Should the world do away with the tests, the scandals, the mistrust, and let any athlete do what they wish? – Sports Scientist, Dr Ross Tucker

About a week ago, I was contacted by a local magazine and asked about an article that had appeared in the Men’s Health UK, in which it is argued that doping should just be legalised.  Do away with the tests, the scandals, the mistrust, and let any athlete do what they wish.

That’s not a new debate, and it always rolls around in an Olympic cycle. I’ve seen three other articles arguing for a similar position. Some are more extreme than others, arguing for total open-policy on taking any substance in any amount. Most are a little more nuanced, effectively saying that we can impose safe doping through supervision. I can’t agree with the former, and I don’t see how the latter would work, because imposing a limit for safety is effectively what we’ve got now, and athletes would always look to work beyond whatever line is drawn. Drawing it higher just means the consequences of breaking through it increase, not that it would stop.

Anyway, part of that magazine’s request was to answer a few questions. I did that, but then I’ve gone back and expanded on my answers to it. So below, you can find a lengthy Q&A where I share my thoughts on the doping legalisation issue.

Do you agree with this statement: “If everyone is doping, taking performance-enhancing drugs (PEDs) it isn’t cheating; it’s the only way to level the playing field.” 

No, not at all. First on principle – you can’t give up just because you can’t win 100% of the ‘battles’. If 50% of athletes are doping, then allowing everyone to dope just because it’s not 0% is defeatist. We don’t use that method for anything, saying that crime is out of control, let’s stop preventing crime. We should be trying to fix the system, not discard it. Now, there are situations where we can learn from the failed efforts to control a given offence X. But let’s look rather at restructuring, or changing the means, and not eliminating the effort

Second, on biology – not everyone responds equally to drugs, and so the playing field wouldn’t be level anyway. Because the effect of drugs is so profound, and profoundly different between people, sports events would be determined in large part by whose body responds best to chemicals. Now, some will say that’s not different to saying whose body responds best to training, but it is significantly different. Training is active, you have to do the work to earn the benefit. Doping is not, so it fundamentally changes the outcome of the sport without changing the input.

And third, health reasons – all you’d be doing is inviting the most ambitious person to be the most reckless person, and to take the most drugs possible without killing or harming themselves.

Instead of trying to root out wrongdoers, why don’t we simply open up doping to everyone? What are the implications? 

The main one is health – people say doping is safe if done in small doses and correctly, but you legaliSe doping, and that upper limit for what athletes can do is gone. So then it’s a free for all – whoever wants to take the most drugs can, and they will push it to the point of risk, I’ve no doubt about that.

At the moment, we might be seeing 50% of athletes doping, but legalisation would not only increase the proportion of athletes who dope, it would also change the degree to which the more “ambitious” proportion dopes. So the bigger change is that the 50% who are already doping would dope MORE, and while we don’t know exactly what the long-term outcomes of that are, they’re probably not healthy. There are a number of reports from the eastern Bloc countries experiencing major health issues associated with doping. Legalising doping would effectively remove the upper limit, which is important to keep athletes safe.

Do we know the risk? No, not entirely, but in a situation of probable risk, I really do believe it would be reckless to act without knowing there isn’t one. In this case, a conservative approach is better.  The idea of saying “Let’s give it a go and see the risks later” is crazy, in my opinion. So if someone can show that the health risks of having no restriction at all would be minimal, then I’d be prepared to reconsider this notion, but not until then.

Second, you’d change the dynamic for the clean athlete – the whole purpose of anti-doping is not to catch cheats. That is the means by which the real purpose is achieved. What is that real purpose? To protect athletes who don’t wish to cheat and harm their health unduly. At least, in my opinion, that’s the fundamental reason to do anti-doping – make sure that athletes who do not want to take chemicals and potentially risk their health have a fair chance at winning and succeeding in sport.

If you legalise doping, that group of athletes would no longer exist. Elite athletes would require two characteristics – talent, plus willingness to dope. Probably in reverse order. Or rather, “talent” would include body’s sensitivity and response to drugs. And that brings with it health risks, regardless of what people say about doping not being dangerous. It’s only “safe” at the moment because it’s limited by the presence of anti-doping.

Is there a statistic that shows the prevalance of the doping debate in South Africa today?

