October 11, 2005
Today, from Major League baseball diamonds to Olympic swimming pools, ugly accusations of illegal steroid use abound. Will tomorrow's sports pages be filled with similar stories about athletes using genetic enhancements that promise a stronger pitch or faster sprint? How will sports change, if technologies like gene therapy designed to cure the sick become tools to boost performance? Can this practice be stopped and should we even try?
These were just a few of the issues debated at the inaugural Genetics Perspectives on Policy Seminar (GenePOPS), held October 11, 2005 at the Johns Hopkins University campus in Washington, D.C. The Genetics and Public Policy Center, established by The Pew Charitable Trusts at Johns Hopkins University, hosted the seminar. It featured a panel of three speakers: Melissa Dalio Mierke, an exercise physiologist and USA Triathlon National champion; Tom Murray, director of The Hastings Center and chair of the World Anti-Doping Agency's Ethical Issues Review Panel; and H. Lee Sweeney, chair and professor of the University of Pennsylvania's Department of Physiology. Kathy Hudson, Center director, moderated the panel.
During the seminar, dozens of journalists, policy analysts, scientists, and other leaders discussed the perils of gene doping. As they learned, the specter of gene doping first emerged in the 1990s, when Sweeney and his colleagues began exploring gene therapy techniques to keep aging adults strong. As humans age, their muscles gradually weaken, making elderly adults frail and susceptible to injury. Because the U.S. population is aging, this health issue is becoming increasingly important.
Over a decade ago, Sweeney had the idea to use gene therapy to halt the weakening of skeletal muscle. In a series of lab experiments, he and his collaborators found that mice injected with a gene dubbed IGF1 a key factor in the aging process did, indeed, retain the muscle mass of much younger animals. But the promise of this newfound "mighty mouse" was tinged with a troubling issue: Could this same technology be used to build up muscle mass in athletes?
"In our experiments, old mice stopped losing muscle function," Sweeney said during the GenePOPS seminar. "But in young organisms, perhaps we could make supermice, stronger than normal." For now, Sweeney notes, gene therapy, which has not been proven safe, is limited to terminally ill patients. As the technique matures, however, gene doping is likely to enter the athletic arena, even before healthcare therapies become standard clinical practice.
Gene doping surely might tempt serious athletes, who face intense pressure to perform. With a higher score or faster time, these stars win endorsements, college scholarships, spots on sports teams, and other success. Today, Mierke noted, performance-enhancing drugs are becoming mainstream. Gene doping may be tomorrow's tool. "If a woman is willing to inject the hormone erythropoietin (EPO) as a performance enhancer, why not DNA?" Mierke asked. "Some coaches and parents are willing to sacrifice everything for success. There is no shortage of willing cheaters even at the cost of health."
Preying on the passion to win, black market salespeople could hawk purported gene doping products to athletes over the next several years long before those products actually contain any real genetic material. Actual gene doping will not become a widespread reality for 10 to 30 years, researchers predict. "When is gene doping going to happen at the Olympics?" Murray asks. "Not in 2006 and not in 2008. This is probably decades out."
Granted this window, researchers say, now is the time to plan policies to prevent, and techniques to detect, gene doping. In a recent trip to Beijing, Sweeney met with World Anti-Doping Agency regulators who will test athletes for steroid use during the 2008 Olympics. "They're very afraid that somebody will try to do for athletes what scientists can do in animals a plasma injection to cause growth hormone releases," Sweeney said. "They want to put out the word to athletes that the research community is one step ahead."
For gene doping, that won't be easy. First, scientists will have to find a way to detect it. Unlike steroids, genetic enhancement will not necessarily be detectable in an athlete's blood or urine sample. Researchers recently have begun discussing possible biomarkers for gene doping. These experiments will need to be completed.
Along with these practical concerns, a more fundamental gene doping debate simmers. Is gene doping inherently unethical? Why? Should regulators even attempt to keep gene doping out of sports?
Murray cited a handful of arguments for simply accepting genetic enhancement. Some athletes and sports analysts contend that gene doping is really no different than other training tools, from exercise regimens and vitamins to structured sleep patterns. Where do you draw the line between acceptable or unacceptable enhancement? Others argue that athletes should be free to decide their own health risks. Besides, what is more human than striving for self-improvement? Finally, they add, even if gene doping and other performance-enhancing drugs are unethical, they can't be eliminated. Why bother trying?
Each of these arguments can be independently refuted, Murray said. But all can be rejected with a broad, basic reason to outlaw gene doping: Fans enjoy sports because competing athletes go head-to-head in a fair match, bringing their inherent talents honed through practice and training - to the game at hand. This philosophy is crucial to the game. "There's some combination of human excellences, and perfection of those excellences, by means that we find praiseworthy or acceptable," Murray noted. "When you move outside that parameter, you move outside sport."
Yet audience members echoed some of the arguments for genetic enhancement. As one person countered: "If certain people have the money to hire professional coaches, join large gymnastics clubs, and get other advantages, you're already adding artificial enhancements to sports. Gene doping is just another." Another added, "I'm an athletically challenged individual. Why can't gene doping be considered leveling the playing the field for those of us who can't compete?"
Responding to such questions, Murray returned to the notion that sports thrive on natural talent. Doctors could go so far as to put a motor in a cyclist's legs, he noted, allowing the cyclist to ride twice as fast. Genetic enhancement lies somewhere on the slippery slope that leads to such outrageously artificial advantages. "As long as sports demonstrate something about natural excellences, that's part of the charm."
That satisfies some. Yet others emphasize that genetic enhancement is subjective. "All these issues are shades of gray," one audience member remarked. "Years ago, marathoners didn't drink water while racing. Then they did. Then they drank water with sugar. Then water with sugar and salt. There aren't any black-and-white training issues. Everything is arbitrary. What's fair and what's not is what the sport decides."
In fact, shades of gray cloak genetic enhancement outside the sports arena, too. To illustrate the benefit - and dilemma of artificial enhancement, Murray posed a hypothetical scenario: Neurosurgeons, who do the most delicate procedures, are offered a safe, reliable drug that removes a little tremor that all people have at rest. Those doctors who take the drug before performing surgery have higher success rates and fewer complications. Imagine that one surgeon uses this drug because of its better result. Another surgeon refuses the drug on ethical grounds. Which doctor would you choose to operate on a loved one?
"I'd choose the doctor more likely to heal my child," added Murray. "The point of surgery is not to demonstrate a surgeon's talents, but to heal patients. In every case, we need to ask: What is the point of the practice we're talking about?"
Building on that argument, Sweeney adds that if surgery is not a sport, neither is aging. He and his colleagues will begin clinical trials within the next year, carefully testing gene therapy techniques on the muscles of patients with muscular dystrophy. Eventually, he hopes this work will lead to therapies that improve the quality of life for elderly patients. "If you or someone you know could lead a healthier life with no risk, why not allow them?" Sweeney asked.
He predicts that the wealthy elderly will drive the market for genetic enhancement in decades to come. Despite the aging U.S. population, Sweeney adds, it's possible that other countries will be first to offer such therapies. The challenge is controlling genetic enhancement once it becomes available to consumers. "Are we going to be faced with a situation where athletes can modify their athletic performance using gene therapy? That's cheating, but how do you regulate it? Especially if society says this is OK for old-age enhancements, without side effects. Someday, these are going to be real issues for sports."
And that "someday" may arrive sooner than we expect.