Recent reports indicate that U.S. Special Operations Command (SOCOM) is open to discussing the possibility of prescribing performance enhancing drugs (PEDs) to service members to increase operational readiness and relieve the physical burden of demanding mission sets. Prior to now, political reservations about responsibly supervised PED programs in the military have suppressed meaningful dialogue in this area. PED use is taboo in the civilian sector and that sentiment seems to have pervaded the military until now. PEDs aren’t permitted in sport because governing bodies want the playing field to be level. Since it is unlikely that every sport participant would have equal access to PEDs, nobody is allowed to use them. Zero tolerance is the only way to ensure fairness, assuming nobody violates the rules. We are willing to accept differences in performance secondary to innate ability/genetics, training, and access to coaching and relevant social support, but not pharmacology. This line is often arbitrary, but reasonable.
That it took the U.S. military this long to contemplate providing human instruments of war an unfair physiological advantage despite its overwhelming superiority in other areas, however, is perplexing. Enemies of the United States would gladly trade drones, advanced surveillance, and close air support for a pharmacologically enhanced assault team. As somebody who’s deployed overseas numerous times in support of various military engagements, I never wished away my side’s technological advantage in pursuit of fairness and logistical equality. Fairness can seem trivial when bullets are involved. Moreover, sleep medication and stimulants have been a medical staple in the military for decades. These drugs can be more performance enhancing than something that directly increases one’s muscle mass or aerobic capacity. Responsible pharmacological intervention can undoubtedly maximize physical readiness, but only if guided by relevant questions.
Before considering these questions, one thing must be made very clear. Even special operations personnel are not elite athletes as the popular and increasingly internal narrative suggests. Equating military operators with sportsmen will inevitably promote the wrong type of preparation. Men and women at the highest levels of the military are world-class performers who are required to execute certain physical tasks under extreme psychological and emotional duress. Even in the special operations community, however, “elite” physiology and motor skill are not prerequisites. Selection, which is characterized by lots of distance running, swimming, calisthenics, and long duration locomotive efforts with external load, is usually the most physically demanding aspect of special operations training pipelines. Even in the most physically selective SOCOM programs, however, the physical standards are far from elite even for the high school level athlete, let alone in the collegiate and professional ranks.
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Assuming the physical fitness abilities and athleticism (constructs that warrant more definitive qualification) of military special operators ranks in, say, the ninety-fifth percentile relative to the general population, the remaining five percent, closer to the “elite” realm, is not inconsequential. In most cases, genetic constraints preclude otherwise highly qualified special operators from bridging that gap. Moreover, the training investment required to actualize “elite” athleticism even in those SOCOM members not limited by genotype would confound preparation in much more relevant domains like shooting, parachuting, diving, urban warfare, small unit tactics, medicine, communications, etc. The physical aptitude required to qualify for a special operations program in the military is not nearly as distinctive as the emotional control, problem solving ability, aggressiveness, tenacity, interpersonal compatibility, composure, and trainability that characterizes this population.
Physical preparation should remain an important component of SOCOM readiness. A requisite level of physical competency is required to conduct operational missions, promote longevity, and support specific skill development. That level should be cultivated and slightly exceeded throughout an operator’s career. Arbitrarily pursuing a 400lb bench press, 5-minute breath-hold, or 17-minute 5k run, however, are simply not worthwhile endeavors for people who must prepare for tactical realities in hostile areas. None of the aforementioned feats are elite either. Time and adaptive resources are finite. When it comes to PEDs, SOCOM needs to first determine if and when physiology is a limiting factor in mission success because every pharmacological intervention has a biological cost. As with many well-intentioned interventions, that cost is often unknown until after an operator has separated from the service. During mission debriefs, are the people who were on target saying amongst themselves, “If only I had more muscle mass or a higher hematocrit?” The military needs more empirical data to determine under what circumstances PEDs are most appropriate so it doesn’t pursue physiological extremes for its own sake.
Additionally, the medical efficacy and ethics of potential PED use in the military are not distinct from political and strategic considerations. The operational tempo among special operations forces is probably not sustainable. Direct action units have bared the biggest burden here. Originally conceived to periodically execute deliberately planned missions of extreme strategic importance, highly trained assault forces are instead being utilized almost nightly all over the world in pursuit of well-armed adversaries (admittedly not humanity’s finest) whose actual strategic significance is often unknown or questionable. Additionally, the more special operations forces successfully employ their capabilities, the more they’re asked to expand their capabilities. Paradoxically, if they were less competent their workload might allow for more sufficient recovery between missions and deployments. When it comes to national security, civilian leadership rarely plays the long game so operator longevity and health is seldom adequately prioritized.
Now SOCOM is being asked to do war “light”, to stabilize dysfunctional countries and curtail civil wars with limited manpower. It’s not a “real war” when only a few hundred (at most) special operations personnel “advise” partner forces against insurgencies. Despite this political gymnastics, the volume and frequency of combat encountered by these units since 9/11 is unprecedented in the history of modern warfare, a point of pride in SOCOM but one that comes at a great cost. The physical and psychological toll of this operational tempo has been extensive and we aren’t yet sophisticated enough to fully quantify the damage. Even with the limited information at our disposal, it is evident that the demands placed on SOCOM have left even some of the most resilient people in the military physically and psychologically broken. Again, this experiment is still too new to fully comprehend the biological complexity of nightly kill or capture missions on repeated 4-6 month deployments. The “War on Terrorism” has few clearly defined objectives. Enemies that pose an imminent threat to the homeland should be systematically confronted and eliminated but “terrorism” itself is a rather ambiguous construct, especially when influenced by poll numbers and election cycles.
Inevitably, SOCOM will administer synthetic hormones (e.g. anabolic steroids) to returning service members whose testosterone levels are frighteningly low secondary to unrelenting chronic stress, after which blood markers may improve and create the illusion of normalcy. Ironically, PEDs may ultimately play a greater role in returning operators to normal physiological baselines during and after deployments than in creating “superhuman” soldiers. PEDs unquestionably can improve one’s ability to recover from a stressor. If there is no regard for the magnitude and frequency of such stressors from policy makers and commanders, however, no amount of PEDs will suffice. The superhuman soldier is a myth. Unfortunately, even the most elite soldiers are only human. Humans can only endure so much no matter how much we try to hack performance with drugs and wearable technology. Asking whether PED use might improve SOCOM’s capabilities is a legitimate question but only if it is not pondered in a vacuum. It’s as much a political and strategic question as it is a medical one.