Is There an Ethical Difference Between Using Performance Enhancing Drugs and Using Performing Enhancing Technologies in Nutrition, Training, and Equipment?

PRO (yes)

Timothy Noakes, MD, DSc, Discovery Health Professor of Exercise and Sports Science at the University of Cape Town, wrote in his Aug. 26, 2004 article "Tainted Glory," published in the New England Journal of Medicine:

"[W]hen used by fully trained, elite athletes, [performance-enhancing] drugs can improve performance to a much greater extent than any combination of the most intensive, sophisticated, and costly nonpharmaceutical interventions known to modern sports science. Scientifically based training regimens, special diets, and complex physiological and biomechanical measurements during exercise and recovery cannot match the enhancing effects of drugs... Thus, drug use in a subgroup of athletes who -- even in the absence of drugs -- are able to compete at an elite level causes their separation into a distinct athletic population, distanced from 'natural' humans by a margin determined by the potency of the drug combinations that are used."

Aug. 26, 2004 - Timothy Noakes, MD, DSc 

Greg Skidmore, JD, founder of and contributor to the Sports Law Blog, wrote in an Apr. 21, 2005 article titled "Performance-Enhancing Surgery and Sports," posted on his website:

"Tiger Woods used LASIK to improve his vision to 20/15 -- meaning he can see at 20 feet, what the average person can only see at 15. Mark McGwire wore specially-designed contact lenses that improved his vision to 20/10. Is this any less cheating than using a supplement or drug that was legal at the time (i.e., andro)?

On the one hand, such corrective surgery can be distinguished from using performance-enhancing drugs and supplements. Surgical techniques, rehabilitation options, nutrition and diets, weight training, equipment: all are technologies that have made sports far different games from 50 years ago, or even 10 years ago. Is surgery that enhances vision all that different from new surgical techniques that can help prevent major damage to aging joints? How different is it to pay a doctor to fine-tune your eyes versus paying personal trainers and nutritionists to fine-tune your body? In contrast, drugs such as steroids produce unnatural levels of hormones in the body so as to move past mere 'fine-tuning.'

Second, and perhaps more important, is the 'role model' difference. Professional sports (and legislative bodies) are concerned not as much with the prospect of 'cheating' in athletic competition, and more with the danger that younger athletes will follow the example of the pros. Use of performance-enhancing drugs among high school athletes has been well-documented in the past few months, which indicates the ease in which they can be obtained. Teenagers can also walk into nutrition stores and emerge with a number of dietary supplements, not all of which are free from side effects. At this time, however, corrective eye surgery is not easy to obtain. The procedure is costly (several thousand dollars) and not all doctors will perform it on someone with good vision. In addition, most (reputable) doctors will hesitate, if not refuse, to perform a surgical procedure on a minor without parental permission."

Apr. 21, 2005 - Greg Skidmore, JD 

Robert Simon, PhD, Philosophy Professor at Hamilton College and former President of the Philosophic Society for the Study of Sport, stated in a Dec. 9, 2004 online chat sponsored by USA Today:

"[S]teroid use raises more significant ethical questions than developments in equipment. When we talk about the ethics of performance enhancing drugs, we have to consider such issues as what human characteristics do we want athletic competition to measure, how important are results such as winning vs. the process of competing, and should athletes at elite levels (or high school for that matter) have to take health risks to compete. I also think there are value questions about equipment, such as how far do we want the golf ball to go... but I think the questions raised by steroids are morally more fundamental."

Dec. 9, 2004 - Robert Simon, PhD 

Patient UK, a health and disease information website, wrote in a July 11, 2008 article titled "Drugs and Sport," published on its website:

"Some would argue that the only way to get a 'level playing field' is to lift all bans on drugs and let us push human endurance to the limit. Records have tumbled with new technologies going back to spikes and starting blocks and including modern running shoes and fiberglass poles for vaulting. Should we encourage the same with pharmacological technology? This is a false argument as the banned substances are not without significant risk. It cannot even be argued that the athlete is free to make his own choice because if the opposition use drugs to gain advantage, he will have to do the same to be able to compete."

July 11, 2008 - Patient UK 

Millard Baker, founder of the websites Steroid and, wrote in his July 2, 2008 article "Swimsuits and Anabolic Steroids - Where is the Level Playing Field?," posted on the website:

"LZR [Speedo's latest innovation in swimsuits] is different from THG [a designer steroid] in many ways. First, LZR is not a closely guarded secret. It is openly promoted and marketing by its creators. The athletes openly display their use of LZR to all of their competitors and the general public. Secondly, LZR has been officially approved by FINA (the international governing body of swimming) and the World Anti-Doping Agency (WADA) has no problem with it! Most importantly, LZR is not an anabolic steroid - it is a swimsuit."

