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.