The system is broken

In 2013, analytical chemist and anti-doping expert Dr Klaas Faber was straight to the point when he told CyclingTips: “Current anti-doping is a total failure. Success rate is extremely poor.”

It’s a view shared by Professor Julian Savulescu and one that led him to the position he’s held and argued for more than 10 years.

“When the EPO test was introduced [in the early 2000s] there were claims this would eradicate doping but over the last 12 years that I’ve been looking at this, the pattern just hasn’t changed.”

As Chief Science Officer of the US Anti-Doping Agency (USADA), Dr Larry Bowers wrote in a witness statement during the Lance Armstrong investigation in 2012, just because we’re not seeing as many positive test now as we have done previously doesn’t mean doping isn’t still happening:

“It is not possible to equate a ‘negative test’ with the absence of doping at the current time.”

According to Professor Savulescu this is because “if you use small amounts of physiological substances, then it’s going to be virtually impossible to detect, even with the biological passport if you’re constantly doping at a low level.”

Or as World Anti-Doping Agency (WADA) director general David Howman told Cyclingnews in November 2011 “We are catching the dopey dopers, but not the sophisticated ones.”

Professor Savulescu agrees:

“Of course if you take large amounts and you disturb normal physiology you’re going to be able to pick up that, but it’s only really the dumb dopers that get caught.”

An alternative

Given doping is almost certainly still happening (albeit not being detected as often as it could be), Professor Julian Savulescu proposes an alternate anti-doping system: one in which certain performance-enhancing substances are allowed while others are still banned. Substances that occur naturally in the body, such as EPO, would be allowed, so long as they are used within healthy limits.

“EPO, blood doping … you could simply measure the hematocrit. If it’s less than 50 — which is the limit set now — you can compete, regardless of whether you got to 49 by doing altitude training or being in a hypoxic tent — which are both legal — or through taking EPO or blood doping.”

Human growth hormone and testosterone would also be allowed in Professor Savulescu’s system, assuming that riders fall within a range that is determined, by medical experts, to be safe. In the case of testosterone, a testosterone to epitestosterone ratio of 4:1 could be used as the enforceable limit.

Under Professor Savulescu’s system the goals would shift from banning performance-enhancement to ensuring athlete health. Cyclists taking EPO in unhealthy amounts (as determined by trained medical professionals) would face sanctions, as too would athletes taking substances that don’t naturally occur naturally in the body and/or that “corrupt the nature of the sport”.

”Mental doping”

“The thing that I think shouldn’t be allowed is the use of painkillers, anti-inflammatory drugs, and local anaesthetics in competition and perhaps even in training to assist continued performance despite significant injury,” Professor Savulescu told CyclingTips.

It is believed that many riders in the professional peloton have used (or continue to use) the opioid painkiller Tramadol in training and in competition. While WADA has told CyclingTips it is monitoring the use of the substance in cycling, the use of Tramadol is still legal. Professor Savulescu believes the use of such painkillers — what he calls “mental doping” — is against the spirit of the sport.

“The spirit of sport is meant to be dealing with the pain that you’ve got during competition so it’s a kind of crazy thing to allow. [Tramadol] is a classic example of something that should be banned, and it’s very easy to test for.”

Spirit of the sport

While Professor Savulescu argues that the use of “mental doping” is against the spirit of the sport, many would argue that taking any performance-enhancing substance is a corruption of the ideals of the sport.

“That’s a perfectly acceptable position, but it’s another perfectly acceptable position, and enforceable, to allow what I’ve called physiological doping — that is, trying to assist performance within a normal human physiological range — and also then banning things that are dangerous or somehow corrupting.”

“The reason why you should think that’s also a perfectly acceptable position is that’s what happens when people take water during competition, or glucose — they’re just optimising their own physiology.”

Professor Savulescu points to the use of caffeine and other substances that are shown to improve cycling performance yet are still allowed and even welcomed in competition.

“Today athletes take caffeine, which is unnatural to enhance performance — nobody thinks that’s somehow corrupting of the spirit of sport. Yet it was banned [ed. up until 2004] and it enhances performance — it increases the time to exhaustion by about 10%. Beetroot extract can also increase the time to exhaustion by up to 20% in some trials. These examples show that it’s not performance enhancement per se that’s the problem.”

An unpopular position

There are many arguments that can be (and have been) levelled at Professor Savulescu’s position. One common objection to allowing doping is that, given there will always be those who cheat, won’t some athletes look to push beyond the newly set limits, leaving us in the same predicament?

“Another analogy that people give is that ‘just because we can’t pick up every murderer doesn’t mean we should legalise murder’. Yes, there will always be people that cheat wherever you set the rules, and yes we will never eliminate any kind of corrupt human activity. But this isn’t murder — these athletes aren’t killing other people, they’re optimising their physiology for competition. There’s nothing inherently wrong with that — it’s not like a murder.”

“Will they try to get around the rules and push to get some advantage? Yes, some people will. The issue is how do you minimise that and do the best that you can? My point is that by looking at substances on a case-by-case basis and then focusing on goals other than performance enhancement per se — focusing on safety or whether there’s some kind of corrupting element in that particular substance — you could draw up a smaller list [of banned substances] that’s more enforceable.”

Another strong objection many people have is that legalising doping of any kind would send a terrible message to children looking to get into cycling — that to succeed in cycling you need to dope. For parents, too, the idea of sending their children into a sport where doping is legal isn’t particularly comforting.

