Writing 1 PSY assignment

e100 I. Palmi et al.

The unethicality of doping in sports I. Palmi1, P. Berretta1, A. Tini2*, G. Ricci3, S. Marinelli3 1Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità, Roma; 2Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome; 3School of Law, University of Camerino, Camerino, Italy

Commentary Clin Ter 2019; 170 (2):e100-101. doi: 10.7417/CT.2019.2117

Copyright © Società Editrice Universo (SEU) ISSN 1972-6007

Correspondence: *Anastasio Tini, Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 366, 00161,Rome, Italy. Tel-fax- +39 06 49912622. E-mail: [email protected]

Dear Editor,

Sport, in its simplest form, is one of the most extraordi- nary human activities. It imposes rules that provide equal op- portunities for all, such as entertainment and enjoyment, and offers participants the opportunity to extend their physical and mental limits, share common values and experiences.

First of all, in the discussion on the question “should doping be considered unethical in sports?”, the reasons why certain substances or methods enhancing physical perfor- mance are banned should be taken into account. The World Anti-Doping Agency (WADA) states that there is an intrinsic value about sports that is the celebration of the human spirit, body and mind, and is reflected in values including fair play and honesty, respect for self and other participants, respect for rules and laws, and health (1). The WADA List of Pro- hibited Substances and Methods, may include any substance and methods that satisfy at least two of the following three

Abstract

Performance enhancing drug use in sport arguably constitutes a crisis, and as such, targeted measures are needed in order to stem it. Substance abuse in professional sports and competitions has besmir- ched many world-class athletes’ reputations and standing, in addition to jeopardizing their health. Furthermore, there are many instances of amateur athletes and school-aged competitors who have taken to using such substances as well, significantly exacerbating the overall picture. The widespread acknowledgement of the potentially life-threatening consequences of performance-enhancing drug use has prodded sports organizations and governments into cooperating on many different levels to preserve the ethical grounding and soundness of sport compe- titions; unlawful substance abuse is in fact liable to undermine the very core of fairness in competition. Doping, along with various forms of cheating, has been recorded throughout the history of sport: prohibition in itself is all but ineffective without reliable and systematic detection strategies and enforcement of sanctions. Clin Ter 2019; 170(2):e100- 101. doi: 10.7417/CT.2019.2117

Key words: doping, drugs, physical enhancement, ethical issues

criteria: 1) it has the potential to enhance or enhances sport performance; 2) it represents an actual or potential health risk to the athletes; 3) it violates the spirit of sport. The points 1 and 3 are mainly ethical arguments of “professional” na- ture: the use of substances or methods that enhance athletic performance violates the principles of equal opportunity and fairness between athletes. Moreover, doping is cheat- ing and it causes unfairness harms to the society, especially in children and young adults who consider athletes as role models. The point 2 is ethical argument strictly linked to the athlete’s health. Most performance-enhancing substances are drugs developed with the aim to treat specific diseases and the off-label use in healthy subjects can induce short- term and long-term damages (2). For example, among the most misused drug there is erythropoietin (Epo) employed to treat anemia resulting from chronic kidney disease or in chemotherapy induced anemia. The intake of Epo in healthy subjects leads to ‘thick blood’ and the danger of thromboses, with the additional risk of heart attack (3). Likewise, the off- label intake of anabolic steroids may lead to an increased risk of arteriosclerosis: the heart muscle mass increases, the myocardial perfusion deteriorates and the liver is damaged, leading to liver failure (4). Therefore, the role of physicians in anti-doping policies and practices is crucial and as matter of fact, medical ethics should be bound to the principles of beneficence, respect for autonomy, non-maleficence and jus- tice (5). For all these reasons developing and administering ergogenic substances or methods for athletes by physicians is unethical since the administration of those substances can cause serious health risks for the athletes and it violates the principles of medical ethics (6-10). In Italy, both the compli- ance of the WADA rules (e.g. the Anti-Doping Sports Rules) and the transposition of the List of Prohibited Substances and Methods, are under the responsibility of National An- tidoping Organization (NADO-Italia). The athletes and support staff are mandatory required to know and respect the Anti-Doping Sports Rules as an essential condition for participation in sports activities. In addition, Italy has also adopted a State anti-doping law (the Law of 14 December 2000 n. 376 - Discipline of Health Protection in Sport and the Fight against Doping) (11), which disciplines doping as

