Performance enhancement, elite athletes and anti doping governance: comparing human guinea pigs in pharmaceutical research and professional sports

Michael J McNamee,Silvia Camporesi

doi:10.1186/1747-5341-9-4

Michael J McNamee, Silvia Camporesi

Open Access

https://doi.org/10.1186/1747-5341-9-4

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Abstract

In light of the World Anti Doping Agency’s 2013 Code Revision process, we critically explore the applicability of two of three criteria used to determine whether a method or substance should be considered for their Prohibited List, namely its (potential) performance enhancing effects and its (potential) risk to the health of the athlete. To do so, we compare two communities of human guinea pigs: (i) individuals who make a living out of serial participation in Phase 1 pharmacology trials; and (ii) elite athletes who engage in what is effectively 'unregulated clinical research’ by using untested prohibited or non-prohibited performance enhancing substances and methods, alone or in combination. Our comparison sheds light on norms of research ethics that these practices exacerbate with respect to the concepts of multiplicity, visibility, and consistency. We argue for the need to establish a proper governance framework to increase the accountability of these unregulated research practices in order to protect the human guinea pigs in elite sports contexts, and to establish reasonable grounds for the performance enhancing effects, and the risks to the health of the athlete, of the methods and substances that might justify their inclusion on the Prohibited List.

Highlights

25 years ago, von Ammon and Wettstein asserted that “Bioethics has paid little attention to the issues raised by health and medical care in athletic competition” [1]
We argue that the introduction of performance enhancing technologies in the practice of professional sports amounts to unregulated clinical research, and that
The motivational force of elite sports status has led to the proliferation of innovative interventions that have in turn led to three leading sports medicine experts to wonder whether the field has more than its fair share of “snake oil” salesmen [4]

Summary

Introduction

25 years ago, von Ammon and Wettstein asserted that “Bioethics has paid little attention to the issues raised by health and medical care in athletic competition” [1]. Both communities lack visibility, in the sense of lack of systemic accountability, due to the absence of a central regulatory system (in the context of pharmaceutical research, individuals can participate in multiple studies run by different companies that do not share data on their pool of participants), and in the sense of lack of information that the subjects have on the substances they are taking, and the procedures to which they are subjected Both communities face a problem of consistency, as the effects of financial incentives not to disclose adverse events, not to respect the required one month wash-out period between trials, and not to comply with the study requirements, further cloud a precise and proper appreciation for the potential enhancing effects of the agent and its side effects. WADA have not hitherto been minded to operate in this way and we suggest that compliance and concordance with the WADA Code might follow upon greater visibility as to their decision-making

Conclusions

13. Calvino I

17. Harvey R: Steroids were not an answer for Heptathlete

19. Thomsen I

31. Resnik DB

33. Fisher J

Findings

37. Maschke KJ