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Sleeping your way to Success: Olympian Ethics

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The London Olympic Games of 2012 could be renamed the Return of the Drug Cheats. After serving bans of various lengths for taking illegal, performance-enhancing substances, sprinters Justin Gatlin (US), Dwain Chambers (UK), and cyclist David Millar (UK) are all making comebacks. Fans and fellow athletes are divided over the issue, and competitive sport is under greater scrutiny than ever before.

In the United States, cycling legend Lance Armstrong - who has never tested positive for any banned substance - is once again being accused by former Tour de France team mates of having 'doped' throughout his glory years. These former colleagues are themselves guilty of taking illegal, performance-boosting chemicals.

There is a long list of athletes banned for taking outlawed substances, and with the World Anti-Doping Agency (WADA) promising that the London Games will be the most dope-tested in history, that list is likely to grow much longer.

WADA's promotional DVD - Level the Playing Field - pushes the message that we worry about performance enhancement in sport simply because we want 'fair play.' In the words of the organisation's Ethical Issues Review Panel, 'we want athletes to exemplify aspects of character that we admire in people more generally, such as fortitude, dedication, self-discipline, courage, and strategic wisdom.' What matters is 'not just the outcomes,' but also 'the means used to achieve those outcomes.' This is what WADA calls 'the spirit of sport.' And it is borne out by the public reaction to sport - we like to see records broken, but when one is broken with the help of an illicit substance or method, we dismiss it and condemn the athlete.

But determining what is legal, and what is not - in effect, deciding what is cheating or doping - is a process mired in confusion and inconsistency, and made more difficult by advances in science.

Grey Areas

WADA was set up in 1999 to regulate anti-doping activities in sport worldwide. It sets the policies and the rules and decides the annual list of prohibited substances and methods. According to WADA, a substance or method goes on the list if it meets at least two of three criteria: first, it must have the potential to increase sporting performance; second, it must pose an actual or potential risk to the athlete's health; third, it must be contrary to the spirit of sport. Thus, for example, anabolic steroids, which enhance performance by increasing muscle growth, but also damage the liver and increase the risk of prostate cancer, are banned.

But, as Professor Barrie Houlihan of the School of Sports and Exercise Science at Loughborough University told me on the eve of the last Olympics, 'there are grey areas'. There are technologies and substances - such as creatine - that fulfil WADA's two-out-of-three criteria, but are still permitted. And by boosting performance and violating the spirit of sport, they potentially deny fair play to all athletes. The most controversial of these grey areas is the use of hypoxic chambers, also known as altitude chambers.

Altitude chambers boost an athlete's red blood cell count, increasing endurance and recovery time. The athlete sleeps at a simulated high altitude, but trains at the optimal sea level, all without having to undergo the rigours of travel. He or she benefits simply by sleeping, and gains the same performance benefits as someone using the illegal hormone erythropoietin (EPO).

For Houlihan, it is an ethical issue. He described the use of the chambers as 'a highly ambiguous area' that will 'never be reconciled' with the current anti-doping criteria,' and said that WADA must 'not only establish a set of anti-doping regulations and protocols, but also give a moral lead in areas where there is this kind of ambiguity.'

WADA actually attempted to do this in a review in 2006 but failed. Its then chief, Dick Pound, condemned the chambers as 'tacky' and 'artificial', and the Ethical Issues Review Panel said that they were 'a violation of the spirit of Olympic sport.' But the chambers stayed off the list.

Practicality Trumps Ethics?

WADA never explained why. In a 2007 report produced by the House of Commons Science and Technology Committee, entitled Human Enhancement Technologies in Sport, UK Athletics' Dr Bruce Hamilton criticised WADA's lack of transparency - its 'behind closed doors' decision-making. But Dr Arne Ljungqvist, vice president of WADA merely says that there was 'a clear message' from WADA's stakeholders 'not to include it on the list.' The Canadian Centre for Ethics in Sport was representative of the stakeholders who went public with their opinions, when it argued that 'there would be no way to monitor the use of hypoxic tents', and that 'a ban would subject anti-doping authorities and their approaches to criticism and even ridicule.'

