Why are placebos not on WADA’s Prohibited List?

Abstract

The placebo effect is a biological response to psychosocial environmental cues surrounding the use of inert or active substances or methods. Placebo effects can be exploited for performance enhancement purposes and their use is not forbidden in sport. WADA’s Code stipulates that at least two out of three criteria must be met to put something on the Prohibited List of substances and methods forbidden in sport. These criteria are: Medical or other scientific evidence, pharmacological effect or experience that the substance or method, alone or in combination with other substances or methods, has the potential to enhance or enhances sport performance; Medical or other scientific evidence, pharmacological effect or experience that the use of the substance or method represents an actual or potential health risk to the athlete; and WADA’s determination that the use of the substance or method violates the ‘spirit of sport’ described in the introduction to the Code. By looking at what is on the Prohibited List and by interpreting the discourse surrounding the ‘spirit of sport’ criterion I postulate that substances and methods with documented placebo effects on performance fully meet the inclusion criteria and should therefore be included on the Prohibited List. Such reductio ad absurdum further illustrates the limits of WADA’s three criteria framework for inclusion of methods and substances on the Prohibited List and reinforces the calls for a change in the way the Prohibited List is established and maintained.