WADA: Best Two Out of Three

Should listening to music before your race be a violation of the World Anti-Doping Agency Code?

Section 4.3 of the WADA Code (PDF) identifies the Criteria for Including Substances and Methods on the Prohibited List (PDF). Rather than quoting the criteria, I will reproduce here the note attached to this section. The language is less technical, but captures the essence of the criteria, and includes a few interesting examples to help explain the rationale:

A substance shall be considered for inclusion on the Prohibited List if the substance is a masking agent or meets two of the following three criteria: (1) it has the potential to enhance or enhances sport performance; (2) it represents a potential or actual health risk; or (3) it is contrary to the spirit of sport. None of the three criteria alone is a sufficient basis for adding a substance to the Prohibited List. Using the potential to enhance performance as the sole criteria would include, for example, physical and mental training, red meat, carbohydrate loading and training at altitude. Risk of harm would include smoking. Requiring all three criteria would also be unsatisfactory. For example the use of genetic transfer technology to dramatically enhance sport performance should be prohibited as contrary to the spirit of sport even if it is not harmful. Similarly, the potentially unhealthy abuse of certain substances without therapeutic justification based on the mistaken belief they enhance performance is clearly contradictory to the spirit of sport regardless of whether the expectation of performance enhancement is realistic.

This two-out-of-three business is a complicated matter. Is it really necessary to prohibit methods or substances (other than masking agents) that aren't performance-enhancing? I guess the last sentence of the note attempts to explain the rationale; if an athlete believes that a substance is performance-enhancing then he or she is trying to cheat, and therefore violating the spirit of sport. But isn't that a bit crazy? If Chinese swimmers believe that their success is due to caterpillar fungus soup, does that mean that eating caterpillar fungus soup is contrary to the spirit of sport? Even if they're wrong?

This nebulous "spirit of sport" is defined more fully in the Introduction to the Code:

Anti-doping programs seek to preserve what is intrinsically valuable about sport. This intrinsic value is often referred to as "the spirit of sport"; it is the essence of Olympism; it is how we play true. The spirit of sport is the celebration of the human spirit, body and mind, and is characterized by the following values: ethics, fair play, and honesty; health; excellence in performance; character and education; fun and joy; teamwork; dedication and commitment; respect for rules and laws; respect for self and other participants; courage; and community and solidarity. Doping is fundamentally contrary to the spirit of sport.

Once you have separated out the issues of performance enhancement and health, does the "spirit of sport" clause add anything useful to the argument? It seems to me that there are some serious problems with this definition in conjunction with the two-out-of-three criteria. If part of the spirit of sport is "health," does that mean that everything that's bad for your health is contrary to the spirit of sport? If so, then any substance or method that's bad for you — for example, smoking — automatically meets the two-out-of-three criteria for inclusion on the prohibited list.

And as for performance-enhancing methods and substances, the Code requires WADA to rule on which are "unethical" or "unfair." In practice, it seems to me, this means that the Prohibited List could be extended to include almost any performance-enhancement technique.

Recently the WADA Ethical Issues Review Panel ruled that hypoxic tents are contrary to the spirit of sport. Hypoxic tents allow athletes to simulate the effect of sleeping at high altitude. The tent contains an oxygen-poor environment; sleeping in the tent stimulates an athlete's body to produce extra red blood cells, which may increase performance in endurance sports. Hypoxic tents are used by a significant number of athletes, particularly in cross country skiing, cycling, and triathlon.

Few people dispute the theory that hypoxic tents are performance-enhancing. If we take the decision of the ethics panel at face value, that means that they would qualify as a Prohibited Method under WADA's criteria. The WADA Executive is clearly reluctant to make that ruling, but they find themselves in a bit of a tight spot. WADA recently announced that they would "seek broad stakeholder comment" on the question of whether hypoxic tents are an unethical performance-enhancing method or not.

So in what sense are hypoxic tents unethical or unfair? How should we decide? I would submit that they are unfair only to the extent that they are performance-enhancing; that is, if the tents were not performance-enhancing then they could not be unethical. There is clearly more to this, of course; at least in the minds of the ethics panel, there is a line between the use of hypoxic tents on one hand, and living at high altitude on the other. At least for now, one of these is "artificial" enough (I'm speculating) that it is not an ethical training practice. But is it really a good idea for WADA to be making such subjective evaluations? Is it necessary?

Let me bring you back to the hook that started this post: could music be added to the list of Prohibited Methods? A few months ago I came across an opinion posted at The Doping Journal. Alexei R. Koudinov of the Russian Academy of Medical Sciences noted that some swimmers at the Olympics in Athens were using headphones when they arrived on the pool deck. Koudinov goes on to point out:

Previously published research … showed that in humans, music makes saturation of oxyhemoglobin (SPO(2)) significantly higher … The statistically significant higher SPO(2) level indicates the "enhancement of oxygen transfer" and implies that "music by the pool" is prohibited by WADA in competition blood-doping method of "the use of products that enhance the uptake, transport or delivery of oxygen"*, apparently conflicting with the essence of olympism, and WADA calls for "ethics, fair play and honestly [sic]."

*Here Dr. Koudinov is quoting from an older version of the Prohibited List. The new version refers to "artificially enhancing the uptake, transport or delivery of oxygen."

I assumed, when I first read this, that Dr. Koudinov intended it to be a satirical barb pointed at WADA's policies. (The "previously published research" he cites concerns music therapy applied to premature infants.) After further investigation, it appears that Dr. Koudinov is quite serious. Although his campaign is unlikely to lead to any action by WADA, is this really so much different than the debate over hypoxic tents? Dr. Koudinov is arguing that listening to your pre-race psych-up tape is performance-enhancing. Most athletes who listen to music before their competition would not dispute that statement, although they may not swallow Dr. Koudinov's explanation of the mechanism for the improvement. That mechanism, he argues, puts pre-race music in the same category as EPO — and hypoxic tents. Note that Dr. Koudinov explicitly refers to the WADA spirit of sport definition.

Could WADA really go there? Are headphones going to be banned on the pool deck? Well, that's very unlikely, I would think. On the other hand, I do think that the current criteria, with their slippery two-out-of-three conditions, leave WADA open to just this kind of nonsense.