Male body builders often take anabolic steroids, human growth hormone, and other supplements to obtain huge masses of muscles.
Consider Saul Phillips, a twenty-seven-year-old male who once considered himself frail and weak. At age seventeen, after three years of lifting weights and secretly taking anabolic steroids and human growth hormone, Saul looked like a young Arnold Schwarzenegger. He played defensive end for his high school football team, which contended for a state title. After high school, he played on a college football team that did not give out scholarships, and he continued taking steroids. After college, his use of steroids and body building continued. Many of his fellow body builders also took similar bodily enhancements.
Is there anything wrong with what Saul does? If so, what exactly is it? In our culture, some famous athletes seem to have won because they enhanced themselves. When Mark McGwire broke baseball's single-season home run record, he was taking a then-legal performance-enhancing substance. Barry Bonds took steroids for several years, probably starting in 1998, before breaking the home run record in 2001.[1]
In 1998, Tiger Woods suffered so severely from nearsightedness that, without glasses, he could barely see golf balls. Then, in October 1999, surgeons corrected his vision with lasers,[2] and he won a golf tournament. Since then, he has become famous. In 2007, he had another eye surgery.
In this chapter, I differentiate attempts to enhance human bodies into purely self-regarding cases and those involving other people. This latter kind raises moral issues because when one person enhances himself to gain a competitive edge, others are affected. For purposes of development in this chapter, I will first discuss the secret use of such substances in male-dominated sports such as football and weightlifting, and only at the end of the chapter discuss noncompetitive enhancements, such as those used by male body builders, tattoo artists, and those who suffer body-identity disorders.
One ethical issue of this chapter involves defining what consistitutes an “enhancement.” Consider running a race, say, a 10,000-meter race or a half-marathon. What counts as an enhancement? Is use of a mechanical prosthesis cheating? Taking mega dosages of caffeine before the race? Using an individually-designed, tailor-made running shoe? Hiring a team to give you water and energy bars at one-mile intervals along a marathon? Using an iPod to listen to songs with a good beat (said to improve 10K times by three minutes)? A GPS device that beeps when your pace slows below your target?
In any competitive sport, coaches are enhancers.[3] Anyone with special knowledge about physiology, training, equipment, endurance, muscles, metabolism, and mental focus helps any athlete to run faster, jump higher, and win. An athlete with the wealth not to work and to hire a personal coach has enhancers. For such wealthy athletes to compete against athletes who must train after work is a kind of cheating. Ideally, everyone should start from the same place. We don’t like to think of races as the chance for the wealthy to leave the poor behind, yet it sometimes is just that (swimming in the Olympic games).
A useful classification about physical enhancement and competition distinguishes between increases in performance due to technique, biology, and equipment.[4] I will not focus on technique (an example is the Fosbury flop, which transformed high-jumping in the 1960s). Instead, my discussion focuses on biological enhancements and then on equipment, such as prostheses and artificial joints.
Biological enhancements in competitive sports involve blood boosting, taking growth factors, supplements, and minerals, as well as injecting various kinds of anabolic steroids. In sports such as football, baseball, hockey, weight lifting, and body building, use of steroids is alleged to be pervasive.
The trial of Barry Bonds in 2011 publicized these issues in baseball. In 1998, Mark McGwire and Sammy Sosa battled to set the record for home runs, but something had changed. As outfielder Doug Glanville noted, he previously had a sense of how far a ball would carry and from whom, but in the early 1990s, that changed as baseballs unexpectedly sailed over fences in record numbers.[5] At the same time, Glanville said, “You were looking around and wondering how that guy got so big in the off season.”
Enhancements come into play when the culture of some sports, such as professional cycling, encourages athletes to use every conceivable form of doping to beat the current tests. Doping, a term of uncertain origins, may have originated from “doop,” a Dutch word Americanized as slang for a way of drugging victims, or from the South African “dop,” a potent alcohol/stimulant combination. Regardless of its origins, doping has come to mean the secret use of performance-enhancing substances to gain advantage over competitors, making it synonymous with cheating.