No, there’s no statistic that shows the prevalence of doping in any sport, anywhere in the world.  Between 1% and 2% of all samples are found positive, but surveys have found between 20% and 40% of athletes will confess to doping, if it is anonymous. Other statistical examinations of samples estimate that the prevalence is between 14% and 40%. So if only 1% of all samples is actually found positive, and doping is happening in 30% of athletes, it means that only 1 in 30 dopers is ever caught. It’s impossible to work out how much it’s actually happening given that set of facts.

As much as I’d like to vouch for the integrity and “purity” of SA athletes, how can I? How can anyone?  We compete against the same dopers, in the same context, and so if it’s possible in Territory A, it’s possible in Territory B. Yes, not all countries have state-sponsored doping, and I’m pretty confident in saying that in South Africa, we don’t have a central authority that is providing drugs to athletes. One upside of our total lack of professionalism and advancement means that even if someone wanted to, they couldn’t run that kind of programme. But the individual athletes, where they are?  With the access to drugs through our gyms, which we know based on how prevalent doping is in schoolboys?  No way anyone could rightly say they are 100% confident our athletes are clean.  If they do, it’s just patriotic blindness speaking.

 Do you agree with is statement?

The Nature vs. Nurture debate:

“Instead of holding on to the antiquated idea that sporting greatness is the product of some kind of organic perfection, we need to acknowledge technology’s role. Especially at the elite level, sport is inherently a relationship between technology and nature. 

The water is muddied by the fact that the thinking behind which substances should be banned is in flux. For instance caffeine is a proven performance enhancer, yet the ruling against allows it, it has also done nothing to affect the spectacle nature, definition of sport? Yet HGH and EPO are found naturally in the body – but they are prohibited.

This is a straw man argument.  In the Ancient Olympics, people used to compete naked, no clothes. But they still had coaches. In other words, coaches were deemed essential, clothing was not. That’s how much value has been placed on training properly since the ancient times. So to say that sporting performance is the product of organic perfection is to assume that people believe that an elite athlete pops out the womb, grows up, and then saunters onto the track or field and becomes a champion with no action on their part.

So that deals with the first part – nobody begins by assuming it’s “organic” anyway. The reason they introduce that false premise is so that they have a platform for the next one, which is that drugs are necessary and normal.

Rightly or wrongly, we’ve drawn a line to say “X is allowed” and “Y is not”. That line should be discussed regularly, openly, but not removed just because ‘technology’ might include doping.

We recognise that we can influence performance with substances we ingest.  I doubt anyone would disagree. It’s the reason we know that diet also matters, and if that is true, then the use of supplements matters as well. At some point, however, a line must be drawn because the extension of that mindset of innovation and technological advancement is towards doping. Now why must a line be drawn? Why must we say “this is OK, that is not”?

Because if we didn’t, athletes would harm themselves, as I explained before. It would skew the results in a way that rewards a person’s PASSIVE response to chemicals, rather than their active efforts at improving through training, and it would also create disparities between those who can afford the very best pharmaceuticals and those who cannot.

Again, I can hear people saying that’s how it works already, and I appreciate that resources, genes etc influence the outcome, but using a medical product, normally reserved for people with diseases, or using a chemical that is solely designed to enhance performance, to me crosses over the line of what is acceptable and what is not.

Caffeine is a mild stimulant, an amphetamine is not. The difference here is risk/safety. EPO, testosterone and HGH are found in the body, sure, but they are part of a system that the body exquisitely regulates in order for it to maintain its own health. If you screw with that, you are clearly taking a health risk.  It’s why the prescription of GH and EPO is done by doctors, and you can’t stroll into a pharmacy and buy it along with a headache tablet.

So the world recognises that some substances are safer than others. The latter category is dangerous, and must be regulated. In sport then, we can apply the same standard, and easily recognise that hormones, EPO, powerful stimulants etc have no purpose in healthy individuals other than to very powerfully enhance performance, and so they’re banned.

My opinion is that a regulated substance, one that is prescribed by a medical doctor for any medical condition, should be regulated in sport. Unless a person really needs it, it should be banned. You tell me that there is not something wrong with the idea that the elite athlete population, supposedly representing the pinnacle of human “health” (a loaded word, I know, but meant in this context as elite performance) should be more likely to be taking medicines for chronic disease than a 60-year old inactive person? It’s outrageous.

