The Ethics of Performance Enhancing Drug Use

1. The Ethics of Performance Enhancing Drug Use Jeffrey M. Anderson, MD Director of Sports Medicine UConn Division of Athletics

2. So What Could Possibly Be Wrong With This?

3. Overview • Review of anabolic steroid structure/pharmacologic action • History of anabolic steroid use in sport • Ethical arguments surrounding anabolic steroid use in sport

5. Testosterone

6. Endogenous vs. Exogenous AAS • Endogenous • Testosterone • Androstenedione • Androstenediol • DHEA • 19-norandrosterone • 19-noretiocholanolone • Exogenous • Nandrolone • Norandrostenedione • Methandienone • Methyltestosterone • Stanozolol • Boldenone • Trenbolone

7. AAS Effects on muscle • Most potent stimulators of protein synthesis at the cellular level • Effects are noted with supraphysiologic doses (10x-100x) • Clearly have a positive effect on muscle growth and hypertrophy

8. History of AAS • Brown-Sequard 1889 • Zoth and Pregl 1920s • Late 30s-testosterone synthesized by German scientists • 1950s-Soviet use of testosterone in athletes • 1960s-John Ziegler-Dianabol

9. History of AAS • 1960s and 1970s-rampant use-not illegal or banned • 1970s-GDR swimmers • Medical establishment still noted no benefit

10. History of AAS • 1988-Ben Johnson +stanozolol test • 1988-Underground Steroid Handbook-Duchaine • 1991-Elashoff publishes review in Annals of Internal Medicine stating that no firm conclusion can be drawn on their effects

11. History of AAS • 1996-Bhasin-first study documenting anabolic effects of steroids • Late 90s-Early 2000s—baseball • 2004-US Anabolic Steroid Control Act

12. Side Effects of AAS • Hepatic • Liver injury (temporary vs. permanent) • Hepatic tumors • Cardiac • Lowered HDL, elevated LDL and triglycerides • Increased thrombogenesis • Cardiomyopathy • Genitourinary • Males • Impotence • Oligospermia/ azoospermia • Gynecomastia • Females • Clitoromegally • Menstrual disturbance • Breast atrophy

13. Side Effects of AAS • Dermatologic • Acne • Male-pattern baldness • Hirsutism • Musculoskeletal • Tendon rupture

14. Side Effects of AAS • Psychological • Aggressiveness • Rage • Delirium • Depression • Psychosis • Mania

15. How Common Are Side Effects? • No controlled trials • Variation in reports depending on perspective • Temporary vs. permanent? • GDR information is concerning

16. Ethics • Autonomy vs. paternalism • Unnaturalness? • Unfair advantage? • Risk of harm? • Personal harm vs. opponents harm vs. societal harm • Right to privacy

17. Autonomy • The principle of respect for persons, and of individual self-determination consistent with that principle. As most commonly defined, autonomy points in the direction of personal liberty of action in accordance with a plan chosen only by oneself. • Paternalism • Stance that a person’s liberty is justifiably restricted to prevent self-harm, or to promote that person’s own well-being. Paternalism is an inherently liberty-limiting principle. It is grounded in a theory of impairment, viz., that an individual lacks sufficient facts or mental capacity to make a sound choice.

18. Unnaturalness • AAS are an “unnatural” way to gain advantage • Are training, carbohydrate replacement, medications, etc. all “natural”?

19. Unfair Advantage • If one athlete uses steroids it gives them an unfair advantage • If steroids are not banned, everyone has access

20. Risk of harm • Harm to Self • Side effects • Harm to Others • What happens to that poor kid on the previous slide? • Harm to Society • If one has to use steroids to compete fairly, how many will be forced into using them?

21. Right to privacy • Drug testing procedure • Witnessed collection • Complaints of embarrassment • Lack of trust • Invasion of privacy