One method of doping removes blood from an athlete’s body before a competition to be stored and later returned to him before competition. Taking blood out of the body enhances the number of red blood cells because the body grows new cells to replace those lost. When the original cells are returned, the body has extra red blood cells, giving it an advantage in sports that require heavy use of oxygen, such as cycling and cross-country skiing. Training at high altitudes in the Rocky Mountains achieves the same effect because the lower concentration of oxygen stimulates the blood to create more red blood cells. Some athletes naturally possess genes that give them more red blood cells.
An athlete may also transfuse himself with the blood of others with high counts of red blood cells. Any transfer of blood runs the risk of infections, mix-ups, and contamination. If such transfusions are done to avoid detection, then the blood must be transported and given secretly and then all equipment whisked away.
So many scandals have rocked the Tour de France that it now symbolizes doping. In the 1980s, cyclists began taking the hormone erythropoietin (EPO), a hormonal growth factor that the body creates to stimulate production of red blood cells. As a medical treatment, EPO was approved for patients with anemia.
In 2006, 2007, and 2008, random testing found leading contestants with high levels of hematocrit, or the percentage of blood volume occupied by red blood cells. These high levels caused cyclists to be dismissed.[6] Several cyclists in the Tour de France later confessed to doping and claimed that every cyclist in the Tour de France also doped.
A small percentage of high school athletes—somewhere between 3 and 12 percent and a larger percentage of college and professional athletes—secretly take anabolic steroids.
Heavy usage of steroids over a decade likely harms bodies and alters personalities. The evidence has recently been building. In one study out of Harvard, the ability of the left ventricle to pump blood was compromised in users who had taken such steroids for nine years.[7] The National Institute for Drug Abuse (NIDA) states that steroid abuse damages livers, increases bad cholesterol and decreases good cholesterol, shrinks testicles, reduces sperm counts, and may lead to renal failure.[8] NIDA even claims that, in some personalities, taking anabolic steroids can be “addicting.”
A special kind of steroid has been called a “designer steroid,” referring to tetrahydrogestrinone (THG). Developed in a private lab called BALCO in San Francisco, THG was not available commercially and had no official uses. But the lab marketed the drug privately to star athletes such as baseball player Barry Bonds and sprinter Marion Jones. Thus it was not on the radar screens of committees testing for illegal drugs. Revelation of THG came when Jones’ coach mailed THG to authorities.[9]
Some athletes believe that the dangers of using steroids are exaggerated and, in particular, that if steroids are used correctly and in moderation, they pose few risks to health. Such athletes believe that ideology biases the public’s view. They liken it to medical marijuana, where people may be pro or con before they learn the facts.
Nevertheless, the practice of taking several steroids together, known as stacking, carries special dangers. Physicians have reported several cases where young male body builders took massive amounts of steroids and damaged their livers or hearts, or became violent. In America, so-called professional wrestling, which is really body building and acting, has witnessed several cases of “roid rage,” as when professional wrestler Chris Benoit in 2007 strangled his wife, suffocated his seven-year-old son, and hanged himself with a weight-machine pulley.[10]
The secrecy of such usage makes it difficult to evaluate. Without oversight by a reputable physician or careful monitoring, it is impossible to know how many athletes take steroids. Unfortunately, because an athlete suspects that his or her competitors use steroids, it motivates him not only to take them, but also to take them in increasingly large dosages. The attitude of “I would rather win a Super Bowl ring and be dead at forty than be a loser” also motivates taking extraordinary dosages.
In one of the more bizarre stories about steroids, a reporter in New Jersey revealed that 248 police officers and firefighters were illegally supplied anabolic steroids by a forty-five-year-old physician, Joseph Colao, who appeared to have transformed himself by taking such steroids and who suddenly died in 2010 of heart failure.[11] “The use of performance-enhancers among first responders has been a taboo topic since it first came to light during the 1980s,” said University of Texas professor John Hoberman in response to the article, who called the problem a national one that “has been systematically ignored” for two decades.
Although what people do to their own bodies outside competitive sports is largely their own concern, especially in taking medical risks to look muscular, a troubling aspect of this story is that Dr. Colao colluded with these men to get group medical coverage to pay for the steroids. Although less than 1 percent of men suffer from any hormonal condition requiring steroids, Dr. Colao certified all these men as such. This bilks public monies in support of unsafe, dubious norms.
