Copyright ©1997-2005 American Society of Exercise Physiologists   All Rights Reserved.


        Professionalization of Exercise Physiologyonline    


         ISSN 1099-5862   Vol 8 No 5 May 2005 
 

 

Editor-in-Chief:   Tommy Boone, PhD, MPH, MA, FASEP, EPC
 

The Impact of the Supplement Business on Exercise Physiology
Tommy Boone, PhD, MPH, FASEP, EPC
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811 

“Cheating is wrong not just because it violates the laws of fair play, but because it violates the rights of individuals.” 

On the heels of the recent ASEP National Meeting in Minneapolis, I’ve been thinking about exercise physiology more than usual.  I would like to briefly examine my beliefs and expectations about exercise physiology.  I believe this is important because it is a remarkable opportunity for exercise physiologists to enter the 21st century healthcare field.  I also think that too few academic exercise physiologists understand the importance of the ASEP vision and mission statements.  They have a lot to learn about ethical thinking and commitment to exercise physiology.  The idea of applying ethical thinking to the practice of exercise physiology needs a lot of work.  And, in a similar way, commitment to professionalism is poorly understood.  In fact, however remarkable, one might even imagine that exercise physiologists do not get the importance of the first physician oath, taken by Hindu physicians [1].  For example, from the first-ever pledge [2] of medical ethics among physicians, there was the commitment:  “Do not harden your heart against the poor and the needy; rather have compassion upon them and heal them.”  The point is this:  In a real sense, exercise physiologists have the same commitment to athletes (and students) and the profession. 

My perception is that exercise physiologists are abusing all three.  It is unfortunate but true that a certain number of exercise physiologists, usually with the self-proclaimed title sports nutrition, are making a mockery of exercise physiology.  If this is true and I think it is, then if the trend is not evaluated and planned for, the values that come from exercise physiology and the study of sports nutrition will continue to erode.  The moral essence of sports will no longer have meaning or value outside of the bottom line perspective.  I’m certain that athletics will then be viewed only as a business; all of which will be detrimental in countless ways.  Paradoxically, many of the adverse effects of  today’s sports nutrition are directly linked to the success of exercise physiologists.  Knowledge derived from ergogenic research and similar thinking has spawned unethical research and/or business practices.  The business of sports nutrition has taken precedent over the education and application of sound nutrition to health and athletics.  While some sports nutritionists have challenged this point [3], it is nonetheless a recognized problem that is only getting worse. 

In short, there is more to sports nutrition than supplements and performance enhancers.  Some, not all, sports nutritionists, who are paid consultants for the supplement industry, are strong advocates of the business model.  These individuals have sacrificed ethical thinking and research practice to ensure the business agenda of their employers.  It is noteworthy that none of the strategies to enhance the bottom line of the supplement industry is equal to the ethical thinking that underpins academic scholarship.  It is also very troubling that some college professors have given over to doing whatever seems necessary to ensure their perceived status and economic income.  While this particular view of sports nutrition is a relatively recent event (say, the past 20 years), it is a corollary to medicine and drug companies.  Whether physicians are prescribing drugs based on solid science or the desire for 20 times the national income average is a concern that can be said of some sports nutritionists.  Apparently, the rationale for the extra money is justified by society’s views about “bigger is better” and making a lot of money is the American dream!  Is this behavior also evidence of success or conflict of interest?

While some supplements and drugs may increase athletic performance, many do not.  The incentives for using supplements and/or drugs are confusing for many reasons.  Often, it is the coach or the trainer who fails to understand their accountability to athletes and society.  By contrast, those who serve athletes by teaching sound nutrition practices are not driven by money or ego.  They adhere to the ethics of the profession by upholding that which is noble and right about exercise physiology, which raises the question:  “How can sports nutritionists teach the ethics and values of exercise physiology if they promote the use of supplements?”  The public expects exercise physiologists to provide sound and ethical nutrition advice.  The American Society of Exercise Physiologists can and must serve as an effective “watchdog” for the profession.  Members expect exercise physiologists to demonstrate teamwork, commitment, and loyalty to the ASEP code of ethics.  Such thinking is built into the very structure of professional organizations.  No one has the right to abuse others with misinformation, even if they request it.  And, for certain, the grant-driven researcher cannot be excused for promoting performance enhancers or for destroying the integrity of sports.  Building character, promoting sportsmanship, and friendship are important in the moral education and development of society.

