‘points of contact’ where contamina

‘points of contact’ where contamination may be introduced (Turner 2003: 3).Furthermore, Kristeva (1982), drawing on Mary Douglas, suggests that par-ticular revulsion is reserved for the body’s waste products, those substances, such as faeces, urine, semen or blood, that leach from the body and open the inner self to the outer world. These fluids are abhorrent because they disturb bodily and social harmony by disrupting the carefully maintained boundaries that distinguish bodies and demarcate the inside from the out. The thought of re-ingesting these substances provokes universal disgust (Curtis 2001), an emotion that is also vigorously directed towards athletes who ‘unnaturally’ augment their bodies with hormones or other human or animal by-products.

Injecting blood, synthetic or natural testosterone or human growth hor-mone, once harvested from cadavers, evokes an intense response that is not evident even when athletes engage in other performance enhancing prac-tices (Magdalinski 2000a). For as David Fairchild (1989: 77) succinctly argues: ‘The deliberate reinsertion into the body, through ingestion or injection, of substances that have traversed the body’s boundaries is both an abrogation of the fundamental inner/outer distinction that determines our clean selves and a culturally revolting practice’, and he cites blood doping and anabolic steroids as instances where the return of bodily fluids, or their simulants, generates revulsion. Similarly, rEPO is rejected as ‘unnatural’ and undesirable, though it presents a particularly curious case,as endogenous EPO, produced by the body, and rEPO share an identical amino acid structure and are, therefore, effectively indistinguishable. Triggering the body to produce the former is not, however, as objection-able as introducing genetically constructed substances, for it is a ‘natural’ physiological response to changed conditions, whereas injections must arti-ficially transgress the body’s border, by penetrating the skin, in order totake effect. It is clear, then, that rather than protecting the health of an athlete, it is their purity, and hence authenticity, that is most valued. For this reason, doping sanctions are severest for those who deliberately permit substances to cross their borders, or even just utilise ‘unnatural’ methods of delivery that invade the body.

The ‘unnatural’ use of ‘natural’ substances was, in part, responsible for the removal of Australian cyclist Jobie Dajka from the 2004 Olympic team. Following allegations made by former teammate Mark French, Dajka and four other cyclists were accused of self-injecting vitamins without medical consent. Dajka denied the claims; however, DNA evidence secured from vials and syringes provided irrefutable evidence of his involvement, and, for bringing cycling into disrepute, he was expelled from the Olympic team (Kelly and Aiken 2004). Admissions of involvement from several of the other cyclists prompted a rapid response from both the Australian Institute of Sport and the Australian Olympic Committee, which each developed policies to ban athletes from self-injecting any substances with the excep-tion of insulin and adrenaline for medical conditions (Anderson 2004;

84 The nature of health

Editorial 2004). Whilst others, including team doctor Peter Barnes, found no significant difference between the injection or oral administration of legal substances, the Anderson Inquiry, established in June 2004 to investigate the doping culture in cycling, found that the Australian Sports Commission and the Australian Institute of Sport were acutely aware that the public perception of self-injection was that it is ‘a sinister and unacceptable prac-tice’ (Anderson 2004: 22). Dajka remarked, following his unsuccessful appeal for reinstatement, that he was ‘probably the first to be ejected from an Olympics for taking a vitamin’ (BBC 2004), and the fact that he is popularly remembered for a doping infringement is tinged with more than a little irony. What it does suggest is that the unnatural penetration of athletic bodies, even with legal substances and regardless of its health promoting potential, represents an unacceptable transgression of the body’s boundaries akin to the use of illicit substances.


Restoration, medication or enhancement?

Although exposing the body to the corruptive forces of external contaminants is reviled in sport, there are instances when athletes are sanctioned in their use of foreign agents, and even substances derived from the body’s own fluids may be celebrated as a welcome, and necessary, remedy. When athletes are ill, injured or are suffering from diseases, their physicians prescribe phar-maceuticals or recommend techniques that are intended to return their bodies to a healthy state. These ‘medications’ thus restore the body to ‘normal’ and work within the limits by which a body is socially, culturally and bio-logically imagined, and are mirrored against ‘performance enhancers’, which, as the appellation suggests, stretch the human body past a ‘normal’ stage to the level of the hyper-normal. Although performance enhancers are banned, on occasion these need to be therapeutically administered to ath-letes, revealing that they too have legitimate medicinal applications. Therefore, a substance that enters the body for therapeutic reasons is deemed appro-priate, whereas if the same product enters the body for less than pure motives, it is rejected as unlawful contamination. ‘Restoration’ and ‘enhance-ment’ are thus materially different within the context of sport, and it is only the intention behind using the substance that seems to distinguish them.

