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Performance enhancement is a multibillion dollar industry, with little known about the efficacy or safety of many practices. Many sport governing bodies have banned certain equipment, supplements, and drugs, yet, some athletes use anyway. This use may pose a danger to the individual user, as well as to other participants, and can challenge the integrity of the sport. We must consider how we, as health care professionals, balance personal autonomy, individual safety, and the integrity of sport in fulfilling our social contract.