We will never know!

Thanks Ben. I didn't think the choice of "excellence" was implicit on your part, but it is implicit in common usage and this appeals to advertisers. I think this is where the link is with "popularity". Sponsorship dollars look for a return based on audience size, sophistication and wealth. Cycling is international like motor racing and football (soccer) and generally draws a fairly cosmopolitan and wealthy demographic as followers and participants. The grand tours, especially, appeal to virtual travelers and actual travelers with an interest in the country and/or the sport. If there is a stream where any and all PESMs are acceptable, big Pharma and later probably bioengineering and genetic modification industries will be interested and attracted to the advertising and the broadcast and digital rights. The big money and vested interests will crowd out the competition (naturals).

Jason,
Thanks for the reply. I work in health care which probably skews my view in this matter. What seems to be the issue here is that this is a clear advocation of medical intervention without a trial to establish its safety, without ethical guidelines and without clear medical parameters. In short, it appears that you wish to conduct a drug trial without the normal ethical requirements and the athletes are your experimental subjects.
A lassaiz faire attitiude towards pharmaceutical enhancement does not benefit the athlete, it benefits the sponsor, team management and the viewer.
Whilst you might wave this way with 'they'll get head injries and joint problems anyway so unknown complications of using PEDs is fine' I'm not convinced that the outcome for the athlete is being properly regarded here.
You wrote:
' However, there has been enough off-label use in the athletic community I think we can have some confidence that the athletes know how to use these substances. '
Unfortunately athletes are not best placed to evaluate the efficacy or the deleterious effects of PEDs, that is what medical science is for.
If you are going to advocate a mix of blood doping, EPO, HGH, Testosterone, Corticosteroids I'd be interested to know the clinical research that you are using to support wholesale doping of a young athletic population.

Benjamin,
If you are advocating wholesale use of PEDs in a young population are you convinced that the befits outweigh the risk to the individiuals in question?
These are motivated but immature individuals who will trade off future health for short term athletic benefit.
Has a long term trial been established for the efficacy of these combinations of drugs?

Not everyone who disagrees with you is in the grip of a religious fervour. I'd actually just like to see clinical evidence for and ethical guidelines about this advocacy of wholesale pharmaceutical enhancement.
i'd also like to see this explored after the biological passport and other measures sure to be instituted after the 'lance-bomb' are trialled and found to be non-effective.

Hi Mal:

To be clear, I am not advocating any form of PESM and/or harm minimalisation. But that is my personal view. I do, however, recognise that harm minimalisation may have a role to play.

In terms of the comment "...trade off future health for short term ... benefit...."

Since you are in the health care, a few parallel scenario to ponder over:

1. Cosmetic surgery and procedures (e.g. Botox)
If a drug/ method has been approved at present day (albeit with risks and side effects known), who are we to judge on an individual's choice for the present day over an unknown future?

2. Experimental drugs and treatment for Cancer
If a drug/ method has not been approved for cancer but available for off-label trial on an informed use basis, who are we to judge on an individual's choice for the present day over an unknown future?

3. Woman's right
If abortion is legal in a state or jurisdiction, who are we to judge on an her choice for the present day over an unknown future?

Other scenarios:
A stockbroker places all his investment in a stock hoping for a short-term gain but risking losing it all in the future. Who are we to judge on an individual's choice for the present day over an unknown future?

Asylum seekers takes a risk on a boat to get to safe haven and out of a war-torn area. Who are we to judge on an individual's choice for the present day over an unknown future?

We must also be conscious of not imposing our value systems and cultural right and wrong on others.

I think the essence to your questions lies in the issue of "informed consent". But that, as you know in health care, is a whole debate in itself.

Interesting,
Your concern seems to be that drugs are 'locked-up' by medicine, medicine is the gate-keeper and that this is paternalism. My CONCERN (sorry for the caps, italics not available) is that these drugs should not be freely available until their safety is established.
My MEDICO-LEGAL/ETHICAL view is that these are controlled substances and are rightly controlled until their safety in the cohort that you have selected for use is established. This is the subject of clinical trial and under the purview of medical research. Luckily (in my view) it uis unlikely that any widespread use of PEDs (especial;ly in combination and to minors) will be instituted until safety has been established. this is totally fit and proper when these powerful substances are bsing considered.
My VIEW on pharmaceutical enhancement is probably no surprise to you, I see it as counter to the naturalness of the atlete and the athletic competition - counter to natural genetic endowment, willpower and response to hard and focused training. Perhaps this view is subject to bias (I'm sure it is) but I have thought about the ethics of the situation and that is my view.

Whilst you might see this as paternalistic or religious fervour or skewed worldview I prefer to see it as acting in the best interesests of the athlete... we're not taslking about acup[uncture or sports massage here, these are powerful compounds and in the case of red cell transfusion - life threatening.

Hi Jason,
Advocacy for the health of the cohort in question is my main driver.

I remain unconvinced that there is sufficient evidence to establish long term safey for widespread drug use, although in saying that I have not looked deeply at the evidence. That notwithstanding, it is the responsibility of those advocating for PED use to establish this safety, not the other way around. I use the word responsibility quite seriously. One cannot be flippant about advocating the widespread use of 5+ drugs to an immature cohort.

My second concern (and I admit this is where I impinge upon paternalism) is that the cohort in question is risk accepting. Ask any elite athlete if they would trade performance now for morbidity later. Whilst you may see that as acceptable consent, i think we need to temper this debate in respect to drug use.

ben Koh makes a very good point that using these drugs may reveal benefits for wider populations, especially with degenerative disease conditions. This is what is called a drug trial - there are specific ethical abd safety parameters for this. If this is an outcome for PEDs that you seek then call it what it is - an experiment.

In regards to your last point:
'Would you be opposed to doping on the basis that it has demonstrated medical safety for the purpose enhancing performance?'

Yes. i made that point in my last post. This is my personal view: i believe that sporting contest is a contest between the genetic endowment, determination and trianing rigour between athletes. Sports science and technology muddies this, of course, but nevertheless driving humans beyond their physiological parameters is, I believe, counter to my idea of what sport is. Believe me this is an argument from analogy (not slippery slope) but would you object to the augmentation of an athlete's eyes with telescopic lenses (should such a modification be possible) or the replacement of an athletes bony skeleton with carbon fibre struts? How about the removal of weighty organs not conducive to climbing in a mountain stage - you don't really need that spleen you know... Like I said this is not resorting to the slippery slope argument I do not believe that anyone would advocate for these modifications, but this how I view enhancement with PEDs: not natural.

Hi ben,i believe only your first point above is germane to the issue as it explores the non-therapeutic use of medications. Botox is interesting as, although it is a powerful neurotoxin, it's safety has been established in the highly dilute form required for subcutaneous injection. The safety of multimodal PED therapy has not been established to the same degree that Botox has. I believe the argument ends there in the analogy with botox.

The second question is with the ethics of denying or making available PEDs should they be demonstrated as being safe in the manner in which you would have them prescribed. You argument is: botox is safe and has been made available why shouldn't HGH, or EPO, or Amphetamines, or Testosterone or Hydrocortisone. fair point, but existence doesn't entail a right to access. We restrict access to a range of drugs so I'd prefer to choose that example than your example of botox. My reticence, again, is based upon safety and also ethical concern. I guess I'll see you with morphine and raise you with roaccutane. It exists, they is are safe when prescribed...why limit their accessibility?