The bottom line in business is money.  It is always about making money.  But, “show me the money” kind of thinking is not (and cannot be) the core of healthcare professionals.  If exercise physiology is viewed only as an opportunity to serve the athletic and supplement industry, then its ability to serve the public at large is vastly curtailed.  Those who disagree with this view are likely to be high-paid quarterbacks for the performance enhancement industry.  Either knowingly or unknowingly, they have jumped from one level of thinking to another and, for certain, having the doctorate degree or working in the industry does not necessarily build good character.  For example, to promote supplements either by writing promotional articles and/or speaking out on the industry’s behalf while ignoring bad science and wrong doing are incorrect behaviors and attitudes.  Cheating is exactly that – cheating, regardless of the form or costs.  Cheating cannot be respected.  The research that underpins it cannot be respected.  It is corruption, such as the steroid use in baseball.  Coaches who cheat are disgusting.  Winning at all costs is not straight thinking.  None of it should be allowed to take from the opportunity for hard work and lessons of growth.  And, yet that is exactly the role of coaches and others who violate rules for their own selfish reasons.  It stinks.  Those who fail to speak out against it are party to the greed and the false sense of security and success [4]. 

Athletics has become a habitat for dishonesty.  Think about it -- academic fraud, illegal recruiting, shaving points, and performance-enhancing supplements.  Athletes from all sports are deceiving themselves and the public.  Money, fame, bling-bling, and the gold medal win out over common sense and character development. Cheating in sports is so widespread that it seems to be the only thing that makes sense to athletes.  Either “win or don’t come back” is the new high.  What could possibly be correct with such thinking?  What could possibly be right about teenage girls using anabolic steroids?  The increase in female use of steroids is directly related to competition, higher financial rewards for winning, and the ‘lean muscular’ hard body image [5].  Regardless of the reason, it is not right to cheat to gain a sports advantage!  Winning at whatever the price is simply wrong.  Using scientific experts to make athletes faster and stronger beyond what they get from training alone is unethical.  Where does it stop -- elite athletes, how about health club members, or better yet, 10-year old kids?  In 2001, nearly 400,000 children ages 10-14 were using performance enhancing products [6].  Where does one draw the line?  Is it age specific, gender specific, or is it sport specific?  Why is creatine not a problem, especially if it is said to enhance anaerobic performance?  What makes something acceptable
and something else unacceptable?  Who are the players (exercise physiologists in particular) who are driving the performance enhancing market?  Why are they allowed to engage in the promotion and marketing of potentially harmful substances to improve the sports performances of teens?  It is frustrating and disappointing that exercise physiologists (as evolving members of the healthcare community) are allowing sports nutritionists who generally refer to themselves as exercise physiologists to get away with their snake oil marketing and behavior. 