Lyle Azado’s story haunts discussions of professional athletes taking steroids. He played fifteen seasons as defensive end for the Denver Broncos, Cleveland Browns, and Los Angeles Raiders.[12] In college in 1969, to be a bigger football player, he began experimenting with anabolic steroids and never stopped. After receiving radical chemotherapy and contracting pneumonia, Alzado died at age forty-three in 1992. Officially, he died from brain lymphoma, a rare form of cancer.
Although steroids cannot be proven to cause brain lymphoma, Alzado himself believed that the drugs had caused his cancer. At the height of his use of enhancing drugs, Alzado estimated that he spent $30,000 a year on steroids and human growth hormone, often buying them at gyms around the country. His second wife, Cindy, blamed the breakup of their marriage on mood swings that steroids caused, a pattern also seen in wrestler Chris Benoit.
Alzado admitted the steroids made him so crazy that at times he couldn't deal with social stress. After years of denying that he used steroids and three months after being diagnosed with brain cancer, Alzado confessed in a first-person story for Sports Illustrated in July 1991. “It was addicting, mentally addicting,” Alzado wrote on his steroid use. “I just didn't feel strong unless I was taking something.” He stated that “It wasn’t worth it. If you’re on steroids or human growth hormone, stop. I should have.”
A woman philosopher whom I once knew engaged in body building in her twenties and developed huge upper-body muscles, well outside the norms of her gender or of most men. Suspected of having taken large amounts of steroids, she died of liver failure before she reached age thirty.
If everyone was able to use steroids, there would be no benefit to taking them. Under the current situation, where only a small percentage of most athletes take steroids, a shot-putter who injects steroids can gain more muscle mass than others and thus gain a positional advantage. A positional advantage confers on the beneficiary an asset in a contest relative to others, but vanishes if everyone else has the same asset. If all football linemen used steroids, none would have a positional advantage. But if only one lineman uses them, he may benefit substantially.
Positional advantage matters greatly in competitive sports. Even gaining a slight advantage over opponents can make the difference between a good performance and an average one. Even when one is competing against oneself, say, in running marathons, runners go to great lengths to gain small improvements.
Citing the myriad problems of the Tour de France, Oxford University bioethicist Julian Savulescu believes that instead of trying to prohibit use of banned substances in sports, we should embrace the inevitable and legalize performance-enhancing drugs to level the playing field. For him, the enormous rewards of winning, coupled with the minimal consequences of cheating and the low chance of being caught, make doping irresistible to athletes.
Professor Savulescu thinks that drug use in elite sport is only wrong because it violates the rules, so we should change the rules. He argues that doing so will not lead to an arms race of drug-taking: “We should not think that allowing cyclists to take EPO would turn the Tour de France into some kind of ‘drug race,’ any more than the various training methods available turn it into a ‘training race’ or a ‘money race.’”[13]
Savulescu thinks the only limit of drugs in sport should be safety. His opponents think the safety of athletes is a good reason for prohibiting enhancing drugs in sports, but Savulescu counters that sports like professional boxing are also unsafe and dangerous. Furthermore, banning a substance may carry its own harms. Just as prohibition of alcohol in the 1920s increased deaths due to the unregulated quality of bootleg alcohol, banning drugs in sports leads to the same problems. For Savulescu, performance enhancement retains the spirit of the sport rather than violating it.
I appreciate Professor Savulescu’s arguments, but for me, the fact that we allow racecar driving and boxing does not mean that we should allow other sportive forms of bodily risk. This is the logical fallacy of tu quo que. Besides, perhaps we made a mistake allowing the original dangerous sports, just as we made mistakes in the twentieth century allowing everyone to smoke cigarettes.
Second, although it’s possible that low dosages of steroids by older adults aren’t harmful, most athletes take steroids and growth hormones for positional advantage not in such low dosages but in very large dosages, and finally, such usage isn’t monitored by physicians. A fortiori, this is true of stacking.
Moreover, Savulescu almost admits that athletes who desire to do so will always find new drugs and new ways to take enhancers without detection. A major flaw of drug testing in Major League Baseball is that players aren’t tested in the off season, when they are lifting weights and trying to gain muscle mass, and hence, most likely to take banned drugs.[14] Doctors may also give players new drugs “off label,” where there is less monitoring and no testing. If so, that doesn’t justify giving up on bans on steroids and other dangerous substances.
