Sebastian Coe fears athletics could go the same way as WWE wrestling in the USA with spectators having no faith that what they are watching is real.
Lord Coe is vice-president of the IAAF
Lord Coe also called again for drugs cheats to be handed a minimum four-year ban from the sport.
Athletics has been marred again by the recent doping scandals surrounding Dwain Chambers and Marion Jones.
"We could end up with a situation like WWE wrestling where everyone knows it is fake and they don't care," he said.
"Frankly, they don't care that what they are watching isn't real but while people still care, we have to hope we can turn it around, otherwise people will vote with their feet."
Last week Chambers, who was banned for two years after testing positive for performance-enhancing drugs, earned selection for Great Britain's World Indoors squad following victory in the men's 60m trial.
And last month American sprinter Jones was sentenced to six months in jail for lying about steroid use and involvement in a drugs fraud case.
Lord Coe, vice-president of the International Association of Athletics Federations (IAAF), feels that the damage done to the sport in recent weeks could be fatal.
"If you are a parent, you have the thoughts and considerations of your children at heart," he told BBC 5 Live's Sportsweek programme.
"And the thought a child is entering a sport that is cavalier about performance-enhancing drugs will see people voting with their feet and finding a sport they are comfortable with and we must not be in that position."
Lord Coe, a two-time Olympic 1,500m champion, has been pushing for longer bans since 2005.
Under current rules, offenders can get away with only two years, and only in serious cases can they receive four.
But Lord Coe feels that the legislation needs to be changed in order to deter athletes from using drugs and cheating the sport.
"I want to have the standard of four years for all cases as I don't think two years is long enough, it is not a big enough deterrent," he said.
"It needs to be proportionate to the damage that is done to the sport."
I won't treat him any different than any of my other competitors, I'll treat him with respect
Chambers's return has been met with disapproval from the sport but he is determined to continue running despite the criticism being aimed towards him.
But 100m world champion Tyson Gay says he will not have a problem lining up against Chambers.
He said: "I don't know if I'll say 'welcome back' but I treat him like any other of my opponents.
"We all have to race, we all have to step on the line and give it our best.
"I won't treat him any different than any of my other competitors, I'll treat him with respect."