Recently, a friend who is not an exercise physiologist, asked me: “What happened to enhancing performance through hard training?”  In other words, is it not possible for athletes to run faster, jump higher, and get stronger without performance enhancing drugs?  Of course they can, but what is the point of doing that if it doesn’t benefit the dietary and fitness industry?  The short answer is nothing!  That is the point isn’t it?  Many of the sports nutritionists/exercise physiologists are making big money as consultants.  They write articles for the industry’s Internet web businesses to promote the products.  Or, they publish pseudo-scientific papers with manipulated statistics and conclusions to support the industry’s advertisement policies.  It is all about the bottom line.  Whether it is making money as a CEO of a supplement company or a college professor writing advertisements for the industry; it is all the same.  In actuality, the behavior is no different from the outrageous snake oil salesman of decades ago except for the fact that today’s deceptive advertising tactics are far more convincing and prevalent.  The “inside story” is that the unscrupulous sports nutritionists/exercise physiologists are using athletes to build their personal-financial agendas.  Their notion that only they have the right view or understanding portrays them for what they truly are --- infomercials to promote themselves.  Failing to act as responsible professionals, they exaggerate research conclusions while spreading half-truths.  It is all done under the pretense of credible research [7].  It is a classic case of greed over common sense, which raises the question:  “Is it likely that these sports nutritionists are just confused about what is right and wrong?”  Again, this calls for a short answer – “No.”  Their behavior has crossed the line.  If they are willing to pursue their career (and money) on the backs of athletes by promoting performance enhancers to “improve” performance, then, their behavior is unethical.  Even if they are innocent of attempting to enhance athletic excellence, they cannot argue on behalf of the assumed or real benefits of the supplement industry without crossing the line.

The price of promoting dietary and fitness supplements is just too high for professionals, especially those in academics.  College teachers who are looking to get tenured and/or promoted should look to balance the potential rewards against the real risks of engaging in research that can be considered unethical.  Even if the topic is thought to be harmless, the research must be spotless in design and statistical analysis.  The conclusions must be accurately stated.  The authors cannot make extravagant claims about the data or otherwise the paper may be viewed as a deliberate and systematic attempt to promote the product.  Even if the supplement does not work, the logical course for professionals would seem to be to avoid contaminating the minds of athletes.  In fact, it is interesting to note that the reality of sports nutrition is (and has always been) a well-balanced diet, not supplements of vitamins and minerals, protein and creatine, and all the rest.  Exercise physiologists should be role models for students, athletes, and other professionals.  They should maintain high standards of conduct when teaching sports nutrition.  Efforts to control and get rid of performance enhancing substances should be spearheaded by sports nutritionists.  If they are not going to do it, then exercise physiologists must assume the responsibility.  It will not be easy, but it is critical to speak out against those who promote sports supplements.  The commercialization of the sports industry by exercise physiologists is a conflict of interest. 

The $3.3 billion retail sale of dietary supplements [8] has changed many aspects of the American life.  Many (if not most) of the changes are negative.  Yet hardly anywhere can you hear another exercise physiologist speaking against or even raising questions about the promoters of this lucrative business. Lacking solid scientific analysis, information on safety, and an ethical backdrop from which to guide the products and advertisements, the industry is in full speed marketing to high school, college, and recreational athletes.  The impact is enormous.  Few exercise physiologists (and consumers) understand the unscrupulous thinking and advertising.  Fewer are talking about the potential for dangerous reactions, such as the side effects of chromium picolinate supplements.  Still fewer get the point that the use of creatine is unethical as is the case with other supplements that have demonstrated significant ergogenic effects.  Performance enhancement through supplements and drugs rather than hard work and practice is problematic in many ways.  If
supplements work, it is wrong to use them.  If they do not work, it is fraud to market them as performance enhancers (such as with carnitine, L-tryptophan, and beta-hydroxy-beta-methylbutyrate (HMB) supplementations) [8].  Similary, the safety of DHEA (dehydroepiandrosterone) must always be questioned. 

The key word in athletics is training, not enhancers.  There are no (or should not be any) shortcuts to sound training or the ethical use of exercise physiology principles for athletics and competition.  Exercise physiologists need to educate athletes, coaches, and the public in sound and ethical practices of sports nutrition.  And, in addition to separating fact from hype about supplements that are said to enhance performance, exercise physiologists need to deal with the ethical issues.  Does the use of supplements send the wrong message to adolescents and others in today’s sports-oriented society?  From my perspective, the search for meaning in sports says the use of enhancers is wrong.  If the nutritional supplement (e.g., creatine) works, then why isn’t it viewed in exactly the same negative way as the use of anabolic steroids?  It makes no sense that one is unethical and illegal and the other is ethical and legal, especially since there are still questions about the long-term effects of creatine on muscles (including the heart and kidneys) [9].   

