Man and Superman
Why football has some serious questions to answer about the ethics of performance enhancement
It's 8 July 2064 and, 98 years after their last World Cup final appearance, England are 90 minutes away from becoming world champions. Star striker Wayne Barwick can't wait to face mighty Brazil, as he goes through his pre-game routine.
His upper body is taut and muscular. The blood-spinning regimen he underwent a few years ago had paid off handsomely. His club doctor called it "rationalising" his blood: changing the ratio of platelets to white and red blood cells. Platelets help the blood clot and the body heal and grow. All they had to do was take some of his blood, spin it round in a centrifuge to separate out the platelets from the red blood cells, concentrate the platelets to ten times their normal levels, throw in some calcium and thrombin and re-inject it all back into his bloodstream. Easy. The added calcium and thrombin mimic the conditions found in a wound, stimulating the platelets to produce Natural Growth Factor hormones (NGFs). And the NGFs, in turn, help his body heal and grow after each workout: because that's what you're doing when you're training or lifting weights, you're destroying muscle tissue and then healing yourself to come back even stronger.
The calcium and thrombin basically trick his platelets into thinking they need to produce the NGFs to make his muscles grow. And because he now has such a high concentration of platelets, he can grow even faster. A long time ago people thought it was a cheating. Now they know better. Now they know it's simply a way to unlock and maximise the greatest power the human body has: the power to heal itself.
The team doctor gives him his tray of pills and he dutifully washes them down. It's mostly cognitive enhancement drugs. They act on his brain, increasing motor function, reaction time, visual recognition... the kinds of things that, at this level, can mean the difference between success and failure. Football is a game played with the brain and, the sharper you are, the quicker it processes information, the quicker your neurons fire off their messages to your body. Ever wonder why the great players seem to have so much time on the ball? It's the brain. Remember Ruud Van Nistelrooy? They used to say he wasn't quick, but his mind was. Speed up the mind and the body will follow.
The problem is that when you speed up, you burn energy. And when you burn energy, you get fatigued, which is simply the brain's way of telling the body to slow down. No problem. He pops a pill containing chemicals that block a protein called IL-6. This is basically how your brain knows you're getting tired. When it detects enough IL-6, the brain sends out feelings of fatigue to the rest of the body. But with these IL-6 blockers he's taking, the problem goes away, because his brain can no longer recognize IL-6. Which means that, effectively, he never gets tired. Makes sense. Why should his brain dictate to his body what it can and can't do, when it's ready, willing and able?
In any case, he doesn't feel tired. He got a good night's sleep last night in the hyperbaric tent in the team hotel. That tent is not as impressive as the one which fully encases his £300million mock-Tudor mansion in Loughton, Essex, but it still does the trick. Living and sleeping a hyperbaric tent helps simulate the conditions at altitude which enable his body to produce more red blood cells, which, in turn, increases his stamina. A long time ago, people used to take erythropoietin (EPO) — a banned substance — to achieve the same effect, but, these days, hyperbaric tents are a must-have (and legal) accessory for any serious footballer. After all, not everybody has the luxury of living at altitude. So if you can't go shack up on a mountaintop, why not bring the mountaintop, or at least its effects, to you?
Barwick does some stretching. At 6' 11" and 20 stone, with 6 percent body fat, he is a big man, though compared to his fellow pros in the EurAsian SuperLeague he is of average size. Most, like him, have undergone gene therapy. When he was 12 and already drawing the attention of scouts, he underwent a treatment which knocked out the gene for myostatin (the protein which inhibits skeletal muscle growth) in his body. He soon developed very broad hips and shoulders, which is a good thing as they allow him to carry his enormous muscular mass. Without the myostatin, as far as getting bigger is concerned, the sky's the limit. Well, almost.
Of course, all that muscle weighing down on his joints could have been problem. But, thankfully, his handlers were smart enough to have him undergo a similar genetic treatment, originally designed to combat osteoarthritis, which effectively doubled the strength of his joints. Why should folks with brittle bones get all the benefit of the wonderful advantages medical technology has given us? It's not his fault he was born healthy. And, this way, he'll stay even healthier.
