LPI and the Negative View of Enhancement: Empirical Data

Based on previous research (e.g., Caviola et al.6, Faber et al.7, Faulmuller et al.8, Schelle et al.9), we thought it likely that LPI may be fueled by the public’s negative attitude toward pharmacological performance enhancement. In contrast to previous studies that presented hypothetical scenarios to the participants (e.g., Scheske and Schnall10) or subtly alerted participants to possible concerns (e.g., Forlini and Racine11), we wanted to investigate which concerns over the use of enhancement lay people raise (1) given the actual current status of enhancement in society (i.e., its current medical development, social distribution and acceptance, existing legislation, etc.) and (2) without being prompted to any specific concern in advance.

To this end, we conducted a survey in a controlled laboratory setting that included 102 university science students (72 female, 30 male) with a mean age of 22.7 years. Our questionnaire contained a neutrally phrased description of pharmacological enhancement, which stated that some medical substances that were initially developed to treat disease can also improve performance in healthy individuals. To avoid raising concerns that may otherwise not have occurred to our participants, we stated our questions in as indirect and neutral a manner as possible: “In what kind of situations should healthy people take performance-improving substances, if any? If they should not take them, please explain why.”

Participants were handed the questionnaire and were asked to write down their responses. To ensure coding reliability, participants’ written answers were coded by two trained independent coders and then analyzed using a content analysis technique that arranged answers into clusters of similar content; the frequency of answers in each cluster was then determined. The two coders concurred in 90% of cases; in the remaining 10% of cases, they reached agreement after discussion. Using this qualitative research approach, we cannot ascertain the causal relationship between specific concerns—for instance, whether competitive fairness would still be an issue even if distributive fairness could be assured. However, we can assess whether, given the current social status of enhancement, lay people care about a certain concern in the first place (e.g., if they mentioned fairness at all) and thus get a sense of the relative prevalence of various concerns.

Our overall finding confirms that lay people have a generally negative view about enhancement: even though they were asked about situations in which the use of enhancement might be accepted, 34% of participants responded that no such situation exists. The remaining 66% described at least one situation where enhancement might be acceptable, but the vast majority of these situations were characterized by absences of potential concerns. For example, several participants responded that enhancement might be acceptable if the situation were not competitive or if the substance had no physical side effects. Underlying concerns could thus be identified from these seemingly positive answers.

Even without prompts, participants raised a range of concerns about enhancement. The most commonly cited concern related to the unintended side effects of enhancers on the user’s health or on their behavior (60% of participants). Fairness and/or competition and/or cheating were mentioned by 54% of our participants. (Because folk reasoning is not as fine-grained as philosophical arguments, we cannot distinguish between these three related factors in our data.) Other concerns included the risk of addiction or dependence (11%), whether the use of enhancers entailed breaking laws or rules (9%), and whether enhancement might undermine users’ confidence in their own abilities (7%). No significant correlations between these clusters were found, suggesting that participants who raised a concern from one cluster were not more likely to also emphasize a concern from another cluster.

Leaving aside concerns about side effects, cheating loomed prominent, which is in line with implications of other recent research for different forms of enhancement (Faber et al.12). Cheating was mentioned more often than breaking laws or rules, and, given that these two concerns were not correlated, we surmise that worries about cheating cannot be simply restated as worries about rule or law violation. Put another way, enhancement use may still be perceived as cheating even if it is consistent with current rules or laws. And the concern that enhancement might undermine a user’s confidence in his or her own abilities suggests that lay people have a sense for concerns about ownership of action and/or personal identity, what we here call the responsibility-shifting and authenticity arguments for LPI.

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