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When do we call it performance enhancing?                                                                                    

Posted at: Aug/08/2012 : Posted by: mel

Related Category: Perspectives, Sports,

If you have followed any of the news about the London 2012 Olympics, you have likely heard of Oscar Pistorius. Oscar was born with missing fibulas (the outer leg bones). As a result of his condition, both of his legs were amputated below the knees as a baby. Despite this condition, Oscar has risen to become a noted sprinter in the 100, 200 and 400 meter dashes. He accomplishes these feats of running with the aid of sophisticated curved composite carbon fiber prosthetics called “Cheetah” legs.

History shows us that prosthetic limbs have been around for at least 3500 years. Now we are entering into an era when a prosthetic can go beyond merely aiding in the ability to participate in society. Prosthetics and engineering have reached the point of enhancing the user beyond conventional physical norms.

There is no doubt that Pistorius, often call the “Blade Runner” (for the appearance of his prosthetics) is a world class athlete. He holds numerous records for the Paralympics and recently began competing successfully against “able-bodied” athletes. Clearly, he is courageous and determined, all traits of great athletes, but he is also testing the limits of what is truly fair athletic competition.

In 2007, after protests from some athletes and coaches, the International Association of Athletics Federation (IAAF) banned Pistorius from competing in able-bodied competitions. This was supported by their own tests at the German Sports University that indicated the Cheetah blades allowed him to expend less energy than able-bodied runners. In response, Pistorius assembled his own team of scientists and lawyers and successfully appealed to the Court of Arbitration in Sports. Further tests showed that he used energy at the same rate as other elite runners. Additional testing also indicated that the Cheetah legs were not more efficient than human. The same testing also showed that while his artificial limbs are lighter than human legs, he must push off the ground harder to get the same thrust, effectively canceling out any advantage. As a result of this appeal, the IAAF decision was overturned.

Far from being the end of the story, this is really just the beginning. There are no actual guidelines or rules at this time for defining the scope or limits of what the court called “adaptive sports equipment.” When does head gear for a soccer player make their headers more potent? When would special glove accessories make the grip of a gymnast better? When does a spring attenuated seat for a rower make their oar strokes stronger? This list could go on and on. In case you missed it, technology is clearly in nearly every other aspect of our lives. What happens when the prosthetic technology used by disabled athletes surpasses the capabilities of able-bodied athletes and their flesh and blood limbs?

The challenge is in the understanding what the limits of true physiological function are and ensuring technology does not surpass that point. Imagine the amputee high jumper who wants to use some variation on the Cheetah blades. As the springiness varies, when does it stop being “fair” for completion? How about the archer whose prosthetic arm does not tremble as much as a flesh and blood arm? We already know that the size of swimmers hands and feet can contribute to their speed, would artificial feet designed for swimming have an unfair advantage?

The other challenge is matching the burden of flesh and blood physiology. Real limbs can cramp, or have circulation problems. During the 2012 U.S. Olympic trials, two-time Olympian Dathan Rithenhein was eliminated from the marathon team because of leg cramps. Flesh and blood changes its efficiency significantly with temperature variations, a concern not likely faced with artificial limbs. Is Pistorius at an advantage because his heart does not need to pump blood and oxygen to his lower extremities?

Then there is the question of pain. Even for the greatest athletes, pain is an inhibiter. Whether pitching a softball or kicking a soccer ball, how much is that activity metered for flesh and blood limbs by the feedback of pain? Clearly, even if pain is experienced, it is something that would not be experienced in the same way with prosthetics. Obviously, Oscar Pistorius will never worry about rupturing an Achilles tendon.

Human growth hormones, narcotics, steroids, drug doping, and a long list of other pharmaceuticals are considered “performance enhancing.” As a result, amateur and professional athletes in nearly all sports are tested often to ensure they are not using these drugs to gain a competitive advantage. In a similar way, how do we tell when the prosthetic technology goes beyond enabling and becomes performance enhancing with respect to some baseline of able-bodied athletes?

Do we have the technology right now to determine the optimum efficiency of a swimmers hand and therefore ensure that the artificial limb does not exceed that mark? Even if the answer is yes, does that mean the athlete with a prosthetic will always come in 2nd or 3rd place? We could be changing the nature of competition.

To this point I have asked more questions than I have answered. In truth, there are two very big issues that Oscar Pistorius and potentially others like him are challenging us to think about and define.

1. What is a disability?
2. What is the rationale for elite sports?

The first is actually not a new question. In 1997, Casey Martin, a professional golfer with a circulatory disorder sued the Professional Golf Association (PGA) under the American’s with Disabilities Act (ADA) to be allowed to use a golf cart in the U.S. Open. The PGA argued that walking the 72 holes of golf over a tournament weekend was a significant factor in tournament play. The U.S. Supreme Court overruled the PGA and Casey was allowed to use a golf cart. He finished tied for 23rd. I’m glad he was able to compete, but struggle with the notion of whether it was fair or not.

Defining “disability” is a challenge I am not capable of. The term “Disability” is clearly a medical term, but it also has modern social and legal definitions. Clearly if you are not “Normal”, you are disabled. Unfortunately, even being normal covers a lot of territory. Are people at the lower end of the normal scale actually disabled? Is a right handed shot putter who is missing the little finger on their right hand disabled?

What is the purpose of sport? Clearly sports are an artificial world. The rules for any given game are continuously changing. Even locally, the National Baseball League makes their pitchers hit while the American League allows for the use of a designated hitter. Whether you agree with the rules on any given day or not, sports work because they are played with an agreed to set of rules. The rules are intended to keep things “fair.” The sprinter who leaves the starting blocks before the gun has an unfair advantage and is disqualified.

Those opposed to Pistorius being included in the Olympics argue that for the competition to be fair, all the participants should have the same basic physiological equipment. His supporters argue that fairness in sports means that all who qualify with a fast enough time should be allowed to compete. I am challenged with how to measure “fairness”. If fairness matters, how do we measure when technology gives an athlete with replacement parts an advantage based not on personal strength, skill or motivation, but on engineering and synthetic materials?

In conversation one person offered the notion, “just like a cramp, the Cheetah blades could fail.” I struggle to see the similarity unless you are competing one machine or technology against another and this is not robot wars.

If the rules of sports are about fairness in competition, when will a boxing match become one guy against one guy and his engineer and is this still fair?

I have always found people with disabilities who participate in life fully an inspiration. There is no doubt in my mind that Oscar Pistorius with his zeal and drive should be considered an inspiration and an example to others. It was inspiring to see him run, but I am also glad he did not end out in the medal competition. If he had, the question of fairness would have hovered over the outcome for years creating another asterisk in the record books.

Competing in sports is ancillary to the basics of life, nevertheless we love our competitions and they are not ever likely to go away. Clearly, competition and sports have been around longer than I can date. As a part-time youth soccer referee I am concerned with “fairness” as a major coefficient of a successful competition. We already monitor all the major sports for any substance that might be considered “performance enhancing”, when will a prosthetic enter this same category and how will we define this enhancement? Where we draw this line can’t be arbitrary.

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