact that the performance is dependent on technology? (Loland) prob is surrending level of control athlete has over daily life -    ME: so, an athlete that wants to stay at home with family, cannot afford to take them to mountain, her quality of life is diminished by not using hypobaric

will what is left be recognisably human?

Questions for Mike: 1.    if your claim is that athletes are passive – ie. not autonomous – then I also doubt my own understanding of . there is no legal basis for supporting the claim that athletes lack autonomy. In 1985, the case of Gillick vs West Norfolk established what’s called ‘Gillick Competence’. it indicated conditions where minors could obtain abortion without requiring parental consent. it has become a critical part of how we think legally about autonomy and consent. there is no way imaginable that you could argue legally that athletes are not autonomous to such an extent that you could step in for them to decide on the basis of some ‘substituted judgement’. Over the last year, my doctor has quadrupled my preventative prescription for asthma. I’m not sure I understand the medical science too well. I feel like I might be building an unhealthy resistance, but there is no doubt that I have autonomously acceded to this treatment. 2.    Medicine makes us well ‘for something’ it is never free from the lifestyles we want to lead.

11.30 - 12.00

Director Michele Verroken - Anabolic Steroid Use – what is the size of the problem for sport and society?

reliability of data = credibility of information

test date from 1993-2003

no of samples increased from 89166 to 151210

no of anabolic steroid findings inc from 940 to 1169 (872+297 – includes beta 2 agonists)

question – is an approx 2% problem, a problem?

in 2002-3, Australia reported only .59% positive test.

we don’t know about the problem

survey of athletes 1998

54% believe that up to 30% of competitors in their sport were using performance enhancing drugs

4% said 60% were doing so

3% (none from weightlifting or rugby league) believed sport was clean

(from the Indenendent)

new york times 2003 ‘how many athletes in us use steroids’ results do not reflect testing data?

also asked whether it bothered people – 30-40% said no.

realibility of testing, random, missed test scenarios

many athletes say random testing is actually targeted.

positive test over the years not significant percentage.

ME: ou mention Beijing. what do we know?

are we helping ourselves by identifying the size of the problem.

better to miss a test than fail a test.

more than 70 British athletes have missed at least one out of competition drug test. 4 of them have missed 2.

IAAF regs say a missed test is for five years, not just 18 months.]

testosterone reporting

testosterone-epitestosterone ratio - upto 2004: 6:1 - post 2004:

Autologous blood injections in soft tissues complaint

alice in wonderland ‘I don’t think they play fairly…’

£2000 to treat abscess from steroid injectors – if teach to inject properly, lower the cost.

future social problems? - France BJSM research – 1/100 of eleven year olds use drugs to enhance performance (could be salbutamol)

we know there are inconsistencies between sport and society use of steroids

to WADA - tighten up testing – not government targets - promote health consequences of using steroids and opportunities of needle exchange.

12.00 - 13.00 Lunch 13.00 - 13.30 Prof. Alessandro Donati - Connections between doping and narcotic drugs

Australian anti-doping agency – image vs performance enhancing drugs

Schwarzenegger was paid by mafia directly for his films

combination of doping and training knowl - day of athlete now is full of training – cannot do other things. - e.g. many cannot read more than 10 books a year - rogge now interested in youth – fight obesity and sedentary – so, youth Olympic games - no connection between doping and obesity/sedentary. - clear that athletes use undetectable drugs, not the others - anti-doping tests died. - dick pound says they’ve improved, which is true, but prob is that anyone can modify and disguise drugs. - we need anti-doping, but not only.

source of proof - in sport – only test - in judicial system - searches, seizure, wire ttapping, expert reports, test biology, documents

what is hidden behind high number of negative tests? - suffer from asthma, high testosterne or hmb - hides anomalous levels – pathologies behind results - interest in lives or appearance – I think only appearance egs. - upward trend of cholestorol levels through t years. why? - unexplained fluctuations of haematocrit and haemoglobin levels (more than 20%) - critical fluctuations of liver transaminase..also azotemia, bilirubin and several other parameters

negative anti-doping hides emerging disease conditions.

electronic health passport is a good idea.

why do we need state laws against doping? -    every country should pass criminal laws against doping or update existing laws concenring addictive and pharmaceutical substances that would allow effiecient action to contrast t diffusion of doping among amateur athletes and in gymnasia.

mistake in Italian law is that specifies for elite athletes, it should be everywhere.

