The Sports Supplements Disagreement:
A Call for a Dialogue About Values and Obligations of University Teachers
Tommy Boone
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
“Tolerating dissent is an
essential means by which societies cope ith change.” -- Peter C.
Newman
Introduction
Unlike so many of the words writers use
to describe their profound understanding of a topic, it is less often the
use of words like “ethics” and “disagreements” that get your attention.
This is unfortunate yet necessary since human behavior is reflected in
words. Even more fundamental is the belief in a common meaning bound
by the understanding of the purest interpretation of fairness and honor.
Athletics is the definition of this belief or, at least, it used to be.
No longer are all athletes competing “head-on” free from sports nutrition
products. The promise of quick success has increased the use of hundreds
of sports nutrition supplements. Forget whether the products have
scientific support. Forget about the claims of superior performance.
Athletes are convinced that they cannot win without them. The assumption
is made that everyone is doing it, so it must be okay. Nutritional
supplements are said to help athletes get an “edge” and, as a result, the
sports nutrition market has flourished in the recent past. Revenue
is expected to reach $4.5 billion by 2007.
The problem is not any one single factor.
There are many problems with nutrition supplements, but hardly no one in
exercise physiology is cautioning the athletes that most claims do not
stand up to close scrutiny. Disagreement is a hard path to take,
even when it is clear that products are often mislabeled. Disagreement
is full of crooked turns, misunderstandings and, of course, the “search”
for the noble path. Seeking the truth often requires a time commitment
most university teachers do not have, but it does not slow many from trying.
And, so the question is whether or not the use of dietary “sports” supplements
is an ethical issue for athletes, regardless of their age, position, or
status. For me, the answer is obvious. Athletes are not supposed
to excel on the backs of supplements. However, for reasons all too
common, athletes are encouraged to believe their very careers are at stake
if they do not use drugs and/or supplements. Confirmation of this
belief is too easy, and anyone intimately connected with athletics knows
it. It would be foolish to believe otherwise and, therefore, the
term athletics has become commonplace with nutrition products. Coaches
and athletes who wish it were not true find themselves in disagreement
with those who believe it is okay. And, yet athletes are seldom aware
of being bombarded with countless fitness and abdominal products, exaggerated
ads for muscular development, and sleazy marketing tactics in almost every
type of media possible.
Despite widespread belief that it is okay
to use drugs and supplements to level the playing field, it is not the
only belief. Others disagree with all aspects of supplementation
that is reportedly necessary for special powers of the mind and/or body.
Those who continue to promote sports supplements through scientific research
may be remembered decades from now as unintentionally misleading and confusing
the public. Can the notion of scientific inquiry save them, especially
when athletes come to realize that supplements cannot replace motivation,
genetics, and training? The answer to this question is not likely
to be found among individuals who are emotionally and/or financially invested
in the fitness supplement industry. But, since the promotion of supplements
beyond the athletes’ normal diet has serious ethical, if not, legal implications,
the outcome is an evolutionary process. There is an immediate need
for answers to the following questions: “Who is responsible for adverse
effects resulting from ingestion of supplements to gain a competitive edge?”
“Should coaches, trainers, and exercise physiologists encourage the use
of supplements at the junior high and high school level?” “What are the
legal implications for coaches, trainers, exercise physiologists, and others
who encourage the use of supplements among adolescents and college-age
athletes?” There is a concern for safety when consuming unregulated
substances. Is the increased health risk of our young people worth
the use of ergogenic substances. Maybe, it isn’t smart to use drugs
or substances to get bigger, stronger, or to run faster.
Because of what I’ve published in PEPonline
and what seems to be an army of professionals who agree with Dr. Richard
Kreider’s point of view [1] and, for reasons fundamentally important to
the ethical dimension of athletics, it is important to remember that the
earth is not flat, that the purveyors’ beliefs and confirmation of sports
supplements are little more than someone’s else thinking, and that the
wonder of athletics and science still exists with a strong and important
ethical dimension. The evidence for this belief is the energy spent
by individuals worldwide who are not interested in giving medals to athletes
pumped up with “enhancers”. This is why the Canadian Centre
for Ethics in Sports (CCES) discourages the use of supplements, from both
a scientific and an ethical point of view. CCES states that evidence-based
research has not demonstrated clearly that dietary supplementation leads
to increased athletic performance. Moreover, if a particular supplement
does increase athletic performance, the supplement may provide athletes
with an unfair advantage over their competitors and may cause athletes
to test positive. Because of these issues, the CCES cannot support the
use of supplements and, therefore, does not support supplement product
endorsement by sport organizations.