Hi Mal,

Thank you for your further contribution to this discussion. I am really enjoying the exchange of merits and detractions in a multi-perspective discourse.

In the interest of keeping this reply succinct (because really it will take a lot more pages than a blog posting to analyze the whole issue), I will – based on the points you have raised– lay out a few pertinent issues in point form. Please feel free to contact me offline for further elaboration and/or literature references.

1. Rules and the law in general are about the rules and the law. While largely influenced (hopefully) by some underlying logic and/or consensus/social norm, rules and the law are not about right or wrong per se. Doping rules thus depends on the anti-doping rules and law (at any one point in time), and not on moral right or wrong.

2. All the examples for consideration in my previous post were pertinent as they all point to the issue of informed choice in a free society within the rules and the law at any point in time. It also highlights the need to be cognizant of not imposing one’s value judgment and social norm on another if both are within the rules and law.

3. While morphine and roacutane are controlled substances, paracetamol and several non-steroidal anti-inflammatory (NSAID) analgesics (e.g. ibuprofen) are over-the-counter (OTC) drugs. Paracetamol is probably one of the most commonly seen overdose drug in clinical practice and can result in liver failure. NSAID are one of the most common causes of peptic ulcers and also contribute towards renal failure. So why is there a free right of access to these and other OTC drugs? Other examples: omeprazole (an anti-ulcer drug) is a prescription drug at the recommended dose of 40mg. However, it is available OTC in many countries in the 10mg and 20mg preparation. What’s stopping someone from taking 40mg using the OTC preparation? Hydrocortisone creams in the low dose preparation is also available OTC in many countries. The list goes on. The issue of right of access to drugs is not consistently applied with a blanket ruling as it is necessarily based on a balance of various pros and cons.

4. When discussing issues of doping, it is important to note that we are talking about BANNED (sorry no italics) performance enhancing substances AND METHODS (PESM). So far the debate seemed to be only on illicit/prescription drugs. IV Fluids (and possession of any equipment for IV Fluids) – specifically more than 50ml over a 6 hour period – is banned. Any amount of autologous blood reintroduction is banned. Caffeine (common in everyday beverages) was also banned previously.

5. Evidence in Medicine takes a long period of time to gather and is fraught with difficulties and costs. The off-label use of many medications in the pediatric cohort is based on reasonable extrapolation of research trials and findings in the adult population. For many reasons, there may never be enough empirical evidence to support the use of many medications in many different cohorts, especially children and pregnant women. But that is the nature of Medicine and therapeutics. Do we deny a child a medication which has been shown through experience and anecdotal support for effectiveness similar to the adult population because there is no randomized controlled trials showing p<.05? Once again, an informed choice and discussion is prudent in the decision and is based on reasonable risk.

6. As previously mentioned, but deserving reiteration, elite level sport is not about health and fitness. It is about competition.

7. It is inaccurate to say that there are no experiments/ trials on the ergogenic effects of various “legal” PESM. Evidence in the statistical sense is based on a threshold of the empirical data. But a lack of evidence of positive effect is not the same as evidence of lack of positive effect. There is just not enough trials and research to provide a p<.05; CI 95%. If we are to ban all PESM (specifically the drugs) on the basis of statistical evidence in the non-disease “normal” population, then we should also ban all vitamins, minerals, protein powders, electrolyte drinks and the such.

Again, I am not advocating for any form of PESM use in sports (that is why we advocated a two-stream approach to include the "natural" camp), but like the similar debate on smoking and alcohol in society at large, I recognize that education, research and harm minimalisation may be necessary and pragmatic measures. The problem is there. No use just saying no, no, no. How do we deal with it.

Respectfully,
Ben

Not sure why posts are not going through.
Apologies if this is a repeated post.

Related articles:
Bring truth into play by saying yes to drugs in sport
http://www.theage.com.au/opinion/society-and-culture/bring-truth-into-play-by-saying-yes-to-drugs-in-sport-20120628-215cn.html

Why punishing cyclists over drugs is dopey
http://www.smh.com.au/opinion/society-and-culture/why-punishing-cyclists-over-drugs-is-dopey-20121019-27w21.html

Thanks Ben,
I feel that paracetamol and NSAIDS rather supports my case, in that unregulated drug supply is harmful and that some compounds ought to have controlled supply.

The position statement from the AMA should be of interest to you, unless you are PhD not MBBS:
http://ama.com.au/node/453

Regardless of our opinions on the matter, I imagine the final arbiter will be the public and those with a financial interest. Here's a final word from a sponsor:

http://www.cyclingnews.com/news/rabobank-to-end-its-sponsorship-of-professional-cycling-teams

I haven't commented upon the consequences to the cyclist of being caught after doping, as that is a separate debate.
I would presume that athletes are rational actors in this debate and, as they sign up to various codes of conduct, codes of ethics and professional standards, they should be subject to some form of sanction should they be caught.
The second issue is, of course: what would you do in their situation? Most people would dope... I've only read of two top cyclists who have turned their back on the doping program, one is Jonathon Vaughters and one other escapes me (im sure there are more) the point being that to not dope would render one uncompetitive, a situation anathemic to athletes. This is where this blends into the argument above:when temptation is so high, how informed is their consent? But I digress....
So what is to be done? The arguments in the opinion pieces can be summarised as

A. Doping has already been conducted for years so its part of the sport,and
B. Doping can't be controlled.

A is a flabby argument, a non argument really, along the same lines as: priests have been abusing kids for years, it's part of the culture lets legalise it ( I'm not drawing parallels, by the way).

B. doping has not been well controlled to date- that doesn't mean it cannot be well controlled in the future. To assert otherwise is a logical fallacy. I would have thought that the UCI have been quite lax in this matter and there has been sufficient evidence in the Armstrong affair to assert, at worst corruption, at best, tolerance of doping.

Should we not assert greater rigour in doping controls before stating that doping control can never work?

Addit:
I hadn't read Craig Fry's report before commenting, I'm sure I've commented sufficiently on the bioethics of doping anyway to Ben Koh and Jason Mazanov.
Craig's is a well written piece, this paper offers a more balanced response, although it is about human enhancement in general not specifically drugs in sport:
Untangling the Debate: The Ethics of Human Enhancement Patrick Lin & Fritz Allhoff

Are you advocating a nanny state and that no OTC drugs be available? Afterall, all drugs have side effects. While we are at it, lets ban alcohol, smoking, betadine creams, hydralyte fluids as well. I think personal health is a personal responsibility.

If athletes are rational actors that they should be included in the discussion into what they want for their sport. So far the process is driven and controlled by everyone but them.

The physical enhancement of the athlete is already seen in the paralympic sports. Ancient Greek Olympians have been eating sheep testicles as a performance enhancing technique.

As to genetic potential, no one really knows what that potential is for each athlete... theoretically no amont of PED can push an athlete BEYOND a potential.The maximum of an athlete is a theoretical maximum.

If we want to be puritanical... athletes with myopia should not be allowed spectacles to see better. Afterall, it is an enhancement of a given genetic endowment, and improving performance. And lets not correct those flat-footers to allow them to run better... Or there's more... lets not allow athletes to train as it enhances performance at the risk of musculoskeletal injuries!

