Well, if you expand the scope of PEDs to include caffeine and substances like alcohol which are not PEDs in the traditional sense but could, arguably, be said to be PEDs in a more indirect way, in that they provide a temporary outlet of some kind that enables people to function better the rest of the time than they would if they didn't have this outlet... although it might be arguable how helpful such an outlet really is, sure, there are far more people augmenting their default mental state. In fact by this definition those who don't use anything are true outliers because almost everyone will use something medicinal at some point in their lives, no matter how backwardsly insane the legal climate, or their own attitude, might be around more exotic choices of pharmacological aid. Actually if we're broadening the scope of PEDs to include just anything then I'd say it's 99.9% not possible to compete without them, and that 0.1% or maybe even less is comprised of people with just extraordinary good fortune, which includes of course the good fortune of cashing in on the genetic lottery to such a great extent that you're not even out of action for a few days with a common cold or something.
While I can't disagree with your general point about how easy it is to get PEDs wrong - or even the general sentiment of this quote really... I gotta mildly object to the unqualified equivalence implied between using PEDs and dishonesty.
While it can indeed be dishonest, for sure, one of the most transparent examples, perhaps, being in the world of fitness influencers who claim to be natural when anyone with even a fragment of a clue could tell that they are so far from it, I think the issue is with actual dishonesty, not just the simple fact of using a pharmacological aid and not talking about it. I think we have to consider the general cultural climate and that for the most part, those who choose to be entirely open about it, rather than just ambiguous, are mostly going to be condemned for it, have all their achievements dismissed as the ill gotten gains of a cheater, and quite possibly jeopardise their career prospects, especially so if they are a public figure of any kind.
I think PEDs can be seen as a leveller of the playing field in a sense. The threshold for substances to be considered "therapeutic" right now is extremely and IMO unreasonably narrow. It's OK to give someone medicine to treat a genetic disease that would otherwise incapacitate them, but if someone can walk and talk, can just about fit in to some middling-to-bottom rung of society without too much complaint or nuisance, but is afflicted such that they are incapable of ever achieving real financial security or having a standard of living equivalent to someone else for whom everything went right in life and understands and enjoys playing the game of capitalism - this is not seen as a malady worth treating. Instead, even if the less fortunate person attempts to self medicate and thus treat themselves, and does this successfully - if this becomes public knowledge their achievements will be written off by many, and they themselves dismissed as just lacking the "work ethic" or drive or some other quality that is far more often a product of good fortune in other areas than it is of some spontaneously self-created quality within any individual - despite what the human ego would have us believe.