In short, the problem is this: My
biggest surprise is the notion that my thinking ought to be dismissed because
it is not founded on science or a current perspective of the fundamental
issues of sports nutrition. And, yet the reflective educator is seldom
unaware of current realities. Even the Kreider and associates’ article
[1] state that “most” dietary supplements available for athletes just don’t
work. But misguided university thesis supervisors, academic exercise
physiologists, sports nutritionists, and others keep doing the research
hoping to find “significance”. There is the impression that if there
are no data to support a particular supplement, it is just a matter of
time. The researchers use terms and phrases, like “does not appear”,
“additional research is needed”, “these findings suggest”, “may have minimized”,
and “studies suggest” to keep the door open as if it works. The following
brief quotes from their article (with words in bold for emphasis)
illustrate the point [1]:
1. “Theoretically, BCAA
supplementation during intense training may help minimize protein
degradation…BCAA supplementation appeared to minimize loss of muscle
mass…these findings
suggest that BCAA supplementation may have some
impact on body composition.”
2. “…there appears to be strong
theoretical
rationale and some supportive evidence that EAA supplementation
may enhance protein synthesis and training adaptations.
3. “…glutamine supplementation…may
help to optimize cell hydration and protein synthesis during training…”
4. “…KIC, a branched-chain keto acid that
is a metabolite of leucine metabolism…may help minimize protein
degradation…”
5. “…it is possible that phosphate
could serve as a potential thermogenic nutrient…”
6. “…chromium supplementation does
not appear to promote fat loss.”
7. “…HCA supplementation does not appear
to promote fat loss in humans.”
8. “…more research is needed, most
studies show no ergogenic value of ribose supplementation…”
9. “…findings suggest that sodium
phosphate may be highly effective in improving endurance exercise
capacity.”
As pointed out in an article published in
PEPonline
[2], “…there is considerably more unknown about supplements than there
is known.” [p. 1] The phrases highlighted in bold are important
to scientific writing, but they should not be used to keep an idea alive
or to constitute a “declared” science when the actual science or rationale
doesn’t exist. This is obvious to most healthcare professionals who
stay current with the scientific literature. For example, refer to
#9 in which the authors use the word “suggest” which means a lack of either
(or both) a failure to reject the null hypothesis (but, instead, interpret
the data using trends) or a failure in reaching the same conclusion from
a variety of studies to demonstrate a definite connection (meaning, “these
data indicate that”) between sodium phosphate and endurance capacity.
Then, in the face of this dilemma, there is the paradoxical expression
“may be” followed by “highly effective”. This kind of writing is
not new in scientific research. However, it should be avoided as
much as possible. Researchers should state the facts. Either
the “treatment” (perhaps, a supplement”) resulted in a statistically significant
difference (e.g., an increase or a decrease in VO2 max) or it did not.
If it did not, then the treatment did not work. It is wrong to conclude
that although not significant, the trend was an increase in VO2
max and, therefore, “may be” highly effective in improving endurance exercise
capacity.
To teach is to always be in reflection
about most things. The most interesting of which are those things
that need the kind of thinking that university teachers do. It is
a deliberate action that is built into the teachers’ inquiry of research-based
material. Any topic that is uncertain, questionable, and especially
complex is analyzed; this is the work of skilled professionals. For
certain, my published articles on this subject are for one purpose.
That is, to offer another point of view for those who may have difficulty
with the drug and supplement issues that surround athletics. There
is the very real possibility that some exercise physiologists who have
not thought about the ethics of supplements will begin to question the
idea of winning at all costs. It is also logical that new ideas as
well as old ideas will be challenged. For example, optimizing training
through the use of supplements is not the same as using the exercise physiology
research literature to find the best method to train or when to stop training.
And, regardless of whether the advocates of sports supplements admit it,
it is still the right of every exercise physiologist to question the rules
of athletics, equipment used, and “smart training” through optimizing nutrition
beyond the kitchen table. Similarly, if a professional should take
the position that supplements lead to questionable use of illegal supplements,
it is not unfair at all to group dietary “sports” supplements in the same
discussion. Here, the question is the use of supplements by athletes
to level the playing field. It just doesn’t make sense to encourage
(if not teach) that it is okay to use supplements to optimize performance
and/or training adaptations. It is a short cut, and it is no different
from any one in an office environment cheating rather than following standard
procedures to do their work and to compete for merit pay or bonuses.
Both are unethical and both are not smart training or necessary preparation
for competition in business. This is best illustrated in the recent
accounts of doping, drugs, and dietary supplements that dramatically draw
our attention to the role of “being-the-best-at-all-cost” mentality.
The tragic death of athletes provides insight into how this mentality leads
to drastic measures and failed careers. Student-athletes should not
have to feel that they are failures if they should not win, that their
way of life is meaningless if they should experience signs of anxiety with
their body weight, or that the idea of intense perfectionism is required
of athletes. It is time to stop the crazy thinking that associates
with athletics. Every athlete ought to know that vulnerability to
failure is part of life.
