Harm reduction in the Enhanced Games: Can performance enhancing drugs be ‘safe’?

The Enhanced Games proposes a model of competitive sport in which the use of performance enhancing drugs is not only permitted but actively supported by the organisers. Whilst they seemingly recognise the evidence around potential harms to the end-user, they contend that the use of performance enhancing drugs can be safely managed. They argue in favour of a medically supervised model in which harms are minimised by careful monitoring of biomarkers (e.g., blood counts) and physiological assessments (e.g. gene testing, electrocardiograms). However, we argue that the extant evidence base is insufficient to properly inform a workable harm reduction model in this context. Specifically, the available evidence is largely drawn from observational studies and as such lacks crucial detail around relationships between specific substances, supraphysiological doses and subsequent adverse health effects. Furthermore, some evidence shows potentially long-term effects for which the epidemiology is poorly understood. We examine gaps in the evidence via three exemplar areas of adverse health effects – cardiovascular, reproductive, and cognitive function – in order to demonstrate the significant limitations of a harm reduction model in the context of medically supervised doping.