ME: if the law should be for everyone where else do you want to police usage? schools, gymnasia,

sport system is scarely efficient as regards acquistion of proof but decisions on sanctions are taken swiftly, but process much longer

dishonest officials stay in the environment, while athlete is out.

the old ioc was a disaster. now we hope wada, but we are late

connections between doping substances and social drugs

common ground – cocaine, stimulants, amphetamines heroin, opiates narcotics cannabis, ghb, alcohol.

sport system

difficult to accept sport system. athlete positive for cocaine. he never went to disco. when is he going to use cocaine for social?

antidoping lasws in eujrope

legal systems on dupong - in June 2006, Italian minister for social affairs appointed me fconsultant

doping substances are assimilated to addictive drugs so that the judicial instruments and the anti drugs criminal las…

se of doping substances not criminal offence for common practiconers but only for professional athletes….because doping gives them an illicit advantage and damages their opponents - create indiv health smart card for all practioners of sport federation. - not important to disqualify, but to stop - inverstigations coordinated by special police squad - contrast traffic of doping substance via the internet

Article 28, item 4, establishes internet acess providers….

Slovenia - websites in several countries -


13.30 - 14.00 Asst. Prof. Ask Vest Christiansen - The use of anabolic-androgenic steroids among non-competitive strength training athletes - cultural, social, and psychological explanations

campaigns against non-competitive strength trainers has failed, why? portrait of a person who took a lot of steroids and loved it presentation of types of questions received by Anti-doping denmark

1999 national household survey on drug abuse – estmate 3m users of steroids in US ADD estimates between 10,000-60,000 in Denmark inexactness reveals how little we know 4 of 5 steroid users are non-athletes in Denmark: 9/10 users non-athletes steroid users larger doses today than previously reported widespread misconception that trainin for improving appearance can only succeed with combined drugs and training

have tried to change things by imposing fear

a paradigmatic change – not just a medical prob but a cultural phenonmenon

take into account cultural norms and values of drug inflicted subcultures

campaigns have been based on bourgeious values, v different from cultures of body-builders

focus of campaigns have focused on side effects and consequences – impotence, acne, damage to vital organs.

subjective experience of drugs vary - inc stength, virtality, libido, social status

a Danish bodybuilder - said how use of drugs gave 2 fantastic years of building, but ultimately spiralled out of control. - from compettive football, but disillusioned. realised potential for muscle building. was well proportioned. but after progress, muscle development levelled off. decided to continue development with steroids. began with anabolic, to nanobolic – injecting 150-250 mg per week – more effective and no side effect of subcut fat, as pills did. achieved high recognition in his milieu. strict diet. other things mattered less. when met a girl, made clear should not complain about his use. experienced none of the side effects, never violent. but lost control of medicine. intervals between treatments completely disappeared. did not bother him at first, but became ill. 3 weeks before contest, body broke down. hospitalized. in recovery, realized seriousness, before moving depression. he felt something was taken from him. – injustice that had not been able to finish project. now recovered and teaching in small village school. - what can be learned? - male status of muscles is crucial to understanding doping of weight training - promise of transformation.

Alan Klein ‘little big men’ – promise of change, from vulnerable to heroic and opposing.

14.00 - 14.30 Coffee 14.30 - 15.00

Prof. Verner Møller - Is the current anti-doping strategy satisfactory, and can it be improved?

doping is what wada assesses it to be

prob not that you dope, but how you dope

eg. caffeine – taken off list, despite being a stimulant why not oppose vanity dopng?

tamburrini – what is wrong with doping?

fact that doping rules are arbitrary does not mean they are mistaken. second claim by tamburrini, is that open access would be discovery of actual risks. -    other areas suggest restrictive use leads to

in spite of these reasons, threre is support for anti-doping

so what is wrong with doping? nothing if ultra-liberalistic perspective

Questions and Answers

Claudio: is the reason for so few doping injuries evidence of underground doping research?

