A key difference is that the games played with higher intelligence are not zero sum. If someone takes Provigil and shortens their life by 5 years (say), yet co

A key difference is that the games played with higher intelligence are not zero sum. If someone takes Provigil and shortens their life by 5 years (say), yet comes up with a breakthrough in physics that improves the lives of millions, then it's not the same as just running a bit faster in the 100m dash by using steroids. The latter is (arguably[1]) cheating, the former is self-sacrificing. As for steroids themselves, they are only considered bad because they have negative side effects. If they had no side effects, they'd be like taking a multivitamin. [1] why arguably? Because things like Phelps' bodysuit are also arguably cheating.