Why not? The answer is simple: because it’s cheating to use such substances, and the question whether it’s cheating fundamentally differs from whether we can catch all cheaters, whether cheaters will find innovative ways to cheat, or whether it's unsafe to cheat.
Perhaps most cyclists in the Tour de France break the rules and cheat. Does that make it ethical? Even if only a small fraction of cyclists do not cheat, an honorable way to race still exists. The appeal of American cyclist Lance Armstrong for years was partially that he did not cheat, that he beat cancer and still won, that he “lived strong” without doping.
In a tv interview on “60 Minutes” in May 2011, Lance’s teammate Tyler Hamilton said he and Lance doped in the Tour de France in 1999, that Armstrong encouraged it, that he personally saw Armstrong inject himself with EPO. Hamilton said that physicians methodically gave each cyclist EPO and human growth hormone in white lunch bags, and that cyclists were driven from airports to clandestine hotel rooms where blood was taken from them to be returned to them during a race.[15]
If the majority of athletes do not cheat, then the sport maintains a dominant ethos that is still good. But when most athletes in a sport cheat—as appears to be so in the Tour de France—the entire sport becomes corrupt.
To me, the history of the Tour de France does not explain why we should legalize enhancements, but explains what happens when a culture of cheating destroys a sport. That the Tour de France has become synonymous with doping, that everyone assumes a winner to be a cheater, that sponsors decline now to endorse athletes because of tarnished images, has killed honorable, professional cycling.
Regardless of whether the practice maims your own body or kills you, taking steroids to compete is cheating, plain and simple, and the secrecy of the usage encourages stacking, as well as using greater and greater quantities, all of which justify banning use of steroids in athletic competitions. Anything not legally open to all competitors should be banned. So the controversy among users and non-users about the long-term safety of using steroids is moot. Steroids are used to gain an unfair advantage.
Of even greater importance, the casual acceptance of cheating through doping, not the use of enhancements in itself, undermines the spirit of sports and fair competition. The attitude of blatantly cheating to win has destroyed some sports. Certainly when we see a large-muscled man in body building, football, or other contact sports, we assume he’s taken steroids or growth hormone. Over the last decade, the average weight of NFL linemen has increased about eighty pounds, and a lot of it is muscle. Only steroids could do that.
This same casual acceptance inside body building, cycling, and weightlifting of taking anabolic steroids and other enhancers is not a good thing. A different ethos could have evolved.
Nor is it inevitable that cheaters never get caught and that athletes will inexorably stack more and more drugs. When East German female swimmers started to look like American football players, everyone knew what was going on and it eventually stopped.
Trite as it may sound in sports, but certainly not in ethics, winning isn’t everything. It’s how you win, and taking banned drugs isn’t the way we want our children and friends to win.
Consider also that if we allowed steroids, doping, and other supplements, as Savulescu argues, there is little evidence that, given the pervasive culture of cheating, athletes would suddenly stop cheating. If the whole culture is secretly injecting enhancement drugs to gain endurance and positional advantage, then that secret culture is not going to go away overnight. Legal drugs will become the baseline and new drugs will be sought for positional advantage.
Moreover, an Exposure Effect occurs in legalizing banned drugs in sports. Yes, 10 percent of football players in the United States use steroids, but if steroids were allowed, 90 percent would. And with that greater public exposure, and probably stacking, many more problems would occur.
We shouldn’t harangue high school athletes about the dangers of using steroids. They will hear the opposite from older, successful athletes in college or elsewhere. Rather, we should also emphasize that it’s cheating and that to use steroids is to undermine the essence of the sport.
I believe that the link between enhancement and cheating is the master philosophical question of all enhancement ethics. The idea that enhancement is cheating underlies the idea that enhancement is, if not immoral, then indicative of erroneous personal values.