15.00 - 15.30 Final discussions 15.30 - 16.00 Epilogue 17.15 Visit and buffet at City Hall

International Performance in Sport Conference (2006, Sept, Newcastle)

International Performance in Sport ConferenceNewcastle, Sept 2006.

Muscle Responses to Exercise Prof Dave Jones

how optimised muscle performance before (training) and during competition? (i.e. by warm up)

muscle size and strength almost synonymous

technological advances in sports surgrery Mr Lennard Funk shoulder and upper limb surgeon,  Manchester, UK.

improvements in surgical skills and ability to teamwork better has asdvanced capabilities -    teamwork with coaches, physios and the conditioning coaches

advancements faster than literature

not clearly evidence based

how allow person to recover faster?

aim = return to previous level of sport

National League Player of the month -    Paul Rowley, Centurians –

shoulder 1.    anthroscopy 2.    surface replacement 3.    osteochondral lesions 4.    rotator cf repair and patches 5.    suturtres and anchors 6.    hyaluronans 7.    acceearted rehab – cryo, tc

knee, sanjiv jari 1.    chondrocye transplantation 2.    meniscal transplant 3.    double bundle ACL

Anthroscopy -    ‘ the needle with an eye -    no sutres, less pain, day case procedures, quicker rehab, lower morbidity -    conditions treated: impingement, AC joint artisritics -    overhead athletes shoulder – o    internal impingement, dynamic assessment (Burkhart et al, Arthroscopy, 2003) – not just baseball pitchers o    anterior plication -    contact athletes shoulder o    labral lesions o    treat all associated pathology o    rapid return (Funk et al. Clin J Sports Med, 2006) -    Rotator cuff repair and reconstruction o    cuff tears o    outcomes of RCR •    time ti surgery; previous steroid injections, quality of tendon tissue; quality of muscle; smoking and NSAIDs -    Collagen patches o    reinforcement of repair; provide protection; incr strength of repair replacement; accelerated healing (growth factors) o    GraftJacket regenerative tissue matrix -    Genetic Engineering o    putting stem cells on collagen scaffold -    Wheelchair athletes shoulder o    acute rotator cuff tear -    Osteochondrail lesions of sholder and elbow -    Sutres and anchors o    extremely strong, semi-biodegradable, controlled release growth factors -    Anthroscopic stack -    anthroscopic theatre – bridgewater hospital, Manchester -    shoulder replacement in young people o    surface replacement (bone preserving, minimally invasive, easier revision, long term results (Funk, Copeland and Levy, JBJS 2004) -    Post-op advances o    anti-implamm •    mechanical, biochemical (inhibit phagocystits) o    viscoseal hyaluronan (less pain, better function) -    Slings and Cuffs (traditional slings, unnatural and no evidence!) o    in France: preferred: 15 deg ER Sling – better early ROM -    Cryocuf (less pain, less analgesics, faster ecover Singh et al 2001) -    Shoulder rehab advances o    protect from physiotherapst! o    effects of immobilisation o    clinical results •    old protocol – 20|%s stiff o    protect and rehab at same time? o    Tendon loading •    immobilisation: dec tendon weight, dec stiffness and tensile strength, irregulat collagen fibres, type 3 :> Type 1 collagen; degenerative changes; Exercise: (incr growth factors, tensile strength, incr •    EXERCISE RATHER THAN IMMOBILISE -    Accelerated Protocol o    Day 1-3 weks (0-20% EMG exerciseds; Low activitiy) o    3-6 Weeks (40% + EMG) o    6+ (40% + EMG)

Kneee (Sanjiv Jari) 1.    chondrocyye

Autologous Chondrocyye Implanatation (ACI) -    cartilege cells harvested and multipled -    isolated defects, stable knee reqs,


Summary Future: Biological Implants Tissue Engineering

Questions and Answers

question: how does it fit with doping

a: don’t know?

a: growth factor unlikely to enhance


Ron: doping do not prevent treatment

Lee: grey area is gene therapy – once therapeutic over, still a permanent enhancement

Michelle Verokken:

Ron: where next big advances?

