Joan Smith: Breast implants, liposuction and hypocrisy

"Love your tan!" has been replaced by "Love your implants!" as the greeting for holidaymakers

A couple of weekends ago, I was shopping with a friend on Portobello Road in west London when one of the stallholders stared pointedly at my friend's breasts. "Where did you get them?" the woman asked in a tone of genuine curiosity. When my friend stepped back, flabbergasted, the woman looked surprised. "Oh," she said, "are they real?"

Since my friend is neither the glamour model Jordan nor a transsexual, her breasts - and the rest of her anatomy - are as nature intended, assisted by nothing more artificial than yoga and regular exercise. But she isn't the first woman to be asked this question, and we have clearly arrived at a point where the idea of giving nature a pretty big helping hand is taken for granted.

Airbrushing is a less painful method than surgery, and it seems to be what Victoria Beckham opted for after posing with her husband for photographs to advertise their new his-and-hers perfume range. Over the next few days, advertising hoardings will show a rear view of an unrecognisable Mrs Beckham, entwined with the former England captain; gone is the skinny behind familiar from recent photographs, and in its place is a positively voluptuous exposed back and thigh.

Mrs Beckham is a businesswoman and her sole personal asset - now that her Spice Girl days are well in the past - is her image. And with growing numbers of British women heading for Spain to have their breasts enlarged, their tummies tucked and their clitorises lifted (really), it seems quite possible that many of them, far from disapproving, share her hankering for a J-Lo derriere.

Spain's cosmetic surgeons perform around half a million "procedures" a year, with a sizeable proportion of Brits taking advantage of all-in surgery packages on the Costa del Sol. Indeed it may be the case that "Love your tan!" has already been replaced by "Love your implants!" as the polite greeting for returning holidaymakers.

Spain has the largest concentration of cosmetic surgeons in Europe and the industry's typical client is not a menopausal woman, worried about signs of ageing, but a 32-year-old working mother. The numbers have yet to catch up with the US and South America, where it has become commonplace; if women in Argentina yearn for bigger breasts and their counterparts in Brazil long for smaller ones, as seems to be the case, there are plenty of surgeons to give them what they want. (Personally, I've always wondered why they don't just move, but then I'm not keen on elective surgical procedures.)

Contrast this relaxed attitude to body-enhancement with the plight of Marion Jones, the former triple Olympic champion who faces a two-year ban if a second drug test comes back positive. If Ms Jones had felt in need of a nose job or a plumper behind, she would have been all right. Instead she is accused of wanting to improve her performance and using a banned substance to do it, an alleged offence heinous enough to plunge her into a career crisis.

In athletics, unlike the world inhabited by the rest of us, natural is still indisputably best. Ms Jones is merely the latest in a series of world-class athletes to face such allegations, which prompt hysterical denunciations from sports journalists; I have to leave the room when the Today programme's Gary Richardson has one of his periodic fits of morality, demanding that some hapless interviewee provide the names of footballers or athletes who have failed to turn up for mandatory dope tests. Name and shame!

Few voices have been raised to question the bizarre underlying assumption that there's nothing wrong with adopting a relentless training programme, diet and lifestyle, but taking substances to enhance your performance is an absolute no-no. Drugs are artificial, you see, and count as cheating, which is the worst thing an athlete can do. Look at what's happening to Ms Jones, whose career has been dogged by doping claims even though she had never tested positive until a blood-boosting drug, allegedly erythropoietin or EPO, was found in a sample she gave two months ago.

The news of Ms Jones's positive test came on the same day that another American, Justin Gatlin, faced being stripped of his share of the 100m world record if found guilty of using performance-enhancing drugs.

Doping allegations are not confined to track events. Tour de France winner Floyd Landis is fighting to clear his name after testing positive for elevated levels of the male sex hormone testosterone, which he says occurs naturally in his body because of his punishing training schedule. The news that Landis had tested positive caused shock and outrage, even though he is still waiting for the result of a second test, and led to calls for even more stringent testing in future.

Cosmetic surgery good, performance-enhancing drugs bad: isn't there something skewed here? Women who elect to have breast implants or liposuction are motivated for the most part by vanity; they are part of a culture of extreme narcissism, in which a standardised version of beauty has become more important than intelligence, health or a sense of obligation towards other people. It is based on a misunderstanding of the body, which has come to be seen as an imperfect canvas, requiring drastic improvement as the only certain route to happiness.

Sport, by contrast, is dominated by a puritan work ethic; modern sporting heroes are cited as role models and expected to suffer, pushing themselves to the absolute limit on the track or field. One of the reasons for this may be unease over the extraordinary financial rewards that await the most successful.

But when the pressure to win is so relentless, whether athletes are representing their club or their country, there is no logical reason why they shouldn't use drugs as well as training hard. The obvious answer is to bring drug use into the open, requiring athletes who use drugs to declare it in advance - and perhaps even having separate events for those who take performance-enhancing substances and those who don't.

The real problem with performance-enhancing drugs, which is rarely mentioned in all this moral posturing, is that they have detrimental effects on health; anti-doping campaigners are on the look-out for athletes who have to get up and exercise in the night, running round hotels to prevent blood clots. No one would wish to force reluctant athletes to use drugs, but this is a question of safety, not morality.

What we have now is an absurd situation in which top athletes fear using over-the-counter medicines in case they fall foul of the moral police. We should stop punishing ambition, in sport or anywhere else. Instead, let's tax narcissism, with purely cosmetic procedures attracting a rate of at least 25 per cent.