Drugs in Sport - A Change is Needed, but What?

Abstract

Performance enhancing drugs (PEDs) confound much of what is considered great about sport. Sport is generally associated with excellent health outcomes that can be challenged by the direct toxicities of PEDs and the indirect effects of enabling the body to push beyond normal physiological reserves, thereby potentiating the risk of some exercise-associated conditions such as atrial fibrillation. Sport should also be a source of aspirational behavioural change but this 'legacy effect' of elite sport is modest, perhaps due in part to the public disillusionment brought about by repeated drug scandals. Elite sport is an extremely lucrative industry and, whilst this money could be used to support grass roots campaigns promoting exercise, it also provides incentive for a "win at all costs" mentality that provides the substrate for drug use to enhance performance. This article discusses these issues and asserts that the destructive influence of PEDs has arguably reached a tipping point at which the reputation of professional sport is starting to become irrevocably damaged. We assert that there is a need for change, and that doctors need to be a part of this change. Repeated attempts by the anti-doping authorities to stay ahead of the PED "industry" have failed, and we argue that new approaches now need to be considered. The controversial concept of a more permissive policy in which physiological limits are set has been championed by some; whilst we propose a more restrictive process in which all drugs are banned except for a few commonly used drugs that are not associated with performance enhancement. This article is not designed to provide definitive answers but rather to promote debate and consideration of novel approaches to what may be sport's greatest challenge - the use of performance-enhancing drugs.

Keywords: Anabolic steroids; Doping; Drug policy; Erythropoietin; Performance enhancing drugs; Sports.