Funk: not sure ewhether tissue engineering will be taken over by synthetically derived growth factors.

Athletic Injury and Gene Therapy Lee Sweeney

muscle injury in context muscular dystrophy

skeletal muscle

somatic cell gene transfer -    delivery of DNA into fully developed tissues (eg lung, liver, heart, skeletal muscles) -    technology developed for gene therapy – correction of genetic mistakes that cause disease -    hwr same technology for genetic enhancement or improvement of functionality of non-disesase, but injured tissue

Gene delivery into muscle -    primary target is post-imtoic (no-dividiing) nuclei of t mature muscle fibres -    gene delivery vectors o    naked (plasmid) DNA – ineffecitent and transient o    Viruses (AAV (Serotypes 6 and 8 are most efficient); Capsule modified lentiviruses o    Non-viral DNA conjugates o    Adult stem cells (muscle and bone marrow derived)

AAV mediated gene transfer -    readily infects skeletal muscle -    no drop off of expression over time -    limb delivery possible, body delivery still limited -    size limitation – some genes don’t fit (duchenne muscular dystrophy) -    virus production had been a problem, but new technologies in viral production … amount required to treat will soon not be a problem. -    immune response problem –

Questions and Answers

Question: a lot of body builders using systemic IGF-1 from China

question: will treatments be relevant for diff fibre types?

a: wouldn’t redistribute muscle mass.

Lee: application to dogs – owners would like dogs to be able to keep going for longer.


biomechanics and sport salo


support issues examples

Conflicts of Interest Panel

mark james, acting head of Salford law school john o’leary mike townley, parters of athletes1

mark Dept of Health recognition of Sport and Exercise medicine as a discrete specialism is releavtn here.

ME: ask question about whether should be charcterised as medicine.

discussions of ‘best practice’ more relevant than legal rules that are tight

ME:  we heard earlier that surgical technological developments does not rely on an established evidence base, so can an athlete expect informed consent?


what do we mean by implied consent in sport?


need for radical difference in physician’s role in sport performance

ME: Is the patient-doctor model an adequate reflection of the athlete-doctor relationship?

Question: Max Jones (runs Marathons (not the Max Jones of UK Athletics)  in what way should aptient-doctor relationship change just because the athlete becomes so good at her hobby. WADA don’t trust doctors. after 1999 lausanne conference,faq was ‘should medical doping be permitted’. answer was no, because only the IOC could control long term effects of doping.

Mike: how should the relationship change? it needs to be less suspicious. doctors must become less suspicious of performance team. athletes must become less suspicious of conseqs off communication of an injury status. in funded sports, not clear that communication leads to de-selection. get beyond idea that favouritism is what counts. british athletes not happy with waiving competition.

ME: 2 athletes, both get injured, one athlete tends to do better with recovery psychologically than another. on this basis, the doctor recommends the former athlete, but on no scientific basis.

Mike: diff between weekend warrior and elite athlete. athletes want to go to limit. amazed at how medical community have reacted.

Rob Dawson: comments outrageous. patient-doctor relationship is sacrosanct. if correct doctor selected for team, they willl have the right values.

Mike: but when accepting claim that nothing breaks patient-doctor relationship

Ross: GMC – doctors role to protect indiv.


Steve Olivier: research ethics. I don’t think the comments are outrageous at all. things can change. why should a rational adult be allowed to waive confidentiality?


Mike: great hostility to that waiving of confidentiality. met with resistance before it gets to the athlete.

