the offending tissue removed rather

the offending tissue removed rather than repaired. The former would require only a brief disruption to the season, though, given the joint is hyper-mobile, this treatment could lead to arthritis later in life, whilst the latter would require six or more months, essentially an entire season, of recovery and rehabilitation after which the knee would likely be fully restored to its prior strength. This is not to suggest, of course, that sports physicians spe-cifically or deliberately operate unethically, but to acknowledge that the athlete’s best ‘health’ interests may not necessarily be the primary or sole concern of their doctor (Dunn et al. 2007; Mathias 2004).

Sports organisations regularly amend or update rules or permit the use of new technologies to ensure the safety of participants (Miah 2006). Helmets, padding, boxes, shinguards, mouthguards, eye protection, knee pads, wrist guards and chest protectors are among a seemingly endless list of devices that can be strapped to the body to shield almost every inch from the dangers of rigorous physical activity. Rule changes, such as the 2006 deci-sion in Little League baseball to implement an age-based pitch, rather than innings, count or the implementation of a ‘no head checking’ in ice hockey, are each designed to protect competitors from serious injury. Nevertheless, invoking changes to promote health and reduce injury is often slow and inconsistently applied across sports, such as in the case of netball.

Developed in the early twentieth century as a version of basketball that was appropriately modified for young ladies, netball today suffers from a high rate of knee and ankle injuries at all levels of the game. These are, in part, a consequence of the ‘no stepping’ rule, which differentiates netball from basketball and which was initially designed to encourage a slower, more modest playing style. The pace of the game would now be unrecognisable to those early adherents, and to stop abruptly in the midst of a sprint down the court places extraordinary stresses on the players’ lower limbs, causing injuries from twists and sprains through to ruptured ligaments and patella dislocation (McGrath and Ozanne-Smith 1998).

Netball is, of course, not a lone exemplar, and at the elite level there are numerous examples of how sport can be ‘unhealthy’, particularly for junior athletes. Young female gymnasts can develop symptoms of osteoporosis as a result of amenorrhoea; junior baseball pitchers risk the integrity of their growth plates through overtraining; bowlers in cricket can suffer long-term spinal damage as a result of a poor or ‘mixed’ action; football players are prone to injure almost every part of their bodies; whilst discus throwers may require knee reconstructions in their teenage years (Caine et al. 2006; Adirim and Cheng 2003; Sabatini 2001). To many, then, it seems contra-dictory to prohibit performance enhancing substances simply to safeguard athletes’ health, when other risky or dangerous practices are not similarly outlawed, and in fact may even be encouraged (Kayser et al. 2005; Savulescu et al. 2004; Schneider and Butcher 2000; Tamburrini 2000).

To rationalise the prohibition of various substances and methods for reasons of health appears to be rather more complex in light of the various

The nature of health 81

risks to which athletes are routinely exposed in high-level performance sport, and the issue is further confounded by several key assumptions about the impact of illicit performance enhancement on health, which underpin anti-doping strategies. There is popular consensus that substances that appear on the prohibited list must be harmful simply because they are included, whilst those that do not appear are consequently presumed to be harmless. Yet this argument is fallacious, particularly when many proscribed drugs, such as Ventolin, are freely available to members of the public, and many permitted drugs, left unregulated, may cause significant harm. By denying athletes these substances, sporting officials may harm them further, and might even imply that the health of an athlete is more important than that of a non-athlete. Furthermore, many banned substances have a therapeutic application and can be safely ingested without the horrendous, and typically overstated, consequences predicted by those who control sport (Street et al. 1996). Indeed, this appears to be accepted by the WADA, for athletes can apply for a Therapeutic Use Exemption (TUE) to utilise substances or methods on the prohibited list in the event of a documented medical condition (WADA 2007).

This is not to suggest, of course, that all drugs are harmless, though without solid empirical evidence, the effects of extreme drug abuse, where athletes ingest extraordinarily high doses, have only been anecdotally recorded (Dawson 2001; Black and Pape 1997). Given that many of these substances can be administered therapeutically, there is little evidence to suggest that the use of ergogenic aids under close medical supervision is equally risky (Kayser et al. 2005). Rather than cleansing sport, prohibition has driven the doping culture underground, and the inclusion of many performance enhancing drugs in controlled substances legislation has prompted athletes to resort to equine and bovine drugs with little or no professional advice as to their dosage or administration. Moreover, in a bid to avoid detection, athletes may ingest more harmful substances than necessary, such that their health is further jeopardised. To assume that those substances and methods that do not appear on the banned list are necessarily risk-free is also problematic, given the dearth of research into the long-term effects of permitted supplementation such as creatine (Tokish et al. 2004).

Other inconsistencies suggest that health per se may not be the overarching concern when determining the legitimacy of performance technologies. Additional, non-medical considerations may contribute to the assessment of potential enhancements, which could explain the differential treatment of substances and methods that provoke the same physiological outcomes in the body. For instance, blood doping, where an athlete’s blood is drawn and later returned to the body, and the injection of rEPO are each banned as ‘unnatural’ or ‘artificial’ enhancements. Yet, altitude training and hypoxic chambers, which simulate the density of oxygen at altitude, are currently accepted as legitimate preparatory measures, though the latter has been at

Hasil (Bahasa Indonesia) 1:

Jaringan offending dihapus daripada diperbaiki. Mantan akan memerlukan hanya singkat gangguan musim, meskipun, mengingat sendi hiper-mobile, perawatan ini dapat menyebabkan arthritis kemudian dalam hidup, sementara yang kedua akan memerlukan enam atau lebih bulan, pada dasarnya seluruh musim, pemulihan dan rehabilitasi setelah lutut akan mungkin sepenuhnya dikembalikan ke kekuatan sebelumnya. Ini adalah tidak menyarankan, tentu saja, bahwa olahraga dokter spe-cifically atau sengaja beroperasi unethically, tetapi mengakui bahwa atlet 'Kesehatan' kepentingan mungkin tidak selalu menjadi perhatian utama atau satu-satunya dokter mereka (Dunn et al. 2007; Mathias 2004).Organisasi olahraga secara teratur mengubah atau memperbarui aturan atau mengizinkan penggunaan teknologi baru untuk memastikan keselamatan peserta (Miah 2006). Helm, padding, kotak, shinguards, pelindung, mata perlindungan, bantalan lutut, pergelangan tangan penjaga dan pelindung dada di antara daftar tampaknya tak berujung perangkat yang dapat diikat ke tubuh untuk melindungi hampir setiap inci dari bahaya aktivitas fisik yang ketat. Setiap perubahan aturan, seperti 2006 permohonan-sion dalam bisbol liga kecil untuk menerapkan jumlah Lapangan berdasarkan umur, daripada inning, atau pelaksanaan 'tidak ada kepala memeriksa' di hoki es, dirancang untuk melindungi pesaing dari cedera serius. Namun demikian, menerapkan perubahan untuk meningkatkan kesehatan dan mengurangi cedera sering lambat dan tidak konsisten diterapkan di seluruh olahraga, seperti dalam kasus jaring.Developed in the early twentieth century as a version of basketball that was appropriately modified for young ladies, netball today suffers from a high rate of knee and ankle injuries at all levels of the game. These are, in part, a consequence of the ‘no stepping’ rule, which differentiates netball from basketball and which was initially designed to encourage a slower, more modest playing style. The pace of the game would now be unrecognisable to those early adherents, and to stop abruptly in the midst of a sprint down the court places extraordinary stresses on the players’ lower limbs, causing injuries from twists and sprains through to ruptured ligaments and patella dislocation (McGrath and Ozanne-Smith 1998).Netball is, of course, not a lone exemplar, and at the elite level there are numerous examples of how sport can be ‘unhealthy’, particularly for junior athletes. Young female gymnasts can develop symptoms of osteoporosis as a result of amenorrhoea; junior baseball pitchers risk the integrity of their growth plates through overtraining; bowlers in cricket can suffer long-term spinal damage as a result of a poor or ‘mixed’ action; football players are prone to injure almost every part of their bodies; whilst discus throwers may require knee reconstructions in their teenage years (Caine et al. 2006; Adirim and Cheng 2003; Sabatini 2001). To many, then, it seems contra-dictory to prohibit performance enhancing substances simply to safeguard athletes’ health, when other risky or dangerous practices are not similarly outlawed, and in fact may even be encouraged (Kayser et al. 2005; Savulescu et al. 2004; Schneider and Butcher 2000; Tamburrini 2000).To rationalise the prohibition of various substances and methods for reasons of health appears to be rather more complex in light of the various The nature of health 81risks to which athletes are routinely exposed in high-level performance sport, and the issue is further confounded by several key assumptions about the impact of illicit performance enhancement on health, which underpin anti-doping strategies. There is popular consensus that substances that appear on the prohibited list must be harmful simply because they are included, whilst those that do not appear are consequently presumed to be harmless. Yet this argument is fallacious, particularly when many proscribed drugs, such as Ventolin, are freely available to members of the public, and many permitted drugs, left unregulated, may cause significant harm. By denying athletes these substances, sporting officials may harm them further, and might even imply that the health of an athlete is more important than that of a non-athlete. Furthermore, many banned substances have a therapeutic application and can be safely ingested without the horrendous, and typically overstated, consequences predicted by those who control sport (Street et al. 1996). Indeed, this appears to be accepted by the WADA, for athletes can apply for a Therapeutic Use Exemption (TUE) to utilise substances or methods on the prohibited list in the event of a documented medical condition (WADA 2007).This is not to suggest, of course, that all drugs are harmless, though without solid empirical evidence, the effects of extreme drug abuse, where athletes ingest extraordinarily high doses, have only been anecdotally recorded (Dawson 2001; Black and Pape 1997). Given that many of these substances can be administered therapeutically, there is little evidence to suggest that the use of ergogenic aids under close medical supervision is equally risky (Kayser et al. 2005). Rather than cleansing sport, prohibition has driven the doping culture underground, and the inclusion of many performance enhancing drugs in controlled substances legislation has prompted athletes to resort to equine and bovine drugs with little or no professional advice as to their dosage or administration. Moreover, in a bid to avoid detection, athletes may ingest more harmful substances than necessary, such that their health is further jeopardised. To assume that those substances and methods that do not appear on the banned list are necessarily risk-free is also problematic, given the dearth of research into the long-term effects of permitted supplementation such as creatine (Tokish et al. 2004).Other inconsistencies suggest that health per se may not be the overarching concern when determining the legitimacy of performance technologies. Additional, non-medical considerations may contribute to the assessment of potential enhancements, which could explain the differential treatment of substances and methods that provoke the same physiological outcomes in the body. For instance, blood doping, where an athlete’s blood is drawn and later returned to the body, and the injection of rEPO are each banned as ‘unnatural’ or ‘artificial’ enhancements. Yet, altitude training and hypoxic chambers, which simulate the density of oxygen at altitude, are currently accepted as legitimate preparatory measures, though the latter has been at