Academic researchers and policy experts advocated the acceptance of pharmacological performance-enhancement by mentally-competent, healthy individuals in a thought-provoking commentary in the journal Nature. The authors of the commentary restricted their argument to cognitive-enhancing drugs such as Adderall, Ritalin and Provigil, but every facet of their argument, point by point, holds relevance for a “presumption” that healthy individuals, not competing in drug-tested sports, should be able to engage in physical enhancement using anabolic steroids and other performance-enhancing drugs. They call for policy on performance-enhancing drugs to be based on a rational, evidence-based approach.
The authors, which include Nature editor-in-chief Philip Campbell, point out that the acceptance of elective, enhancements for healthy individuals has been widely accepted in certain medical specialties (“Towards responsible use of cognitive-enhancing drugs by the healthy,” December 7).
Physicians who view medicine as devoted to healing will view such prescribing as inappropriate, whereas those who view medicine more broadly as helping patients live better or achieve their goals would be open to considering such a request. There is certainly a precedent for this broader view in certain branches of medicine, including plastic surgery, dermatology, sports medicine and fertility medicine.
The authors do attempt to distinguish pharmacological physical enhancement as a form of cheating, as contrasted with cognitive enhancement, but ONLY in the context of sport.
In the context of sports, pharmacological performance enhancement is indeed cheating. But, of course, it is cheating because it is against the rules.
It is well-established that the overwhelming majority of anabolic steroid users do NOT compete in a “context of sports” and are adults who use anabolic steroids simply as a tool to increase their muscle mass, reduce bodyfat, and/or enhance physical attractiveness. If it is not against the rules, it is not cheating (A league of their own, too: motivational and age of onset comparisons between American male and female AAS users, September 17).
Most NMAAS [non-medical anabolic-androgenic steroid] users did not initiate use during adolescence nor was their use motivated by athletics. The typical male and female user were Caucasian, highly-educated (female users evidenced a slightly higher prevalence of advanced degrees), gainfully employed professionals approximately 30 years of age, who were earning an above-average income, were not active in organized sports, and whose use was motivated by increases in skeletal muscle mass, strength, and physical attractiveness.
The authors of the Nature commentary also try to distinguish cognitive enhancement drugs from physical enhancement drugs by suggesting that the latter are essentially zero-sum games, i.e. one person’s gains are necessarily accompanied by another person’s losses. But in many cases physical enhancements, JUST LIKE cognitive enhancements, are not zero-sum games.
After all, unlike athletic competitions, in many cases cognitive enhancements are not zero-sum games. Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.
It appears that the Nature commentary specifically excludes the physical-performance-enhancing drugs (PEDs) based on the assumption that anabolic steroid and PED use ONLY occurs in the context of sports. This is a faulty assumption; the vast majority of steroid users are not participants in a sporting context therefore the issues of “cheating” and “zero-sum games” are irrelevant. Otherwise, the Nature commentary would be equally applicable to cognitive-enhancing pharmaceuticals AND physical-enhancing pharmaceuticals rendering such enhancements as “morally-equivalent.”
However, I would like to point out one notable difference between cognitive-enhancing drugs and physical-enhancing drugs raised by this article. Pharmaceutical cognitive-enhancers are not regulated for their enhancing abilities, but physical-enhancers are regulated primarily because of their enhancing abilities…
The authors of the journal commentary are Henry Greely (Stanford Law School), Barbara Sahakian (Department of Psychiatry, University of Cambridge, and MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute), John Harris (Institute for Science, Ethics and Innovation, and Wellcome Strategic Programme in The Human Body, its Scope, Limits and Future, University of Manchester), Ronald C. Kessler (Harvard Medical School, Department of Health Care Policy), Michael Gazzaniga (Sage Center for the Study of Mind, University of California, Santa Barbara), Philip Campbell (Editor-in-Chief, Nature), and Martha J. Farah (Center for Cognitive Neuroscience, University of Pennsylvania).
About the author
Millard writes about anabolic steroids and performance enhancing drugs and their use and impact in sport and society. He discusses the medical and non-medical uses of anabolic-androgenic steroids while advocating a harm reduction approach to steroid education.
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