The issue of PEDs (performance enhancing drugs) in ultrarunning has been front and centre of our sport for the last few weeks, with firstly Ian Torrence’s excellent article on irunfar, followed by a reader survey we conducted that looked at the issue a little more deeply in terms of use and specifically where in training and racing.

Following on from this, I received an email from Matthew Vest, a Lecturer in Bioethics at The Ohio State University. Matthew came to trail running out of a background in kayaking, backpacking, and rugby only after his better half (also an ultrarunner) told him he’d have to learn to run to keep up with her!

Matthew forwarded me an article he wrote off the back of the two pieces of work, in which he proposes an argument for PEDs in ultrarunning. Controversial for sure, but it’s a debate that requires discussion and should be brought out into the open. While some may not agree with this notion entirely, Matthew has constructed a well thought through article, that we’ll be publishing in two parts. 

A massive thanks for Matthew for his time in penning this article and for making us think a little more deeply about the issues at play. In this first part, Matthew seeks to catagorise PEDs and what we mean by them. In the second part, Matthew will look at how that might create a competitive advantage and the notions of ‘honesty’ in our sport. We’ll love to have comments for this one, so whether you agree of disagree, let your feelings be known in the comments section.

Reconsidering PEDs in Ultrarunning

Matthew Vest, Center for Bioethics, The Ohio State University

As an ultrarunner who researches and teaches in bioethics, I found Ian Torrence’s recent iRunFar article interesting on a personal and professional level. Torrence gives a helpful and balanced picture of PEDs in ultrarunning, and Ultra168 followed that up with a reader survey that yielded interesting data from more than 550 ultrarunners. Clearly, PEDs is a topic of growing interest in ultrarunning, and I have yet to encounter any ultrarunner who wants to see a “dirty” culture of “cheating” in ultrarunning. Honesty, integrity, and personal accomplishment surely belong at the core of ultrarunning.

That said, I would like to propose an argument for PEDs in ultrarunning.

Now, with that brow-raising statement out there, let me clarify that I am not offering a concrete proposal recklessly favoring PEDs. Currently, WADAs authority in ultrarunning is limited to a few races, and we have no other governing body (yet) to implement widely accepted rules on PEDs. What I am proposing, rather, is an ethics argument, a line of thinking for us to reflect on. Yes, the above statement is provocative and controversial. That’s part of my point. I would like to provoke us to think further on PEDs. Too often, we all gather and cheer (rightly, in one sense) around calls for a clean sport without cheating. Lest anyone doubt it, I stand firmly behind honesty and integrity in ultrarunning, but I believe we need to reflect further about what we mean and how we define those critical terms. In this spirit, ironically, I think an argument for PEDs can help further honesty and integrity in our sport.

According to the Ultra168 reader survey, over half of the participants were confused or didn’t know if the issue is confusing. With this in mind, the goal of this article is to help educate and further the discussion on PEDs in ultrarunning.

Torrence’s Summary of PEDs

Torrence’s essay on PEDs is helpful for a number of reasons. First, Torrence accurately identified the complexity of PEDs. From steroids to hormones to diuretics to stimulants to narcotics to cannabinoids, the list of chemical substances (i.e., drugs) that enhance performance is expansive, and naturally the degrees of enhancement vary significantly from the widely used psychoactive drug “caffeine” to the cycles of steroid compounds (Primoblan, Deca Durabolin, Dianabol) popularly associated with a certain former governor of California.

Second, Torrence rightly illustrated the debate around the shifting terms “therapy” and “enhancement”. This is a major healthcare issue, and insurance providers play a key role here in defining these terms as they provide greater coverage for “therapeutic” needs (i.,e. eyeglasses) verses “enhancement” or cosmetic desires (i.e., such as contacts). Third, Torrence highlighted the difficulty in determining who in ultrarunning is using PEDs (defined primarily by the examples of testosterone, blood doping, ephedrine, prescription painkillers or narcotics, insulin, EPO, HGH, marijuana, or (met)amphetamine.

