Thursday, March 13, 2008

Risk of Harm in Sport

Almost everything we do in life poses some risk of harm to ourselves or others. Every time you get into your car there is a chance you will get in an accident. The same applies when you walk across the street or board an airplane. Undergoing a medical procedure has some risk of harm, as does taking a prescription drug. Even mundane activities like walking down a stairway or getting out of the bath could result in an injury ....

When faced with such an onslaught of risks of harm we need to think rationally about responsible risk management.

On Monday my "Genetics and Justice" class will be discussing the President's Council of Bioethics Report on "Beyond Therapy". And chapter 3 of that report deals with "Superior Performance". This is a timely topic given the current attention (from the Tour De France to the Mitchell report in MLB) that has been given to the issue of enhancing performance drugs in sport.

The issue of enhancements and sport is a fascinating topic. And as I was preparing things for my class on Monday I came across a series of interesting videos (like this one) that you can find on You Tube. The full debate is available from the Intelligence Squared US site here.

This debate, hosted by Bob Costas, focused on the following suggestion: "We Should Accept Performance-enhancing Drugs in Competitive Sports"

Now this question raises a diverse range of issues, like what the value of sport is, etc. But perhaps the most obvious reaction people are likely to have against permitting performance-enhancing drugs is that it poses a risk of harm to the athlete (and thus should be banned). At one point in his argument against this point Julian Savulescu makes the great rejoinder that sport is inherently risky, and so pointing out that some enhancements pose a risk of harm is not sufficient for claiming they (rather than other risky things) should be banned from sport.

There are many ways of making the point that sport poses a risk of harm to athletes. Firstly, just ask yourself if you have ever suffered an injury while playing a sport. No doubt the answer is "yes!". Indeed, if you are serious about sport you may have even suffered a major injury. Growing up in a family that was active in sport I have always been aware of the risks sport poses to our health (though this risk is much smaller that the risks of being inactive!).

I myself was never a serious athlete but my sister was a competitive swimmer (until she suffered a serious shoulder injury) and my father was in the 1976 Olympics for racewalking (an activity that put a lot of strain on his knees). This study here, for example, examines the risks of injury with racewalking and it notes that those who train 6 or 7 times a week have a much higher risk of injury than those who only train 3 or less times a week. And this perfectly illustrates the dilemma facing our decision about permitting performance enhancing drugs: how much risk of harm should we allow athletes to pursue in their quest to be the best? Training only 3 times a week is safer but if others train 6 times a week they will have a competitive advantage. So if you want to win races you will train almost every day (even though it poses a higher risk of harm).

One could accumulate endless statistics of this sort noting how many injuries (and deaths) occur in various sports. But to really capture this point few things match the drama and vividness of visual images. And so I will show my class the following videos which I gathered from You Tube which show the risk of harm in certain sports.

Now just a word of warning..., these videos are not for the squeamish. But they effectively reveal the point that we already tolerate some pretty serious risks of harm for athletes. No doubt these risks vary depending on the sport in question. Boxing, for example, is a brutal sport with obvious risks (e.g. brain damage). But even something like cheerleading can pose significant risks of harm (as is evident in the last video below).

So here are the videos:

(1) The first is the tragic video of the death of race car driver Dale Earnhardt in 2001.

(2) This video, obviously put together by a boxing fan with an unhealthy appetite for seeing pain inflicted on other human beings, effectively illustrates the brutality of the sport.

(3) This video captures the horrific accidents that frequent skiing.

(4) And finally this tragic live News video captures the dangers of cheerleading. This ABC NEWS story notes that a recent study found that 16,000 cheerleaders get injured every year doing stunts and tumbles.

Is there a difference between allowing boxers to repeatedly receive blows to their heads, and skiers to fall at perilous speeds down steep mountains and permitting an athlete to boost their performance by taking performance enhancing drugs in pursuit of athletic excellence? It's a tough question, one we cannot answer without a great deal of empirical facts concerning the likely risks of activities we already tolerant (like those in the videos above) and the risks of things like steroids and gene doping. It is arbitrary to simply ban certain risky actions but tolerate those that pose an even more significant risk of harm.

So to answer the ""Should We Accept Performance-enhancing Drugs in Competitive Sports?" question we really need to answer the question: "How much risk of harm should we tolerate in sport?" and then try to figure out where different kinds of performance-enhancing drugs fit in this picture (e.g. below or above that risk threshold). Answering this question would also permit us to re-think those risks we currently tolerate (but should not), especially in brutal pursuits like boxing.