Monday, July 21, 2008

Science and medicine in sports

Sport science papers often leave a lot to be desired. Despite all the hoopla about the scientific method, I found the field to be severely lacking in rigor. While I understand that it is difficult to work with human subjects and that good controls are hard to come by, the authors often fail to take into account how biased their samples are, and how poorly reproducible their findings turn out to be.

Working with the best athletes poses extra challenges. First of all, these individuals have personal goals that may not align with the study goals. They are likely to be secretive if a potential edge is expected. Nobody wants to be a control subject in a double blind study and few will participate unless it is expected to benefit them. But more importantly, top athletes do not have the time and the energy to spend on a rigorous research study. Their careers are short, and unless they are at the very top of a highly popular sport, they may have trouble making enough money to support the remainder of their life.

Readers, especially those of popular magazines are equally uncritical. They are eager to find an edge or know about a breakthrough. Breakthroughs are by their nature extremely rare and not responsive to publication deadlines. Yet everyone is eager to find an edge and many do find what they think is an edge. In such cases, they rarely want to verify their results. They do not want others to find out, and perhaps they are loath to burst their bubble too.

It doesn't stop there. The sports arena is one of remarkable contradictions. The quest for performance enhancing methods and substances is ever greater, and many companies tout the performance enhancing value of their products. They often resort to scientific-looking results to do so. Yet as soon as something is proven to enhance performance, it is immediately outlawed and its users are branded cheats and run the risk of being banned from further competition. 

It is curious to see how amateur athletes will take supplements and vitamins, yet complain when their idols use performance-enhancing "cheats." It is as if everybody knows that the magic potions don't work, or are illegal if they do, yet at the same time, everybody wants something to perform better. 

The rationale for these taboos is totally shaky. It usually comes down to some vague unproven claim of adverse health effects. The authorities do not want competitors to get hurt? Yet they do allow certain methods but outlaw others, although the final results are identical.

Eg. high altitude chambers, infusion of red blood cells, and erytropoietin all strive to increase the oxygen carrying capacity of blood. That leads to better performance. In many subjects these methods can be equally effective, yet while the first one is legal and extensively used by Olympic training centers -including the US center in Colorado-, the latter two are illegal and will cause the subject being barred from competition for a minimum of two years. So while everyone applauds the US Olympians who spend their waking hours in high-altitude tents, these same people will vilify others who resorted to "blood doping" or injecting EPO. 

This bipolar attitude has created a whole subculture of illegal performance enhancing substances and a similar subculture of testing for such substances. And while studies clearly show that some individuals can take these illegal substances without testing positive, while others cannot, the establishment continues to discriminate between the two, to uphold its "moral high ground."

History has shown that this attitude is unproductive. The "cheats" will continue to cheat and will not be deterred. Instead they will go and find newer ways to evade the rules. The game of cat and mouse can go on forever. In the process tons of money is wasted on needless testing and law enforcement while a whole subculture of providers, who stand to gain more the more illegal their products are, develops and thrives.

Perhaps the worst effect is that people are experimenting with powerful drugs without any medical or scientific oversight. No new knowledge is gained from this large scale experiment. Yet knowledge about performance enhancement would benefit society as a whole.

Instead, people get hurt, careers are destroyed, money is wasted, legal issues are raised, while nobody seems to care. This is a war of ideologies, a witch hunt that ultimately benefits nobody but the drug pushers and the odd consumer who is lucky enough to get away with it or be in a sport where nobody cares very much (like baseball).

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