Medications and performance enhancers are treated disparately by sports officials committed to keeping sport ‘clean’, yet substances that are pro-hibited for athletes also have non-athletic therapeutic applications. Human growth hormone, for example, is used to treat patients with growth hor-mone deficiencies, chronic renal failure or HIV-related cachexia (Tritos and Mantzoros 1998); anabolic steroids can be administered to those suffering from, amongst other conditions, age-related sarcopenia (Evans 2004); whilst rEPO is prescribed for those diagnosed with anaemia (Fisher 2003). Yet, despite the fact that these drugs each have medical functions, it is their application to what are presumed to be otherwise ‘healthy’ bodies that is

The nature of health 85

considered problematic. Medications, it seems, are only acceptable to repair a body rather than improve upon it, yet the distinction between restoration and enhancement is not easily established as each concept fundamentally rests on the presumed existence of bodily norms (Parens 1998). Biomedical models accept, for the most part, that health is a kind of statistical standard, which provides medicine with the specific mission of restoring an incapacitated body to physiological equilibrium. Trying to improve the body beyond the accepted norm, however, is to ‘enhance’ the body and to utilise ‘interven-tions designed to improve human form or functioning beyond what is necessary to sustain or restore good health’ (Juengst 1998). Yet, as Julian Savulescu (2006: 325) points out, ‘the mutually exclusive distinction between treatments and enhancements is a false one’, because ‘treatments are enhancements’, and, as such, others have reframed the debate in terms of ‘health-related enhancements’ and ‘non-health-related enhancements’ (Walters and Palmer 1997: 110). In other words, all interventions into the body are designed to better it from its current position, however well or ill it might be. It is, essentially, the degree to which the body is improved, as well as the motivation for doing so, that is under interrogation.

Medical ethics debates are inconclusive about the appropriateness of treatments that try to extend the body beyond its usual limits, and within sport, strict regulations ensure that any intervention is confined to the restoration of health rather than the enhancement of capabilities. Nevertheless, there are many examples of treatments that are used by elite competitors to improve the bodies that nature allotted. For example, dozens of professional athletes, including, most notably, Tiger Woods, have used LASIK eye surgery to improve their eyesight to a ‘better than normal’ level of 20/10 or 20/15, yet for many, this is as indefensible as taking anabolic steroids. There has been, to date, no attempt to have such surgeries outlawed, perhaps as they are represented as ‘corrective’ proce-dures designed to restore faulty vision rather than enhance a healthy, well functioning organ. Permitting athletes to submit to such procedures sug-gests that it is not merely the artificial manipulation of the body that is of concern, but rather the underlying intention that is critical. If one intends to enhance performance, then punishment is warranted. Conversely, if an ath-lete intends to correct or restore health, then the motivation for consuming even the same substance is, with permission, acceptable. The Australian Olympic Committee (AOC) in its submission to the 1999 IOC World Conference on Doping in Lausanne, where the WADA was formed, con-firmed that intent is critical in determining instances of doping and pro-posed that ‘athletes should be permitted to take prohibited substances for genuine therapeutic reasons’. The AOC insisted that the ‘object should be to merely bring the athlete back to the level playing field, not to give him or her an advantage’ and further asserted that ‘no enhancement of the athlete’s normal level of performance’ should result (emphasis added), suggesting that heath and intent are critical determinants of ‘real’ cases of doping.