“A 2001 national survey of 785
youths by Blue Cross/Blue Shield estimated that 1 million American 12-
to 17-year-olds (roughly 4 percent of that age group) take one or more
of the purportedly performance-enhancing sports supplements once aimed
largely at professional athletes and serious amateur competitors. For children
age 10 to 14, the estimate is 390,000 (about 2 percent of that age group).”
-- John Briley, Special to The Washington Post, 2002
The Language of Disagreement
The very nature of academic subjects and
published manuscripts makes occasional differences among writers inevitable.
The disagreements are most commonly found in exercise physiology
research. Indeed, the structure of scholarly writing is based on
different points of view. Disagreements are expected and necessary
for significant advances in any field of study. Most recently, Robergs
[3] published a report that is clearly a strong disagreement with the way
research articles are reviewed. Implicit in the article is the disagreement
with the peer review process itself; a review system that is defined by
an enculturation (and thus an almost blind acceptance) of the functionality
and unquestioned power of the gatekeepers in publishing scholarly work.
The article is not a confrontive disagreement in that no individual is
identified as responsible for the peer review schema that drives the scientific
paradigm. It is, nonetheless, a very strong statement of facts and
opinions. It is also an article with controversial information, based
on the existing data and personal convictions. And, it is about “character”.
Character counts. According to the Josephson Institute of Ethics,
the members believe that student-athletes should be educated about the
dangers of unhealthy drugs and supplements (including alcohol, tobacco
and recreational or performance-enhancing drugs and nutritional supplements).
The reality of most published work is that
personal and professional thinking is built into the structure of the story
telling. Organizing and writing an empirical report for an exercise
physiology journal is actually not that different from other types of writing.
In general, the overall purpose is to portray both a logical and linear
sequence of ideas and activities. The published version is valued
in its ability to influence the reader(s) to consider new ideas and new
models of thinking. Regardless of the authors’ academic specialty
or areas of personal research, what appears in print is a contribution
of one or more distinct points of view. Skilled writers understand
this point. They work at mastering both the rhetorical approach to
getting their point across to the reader and the stylistic nuances that
suggest to the reader the article is worth reading. This is not unusual,
wrong, or problematic since its attests to the functionality of discussing
different points of view.
However, what is clear is that not all
writers are willing to express their disagreement with ideas that have
become enculturated into their discipline. And, yet disagreement
can be (and often is) the stimulus to view a topic from a new perspective.
Different points of view are natural and desirable. This is obviously
the backbone to the analytical nature of scholarly writing. Hence,
to take issue with a writer’s alternative thinking or to not believe a
different view is possible is to fail to understand the rights of every
person and professional to disagree about most everything. Moreover,
to state, as Kreider has in his article [1] that “…the comments [referring
to my articles]…cannot be supported by the current scientific literature…and…that
much of the logic…is flawed…” is an unfair representation of my work.
My thinking is not so different on the subject of sports nutrition as other
subjects. Also, it is highly unlikely that my assessment is a glossy
report of just what I believe. Similarly, at first glance, to read
that authors (such as myself) “…should be careful that the opinions are
based on a thorough and comprehensive analysis of the literature so that
unfounded conclusions are not made…” took me by surprise. Disagreements
usually focus either on the empirical process that also includes the summary
and conclusions of published research or a consensus judgment about a topic
that calls for exploring options. The disagreements aren’t usually
directed to an individual per se. The article by Kreider and colleagues
is different in that they state my articles have “…served to alienate exercise
physiologists…have reflected poorly upon ASEP within the broader scientific
community….” [1]
Actually, my articles are about the rights
of individuals to disagree, especially when the existing data doesn’t support
an ethical rationale for using supplements. It is true that some
of the data supports the use of supplements from a physiological perspective.
But, just because some supplements may work does not mean that they are
appropriate in the first place. Also, it doesn’t take a rocket scientist
to figure out that a lot of the rationale for using supplements is not
supported by research. This is illustrated very nicely in the following
brief quotes from Drs. Melvin H. Williams and Brian C. Leutholtz’s chapter
in Nutrition in Sports entitled “Nutritional Ergogenic Aids” [4]:
1. “…amino acid supplementation
is theorized to stimulate the release of insulin…” p. 357
2. “…HMB supplementation may increase
lean muscle mass and decrease body fat…” p. 358
3. “Increased levels of 2,3-DPG could
facilitate release of oxygen…” p. 360
4. “…L-carnitine supplementation could
enhance FFA oxidation and help to spare the use of muscle glycogen, which
might
be theorized to improve prolonged aerobic endurance capacity.” pp.