And why stop there? Lets remove all the vitamin supplements from the supermarket shelves lest those pure and healthy kids be tempted to abuse them with no large trials to show efficacy in well-nourished kids!

An evidence-based approach to a problem needs to be... hmm... based on the evidence. Religious evangelical rhetorics based on biased "moral" ranting is not a discussion of facts. And if pragmatism is shunned upon, then at least be consistent and non-hypocritical in ALL measures, not just cherry-picked causes.

I find it difficult to believe that you could infer that from my post, especially had you read it in context with the previous ones.
The answer is no to your first two questions.

Fine, Michael- I wonder how much they enjoy having to blood dope to compete? It must be a hoot.

Even if they wanted to dope existence of a drug does not infer right to access.

I also bet the parents of teenage cyclists can't wait for their sons and daughters to become pro so they can be subject to HGH, EPO, Testosterone and blood doping in order to compete. Or you could read about a young neopro and his desire to dope here:

http://www.theage.com.au/sport/cycling/wheels-turn-away-from-big-league-20121019-27wtn.html

We need to separate issues of illicit drugs and non-illicit drugs. I think any reasonable person will condemm illicit drugs in any context.

It is inaccurate to state that there are no drug trials on "normal" populations. It depends on what the drug in question is.

Your arguments actually support the legalising of PED in sports... at least it can be monitored and carefully (and safely) prescribed by health professionals with informed consent and active freedom of choice by athletes.

Rather than restate my case from this forum and the preceding one, have a look at this article which neatly states both your side and my side of this argument.

Untangling the Debate: The Ethics of Human Enhancement Patrick Lin & Fritz Allhoff

The article "Untangling the Debate: The Ethics of Human Enhancement by Patrick Lin & Fritz Allhoff" is good but the authors also acknowledges that "...strictly speaking, 'human enhancement' includes any activity by which we improve our bodies, minds, or abilities—things we do to enhance our welfare. So reading a book, eating vegetables, doing homework, and
exercising may count as enhancing ourselves..."

Even if we restrict the argument to ",,,boosting our capabilities beyond the species-typical level or statistically normal range of functioning for an individual..." we are still left with the problem of "normal range". For example, "normal" height of the human species has increased over the centuries. Partly because of nutrition, perhaps due to socioeconomics and hygeine, and possibly from evolutionary selection. Should we stop good nutrition, good hygeine and adopt eugenic social planning to keep the species in the status quo? Or should we simply embark on a clinical trial for a decade to gather the evidence?

Please quote the longitudinal trials on healthy subjects that establish the safety of combining HGH, EPO, Testosterone and corticosteroids in a young cohort of athletic men and women? Can you establish he safety of he very drugs toe advocate in these populations in the environmental condition these athletes are subject to?

Can you safely assert that allowing a lassaiz faire approach is safer for he athlete than tightening the scrutiny on doping hat the UCI have demonstrably failed to achieve?

Why do a clinical trial to establish any evidence? Why do we need to have PEDs in sport? We do not.

There is no argument from logic or ethics that states that we ought to have athletes dope. The only argument at is cogent is one of harm minimisation. This is better served by tightening existing procedures than exposing both trial subjects and athletes to risk of unnecessary harms from drugs.
Should this fail there is a clearer case for trialling doping.

In that same flawed spirit, there is also no argument from logic or ethics that states we ought to let individuals have plastic surgery or cosmetic products of aesthetic reasons.

So you are agreeing to the option of harm minimisation then?

Your reply shows your obvious lack of insight into the pragmatics of clinical therapy.

A few simple Black swans to your argument:
Please quote the longitudinal trials on patients with bleeding GIT that establishes the safety and efficacy of high dose IV infusion of Omeprazole over 40mg bd doses.

There is no evidence-based trial. It is based on expert consensus recommendation and is a common clinical practice.

Can you establish the safety of the drug to advocate in these populations in the context these patients are subject to?

Please quote the longitudinal trial on pediatric patients that establishes the safety of combining adrenaline, beta-1 agnosist drug, steroid, anti-inflammatory, anti-histamine AND acetaminophen/tylenol.

There is no evidence-based trial because of the practicalities of having a large enough homogenous sample size for that number of combination drugs. But it a drug combination that is not unoften used in clinical practice.So again can you establish the safety of the drug to advocate in the kid populations?

Can you safely assert that allowing a hardline approach is more effective and safer for the athlete than having an open discussion, professionally-guided administration and monitoring of drugs in an informed-consent situation?

Mal-
How much do women enjoy having to go through surgery in order to augment their breast size. Must also be a hoot.
Even if women enjoyed having surgical trauma inflicted on their bodies, should we prevent them right to access to breast implants?
I also bet the parents of teenage girls can't wait for their daughters to become of consenting age so they can be subject to the media, the magazines, and peer pressure to have larger breasts in order to exist.

How else does one infer your position? Your position in the various posts and context is inconsistent and illogical.

They are not black swans, or category mistakes.
The decision to describe a new drug to a patient is based upon the therapeutic need of the patient balanced with the risk of the therapy.
There is no therapeutic need in cyclists so why visit a drug therapy upon them with all the attendant harms?
The case for establishing safety with non-therapeutic interventions is greater as there is no requirement in the subject for therapy.
The case of the cancer patient getting an experimental medicine stated by others on this forum is a complete non-sequitur when applied to doping.
Your last paragraph is one which can only be asked when other strategies have failed. The strategies have not failed, or rather the UCI have failed to apply them. Professional cycling has a culture of doping which has skewed this debate and has, in some eyes, established a need for PEDs which does not in fact exist.
As Hume would say, an is does not infer an ought.
Because cyclists dope does not mean they ought to dope and does not mean the medical profession should pander to this want.

Please demonstrate where I have been inconsistent or made an error of logic?

Yes, you make a very good point. And the logic of your argument is that we should look again at the cosmetic surgery industry. This has progressed from a genuine need for therapy in a patient being subverted to pandering to a want. Although under the guise of correcting a psychological deficit.
In this sense cosmetic surgery is different, also, to doping. The cosmetic surgery industry, like other forms of healthcare is therapeutic. That is, it is about restoring the body to a norm, or correcting a deficit. In this case the deficit is structural beauty, or psychological harm resulting of loss of structural beauty.
What is the physical deficit that needs to correcting in Cyclists that is sufficient to warrant supply of drugs to healthy athletes?
Where is the psychological problems that would corrected by PEDs?

The truth is that doping exists and has become the norm, even where ethically and bio ethically dubious. The status quo seeks to maintain the norm and sports doctors, this is my belief not a logical entailment, operating on the extreme edge of their profession are very excited about being involved in this new area of endeavour.
But as I have stated, existence does entail entitlement. I would love to have access for morphine for recreational purposes but I am denied this want. Why? Well as a medical professional I'm sure you know the answer. I'm mystified as to why applying this same restriction to PEDs is so irksome to you.

Cyclists and sports physicians being denied access to the lolly jar is no argument, particularly when the contents of this lolly jar causes more than tooth decay.

See my comment above to the poor analogy of cosmetic surgery.
As to your second question, I think the only argument for PEDs that has any ethical or pragmatic grounding is that of harm minimisation. But this is not the argument employed on this forum. The arguments so far are specious references to paternalism and 'rights of supply' which anyone who has studied bioethics 101 can see are a mask for wants to supply not requirements.