e101The unethicality of doping in sports

a criminal offense, providing both imprisonment and pecuni- ary sanctions. This law identifies the health protection as the critical point, especially focusing in the amateur sport. As matter of fact, while elite athletes are engaged with the anti- doping system of WADA (i.e. routine anti-doping testing, educational training), amateur athletes have been generally left out of any anti-doping rule. Even the role of expertise or expert advice is different in the amateur context, where institutional expertise (i.e. sports medical professionals, anti-doping organizations) may be less accessible than it is for elite athletes. Amateur athletes may instead rely on lay or community sources of expertise (i.e. fellow runners, online athlete forums) to be informed on what substances or products may improve health or performance. The implica- tions for health are evident as well as the series of challenges that anti-doping organizations should face when applying their policies to amateur athletes. The Italian anti-doping law heals these shortcomings, having created the “Section of the Technical Health Committee for Supervision and Control on Doping and for Health Protection in Sport Activities”, that carries out, among the others, the following activities on amateur sport: 1) it updates each year the list of prohibited substances and practices, adapting it to the WADA list; 2) it determines cases, criteria and methodologies for anti-doping controls; 3) it promotes research projects and information/ training campaigns to protect health in sports and prevent doping. In this law, the promotion of athlete health became one of the central reasons to ban the prohibited substance use among both elite and amateur athletes, and the main reason to consider doping as a unethical practice. In conclusion, Italian antidoping approach on amateur athletes seems to be a good strategy to unify the fight against doping both in the professional sports with that amateur sports. It can be considered a good practice, which can be an input for all the other international countries for a comprehensive fight against the unethicality of doping in sports.

References

1. WADA Ethics Panel: Guiding Values in Sport and Anti- Doping at https://www.wada-ama.org/sites/default/files/re- sources/files/wada_ethicspanel_setofnorms_oct2017_en.pdf (last accessed: January 29, 2019)

2. Pellegrini M, Rotolo MC, Busardò FP, et al. Non-allowed Pharmacologically Active Substances in Physical and Sexual Performance Enhancing Products. Curr Neuropharmacol. 2017; 15:724-30

3. Corlett AJ, Brown V, Kirkland K. Coping with doping. J Philos Sport 2013; 40:41–64

4. Solimini R, Rotolo MC, Mastrobattista L, et al. Hepatotoxi- city associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci. 2017; 21:7-16

5. Conti AA. Bioethics and the Italian National Bioethics Com- mittee: historical highlights. Clin Ter. 2016; 167:147-9

6. Ekmekci PE. Physicians’ Ethical Dilemmas in the Context of Anti-Doping Practices. Ann Sports Med Res 2016;3: pii: 1089

7. Carlier J, Giorgetti R, Varì MR, et al. Use of cognitive enhan- cers: methylphenidate and analogs. Eur Rev Med Pharmacol Sci. 2019; 23:3-15

8. Busardò FP, Kyriakou C, Cipolloni L, et al. From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate. Curr Neuropharmacol. 2016;14(1):17-27

9. Frati P, Kyriakou C, Del Rio A, et al. Smart drugs and syn- thetic androgens for cognitive and physical enhancement: revolving doors of cosmetic neurology. Curr Neuropharma- col. 2015; 13:5-11

10. Gentili S, Mortali C, Mastrobattista L, et al. Determination of different recreational drugs in sweat by headspace solid-phase microextraction gas chromatography mass spectrometry (HS- SPME GC/MS): Application to drugged drivers. J Pharm Biomed Anal. 2016; 129:282-7

11. Law of 14 December 2000 n. 376 - Discipline of Health Protection in Sport and the Fight against Doping at http:// www.salute.gov.it/imgs/C_17_normativa_652_allegato.pdf (last accessed: January 29, 2019)