360-361
5. “Theoretically, choline supplementation
will enhance acetylcholine synthesis and prevent acetylcholine depletion…”
p. 362
Note that the authors used the words “theorized,
may, could, and might” in their explanation of the purported
ergogenic effects of the supplements. To argue that athletes should
be allowed to use supplements when a significant volume of the research
is based on a theoretical rationale and/or expectation without solid scientific
confirmation is a well-recognized problem (even if a sound rationale exists).
Often times, the reader gets the impression that the research is a “fishing
expedition” [5]. As McArdle and colleagues point out their book,
Sports
& Exercise Nutrition, “It should occasion little surprise…that
supplemental iron enhances aerobic fitness in a group with iron-deficiency
anemia. The inference can not be drawn, however, that iron supplements
in general would benefit all individuals.” [4, p. 297] The indiscriminate
extrapolation of the conclusions from nutritional studies beyond the scope
of the research data is a concern. Often, in response to reading
dietary supplement research, the finding of statistical significance may
have little practical value. The omission of discussion concerning
this point, much like the failure to discuss the ethical issues of nutritional
supplementation, is not good science. And, as McArdle et al. [4,
p. 298] put it: “…an increase in anabolic hormone levels in response to
a dietary supplement reflect just that; they do not necessarily indicate
an augmented training responsiveness or an improved level of muscular function.
Similarly, significant improvement in brief anaerobic power output capacity
with creatine supplementation does not justify the conclusion that exogenous
creatine improves ‘physical fitness’.” This point ought to
be an “eye opener” about the supplement industry and the researchers’ pursuit
to press forward with their own view at all costs of sound research and
reasoning.
Whether nutritional supplements work or
not, they should undergo the same exact analysis as other research topics
and areas of interest. Just because sports nutritionists believe
in using drugs to enable athletes to train harder and recover faster doesn’t
automatically make it right. In my opinion, there is a very small
jump from legal drugs and supplements to illegal drugs and supplements.
Using the scientific method to break the spirit of athletics or to argue
the use of drugs for ergogenic purposes is an ethical problem. The
exact degree to which it is a major ethical problem remains to be answered,
but it will be answered. There are too many high school and even
junior high school athletes using drugs and supplements. They have
been led to believe that they must do so to be competitive. The very
scientists who know that “…despite scant ‘hard’ scientific evidence indicating
a performance-enhancing effect of many of these chemicals” [4, p. 306]
promote their use even when, in time, some will be officially in violation
of the principles of fairness and openness in sports.
Yes, without question, there are serious
legal and ethical implications to using nutritional supplements.
Just because they are assumed to be safe and legal today is not enough.
Deception by omission of the examination of ethical issues is problematic.
In short, the question: “Is it ethical?” needs answering, too. To
also argue that supplements are necessary to improve performance is to
argue for an understanding of the science of supplements that doesn’t exist.
There is too much unknown about most supplements, especially those that
appear as advertisements in Muscular Development and other popular
bodybuilding magazines. The potential “…for fraud, financial waste,
and possible harm in the expanding marketplace for ergogenic aids…” [4,
p. 298] is extremely high. Many professionals believe it has gotten
out of hand. The likelihood of negative effects, mental and/or physical
discomfort, and the threat to the very lives of the athletes is increasing
exponentially with the ever-present acceptance of ergogenic substances.
To argue that my articles have reflected
poorly upon ASEP is to make a case for something that doesn’t exist as
well. It is unfortunate that researchers outside of the sports nutrition
field can’t have their own opinions. For example, if I were to say
that numerous dietary surveys of athletes indicate that the vitamin intakes
of all but a small percent of athletes exceed the RDA levels, someone would
say that seldom do athletes consume a well-balanced diet. The conflict
lies not with my disagreement with supplement usage, but with the fact
that a certain percentage of the exercise physiologists interested in sports
nutrition recommend supplements. It is therefore no surprise that
pharmaceutical manufacturers wine and dine exercise physiologists who believe
they need the money for research. In the never-ending quest for more
grants, there is also the company’s need for more financial profits fed
by the seemingly endless series of products. The claims for superior
performance are “…often dubious, ill-founded, unproven, or abysmally deficient
of scientific merit.” [6, p. 523]
It is not logical or right that a commonly
accepted way of thinking (e.g., sports supplements) cannot be contested.
Exercise physiologists, as researchers, collect and analyze data all the
time. They study the research design, the data collection and statistical
analysis procedures and whether the conclusions are warranted. They
may even disagree with the authors of the related literature or the manner
in which the authors interpreted the data. To disagree with the authors
or to think differently from a commonly accepted view about a topic is
not a problem when the focus of the published work is on empirical details.