As I have already stated, and I don't know how many times I have to write this, the UCI have demonstrably failed in their mission to apply the standards of WADA. It is in general agreement that this is due to cultural forces and corruption. Once the UCI are dragged kicking and screaming into the 20th century we will see how efficaciously doping controls can limit access by the professional cycling fraternity. If this fails and if it can be demonstrated that athletes are harmed by access to PEDs that cannot be controlled than there is a clearer argument for prescription by sports physicians. Until that time it appears to be sports physicians and athletes squealing because they're denied access to the lolly jar.

We ought not to treat the after-effects of patients who indulge in alcohol or smoking so they can drink and smoke another day but there you go.

We ought not to treat sexually promiscuous patients who contract sexually-transmitted diseases so they can engage another day in casual sex but there you go.

We ought not to give anti-emetics to individuals before a leisure sea cruise, or anti-mountain sickness diuretics for hikers before a holiday mountain climb but there you go.

We ought not to give anti-malarial pills to tourists who voluntarily venture into malaria infested areas for fun.

We ought not to give women breast implants but there you go.

We ought not to save genetically deficient individuals or allow them to live to their potential/ ambitions so they can propagate their defective genes in the human population. We ought not to save Blacks in a White community so that there will be more Blacks or mixed race kids in the White population.

Not everything in medicine or the social world is based on a "therapeutic" need. That is a very positivitic view. It is a social acceptance of what the stakeholder community cherish as important that determines the need. Just because individuals choose to smoke, drink alcohol, have casual sex, venture into different terrains, and improve/enhance their state of genetic endowments does not mean they ought to do so and does not mean the medical profession should pander to this want. But there you go. That's life.

The current anti-doping strategy has also not shown success. Parallel context of such a strategy shows that it is also likely to fail. What's the resistance of entertaining options?

I'll only address onr of your statements above as the rest are derivations of the same erroneous concept:
'We ought not treat treat promiscuous patients for STDs'
There is a therapeutic need here as these patients have a health deficit that needs correction, so this is entirely inconsistent with what I have stated.
You have conflated therapeutic need with patient responsibility, or at least moral judgements by the clinician.
Your approach in argumentation here is known as the strawman argument, it does nothing to address my argument.

As to your last point... Read below.

That is a politician's weak defense to wave everything away as erroneous or a strawman argument. Clarify why it is so.

Activity: casual sex/ finishing final stage tour de France
Impediment to activity: STI/ fatigue
Therapy to impediment: antibiotics/EPO

If you are equating an STI with fatigue there is nothing for me to rebut I have previously stated my case and if you cannot see fit to debate it on its merits contninually restating your case will not help you.
Secondly, If you cannot differentiate pathophysiology from normal physiology what am I to do about that? I cannot force you back to undergraduate medical school to learn again the distinction.

Fatigue was just a convenient example. You can frame the "impediment" and "normality" in anyway you want. That is just context.

"...contninually restating your case will not help you.." right back at ya.

Is small breast a pathophysiology?
Is homosexuality a pathophysiology?
Which cohort determines the norm?

I cannot force you to take a course in critical thinking or philosophy to accept that there are more than one version of truth in life. And society is not governed by a religious view of what is right and wrong.

"...The cosmetic surgery industry, like other forms of healthcare is therapeutic. That is, it is about restoring the body to a norm, or correcting a deficit. In this case the deficit is structural beauty, or psychological harm resulting of loss of structural beauty..."

See also other reply on cohort that determines the norm.
What determines the norm of beauty?

Why is normal or abnormal? The determination of pathology and physiology and the norm is as much a social derivation. Homosexuality used to be deemed a "pathology" that needed to be "cured". Having flat feet used to be pathology that needed to be fixed. Left-handedness used to be a pathology that needed to be fixed. Post-traumatic stress disorder was not previously recognized as a legitimate condition. Chronic fatigue syndrome was not previosuly recognized as a medical condition. Hysteria used to deemed a medical ailment in women that needed to be treated with hyster-ectomy. Ageing is now viewed as a "disease" that should be "treated" to improve quality of life... the list goes on.

What is the physical deficit that needs to correcting in women with small breasts that is sufficient to warrant supply of breast implants to healthy women with no psychological issues but have strong personal choice?

As an example of framing anything in context: the psychological "problems" that would corrected by PEDs is self-esteem in winning a race, known for physical prowess. Compare this to the psychological "problems" of self-esteem of having bigger and firmer breasts, known for beautiful breasts.

The truth is that may dilemmas in life exists and has become the norm, even where ethically and bio ethically dubious. Beauty, wealth, quality of life etc...

"...The status quo seeks to maintain the norm..."
Actually most reasonable commentators (myself included) seek to find a better way, and accepting a multiple perspective that doing things one way and one way only is the only answer. I reject an ultimatum on right and wrong.

".. and sports doctors, this is my belief not a logical entailment, operating on the extreme edge of their profession are very excited about being involved in this new area of endeavour..."

That is a flawed and prejudicial belief. It is like saying that plastic surgeons operating on the extreme edge of their profession are very excited about correcting every girl with small breasts. Or, that it is my belief not a logical entailment, that all religious Muslims operating on the extreme edge are capable of terrorism.

Having an alternate view and entertaining the idea that there are other ways of doing things is not blasphemy. The real world does not operate on a "with us or against us" mentality. To accept otherwise is culturally ignorant.

"... existence does entail entitlement. I would love to have access for morphine for recreational purposes but I am denied this want..."

Now you are belittling athlete's pursuits as "recreational". Wanting to break a world record or breaking the boundaries of human capabilities is not a hobby or past-time for some. Jumping off a space capsule to break the speed of sound record is not a recreational and meaningless pastime. Having (monitored) access and (controlled) use of PED to assist in personal goals and achievements is not wrong.

"...I'm mystified as to why applying this same restriction to PEDs is so irksome to you..."

The issue is not in the application of restriction of PED. It is the fact that you are myopic in realizing that different individuals have different endeavors and focus in life. Some aim to be the best skilled surgeon in the world, other aim to be the best athlete in the world. We value academic pursuits and achievements and so readily accept performance-enhancing tutoring, intensive training courses, and coffee-drinking without question; but frown on "recreational" athletic pursuits and reject any means to assist in that goal. Maybe NASA should not have allowed Felix Baumgartner because it is a meaningless recreational pursuit.

Sky divers and NASA being denied access to the equipments for flight is no argument, particularly when the results of flight is falling to your death.

'Fatigue was just a convenient example' rather the point I would have thought.
Fatigue is not pathophysiological, your argument rests upon fatigue being e state worthy of medical intervention. Your analogies rest upon the equivalence of fatigue -state and a pathophysiology such as an STI. Fatigue states are not pathophysiological and neither are any of the states of being affected by PEDs.
All these arguments have been discussed by my self in previous posts, unless you can demonstrate that athletes are required to have PEDs and the dangers attendant, you have not asserted your case sufficiently.
You clearly have not read the article I cited at the beginning of our discussion which illuminates many of the novice arguments that you present.
As a last ditch effort your assertion of religiosity is ad hominem and does nothing to prove your case. In the same way as your tu quoque rebuttals add nothing to your argument.
If you cannot distinguish between pathophysiology and normal physiology, if you cannot distinguish between beneficence in healthcare, or at least non-maleficence, and libertarianism than I feel that you contribute any more than superficially to this debate.
Are you sure that it is I who is being religious in their resistance? Have is used tu quoque and ad hominem fallacies in this debate?

