Let’s talk doping. Not the EPO and blood kind, which – though made famous by cyclist Lance Armstrong – has probably contributed to many Olympic running medals. Or the testosterone and growth-hormone kind, that sprinters use to help them train harder and recover faster.

Those drugs are outright illegal. (Though a worrying number of non-elite athletes also have access to them, thanks to doctors who prescribe them to people unnecessarily.)

No, I’m talking about legal doping.

The line between doping and the normal use of legal medical products has become blurred, because of what I call the ‘medicalisation’ of sport.

Anti-inflammatories and painkillers are widely used by runners. Sure, they won’t get you banned, even if you are tested; but that’s only for logistical reasons – it would cost too much time and money to put an end to painkiller and anti-inflammatory abuse.

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Beneficial or dangerous?

The reason any drug is put on the banned list is because a) it offers a significant performance benefit, b) it may cause physical harm, or c) it contravenes the spirit of the sport.

Ask those questions of anti-inflammatories and painkillers. Are they beneficial to performance? Yes, because they block pain, allowing a runner to push beyond their normal limit. Often, they’re the difference between running and stopping. That’s a significant performance benefit, whichever way you look at it.

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Are they harmful? Every year, at marathons and ultra-marathons around South Africa, a handful of runners end up in hospital, because of acute renal failure that’s strongly linked to the use of non-steroidal anti-inflammatories (NSAIDs), such as Voltaren.

There’s even a scientific paper documenting such cases that have been recorded at the Comrades marathon. They happen because NSAIDs affect kidney function – and that’s not a good side effect when you’re about to undertake 11 hours or more of running, with all the fluid challenges that involves.

So, yes, they’re dangerous. In the medium to long term, there’s also reason to think the answer is affirmative for both NSAIDs and painkillers, because they mask pain, and pain is an important protective signal. Override that, and you risk causing more structural damage, turning a mild injury into a much more serious one. And finally, they cause long-term damage to the stomach and intestines.

Are they ethical?

They’re not banned, and you don’t even need a prescription for many of them. So you’re not pushing the boundaries of medical ethics – unlike, say, Alberto Salazar does with athletes like Mo Farah, when he gives them asthma and thyroid medication that they don’t need, intravenous infusions, and various other drugs (legal or not).

But if marathons are a test of human endurance, then one could argue that getting to the finish line with chemical assistance is unethical.

I realise this is all rather fire-and-brimstone. I confess, it’s written with deliberate extremism. Let’s face it – most of us have taken something that offers a small amount of assistance. Is it any different to a caffeine hit before a big day at work?

It could even be argued that you’re just using medicine for its intended purpose.

It’s your call

I’m offering you the extreme, dogmatic argument against these drugs, and few things work in a dogmatic and extreme sense. I’ll soften it by admitting to partly playing devil’s advocate. I did so because: a) I hope that you’ll reconsider using these drugs to get you to the line – and if you do, that you’ll use a lot less of them; and b) I want to make you think about the ‘medicalisation’ of your own running, and whether you’re putting your energy (and your money) into the wrong places – when running natural may be the way to go.

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RW Scientific Editor Dr Ross Tucker has a BSc (Med) (Hons) Exercise Science Degree and PhD from the Sports Science Institute. Visit him at www.sportsscientists.com.

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