James: how does one define relationship between doctor and athlete? eg. a power relationship – doctor is older usually, more formal education, perhaps greater level of sophistication. compared with athletes who are youngerk, less experienced in t ways of life, and, perhaps, possessing lesser degree of sophistication. standard I use to make sense is – lookinjg at perspecxtive of aptient – it’s the REASONABLE athlete standard. defining reasonableness is difficult. how achieve informed consent from this perspective? not as an event disclosure – eg. signing a form = consent – I think, compared to gen medicine, sports practictionaer already has special relationship that there is an ongoing comm., that athletes and doctors are working together. sports produce injury. tf, athletes and doctors will have the regular contact. som, there is a special relationship – not legal term. then, issue of informed consent is easier, as ‘process’ or ‘educational’ consent. PROCESS MODEL.

Michelle Verokken: would be fine if informed consent and confidentiality if all athletes over 18. one of my concerns is youngsters brought rhough sports system, where they learn to trust various people. not consent, but only alternative you have to achieve public funding in order to compete. no genuine capacity to consent. implies doctor has nobody behind them, but we know they are.if try to achieve informed consent, must take sport system as a whole.

James: difference between Consent and Assent – if assent, then different from consenting.

Michelle: difficulty in sports is that getting to top, few people who fund themselves without trappings. ie. not sure there is a consensual relationship anymore.

James: objectify athlete

Max: the athlete? the antidoping codes don’t apply to athletes, but to Athletes – defined as International andnational athletes.  WADA 2004 best practices code – form at end – ‘I agree and had opp to review IAAF anti-doping code). they don’t need consent. WADA Code not an Agreemnt – if effected by it must sign.  when Dick Pound said antidiopng rules are rules that athletes consent to, he said if they don’t like rules, tough!

john:  concerned about idea of ‘best interests’ in sport. seems to be a nebulous consent that runs riot.. idea of waiving confidentiality falls in that confidentiality? how does this benefit athlete?

ME: if we are propsing a non-medical model, would this change DoH funding?

john: interests of sport, or interest of athletes.

mE: rights of sport, wrong, but protection of a practice is.

Question: as an athlete, you choose to compete and accept rules. eg. agree that netball is a non-contact sport.

Naomi, UK Sport: project on datsa storing of injury data

Mike: IOC philosophy – ‘exhaulting life…’ that’s not the way it’s viewed.

John: are you talking about implics of practie, sport, or criminal law? probably committin criminal act to defraud – money involved? prize money

Michelle: informed consent from eam doctor’s perspective be suspicious of.

Rob: who owns the records?  if change definition of doctor in sport… when a clinent, not same duty of care.

Bruce Hamilton: if genuine consent athlete won’t do it?

Mike: to get informed consent, are you saying

james: ongoing consent. significant practicality – not enough time.


visualisation techniques

functional equivalence -    motor iagery and motor preparation are related to same represn stem -    some differences o    outcome o    dual pre-motor system

a good experience is good when you do not recall how you did it

bad ones often bad because consciously controlling what is wrong -    can recall in fullest detail

Practice makes Permanent


Medical Complicity in doping John Hoberman

historical imeline

1893: philippe Tissie performs a doping experiment 1933: a german pharmacologist condemns doping 1941: androgens for the ‘male climacteric’ 1957: American medical association studies doping 1957: ‘should athletes take ‘pep drugs’?’ (UK) 1957: AMA Denounces Amphetamine Doping 1960: an American sports physician on doping

1969: drugs: a threat to sport (Sports illustrated 1972: physican claims steroids don’t work 1985: west german sports doc condemns ysteria 1988: The Lancet on Physicians an Doping 2005: A South Carolind Doc upplied steroids and GH 006: inteview with Loptha Heinrich (Jan Ullrich) 2005: doc comments on golof and testosterone