When I spoke to Professor Houlihan, he saw the stakeholders' point. He said that because these chambers have 'the same impact as illegal substances, but also the impact of perfectly legal occurrences' (such as living at high altitude) 'it would be hard to envisage having rules that could be enforced.' So, there remains a suspicion that the use of altitude chambers remains legal because practicality has trumped ethics. Dr Olivier Rabin, director of sciences at WADA, did not want to be drawn on this issue when I spoke to him. He stated that practicality was 'not an element we take into account at the scientific level.'

A 2007 study by scientists at the University of Verona has noted increased blood viscosity in athletes who use the chambers. It concluded that there were 'tangible health risks to the widespread use of hypoxic devices, which would make them as unsafe as other forms of blood doping.' So altitude chambers now potentially meet all three of WADA's doping criteria.

The use of altitude chambers is part of a wider debate about the role of science in athletic performance. For Professor Houlihan this is yet another grey area. He told me: 'If you see doping as the appliance of science to gain an advantage, then the development of frictionless swimsuits (now banned) or super-light fast bicycles for the velodrome all come under that heading.'

Describing the ambiguities in deciding what role technology should play in sport, Houlihan said: 'We have tended to see the development of equipment and sportswear as acceptable areas of innovation and the appliance of science, whereas doping - taking a substance - has been considered unacceptable. At one level there is no difference between the two. I've read lots of attempts to try and rationalise the distinction, saying that one is external to the body and one is internal.

'Then there's the difference between natural and unnatural substances. But these distinctions all fall down eventually. I think it comes back to be what is eventually considered to be acceptable and unacceptable. But there's no neat distinction between them at all.'

Richer, Faster, Stronger

And these grey areas not only erode the ethical high ground taken by WADA, they also have far-reaching consequences for competitive sport. Sleeping in a space-age chamber that alters your blood chemistry costs anything from $7,000 for a small tent, to $25,000 for a room. It is an expensive business, and a lack of money disadvantages the athletes from poorer countries.

Retired sprinter and 2004 Olympic gold medalist Darren Campbell voiced some concern about this issue when I spoke to him, especially in relation to altitude chambers. Although he did not think that their use was unethical, he was concerned that the cost of this technology put medals beyond the reach of poorer athletes: 'If it's only the top people that can afford it, it means the top people progress and everybody else doesn't. I can see the argument with regard to fair play: the top people will get better and no-one will catch them up.'

But WADA's Dr Rabin dismissed expense as an issue: 'We shouldn't be too naive. Many of the top athletes in the world, even if they wear the jersey of a one country, very often train in another country. So, many of them are wealthy enough to have access to a lot of devices and resources.'

The Wealthy are Sprinting Away

But the statistics suggest it is Dr Rabin who is being slightly naive. Professor Houlihan, who has studied the economics of international sport, said: 'The share of medals won by the G8 countries - the richest eight countries in the world - is almost the same as their share of world trade. There's a close association between being wealthy and winning medals. And it's because it's expensive science. It's interesting when you look at athletes from poorer countries who win medals. They tend to win in those sports where the application of science is still in its early days - middle and long distance running - rather than in highly scientific and technical sports such as diving and short distance running, or high jump and long jump. And the athletes from poorer countries who win those events tend to be those who get scholarships to American universities.'

What does this mean for the future of international sport? According to Houlihan: 'I think there is a danger that there will be a growing divide between a small group of sports superpowers and the rest, who simply can't afford the technology.'

And this divide has already started. The final medal tally of the 75 countries that took part in the 2004 Olympics showed seven of the G8 countries represented in the top ten medal-winning nations. An analysis of the 2008 Olympics medal tally shows the very same pattern. In 2004, only two of the UN's poorest 50 countries in the world managed to win any medals at all: Ethiopia and Eritrea. Over the last four major international competitions - two World Championships and two Olympics - the G8 countries have won on average 45 per cent of the medals awarded.

Against this evidence, the WADA Ethical Issues Review Panel's words that 'Sport is about the athlete and not about the equipment or expert systems upon which the athlete may rely' seem almost naïve. And the level playing field that WADA is so keen to promote in its DVD is already long gone.