Let’s consider a related issue about cheating and enhancement in sports, namely the role of the physician who supplies banned drugs. If athletes taking enhancers are cheating, then physicians who provide enhancers to athletes are corrupt. Although medicine is too elastic to rigidly uphold any distinction between therapy and research—where one is a proper, the other, an improper, goal of medicine, it is not too elastic to ignore the distinction between what is in the rules and what is not. Arne Lundqvist writes that providing banned prescription drugs to healthy adults is “medical malpractice.” That is too strong for most drugs, e.g., Viagra, but not for purposes of breaking the rules in competitive sports to gain positional advantage.
Another important issue in the general area of the ethics of bodily enhancement concerns use of external equipment. All equipment can be enhancing, and the best equipment offers the best enhancement. In the same way, the best running shoes and clothes require money and help the best runners. So, if you’re serious about running, eventually you find a way to buy such shoes and equipment.
Of course, some nations possess good athletes in some sports only because citizens can afford Olympic-size swimming pools or have access to the money, time, and mountains to learn how to ski. This is a good example of cheating by citizens of developed nations in competing in, say, the Olympics, against citizens of developing nations. What good is it to be proud of your swimmers when most people in most developing countries lack swimming pools or the leisure time to train in them? Let’s give every country a dozen Olympic-size pools, subsidize a hundred athletes to train there, and then see who wins the Olympic swimming medals.
It’s one thing to implant an artificial lens in your eye so that you can see better or a joint in your hip so that you can walk better, but what if you do so to compete better? What is allowed and what is cheating?
Consider Oscar Pistorius, the Australian who was born with deformed feet and whose parents chose carbon blades called “Cheetahs” for him. Oscar became so good at sprinting that it became a serious ethical issue for the International Olympic Committee as to whether he could compete in the 2008 summer games in Beijing or in the 2012 games in London. He had gone from being disabled to too-abled. Ultimately, like single-amputee Sarah Reinersten, he was allowed to compete to try out for the South African team. In 2012, he hoped to win the London summer Olympics and in doing so, be the highlight of that competition.
After a 1976 water-skiing accident, Van Phillips, aged fifty-four, lost his leg below the knee, leading him to develop the prosthesis used by Pistorius. Obviously a genius, his need fused with intellect to think creatively and in doing so, he started a Copernican Revolution in rehabilitative medicine.
Phillips said he became obsessed with creating a better prosthetic leg. … He learned that the artificial limb industry had changed little since World War II and the Korean War. Most prosthetics were designed within the cosmetic envelope — a prosthetic foot resembled the human foot. There was no energy to propel a leg. Borrowing concepts from pole-vaulting, the spring of a diving board and the C shape of a Chinese sword his father owned, Phillips imagined a prosthetic that would let him jump and land. The result was the Flex-Foot, which included many designs of prosthetics for a range of people. One of the designs, the Cheetah, was intended for elite athletes. … He used carbon graphite, which is stronger than steel and lighter than aluminum.[16]
Along the way, Phillips realized that previous designers of prosthetics had mistakenly tried to replicate human bones. He realized that
“you can’t function unless you have a power source,” (my emphasis), Phillips said. He studied ligaments that store muscle energy, observing the tendons of porpoises, kangaroos and cheetahs, noting how the cheetah’s hind leg landed and compressed, and the elastic nature of it. … Paddy Rossbach, president and chief executive of the Amputee Coalition of America, said: “Van Phillips’s foot changed the whole field of prosthetics. It was an extraordinary change.” Sarah Reinersten, now 33, said that when she switched from a hollow wooden leg to a Flex-Foot at age 12, it felt as if “I was walking on a cloud.” In 2005, she became the first female amputee to complete the Ironman triathlon.
But was it fair that Oscar could compete? I don't think it was because Pistorius was using his Cheetahs to get an extra advantage unavailable to other runners. He was RoboCop entering a shooting contest for police officers. That he was formerly disabled is irrelevant. What matters is that he was now using substances (graphite) that were stronger and more flexible than human bone, and using them to run faster. More importantly, doing so gave him an artificial source of power that natural runners lack.
I do not believe that athletes enhanced this way should compete against the non-enhanced, even if they were once disabled. It’s not fair that some run on materials stronger than bones and with an ability to spring the runner forward.