Imagine you’d travelled to Rio on vacation, suffering from heart and thyroid conditions. You leave your medication behind by accident. No problem, you just wander over to the athlete village in Rio because one of those young, fit, Olympic hopefuls will have some you can borrow!  It’s a bizarre situation, and perhaps I’m being an idealist, but it’s a bad situation, and so I believe anything that is medically prescribed – EPO, HGH, testosterone, thyroid hormones, meldonium etc should be aggressively regulated. Not allowable at all.

For the rest, I think we need to actually be LESS aggressive. Let’s relax the policy around the weak stuff.  It may be less effective than eating a meal, so why allow it to create such a stigma, and a drain on resources?

Caffeine, for instance, is a weak stimulant – you can take a ton of it and you might feel buzzed, but the performance advantage is tiny. It’s not the same for the other drugs.

All this said, one step towards fixing the anti-doping mess is to trim the list of banned substances a little. Destigmatise the situation by allowing certain things that are part of the natural search for “Citius, Altius, Fortius”, or “faster, higher, stronger”.

But not completely.

What’s the way forward as a proponent of anti-doping?

First step – ask what the main issues are? In my opinion, it’s two things – the will, and the way. We have to address both of those.

The “will” means governance. It means whether the people in charge actually have the appetite to stamp out doping. It means whether antidoping agencies are really committed to doing what it takes to catch dopers. I think the last two years have shown that the answer to this is no. There is currently a lack of will at the very top of the organisations. I think the people within the organisations are often doing the very best they can, and they have integrity and a real desire to stamp out cheating. I don’t believe the same of the people at the top.

So basically, you’ve got people at the steering wheel who are taking this “vehicle” wherever they wish, and all the passengers, which includes some of the “foot soldiers” and most importantly, the athletes, are being taken for the ride.

The interview with Jack Robertson, done by David Epstein, is so profound for that reason.  Here are just three quotes from that interview:

“When I started (investigating doping in Russia), I didn’t think there was any chance whatsoever we’d come to prove these things, but by the grace of God everything fell into place. And then it was put in the hands of people with self-interest, who are compromised. The anti-doping code is now just suggestions to follow or not.”

“The world needs WADA and IOC and IAAF, but we need people to run them who value integrity. That’s all. The people I worked with at WADA were absolutely amazing, the best in the field. But it’s my feeling they’ve been betrayed by their leadership. You know, I lost much of my voice to throat cancer, so I know a thing or two about cancer. And this is like cancer, if you don’t get all of it, it can come back worse. We’ve seen it in FIFA, you have to take out the boss, but you have to take out their henchmen too, those who would follow them for their own careers. Everyone who supported them in their decisions has to go.”

“Before now I’ve avoided the spotlight, as you know. I don’t want people to believe I’m looking for my 15 minutes of fame. And the leaders failed me, but I’ve experienced that before in law enforcement. But more importantly they failed clean athletes and our own whistleblowers. Change has to happen, and even as damaged as my voice is, it needs to be heard”

That’s depressing stuff, but I don’t believe it’s inaccurate. The reality is that anti-doping is currently a top-down failure, because some excellent people who have great intentions are unable to effect change because of leadership.

So the first step in fixing it is to get rid of the people who have demonstrated a lack of will, and instead replace them with those who do have a will. One way this might be achieved is to put athletes more in charge of the strategic and tactical level anti-doping policies. After all, they’re paying the price, because innocent athletes are denied opportunities by the failures of the current authorities.

Another group who might be incentivised to catch doping, rather than to hide it, is the media. Or a new body, independent of the IOC, who are actually mandated to expose doping. What we currently have is a “family” who is trying to protect the sport, and they invariably, even for “noble” reason, have little incentive to expose doping.

There’s a concept called “Red teaming” that the US military use – it’s where they specifically bring in people from outside and have those people expose the weaknesses in their planned strategies and tactics. That’s what anti-doping needs, and if I could change one thing, it would be to search for a way that the incentive balance to expose doping can be tilted the other way. Currently, there’s no incentive to expose it. All the incentives exist to suppress it. That’s so patently clear when you read the experience of Jack Robertson when investigating Russia. The WADA president was more sensitive to the media allegations, and whether they were loud enough, than he was to his own people and knowledge of doping. That must change, so I’d look to find a way to actually reward the exposure of doping, not to punish it.