It is a sad observation that participation in athletics no longer epitomizes integrity and trust.  Cheating scandals at all levels of athletics make news.  Athletes have accepted the fact that either you cheat or you stand no chance to win.  Many of their coaches have drilled the idea into the their minds.  It is said that “everybody cheats so it is okay to do it too.”  There is no honor any longer among athletes.  Standards of conduct do not impress athletes.  The character of athletes is a joke.  Values like fair play and honesty are jokes.  Why is it that parents and society in general cannot see that the erosion of athletic values is partly related to the failure of coaches to keep athletics clean?  It seems to me that coaches could put the industry out of business if they wanted to.  Another part of the problem is a function of the “get ahead mentality regardless of who you must step on” in this country.  This is witnessed throughout the business world.  Still another (major) contributor is the failure of teachers to confirm everyday in their classes that cheating in any form will not be tolerated.  Not surprisingly, students of sports nutrition teachers hardly ever hear the words, “using performance enhancers of any kind is wrong.” 

Isn’t it interesting that the impact of the supplement industry is essentially overlooked by exercise physiologists.  Frankly, it does not speak well for the profession.  The role of the industry in athletics has changed it.  This change has been especially evident with young athletes.  The influence of organized sports nutritionists who work for the industry has emerged as a powerful force to be reckoned with.  This fast-growing pseudo-scientific advertising movement seeks to transform athletes and society into one big cash cow business.  It has left its mark on athletics and society and, yes, on exercise physiology.  The leaders of the industry promote the view:  “You can win with us.”  The view breeds the attitude that success is only possible if you cheat.  Unless exercise physiologists stand up to the all-pervasive influence of the supplement industry, the average person will not get the big picture.  The industry’s false views of athletics need examination and clarification.  Exercise physiologists must tell athletes that it is wrong to cheat.  They should argue that taking “…performance enhancers do not reflect the forms of human excellence which sports are intended to honor…” [10, p. 2].  The integrity of exercise physiology depends on it.  Exercise physiologists can avoid being a victim of misguided thinking in sports nutrition by recognizing the techniques used by representatives of the nutrition supplement industry. The marketing message may be embedded in published research articles, which drives the bottom line.  Everything seems to be about money, recognition, and power. 

Thus, the ideas behind the original reasons for teaching sports nutrition are obsolete.  We have come to think of performance enhancers as part of the athletic experience, so that if you are not taking them, you are not a serious contender.  The culture of dishonesty is so common and expected that cheating is admired among athletes [11].  Cheating is everywhere.  No one seems to be outraged, which is a huge ethical problem.  Remember Ben Johnson.  The world’s fastest man!  He is now remembered as the world’s fastest steroid abuser [12].  How many exercise physiologists have grown their resumes abusing good science?  How many arrogant researchers will be remembered for promoting dishonesty among athletes?  Can the scientific community trust the supplement industry [13] not to influence the findings of the university researchers?  Will there ever be an end to the “corked bat” mentality?

What is for certain is this:  “Having the doctorate degree does not help.”  Society and professions continue to award praise and recognition to sports nutritionists who play outside the rules.  The titles of certain published papers reveal the fine line between good science and questionable science.  We are seeing more republishing of the same article in different web sites because the papers are advertisements!  They do not follow the rules of scientific publishing.  Researchers without character do as they please.  They make up their own rules, often defined by the agenda of the industry.  It is a no-brainer that these researchers are after the big bucks.  This kind of thinking is having a negative impact on exercise physiology.  The tactics are as irrational as excuses used by athletes.  For example, if you listen, you can hear sports nutritionist say,  “Others are doing the same thing.”  Or, it is my way of “leveling the playing field.”  For some sports nutritionists, “winning is the only thing.”  The difference between supporting and not supporting the products of performance enhancing companies can mean thousands (if not millions) of dollars in grant money and endorsements.  They seem to have forgotten that the behavior is wrong [14], just as it is for the crooked thinking coach who encourages athletes to take drugs to enhance performance [14].   It is just a matter of time when both will be held accountable for their unjustified and unethical behavior.