Still, football is a physical game and you can get hurt. He tore up his anterior cruciate ligament a few years ago. A long time ago, that would have been a problem. Not these days. He had the foresight to bank some stem cells from his buttocks a few years back. When his ACL did go, the surgeons simply used his cells to reconstruct it from scratch and he was back in no time. Somewhere in a Swiss clinic — most likely in a vault — there are plenty more of his own stem cells, ready to spring into action. Think of it as his spare part kit.
Not that he spends much time thinking about all this. It has all become routine, standard practice; no, best practice, because he gets the best medical attention out there. Today we know better. None of this is cheating, because it's freely available to all. Nobody gets an advantage which his opponent can't also gain. He's a football machine and there's something beautiful in that: science and nature coming together to produce the überfootballer. Michelangelo would have approved.
Time to head down the tunnel, the warm-up is almost over. Greatness beckons.
Football predates bioethics by some 100 years, which may explain why only recently has it begun to be viewed through a bioethical lens. It's been a long time coming, but it's probably a necessary step, and that's why Art Caplan is now in demand. Caplan is the director of the Center for Bioethics at the University of Pennsylvania in Philadelphia and, in the past few years, he has moonlighted for Fifa and the International Olympic Committee.
Why? Because advances in science and biotechnology — but also changes in law, philosophy and social mores — have necessitated some kind of bioethical input.
It's not just the "sport-is-now-big-business" argument (people have been making that point since at least the 1950s) or the fact that it pervades our social fabric to an unprecedented degree and has done, arguably, for the past four decades. It's also the fact that the experience of sport — particularly football — has changed, achieving a parallel interactivity played out via the web, twitter, and radio phone-ins but also simple pub conversations. In other words, sport matters like never before.
At the same time the game's globalisation, and potential advancements in technology and medicine, have raised questions which have never before been asked, much less answered. It's not just issues of doping and drugs — though these receive the most attention — it's the cacophony of what is "right" in sport: from why we play to how we play, with everything in between, from diving to squad rotation.
To determine what is "right" and "wrong" you need some sort of ethical framework, some kind of common lens through which to view the game. And that has been sorely lacking. For all the acres of newsprint devoted to sport, very little covers the most fundamental issues of what constitutes sport and how we should react to it. Which is why Caplan is as much about "ethics" as he is about "bio".
"I don't think there has been an agreed upon framework for thinking through these questions but I've started to think about it and here's the best I've come up with so far," he says. "Four basic points on which, I hope, we can agree. The first is that games are conventional. We sometimes believe that there is some kind of eternal truth or verity behind what sport is about. But, in fact, it's not true. It's all governed by rules that humans decide to make up. There is nothing inherently obvious about playing 18 holes of golf or running 100 meters. So if we want a sport with all the drugs and all the interventions we can do it."
Seems obvious, doesn't it?
But, in fact it isn't. We often overlook the fact that we control sport. We have absolute power over its rules and its role in society. Sport is a purely human pursuit, animals don't engage in it. (In fact, sport and ethics may be the only things that distinguish us from animals. And, perhaps not coincidentally, we often teach our ethics via sport.) And that means we can change or alter our sport according to our best judgment.
Would football be substantially different if it were played by 10 or 12 men or if the goals were bigger or smaller? Would the essence of the game change?
No, it would not. Yet there is a steadfast conservatism running through the veins of football which may explain why there has been virtually no evolution in the framework of the sport in the past 120 years. Sure, the game looks different today. But except for relatively minor factors like substitutions or the off-side rule, the framework is the same. What has changed is the people who play it, who, generally speaking, are bigger, stronger, faster and more skilful. They're also the beneficiaries of a century of study and know-how, which is why Barcelona v Inter today may look different to Preston v Sunderland 125 years ago.
But the differences are a function of the protagonists evolving. And the pace of that evolution has quickened and will accelerate still further, given advantages in medicine, technology and sports science. Denying this is denying the obvious. Alfredo Di Stéfano's Real Madrid would clobber the Austrian Wunderteam but, in turn, would probably get smoked by Wolves.