I'll leave you to ponder on this, in the meantime perhaps google bioethics and medical ethics for a fuller understanding of the ponts that I have made.

Well, you seem to have spun off in a series of rants there. It's clear now that the reason you want PEDs to be administered is about performance not protection of the athlete. If this is the case why not reveal this earlier?
You have used some very flawed argumentation to press you case and its very clear that logic is no impediment to you seeking athlete's access to PEDs.
If potential harm to athletes is no impediment for you either, is actual harm to athletes an impediment I wonder?

On the most basic note you have equated all human endeavors and issues as directly comparative. They are not. You cannot compare apples with oranges.

You assume that there is a right career and acceptable social pursuit and a bad career or frivolous pursuit. Anything that does not fit into your worldview is rejected as not relevant.

You keep needing to equate "norms" in the general population to the "norms" of a distinct cohort of individuals. It is like the European anthropologist telling the indigenous community that polygamy, and mixed-heritage children is not "normal" and we will use everything we can (because we have the power to) to make sure you do not practice polygamy, that we will separate your mixed-heritage children to breed the "Blackness" out of you.

You have this puritanical vision that evidence for medical treatment is only based on level I (or level II-3 more accurately for your need for longitudinal trials) and anything less than that means there is a zero tolerance for using it as treatment. Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees (level V), by your standards is not enough to allow any form of use. I think that experts in the field would have more credible insight into the discussion of any phenomenon than someone from outside it.

You keep asking for evidence for safety for PED even though the fact that the current legislation and set up prevents the widespread setting up of research into these evidence in the first place (although there are many that are still done in private sports labs but not reported in the mainstream literature). It also ignores the fact that safety in any therapeutic is established over decades and can only occur... after several decades of use. There is never ever going to be enough research for every single drug that is used in clinical practice. There are already a lot of phases of research and therapeutic standards before use in clinical practice for all drugs. That is a limitation in the real world.

You have a view that pathology and physiology exist as a distinct dichotomy for all phenomenon and not realizing that our definitions of norm is ever evolving and is as much a social contract as it is an empirical science. I think your undergraduate medical school (assuming you were trained in a medical school and are not an allied "medical" person) must have missed that in its syllabus.

Someone who wants to win a beer drinking contest and seeks treatment for nausea is "therapeutic". Someone who wants to complete the final leg of the Tour de France and seeks "treatment" to do that is "non-therapeutic (for the sake of avoiding a tangential argument into "fatigue"as not a pathology but "nausea" is, I have omitted the "issue" that needs "treatment").

The literature will disagree with your comment that fatigue is not pathophysiological.
I suppose nausea is also not pathophysiological that is not state worthy of medical intervention.

"... neither are any of the states of being affected by PEDs.." that is a convoluted statement. The discussion is using PED/drug FOR a state (fatigue/nausea) not BY a PED/drug.

Unless you can demonstrate that women are required to have breast implants and the dangers attendant, that we have to treat symptoms of alcohol so that individuals can carry on drinking, that we have to treat symptoms of smoking so that individuals can keep smoking, you also have not asserted your case sufficiently.

I have read the article. You obviously have not my critique to that article (or choose to ignore it for lack of a credible response).

You religious fervor in one and only one acceptable view is equivalent to religious fervor and not a discourse based on logic. You keep insisting that nothing proves the case for a view opposite to yours with no reasonable reasons for its rejection.

I think you are naive to think that pathophysiology and normal physiology is easily distinguished in all circumstances and in all phenomenon. If you cannot distinguish the fact that beneficence in healthcare, or at least non-maleficence is not always the norm (e.g. plastic surgery for aesthetic reasons) then I feel that your contribution is equally superficial in this debate.

The fact that you are sensitive to being called religious for adopting a myopic view point speaks volumes. I guess one can never describe to a blind person the colour of the sky. You don't know what you don't know.

You could do likewise to Google multiple perspective of reality and the role of paternalism and "morality" in evidence-based inquiry.

I think you are missing the point. The discourse is that there must be other alternative ways of handling the issue at hand (doping). Your hardline approach at the exclusion of all else is the reason for the criticism. I am indifferent to whether we allow a monitored use of PED, the adopting of different codes of sports, OR the zero tolerance of PED. I just reject the idea that there is only one way that is "right" and "normal". I am also indifferent to whatever pursuits each free citizen chooses for himself, be it alcohol or PED. I reject people who feel wanting to have excellent performance as a ethically wrong endeavor.

I also believe that all stakeholders should have a say in what they want, unpressured by moralists. Your persistence in adopting a paternalistic approach to inhibit other views by claiming that they are not logical is flawed. Again, my view is that athlete's access to PEDs is an equally valid view point to your authority-driven restriction and gate-keeper to access of any forms of drugs.

Potential (or actual) harm to athletes is but one consideration in the discourse. There are other factors and interests that needs to be considered. You seem to reject all other requirements and wants as illogical and/or irrelevant.

While you are at it, Google "Informed Consent".

This is a classic case of special pleading fallacy. You assert the right of athletes to have privileged access to drugs that are restricted to the general population, restricted because of the attendant risks of medicating a healthy individual with no requirement to do so.
You believe athletes have a special right because of their need to excel. I assert the reverse: athletes have no special right to pharmaceutical enhancement. In fact they should rely on their own genetic endowment. If they cannot beat eddy merckx's results without enhancement let it be so.

That is a selective and biased reply choosing to only recognize illicit drugs and/or prescriptive drugs as PED. If a drug is available OTC to the general population and not restricted (albeit the attendant risks of the medication in a healthy and/or ill individual with/without requirement to medicate) why would it be a special pleading fallacy?

I believe that athletes should have the same rights as any other citizen as a minimum in using/rejecting a drug, in choosing/rejecting a goal.

Even if a drug is not OTC but legal by prescription:
If a tourist seeks an anti-emetic so that he can venture on a sea voyage to explore the world, that is his choice. If an athlete seeks something to speed his recovery so that he can venture into the next stage of the cycling competition, that is his choice.

Using a biomedical perspective in a postmodern socio-psychological world is ignorant.
Your views are akin to saying that ambitious women who inconveniently get pregnant whilst on a career-driven path in life have no special right to medical resolution (i.e. abortion). In fact they should rely on their own genetic endowment: if they cannot have a natural/spontaneous abortion and have to carry the pregnancy to term (and forfeit a career) then so be it.

Informed consent does not imply carte Blanche access to the pharmacopeia.

Irrelevant comment

Well let me put it this way, if an athlete came to me and said 'I am fatigued after racing' I would suggest rest as the cure, as it is the safest and most efficacious cure. If an athlete came to me and said 'I want PEDs as rest is inconvenient or insufficient to make me competitive' I would suggest that given the constraints of his training program and his physiology he has reached the limits of his performance. I would not suggest PEDs as an answer to his lament as the potential harm is not commensurate with the alternative.
Tisis the principle of beneficence, and is the same principle that has priority when a patient is in ED and seeks alcohol as an answer to his alcohol addiction. Do we supply alcohol, no... We act under thenguiding principle of beneficence and prescribe a benzodiazepine, despite the patient's request for alcohol.
You see the principle of beneficence as acceding to the athlete's request for PEDs as having precedence over the attendant harms of the supply. I do not.