“Would this send the wrong message? I think this would send the message that you should respect your body, you should use these sorts of substances under medical supervision and you shouldn’t use them until you’re over 18.”

“And you would pursue that by testing people. If you’ve set these sorts of limits, you could be testing very easily during amateur competition or children, at least then you’d be picking up dangerous levels of use.”

A similar objection considers the effect on lower-level athletes. That is, if the pros are doping, won’t domestic-level racers and even amateur riders be more inclined to follow suit, albeit without the medical supervision available at the highest levels of the sport?

“You’ve always got to ask: ‘is what’s being proposed going to be worse than what’s actually happening now?’, not what some ideal is.

“There’s nothing to stop [lower-level] athletes from doping now. I’m sure there’s plenty of people around taking growth hormone. A friend of mine competes in the veterans time trial world championships and the guy that won that was subsequently found to be doping, either with steroids or EPO.

“Of course that does happen. But at least if you set safe, enforceable and logical limits, you’d have more achievable testing and you’d also have more resources to focus on the important areas, like children.”

Other benefits

For Professor Savulescu there are a number of benefits to a system in which some forms of doping are allowed. In addition to shortening the list of substances the authorities have to test for, the proposed system could narrow the gap between those who cheat and those who don’t.

“By allowing some physiological performance enhancement you enable honest athletes who don’t want to harm themselves, to increase their performance to some degree. So the people that are cheating are going to be getting less of an advantage than they are now.

“So you’re reducing the unfairness of the situation by creating what you might call a ‘white market’ for physiological enhancement which competes with a ‘black market’ for non-physiological enhancement.”

At arms length

Professor Savulescu isn’t involved in professional sport in any way and certainly not in the governance of it. His interest in the subject of doping came about through a kind of philosophical curiosity and frustration.

“I personally couldn’t care less about doping in sport but why I got interested in this was the hypocrisy and bad arguments that occur. [The anti-doping crusade] sort of ruins the spectacle and the athletes’ lives and it’s all for really no point. Show me a modern athlete who has suffered as a result of engaging in doping.”

“People always raise these cases from the early 90s of people dying from taking EPO. If you look at those cases it’s not clear that the athletes concerned did die from taking EPO. There’s sudden cardiac death among elite athletes just from sport, and even if it were the case that they were all related to EPO, you can very easily set the hematocrit level so that that doesn’t occur.”

And while he’s argued for relaxed anti-doping laws for more than a decade, Professor Savulescu has no interest in campaigning for their introduction.

“There’s two views of practical ethics — one is the sort of missionary view [in which] you go out and you convert people to what you believe is the truth and the right and there are a lot of people in my field that do that.

“I have this Socratic view that it’s about getting people to think for themselves and identifying bad arguments. I’m not an advocate for doping — I’m providing arguments for where I see the limitations. It’s up to sporting bodies [to push for change].”

A frank discussion

Cycling’s omertà, or “code of silence”, is a source of bemusement and frustration for Professor Savulescu.

“The closest any athlete has come to having a frank and reasonable conversation about doping is Tyler Hamilton. And even he wasn’t really embracing rethinking the rules.

“I’ve only seen anonymous survey data on the prevalence of doping — something like 90% of Olympic athletes would take doping substances if they weren’t going to be caught. But I’ve never seen interviews with people that have suggested what’s going on and what should be done about it.”

For Professor Savulescu, the staunch arguments against doping aren’t as clear or convincing as many people believe; indeed, we should look to other alternatives to keep athletes healthy.

“Years ago I used to say we tried this absolute prohibition in terms of prostitution and alcohol and recreational drugs and they’ve all failed. The only policies that work are harm-reduction strategies. And the doping in sport case is even easier than all of those because physiological doping is completely normal and no third-parties are harmed so all the problems you can get — the involvement of criminal elements and scandals and ruined careers — are due to the rules we create. You don’t just need to have that.”

“WADA’s stuck in an anti-drug mindset from 30 years ago and they’re just failing to use science in a way that could contribute to sport.”

Negative reactions

As you might expect, people often disagree with Professor Savulescu’s ideas. But it’s not something he’s particularly worried about.

“In general the people that are most vocal are the most fanatical and the least reflective and the angriest. So you always tend to get a biased sample. People who like what you do don’t come up and go ‘that was really good’, by and large.”

And while many people react angrily to his ideas, Professor Savulescu believes that, when he’s given the time to outline his arguments, he’s able to convince a substantial proportion of people.

“In a debate in Sydney on this, where I was up against Shane Gould who was on the anti-doping side and who’s obviously a huge icon, I think we moved about 30 or 40% of the vote to our side. We still didn’t have a clear majority but I think that ordinary people, when they start to think about it, and you can present them with some arguments … often they do shift.”

And Professor Savulescu believes things are shifting … slowly.

“I think it’s like the euthanasia debate — it takes an enormously long time. I began working in that in 1990 and only now can you start to see the dominoes falling. I think the same will happen with doping. It will take quite a while for enough momentum to build up but eventually people will see the lunacy of this current system.”

What do you think? Would Professor Savulescu’s ideas be worth exploring professional cycling? Why or why not? Please keep your comments civil and constructive. NOTE: CyclingTips does not agree with Savulescu’s views.

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