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Friday, September 06, 2013

Gladwell on PEDs

Malcolm Gladwell has a piece in The New Yorker (which he defends on this podcast) that basically lays out in detail an argument I've made previously--there is no good reason that performance-enhancing drugs are outlawed when performance-enhancing medical procedures (e.g., Tommy John surgery or eye surgery to improve vision) are permitted and that people with random genetic benefits (for example, an Olympic cross-country skier with a genetic mutation that over-produces red blood cells, which provides a tremendous advantage in endurance sports) are allowed to benefit from them. It is definitely worth a read, as is the new book The Sports Gene by journalist David Epstein, which Gladwell is reviewing in this piece.

People (particularly present and former players, who should know better) often criticize PEDs as short-cuts and PED users as lazy; the player used instead of putting in the hard work of making himself a great player. In fact, many PEDs actually are all about hard work; the reason cyclists blood dope is so their bodies can work harder for longer and the benefit of steroids is to allow players to work-out longer and become stronger. When Lance Armstrong insisted "I am on my bike busting my ass six hours a day", he was telling the truth; the doping was what made it humanly possible for him to do that much work.  On the other hand, we don't think of genetic advantages (say, especially good eyesight for a Major League hitter) as a short-cut, but as a natural tool that the player then must maximize through hard work. The point of PEDs is to level that genetic advantage, which he then must maximize through hard work. What's wrong with that?

Posted by Howard Wasserman on September 6, 2013 at 07:46 AM in Current Affairs, Sports | Permalink


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Last comment. Lest I be accused of exaggerating, "dozens" of deaths is perhaps an overstatement. It may only be a dozen or so.


(Also look at Wikipedia's entry on blood doping cases, where they have a complete list of fatalities suspected to be linked to blood doping.)

Posted by: My $0.02 | Sep 7, 2013 8:47:30 PM

Seriously, this is really annoying. You picked a handful of PEDs that either (1) are used for legitimate medical purposes (EPO for anemia, HGH for growth disorders, testosterone for low testosterone) or (2) have been definitively linked to fatal incidents (blood doping). We know all about the side effects for these drugs/practices -- the FDA spent years investigating them (or the press spent years writing about them).

I agree that the issue is much more nuanced than the "drugs are bad, m'kay" side would have it. But Howard, what you are doing isn't much better. It's disappointing.

Posted by: My $0.02 | Sep 7, 2013 8:40:38 PM

"But does HgH? Does Testosterone (given that many people have naturally high T/E ratios)? Does EPO? Does blood-doping? And do we have any idea whether even steroids would be as harmful if they were legal and regulated and could be prescribed and monitored above-ground?"

Howard, I don't know if you really don't know the answer to your questions, or if you're just playing coy. But yes. All of these PEDs have side effects, some of which are fatal. For example, blood doping has been attributed to the deaths of dozens of cyclists in the 90s. HGH has been linked to an increased risk for several different cancers. Testosterone supplements are hugely problematic, and repeated studies have shown that taking them basically throws men's natural hormone levels completely out of whack (which is why they're not routinely prescribed to every man older than 40).

On the other hand, pretty much everyone agrees -- these side effects can be minimized (or at least the risks can be) if the regime is closely monitored by medical personnel. BUT ISN'T THAT THE POINT? The sixteen year-old two-miler looking to drop his time from 9:45 to 8:45 and grab that full ride to Oregon or Colorado isn't going to take EPO and HGH under a closely-monitored regime. He's going to take a handful of unmarked pills, and when his time drops twenty seconds virtually overnight, he's going to double the dosage. Maybe that won't kill him. But there are a lot of cyclists who re-injected platelet infused blood twenty years ago who came up on the wrong side of that bet.

Posted by: My $0.02 | Sep 7, 2013 8:34:12 PM

• The powers-that-be in sports (officials and the media) don't justify prohibitions on a harm principle, but on an integrity-of-the-game rationale. If that is the proferred reason, then the line-drawing also must focus on that reason. So Gladwell is right to question the lack of justification for the lines that have been drawn in those same integrity-of-the-game terms.

• The reason for not relying on a harm principle is that it is not so clear. Yes, steroids cause the harms Steven describes above (rage, sexual dysfunction, cardiac problems, etc.), at least when abused. But does HgH? Does Testosterone (given that many people have naturally high T/E ratios)? Does EPO? Does blood-doping? And do we have any idea whether even steroids would be as harmful if they were legal and regulated and could be prescribed and monitored above-ground?