We differ on this matter. I see the difference as a special pleading fallacy. The athlete as having more rights to S4 medications than another citizen is not logical to me. I also have a problem with prescribing harmful,medication for non-therapeutic purposes. You do not. On this we differ also.

I am sanguine about our differences, you are appear not to be. Is there some special enthusiasm you have for prescribing S4 medications for athletes that would make you so overwrought when someone differs with you?

I have embarked on this debating project not because I think I'm right and not to change your mind (I don't think this would be possible). Tis project is about ensuring that you are certain that you're right. It concerns me that you see no way in which you could be wrong and it concerns me that any argument that you meet is replied with strawman, tu qocque, special pleading and ad hominem fallacy. Your argumentation reveals the depth of bias attendant to you belief. I am concerned that you are quick to accuse others of religious fervour yet do not see the extremity of your own argument.

Well it's been interesting. I'm mollified by the fact that the bulk of opinion both medical and public is towards my argument, that is PEDs are not worth the risk. Good luck with your project, I suggest you work on your argument if you wish to convince the greater public.

So why prescribe a drug that is not required, purely to satisfy the vanity of sports doctors and the wishes of athletes? PEDs are not required, the harms are not balanced by the gains, except for those with vested interests.

"...if an athlete came to me and said 'I am fatigued after racing' I would suggest rest as the cure, as it is the safest and most efficacious cure..."

Well you are obviously not a sports physician. Neither am I. But I would think that recommendations into nutritional modification and looking high carbohydrate diets may be a more professional response to the presenting issue and desired goals of the athletes. Your response harks back to the good old days where women was just asked to put up with the pain of childbirth and the idea of analgesics seemed ridiculous.

"...If an athlete came to me and said 'I want PEDs as rest is inconvenient or insufficient to make me competitive' I would suggest that given the constraints of his training program and his physiology he has reached the limits of his performance. I would not suggest PEDs as an answer to his lament as the potential harm is not commensurate with the alternative..."

Again you are placing your values of what is important on the athlete. If a CEO comes to a doctor asking for help in solving his panic attacks before giving a speech to board members, a good doctor would find various measures to assist the CEO patient like public speaking lessons, relaxation techniques, AND/OR possibly of anti-anxiolytics. This is instead of a dismissive patronizing response of given the constraints of his work schedule and commitments, and his psychology/physiology he has reached the limits of his performance. I would not suggest anxiolytics (as one of a suite of options) as the potential harm is not commensurate with the alternative.

"...when a patient is in ED and seeks alcohol as an answer to his alcohol addiction. Do we supply alcohol, no... We act under thenguiding principle of beneficence and prescribe a benzodiazepine, despite the patient's request for alcohol..."

Addiction is a different discussion. I do not condone illicit drug use for fun. You seem to be mixing the concepts of athletic pursuits as a illogical choice.

"...The athlete as having more rights to S4 medications than another citizen is not logical to me..."

I assume you are referring to the Australian system of drugs? I also assume you mean S4 medications to mean addictive prescriptive drugs? Again, you seem to neglect the fact that doping does not only apply to illicit/prescriptive addictive drugs but any substance and/or method that can result in improving sporting performance.

"...I also have a problem with prescribing harmful,medication for non-therapeutic purposes. You do not. On this we differ also..."

You have twisted my words. My view are that all medications, and elite level training itself, is potentially harmful. To mitigate that harm, one option is to have a supervised system to deal with the issue as one of the possible options. The point is not to advocate one system over the other, but that we allow a discussion of the various possible system and consider each option based on the objective evidence on its own merit AND the social sentiment of all stake holders.

"Elective" abortion is a risky procedure and not a therapeutic indication. Abortion of unwanted pregnancy is going to happen in society with or without the mainstream medical profession's involvement. History has shown that. Even if I personally do not believe in elective abortions, as a professional, if the objective social science evidence suggests that legalizing abortion is the safest way for managing the phenomenon, I would as a professional support a policy that puts in place safe practices [and slowly gather more empirical evidence over years to guide measures to improve the safety of doing such abortions], over a policy that criminalizes abortion as the only option [hence removing the possibility of gathering evidence of making the practice safer] without discussion with the individuals who are the key stakeholders.

"...Is there some special enthusiasm you have for prescribing S4 medications for athletes that would make you so overwrought when someone differs with you?..."

I will not personally prescribe addictive prescriptive medications as a personal professional practice. Again you seem to be linking doping only to illicit/addictive prescription drugs.

"...I have embarked on this debating project not because I think I'm right and not to change your mind (I don't think this would be possible). Tis project is about ensuring that you are certain that you're right...."

For clarification, I am not stating that I am right that legalizing all drugs is the only solution to the problem. What I am certain is that the current measures are inadequate, that there are other options of addressing the issue of doping, and an open discussion and consultation of the best choice to adopt needs to be had. You on the other hand are shutting down all discussion of alternate measures and sticking to one tried-and-failed policy.

"... It concerns me that you see no way in which you could be wrong and it concerns me that any argument that you meet is replied with strawman, tu qocque, special pleading and ad hominem fallacy..."

As above, I do not claim to know the ultimate solution, or the real "truth" of reality. I do know that there are more than one way to address any problem, multiple perspectives of truths, and any policy adopted should be open and in consultation with all stakeholders. Your statement should actually be addressed to yourself: you should be concerned that you see no way in which you could be wrong, that you dismiss any alternate perspective as irrelevant and illogical.

"...Your argumentation reveals the depth of bias attendant to you belief. I am concerned that you are quick to accuse others of religious fervour yet do not see the extremity of your own argument..."

Actually I am always checking on my own personal unobjective biases (as stated earlier, my personal view is that I do not believe in elective abortion and I will not personally casually prescribe addictive drugs), but cognizant that an academic discourse and objective policy making needs to be sensitive to alternative perspectives (that abortion and unwanted pregnancy will still happen without my consent) and consider various options that include sociocultural factors and not just biomedical ones. You, on the otherhand, are biased without realizing or admitting, and seemed to be highly sensitized to the idea that your views may be perceived as religious fervor. Last I check, the view a person has of another (good or bad) is still the prerogative of the person. Or is having a personal view also not allowed in your worldview?

"... it's been interesting. I'm mollified by the fact that the bulk of opinion both medical and public is towards my argument, that is PEDs are not worth the risk..."

It certainly has been interesting, at least that we concur. You are wrong is stating both medical and public opinion is that PED is not worth the risk. Your unconscious bias has caused you to filter the available views out there. You should do an evidence-based literature review of supporters for and against PED in sports and have a read into the discourse on the confusion and inconsistencies within the anti-doping rules as it stands today.

"... Good luck with your project, I suggest you work on your argument if you wish to convince the greater public..."

