Chapter 43 — Exercises

Enhancement Outside the Clinic: Work, Sport, Military, and the Coercion Question

Thirty-three items. Work through them in order the first time; the later groups assume the earlier ones. Items marked † are the ones worth doing even if you do nothing else — they are where the chapter's transferable skills live.

No answers are provided. Several of these questions have no correct answer, only better and worse reasoning, and an answer key would quietly suggest otherwise. Where a question asks you to take a position, the assessment is whether you presented the position you reject at its strongest before rejecting it.

A standing rule for every item in this set. Do not name a private individual, an athlete, an employer, or a company in any answer, and do not speculate about what any real living person may or may not use. Describe roles and structures. This is the same rule the chapter follows, and it is a rule about the kind of reasoning that is useful, not only about discretion.

Group 1 — Recall and definition (A–H)

A. List the four things clinical medicine supplies that §43.1 says enhancement removes. Write each one in a single sentence, in your own words, without looking.

B. Define positional good and give two examples from your own life or work that are positional, and two that are not.

C. State the difference between a claim being rated ❌ and a molecule "not working." Use the chapter's rule 2.

D. † Write out the coercion structure from §43.5 in five steps from memory. Then check it, and note which step you dropped or garbled — the step people forget is diagnostic of how they are thinking about the problem.

E. Define adoption externality and explain, in one sentence, why the word externality is doing real work rather than decorating the sentence.

F. What is a therapeutic use exemption, and what does the existence of such a mechanism concede about the therapy–enhancement distinction?

G. Name the five conditions from §43.9. State which are empirical, which are institutional, and which is structural.

H. Define reversibility and explain why the chapter places it on the list of conditions specifically because evidence is thin rather than despite it.

Group 2 — Comprehension and explanation (I–P)

I. Explain why the chapter says the diagram in §43.1 is "an inventory, not a moral scorecard." What would change if it were a scorecard?

J. † Explain in your own words why the compounds most available for enhancement are systematically the ones with the least human safety data. Your answer must identify the common cause, not merely observe the correlation.

K. The chapter says sport is a "natural experiment." Explain precisely what makes it one, and name one thing it can tell us that no amount of philosophical argument can.

L. Why does the chapter refuse to give a prevalence figure for peptide use in workplace contexts? State the reason, and then state what you would need in order to produce a defensible figure.

M. Explain why "voluntary" means something different inside a hierarchy, using no example that involves anyone threatening anyone.

N. Why is the coercion problem harder, not easier, when the institution's motives are good?

O. † Explain the finding that Chapter 16 calls "mass without function," and then explain why that finding is unusually corrosive to personal testimony as a form of evidence.

P. The chapter says the level-playing-field argument is "much stronger as a safety argument than as a fairness argument." Explain both halves of that sentence.

Group 3 — Application (Q–X)

Q. † Take any competitive setting you know well — a workplace, a program, a league, an admissions process. Score it against the four features in §43.5 that make the coercion argument bite strongly. State your conclusion about how susceptible that setting would be, and name the single feature that mattered most in your assessment.

R. A colleague says: "If it's legal and I'm paying for it myself, it's nobody's business but mine." Identify which of the five conditions in §43.9 this claim addresses and which it leaves entirely untouched.

S. Rewrite the claim "enhancement is inevitable" so that it becomes rateable. Your rewrite must specify a population, an endpoint, a timeframe, and a falsifier.

T. A product page states that a compound "is used by professionals in high-performance environments." Identify three distinct things this sentence is doing that are not making a claim about efficacy.

U. † Write a 📊 Evidence Rating block — all four lines, in the chapter's format — for the claim "Supervised enhancement reduces serious adverse events relative to unsupervised use of the same compounds." You may not use the chapter's wording; write your own reason line and your own falsifier.

V. Apply the §43.5 weak/strong grid to a metabolic drug used for appearance rather than for a diagnosed condition. Does the coercion argument apply weakly or strongly? Defend your answer, and identify the feature of the setting your answer turned on.

W. Take a compound from your dossier and complete the five-part Field 9 (non-indicated use) from the chapter. Answer question 5 — attributable how? — last, and in writing.

X. Suppose a compound with genuinely excellent healthy-adult safety data appeared tomorrow, freely available and inexpensive. Which of the five conditions in §43.9 would now be satisfied, and which would be exactly as unsatisfied as before? What does that tell you about which condition the safety research was ever going to solve?

Group 4 — Analysis and evaluation (Y–AB)

Y. † The chapter argues that a coercive structure built on a false belief about efficacy is worse, not better, than one built on a true belief. Reconstruct that argument, then attack it: is there any reading on which the false-belief case is genuinely less bad? State your final position.

Z. Identify the strongest objection to the chapter's own framing in §43.1. (Hint: is the four-part clinical structure as reliably present in ordinary medical practice as the section implies?) Then say whether the objection damages the chapter's argument or merely qualifies it.

AA. † The chapter declines to rate "enhancement is inevitable." Argue the opposite position: that it should be rated, and that refusing to rate it is a way of avoiding a claim that is doing real work in the debate. Then respond to your own argument.

AB. Sport's enforced answer produced a category of unintentional violations from contaminated supply. Analyze this as a cost. Who bears it, was it foreseeable, and does it count against having an enforced answer at all — or only against this particular enforcement design?

Group 5 — Ethics dilemmas (AC–AG)

These have no answers. Each is constructed so that the obvious response has a cost you are expected to name. Write at least a paragraph on each, and in every case state explicitly which of your conclusions rest on facts and which rest on values.

AC. † The baseline has moved. You are in a positional contest. An enhancement has become common enough that declining it means accepting a measurable disadvantage — not falling behind where you were, but falling behind where you would have been. You did not want any part of this and did nothing to bring it about. Is adopting it now a free choice? If you say no, say what it is. If you say yes, explain what work the word "free" is doing.

AD. The manager's problem. You lead a team in a competitive environment. You suspect, without evidence, that some members are using something. You have no testing mechanism, no policy, and no authority to create one. Enumerate your options, including doing nothing. For each, identify who bears the cost of that option — and note where the cost falls on someone who is not in the room.

AE. † The offer inside the hierarchy. An institution with authority over its members offers an optional program, in genuine good faith, with a genuine right of refusal. Design three safeguards that would make the consent meaningfully voluntary. Then identify, honestly, which of your three safeguards the institution can actually deliver — and whether the residue is a design failure or something that cannot be designed away.

AF. The clinician's dilemma. A patient discloses that they are using a compound you did not prescribe, that has no approved indication for their situation, and that you have little safety data on. They are not asking permission. What do you owe them? Consider at minimum: the value of continued disclosure, the limits of your knowledge, your obligation not to abandon, and what happens to their care if they stop telling you things.

AG. † The sanctioned regime. You have been asked to design a permitted, supervised enhancement program for a competitive domain. Write the strongest version of your proposal — supply, supervision, documentation, adverse-event reporting, and access. Then write the objection you cannot answer. You are graded on the second part. A proposal without an unanswered objection has not been thought about hard enough.