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BJSM blog social media leading SEM voice Blog Archive The legality of Pistorius
I'm pleased to see Professor Lippi's opinion piece on Oscar Pistorius in BJSM Online first [1],[link widoczny dla zalogowanych], because it is an essential topic and the BJSM is a very appropriate forum to write about this debate. Much of the article is a good neutral summary of the parameters of the debate. However I disagree very strongly with some of the conclusions made. Particularly this:
"If all of us agree-as we do,[link widoczny dla zalogowanych], indeed-that whatever artificial addition on athlete body shall be considered unfair or even illicit (the ban from the swimsuits that enhanced swimmers performance is a paradigmatic case), then, prosthetic technology should follow the same route. Near the proven fact that Pistorious running performance may be higher, the basic dynamics has been definitely shown to be grossly different from those of intact-limb sprinters, and that he shouldn't be allowed to race in the Olympics,[link widoczny dla zalogowanych], whereby his natural field continues to be Paralympics." [1]
Firstly, I do not think that there's universal agreement that "all artificial aids ought to be illicit". What is a running shoe apart from an artificial aid? It's just an artificial aid that everyone is permitted to use (although different brands, which have actually different biomechanics, are allowed and chosen). Equestrians are allowed saddles, cyclists are permitted helmets that reduce drag and footballers can wear studs on their boots to improve grip on grass. Artificial aids can be found in many sports and we debate and regulate based on a mix of scientific argument and consensus opinion. We also debate whether caffeine,[link widoczny dla zalogowanych], pseudoephedrine and salbutamol should be about the banned substances list and sometimes change our minds. Lippi highlights the decision was made to ban 'fast swimsuits' as if it was the only real decision available, when obviously you can easily envisage a predicament where this decision might have been determined using the opposite outcome and we all just accepted better technology. We believe that modern baseballs and clubs allow the ball to become hit beyond previous versions, even though many make the argument to limit fraxel treatments. These are all decisions on artificial aids,[link widoczny dla zalogowanych], not automatic choices where we now have only had one option.
I don't believe it is a recognised 'fact' that Pistorius has biomechanical advantages over able-bodied runners which outweigh his disadvantages. Obviously you will find respected biomechanics experts who have quantified advantages he comes with, but there remain multiple unknowns with respect to the disadvantages. The counter-argument that Pistorius and his supporters (including myself) make is: you can have as much 'in vitro' science as you like, why do able-bodied runners post faster times in each and every discipline than amputees using artificial limbs within the same distance? In vitro science is fallible. I imagine that a motivated biomechanist could produce an in vitro study suggesting that a running shoe would make you take slower when compared with bare feet or a physiologist similarly that women had a theoretical advantage within the marathon than men. You wouldn't need better science to mount a strong counter-argument - how about we barefeet athletes (since Abebe Bakila) win running events or women beat men? If amputee runners were consistently beating able-bodied runners then your science alleging an unfair advantage to Pistorius might have a lot more weight. Let's face it, science can't yet inform us whether Nike shoes lead to more injuries than Asics shoes or even result in faster running (even though we could actually do RCTs on these hypotheses, which isn't available in the situation of amputee athletes) and we have to be humble by what the limits of scientific analysis are.
When the jury continues to be out on whether Pistorius has an unfair advantage then he deserves the benefit of the doubt. If he was a completely crazy second tier able-bodied athlete who had stop his own legs in order to attempt to improve his times, then you may mount a very good ethical argument that he should be excluded (in order to discourage others from following suit). He's actually the opposite - one of the very inspirational athletes ever. Where biomechanics can't provide us with a foolproof answer, we need to judge this depending on our ethical preferences, just like it was chose to ban fast swimsuits,[link widoczny dla zalogowanych], but to keep caffeine legal. Just like we decide whether drug cheats should obtain a 1, 2,[link widoczny dla zalogowanych], 4 year or life suspension. The key real question is "what will we want the Olympics to look like?" We decide that you cannot compete in the Olympic marathon in a wheelchair because we do not want the Gold, Silver and Bronze medals all likely to wheelchair athletes. That's a value judgement. If amputee runners were winning every medal at the Olympics, I'd be comfy with a decision that banned them in the events before we did start getting lunatics chopping their legs on compete. Right now we have a single amputee runner (Oscar Pistorius) who is internationally competitive within the able-bodied 400m but nowhere near as fast as Michael Johnson, the world record holder. Will we want this sort of athlete in the Olympics? I can't comprehend an ethical world where it could be determined, ethically, that LaShawn Merritt could return from a drug suspension in time to compete in the 400m in the Olympics, but that people decided to exclude Pistorius in the same event because we thought he'd an unfair advantage that we weren't comfortable with. I'm very relieved the IOC didn't exclude him. It has recently been shown, however, in the Pistorius case, that it's possible to alter the guidelines (from Pistorius being ineligible in Beijing to eligible working in london). The "thin fringe of the wedge" argument can be countered with the obvious - if Pistorius,[link widoczny dla zalogowanych], or any other amputee athlete, starts beating world records by huge margins, there's every opportunity to change the rules once again.
Personally I would rank Oscar Pistorius amongst the most significant Olympic athletes of all time, alongside Paavo Nurmi, Jesse Owens, Dawn Fraser,[link widoczny dla zalogowanych], Abebe Bakila,[link widoczny dla zalogowanych], Bob Beamon, Mark Spitz, Nadia Comanici, Cathy Freeman,[link widoczny dla zalogowanych], Steven Redgrave,[link widoczny dla zalogowanych], Michael Phelps and Usain Bolt.
All of these athletes result in the list due to the Gold medals performance that they have place in. Pistorius is possibly the only real non-Gold medallist who belongs in such an esteemed list. Most importantly I believe he will possess a greater effect on the planet than the other legends, for the reason that he may lead to a different vision we have of 'disability'. I will explore this possibility in my upcoming Dr J. column in Sport Medicine Australia's magazine Sport Health insurance and co-publish it on the BJSM Blog in the near future.
Lippi G. Pistorious at the Olympics: the saga continues. Br J Sports Med doi:10.1136/bjsports-2012-091545
See also medical student Abhishek Chitnis BJSM Blog about this topic. (Retweeted 21 times in first hour it was up)
John Orchard is an Australian sports physician who has caused numerous professional team sports,[link widoczny dla zalogowanych]. His sometimes controversial views are personal and not necessarily representative of organisations he is affiliated with. Your submission is going to be considered and you will be contacted prior to the submission gets posted,[link widoczny dla zalogowanych].
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