Keeping Viagra in the bedchamber and out of the arena?

Viagra may not just be a performance enhancer in the bedroom, but also on the sports arena. Researchers are studying whether it helps dilate athlete's blood vessels and improve their oxygen-carrying capacity. If it is found to improve performance it will likely be put it on the list of banned substances for athletes. But should it? 

That sildenafil (the active substance in Viagra) could have effects on athletes is not inconceivable, since it was originally a hypertension drug. It acts on the mechanisms that control whether blood vessels relax or widen, which has led to its bedroom applications. Getting more cardiac output or better oxygen transportation would be useful to athletes, especially when competing at higher altitudes. One study done at a base camp of Mount Everest (and another one in Ecuador) found that sildenafil may indeed have beneficial effects when oxygen is low.

At the same time it is not obvious that sildenafil would give any benefits to athletes - the body is complex, self-adjusting and often responds in contrary ways to medication. Maybe it only gives a tangible benefit at the extreme conditions at Mount Everest but not in normal conditions. But that will not stop athletes from trying doping of uncertain value: there is a debate in the medical community over which doping drugs actually work and which just provide a placebo advantage, but athletes will use them anyway. There is no current evidence of sildenafil use by elite athletes, but after the New York Times article it would be surprising if no athletes tried it - so far it is not prohibited or screened for. The earliest date it could be put on the list of prohibited substances is September 2009.

One aspect mentioned in the article is sildenafil might be useful when competing in polluted air (such as during the Beijing Olympics, where it was not measured). Another intriguing mention is that in one of the studies, sildenafil improved performance just in some participants, elevating their performance to the same level as those less affected by altitude. It apparently did not enhance performance beyond normal. There is also a study that it might improve jet lag recovery, a real issue for athletes travelling to competitions.

Most arguments against doping focus on the unfairness of the practice: somebody gets a benefit they have not earned through training or had the biological preconditions for. But just testing who happens to have the greatest preconditions seems to be a very limited perspective on sport: in that case we could just use DNA testing to find people with mutated myostatin or EPO-receptor genes and exhibit them. In fact, reducing natural advantages may make sports more of a challenge of the truly impressive human qualities - determination, skill, ability to train well, etc. If sildenafil only gives advantage to people who would, due to their biology, be worse off in a polluted or high altitude environment (or different timezone) then it would promote these competition based on interesting and admirable qualities rather than lung properties.

The three reasons to ban a substance in sport that make sense is 1) that it is against the agreed upon rules, 2) that it is unfair, and 3) that it is unhealthy. The first reason, often formulated as "being against the spirit of sport", is very flexible since exactly what constitutes the important parts of a sport or what rules the participants agree on is open for constant cultural negotiation. It is not at all inconceivable that drugs that even the playing field in certain ways could be quite acceptable (consider the widespread use of asthma treatments in sports). The unfairness will depend on whether we think the biological differences between people should be a crucial point in a sport or not; one could make a case either way.

It is really the third reason that may be the strongest reason to keep Viagra in the bedroom: it can have unhealthy side-effects. But if we regard a good sex life as a sufficiently good reason to risk these side-effects, it seems strange to argue that the rewards of sports are not sufficiently strong reasons. The medical approach is to check patients for contraindications and to monitor their health. The same could be done for the athletes.

Traditionally athletes have been regarded as more virile than their audiences. Maybe it will reverse in the future if sidenafil is prohibited.

Comments

[Tomasz Wegrzanowski]

Oh come on, the obvious reason to ban doping is combination of unhealthy side effects and race to the bottom problems - once we allow some performance enhancement, it will be absolutely obligatory to take, because sportsmen who don't take it, even if they're only 1% less effective, are completely out of the competition.

Such race to the bottom exists in other fields, for example people might feel the need to take amphetamines to compete professionally, or viagra to compete sexually with your partner's ex, but these are nowhere as extreme as with sports.

This is not a theoretical issue. See competitive body-building for a good example of a sport where doping is widely accepted - extreme levels of doping are universal. I don't think there's anything except competitive body-building where doping is so prevalent.

Fairness is pretty much irrelevant for this line of argument.

[Anders Sandberg]

But what is wrong with races to the bottom? (or in this case, to top performance) It seems that the concern is that people who don't want to use doping would have to use it to compete with the users, and that the use is bad for the spirit of the sport.

But trying to become a top athlete already involves having to agree with numerous constraints on life and behaviour that many people might wish to reject: e.g. extensive training and diet regimens, pressure to give the right public impression that limits freedom of speech, sizeable risks of being hurt, being forced to constantly keep antidoping authorities updated on where one is in order for them to be able to do random drug tests, the result of which may be made public. In what way would doping be different?

If it is a bad thing to add another "must have", then we should maybe consider the benefits of removing some of the above "musts". Maybe the key problem with professional sports these days is simply that it is professional, highly competitive and gives extreme rewards for positional advantages - removing some of that would remove the incentives for doping or similar tricks. But it might be that sports consumers actually want this extreme, doping-motivating regime. They might not say they want it, but their actions seem to imply that they do.