Blame the National Science Foundation. It was a grant they awarded to The Hastings Center around 1980 to investigate ethics and non-therapeutic drug use that first got me thinking about drugs and sport. One of the rules we live by at the Center is that good ethics begins with good facts. So I began talking with people involved in elite sport—amateur and professional, athletes, coaches, and others—about how and why athletes were using performance enhancing drugs.

Anabolic steroids and stimulants such as the amphetamines were the drugs of choice back then. EPO and other biosynthetic drugs had not yet made their appearance. The only human growth hormone available was made from ground up cadaver pituitaries and was scarce and tightly controlled.

The sports medicine community was in denial, saying that anabolic steroids didn’t enhance strength. They claimed that the drugs were too risky. Philosophers call this argument “paternalism,” roughly, doing something to benefit or protect you, but without regard for your own preferences or consent. Fans of the movie “A Christmas Story” will recognize paternalism in what every adult says to Ralphie, who desperately wants a Red Ryder BB gun for Christmas: “You’ll shoot your eye out!” Parents act paternalistically all the time with their young children, as they should. But paternalism gets tougher to justify as children grow into late adolescence. It’s awfully unconvincing when you deal with competent adults, and downright hypocritical when we try to tell a 25-year-old professional cyclist or downhill skier who descends mountains at 60 miles an hour that you shouldn’t take drugs because “you might hurt yourself.”

The athletes I came to know described a now-familiar predicament. In a sport where drugs gave an edge, competitors faced three unhappy choices. They could compete at a disadvantage and perhaps lose to a less-talented athlete who got a boost from drugs; they could cease competing at that level; or they could try to level the playing field by using the same drugs as their competitors. The option they preferred was a drug-free environment, but how to get there was neither clear nor easy.

Early on, we understood that there were different sorts of problems. There are the practical challenges of designing a fair and effective drug control program that respects the rights of athletes. But there are other, much deeper, conceptual and ethical questions. How can we distinguish between an unethical performance enhancing technology on the one hand, and a legitimate means for boosting performance, or a justifiable therapeutic use of an otherwise banned substance on the other? Before we can answer that question we need to ask why sport matters at all.

Riding in the Hudson Highlands, where I now live, means climbing plenty of long, sometimes steep hills. Having a light bike helps. An electric motor would help even more, but then what would be the point? EPO could probably increase my speed and stamina. If my goal was to climb this hill as fast as possible, then EPO or motors would be very appealing. But sport is never just about how fast, how far or how high; if it were, all sorts of machines, prostheses and drugs would be not merely accepted, they’d be celebrated. But athletes and people who love sport understand that the triumph of the Performance Principle—maximizing performance by any means at whatever cost—would drain sport of all meaning.

It’s helpful to think about why sports have rules. For one thing, without rules there would be no sport. (Except perhaps for Calvinball, where there is only one rule: that you cannot use the same rule twice.) The rules give each sport its particular shape. Imagine basketball with 30 players on the court for each team: it would look like rugby on hardwood. Or soccer if every player, not just the goalkeeper, could carry the ball. They might be interesting games—or not—but they would surely be different sports than the basketball and soccer people now enjoy. Good rules are not ethically arbitrary if they are crafted to bring out those forms of athletic excellence each particular sport embodies. Basketball favors height of course, but also speed, quickness, strength, grace, coordination, determination (especially on defense) and cooperation, among other things we value, both physical talents and moral virtues. Success in the Tour de France requires incredible courage, a willingness to suffer, astonishing endurance, and sound team tactics—physical talents that must be honed and perfected combined with traits of character that we admire.           

We test ourselves through sport, searching for our limits and trying to break through them, experiencing a merging of body and will uncommon in everyday life. The rules of any sport, if those rules are wise, provide a structure within which whatever is admirable, beautiful, and honorable in that sport can flourish. The rules may give each sport its shape, but they don’t give it its value or meaning. Those come from the forms of human excellence given expression in that sport: speed, strength, grace, endurance; courage, tenacity, flair, tactical brilliance.

So, what does all this mean for the aging athlete? If someone has a clear medical need for a drug that could also serve a performance enhancing purpose, the ethical case for permitting that athlete to use that drug at a therapeutically appropriate level is strong. If someone needs insulin to manage their diabetes, or as in one case I saw while serving on a USOC committee, testosterone to prevent feminization of secondary sexual characteristics after having both testes removed as treatment for bilateral testicular cancer, then, under proper medical supervision, they should be permitted to take the drugs they need.

The ethics get fuzzier with so-called anti-aging medicine. Part of the point of having masters’ competitions is the acknowledgment that bodies change as they age, with sport performance declining after peaking in one’s twenties or thirties. What does it mean if a man in his sixties has a serum testosterone level somewhat below the usual range for all adult males, or even for all males in his age bracket? A good clinician will look for symptoms. If the man is otherwise healthy, what is the medical reason for giving him additional testosterone? What if there is, at best, flimsy scientific evidence that boosting testosterone has any significant positive impact on his overall health or longevity?

People disagree about whether to regard aging as a disease to be treated, managed (and, in the more far-fetched scenarios, overcome), or as an ineluctable reality of the human condition. The very fact that we have masters’ competitions seems to embrace—at least in part—the view of aging as inescapable reality.

Let me stop being, for the moment, a two-handed ethicist (“on the one hand, on the other hand…) and propose a rough principle here: If the drug proposed for use by a particular aging athlete is medically indicated to treat a disease, then the athlete should be permitted to use a therapeutic level of that drug; if the drug is meant to preserve the athlete’s health and well-being, and there is compelling scientific evidence that its benefits outweigh its risks for that population, then again the athlete should be permitted to use a medically sound dose. But, if there are no clear clinical indications or compelling scientific evidence, then athletes competing in masters’ level competitions should not use the drug. In this last instance, the risk is that flimsy science could be used to back drug use whose primary purpose and effect is sports performance enhancement.

Aging athletes have the same right to a level playing field as young athletes. A sensible policy towards dual-use drugs—drugs that have both legitimate medical uses but can also enhance performance—can help to keep that field as level as our years allow.

AGE-GROUP ANTI-DOPING CENTRAL