When can enhancement-permissive sport count as harm reduction? A legitimacy test for the enhanced games

Abstract Background The Enhanced Games publicly permit performance-enhancing substances and thereby challenge prohibition-centred anti-doping regimes. The event’s proponents invoke transparency, medical supervision, science and athlete autonomy to argue that open and supervised enhancement may be less harmful than clandestine use. The key question is not merely whether enhancement can be allowed, but under what governance conditions a commercialised enhancement-permissive model could credibly count as harm reduction. Main body Permission, organiser-reported transparency measures and structured medical contact may support harm-reduction potential, but do not establish harm-reduction achievement. This article separates formal institutional documentation, organiser-reported claims, external research, unresolved event-specific information and normative inference. It develops a non-compensatory legitimacy test across six domains: comparative evidentiary adequacy; transparent risk and uncertainty disclosure; independent medical and ethical oversight; non-coercive and revisable consent; longitudinal monitoring and continuing care; and institutional accountability and commercial boundaries. The final domain distinguishes governable conflicts of interest from commercialised risk production, in which commercial actors help shape or normalise bodily risk while retaining insufficient responsibility. Applied to the public record reviewed through 15 August 2026, registry and filing materials describe the study design, oversight arrangements, a standard-form athlete agreement and five-year follow-up. The company reports that the interventional phase has concluded, but the registry posts no study results. Comparative outcomes, event-wide exposure rules, executed contract terms, continuing care and effective role separation remain unresolved. Short conclusion Enhancement-permissive sport may have harm-reduction potential, but achievement requires comparative evidence and independent, transparent, non-coercive and longitudinally accountable governance. Applied to the public record reviewed through 15 August 2026, the Enhanced Games are partially evaluable, but harm-reduction achievement has not been established.