To disagree with conclusions that extend beyond the data is required of
all educators and researchers. Similarly, to disagree with the authors’
over-use of hedged wording (e.g., tend, suggest, and may) is appropriate
(especially when the words are used to emphasize a response that did not
reach statistical significance). The process of change dictates an
openness to challenge existing thinking. Any dialogue that furthers
the identification and analysis of factors that help facilitate self-determination
is an important process of empowerment.
Teaching as Persuasion
For the vast number of exercise physiologists
who engage in teaching, they go about it without reflecting on the nature
of cognitive development and the educational process. It is a rather
straightforward responsibility of covering the material, whether it is
the physiology of women training, altitude training, cardiovascular responses
to different forms of exercise, or one of a hundred other topics.
Certainly, the idea that teaching “…is a process of persuasion” [7] whereby
professors systematically alter beliefs and attitudes is seldom discussed.
But, on many occasions, the classroom is exactly what the university teacher
wants it to be. Using it to systematically teach historical beliefs
or new ideas is not presently a controversy (i.e., as long as teachers
are collectively in agreement about a topic, belief, or value). Strangely
though, the important thing about academics is that teachers are often
times not taught to be “constructive discontent” thinkers. The secret
of staying ahead of the game is unknown to many teachers. They fail
to listen and learn and, where necessary, to change. The simple truth
of the matter is that change is hard to do, especially when it requires
giving up well-accepted and comfortable thinking.
This difficulty raises several important
questions: “What is the purpose of the students’ education?” Is it
to think just as the teacher thinks or is it to learn how to think?
Parents are seldom aware of what goes on in the university setting.
Most probably believe their sons and daughters are being taught how to
think and not what to think [9]. Said somewhat differently, how do
teachers teach without systematically causing students to think as teachers
think? And, even if teachers are fully aware of the subtlety of presenting
just the facts, the act of teaching itself is a definite form of persuasion
when teachers influence students’ attitudes and beliefs to embrace a particular
point of view about a topic. Of course, teachers can present a view
that is very convincing without knowingly trying to be persuasive.
Here again, the use of persuasion isn’t acceptable or is it? Perhaps,
it is only manipulative when conflicts are not addressed when there is
a lack of a balanced and objective presentation of material. Perhaps,
it is logical that students should be free from ideas driven by grants
funded by specialized forces within the industry. Still others have
questioned the role of ethical issues in the context of teaching and organizational
development [9-11].
“When vision, standards, and a
strong, visible show of support from the leadership for practicing ethical
behavior is lacking, any corporate culture — including a legal organization
— can prove to be a breeding ground for unethical behavior. Conversely,
given the proper framework and show of support from the top, the corporate
culture can be the venue to foster ethical behavior by an organization’s
employees.” -- Michael G. Daigneault, Ethics Resource Center 1996
Many teachers believe that persuasion is a
critical component of university teaching. They see nothing wrong
with altering students’ attitudes, beliefs, and behaviors. From their
perspective, university teachers are supposed to influence what students
think. They believe that, as long as they don’t lie to the students,
they come across as dispassionate purveyors of the truth. As long
as they don’t misrepresent the truth, their behavior is not questioned.
Yet, they have the professional obligation to organize class lectures and
content that accurately reflects a consensus of opinion. And, where
appropriate, teachers are expected to present alternative, dissenting views
[7]. Teaching is enormously complex and, thus what is expected of
university teachers is critical inquiry.
As a course, sports nutrition (or as McArdle
et al. prefers, exercise nutrition) would appear to be no different from
sports physiology, sports psychology, or sports biomechanics. This
belief is misleading, however. The difference is that exercise nutritionists,
who are generally exercise physiologists, teach sports supplements as if
the athletes’ very performance is dependent on the supplements. From
reading the literature, it appears that exercise nutritionists seldom advance
the notion that the use of supplements may be wrong, which raises the question:
“How, then, can students and/or athletes come to understand the truth when
their very attitudes, beliefs, and behaviors are changed from within the
context of teaching?” There isn’t a quick answer. Most teachers
are hopeful that, with an objective analysis of the research articles and
other published accounts on the subject, student-athletes will avoid supplements.
On the other hand, when students are not taught both sides of an issue,
there is the real possibility that the lectures involve some form of persuasion.
This is a problem that has been addressed best by Friedrich and Douglass
(1998), who wrote: “Not only should instructors help students weigh
special bias or opinion in source materials….the object of such a strategy
is not to indoctrinate students but rather to encourage them to see the
affective, personal dimension to knowledge and to develop in them the habit
of critical consideration of all sources. By the same justification,
instructors should disclose to students their…persuasion agendas.” [7,
pp. 554-556]
Willingness to Tolerate Honest Answers
In the May, 2002, issue of PEPonline,
I published the “Exercise Physiology Quackery and Consumer Fraud”
article [12]. It should be recognized that my statement regarding
protein (i.e., “It is obvious or it should be that athletes meet the high
protein requirement through their diet, not through supplementation.