In Torrence’s view, it’s clear that honesty and self-policing according to the rules is the ideal, but in light of human reality, the focus inevitably turns to the extreme difficulties of testing to prove who is and isn’t playing by the rules. Fourth and lastly, in light of the prevailing “lack of appetite” to undertake the efforts to test (as far as able) PEDs, Torrence points to the importance of trust in the ultrarunning culture and community. This is the issue behind PEDs that is most at stake. As Torrence comments: “PED use alone isn’t the problem; dishonest intent, taking drugs when they aren’t needed, is the key issue at hand.”

I could not agree more with Torrence that the issue of “honesty” is critical, and honesty is exactly the point where I hope to further the dialogue on PEDs.

How do we define PEDs?

The first thing to admit is that honesty is not a stand-alone. Honesty is not an isolated phenomenon. Honesty depends upon being true to the rules of the game. The concrete, real life situation at hand—ultrarunning in this case—defines what it means to cheat in either the letter or spirit of the law. As Torrence pointed out, is the enhancement-drug-called-coffee that so many of us consume daily (and in races) to be inside or out of the rules? How much caffeine is too much? And lest we think this example is too easy, the International Olympic Committee allows caffeine but since 1984 has limited urinary caffeine levels to below 12 micrograms/ml (http://www.ncbi.nlm.nih.gov/pubmed/7550260). The rules of society and sports currently favor caffeine, but the rules can change.

Personally, I have not met anyone who thinks the rule allowing caffeine before, during or after an ultrarace is problematic, and yet a simple Google search on a hotter, current topic—“cannabis and ultrarunning”—reveals a plethora of opinions. Despite a growing push for legalization in many places, cannabis is banned by WADA in competitions—pace the case of Ross Rebagliati’s 1998 gold medal in snowboarding that launched the mini-slogan “smoke a fatty for Rebagliati.”

At the core of this is the matter of how we define the terms. What is “clean” ultrarunning? What is cheating? I imagine that—for someone skeptical to my opening, scandalous statement—it’s tempting to say immediately that any use of PEDs is cheating. We hear these seemingly obvious comments frequently: “our sport must be kept clean”; “I can’t imagine anyone in the ultra community dopes”; “how awful that 9% of the runners in Torrence’s survey are in the wrong.” Let me say again, I agree entirely with the spirit of all such comments. Cheating is wrong and damaging, and yet this is where Torrrence’s article brings a sobering, clarifying point: namely, the circumstances are muddy, and it’s not easy to claim that we have universally agreed-upon definitions for PEDs. We don’t always know clearly what we’re talking about. What is the line between therapy and enhancement? What is the absolute, rational definition of “clean” and “natural” in the sport of ultrarunning? The best aspect of Torrence’s article, in my opinion, is a push to be honest that the lines of definition on enhancement are simply not black and white.

Categorizing PEDs

Building on Torrence’s article, I suggest that honesty with PEDs in ultrarunning does not have an absolute, universal nature. That is to say, honesty is absolutely necessary, but honesty does not have an absolute measure. Honesty is contingent and depends on our customs and rules, and this brings us back to how we define the PEDs. In Torrence’s article, Torrence defined PEDs by listing a broad range of examples. Rather than list PEDs by example, however, I propose to consider Oxford ethicist Julian Savulescu’s classification of the most common substances used by athletes today (http://aeon.co/magazine/health/why-most-forms-of-doping-in-sport-should-be-legalised/). In light of these classifications, we can envision a reasonable argument for why ultrarunning should consider permitting PEDs that fall within the first two categories below:

• Physiological Doping I (PD I): enhancing normal physiology in training and recovery—this class of substances includes some anabolic steroids such as testosterone and growth hormone
• Physiological Doping II (PD II): enhancing normal physiology in competition—this class includes blood doping and EPO, both of which improve the flow of oxygen through the bloodstream.
• Non-Physiological Doping (NPD): enhancing via unnatural substances to modify normal physiology during training, recovery, and in competition. This category includes beta-blockers, diuretics, painkillers, anti-inflammatory drugs, cognitive boosters (i.e., methylphenidate, modafinil, cocaine, and amphetamines), etc.