In 1998, Casey Martin, a twenty-five-year-old golfer with a disability wanted to ride a golf cart between holes rather than walk. A federal judge ruled that he could compete on the professional golf tour and ride his cart. Does the game of golf simply consist of driving the ball, putting, and expertly shaving par into birdies and hole-in-one shots? Of course not! Endurance, and specifically walking, factors into the sport because the more tired the golfer is, the harder it is for him to hit accurately and far. Long ago, professional golfers abandoned carrying their own bags, employing caddies instead. That was the beginning of ending golf as a real athletic event, but at least every professional golfer can have a caddy.
Some disagree with my view. Among the people rooting for Pistorius is Hugh Herr of MIT’s biomechatronics lab, who said of Oscar’s Olympic competition,[17] “the minute an athlete with an unusual body or mind becomes competitive, they’re a threat. Before that happens, they’re seen as cute or courageous. Once they win, they’re accused of cheating.”[18]
In both the case of Oscar Pistorius and of Casey Martin, sympathy for a person with a disability resulted in the wrong decision to allow them to compete with a superior advantage. That is, they were allowed to cheat because they had a disability. The same reasoning should allow the blind to compete in archery by using finger-initiated laser trails to guide their arrows to the target.
My central argument against the common use of enhancements in competitions is not an indirect one but a direct one: enhancements are wrong because they are cheating. Cheating in competitions is wrong. Widespread cheating corrupts the sport and renders its prizes meaningless.
What, then, about Saul Phillips, the twenty-seven-year-old, single, competent male who has transformed his body over the last decade from a stick-like Ichabod Crane to a muscle-bound Hulk? He is ripped. Where previously Saul despised his body and women scared him, he now proudly exhibits his body and seeks the company of women. Like Jennifer in the last chapter, when he sees people staring at him, he enjoys it.
Is he a cheater, too, like the cyclists on the Tour de France? In my opinion, he’s only cheating like Jennifer, and if so, only in a very small sense. Like Jennifer, he may be only fooling himself if he thinks everyone else believes he achieved his muscles naturally. Like some Jennifers, he may freely admit to others that he didn’t achieve his bodily results naturally. But when these men enter bodybuilding competitions, they are cheating. The way they look and their ability to lift weights or pose is only partly due to their efforts. The other part is due to the substances they take secretly and, if not all others take the same substances, then they have an unfair advantage.
Second, given the medical dangers discussed in the beginning of this chapter, physicians who enable such men to bulk up are corrupt. Fake bodily enhancement is a two-way illicit street, brining down both those who prescribe and those who get steroids, growth hormones, and other muscle-producing substances.
Consider a different kind of enhancement, one that calls into question the definition of the term. If Enthusiasts subscribe to the Anything Goes view that physicians and competent males should be able to do anything they want to their bodies, so long as it doesn’t harm others, then what about tattoos? One in fourteen people in North America and Europe sports a tattoo; tattoos cover significant portions of some people’s bodies. Other people may find such extensive tattoos offensive, even repulsive. Although people may not realize it, the skin is also an organ, and tattoos may inflict long-term damage on the skin’s ability to protect the body from assaults.
Yet their owners usually think of tattoos as embellishments. Is one person’s disfigurement another’s beauty? Why else would such people spend considerable amounts of money to obtain the tattoos, sit under a needle for hours while the tattooist stains their skin, and undergo minor pain? In the same way, others sport metallic jewelry surgically implanted on various parts of their bodies. One woman’s blemish is another’s trophy.
Obviously, whether to permanently color one’s skin in patterned ways is a personal issue and one that only minimally affects other people. Those offended can look away, just as they don’t have to read every bumper sticker or every salacious book cover. Of course, it’s reasonable that medical insurance and state funds don’t pay for tattoos.
But how far should physicians go with bodily modifications? Consider also Cat Man, aka John Doe, who has had his face modified to look feline, including having his teeth sharpened to resemble a cat’s incisors, whiskers implanted, and eyebrows changed. He thinks he looks good, but his looks repel others. Chacun à son gôut?
No matter what we think about tattoos or Cat Man, such bodily self-modifications rest in the area of aesthetics, not morality. We may dispute whether having your body covered with tattoos counts as beautiful, but some think so. So long as no one is harmed by such tattoos, or sharpened teeth, it’s just personal aesthetics.