To argue otherwise is groundless and scientifically not a plausible rationale.”)
is supported by Lowenthal and Karni [13]. Kredier and associates
[1] state that my statement about protein is misleading if not unethical.
Their belief is said to be based on the notion that I am “…not …aware of
the scientific literature…” and have, therefore, made “…blatantly or false
statements….” They failed to understand that my statements are based
on previously published literature. For example, I used Powers and
Howley [14, p. 443], Wolfe [15], and Eichner [16] to support my statements
about protein. They stated that: “The scientific data provide no
rationale for increasing protein intake when exercising.” Here
again, I pointed out that: “The real question is whether the athlete who
engages in strength training is eating a nutritiously balanced diet to
begin with….” Brotherhood [17] concluded that the ‘average athlete’s
diet is about 16% protein. This value exceeds 1.5 g/kg/d or the equivalent
of 88% more than RDA [13]. It would have been better had Kreider
and associates not implied that “I had not done my homework” or that “…opponents
of nutritional supplements and ergogenic aids are either unaware and/or
ignorant of research supporting their use [1]. For example, I quoted
Robergs and Roberts [18] and Fogelholm [19] who, in short, stated that:
“no research evidence exists to support the claim that added vitamins increase
exercise performance.” Of course if Kreider and associates want to
believe that what I’ve written “makes little sense” – so be it. It
is unfortunate they agreed to put their name on an article that fails to
adequately address the specificity of the issues and concerns discussed
in the “Quackery…” article. This is part of the reason why
the article was written in the first place.
In my more recent article, “Dietary
‘Sports’ Supplements: The University Teacher’s Role in Teaching Values”
[20], I wrote the following: “While it is important to teach sound sports
nutrition, it is an ethical problem to teach students and athletes that
it is okay to take supplements to level the playing field. Or, is it unethical?”
[p. 1] Please note that I asked a question! “Exercise
physiologists ought to be teaching that it is wrong to substitute supplements
for athletic training.” [ p. 1] It seems highly unlikely that
any one could disagree with the statement. “Who among exercise
physiologists is analyzing the ethical questions that surround sports supplements?
Is there an ethical problem with the use of supplements? Or, does
it become an ethical problem only when the supplement becomes illicit or
banned or when an athlete dies?” Here again, I asked several questions!
The content of the article is a fair statement of the ethical concerns
that exercise physiologists face in the months and years to come.
There is nothing about it that is inappropriate or false. It represents
my personal and professional feelings and beliefs about athletics, professionalism,
and the ASEP organization.
Frankly, every author of the Kreider statement
[1] should be concerned that much of what is in the “introduction part
of their article” in regards to what I’ve written has either been taken
out of context or misinterpreted altogether. As leading researchers
and educators in the exercise nutrition field, they should take the time
to analyze the impact of what they agree to (given their names on the paper).
Students who read the article and cross compare it with my articles will
be surprised with the authors’ critical approach to what I’ve written.
Also, the authors’ decision-making in what they have agreed to define as
their professional choices has subsequently uncovered their focus on the
use of supplements above and beyond the value that many people place on
athletics. For me personally, sports is a way of life; it gives direction
and, to a large degree, sports make a difference in the mental and emotional
development of the participants. To encourage supplement usage as
the law of the land without considering how it affects a cherished part
of our culture is troubling.
Although it is obvious that personal values
and professional values are not always consistent, the stated beliefs of
Kreider and associates [1] cause me to ask the following questions: “Are
they going to purchase the unproven and unscientific supplement products
for their children? Do they believe it is important that their children
take supplements to play high school football or to participate in track?
What about college gymnastics for those who have daughters, “Is there a
conflict with their 18 or 20-year old talking supplements advertised in
Muscular
Development?” The importance of values cannot be overlooked,
for they are part of what we are, what we say, and what we teach.
Therefore, an exercise physiologist, such as myself, has an absolute right
not to participate in a situation, such as the approval of athletes using
legal drugs and/or supplements to enhance athletic performance, which violates
my personal values. Maybe other members of the Kreider article will
share their thinking in the PEPonline
electronic journal. ASEP members need to know what others are thinking.
For example, I found it interesting that one member of the Kreider article,
Dr. Tim N. Ziegenfuss, stated the following on the Internet: “Athletes
under 18 years of age should never be encouraged to use supplements because
their use degrades the ethics of sport by fostering the "win at all costs"
mentality.” For certain, everyone benefits with more information
about how we should think about exercise nutrition 5 or 10 years from now.