The basic function of PD I & II is to enhance the abilities of an athlete that are naturally present, whereas NPD involves foreign substances that incidentally are easier to detect through blood and urine tests. Importantly, PD I & II are “add-on” and not “substitutionary” enhancements, meaning that an athlete will gain little from passive use of PD I & II. The athlete must remain active, putting in every possible minute of training and work to remain at the top of her/his potential. Absolutely, PD I & II will increase the benefits from such training, but it’s not right to think that the effort of these athletes can decrease. PD I & II offer additive gains that do not substitute for the courage and commitment needed to train for competitive ranks of ultrarunning. This is vital for considering the possibility of permitting some PEDs while maintaining the right spirit of competition in ultrarunning.

After suggesting the above three classes of doping, Savulescu argues for legalization of PD I & II and against NPD. His example of NPD is an athlete who suffers with chronic pain from the wear and tear of long years of training. The athlete wishes to enhance with analgesics and anti-inflammatory drugs so as to train and compete without pain. For Savulescu, PD I & II maintain the true spirit of sport as they “optimize the physiology” while not transferring “responsibility for the outcome to some external agent.” In short, PD I & II present acceptable physiological enhancement that keeps a level playing field when/if the rules allow all who wish to enhance via PD I & II. NPD is unacceptable as its benefit is more or less a “mental doping” that “undermines courage, determination, and ‘toughness’” in our sport.

Notably, the implication of this logic rules out cannabis for racing ultras. During training or recovery, cannabis could be valuable and justifiable. However, though some will disagree, suppressing pain and mental focus in races seems to me contrary to the mental endurance and toughness that is so essential to racing ultras. Modafinil (promoting alertness and focus), propranolol (reducing nerves), and prescription-based anti-inflammatory analgesics all would be against the rules for PEDs in ultrarunning.

Admittedly, this line of thought does not remove all room for debate. Whereas I would recommend the rules exclude the more powerful (and potentially dangerous—as runners are numbed to pain indicators) prescription-based analgesics and anti-inflammatory drugs that do not naturally occur in the body, other over-the-counter medications such as Tylenol and Ibuprofen could also be questioned. Such questions, however, are matters of degree regarding pain suppression. These matters are meaningful as the rules are being drafted, yet the process of teasing out such details would surely seem like small fries compared to the scope of the overall debate on PEDs without distinction.

Further, the question of “degree” with some common analgesics and anti-inflammatory drugs brings up the vital matter of health and sound medical advice for ultrarunners. The argument here for PD I & II admittedly hinges on the rules that we select to define clearly what is and isn’t “clean” ultrarunning. This argument is along ethical lines, and it’s another, different matter to speak about what is clear, recommended medical practice. Speaking personally, my primary care physician has recommended I not use Ibuprofen (Advil) in ultraraces for fear of overstressing my kidneys; his recommendation was Tylenol. That’s a small example of medical advice on the matter of over-the-counter drugs (which, by the way, seem harmless enough to exclude from the NPD category). Equally, the issue of medical advice is especially important if enhancement via PD I & II is deemed harmful to the athlete. The general consensus seems to be that PD I & II in moderation may not harm athletes, but, truthfully speaking, it’s difficult to know some of the medical issues with PD I & II given that studies on banned forms of enhancement are basically impossible. Because a substance (i.e., growth hormones) occurs naturally in the body does not mean that an overabundance of it will not lead to damaging tumors, imbalances, or other mal-health. As with any medication, balancing the desired enhancement/therapy with the possible side effects will remain both a public health and individual case scenario decision. Regardless, the health issue with PEDs is a matter that surely must be kept front and center.

Additionally, it is important to note that Savulescu’s categories hinge on the definition of “normal” physiological substances that are deemed natural. Here I would suggest that Savulescu’s definitions are somewhat oversimplified, and he has missed an even further point of confusion: not all NPDs are abnormal in the sense of not being present in the body. Some anti-inflammatory steroids such as cortisol do occur naturally in the body. The definition of “natural” vs “unnatural” substances in the body is immensely complicated, and at the very least we should be able to agree that the science and medicine of chemical substances proper will not guide us in the acceptable or unacceptable modes of enhancement.

In Part Two tomorrow, Matthew looks at the competitive advantage PEDs would bring and what a sport with PEDs might look like.

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Dan

I'm a mediocre runner who can bat above his average when I train hard. A man of extremes, I do enjoy everything life offers and consider it an absolute pleasure just to be able to put one foot in front of the other and let my mind wander somewhere different.