July 2, 2008 - Millard Baker 

CON (no)

Kenan Malik, Senior Visiting Fellow at the Department of Political, International and Policy Studies at the University of Surrey and presenter of the British Broadcasting Corporation (BBC) Radio 4 show Analysis, stated during a Jan. 4, 2004 Analysis episode titled "Tainted Gold":

"But scientists already help athletes win. Cyclist Chris Boardman won his Olympic Gold in Barcelona in 1992 sitting on a specially-engineered machine. In the Rugby World Cup, England players wore body-hugging shirts specifically designed to help evade tackles. In neither case did the scientific work in the labs devalue the sporting triumph in the stadium. Why view drug use differently?

It's difficult, in any case, for proponents of the current drugs policy to assume the moral high ground."

Jan. 4, 2004 - Kenan Malik 

Carl Thomen, PhD student in Sports Philosophy at the University of Gloucestershire, wrote in an Apr. 24, 2008 post titled "Doping and the Double Standard in Professional Sport," published on the Philosophy of Sport blog:

"Technological innovations are present in all sports, and at all levels... For example, swimmers are now using full-body suits made out of material that minimizes friction with the water...

Spiked athletic shoes are also standard issue today. These shoes have been proved to reduce times by full seconds by virtue of the better grip, and therefore propulsion, that they afford the athlete. Simply put, if you don't wear them, you are going to lose.

The examples above of swimmers and track athletes are particularly good ones as they both involve sports that have been the traditional bastions of those blowing the anti-doping trumpet the loudest. But isn't this remarkable, as it seems athletes can use any technology (clothes, shoes, heart-rate monitors, etc.) to help them beat their opponent, as long as this technology is put on the outside of the body. Yes, comes the immediate response, but when you take performance enhancers, you are not competing. It is some super-you; you are performing way beyond your natural capacity. People who use this line of argument are simply (and conveniently) omitting the impact of new technology. Don't swimming suits and running spikes do exactly the same thing? Anyone arguing from an 'all athletes need equal footing' perspective is going to have to go the whole way and have us all passing the baton barefoot and naked."

Apr. 24, 2008 - Carl Thomen 

Sam Shuster, PhD, Emeritus Professor of Dermatology at Newcastle University, wrote in his Aug. 4, 2006 article titled "There's No Proof That Sports Drugs Enhance Performance," published in the Guardian:

"The ethical argument...disappears on examination. Sport is for enjoyment and competition, and usually aims to improve; but what is the difference between increasing skill and performance by training, and taking drugs? If it is the use of personal effort rather than outside help, then what of ropes, crampons and oxygen for climbing? What of advanced training by teams of sports physiologists who wire athletes to equipment monitoring heart, muscle, brain and nerves to optimise activity; or teams of sports psychologists improving your responses and neutralising those observed in competitors? What of dieticians tampering with foods and additives - drugs by any other name - to improve performance?

What is more 'fair' - the use of a team of sports specialists or a simple pill? What is the difference between training at altitude and taking erythropoietin to achieve a similar effect? And why are the strips of adhesive plaster on the nose - absurdly believed to increase oxygen intake - more acceptable than a drug which reduces airway resistance?"

Aug. 4, 2006 - Sam Shuster, PhD 

Julian Savulescu, PhD, Professor and Uehiro Chair in Practical Ethics at the University of Oxford, and Bennett Foddy, DPhil, Harold T. Shapiro Postdoctoral Fellow in Bioethics in the University Center for Human Values at Princeton University, wrote in their Aug. 3, 2004 article "Good Sport, Bad Sport," published in The Age:

"EPO is a natural hormone that stimulates red blood cell production, raising the haematocrit (HCT) -- the percentage of the blood comprised by red blood cells...

There are other legal ways to increase the number of red blood cells. Altitude training can push the HCT to dangerous, even fatal, levels. More recently, hypoxic air machines simulate altitude training. The body responds by releasing natural EPO and growing more blood cells, so that the body may absorb more oxygen with every breath...

There is no difference between elevating your blood count by altitude training, by using a hypoxic air machine or by taking EPO. But the latter is illegal. Some competitors have high HCTs and an advantage by luck. Some can afford hypoxic air machines. Is this fair? Nature is not fair."

Aug. 3, 2004 - Bennett Foddy, DPhil 
Julian Savulescu, PhD 

Aaron Steinberg, Editor of The CEO Report, wrote in his June 2005 article "In Defense of Steroids," published in Reason magazine:

"If players don't get the desired performance out of diet, diagnostics, and exercise, there's always surgery. Consider Tommy John surgery, a ligament transplant invented for baseball players and named for the first pitcher to undergo the procedure. It has advanced to the point that the Chicago Cubs' Kerry Wood actually picked up velocity on his pitches after wrecking his arm and having the surgery...

In short, sports technology isn't just for golf club shafts and running shoes. It's for muscles, ligaments, and organs, and it's getting more sophisticated all the time. If such technologies are available to everyone and if the health risks are low--or lower, at least, then getting pulverized by a bulky baserunner sprinting toward home plate--then why single out steroids?"

June 2005 - Aaron Steinberg