The issue then becomes at what stage and to what degree do we change the rules to suit the modern athlete? That's a debate for another time. But if we're ever going to have it we have to agree on the basic fact that the Laws of the Game were designed by men; there was no footballing equivalent of the Council of Nicaea with divine intervention somehow bestowing 'truth' on these rules.
The fact that we play the game by (largely) the same rules as 100 years ago may be appealing to many, but there is no inherent or universal beauty — beyond pointless traditionalism — in the fact that they haven't changed: it's just a lie we like to tell ourselves.
"The second point is that we want to prevent harm to the performers," Caplan says. "We're interested in performance, but not at the expense of personal injury. In the past, some fought to the death. No longer."
Performance-enhancing drugs have made this issue a cardinal point. We ban them because they can cause harm to our bodies either immediately or down the road. But there are several major flaws in this line of reasoning.
For a start, most sport, when carried out at a professional level, causes some degree of harm. Anybody who has been around retired footballers can tell you that they have a range of ailments, usually bad knees or a bad back. These are sometimes the result of accidental injury, but more often than not simply a function of the strains and stresses professional athletes put their bodies through, coupled with a lack of recovery time. Professional athletes, especially in team sport, often have lower life expectancies too, which may come as a surprise to those who equate fitness with health and longevity.
Gianluca Vialli likes to say, "Sport is good for you. Professional sport not so much." The human body wasn't built to train and be pushed to the levels to which they push it. And while the potential medical remedies are far greater than they once were, there is still so much we don't know. If a postman twists his ankle, he'll probably be on crutches for several weeks. If Rio Ferdinand does it, he'll be back in training after a few days and back on the pitch a week later.
The whole essence of training, at its most basic level, consists of destroying muscle cells and then letting the body heal them, so they come back stronger. This applies whether you're being yelled at by a personal trainer in spin class or you're in pre-season training with Real Madrid. That constant destruction and rebuilding is what makes you stronger, faster and more durable.
What's more, two of the most basic narrative archetypes in sport are based around celebrating those who overwork their bodies and those who ignore pain. It's not just the familiar tropes of "practice makes perfect", "10,000 hours of quality training" and the notion that "if you set your mind to it, you can achieve any goal." Hard work and diligence are prized to the point where the effects on the body are overlooked. In fact, our athletes are supposed to "grit their teeth", "suck it up" and "play through injury" because, when it comes to training "no pain, no gain."
At the 1996 Atlanta Olympics Kerri Strug, a 4'10", 89 pound teenage US gymnast, badly injured her ankle during a vault in the team competition, tearing her medial and lateral ligaments. The way the contest unfolded, she had to complete one more vault for the USA to win the gold medal. If she pulled out, the medal would go to Russia. She would later tell Sports Illustrated magazine that, as she lay there in pain, she turned to her coach, the legendary Bela Karolyi and asked, "Do we need this?"
"Kerri, we need you to go one more time," he replied. "One more time for the gold. You can do it, you better do it."
And so she did, collapsing almost immediately after the vault. The US won the gold medal, her tremendous heart was widely celebrated and she ended up on a box of breakfast cereal, becoming an international icon of courage.
Football has its Strug equivalents, from Franz Beckenbauer taping his broken arm to his chest to see out the 1970 World Cup semi-final to Bert Trautmann finishing the 1956 FA Cup final with five dislocated vertebrae, one of which was cracked in two.
We call these performances heroic because we admire the strength of character required to ignore the pain and press on, regardless of the consequences. It fits with that other archetype, competition as war, which we so readily embrace; the idea that there is nobility in playing through injury just as there is nobility in laying down your life to protect your country, your family or your ideals.
But that's where the first contradiction comes in. If it's right and noble to sacrifice your body in the pursuit of victory, does it really make a difference if that sacrifice is made through sheer bloody-mindedness or by ingesting the right chemicals? In terms of end result, rushing back from an injury before a bone is properly healed and doing long-term damage is not that different from, say, taking performance-enhancing stimulants that may cause an irregular heartbeat. Both can cause catastrophic long-term damage. The only difference is the method you use to inflict that damage. Why should one be more acceptable than the other?
The reality is that we expect our professional athletes to damage their bodies all the time in the pursuit of excellence (in fact, we even celebrate it). It's just that we make a distinction in how they do it.
