By Julian Savulescu and Bennett Foddy
The anti-doping witch hunt being perpetrated by the US Anti-Doping Agency (USADA) is ruining cycling. There is a simple solution: an amnesty for dopers and relax anti-doping laws.
The Story So Far
Lance Armstrong has accused the USADA of running a vendetta amidst claims from a Dutch newspaper that 4 former team mates are witnesses against him, all of whom are riding in this year’s Tour de France. Speculation on what was offered to these riders in exchange from their testimony has focussed on a six month ban, delayed until after the Tour de France, though this has been denied. USADA has refused to name any of the 10 witnesses. Lance Armstrong, in a tweet, has labelled the anonymity and immunity offered in exchange for testimony against him as ‘selective prosecution’ and a ‘vendetta’.
Armstrong stands accused of doping violations between 1998 and 2005, and, if found guilty, will face losing all his seven wins, with accusations including the use of EPO, blood transfusions and steroids, following his treatment for cancer and throughout his Tour de France wins. His former team mates Hincapie, Leipheimer, Vande Velde and Zabriskie did not stand for consideration for the United States Olympic team. A two year federal investigation resulted in no charges filed and Armstrong has not failed any drug tests but has been dogged by rumours and accusations for many years.
The fact is though that every winner of the Tour de France has been implicated in doping since Miguel Indurain, except Cadel Evans and Andy Schleck.
By Julian Savulescu and Bennett Foddy
Former Brazilian President, Fernando Henrique Cardoso, has argued that the war on drugs has failed and cannabis should be decriminalised. He argued that the hardline approach has brought “disastrous” consequences for Latin America. Having just returned from Rio, one can only agree. One of us was staying with an eminent professor of philosophy. We were returning to her house with her 11 year old daughter, only to have our way blocked by police with machine guns. They were hunting a drug lord in the local favela – this road was the only escape route and they were preparing for possible altercation.
Cardoso highlights the practical failure of a zero-tolerance approach. A zero tolerance approach to a crime like taking drugs must always fail, in the same way as a zero-tolerance approach to alcohol, prostitution or drugs in sport will always fail. Paradoxically, the worst thing you could do to the drug lords in Rio is not to wage a war on them, but to decriminalise cocaine and marijuana. They would be out of business in one day. Supplies could be monitored, controlled and regulated – the harm to users and third parties significantly reduced.
The case for legalizing drugs has been made often, most recently by Cardoso and by Australia’s foreign minister, Bob Carr, who this week co-signed a report declaring that ‘the war on drugs has failed’. The argument is nearly always put forward in terms of the burdens that the drug war has imposed on us in terms of crime and public health. And it is true that these things give us good reason to abandon Nixon’s war on drugs. But we so rarely hear a moral argument in favour of liberalizing drug laws. This is a mistake. Although experts have told us time and time again that things would be better without the drug war, politicians have ignored the expert advice because voters do not want drugs laws to be loosened. And voters feel this way not because they think they know better than the experts, but because they have moral objections to drug use. There is a hidden moral debate driving the war on drugs that we never seem to bring out in the open.
The German Medical Association has recommended that doctors should sometimes make use of deceptive placebo treatments when those treatments may be more effective than pharmacologically active alternatives. This recommendation stands at odds with the position of nearly every other international medical association, including the British Medical Association and the American Medical Association, which ruled in 2007 that it would always be unethical for doctors to prescribe placebos without informing their patients.
There is a gathering controversy on the placebo issue; for a long time it has been assumed that placebo treatments are both unethical and/or ineffective, and that widespread use of placebo treatments would grievously undermine the trust between doctors and patients. But a series of recent studies has been undermining the orthodox opinion:
In their experiment, test subjects were subjected to pain in the form of heat, while inside an fMRI brain imaging machine, and asked to rate their subjective feelings of pain. After the pain was induced, a powerful opiate analgesic drug, remifentanil, was administered by a covert injection, leading the subjects to report a slightly lower level of pain. Next, they were informed that a drug had been given, and their reported pain fell much more. And finally, they were told (falsely) that the drug had been withdrawn, upon which their pain returned to the level it was at before the drug was injected.
The experiment is significant for three reasons: first, it provides the strongest evidence so far that our expectations of benefit significantly contribute to our experience of suffering. Second, it shows that the benefit of a powerful modern painkiller can be completely eradicated if the patient believes she is not getting a drug. And finally, the experiment’s fMRI data showed that the positive effects were associated with the same pattern of brain activation as inert placebos, but that the negative effects were associated with activity in unrelated parts of the brain that are associated with increase in pain due to anxiety. This last point proves that the total elimination of the drug’s effect was not simply due to the removal of the beneficial placebo effect—rather, our minds have the ability to entirely block the beneficial action of a real analgesic drug.
The experiment has deep implications both for the neuroscience of pain and for philosophical questions in phenomenology. But it has immediate implications for the ethics of clinical practice as well. It is essential that we start to understand the power that our expectations have over our experiences. Prescribing a patient a pill for pain is simply not enough on its own; in fact, if the patient expects the pill not to work, it might be better not to prescribe anything at all.
[note: the original version of this post contained some interactive code, which has been removed from the archives]
A new report released by the US Surgeon General last month reminds us that cigarettes are designed with addiction in mind. Tobacco companies infuse tobacco with ammonia so that the nicotine crosses the membranes in the lungs faster, reducing the delay between inhalation and pharmacological effect. They add flavourings like chocolate and vanilla to the blend, knowing that smokers will be more likely to smell something in their food that they associate with smoking, and to feel like lighting up. These tricks are a source of moral outrage for many of us; it seems as though the tobacco companies are exploiting weaknesses in our biology to make us buy things we would not otherwise have bought, and to do things we would not otherwise have done (or would not have done so much). And tobacco executives have often denied engaging in these kinds of tactics.
All this makes for an interesting contrast with the case of video games, in which addictiveness is universally held to be one of the hallmarks of an excellent game, in which games can win awards for being addictive, and in which a developer can unabashedly boast of putting the most addictive systems into their games.
On Sunday, scientists at the Harvard Dana-Farber Cancer Institute announced that they had succeeded in reversing age-related decline in mice, using genetic engineering techniques. The scientists created transgenic mice with a gene for telomerase expression that could be switched on and off with a chemical signal.
Last week it was reported that police in Bangladesh had made a major bust at a factory that was producing counterfeit homeopathic drugs. The counterfeiters were attaching the labels of other drug producers to the remedies they were producing in their own factory. Dhaka's Daily Star reported the bust with the rather ironic headline "Fake Medicine Factory Busted".
Of course, even homeopathic remedies need to be guaranteed safe if they are sold in stores, and counterfeiters are not bound by the same safety controls as other more reputable sources. There are also 'intellectual property' issues concerning the use of other company's labels and trademarks. So I am not here to tell you that this drug bust was unnecessary or ridiculous. In fact I want to challenge The Star's implicit suggestion that homeopathic remedies are by their nature counterfeit therapies.