What about amputation envy or apotemnophilia, officially body integrity disorder (BID).[19] Portrayed on medical dramas such as Grey’s Anatomy, CSI: New York, and Nip/Tuck, as well as in the book, Geek Love, subjects commonly yearn intensely to have a leg amputated above the left knee. Although almost all surgeons refuse to operate this way, at least one surgeon in Scotland has amputated legs of two competent patients.[20] Assuming such patients are competent, does such amputation really benefit them?
Within days after a suspicious amputation in Tijuana, Philip Bondy, a seventy-eight-year-old retired satellite engineer, who suffered for years from apotemnophilia, died from gangrene in 1998. The surgeon who amputated Bondy’s legs was John Ronald Brown, dubbed by one documentary as “The Worst Doctor in America,” for botching surgeries involving penis enlargement, sex reassignment, and apotemnophilia. But as one author states, “Bondy's case is illustrative of both the grim determination of apotemnophiles to effectuate the amputations they desire and the serious physical harm to which this determination makes them potentially vulnerable.”
If this chapter leaves the reader with a sleazy feeling about males enhancing their bodies, and the physicians who enable such males, so be it. The combination of direct payment, off-label prescribing, and stealth muscle building has been dangerous for many men. It is a dangerous norm building up in sports, one that may corrupt them. The conviction of Barry Bonds in April 2011, for obstructing justice in an investigation of his taking banned steroids, shows how low the sport of professional baseball has fallen, joining the Tour de France in the Hall of Shame.
Mark Fairnau-Wade and Lance Williams, Game of Shadows: Barry Bonds, BALCO, and the Steroids Scandal that Rocked Professional Sports (New York: Gotham, 1997).
Woods Has Second Laser Eye Surgery,” Golf Tours and News, May 15, 2007.
http://www.golf.com/golf/tours_news/article/0,28136,1621439,00.html
Early Olympic rules about amateurs once attempted to exclude coaches and limit amount of time practiced.
I owe this distinction to Julian Savulescu, Nick Bostrom (eds). Human Enhancement (London: Oxford University Press, 2009).
Kristen Merriweather, Epoch News Staff, December 23–28, 2011, B4 (Washington, D.C.).
Jamey Keaten, “Tour Rocked Again by Doping,” Associated Press, July 18, 2008, Birmingham News, D8.
Aaron L. Baggish et al, “Long Term Anabolic-Androgenic Steroid Use is Associated with Left Ventricular Dysfunction,” Circulation and Heart Failure 109, April 27, 2010.
NIDA Info-Facts; Steroids. http://www.drugabuse.gov/infofacts/steroids.html .
Julian Savulescu and Bennett Foddy, “Le Tour and the Failure of Zero Tolerance: Time to Relax Doping Controls,” in Enhancing Human Capacities, ed. Julian Savulescu, Ruud ter Meulen & Guy Kahane (London: Wiley-Blackwell, 2011), 305.
Associated Press, “Cops Eye 'Roid Rage’ in Wrestler's Murder-Suicide,” June 27, 2007.
Amy Brittan and Mark Mueller, “New Jersey Doctor Supplied Steroids to Hundreds of Law Enforcement Officers, Firefighters,” New Jersey Star-Ledger, March 9, 2010.
Julian Savulescu et al, “Why We Should Allow Performance Enhancing Drugs in Sport,” British Journal of Sports Medicine, 38 (2004), 666–70.
Daniel Pauling, “MLB Drug Testing Doesn’t Cut it,” letter, Birmingham News, May 23, 2011, D2.
Carol Pogash, “A Personal Call to a Prosthetic Invention,” New York Times, July 2, 2008.
Herr quoted in Rowan Philip, “Oscar Could Be Fastest Man,” TIME, January 29, 2012.
A. A. Lawrence. “Clinical and Theoretical Parallels between Desire for Limb Amputation and Gender Identity disorder,” Archives of Sexual Behavior, 25, (2006), 263–78.
Annemarie Bridy, “Confounding Extremities: Surgery at the Medico-Ethical Limits of Self-Modification,” Journal of Law, Medicine & Ethics, 32, 2004.
Annemarie Bridy, “Confounding Extremities.”