It depends what you think that argument is. If the argument is to legalize PED in sports, that is not my aim. If you think (correctly) the aim is to engage the public in a discussion that there are different perspectives on the issue, that various possible measures exists, and that the existing paradigm is not faultless, then I do not think I am the only one that believes that. I mean, I managed to get this discussion going, didn't I? But alas, sometimes you just cannot describe the color of the sky to a blind person.

One can only lead the camel to water. Thankfully my aim does not extend to making that camel drink.

So why allow elective abortions that is not required (by your standards of what is a legitimate requirement), purely to satisfy the vanity of gynaecologists and the wishes of the patient? Abortions are not required, the harms are not balanced by the gains (by your standards of what is important and of value to a patient), except for those with vested interests.

Tu qocque,,and completely misrepresents my argument. Elective abortions benefit the mother. To try and assert this argument trivialises abortions and the decisions that mothers make. What a ridiculous attempt to assert your argument. How about you address my argument directly without resort to inappropriate analogy.
Why prescribe a drug wit no clinical indication? Answer this question.

This statement is completely relevant. Informd consent has nothing at all to do with acceding to a patient's wishes. Tell me why patients should have unfettered access to the pharmacopeia?

What an absolutely stupid response!

If elective abortion benefit the mother, then PED benefit the athlete.
Just because you stamp you feet and throw tamper tantrums alleging tu quoque does not make it so. I think Michael has basically just addressed your question using your arbitrary, inconsistent, and illogical standards!

What is the clinical indication for elective abortions? Pro-choice of mother. What is the clinical indication for PED use in athlete? Pro-choice of athlete.

How you define clinical indication for the mother with a normal but socially-inconvenient pregnancy will apply for the athlete's clinical indication for PED use.

Every argument in favor for elective abortion can be equated to PED use.

I think the others are right (based on their posts in response to you) your position is myopic, inconsistent, and you keep thinking that doping only refers to illicit drugs.

God! I really hope you are not a doctor. Your stupidity astounds me!

When you've stopped and whipped the froth from your mouth:
http://ama.com.au/node/453

http://ama.com.au/node/453

I agree with Michael. Your statement is irrelevant and illogical.

If a patient has a "problem" he seeks the therapist's help.
Therapist has an arsenal of choice.
Every choice has pros and cons.
Therapist explains to patient
patient asks questions and clarifies
Informed consent occurs when patient understand the pros and cons and chooses.

If patient is pregnant woman, then problem is the unwanted pregnancy, therapist is obs and gynae doctor, choices include drugs and surgery.

If patient is athlete then problem is not being in best physical and mental state for a competition or sport, therapist is sports professional (doctor, trainer,psychologist etc), choices include physical training, altitude training, caffeine drinks, sleeping tablets, carbohydrate loading, high protein diet, other drugs.

Your ridiculous question either implies that the pregnant woman should not be given various options for abortion that are available, or that athletes are asking to be given access to illicit drugs that will impair sport performance. The second is totally off topic in this discussion.

Caffeine is a PED. Why should the general public be allowed it and not athletes?

Oh and if you want to keep accusing others of tu quoque (get the spelling right!), special pleading, argumentum ad hominem and the straw man fallacy:
1. Read first what people are actually writing and the context for which they are written, and not just reply based on your own agenda and a priori script.
2. Understand the etymology and definitions of what those terms actually mean before using it.
3. Looks first in the mirror.

You seem to be conflating the normal physiological response to exercise with pathophysiology here. Lets discuss the problems with the proPED argument in more detail.
The argument from analogy, the analogies used are abortion and cosmetic surgery. The argument being that abortion and cosmetic surgery are examples where beneficence is subordinated by patient desire for a therapeutic intervention. The argument then goes 'if this is ok why not extend it to PEDs. There are two reasons why this is a weak support for PED use.
A. Abortion and cosmetic surgery are indeed two examples where the principle of beneficence is subordinated. This has come about because in the case of abortion the prospect of a child growing up with out parental support is sufficient to make the risk of abortion worthwhile. There is also the argument from harm minimisation. It should be kept in mind that abortion was originally made legal in the case of protecting the mother from harm and has been extended by both the harm minimisation case, and from societal pressure, to now be a form of contraception. Cosmetic surgery is similar in. That it as an exception to the rule of beneficence vs patient desire for therapy. Again, initially, cosmetic surgery has significant societal pressures that have overridden the beneficence principle. It should also be noted that this is still controversial, and as recently as yesterday, there were media discussions centring around the ethics of cosmetic surgery.
B. your argument of patient liberty over beneficence is flawed because if you extend the exceptions in A to replace the principle of beneficence, than the result is you now must apply this rule to everyone seeking therapy. For example, if someone goes to a surgeon and says 'I find my ears inconvenient, please remove them' or 'please sew a live cat to my chest'. By what manner can a surgeon deny this request? Similarly, if I go to my GP and say 'I want morphine, prescribe it to me' how can my GP say no?

So the only way out of this conundrum is to apply special pleading to your argument. The special pleading fallacy is that athletes are so special access to PEDs should override the principle of beneficence. My argument would be - why are athletes special? Why should not amy person have access to PEDs to facilitate their professional goals? Why should I not have access to amphetamines to make my assignment marking easier? Why should you deny amphetamines to shift workers who need to stay awake even though it does them harm, just to satisfy the principle of libertarianism over beneficence?

It is true that special pleading has been applied to abortion and cosmetic surgery, ,they are the exceptions to the rule. Why are they excepted? Well, I'm not going to answer every question for you.

Because of the strong principle of beneficence it is incumbent on those suggesting PEDs such as EPO, amphetamines, HGH, testosterone, blood doping etc to demonstrate above the normal standard of patient safety, that doping is safe. It is also incumbent to demonstrate why athletes should be a Special Case of making the principle of beneficence subordinate to libertarianism. Finally, the case should be made strongly why athletes NEED PEDs.
The arguments I have seen have been quite weak,, despite ad hom attack, tu cocque and strawman argumentation the arguments have been quite superficial, certainly insufficient to overcome the strong principle of beneficence. I included the link to the AMA ethical position statement to demonstrate that this argument has already been conducted and found wanting, and furthermore sports physicians should abide by the ethics of their profession unless they possess a strong case for not doing so.

Tis has been an entertaining debate and I'm glad to see the variety of arguments, as insufficient as they have been. You will probably reply to this post due to vexation and vanity. Pease do so but I shall not be reading it. Not because I am sure of my position, but that you have added nothing to the debate. This forum is now wending its way back to the nether regions of the website and , despite a couple of posters, was scarcely patronised anyway.
This reflects the community feeling against doping and the spurious arguments in support.
Events of last night (the UCIs) decision on doping and Armstrong, have made it clear that the position espoused by the author of this article and by the various commentators espousing PEDs is simply not going to happen.
It appears that the principle of beneficence has won after all.

"...You seem to be conflating the normal physiological response to exercise with pathophysiology here..."

I think once again you have lost the plot. The discussion is on debating on other measures of handling the present phenomenon. You seem to accept that there is only one and only one way of doing things.

"...A. Abortion and cosmetic surgery are indeed two examples where the principle of beneficence is subordinated. This has come about because in the case of abortion the prospect of a child growing up with out parental support is sufficient to make the risk of abortion worthwhile..."

Spurious argument. If you bother to look at the history of abortion and human rights issue in relation to women, the reasons for allowing legal abortion for non-medical purposes was not for fear of lack of parental support. Your argument flies in the face of reality and history.

