Doping in sports is hardly a new phenomenon. Athletes participating in the Enhanced Games will be aware of the hazards — serious injury, or even paralysis. Yet bioethicists also worry we are paving the way for altering our core human biology.
Athletes are preparing to openly compete using performance-enhancing substances for the first time at the Enhanced Games in — where else? — Las Vegas!
While advocates claim the event marks a new direction for elite athletics, the conventional sports community has condemned it as a hazardous biological experiment.
What does 'enhanced' signify in contemporary sports?
Established by Australian entrepreneur Aron D'Souza, the competition permits athletes to perform without standard anti-doping regulations.
Substances must receive approval from the US Food and Drug Administration and be used under medical oversight. But beyond that, the choice rests with the athletes.
The concept of enhancement is not novel, according to Andy Miah, a bioethicist at the UK's University of Salford.
"In the ancient Olympics, this involved applying olive oil to the body to regulate body temperature," Miah told DW. "When modern sports emerged, it was typical for athletes to consume a shot of alcohol, which was incorrectly thought to have an enhancing effect."
Many of the substances linked to the most notorious form of enhancement — sports doping — are well understood scientifically.
Michael Joyner, a physiologist at the Mayo Clinic in the US, told DW that modern enhancement strategies generally fall into three broad categories:
Anabolic steroids that boost muscle mass and recovery
Blood doping and EPO that enhance oxygen delivery
Stimulants that lessen fatigue
Additionally, peptides may stimulate the body to generate higher levels of beneficial hormones like testosterone and EPO.
"There is solid evidence that steroids, blood doping/EPO, and amphetamines are effective," said Joyner. "Less so for peptides and other substances."
Enhancement science: Doping methods are not new
Although the Enhanced Games' showcase is novel, much of the underlying science is longstanding, said Arthur Caplan, head of the Medical Ethics division at NYU Grossman School of Medicine.
"Despite all the focus, many of the substances people are using have been available for a long time: Steroids, growth hormones, and even some drugs like Ritalin that aid concentration, or pain medications that let you keep competing or performing despite bodily pain signals," said Caplan.
These drugs carry a variety of risks.
So-called primary risks can result in significant health conditions. Growth hormones, for instance, may elevate cancer risk. Anabolic steroids, meanwhile, have long been tied to cardiovascular issues.
But scientists and physicians also caution about secondary risks from sports doping. Artificially enhancing one part of the body can put strain on others, said Caplan.
"If you use creatine [supplements] or other drugs that build muscle, that can be dangerous because you can overload the rest of your body with enormous muscles," said Caplan. "Your tendons don't get stronger, your joints don't get stronger, and you can suffer all sorts of terrible, even debilitating injuries."
How safe are the Enhanced Games for athletes?
The Enhanced Games could be highly unsafe, with harm ranging from spinal injuries to paralysis.
"Safety is one of the factors anyone weighing the acceptability of a technological intervention must consider," said Caplan. "I would say that in the Enhanced Games, athlete safety is sadly being pushed to the background."
Addressing the motivations of the organizers and their backers, which include tech billionaire Peter Thiel and Donald Trump Jr., Caplan referenced the concept of gladiatorial combat in ancient Rome.
"It's almost fantastical. It's like the wealthy investors in these games come from a culture — partly Silicon Valley, partly billionaire — where they say: I want to see what the most extraordinary performance could be, and I don't care about the athletes. I don't care about the individuals. I want to be thrilled."
While organizers might present the event as a celebration of bodily autonomy, Miah said this would be "a difficult argument to make."
"Many of the athletes appear to be choosing their participation from a place of vulnerability, either because they are at the end of their careers and facing financial difficulties, or because they have accepted they won't become champions in traditional sports and are trying this new format," said Miah.
Future of enhanced sports: Altered fundamental biology
Despite the risks, scientists and athletes aiming to push boundaries are increasingly turning to other, more experimental methods.
Several newer strategies target muscle mass, including inhibiting myostatin, a protein that controls muscle growth.
"Animals lacking myostatin are extremely muscular, so if you block that in humans, the theory is you'll get bigger muscles," said Joyner of the Mayo Clinic.
Researchers are also exploring gene-editing technologies like CRISPR, which could theoretically modify genes related to endurance, metabolism, or muscle development. Unlike conventional doping, altering genes would induce lasting biological changes in the body — which would also be inherited by future generations.
"What concerns me is not just what we'll see at [the Enhanced Games], but also what's truly in store as we improve at altering our fundamental biology," said Caplan.
"I think we're on the brink of interventions, molecular and genetic, that are very different from — I'll call them crude pharmacological interventions — that we have now."
As to whether enhancement could become safer in the future and more medically regulated than today's doping culture, Miah has his reservations.
"A new system could develop with a different approach to the ethics of enhancement, but we'd first need to allow experimentation on healthy subjects, and that's highly improbable," said Miah. "They don't want to conduct those studies. Ethically, they're hard to justify when there's no medical necessity."
Edited by: Zulfikar Abbany