clarifying my thoughts on therapeutic use exemptions

i have previously expressed an argument wherein i discussed the possibility of eliminating therapeutic use exemptions (tue) from professional sports. this argument was derived from the logical conclusion of a ‘zero tolerance policy’ on performance enhancing drugs. it was my belief that if one was to consider all potential consequences of a zero tolerance policy, then it would inevitably lead to the prohibition of tues for athletes competing in the professional tier of sports. briefly, the argument stated that if, without the use of medications, an athlete was unable to compete, unable to compete at the highest level of competition, or unable compete to their fullest potential, then these drugs would be, by definition, performance enhancing. thus, a puritan view of athletics would be compelled to argue against athletes competing whilst taking these drugs.

recently, i discussed these views with a friend, who disagreed with this stance on therapeutic use exemptions. since this conversation (and a brief follow up) i have thought about this position extensively and want to take the opportunity to refine my stance and emphasize some points. of course, the purpose of this blog is to stimulate conversation and have educated discussions around these topics. these are not easy discussions, as they often reach to the depth of unresolved philosophical discussions of morals, ethics, and fairness - topics of which i am clearly not an expert. however, becoming convinced of a position, or indeed modifying ones position, is a process that requires tough conversations that challenge our perspective (hence the name of the blog). while these conversations are difficult, both intellectually and emotionally, i think they are healthy in the end, and help to move the needle in the “right” direction - whatever that may mean.

so, here are several points of clarification i wish to make:

1. the position espoused above is not expressed from a point of absolute (real or imaginary) purity. in reality, the argument actually excludes me from competition, as i was the beneficiary of a number of substances that required a tue. without these, my career - for what it was - would have been even shorter. moreover, i have a number of friends that I care for greatly who would be targeted by such a policy. therefore:

2. the argument, at least as presented (and in light of my recent conversation), i believe to be untenable, unrealistic, unwanted, and undesirable in the current athletic climate. i believe that such an approach would cause a massive upheaval to even our current perspective of athletic competition and thus should not be seriously considered in terms of framing regulations.

3. however, this position does necessitate interesting conversations around the space, and so from hereon i believe i will be expressing this argument as a thought experiment rather than my actual position (see point #2).

4. i am perhaps one of the last people to discourage sport and exercise, let alone competition. this argument specifically identifies professional athletics, and does not mean to exclude anyone using medications from competing at an amateur level. it is possible that the most well equipped ‘professional’ athletes in this context then (i.e. those that require no tue) may actually be worse at the chosen athletic endeavor than the now ‘amateur athletes’ who, through no fault of their own, require some medical intervention, potentially for some condition unrelated to their sport. it is possible therefore that in this hypothetical world, professional and amateur sports simply exchange places on the socially desirable hierarchy and no progress would be made, rendering this argument and perspective inconsequential.

5. the argument seriously challenges notions of fairness, in that it eliminates the possibility of professional athletic competition for those born with, or develop a predisposition for, a range of medical conditions. my rebuttal to this point of fairness was that the argument is inherently unfair in its discrimination on this point, but promotes fairness in that those individuals who remain in competition are now pitting inherent physical abilities against one another. this would be in comparison to the current state of affairs in which the physiological playing field may be level, albeit by some pharmacological intervention in some athletes but not others. i think i have been swayed on this point, in that the sum total of ‘fairness’ may be greater in allowing tues, leading to point #6:

6. given this, i, nor anyone who authorizes tue use in sports, can purport a zero-tolerance policy on peds.

7. if tues are to be used to restore health, in that they combat medical conditions that impair health, we require an establishment of what ‘health’ constitutes in the realm of athletic participation. both the medical community and philosophers have a mercurial interpretation of ‘health’; but if we are to seriously create rules and regulations around which drugs are permitted and when (as wada, usada, and others are tasked to do), the term ‘health’ requires clear definitions and ranges for all potential variables. while we know health operates on some continuum, as biological systems all variables one could consider within this domain each operate on their own continuum that are dynamically interactive with all other variables. therefore, the use of a tue to promote athlete ‘health’ may be clear in some scenarios and incredibly unclear in most others. it is in this area that much work remains if we are to progress to a system that promotes ‘fairness’.

8. the push-back to the elimination of tues is understandable, and yet curious. at a time when columnists for reputable sports publications are positing the elimination of drug testing and simply allowing athletes to dope with whatever and however they please, i believe the space could use some balance by arguing the exact opposite end of the spectrum (i.e. not even permitting medically required pharmaceutical use).

9. the solution to the peds arms race certainly can not be a peds free-for-all, nor (as explained above) do i think the pendulum should swing the complete opposite direction. while the solution surely lies between these ideas, the formation are argumentation of the ideas are not without merit; indeed, the arguments for allowing athletes to use whatever performance enhancers they choose has forced me to examine my position against this. while i am familiar with the so called ‘backfire effect’, where people become more entrenched in their position when challenged, the absence of a challenge to ones views can also cause solidification of a position.

10. finally, as has been said before me (and much more eloquently) i am committed to believing as many true things as possible, and as few false things as possible and this recent exercise has given me the opportunity to refine my thinking. i am thankful for these conversations, and indeed the privilege to disagree with one another. i believe that (again, not an original thought) conversation is the only viable tool we have to make progress in our world.

on this topic there is much progress to be made, so let’s keep having the conversations.