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Thursday, Sept. 4, 2008 | In August, just prior to the start of the 2008 Summer

Olympics in Beijing, the local media reported that researchers at the Salk Institute in La Jolla had successfully tested two experimental “endurance” drugs on mice. The experimental drugs, while not approved by the Food and Drug Administration for use in humans, significantly improved the performance of the mice.

The “marathon mice” exhibited increased levels of HDL, or good cholesterol, and lower levels of fatty acids and blood sugar. The first drug, known only as GW1516, combined with regular exercise, produced 77 percent improved endurance in treated mice compared to mice (on the same exercise regimen) without the drugs. In another experiment, the team fed untrained mice a second drug, Aicar, which miraculously appears to improve endurance even without training. 

Potential drugs that produce the health effects of exercise e.g., improved endurance, hold enormous therapeutic potential, extending hope to those suffering from a variety of muscle diseases that impair strength and mobility. They have also caught the attention of athletes wanting a competitive edge. With the Summer Olympics in Beijing now behind us, it’s worth asking what these developments portend for the future of sport. Even before this year’s Olympics got started, Antonio Pettigrew’s admission of using illegal performance-enhancing drugs led the International Olympics Committee to strip him and his teammates of gold medals won in the 2000 Olympics. This year’s Olympic spectacle included multiple instances of failed drug tests and disqualifications. Nor is the spectacle of revoked titles and discredited athletes restricted to the Olympics. Professional sports, like baseball, have provided a steady stream of revelations about the illegal use of steroids and other banned substances.

Although the Salk scientists, led by Ronald M. Evans, Ph.D., worked with the World Anti-Doping Agency (WADA) to develop a test to detect Aicar and GW1516 in advance of the Olympic competition in China, the Marion Jones revelations demonstrate the difficulties of relying on drug testing to prevent covert use. From an ethical perspective, the use of Aicar and other performance-enhancing drugs allow athletes to compete with unfair advantage and are thus a form of cheating. But what if all athletes had access to these advantages? Some have argued that the rules should change, that WADA should recognize the growing difficulty of testing an ever-growing range of sports enhancements (new drugs, blood doping, and gene therapy). A better strategy than attempts at prevention, some argue, would be to legalize and regulate such enhancements, making them available to everyone and hence leveling the playing field. 

What concerns does such a proposal raise? And how should the public respond to these concerns, since they affect both professional and amateur sports?

The first concern is safety. It’s important to recognize that any drug, even those used for treating medical illness, carries risk. Establishing the correct dosage is a key element in establishing safety. These new treatments are no exception. Drugs not approved by the FDA for use in humans or ones approved for particular medical uses have unpredictable side effects. Some side effects are minor and may disappear when drug use stops. However, it’s also possible that the levels of drugs used can have long-lasting and perhaps permanent effects on body anatomy, chemistry or physiology.  Even the effects of FDA approved drugs are difficult to know or predict. Predicting long-term health effects becomes more difficult under conditions of uncontrolled experimentation — athletes undergo years of vigorous training that pushes the limits of human endurance.

A related concern is the threat of coercion. Both professional and amateur athletes face unrelenting pressure to gain every conceivable competitive advantage. Were performance-enhancing drugs to become a legal staple of competition, such pressures would only increase. We now know that the spectacular successes athletes from East Germany in the 1970s and 1980s resulted, at least in part, from a state-sponsored program of steroid “vitamins” administered by duplicitous coaches.

Once-top athletes now suffer a range of debilitating health issues, including liver and kidney damage. One wonders too about the pressures brought to bear on the very young Chinese children “selected” for a lifetime of rigorous state-sponsored sports training. But what of choices athletes themselves make? Many willingly train for years to have a shot at Olympic Gold. A survey of Olympic contenders revealed that a majority would unhesitatingly take a “magic pill” to gain advantage even at the risk of serious health problems or a shortened life. But as Heidi Krieger, the 1980s world shot put champion, puts it “If today’s athletes say they want to take the risk, they really don’t know what risk they are taking.”

Heidi Krieger underwent a sex-change operation, becoming Andreas, a man, in response to drastic physical and psychological changes that resulted from the East German doping regime.

Concerns about health risks and coercion suffice for many to rule out legalization of pharmaceutical enhancements. But in addition to these concerns, sports enthusiasts should consider a final issue: What is it that we, particularly as Americans, value about the Olympics and athletic competition at its highest level? One thing of course is the way in which “winning the Gold” resonates with the national ideal of hard work and heroic effort. Winning the Olympics is meant to be difficult, to demonstrate what human beings — albeit with determination, discipline, and years of training — can achieve. Of course, such accomplishment requires more than grit and sweat. Natural talent, money, good coaching, diet, and determination all play an essential role. As the Salk experiments showed, however, science may soon provide drugs like Aicar, artificial means of boosting performance. (Should all athletes gain access to these drugs, the competitive advantage would of course be minimized.)

From one perspective, the latest generation of performance-enhancing drugs may raise no questions above the usual ones of safety, choice, and fair access. From a long-term perspective, “endurance drugs” such as Aicar, may herald the end of the “clean” Olympics ideal. The future of sports may come to include the longed-for “magic pill,” a kind of shortcut. If human athletes, like the Salk mice, can enter the Olympic arena without heroic effort, bypassing years of agonizing training with regular trips to the medicine cabinet, what then? Detection has become increasingly cumbersome, costly, and ineffective. New doping regimes may be even more difficult to detect.  In contemplating such a future, we can’t avoid asking questions about the nature of sport and what we value about it. Nor can we avoid ethical concerns about the costs we’re willing to ask young athletes to bear in pursuit of Olympic entertainment and national glory.

Dr. Mary Devereaux is a biomedical ethicist at University of California, San Diego’s Research Ethics Program, and a fellow San Diego’s Center for Ethics in Science and Technology.

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