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Bigger, Faster, Stronger: Genetic Enhancement and Athletics As we learn how to fix broken bodies and cure disease with gene therapy, we're faced with an impending ethical problem. In addition to therapeutic uses, it's possible that genes could become applicable for genetic enhancement – to augment physical traits, boost cognition, modify personality traits, and possibly, even improve athletic performance. While current U.S. policy restricts human gene transfer studies to treating disease, it seems likely that increased efficacy and safety of the procedures in the next few years will lead to the application of therapeutic gene transfer methods to augment non-disease human traits. Some of the earliest and strongest pressures are likely to come from the highly lucrative and high visibility world of competitive sports. Because athletic prowess is valued and stunningly well rewarded in our society, there will be enormous pressure on athletes, teams, coaches and trainers to develop and use ever more effective means of improving athletic performance. With genes available not only to treat disease, but potentially also to improve muscle function, increase endurance and make energy utilization more efficient, it seems likely that the temptations to use genetic means to enhance performance will be irresistible to athletes, their trainers and handlers, and to national sports efforts. The Ethics But, would such uses of genetic technology be appropriate and fair? What would happen to the so-called "level playing field" if some of the participants have been genetically altered? The dilemma is well-expressed by New York Times writer Jere Longman, who notes in a May 11, 2001 article that "ultimately, at the heart of the issue will be a profound question: what is a human athlete?" Ethicist Thomas H. Murray, Ph.D., president of The Hastings Center and a speaker in this AAAS symposium, says "the ethics of genetic enhancement in sport, as with other forms of enhancement in sport, raises deep questions about the meaning of sport. Once a sport decides that some particular form of enhancement violates the meaning of that sport, then banning it and resolutely enforcing that ban becomes a matter of justice – ensuring fair competition." He adds, "should our understandings of what matters change, then the wrongness might change as well. That said, all forms of genetic enhancement I can envision for the foreseeable future would almost certainly be regarded as violating the meaning of sport and would therefore be wrong." The Problem of Doping in Sports AAAS symposium speaker Gary I. Wadler, M.D., an NYU associate professor of clinical medicine and a medical advisor on doping to the White House Office of National Drug Control Policy, notes that abuse of drugs for performance enhancement dates back more than a century with the first recorded fatality a cyclist in 1886. Since then, doping in sports has grown in scientific and ethical complexity. New inflection points in doping occurred in the 1950s with the first uses of anabolic steroids and in the 1960s with amphetamines. "As science marches on, abuse is never far behind," Wadler says. "It appears as if for every new drug that is developed, some athlete, determined to gain athletic advantage, will misuse it or abuse it." Abused drugs in recent years, for example, include erythropoietin (EPO), human growth hormone (HGH), and insulin-like growth factor-1 (IGF-1). In therapeutic usage, synthetic EPO promotes the production of red blood cells which carry oxygen, and has important clinical uses in patients with

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inadequate blood production as occurs in cancer, chronic kidney disease and other disorders. However, the same substance has been used illegally by endurance athletes such as cyclists and distance runners to increase the efficiency of oxygen utilization and thereby improve their endurance. Similarly, while HGH is a vital growth hormone needed for normal human growth and development, it has been used by athletes in an attempt to increase muscle mass. The related growth factor IGF-1 helps muscles grow and repair themselves when damaged, but some athletes have been tempted to use it to recover more quickly after training or competitive injuries. AAAS symposium speaker H. Lee Sweeney, Ph.D., a genetic researcher at the University of Pennsylvania, has conducted IGF-1 studies in mice and observed that a synthetic version of the gene makes muscles grow. He notes that whenever the news media writes about substances that enhance physical ability, he gets phone calls and emails from athletes – mostly weightlifters – asking for the gene to give them a competitive edge. With improvements taking place in gene transfer technology, it seems probable that physicians will be able to use genetic means to treat and possibly even cure life-threatening human disease within the next few years. With that door opening for abuse, athletes may consider moving from drugs to gene therapy, largely because of "an underground feeling in the athletic community that the genetic approach might be more difficult to detect," said AAAS symposium co-organizer Theodore Friedmann, M.D., of the University of California, San Diego (UCSD). This possibility, while not necessarily accurate, argues for the need for new methods of detection to keep pace with gene technology. A Pro-Active Approach Historically, in the world of drug use in sports, the governing bodies of sport have been playing the reactive game of catch up, while the forensic detectives of the laboratory seem to be one step behind the cheaters, Wadler notes. He adds that both this AAAS symposium and an international conference held last March are taking a pro-active approach to the potential problems of genetic enhancement. The March program, sponsored by the World Anti-Doping Agency (WADA) and co-organized by Friedmann and Wadler, was attended by leaders and experts in biology, genetics and sports medicine, plus policy makers, legal experts, athletes, and representatives from the Olympics and other sports organizations. Among the conclusions and recommendations were the following: • • • • • • •

While genetic technologies hold immense therapeutic promise, there is potential for their misuse and the need for collective efforts of scientists, ethicists, athletes, medical practitioners and others, to avert such misuse; Compliance is essential with established international standards; Governmental and other regulatory agencies must work with a continued sense of urgency to establish a social and policy framework to guide this research and its applications; Genetic transfer technology that is non-therapeutic and merely performance-enhancing should be prohibited; Detection methods should be developed; The WADA Code, to be implemented in 2004, should prohibit the use of genetic transfer technologies to enhance athletic performance; Governments and sport authorities should establish and fund educational and ethics programs to prevent misuse of genetic transfer technologies in sport.

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In this AAAS symposium, presented by several individuals who participated in the WADA conference, discussions will include the technology of gene transfer, the potential abuse to enhance athletic performance, and ethical questions regarding genetic enhancement.

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