"...There is also the argument from harm minimisation. It should be kept in mind that abortion was originally made legal in the case of protecting the mother from harm and has been extended by both the harm minimisation case, and from societal pressure, to now be a form of contraception...."

Wrong. Protecting the mother from illegal abortion is but one of the many factors. If you read the various law reform papers in Australia and overseas you will note that criminalization and legalizing of abortion is often about other factors but protecting the mother.

"...Cosmetic surgery is similar in. That it as an exception to the rule of beneficence vs patient desire for therapy. Again, initially, cosmetic surgery has significant societal pressures that have overridden the beneficence principle. It should also be noted that this is still controversial, and as recently as yesterday, there were media discussions centring around the ethics of cosmetic surgery..."

This only adds support to the current debate that how we deal with PED in sports is controversial and that society has differing views on the matter. It also shows that biomedical principles and rule of beneficence is not a static thing and that society as a whole (or all stakeholders relevant to a phenomenon) needs to decide what measures to adopt.

"...B. your argument of patient liberty over beneficence is flawed because if you extend the exceptions in A to replace the principle of beneficence, than the result is you now must apply this rule to everyone seeking therapy..."

Wrong. That is an incorrect extrapolation of the issue. For the issue of abortion, the debate and societal support is on the cohort of pregnant women. It is not specific to any individual female, pregnant or not. A non-pregnant woman seeking to have an abortion pill or a surgical procedure to scrape her womb would not apply. A pregnant woman who wants to keep her baby but asks for an abortion pill or surgery to poke instruments into her womb does not apply.

"...For example, if someone goes to a surgeon and says 'I find my ears inconvenient, please remove them' or 'please sew a live cat to my chest' By what manner can a surgeon deny this request?..."
Again, for the sake of argument, if you have a large cohort of individuals who wants a surgical procedure then it would apply, not just for isolated cases. The sewing of a cat to the chest is just hyperbole silliness. If you want to argue the necessity of a treatment in the context of patient liberty over beneficience, use a more realistic example. For example, if a whole community of Jews, Muslims or Christians requests for an elective circumcision this would apply. Although there is no medical need the procedure will be done, and the procedure does have risks, the reasonable surgeon will not deny the request. Circumcision is controversial (as recent debate has shown), but the example goes to the point that no one view has the monopoly of what is right or wrong for society.

"...Similarly, if I go to my GP and say 'I want morphine, prescribe it to me' how can my GP say no?..."
Once again you are equating PED to only illicit drugs and/or confusing the problem of addiction to the discussion.

"...So the only way out of this conundrum is to apply special pleading to your argument. The special pleading fallacy is that athletes are so special access to PEDs should override the principle of beneficence. My argument would be - why are athletes special?..."

Again, you are linking PED to illicit drugs. OTC drugs are also considered doping. Caffeine widely available in food was also considered doping. Same question back to you: why are athletes so special. They should be allowed the same OTC drugs as everyone else in society.

"...Why should not amy [sic] person have access to PEDs to facilitate their professional goals? Why should I not have access to amphetamines to make my assignment marking easier? Why should you deny amphetamines to shift workers who need to stay awake even though it does them harm, just to satisfy the principle of libertarianism over beneficence?..."

As per previous discussions, you seem to place a value-added judgment on what is, or is not, a valid professional goal. You also only focus on specific drugs that are either illicit or have higher side effects than others (e.g. amphetamines versus caffeine).

A CEO that has stage fright may be prescribed anti-anxiety medications to help before a stage performance before shareholders; shift workers consume lots of coffee (caffeine; which is a drug), energy drinks with caffeine, or take legal caffeine pills to stay awake to do their job; executives may take sleeping tablets to help with a good night sleep for an important work day the next day; professional mountain climbers may take anti-diuretics to avoid mountain sickness before the climb; individuals that work on oil rigs may take prophylactic anti-emetics to avoid sea sickness. The list goes on. The issue of PED to assist in everyday life (work and leisure) is part of modern day society. Climb out of your Armish cave and smell the coffee.

"...It is true that special pleading has been applied to abortion and cosmetic surgery,..."

It is not special pleading when it is available to all members of society.

"... ,they are the exceptions to the rule. Why are they excepted? Well, I'm not going to answer every question for you..."

Herein lies your problem. You skirt the issue and go off on a tangent selecting extreme examples to support a point that has marginal relationship to the present discussion.

"...Because of the strong principle of beneficence it is incumbent on those suggesting PEDs such as EPO, amphetamines, HGH, testosterone, blood doping etc..."

Again, you are only linking PED to specific drugs. This discussion is wider than that. I believe Jason has already commented on EPO and AAS. As for the other substance, see other post on chicken-and-egg situation: you can't do a study on the effects of a drug on a specific cohort, if you don't allow that specific cohort to use that drug. Besides, as Jason and others have mentioned before, the drugs that you mentioned have already been approved in human use.

"... to demonstrate above the normal standard of patient safety, that doping is safe...."
Again, chicken-and-egg...

"... It is also incumbent to demonstrate why athletes should be a Special Case of making the principle of beneficence subordinate to libertarianism..."

See comments above.

"... Finally, the case should be made strongly why athletes NEED PEDs..."

Irrelevant.
Why do tourists need anti-emetics, sleeping pills, anti-anxiety pills? Why do workers prone to overuse injuries need analgesics? That is a silly and off topic statement. The debate is on why anti-doping strategies need to change (because the current system is ineffective). Not why athletes need PED.

"...The arguments I have seen have been quite weak,, despite ad hom attack, tu cocque and strawman argumentation the arguments have been quite superficial, certainly insufficient to overcome the strong principle of beneficence..."

Look in the mirror when you say that (when you understand what it means and have not been using it yourself).

"... I included the link to the AMA ethical position statement to demonstrate that this argument has already been conducted and found wanting, and furthermore sports physicians should abide by the ethics of their profession unless they possess a strong case for not doing so..."

So had the ethical position of criminalizing abortion to keep the White middle class population alive. Ethics is a social contract. Your biomedical and quasi-religious myopia prevents you from seeing that.

"...Tis has been an entertaining debate and I'm glad to see the variety of arguments, as insufficient as they have been. You will probably reply to this post due to vexation and vanity. Pease do so but I shall not be reading it. Not because I am sure of my position, but that you have added nothing to the debate. This forum is now wending its way back to the nether regions of the website and , despite a couple of posters, was scarcely patronised anyway..."

That is your prerogative. The purpose to engage in debate and allow others to see both sides of the argument. Not just the biased and unobjective ones like yours.

"...This reflects the community feeling against doping and the spurious arguments in support...."
Wrong. Biased lenses.

"...Events of last night (the UCIs) decision on doping and Armstrong, have made it clear that the position espoused by the author of this article and by the various commentators espousing PEDs is simply not going to happen...."

Issues of UCI (and their inconsistent historical positioning) and various matters on doping in sports is simply politics. Politics is not evidence or the gospel. Nor is it static.

"...It appears that the principle of beneficence has won after all..."
Maybe in your Armish cave...

Another related article of interest just published

http://www.theage.com.au/sport/cycling/wheels-turn-away-from-big-league-20121019-27wtn.html