86 The nature of health

The ‘harmonisation’ of anti-doping policies in recent years has invested the WADA with the power to coordinate and monitor international anti-doping e

Hasil (Bahasa Indonesia) 1:

'titik kontak' yang mana kontaminasi mungkin memperkenalkan (Turner 2003:3). Selain itu, Kristeva (1982), menggambar pada Mary Douglas, menunjukkan bahwa par-khusus mereka dan jijik disediakan untuk produk-produk limbah tubuh, zat tersebut, seperti tinja, urin, semen atau darah, yang leach dari tubuh dan membuka diri batin untuk dunia luar. Cairan ini menjijikkan karena mereka mengganggu harmoni tubuh dan sosial oleh mengganggu hati-hati dijaga batas-batas yang membedakan tubuh dan membatasi dalam dari luar. Memikirkan kembali menelan zat ini menimbulkan rasa jijik universal (Curtis 2001), emosi yang juga keras diarahkan atlet yang 'wajar' menambah tubuh mereka dengan hormon atau oleh produk lain manusia atau hewan.Injecting blood, synthetic or natural testosterone or human growth hor-mone, once harvested from cadavers, evokes an intense response that is not evident even when athletes engage in other performance enhancing prac-tices (Magdalinski 2000a). For as David Fairchild (1989: 77) succinctly argues: ‘The deliberate reinsertion into the body, through ingestion or injection, of substances that have traversed the body’s boundaries is both an abrogation of the fundamental inner/outer distinction that determines our clean selves and a culturally revolting practice’, and he cites blood doping and anabolic steroids as instances where the return of bodily fluids, or their simulants, generates revulsion. Similarly, rEPO is rejected as ‘unnatural’ and undesirable, though it presents a particularly curious case,as endogenous EPO, produced by the body, and rEPO share an identical amino acid structure and are, therefore, effectively indistinguishable. Triggering the body to produce the former is not, however, as objection-able as introducing genetically constructed substances, for it is a ‘natural’ physiological response to changed conditions, whereas injections must arti-ficially transgress the body’s border, by penetrating the skin, in order totake effect. It is clear, then, that rather than protecting the health of an athlete, it is their purity, and hence authenticity, that is most valued. For this reason, doping sanctions are severest for those who deliberately permit substances to cross their borders, or even just utilise ‘unnatural’ methods of delivery that invade the body.The ‘unnatural’ use of ‘natural’ substances was, in part, responsible for the removal of Australian cyclist Jobie Dajka from the 2004 Olympic team. Following allegations made by former teammate Mark French, Dajka and four other cyclists were accused of self-injecting vitamins without medical consent. Dajka denied the claims; however, DNA evidence secured from vials and syringes provided irrefutable evidence of his involvement, and, for bringing cycling into disrepute, he was expelled from the Olympic team (Kelly and Aiken 2004). Admissions of involvement from several of the other cyclists prompted a rapid response from both the Australian Institute of Sport and the Australian Olympic Committee, which each developed policies to ban athletes from self-injecting any substances with the excep-tion of insulin and adrenaline for medical conditions (Anderson 2004; 84 The nature of healthEditorial 2004). Whilst others, including team doctor Peter Barnes, found no significant difference between the injection or oral administration of legal substances, the Anderson Inquiry, established in June 2004 to investigate the doping culture in cycling, found that the Australian Sports Commission and the Australian Institute of Sport were acutely aware that the public perception of self-injection was that it is ‘a sinister and unacceptable prac-tice’ (Anderson 2004: 22). Dajka remarked, following his unsuccessful appeal for reinstatement, that he was ‘probably the first to be ejected from an Olympics for taking a vitamin’ (BBC 2004), and the fact that he is popularly remembered for a doping infringement is tinged with more than a little irony. What it does suggest is that the unnatural penetration of athletic bodies, even with legal substances and regardless of its health promoting potential, represents an unacceptable transgression of the body’s boundaries akin to the use of illicit substances.

Restoration, medication or enhancement?

