Performance Enhancing Drugs and the Value of Sports with Dr. Thomas Murray

In this interview, Dr. Thomas H. Murray joins KineSophy to discuss performance enhancing drugs and the value of athletic competition in connection with his latest book, Good Sport: Why Our Games Matter…and How Doping Undermines Them

Dr. Murray is President Emeritus of The Hastings Center, the world’s first bioethics research institute. He has served as the Director of the Center for Biomedical Ethics and the Susan E. Watson Professor of Bioethics at Case Western University School of Medicine, the Chen Su Lan Centennial Chair (Visiting) at the National University of Singapore School of Medicine, a Presidential appointee on the National Bioethics Advisory Commission and as chair of its Genetics subcommittee, and as the president of the Society for Health and Human Values and of the American Society for Bioethics and Humanities. 

He received an honorary Doctor of Medicine degree from Uppsala University in 2004, the Henry Knowles Beecher Award from The Hastings Center in 2012, and the Patricia Price Browne Prize in 2013. Dr. Murray is a member of the Independent World Athletics Ethics Board and its Disciplinary Tribunal, and was previously the first chair of the World Anti-Doping Agency Ethics Panel. He has testified before many Congressional committees and is the author of more than 300 publications.

Dr. Thomas Murray

Enter the giveaway below to win a physical copy of Dr. Murray’s book Good Sport.

Greg: Do you have an athletic background? What led you to study sports and ethics?

Dr. Murray: I grew up watching the [Philadelphia] Phillies and playing catch with my father. After school I’d join my friends at the park to play pickup baseball or football—whichever was in season. Later came basketball, for which my almost six-foot height was an advantage. Until my late teens, I was thin and uncoordinated. But I could run fast, make a jump shot, and was willing to take punishment under the basket. I played intramural basketball in high school and at Temple University. In my first full-time faculty job, the institution fielded a student-faculty team in the city’s industrial league. I started at guard or forward—positions were flexible. I lacked the talent to play on a varsity squad, but I played wherever I could. 

When I came in 1979 to The Hastings Center, the pioneer research institute in bioethics, we’d received a grant from the National Science Foundation to study the ethics of non-therapeutic drug use. I led the work on the use of drugs for enhancing performance. Sport was the most visible arena for that category of drug use. My college friend Dick “Hoops” Weiss introduced me to other sports journalists and to athletes in the NBA and NFL. We also developed sources in the Olympic movement and in sports medicine and sports science. From those people I learned the bedrock reality upon which any understanding of the ethics of performance enhancing drug use in sport must be built: the relentless pressure NOT to give up a competitive advantage—including steroids, amphetamines or other drugs that enhance performance in your sport.

As a grad student at Princeton I was involved in research that deceived undergraduate students into thinking they might be witnessing an emergency, and then recorded whether and how swiftly they sought help. Many of the research subjects were severely rattled by the experience, especially the majority who failed to seek help within the six minutes we allotted. I came to believe that whatever knowledge we might gain from the study wasn’t enough to justify what we made them go through. I began asking questions about the ethics of such research. Ultimately that led to post-doc fellowships at Yale to study ethics, and then to The Hastings Center.

Greg: Good Sport is essentially divided into two parts: the values we assign to athletic competition and the way performance enhancing drug use undermines those values. Let's start with the first point—what makes sports valuable to us?

Dr. Murray: A colleague and dear friend at The Hastings Center would pull out and throw away the sports section each morning. I, of course, devoured that sports news. Let’s begin by acknowledging that not everyone values athletic competitions the same way or values them at all. But, I believe that if you do like playing or watching sports, there are common threads we can follow to the sources of value shared within and among sports. 

Two components stand out. First is natural talent. Critics argue—correctly—that natural talents as such are unearned and people deserve no moral credit for possessing them. That’s true of course for all sorts of natural talents: mathematics, art, singing, composing, or, for that matter, analytic ability. It’s also true, of course, that every natural talent needs honing and perfecting. That’s where the moral worth lies. We may be awed by natural talents; but we admire the hard work and thought required to perfect them. I’ve proposed that we think of meaning and values in sport as the virtuous perfection of natural talents. The World Anti-Doping Agency Code adopted my formulation some years back.