Then one must address the way. There is a lot to this. First, do the authorities have the power and mandate they need? WADA, until relatively recently, had no mandate to investigate. It was ludicrous.  They could only ask the relevant authority to investigate. It was basically designed to be powerless.

OK, that’s now changed, but they still don’t have the investigative clout that is needed, or the authority to back up their own rules. Nor do they want to, which brings us back to the “Will” issue I’ve just mentioned. Note Jack Robertson’s words, as WADA’s investigator ‘The leaders failed me”.

I think it’s safe to say that investigations are not prioritised nearly enough, and certainly not rewarded.  The fact of the matter is that most of our knowledge of doping in sport comes from investigation. It’s not failed tests. Hardly anyone fails tests – 1 in 30, as I said earlier. But investigation, that’s the future.

So I’d look to restructure the WADA code to enable this, and then I’d really make sure to enforce the penalties for breaking rules. This IOC farce around Russia sends precisely the wrong message – it says that even revelations of state-sponsored doping, compulsory, is not enough for sanction. So any future threat is hollow.

And finally, on the “way”, you have the scientific tests, the tools. There’s no doubt that testing has improved over the last two decades. It used to be impossible to test for just about anything, then slowly better tests have been developed, and now we are in the age of “smarter testing”.

Unfortunately we are still in the age of even smarter athletes, and so the tests still need improvement, there’s no doubt about that. But it’s not as though the dopers are decades ahead of the testing. I think the testing has the benefit, as I said earlier, of helping limit the degree of doping, it squeezes it down. But it hasn’t eradicated it, and so we need to work harder to develop better tests.

Better tests, by the way, means new tests for new drugs, and better tests for existing ones, so that we can detect them a) for longer, and b) in smaller and smaller doses. If we can continue to improve our ability to find the effect of the drug, rather than the drug itself, then that really helps, and without going into technical detail, there’s an avenue of testing based on what is called the “omics” approach that may do this.

Anyway, that’s the will, and the way. I will emphasise that unless you get the “WILL”, then the way is irrelevant. And that’s the biggest issue faced today – the will is lacking. Remember Sochi? A hole in the wall beats any test ever developed. You can have a test so sensitive that you could find a single molecule of EPO or testosterone in the Pacific Ocean, and it would be utterly useless against a hole in the wall.  Human behaviour, that’s the root cause, and everything else stems from that.

Technologies are progressing, competition is growing worldwide in all areas of sport. Athletes are getting bigger, faster, stronger. What’s your doping forecast of the next 20 years?

If the testing can’t improve, and if the governance of anti-doping cannot change more towards the athletes and the media, then I suspect that apathy will just grow and grow, and not much will change other than that every year, a smaller proportion of people will start to dope, and those who don’t want to for health and moral reasons will retire or quit. The result is that if one assumes that say 45% of athletes dope in 2016, I reckon by 2025 it will 65%, creeping up very slowly.

Apathy is the one thing we must really push back against, and this idea of legalising doping is a manifestation of that. I’m not arguing for the current system – it has clearly failed. And I want to stress that a big part of the solution, as I mentioned is to really trim that list, and allow athletes to take a lot more than they are taking. This is the compromise we should be looking for.

But the legalisation, no way. Even trying to manage doping by making it legal within certain limits will simply create the same problematic set of circumstances where athletes are trying to work around and above those limits. So I’m not a fan of the idea, but I think high level strategic, tactical and operational changes can be made as a compromise.

What I’d do is get everyone in a room together, except for the current leaders. They’ve been at the wheel for years, and we are totally lost. Rather, get the former cheats, the athletes, clean and dirty, but with a willingness to debate and discuss the hard questions, into a room together. Get the “so-called scientists”, those involved in detecting doping, and also those involved in avoiding doping controls, making drugs, into that same room. Get passionate lawyers, law enforcements officials like Robertson in there.  Give the media a voice too. And let’s chart a way forward that actually learns from the past. Don’t give up just yet, but equally, don’t sit in the backseat of a car being driven by a person who is leading it towards a cliff at high speed.

Dr Ross Tucker

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