Shame on Sharapova? Time to Rethink the Banned List

Professor Julian Savulescu further discusses this subject at The Conversation

Maria Sharapova has been caught taking the banned performance enhancing drug Mildonium (Mildronate). It was added to the ever growing list of banned substances by WADA in January 2016. She claims to have not read the information sent via email informing athletes of the change of rules and says that she had been taking the drug since 2006 for a magnesium deficiency, an irregular EKG, and her family’s history of diabetes. Mildronate is marketed by the company as a performance enhancer (alongside other uses) and is one of Latvia’s biggest medical exports, accounting for up to 0.7% of its total exports.

Should we feel sorry for her?

Every professional athlete nowadays knows:

1. Strict liability obtains – that is, they are responsible for everything they put into their bodies. Ignorance is no excuse.
2. If you are taking any potentially, even vaguely performance enhancing substance you have to watch the WADA banned list like a hawk. It is added to on a regular basis. Indeed, substances may not even be specifically named but fall under a generic category of effect, such as accelerating tissue healing.
3. If you are taking a banned substance for medical reasons, you need to get a therapeutic use exemption. These are very common: there were at least 550 in cycling from 2008-2014. For example, a cyclist with a diagnosis of asthma can take the beta stimulant, salbutamol. In 2011, 8% of baseballers had a diagnosis attention deficit disorder (and so are allowed to take ritalin, related to amphetamine). Of course, the distinction between health and disease is fuzzy, but that is another story. It is very possible that Sharapova would have been granted a therapeutic use exemption, if she had applied.

Sharapova is a professional. Even if her medical need for what is widely advertised as a performance enhancer is justified, she should have known how to handle the administrative burden around it. Strict liability obtains. She broke the rules and will face the consequences.

The more interesting question is: why was Mildonium placed on the banned list?

The answer is that it is either unsafe, performance enhancing or against the spirit of sport, or some combination of these.

Is it unsafe? It is allegedly licenced in Europe and Australia for medical purposes. I have not gone into the safety profile in detail, but it is unlikely to be more unsafe than ordinary sporting practices involving training and full contact, or other permitted substances, such as caffeine. Caffeine, after all, will kill you if you take enough of it.

More likely, the reason it is banned is because it is potentially performance enhancing. But wait: so too is caffeine, which is now off the banned list.

So why was caffeine taken off the banned list, and mildonium put on? The only answer I can see is that caffeine occurs naturally but mildonium is artificial. Indeed, this seems to be the basis for WADA’s approach to enhancement via increasing oxygen carrying capacity through increasing hematocrit levels. For example:

Erythropoetin – banned
Hypoxic air tents and altitude trained – allowed.

Yet erythropoetin is naturally produced by the body. And so too is blood transfusion, even transfusion of your own blood, which is also banned. Presumably both of these forms of blood doping are banned because the methods are artificial – injection.

So, although this is not stated, a hidden clause in WADA’s code is that something will be banned if it is both performance enhancing and artificial, either in preparation or delivery. For that reason, natural performance enhancers like creatine, beetroot extract or caffeine are accepted. You can even purify these into pill form, but as long as you could take them naturally, they are OK.

But what moral difference does whether something is natural or artificial make? Running shoes are artificial, aero helmets are artificial; sport is full of artificial performance enhancement.

The natural/unnatural(artificial) distinction is deeply important to ordinary moral thought. Natural therapies are seen to be preferable to medicines; complementary medicine is a massive industry; education is preferable to cognitive enhancers.

But nature is itself a series of chemicals and chemical reactions. A wonderful and splendid series of reactions, but not fundamentally different to our own attempts to emulate it. To be sure, artificial constructs often have greater risks and unpredictable effects than those already existing in nature. But it is the effects that matter, not the means of achieving them. If an individual artificial construct does not have a greater risk then the very fact of it being artificial should not matter.

What sort of effects should matter? WADA is on the right track with two of its key criteria:

1. Safety
2. Undermining of the spirit of sport.

But something that merely enhances performance, like modest steroid use, for example, used to accelerate recovery from the injury of training should not be banned.

The bar for safety should be set at the level we allow athletes as  persons to take risks. We can compare the risks of Mildonium with, say, spinal cord injury from horse riding or rugby or football, or brain damage from contact sports, or the risks of caffeine overdose.

Most of the substances on the WADA banned list would fail this test, especially those natural substances like blood and steroids, when taken in the physiological doses where an athlete’s parameters remain within the “normal” range.

The spirit of sport is more complex and WADA does a hopeless job at defining this. The spirit of sport should include two components:

1. Preservation of an essentially human component to the sport. Using bionic limbs or super blades for running would confer a dominating advantage. They should be banned in ordinary sport.
2. Preservation of the test of the particular skill or strength. Beta blockers for archery or pistol shooting should be banned

Fortunately, both of these instantiations of the spirit of sport are easy to detect because they are foreign to the body and easily measured.

Should Mildonium be banned? I don’t know enough about its precise details but I suspect it would fail both of these tests. It would neither be unsafe enough compared to the risks of sport nor would it undermine the spirit of sport.

We should shorten, not lengthen, the WADA banned list. We should give up the principle that anything that enhances performance is against the spirit of sport and that the natural/artificial distinction has moral significance. We should ban substances or practices that are clearly or likely significantly unsafe and we should ban specific substances that corrupt the spirit of a particular sport.

If we applied that test, we might remove a majority of the substances from the WADA list.

Sport has become too bureaucratic as WADA is forced to constantly extend its lists, and find new proxy ways to uncover cheating, such as whereabouts rules, where athletes can be banned for forgetting to file accurate paperwork. Sure, we need some rules to keep athletes reasonably healthy and to preserve what we love about sport. But that doesn’t require a Stasi-like approach to performance enhancement in sport. Let the athletes get on with and let’s get back to enjoying it, rather than placing every athlete under a cloud of suspicion.