1890s, era of high performance sport begins crude exptl period of stressing human physiology cyclists become great subjects for testing human limits Tissier linked with De Coubertin – concerned about stree on body from sport ie. physician concern about welfare of athlete goes back far

two aspects of tissier – -    1890s, naïve and is sending cyclists around track with diff liquids, rum, milk, champagne -    performing a dopping expt of hisoown

before concept of doping existed, he was interested in wht to do about fatigue

he described athlete as a sick person

athlete as a pathological case

when does idea of doping emerge


1933, A German Pharmacologist Conmens Athletic Doping - check Mortal engines for quote

UV rays to boost performance

inter-war period, doping discussion as we know it begins

don’t tell me that steroids spoil everything!

marketing of androgens

1941 – Androgens for the ‘Male Climacteric’ healing of male menopause

testosterone synthesisee in 3 labs in 1935

by 1939 being used wrecklessly by US docs

aphrodisiac property of testosterone -    irony, was given to women who were in no condition to be sexually active

the focus on athletic doping is imp, btut not enough need to look at the entire medical landscape

booming anti-ageing market

1957 Four Minute Miles accused of Amphetamine Doping, New York Times, June 6 ‘AMA to Study drugs in Sports: Use in Four-Minute Mile Hinted’ [front page story] -    assumption by phywsician was that humans not capable of this without supplementation

this set off a discussion

1957 The New York Chapter fo the AMA Denouncest Doping as a Threat to Youtyh – JAMA, June 13: 1244)

ME: What is the motivation of these doctors?

we are still at this stage of the discussion

1957 Sir Adolphe Abrahams on Amphetamine Doping, The Sunday Times June 16 ‘should athletes take ‘pep’ drugs’?

he did not succumbe to the moralising syndrome of the previous eg

need to understand how naïve some physiscians have been about doping before

a victorian outrage in response of AMA officials

this is also recognisable to use, as their genuione alarm of illegitimate use of drugs, what we get is something that is conflation of moral/ethical argument against drug use and the medical argument

ethics and health underpinned anti-doping

conflation of moral and medical is effortless

for Abrahams and brother who were publishing commentaries at the time, Abrahamas was an indep type. refused to assume drugs were effective. he also said ‘quite apart from the possibility of physical illconsequences, physician cocenr about amphatem…. was about suppressing self-inhibiting;’’’ concrn that would suppress limit recognition ‘as to anything unsporting’… o’one is forced to face debatable’ -    ie. he did not take automatic moralising position. he insists on thinking about what constitutes doping. this was a sophisticated posn for his day.

imp to understand that this issue was being given attention 50 yrs ago

what constitutes doping was unsettled

groping for a workablre doping definition


partly because assaled by claims about drug use and by medical concern

1960 An American Sportw Phyiscian on dopin: Amateur vs Professionals, New York Times, sept 12, ‘use of drugs in sport’ first drug induced Olympic athlete death

letter to NYT where immediate parst president of American Coll of Spots Med says ‘the proesional athlete has a job to do, which may be his sole livelihood’ ‘sounds like prince de merode] so he ‘may use any means to acxhieve’ calculated risk of means are recog part of any professional sport

who could describe subculture of toure de france any better!?

using words likke ‘perversion’

he was saying let them do what they want

1969 Sports Illuswtrated: ‘drugs – a threat to sport’ sports Ill, June 23

HK Duley – physician on US team -    offered 4 args on behalf of physican involvement in steroid doping o    1. indespensible in weight sports o    2. physician had no obligatin to dissuade athletes from using drugs ‘I did not give steroids at Taho, but I did not inquire what the boys were doing on their own. I did not want to be forced into a position where I had to report them’ o    3. drugs did not differe in any essential way to other performance enhancing techniques. if I know something that would improve performance, without any serious health risk, I see no reason not to make available to an athlete. o    4. medicasl supervsision was safer than no supervision at all ‘lesser harm’ argument. ‘athletes hear about these things arnd are going to get them one way or anyohter’

have to agree with hum on one point -    in 1960s etc were many physicians who did not know about these drugs.