• Even if we rely on a harm rationale, athletes do (or are made to do) a lot of stuff that is harmful in the name of their sport. Gladwell discusses how Hamilton basically starved himself to lose the weight needed to be a competitive cyclist, something that has long been feared with female gymnasts. No one is talking about the long-pervasive use of amphetamines and now Ritalin to help baseball players get ready for games over the long season. And what about the cortisone and painkillers that football players take to get them back onto the field? So we're back to line-drawing--why are these potentially harmful drugs and techniques OK, or at least not the subject of a similar moral panic?

Posted by: Howard Wasserman | Sep 7, 2013 1:06:44 AM

Let's think of the children this way: would you want your 12 year old playing a sport in which it is acceptable for the adult players to dope? The implicit lesson is that at some point, if your 12 year old is to progress in the sport, then he/she too must dope, or at least it will be acceptable if she does. That's a different calculus than knowing that at some point he/she might have to get corrective eye surgery. And at any age, eye surgery is not per se harmful; doping is. At the least the doping that we now recognize as doping is. Sure, perhaps there may come a time when a PED emerges that doesn't cause rage, sexual dysfunction, or cardiac arrest. I understand Gladwell's difficulty with, for example, distinguishing painkillers with human growth hormone. But isn't this a problem with line drawing and definitions (eternal legal problems both), and not, as Gladwell suggests, an invitation to wonder why we ban ANY performance enhancing drug? We ban them now because (1) most are harmful, and (2) in the past, they all were harmful.

I'm wondering why I'm even interested in this thread, because I don't care about sports, I generally don't care whether individual people want to harm themselves by ingesting dangerous substances, and I also think that if parents want to keep their kids safe, then it's their responsibility to steer them clear of bad role models (which are all around, and not just in sports). I think I'm interested because I'm ultimately sympathetic to Gladwell's and your line drawing and conceptual dilemma, but also to what the troll kodhambo wrote. I guess that's my own line drawing dilemma.

Posted by: Steven R. Morrison | Sep 7, 2013 12:06:56 AM

I reject "think of the children" in most public-policy contexts, because there are (and should be) all sorts of things that adults can and should do that children should not. I would not allow my 12-year-old with 20/20 vision to have corrective surgery to give her 20/10 vision. I would not allow my 12-year-old to have Tommy John surgery, either. I would not allow my 12-year-old to do the sort of basic physical training that elite professional athletes do.

Plus, I think we should be somewhat nuanced about the risk of harm. It is impossible to say "PEDs are harmful" because "PEDs" are not a thing (just as "cancer" is not a thing). PEDs are an imprecise term that covers a broad range of drugs, treatments, and medical techniques--some of which might be harmful, some of which are not, and most of which we just don't know.

Posted by: Howard Wasserman | Sep 6, 2013 8:19:36 PM

Maybe the "think of the children" test is appropriate here. Would you want your 12 year old doping? If so, then by all means let the big league players do it. Would you want your 12 year old getting corrective eye surgery? How about letting NFL players use cocaine on the sidelines? Why not? Because, as Joel Fineberg suggested, such drugs entail either a harm to self or a harm to others. Corrective eye surgery entails no such harm.

Posted by: Steven R. Morrison | Sep 6, 2013 7:43:08 PM

Are faculty seriously injured in their brains to write articles like this? May be they have no hand in the game that they can fill the internet with this nonsense?

Walk over t the med school and ask medical faculty about the negative impact of the PEDs on the body. Honestly, I cannot take this kind of nonsense liberal arts majors write any more.

Posted by: kodhambo | Sep 6, 2013 2:52:35 PM

Damien: That describes the current situation. I think we should focus on the prior question--why make PEDs unlawful in the first place? I don't think we have a good reason and that is what Gladwell (and Epstein's book) show.

$.02: That's a really bad way to make policy. Besides, PEDs are part of "training methods."

Posted by: Howard Wasserman | Sep 6, 2013 1:47:52 PM

Why can't we just chalk up anti-PED attitudes to good ol' fashioned trolley problem moral intuitionism? In other words, there are some things that we think should factor in to athletic contests -- natural (genetic) ability, training methods and habits, nutrition, etc. PED regimens (and the body's ability to respond to them) just aren't one of them, just because. And while there may or may not be a fundamental basis for that gut feeling (with the main culprit probably being a core uneasiness about non-professional teenagers experimenting with PEDs without medical supervision), it's really neither here nor there.

Posted by: My $0.02 | Sep 6, 2013 1:33:15 PM

I see your point but isn't some of the objection to PED use based on fairness considerations? I mean, the rules say that you can't use them, yet some people broke the rules and thereby gained an advantage over others.

Posted by: Damien Schiff | Sep 6, 2013 12:59:46 PM

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