High altitude, enhancement, and the ‘spirit of sport’

ABSTRACT The World Anti-Doping Code (2021) includes a substance on the prohibited list if it meets at least two of the following: (1) it has the potential to enhance or enhances sport performance; (2) it represents an actual or potential health risk to the athlete; (3) it violates the spirit of sport. This paper uses a case study to illustrate points of tension between this code and enhancements that are appropriate to ban; we argue that there are banned drugs (e.g., acetazolamide and dexamethasone) the use of which we have good reason to not only permit but encourage for high-altitude sports. Drawing on lessons from this case study, we propose a reformulation of the Code that requires (1–3) be met but offers preferable ways of unpacking conditions (1) and (3) – and in a way that better preserves how the spirit of sport condition should be indexed to particular sports. Our formulation is inclusive enough to rule in drugs like acetazolamide and dexamethasone as permissible in high-altitude sports while at the same time ruling out problem cases – including many drugs already on the prohibited list. The result is an attempted alignment between the conditions specified and those drugs that should be banned.