Anti-Doping: A Contrarian Approach

Anyone who’s watched the Floyd Landis scandal unfold over the last year has gotten a chance to see the anti-doping system, warts and all, as it operates. We’ve gotten this view because Landis insisted on a public hearing, and because he’s put as much of his case as he can (until gag orders prevented publication of additional material) on the Internet for all to see.

We were treated to open hearings in Malibu, where USADA’s hired guns and Landis’ defense team battled it out in front of the arbitration panel. And we’ve learned before and during the hearings, how the anti-doping system differs from our standards of justice. And yet, to hear USADA and WADA tell it, the system needs more funding because they can’t catch the cheaters.

Yesterday USADA announced that they are teaming up with the American College of Sports Medicine to produce a “statement principles of ethical behavior” that reads (according to a USADA press release):

Members and affiliates of the American College of Sports Medicine are committed to the highest standards of conduct. As advocates for athletes’ health and performance, all ACSM members assume an obligation to train, treat and support athletes with the highest ethical standards. Avoiding inappropriate treatment of athletes as well as the appearance of inappropriate treatment is of the utmost importance. I hereby affirm:

1. I will treat or train athletes with the objective of maintaining the integrity of competition and fair play.
2. I will treat or train every athlete with the utmost care and to the highest level of my professional competence.
3. I acknowledge that I am aware of international doping control standards as determined by the List of Prohibited Substances and Methods published by the World Anti-Doping Agency.
4. I will treat athletes only as their medical conditions warrant and will observe the rules of the appropriate anti-doping organizations regarding use of prohibited substances or methods.
5. I will not advise, aid, or abet any athlete to use prohibited substances or methods of doping.
6. I will use all means possible to deter doping by athletes I am treating or training.
7. I will maintain confidentiality of personal medical information and will protect the right of the clean athlete to compete.
8. I agree that departure from these principles of ethical behavior in treating athletes may result in sanctions by ACSM and will accept those sanctions as determined.

“Up to now the emphasis has been on athletes, and often on detection and sanctions for doping rather than prevention,” said Gary I. Wadler, M.D., FACSM, an expert in doping and steroid use in sports. “Now we’re working to directly involve the professionals who work with the athletes, emphasizing their professional education and responsibilities.”

Well, it’s a good idea in theory. The anti-doping fight needs to focus on more than just the athletes who are cheating by using prohibited drugs or prohibited techniques. But let’s take a look at this code of ethics for a few moments and dig deeper.

The slippery slope begins with the statement “Avoiding … the appearance of inappropriate treatment” in the opening paragraph. The problem with that, is who decides what creates the appearance of inappropriate treatment? Something might appear inappropriate to an outsider’s eyes, while being perfectly legitimate and appropriate medical treatment.

Consider Lance Armstrong. It’s well known that he was given EPO during his cancer treatment. But EPO can be used for doping, especially by endurance athletes like professional cyclists. Armstrong is no stranger to allegations of EPO use. He was saddled with allegations of EPO use during the 1999 Tour, after “research” at LNDD seemed to indicate he had done so.

I’d imagine that somewhere, someone might argue that using EPO to treat a cancer-ridden professional cyclist might appear to be inappropriate, given that it can also be used to dope. Of course, during the time Armstrong was being treated, he wasn’t exactly up to competing — even if he wanted to. His job, at that point, was to beat the disease.

Stepping through the list:

Point #2: This should go without saying, and doubtless is covered by other codes of ethics that physicians must already follow.

Point #4: On the one hand, the doctor is already obligated to treat patients as medical conditions warrant. To do otherwise might risk harming the patient’s life, committing a legal offense or committing malpractice, none of which is conducive to continued work as a physician. But then the doctor is obligating him/herself to take the list of prohibited medications and treatments into account.

What happens when the appropriate treatment is in conflict with anti-doping rules? Or when the anti-doping rules are not based on valid medical or scientific reasoning? (For example, various drugs — such as finasteride — have been deemed to be masking agents without any studies to indicate that such use is possible.)

Point #5: To do otherwise might be to commit a felony, which carries penalties that most doctors would seek to avoid.

Point #6: I’m not sure, other than making an impassioned plea to his/her patients to “Just Say No,” what a doctor can do to satisfy this point, but at least it’s worth a try.

Point #7: Medical ethics, as well as various laws, protect patient privacy and confidentiality. Are the authors suggesting that it is OK to rat out a patient who a doctor suspects of doping? Wouldn’t that be a breach of confidentiality? What about a patient who doped in the past, and is now seeking treatment for the side-effects? Should the doctor rat out this athlete, if the athlete is still competing?

Point #8: As “eightzero” points out in a comment at Trust But Verify, this is exactly the kind of situation that Floyd Landis and other athletes accused of doping confront. The doctors who sign on to this face unilateral determinations of violations and penalties without any rights to due process.

Missing from the new ethics code: A promise to forfeit a year’s salary if caught helping an athlete dope. Hmm. Guess the docs won’t go for that.

Something to consider about doping and those who help athletes dope: In virtually every case, someone is committing a crime. Whether it’s possessing prescription medications illegally, or prescribing those medications or treatments, someone has already broken existing laws or rules. Do we really need more laws or rules to muddy the waters?

Consider, further, that law enforcement has been responsible for the biggest cases of doping being broken wide open. Think the mail-order pharmacies supplying athletes with various medications, or BALCO, or that albatross of a doping case, Operacion Puerto. In every instance, it was law enforcement that cracked the case.

And in each of these cases, the athletes and others involved were entitled to their full legal rights — which in this country includes the presumption of innocence (although trial by media is an entirely different matter).

Just a thought, but: Perhaps we should scrap WADA, USADA and all the other anti-doping agencies and let law enforcement and the justice system do the work. The biggest successes seem to come from those agencies to begin with.

We could still have drug testing in sports, but the labs charged with doing the work would be subject to public oversight, the accreditation standards would need to be rigorously enforced (not overlooked, as appears to be the case with a certain lab in France), and prior to bringing charges against an athlete, a thorough review of the data would be conducted to determine if anything other than doping might have caused the result.

The IOC could return to establishing the guidelines for what constitutes positive drug tests, for the purposes of disqualifying those who violate rules against performance-enhancing drugs. Let the legal system handle any charges that might arise from the use of those drugs, however.

The only problem with walking away from the current anti-doping system is that enforcement might be different in different countries. And athletes charged in one country might walk free, while athletes charged in another might suffer fines, imprisonment, or both.

Given that WADA has not been able to “harmonise” the rules and practice of anti-doping agencies throughout the world, maybe that’s not so much different than what we already have.