“I think Good Sport is the first popular book to make meaning and values in sport the central reason to shun performance enhancing drugs.”

Greg: Can you say a little more about how performance enhancing drug violates what we admire about sports?

Dr. Murray: There is one misleading reason, and two robust reasons for opposing performance enhancing drugs (PEDs) in sport. “Fairness” is the misleading one. Why? Because we could “level the playing field” by allowing everyone to use anything and everything. That would be “fair.” But also nuts. Fairness becomes important once we’ve decided which technologies of enhancement should be permitted and which ones prohibited. All athletes should play by the same rules. 

Here’s where the other two reasons come into play. Safety is one. Forty years ago athletes told me why they and their fellow athletes used PEDs: they didn’t want to lose to someone not as talented or dedicated but who won by using drugs. Wherever PEDs can make a decisive difference they become tyrannical: That is, if some competitors use them, it becomes almost impossible to compete successfully without using them yourself. And it’s fanciful to think that using large doses of powerful hormones or other drugs can be entirely benign. Especially in light of the ever-present pressure to push the envelope—using higher doses and adding more drugs to the mix.

Safety also alerts us to the ripple effects of PED use by elite athletes: younger, older, amateur, less talented athletes will also be tempted to boost their performances with the drugs their models are taking. They’re more likely to get their drugs from sketchy sources, and to lack the expert advice and supervision elite athletes can rely upon. This is the public health dimension of doping in sport.

For all that, I think Good Sport is the first popular book to make meaning and values in sport the central reason to shun performance enhancing drugs. To the extent that drugs weaken the connection between natural talents, dedication, and performance, they undermine why we care about sport. A carbon fiber vaulting pole allows the vaulter to go higher; but success still depends upon her speed, strength and technique. Enhancing the leap with small explosive charges under the heels of her shoes adds nothing good to the pole vault. We admire explosive speed in the hundred meter sprint along with the endurance required to run a marathon or ride the Tour de France. Using EPO, steroids, growth hormone and other PEDs muddies the connections among talents, dedication and performance.

Greg: You mentioned safety concerns surrounding performance enhancing drug use. What are some of those concerns? Has use of these substances become safer after years of experimentation? And if an athlete is aware of the possible side effects but still chooses to use performance enhancing drugs, can we still use the safety argument to restrict his choice?

Dr. Murray: Some of the safety concerns pertain to the particular drug. Anabolic steroids, for example, have an array of effects on the human body beyond building muscle. It’s important to note that the hazards of powerful hormones like steroids, EPO or growth hormone increase when administered to young athletes, whose bodies are still developing. That’s one reason the East German state-sponsored doping program was so heinous; it caused life-long harm to many of its victims.

Have athletes learned to use certain drugs more safely? That’s likely I suppose. But when drugs are used in extra-therapeutic doses, in combinations that science hasn’t studied, or when novel substances are used, it’s smart not to expose yourself to uncertain, possibly serious and lasting risks.

Your question about the athlete who knows the risks and chooses to use anyway allows me to clarify a vital point. An isolated, informed adult weighing the advantages and disadvantages and choosing to take a risk can argue plausibly that her choice should be respected. To do otherwise is to engage in unjustified paternalism. And indeed, many of the early arguments over the ethics of doping were framed in terms of paternalism. Here’s the problem with that framing: Philosophers distinguish between self-regarding and other-regarding actions, roughly actions where the consequences fall completely or almost completely on me, versus actions with significant consequences for others.

So, if I just wanted to take EPO to bike farther and faster on my own, the consequences fall more or less exclusively on me. People are allowed to do dumb things, and while we can try to persuade them not to, the decision is theirs. It all changes when we compete against other athletes. My decision to use PEDs directly affects the people against whom I’m competing. This is a quintessential case of an other-regarding action. This is why I describe PEDs as tyrannical: if they’re effective, competitors are more or less compelled to use them to have any chance at success. Banning PEDs in sport preserves justice; we’re not doing it primarily out of paternalism, but out of a desire to preserve meaning and values. It has the side-effect, of course, of also saving athletes from the risks of PEDs.