But there's another wrinkle to this point. Even if we could all agree that athletes should not harm themselves in the pursuit of their sport, the argument would not be of much use when it comes to performance-enhancing drugs. Why? Because some performance-enhancing drugs simply aren't harmful. And, in the very near future, as Caplan explains, there might be many more drugs which enhance performance without long-term negative effects.
The day when footballers will be able to significantly enhance performance by taking drugs, possibly undetectable drugs with no harmful side-effects, is near. What do we do then?
Even now, there are plenty of drugs and procedures that diminish recovery time after injuries which remain in a grey area. The practice of "blood spinning" to heal injuries is one example. Officially, it's banned by the doping control bodies. Yet there is plenty of medical evidence to suggest that, if done properly, it's perfectly safe. What's more, it's nearly impossible to detect.
"Assuming [these drugs and procedures] are safe, it becomes an open question of how you want to use them," Caplan says.
In other words, from an ethical perspective, we're going to need another argument to ban performance-enhancing drugs. Which brings us to Caplan's next cardinal rule on which we can agree.
"Third, let's keep competition fair," he says. "I think that does seem to matter to us. We want a notion that sport is competitive and some notion of fairness. That's why we have age divisions and weight divisions for example."
Here, the argument against performance-enhancing drugs is fairly clear cut. We ban them because they give one party an unfair advantage over another. Case closed.
Or is it? The most basic consideration is that you can eliminate the "unfair advantage" in one fell swoop by simply making the drugs available to everyone. But, even then, we're kidding ourselves if we think that competition is necessarily "fair" because of the number of factors that go into it.
Train at altitude and you'll have an advantage over those located at sea level. Eat nutritious food and you'll have an advantage over those who can't afford to do so. Train in a state-of-the-art facility and you'll have an advantage over those who have to practise in the park. Wear hi-tech boots and kit and you'll have an advantage over those who don't. There are, simply put, massive disparities even within the same nation which rather dispel the notion of a "level playing field". We want our sports to pit 'like' against 'like'. But when Brazil, with its 190 million strong population plays football against the Faroes and their population of 50,000, it's not "like v like". It's juggernaut v minnow.
You can take the fairness argument even further if you take into account genetic differences, which, though we don't always like to recognise it, are the single biggest discriminant in athletic success according to Caplan. "We like to think that success in sport is connected to our will, the virtues of training and persistence, but what if it's just about biology at the end of the day?" he says.
Most coaches and players would vehemently disagree, arguing that commitment, good coaching, strength of character and all those intangibles are what determine success.
"I think it's a great myth," says Caplan. "It's something we tell ourselves to justify the rewards we bestow on our top athletes. But, in fact, it's probably more about muscle fibre and coordination than anything else."
You can take two eight year olds, lock them in the finest youth academy in the world for 10 years (say, Barcelona's La Masía) and, when they turn 18, the one who is a naturally gifted athlete will succeed, while the one who is just average will probably spend his career playing pub football. Work ethic, coaching know-how, strength of character and personality... all these things don't really come into it. The guy who is in the top one percent of the population in terms of athletic gifts (or, put another way, the guy who is a genetic freak of nature) will succeed, the other will fail.
As Caplan says, we don't like to hear this because, somehow, it doesn't seem "fair". But anybody who has played competitive sport even at school level will tell you that hard work and commitment matter little when set against athleticism and coordination.
Which brings us to another ethical conundrum. Should we be rewarding effort or performance? From the time we are old enough to understand what adults tell us, we are taught that if we work hard and follow the rules, we'll be rewarded. In sport, at least, that's a colossal lie (and possibly in the real world too). If you're a genetic freak of an athlete you'll succeed, if you're not, you won't. But nobody wants to hear that, because it's not "on-message" in pedagogical terms.
The AC Milan striker Antonio Cassano, arguably the greatest natural talent Italian football has produced since the days of Roberto Baggio and Roberto Mancini, boasted in his autobiography that he never gave more than "50 percent". "What is truly important is being happy now," he wrote. "I know I haven't given 100 percent physically or mentally to this game. At best, I gave 50 percent. Maybe a little more in the good years... But so what? Thanks to my talent, I live like a king, I play football and I have a great time."