We need it for survival as an emerging profession, and we need to make
good choices in what we do and how we think. Instilling values that
make a difference is important. It is our responsibility, as members
of the emerging profession of exercise physiology, to influence the values
held by its members to be sure that the values exemplify the ethical dimensions
of the profession.
Understanding Ethical Behavior
I must admit, although I’m sure it must
be obvious, my education in ethics is limited. While I may have incorrectly
linked certain ideas in past writings, the intent has been always to understand
exercise physiology as a “healthcare profession”. It is not a specialized
area of study (like exercise nutrition or cardiac rehabilitation), but
a complete profession with knowledge and responsibility over health, fitness,
rehabilitation, and athletics issues and concerns. ASEP members,
in particular, and interested readers, in general, should therefore “understand”
that the purpose of the PEPonline articles
is to move exercise physiology from a technician school of thought to a
“practice” of exercise physiology. When this thinking becomes a shared
vision, exercise physiologists will think in terms of standards of practice
and a code of ethics. One reason for what I’ve written in regards
to exercise nutrition is my interpretation of the ASEP Code of Ethics.
Another reason is the personal dilemma I have with the worldwide use of
drugs, particularly as they relate to influencing athletic performance.
Personally, for me, there is one and only one way to compete in athletics,
and it has everything to do with what you are as an athlete. Playing
within the rules is important, but also important is what the athlete comes
away with after the sporting days are over. For me, that “special
something” (or, if you will, sense of pride and strength of character)
is more important than the deception that associates with the business
of athletics driven by the drug (legal and illegal) and supplement culture.
The problems of questionable practice arise from within a profession linked
to a code when its members give themselves authority to define what is
acceptable, unacceptable, safe, unsafe, ethical, or unethical practices.
This has, in my opinion, evoked mixed emotions among many who are uncomfortable
with coming forward with their feelings. The lack of a moral objection
and discussion of concerns with drugs, supplements, and athletics has fueled
the “theoretical” notions that lubricate the economic and research dimensions
of research and athletics.
Since individuals make decisions based
on their personal level of moral development, my ethical views are probably
considered a very narrow analysis. Perhaps, it is time for exercise
physiologists who use supplements and drugs to influence their physical
development to come forward and discuss their self-chosen ethical principles.
Throughout history, individuals have fought extensive battles to safeguard
ideas and ways of living. It is probably too much to expect other
exercise physiologists to become serious stakeholders in the cleaning up
of athletics. This conclusion is supported by the lack of published
articles, chapters, and books about the ethics of athletics and, of course,
the lack of having a professional code of ethics until 1997. This
doesn’t mean that others aren’t writing about the ethics of competition.
They are, but they are not within exercise physiology and, for certain,
they are not members of the ASEP organization. Simply put, this understanding
is shared with the reader only to convey what I believe is a serious problem
in exercise physiology. Those who are invested in the exercise nutrition
subject matter don’t see it as a problem having ethical dimensions.
For them, it is what they do. They believe their research justifies
the use of ergogenic aids. It is not hard to see why they think this
way. After all, exercise nutrition has become, for many, an economically
and politically valued area of study to which the actions of some call
into question the integrity of their own reputations. And, when left
unchallenged, their motives and/or actions also call into question the
integrity of the profession.
At the gut level, this is the reason for
my articles on ethics, values, critical reflection, and athletics.
Professional ethics need to be discussed, and opinions need to be presented.
If university teachers cannot be believe as fair and open minded leaders,
who will students believe? On a personal level, have many of us have
pressed a particular point to the exclusion of alternatives to get our
views across? Distortion of the truth in the form of confirming one’s
bias, however inadvertently or intentionally, is still distortion and not
an education. Quite simply, exercise physiologists cannot give in
to a popular belief or a historical view if it violates the ethics of the
profession (in this case, both the profession of education and exercise
physiology). Yet, many teachers do just that and more. They
not only give in to the arguments of the powerful, they popularize their
thinking by teaching their beliefs. The obligation to critical self-expression
is not taught at the doctorate level. Intellectual honesty and “how
to” teach are seldom taught. Teachers fail to lecture on integrity
of professional conduct or ethical standards. All of this is a statement
of what is to change as exercise physiologists mature in their understanding
of the dignity of others, especially their responsibility as professionals
to act as professional.
Concluding Remarks
Critics of the articles I’ve published
on the PEPonline journal can go on
criticizing me. I have no problem with that. I’m doing what
I believe is correct, and I’m personally challenged to find integrity in
athletes who win on drugs, supplements, and God only knows what else.