A pole vaulter ascending toward the bar and swimmers lining up for a race

Greg: So performance enhancing drugs are out. Are there other enhancements, like carbon fiber poles, that are acceptable? What about some that go too far? Is it possible to draw a line to distinguish the acceptable enhancements from the violations?

Dr. Murray: Every candidate enhancement technology in sport needs to be judged on its own merits. Some, like the carbon fiber pole, are consistent with that sport’s meanings and values. Others, like super-slippery, body-molding, waterproof swimsuits changed what mattered in their sport; so swimming banned them. The test in every case is straightforward, though not at all simple: Does this performance enhancing technology preserve and perhaps advance; or does it undermine and distort, what gives this sport its value and meaning? The people who know and love the sport are best placed to make those judgments.

In any case the ethical decision rests upon the meaning of the activity. Suppose your job is rescuing cross-country skiers, and there’s decent evidence that a modest dose of EPO boosted your ability to make a successful rescue. You could ski further and faster, and still return in good health. The point of ski rescue is saving skiers and keeping yourself alive. If EPO or other drugs contributed to that without imposing other risks on you, why not use them?

Or imagine a neurosurgeon who proves that a common, very low risk drug steadies the surgeon’s hand and leads to fewer complications and faster recoveries in patients. It would be arguably unethical NOT to use a performance enhancing drug in this circumstance. The point of surgery is to heal patients, not to display the surgeon’s virtuosity.

Greg: Record-keeping is an important aspect of almost every sport. Technological advancements like the carbon fiber pole give modern athletes an advantage over their predecessors when it comes to historical records. Does this consideration provide sufficient grounds for limiting technological advances in sports?

Dr. Murray: This is great question for sports fans to wrestle with. My inclination is to look beyond historical records and ask instead, what counts as excellence in this sport? What makes it interesting, exciting to play or watch? It took quite a while but the three-point shot transformed basketball, more, I think, than the dunk. Strategies evolved, analytics demonstrated the disadvantages of mid-range jumpers compared to shots under the basket or beyond the three-point line. Players excelling at the three became more desirable; even veterans worked to add the three to their repertoire. Nevertheless, speed, accuracy, driving, finishing, rebounding, great passing, tenacious defense all continue as essential components of great basketball. When changes in strategy, players, or technologies alter a sport, that sport needs to ask itself what really matters and, if needed, change the rules accordingly. Examples abound: swimming banning certain swimsuits; baseball lowering the mound when pitchers began to dominate hitters; insisting that all speed-skaters have access to the best-quality hinged skates when they entered that sport.

“The mission of every sports governing body should be to protect the integrity of its sport and to protect and support the athletes in its care.”

Greg: What recent developments on the ethical boundaries of sports most interest you?

Dr. Murray: I’ll mention a few briefly:

  1. Protecting athletes against head injuries. This will only become more critical in sports like football and soccer.

  2. Welcoming athletes’ voices into all aspects of sport governance. The governance of sport, especially amateur sport, needs massive reform. Some governing bodies appear to be taking the challenge of reform seriously. Others remain cauldrons of corruption, self-dealing, and indifference to the well being of the athletes in their care.

    For example, US gymnastics, swimming and every other youth sport that tolerates predators of any kind. Any sports governing body that lavishes money and perks on itself rather than on the athletes it’s supposed to protect and support. Any entity that tolerates, or worse, encourages and covers up doping or other corruptions of sport. Take a look at what’s happening in international boxing, wrestling or weightlifting for starters.

    If nothing else comes from this conversation I hope your readers will begin to pay far closer attention to how their sport is governed, and to highlight shortcomings and abuses. The mission of every sports governing body should be to protect the integrity of its sport and to protect and support the athletes in its care. Not to entertain board members and bureaucrats at the fanciest hotels and restaurants. Enough.

  3. Finally, after decades of laying blame for doping exclusively on athletes, anti-doping is going after what I’ve called the doping ecosystem—the coaches, doctors, scientists, officials and hangers-on who enable, encourage, and in some cases compel athletes to dope. We need to sanction these exploiters and get them out of sport.

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