1972 An American sports physician claims that etoids don’t work: doping is quackery, JAMA, vol221 August 28, 1972 ‘Drugs and the Athlete’ (Donald L Cooper), pp.1007 ‘normal is the best there is’ ‘ drugs are for losers’

this phase cost sports physicians credibility

1985 West German sports doc (Mortal engines, 1992, p.262) condemns hysteroa about therapeutic anabolic steroid use: Heinz Liesen

1976 most prominent german sports physicans testified that steroids were safe and recommended should be used by national athletes

Heinz Liesen (1985) – testosterone less dangerous than female pill ‘why do we make such a drama out of this?’ -    this question keeps returning -    if we want to get at deep roots of crisis or, more strongly, freefall, mst see how commercial interests in sport, negotiate performance enhancing treaty with war on drugs

West gErman only place I know that had celebrity sports physicians

Lieson has something interesting to say – substitution therapy

therapy vs enhancement problem

1988 The Lancet on Sports Physicians and Doping, Sept 10: 612 two weeks before ben Johnson ‘Sports Medicnie – is there lack of control?’ -    ‘although evidence of involvement of med practitioners…is lacking..they are connivers…’

a real problem brewing with doctors involvement

2006-2006 ‘James Shortt’ -    ‘an alternative medicine and longevity doctor provides doping drugs to professional football players in Southc Carolina’ ( -    he has just been sentenced to prison for prescribing GH -    he is a ‘rogue sports physician’ n -    not with an official position -    from Jan 01 to Jun 04, authorised around 139 GH prescriptions, etc etc, -    comparative context imp -    market for anabolic steroids has v little to do with elite athletes! (there is a range of clients). -    prescribed to athletes, police officers (thisis imp) - -    cops, soliders, bouncers, security, fireman, all use them -    he take recordedhis own incriminating conversations -    he says ‘for you guys what I’m looking for is a non-detectable performance enhancement’ -    athlete as client – what does a sport physician owe an athlete? -    My guess is that Dr Shorrt is looking for stress from a functional standpointm, rather than therapeutic -    treated about 14 NFL to help athletes ‘heal’ from athletes -    but he just said the opposite! -    medical authorities did not look at Shortt as he saw himself. they blamed him – no medical justification for prescriptio -    he then collapses and confesses, saying he wrote prescriptions and he says he knows it was ‘federally wrong’ -    he failed his social obligation to create role models

mE: I’m inteeresrted in the range of characters you present.

Dr Lothar Heinrich -    ‘anti doping work is not my mission’ -    focused on health

ME: why does heinrich not see antidoping work as health work?

-    when Ullrich and other 57 got wiped out of Tour, tv viewings went down by a third -    ‘cycling is not a drug-ridden sport’ -    in sport ‘you hope to participate in something of historic significance’

so much for the detacthment of sports physicians

Questions and Answers

Rob: crucial aspect is that is ‘sports entertainment’ industry

ME: comparable to others?

Rob: bottom line is that it is against the rules. and this is the key Partl.l the future?

John: public survey data suggest around 30-40% say they are unconcerned about medically supervised steroid use. we’ve reached a point when have to think about being a conscientious defector from performance culture of sport.  Heinrich doesn’t want to take any social responsibility.

Michelle: where is best pase to have debate about medeicl involvement on performance enhancement


prof. david cowan, UK Sport kings college London

DTI Foresight -    ‘analysis of substance that influence performance’ -    he was involved with this. - -    landmarks in drug analysis

pharmacogenomics microchip technology

post 2010 -    inviv in situ analysis -    electromagnetic scanning -    direct measurement in complex matrizes -    isotope signatures

would we have sport where everybody wins? no.

as long as it is the will of sport comptitors to control doping, effective doping control must be continued


Garnier ‘medscape ortopediat and sports med 2006 ‘in sport with are dealing with  a health even a super-healthy population

Medication Use in Athletes Selectf for Doping Control at t Sydney Olympcis 2000 Caorrigan and Kazlauskas CJSM 2003 ‘it is diffi to udst why t med starff has endorsed such under dosing as apriri one a day…

autologous blood injections

blood spinning -    spin off from autologous blood injections


baseball need consent of union in order to do doping tests