I guess, in all fairness to Kreider and his co-authors [1], until ASEP
members argue strongly for a Code of Ethics to guide them, then, in actuality
the Code doesn’t exists. What they have agreed to is summed
up in the following expression: “When in Rome, do as the Romans.”
This type of thinking suggests that exercise physiologists who are exercise
nutritionists and interested in athletes will do as athletes have done
for centuries to ensure that they win. This type of demarcation of
their version of what is right sets them apart from those who disagree
with them. On their behalf, it is correct to point out that, according
to Von der Embse and Wagley [21], ethics is defined “… as the consensually
accepted standards of behavior for an occupation, trade, or profession
and morality, in contrast, is “…the precepts of personal behavior,
based on religious or philosophical grounds.” [21, p. 76] I’ve written
about both, and others have too [22]. Take, for example, the words
(and questions) of Dr. William O. Roberts, a clinical associate professor
at the University of Minnesota and a charter member of the American Medical
Society for Sports Medicine:
“Is it ethical to pursue performance
enhancement outside the traditional mix of hard work, skilled coaching,
genetic gift, proper training, proper rest and recovery? Should a
substance like creatine be advocated to gain an edge over an opponent,
or have these substances become necessary to maintain a level playing field
with the school across the tracks? Finally, should potentially unethical
behaviors be tolerated, much less endorsed, by coaches in the youth sports
setting? If a substance like creatine is recommended, can you as
a coach give an adequate and informed discussion to allow both the parents
and athletes to make a reasonable decision regarding the use of the substance?
Since youth coaches deal mainly with minors, informed consent must be presented
to both the parents and the athletes. How should an informed consent
be given to families and players? Who should be informed first?
What are the legal implications if the informed consent is given and accepted
by the parents, or if informed consent is omitted, and something goes wrong
during the substance use? Is the sports program liable or does the
liability fall on the shoulders of the coaching staff? [23, p. 2]
ASEP is about the professional development
of exercise physiology as a healthcare profession. The Board of Directors
must be concerned about issues that influence how other healthcare professionals
view the “Society”. Position and status per se do not offer the right
to perfect freedom to embrace an idea without considering its limitations
as well as its strengths. University teachers, like members of the
ASEP organization, have the responsibility to share knowledge with some
ground rules for moral debate and scrutiny. The uncommon view should
be taught along with the common view. The opportunity to disagree
in itself is how professionals grow in their thinking. Classroom
lectures and content should be tailored to the changes that reflect society’s
concerns with ethics, morality, and values in athletics. Therefore,
the impulse to avoid discussing both sides of the ethical dimension and
implications for athletics and sports nutrition must be evaluated.
A “beginning” for discussion of the ethical issues of using performance-enhancing
substances that are not banned and the controversy that surrounds nutritional
ergogenic aids has been laid out in the PEPonline
articles. A meaningful dialogue about values and obligations should
follow to promote professionalism. We don’t want to inadvertently
pass the wrong message to ASEP members and/or athletes that the drug and
supplement debate only has one dimension to it, to win at all costs!
Exercise physiologists must take a long hard look at the contradictions
and tensions that exist within sports nutrition. I think it would
be fruitful for ASEP to develop a common ethical stance regarding drugs
and supplements by members of the ASEP organization. The building
of character, regardless of age, but particularly important with young
athletes, the development of virtues, and the implications of dealing with
challenges in sports and life in general are among the highest reasons
we value athletics.
In summary, this article is not intended
to create a divide between those who encourage supplement use and those
who do not. The purpose throughout the article has been to introduce
an ethical dimension to nutrition supplementation and to raise important
questions so others can begin to reflect on where they stand on this issue.
While I appreciate that our views are seldom black and white, there is
the opportunity to reach a consensus or, if you will, come to agree on
the gray areas of exercise nutrition. The most important thing is
not necessarily to take sides, but to come together and do what is right
for our student athletes and, yes, what is right for the professional development
of exercise physiology. In the ideal professional environment, there
are members of a discipline who represent a community of professionals.
Among the community members there are leaders who have views that are congruent
with the professional development of their field. When the views
reach a critical point of distinction, the reality is that a new leadership
emerges. This new leadership has a perspective that is aligned with
the new emerging philosophy that defines the new community of professionals.
The resulting outcome is a fresh and decisive style of thinking and reacting
to everyday problems. Driven by solutions and empowered by their
new control, the community leaders achieve their goals by communicating
a new paradigm. It is a process that shapes organizational leadership.
“Ethical compromises in sports
will continue as long as fans tolerate them. Scandals and shortcomings
are tolerated as part of the way sports "work." Raising awareness would
mean that fans first have to admit there is a problem and then have to
demand that the problem be fixed.” – Jerry Brown, Ethics Resource Center
/ Ethics Today 2003
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