Let Them Dope!

Now that the 2008 summer olympics are upon us, I thought I'd take the opportunity make clear my stance on the use of performance-enhancing drugs. I'm 100% for it. http://2dopeboyz.com

There are a number of problems with making performance-enhancing substances illegal - the most significant, to my mind, being that there is no clear boundary between what is medically indicated and what is indicated only for performance-enhancing purposes. For example, in weight lifting it is prohibited to use furosemide in order to pee off some fluid and make your weight class. Perhaps HCTZ is also banned. Should it be? What if an athlete has hypertension? Should he be consigned to suboptimal blood pressure control while in active competition? Or perhaps the athlete will only be allowed to choose from a pre-approved list of medications that are sufficient to control his illness but, at the same time, will not offer him a competitive advantage.

Caffeine also acts as a diuretic, as does alcohol. Should we test for these substances as well? Surely, if a patient has asthma, we can't ban his steroid inhaler. His inhaler does not represent an exogenous, performance-enhancing substance but rather we prescribe it in order to correct an underlying pathology; although, if the athlete happens to be a distance runner, his inhaler will undoubtedly have the side-effect (intended or otherwise) of improving his performance.

Stimulants like pseudoephedrine can help correct the symptoms of an underlying pathology (like a cold). If the athlete has a cold, can he take a Sudafed®? What if he's just a little bit congested? What if he's not really congested, but he just needs that extra little boost? Should a female-to-male transsexual be denied her hormone therapy? Should she/he be barred from competing altogether? Endocrinologists have even proposed the use of human growth hormone for use in children who "fall off the growth curve." How does one determine who has normal shortness versus pathological short stature? My point is that I believe it doesn't matter what you or I think about these questions but that they are questions which the patient-athlete must approach jointly with his or her doctor.

Now, you may object, citing that some doctors are clearly more liberal than others. If you have chronic pain, some doctors will give you enough pain medication to sedate an elephant for a month (trusting you to take it only as prescribed), others only enough to get a very small rodent sleepy for a few days. The same will naturally be true of drugs that have the ability to enhance an athlete's performance. If you have iron deficiency anemia with an hemoglobin of 11.2, some docs may just give you iron supplements. Maybe a female athlete with this condition can start to cycle her oral contraceptives with the provision that she go back to having regular periods once her hemoglobin returns to an acceptable level. But, then again, there may be one or two female athletes who have had their uterus removed for one reason or another, or who have congenital absence of uterus, putting them at a possible relative advantage. Does taking erythropoietin give you an unfair advantage if it only brings your hemoglobin up to the level of your competitor who trains at high altitude, or your other competitor who happens to have hereditary polycythemia?

As you can see, any attempt to create a set of uniform standards of practice when it comes to using medical therapy in professional athletes descends quickly into absurdity. This is why, in order to level the playing field, all athletes must be given complete access to whatever substances are available. We need to stop the testing of athletes and the banning of substances altogether. Yes, by taking advantage of this, professional athletes would potentially be taking on some serious additional health risks. But they are already taking on a number of additional health risks that the rest of us don't face just by making the decision to be an athlete in the first place! It's not for you or I to decide how much additional risk to one's health is tolerable in order to improve athletic performance. It is a personal decision to be made by the individual patient-athlete in conjunction with his or her doctor.