Infuriating? Yes. Role model? Definitely not. But he's honest. And he's probably right. His natural technical and athletic talents, though never fully exploited, brought him untold riches. That's all he had to do. So, in fact, we'd like our sport to be "fair" but we should accept that it often isn't. Certainly not enough to draw conclusions about the moral fibre and character of those who excel at it. "If that's the case, if our best athletes are natural born genetic freaks, isn't celebrating them a little bit like celebrating the winner of a beauty contest?" asks Caplan. "I mean, you can celebrate beauty, but it's not something which is earned. It's something you're largely born with, you might improve on it a little bit, but that's it."
Want to make it truly ethical and fair? The one solution may be genetically to map everyone and pit like against like. Let great athletes take on great athletes while those with moderate athletic gifts challenge each other. What if we had a football championship for people who were between the 45th and 55th percentile in athletic terms, some combination of size, strength, agility, coordination, etc.?
If you did that, the winners would, most likely, be the ones who work hardest, who show the greatest strength of character, who display all those heroic qualities that we erroneously bestow on our professionals today, not realising that most of them, like Cassano, were born that way.
We do it in weight-lifting, boxing, judo, any sport that has weight classes... why not football? Audley Harrison may have become a figure of fun, but the fact of the matter is that you could put him in the ring in any weight class below light heavyweight and he would destroy all comers. You think Manny Pacquiao is tough? Give him twelve rounds with Audley, mano a mano and we'll see how tough he is.
In fact there's a certain irony that boxing is, in many ways, more ethical than most other sports, precisely because it begins with an attempt to distinguish between athletes based on physical gifts (though, of course, it does so by weight alone, which is rather imperfect).
Caplan's fourth pillar for ethical sport does, at least, provide some good news for football. "It's the issue of access," he says. "With sport, there has to be a sense that people be allowed to play it. We have an ethic of participation, if certain people are physiologically shut out of a sport, this can't apply."
The idea is that anyone can be a footballer or a golfer or a tennis player, at least in theory. Again, this may seem obvious, but it wasn't always the case. Some populations have no real concept of organised sport. In others — say polo or Formula One racing — financial concerns pose serious barriers to participation. But the basic ethos is that a sport should be available to all. And, in this, football is about as good as it gets.
That's something to be celebrated. If you can stand and move your legs, however slowly, you can play football. And all you need is a ball.
And there's more good news for those who fear the "doping monster". You can increase strength and stamina, but, compared to most sports, these components are less important. "I think football is relatively safe, for now," Caplan says. "It's about more than just stamina or strength; it's about technique, which is a combination of motor skills and coordination, which are very finely tuned."
These multi-faceted skills are difficult to enhance in concert. Antonio Pintus, Chelsea's former fitness trainer, once highlighted the problem of performance-enhancing drugs in football. "You can build a bigger cannon," he said, "but then how are you going to calibrate it and make sure it's accurate?"
If Leo Messi could instantly pop a pill to give him Cristiano Ronaldo's body, he'd instantly be a better athlete: bigger and stronger (more handsome too). But he would struggle to come to grips with his new body, it would be extremely difficult to replicate the muscle memory he has now and re-calibrate it to a bigger frame. Which rather means that unless athletic doping, particularly when it comes to physiological benefits, is applied gradually, ideally from the moment a child starts developing his or her football skills, you really won't get much benefit out of it. We are beholden to our historical legacy in sport and, in many ways, it has enslaved us. We accept certain dogmas as unchangeable because of the comforts they provide: hard work will be rewarded, drugs are bad, we're all created equal, etc. Lose these basic principles and society might well unravel. We might all be lazy and live for the moment. We might take chemical short cuts to reach our goals. We might point out that our neighbour is lesser (or greater) than we are. All things which are undesirable in real life.
Our sporting tradition has held us in good stead for more than a century. But now, perhaps, it's time for a rethink. Time to figure out what truly matters to us and what we can realistically do about it, even if means shattering some myths and shaking us out of our comfort zone. Sport isn't axiomatic: just because something worked for a long time, doesn't mean it will work forever.