Sports nutritionists who condone performance enhancers and drugs and even provide them for their students and athletes do not understand the importance of values and ethics in sports and life.  They are not responsible professionals.  They do not recognize the negative influence they have over their students, athletes, and colleagues.  The truth is, if they were to take just a moment to consider their actions, perhaps, the legitimate use of their powers could be used to help athletes.  Ultimately, they would understand that “cheaters never win.”  Whether it is using cell phones to cheat on tests, corporate executives embezzling funds, or sports nutritionists exaggerating their research findings, cheaters never win!  From the sports nutritionist who thinks he/she is not doing anything wrong to the journalist caught plagiarizing -- everyone rationalizes dishonest and unethical behavior.  In some sense, it seems to be “the American way.”  In another sense, it is anything but the American way.  This country was built on core values derived from hard and honest work in accordance with a recognized standard of conduct that guided decisions and interactions with others.  Ethical thinking was inextricably linked to values of honesty and fairness.  It is the same today, that is, honoring core values, honesty, and fair play is still important.  And, that is exactly why it is wrong to cut corners to promote performance enhancers.    

A professor turned to me several days ago and said:  “I’m tired of sports nutritionists writing articles about performance enhancers.  It makes no sense to me.  Everyone knows the articles are advertisements.”  I agree.  Eventually, the public and the academic community will come to recognize that sports nutritionists who promote performance enhancers are not victims of their work.  Rather, their self-perpetuating behavior will be recognized in a similar way to the CEOs who take retirement money from the employees, the baseball players who use steroids, or the athletes who use unethical and deceptive practices to gain an advantage over their competitors.  Once it is clear to the public (and other professionals) that the pseudo-science is all about money and fame [15], the behavior will change.  The deceptive practices and conflicts of interest will decrease.  The public will not accept the idea:  “It can’t be wrong if everybody is doing it.”  And, even if others [16] continue to say,  “You’ve got to do what you’ve got to do,” everyone will recognize that the sense of entitlement to cheat is a moral problem.  The interaction with students and athletes will be guided by fair play, integrity, and respect more so than playing by the business rules and ethos.  Sports nutrition leaders will work hard to put the welfare of the community at ease by embracing a balanced approached to competition.  They will develop a code of ethics to guide their thinking, practice, and opportunity to decrease negative results.  As an example of the latter, probably 15% of the sports nutrition supplements are contaminated with banned substances [17].  The only logical alternative is a set of ethics and testimony to set the world free of the magic of supplements.  Sports nutritionists have yet to wrestled with this issue, but there will come a time when they will because it is in the best interest of the profession.  In others words, just as tennis has banned certain rackets and golf certain clubs [18] to maintain the integrity of the sport, exercise physiologists will come to the understanding that teaching only sound nutrition concepts isn’t any different than baseball using only wooden bats.  Otherwise, the loss of public trust will have a negative impact on exercise physiology. 

The point is this:  Once trust is lost, it is hard to get it back.  Why allow it to happen in the first place?  That is why ethical thinking and professionalism are important.  Both separate us from unethical and unprofessional colleagues.  The irony is that every profession has its moments when its future is played out by making hard decisions.  Today is such a deciding time for exercise physiology.  The line must be drawn in the sand.  If you promote performance enhancers, you are on that side of the line.  If you do not, you are on this side of the line.  Most people who think ethics is important would rather be on the side that does not promote cheating in any form.  This is consistent with an earlier statement in which I concluded that [7, p. 8]:  “All professions must not ignore unprofessional or misguided behavior.  Every member is responsible for balancing the ethical budget. Every member must live a shared responsibility and passion for growing the profession.”  Unfortunately, too little has been done for far too long [19].  To argue like athletes do about taking supplements, “everyone is doing the research” is not a serious argument at all to justify the practice.  It makes little or no sense to anyone except those who are in the supplement business. 