Although exposing the body to the corruptive forces of external contaminants is reviled in sport, there are instances when athletes are sanctioned in their use of foreign agents, and even substances derived from the body’s own fluids may be celebrated as a welcome, and necessary, remedy. When athletes are ill, injured or are suffering from diseases, their physicians prescribe phar-maceuticals or recommend techniques that are intended to return their bodies to a healthy state. These ‘medications’ thus restore the body to ‘normal’ and work within the limits by which a body is socially, culturally and bio-logically imagined, and are mirrored against ‘performance enhancers’, which, as the appellation suggests, stretch the human body past a ‘normal’ stage to the level of the hyper-normal. Although performance enhancers are banned, on occasion these need to be therapeutically administered to ath-letes, revealing that they too have legitimate medicinal applications. Therefore, a substance that enters the body for therapeutic reasons is deemed appro-priate, whereas if the same product enters the body for less than pure motives, it is rejected as unlawful contamination. ‘Restoration’ and ‘enhance-ment’ are thus materially different within the context of sport, and it is only the intention behind using the substance that seems to distinguish them.

Medications and performance enhancers are treated disparately by sports officials committed to keeping sport ‘clean’, yet substances that are pro-hibited for athletes also have non-athletic therapeutic applications. Human growth hormone, for example, is used to treat patients with growth hor-mone deficiencies, chronic renal failure or HIV-related cachexia (Tritos and Mantzoros 1998); anabolic steroids can be administered to those suffering from, amongst other conditions, age-related sarcopenia (Evans 2004); whilst rEPO is prescribed for those diagnosed with anaemia (Fisher 2003). Yet, despite the fact that these drugs each have medical functions, it is their application to what are presumed to be otherwise ‘healthy’ bodies that is

The nature of health 85

considered problematic. Medications, it seems, are only acceptable to repair a body rather than improve upon it, yet the distinction between restoration and enhancement is not easily established as each concept fundamentally rests on the presumed existence of bodily norms (Parens 1998). Biomedical models accept, for the most part, that health is a kind of statistical standard, which provides medicine with the specific mission of restoring an incapacitated body to physiological equilibrium. Trying to improve the body beyond the accepted norm, however, is to ‘enhance’ the body and to utilise ‘interven-tions designed to improve human form or functioning beyond what is necessary to sustain or restore good health’ (Juengst 1998). Yet, as Julian Savulescu (2006: 325) points out, ‘the mutually exclusive distinction between treatments and enhancements is a false one’, because ‘treatments are enhancements’, and, as such, others have reframed the debate in terms of ‘health-related enhancements’ and ‘non-health-related enhancements’ (Walters and Palmer 1997: 110). In other words, all interventions into the body are designed to better it from its current position, however well or ill it might be. It is, essentially, the degree to which the body is improved, as well as the motivation for doing so, that is under interrogation.

Medical ethics debates are inconclusive about the appropriateness of treatments that try to extend the body beyond its usual limits, and within sport, strict regulations ensure that any intervention is confined to the restoration of health rather than the enhancement of capabilities. Nevertheless, there are many examples of treatments that are used by elite competitors to improve the bodies that nature allotted. For example, dozens of professional athletes, including, most notably, Tiger Woods, have used LASIK eye surgery to improve their eyesight to a ‘better than normal’ level of 20/10 or 20/15, yet for many, this is as indefensible as taking anabolic steroids. There has been, to date, no attempt to have such surgeries outlawed, perhaps as they are represented as ‘corrective’ proce-dures designed to restore faulty vision rather than enhance a healthy, well functioning organ. Permitting athletes to submit to such procedures sug-gests that it is not merely the artificial manipulation of the body that is of concern, but rather the underlying intention that is critical. If one intends to enhance performance, then punishment is warranted. Conversely, if an ath-lete intends to correct or restore health, then the motivation for consuming even the same substance is, with permission, acceptable. The Australian Olympic Committee (AOC) in its submission to the 1999 IOC World Conference on Doping in Lausanne, where the WADA was formed, con-firmed that intent is critical in determining instances of doping and pro-posed that ‘athletes should be permitted to take prohibited substances for genuine therapeutic reasons’. The AOC insisted that the ‘object should be to merely bring the athlete back to the level playing field, not to give him or her an advantage’ and further asserted that ‘no enhancement of the athlete’s normal level of performance’ should result (emphasis added), suggesting that heath and intent are critical determinants of ‘real’ cases of doping.

86 The nature of health

The ‘harmonisation’ of anti-doping policies in recent years has invested the WADA with the power to coordinate and monitor international anti-doping e