5 Aug, 12 | by Karim Khan
I’m pleased to see Professor Lippi’s opinion piece on Oscar Pistorius in BJSM’s Online first , as it is a very important topic and the BJSM is a very appropriate forum to publish on this debate. Much of the article is a good neutral overview of the parameters of this debate. However I disagree very strongly with some of the conclusions made. In particular this section:
“If we all agree—as we do, indeed—that whatever artificial addition on athlete’s body shall be considered unfair or even illicit (the ban of the bathing suits that enhanced swimmers performance is a paradigmatic case), then, prosthetic technology should follow the same route. Beside the fact that Pistorious’s running performance may be higher, the basic dynamics has been definitely proven to be grossly different from that of intact-limb sprinters, and he should not be allowed to race in the Olympics, whereby his natural field remains the Paralympics.” 
Firstly, I don’t think that there is universal agreement that “all artificial aids should be illicit”. What is a running shoe other than an artificial aid? It is simply an artificial aid that everyone is allowed to use (although different brands, which surely have different biomechanics, are allowed and chosen). Equestrians are allowed saddles, cyclists are allowed helmets that reduce drag and footballers can wear studs on their boots to improve grip on grass. Artificial aids are available in many sports and we debate and regulate depending on a combination of scientific argument and consensus opinion. We also debate whether caffeine, pseudoephedrine and salbutamol should be on the banned substances list and sometimes change our minds. Lippi points out that the decision was made to ban ‘fast swimsuits’ as if this was the only decision available, when of course it is easy to envisage a scenario where this decision could have been determined with the opposite outcome and we all just accepted better technology. We accept that modern golf balls and clubs allow the ball to be hit further than previous versions, even though many have made the argument to limit this technology. These are all decisions on artificial aids, not automatic choices where we have only had one option.
I don’t think it is an established ‘fact’ that Pistorius has biomechanical advantages over able-bodied runners which outweigh his disadvantages. Obviously there are respected biomechanics experts who have quantified advantages that he does have, 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, but why do able-bodied runners post faster times in every discipline than amputees using artificial limbs over the same distance? In vitro science is fallible. I imagine that a motivated biomechanist could present an in vitro study suggesting that a running shoe would make you run slower compared to bare feet or a physiologist similarly that women had a theoretical advantage in the marathon than men. You wouldn’t need better science to mount a powerful counter-argument – why don’t barefeet athletes (since Abebe Bakila) win running events or women beat men? If amputee runners were consistently beating able-bodied runners then the science alleging an unfair advantage to Pistorius would have a lot more weight. Let’s face it, science can’t yet tell us whether Nike shoes lead to more injuries than Asics shoes or even lead to faster running (even though we could actually do RCTs on these hypotheses, which is not available in the case of amputee athletes) and we need to be humble about what the limits of scientific analysis are.
If the jury is still 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 cut off his own legs in order to try to improve his times, then you could mount a very good ethical argument that he should be excluded (in order to discourage others from following suit). He is in fact the opposite – one of the most inspirational athletes of all time. Where biomechanics can’t give us a foolproof answer, we need to judge this based on our ethical preferences, just as it was decided to ban fast swimsuits, but to keep caffeine legal. Just as the golf authorities will decide whether or not long putters stay legal or become illicit. Just as we decide whether drug cheats should get a 1, 2, 4 year or life suspension. The key question is “what do we want the Olympics to look like?” We decide that you can’t compete in the Olympic marathon in a wheelchair because we don’t want the Gold, Silver and Bronze medals all going to wheelchair athletes. That is a value judgement. If amputee runners were winning every medal at the Olympics, I would be comfortable with a decision that banned them from the events before we did start to get lunatics chopping their legs off to compete. At the moment we have a single amputee runner (Oscar Pistorius) who is internationally competitive in the able-bodied 400m but nowhere near as fast as Michael Johnson, the world record holder. Do 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 at the Olympics, but that we decided to exclude Pistorius from the same event because we thought he had an unfair advantage that we weren’t comfortable with. I am very relieved that the IOC didn’t exclude him. It has already been shown, however, in the Pistorius case, that it is possible to change the rules (from Pistorius being ineligible in Beijing to eligible in London). The “thin edge of the wedge” argument can be countered with the obvious – if Pistorius, or any other amputee athlete, starts beating world records by huge margins, there is 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, Abebe Bakila, Bob Beamon, Mark Spitz, Nadia Comanici, Cathy Freeman, Steven Redgrave, Michael Phelps and Usain Bolt.
All of these athletes make the list because of the Gold medals performance that they have put in. Pistorius is possibly the only non-Gold medallist who belongs in such an esteemed list. Most importantly I believe he will have a greater impact on the world than any of the other legends, in that he may lead to a completely 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 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 on this topic. (Retweeted 21 times in first hour it was up)
John Orchard is an Australian sports physician who has worked with numerous professional team sports. His sometimes controversial views are personal and not necessarily representative of organisations he is affiliated with. You can read more at www.johnorchard.com and/or follow @DrJohnOrchard on Twitter
Professor Lippi whose article in Italian can be found here