“Hello, wake up America” is an expression I have used in class and in writing about supplements and cheating in sports [20].  Perhaps, the expression should be:  “Wake up parents.”  Do you know what the industry has lined up for teenagers younger than 18 years of age?  That’s right, you guessed it.  Either they want them on the sports supplements or they believe taking the supplements is in the best interest of 10 or 12 year olds, and they have key sports nutritionists who are willing to promote the supplements [21].  This reminds me of a quote by Shirley M. Steele and Veram M. Harmon, “There comes a time when it is necessary to question, to argue, to challenge.”  Frankly, drawing a line in the sand is long overdue.  This ever-increasing use and promotion of performance enhancers can no longer be unquestioned or unchallenged.  The CEOs and managers of the industry, the owners of retail stores, and others (whether they are coaches, parents, athletes, trainers, researchers, sports nutritionists, or exercise physiologists) must be held accountable for their negative impact on athletics and society.  As I have said before [22, p. 8]:  “Supplements are not harmless.  Supplement contamination is real.  Many long-term side effects are yet to be determined.  The price tag is high.  Cheating is a problem.  Ethical thinking cannot be pushed aside.”

The impact of sports supplements on young athletes must be taken seriously by members of the exercise physiology profession.  The issues concern more than performance enhancement.  For example, is athletics already too far gone with many athletes competing on a drug cocktail?  Is there hope of stopping the use of drugs?  Will the scandals in sports get worse?  Is the breaking of records more important than the safety and character of athletes?  Is genetic enhancement by athletes [23] just a few years from becoming reality?  Will genetic manipulation of athletes become an issue in athletics?  Are parents interested in engineering the genes of their children to be taller, stronger, and faster athletes?  Is genetic enhancement in sports cheating?  Do sports nutritionists think gene doping is good for athletics?  The list of questions is long and getting longer (e.g., Are researchers now for hire?  Is biological manipulation good for sports?  Does anyone know where sports nutrition is going?)

I think it might not be unreasonable to conclude that certain sports nutritionists have lost their way.  These hustlers appear very interested in making big money and a name for themselves.  Some exercise physiologists believe they are hurting the professional image of exercise physiology.  If this is the case, it has to change.  Sports nutritionists who promote performance enhancers and/or sell out to the grantors are accountable for their actions.  In particular, the relatively new sports nutrition paradigm that endorses  supplementation must be held accountable for their the use of weasel words [24] (e.g., may enhance recovery or may benefit or it appears).  Jarvis [25, 26] points out that:  “When you hear a weasel word, you automatically hear the implication.  Not the real meaning, but the meaning IT wants you to hear.”  While the impact of the weasel words and misinformation is bad news for exercise physiology, it is big business for sports nutritionists and exercise physiologists. 

In 2003, the sports nutrition industry was a $2 billion a year business.  Tallon [27] believes that by 2007 the sports supplements revenue will be in the excess of $4.5 billion [27].  Much of the popularity with dietary supplements and ergogenic aids has resulted from the research of exercise physiologists [28, 29], which poses an ethical dilemma [29].  A message of disapproval toward all performance enhancing substances should come from the exercise physiology community to help the members of the profession deal with the ethical issues and the potential side effects of ergogenic aids.  In particular, the use of creatine as a nutritional supplement warrants investigation of those who promote it to people less than 18 years of age [30].  The use of creatine in people less than 18 years old should be discouraged because of the potential for adverse health effects [31].  Aside from being another high priced item that capitalizes upon the athletes’ wishful thinking, the only magic in the products is how easily the industry is making millions of dollars. 

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