Uneven book on doping and public health

Ask Vest Christiansen
Department of Public Health, Section for Sport Science, Aarhus University

Professor Arne Ljungqvist is a heavyweight player in international sport. Not so much because he finished in the top three of European high jumpers at the Olympic Games in Helsinki in 1952. But because of his massive influence in international sport policy via his high ranked positions in the IAAF, the IOC and the WADA. You can check his profile on Wikipedia for the full list. Here it should suffice to say that he was member of the IOC Medical Commission from 1987-2014, its chairman from 2003-2014, member of the Board and Executive Committee of WADA 1999-2014, WADA vice-president from 2007-2014, and Chairman of WADA’s Health, Medical & Research Committee 1999-2014. While he thus cannot claim to be have an impartial voice in anti-doping, he does have extensive knowledge and an enormous network.

In September 2012, Ljungqvist drew on this network and through his anti-doping foundation organised a symposium on Doping and Public Health in Stockholm. As is often the case with such events, the organisers would like to have a tangible outcome of the meeting, so it is not left as just a vague memory with the participants. The result is often the well-known anthology with a collection of papers that, at best, should both reflect the original theme and content of the symposium, while at the same time also be saying something new. With so many anti-doping stakeholders involved in the symposium and the book, the former is much easier than the latter. Hence, if it should be a success, it demands an effort from the editors. Otherwise it risks being nothing more than, well, a tangible memory.

My assessment is that the editors, in this case, took their job too lightly. While there are some well-written and informative chapters, there certainly also are some that are too wound up in the anti-doping agenda and overloaded with normative assertions. Additionally, there are some with deficient English, and some that appears not to have been updated on the content side. It is thus a little ironic when Theodore Friedmann – chair of WADA’s gene and cell doping expert group – quotes IOC President Thomas Bach, in preparation for the Games in Sochi, for saying that “the battle against doping in Sport will require a greater and more stable level of funding for anti-doping research […] so that innovative anti-doping techniques can be developed and implemented quickly” (p. 145). Not a word on the Russian doping scandal. An observant editor would have asked for a contextualising comment elaborating on this. Left without any reference to what happened next in Sochi, it appears as an embarrassing reminder from someone running on autopilot while unconsciously asking for more money to anti-doping.

For non-native speakers, publishing in English is always a delicate issue. I know everything about how problematic it can be. At the same time, I realise that if we (non-native speakers) are not careful, we risk coming across as less rigid in our thinking. As it reads, Nader Ahmadi and Göran Svedsäter’s chapter on “individualization and performance and image enhancing in sport and society”, appears to be a little unfocused, riddled with postulates and lacking sufficient argumentation. The authors make categorical statements like: “The goal justifies the means as long as one is not detected” (p. 42). Or “Doping can be completely understood as a matter of rational calculation” (p. 45). Such oversimplifications are rarely helpful. Additionally, their writing does not flow and I thus get the impression that the reasoning would have been better had the text been in Swedish. In this instance, however, Routledge, the publisher, is also to blame. It seems that with the ‘blue-book cover-sports-research-series’, Routledge has cut away all external costs, including copy editing for style and clarity. Consequently, the reader is left with an impression of not only an uneven book, but also of a series where the publisher seems uninterested to do more than add its name and an absurd price tag.

That said, the volume also has some fine chapters. While Ivan Waddington’s chapter may work as textbook-like introduction to some of the theories that has been applied to doping research generally, David Hoff is more specific when he carves out some of the important distinctions that needs to be made when attempting to understand doping in elite sport and the drugs taken at the local gym. Hoff is well read in the literature on drug use in gyms, and he applies this to highlight where some of the often-used theories lack explanatory power. As an example, he points out how existing theories do not cover “an individual who is lifting weights every day in the gym to build strength and muscle and is using AAS without any sporting ambitions may be associated with neither risk behaviour [e.g. Kanayama or Wichstrøm] nor sporting ‘over conformity’ [Coakley]” (p. 52).

Another fine chapter is Letizia Paoli’s “The market for doping agents”. She builds on her detailed and systematic work with Alessandro Donati to analyse the supply-side of the Italian doping market. One of the surprising findings is that suppliers of doping products are not hard-boiled criminals linked to the Italian mafia. Rather, they are mostly male, Italian citizens with legitimate white-collar occupations, without criminal records, and who rarely use violence. In addition, while it may have been anticipated that many doping suppliers are related to the gym, fitness and bodybuilding industry, most people will probably be surprised to learn that the second largest group of suppliers are associated with the world of horseracing. In third place came owners of dietary supplement shops, fourth pharmacists and fifth physicians. Outside the top five we find staff members of cycling teams, sport federation officials and hospital employees. This is thought-provoking findings that rightly “calls for a more thorough reflection on the concept of ‘illegal market’ and a more nuanced categorization of the various types of illegal and quasi-illegal markets” (p. 72).

In their chapter on WADA’s ‘spirit of sport’ criterion, Sigmund Loland and Michael McNamee – both members of WADA’s Ethics Panel – “consider the ethical aspects that underpin the justification of WADA’s anti-doping efforts” (p. 112). The essay is reasonably balanced in pointing out the disagreements on the consequences of the anti-doping campaign, and it offers a fine introduction to the relevant philosophical concepts and fundamental positions in the debate. Nevertheless, the authors are firmer when it comes to pointing out weaknesses in their opponents’ positions than to the criticisms offered of their own.

In many respects, Thomas Murray’s chapters follow a pattern similar to that of Loland and McNamee’s. Murray – who has also held official positions with WADA – looks at the arguments from the perspectives of both the proponents of anti-doping and those who criticise anti-doping. For the latter group, he rightly distinguishes between pro-doping scholars and those who better fit the awkward label ‘anti-anti-doping’. While the former group argues for the moral desirability of doping, the latter focuses on the problems and flaws in current anti-doping policies and practices. Most interesting is Murray’s discussion on how doping control may constitute a problem in public health ethics. One of the major ethical discussions in this respect has been the whereabouts system. Murray analyses this in the light of five justificatory conditions for public health interventions, namely: 1) effectiveness, 2) necessity, 3) least infringement of presumptive value, 4) proportionality and, 5) impartiality. Although he concludes that whereabouts programs appear to satisfy the five conditions, he also calls for a more democratic involvement of athletes in the process. Whereas players’ unions in some of the American professional leagues have empowered athletes to negotiate with league owners and officials, this is not the case for athletes subjected to the WADA Code. Even if the book’s title promises to deal with public health in broader terms, Murray’s analysis sticks with elite sport and the whereabouts system. It could have been interesting to see if the conclusion would have been the same, had the five conditions been applied to an examination of doping controls in gyms and fitness centres – a practise now in place in Scandinavia, Belgium and a few other countries.

With the above-mentioned reservations in mind, the book offers a decent outset for the student interested in discussions around anti-doping from many individuals charged with shaping anti-doping policy. Some chapters have succeeded in stepping outside the normative anti-doping agenda, while others are too embedded in it. That, perhaps, is no surprise when it was Arne Ljungqvist and his anti-doping foundation that organised the 2012 Symposium. Hence, it is also no surprise that the overall impression is that of an uneven publication, aimed more at the delegates to the 2012 symposium or other WADA insiders, rather than scholars in the field seeking new insights.

Copyright © Ask Vest Christiansen 2017