If you were a professional athlete and had the ability to become an all around better athlete and have an increased chance of winning by making a simple change to your DNA, would you? Gene doping, a specific form of gene therapy, has the ability to create “super humans” by editing a person’s DNA to add, remove, or suppress specific genes for athletic purposes. The use of gene doping has sparked ethical debates over whether or not gene doping should be allowed. This paper will explore the values ingrained in sports, specifically fairness, and the purpose of sports, in addition to discussing regulation and detection issues, possible consequences, and solutions in an attempt to solve the controversy of gene doping.
If you were a professional or olympic athlete and you had the ability to become stronger, faster, and all around better by making a simple change to your DNA, would you? What if it is banned, but other athletes are still using it?
This paper will focus on the use of gene therapy that was originally designed for medical reasons and is now being looked at for enhancement reasons. Specifically, it will focus on gene doping, the ethical consideration of using these techniques to enhance athletes, and the repercussions that will come along with the decision to allow or ban gene doping.
Gene therapy techniques focus on changing genes in some way to treat or prevent disease. These techniques include replacing a mutated disease-causing gene with a healthy copy of the gene, inactivating or knocking out the improperly functioning mutated gene, or adding a new gene to fight a specific disease (NIH). Gene editing uses a process called CRISPR, which is a new technique that could also be used for gene therapy. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeat, which are segments of DNA containing short, repetitive base sequences. CRISPR essentially works in three steps: adaptation, production of CRISPR RNA, and targeting. Adaptation is when a virus injects the DNA into the cell and that DNA is processed into short segments that are inserted into the clustered regularly interspaced short palindromic repeat. Next, the CRISPR repeats and spacers in the bacterial DNA and undergoes transcription. Finally, in targeting, CRISPR RNAs guide bacterial molecular machinery to remove the viral material through the use of an enzyme called Cas9. The CRISPR DNA are exact matches to the viral genome, but contain the genetic changes desired, so the serve as excellent guides. This process allows DNA to be successfully changed and the new gene to be implemented.
There are two main kinds of gene therapy: somatic and germline. Somatic gene therapy is not heritable and therefore the effects on the following generations do not have to be considered when looking at the ethical considerations of changing a person’s DNA. On the other hand, germline gene therapy is heritable and will affect the following generations, which leads to more ethical considerations on what it means for future children, grandchildren, and so on. For the remainder of this paper I will be focusing on somatic gene therapy, not germline gene therapy.
The original purpose of gene therapy was for medical purposes uses to treat and possibly prevent diseases like Alzheimer’s, Huntington’s, Muscular Dystrophy, cancer, HIV, and many more. The first use of gene therapy to treat a patient was on September 14, 1990. Researchers have been yielding promising results for diseases that do not have cures and rely on preventative or other treatments, like the ones listed previously. Despite the promising ability that gene therapy provides to doctors and patients, gene therapy is currently stuck in the research phase due to safety concerns. One major concern that scientists have noted is gene therapy triggering immunological reactions. For example, researchers have found that using Erythropoietin (EPO) gene therapy, which will be discussed in more detail below, has caused some healthy animals to suffer drastic side effects from fatal anemia caused by an immune reaction to blood vessels clogged with overproduced blood cells (CyclingTips). Once safety concerns like these are overcome, gene therapy can be deemed safe to use, but until then, it will continue to remain in the research phase.
Almost twenty years after gene therapy was used with a patient, gene therapy has become a vehement topic of discussion due to its ability to revolutionize the human race. Despite the medical advancement potential gene therapy has, it has also become of interest for human enhancement in general, and specifically for athletes, who have begun using specific medical technologies for enhancement purposes outside of a medical context. While this use of gene therapy, known as gene doping, has the ability to create “super humans” it was designed for disadvantaged patients to be brought up to the “normal” level. This has sparked ethical debates over the fairness of people using gene therapy to push themselves above the “normal” level and give themselves an advantage against competitors. Gene therapy, although originally designed to cure diseases that have no other solution, has begun to open new doors in the world of sports, in turn, leading to the questioning of the future of sport.
Gene doping involves inserting DNA for the purpose of enhancing athletic performance (Pray). In other words, it is using gene therapy to achieve greater athletic performance. This raises lots of ethical concerns for the future of sports as a whole. Sports enhancement in general is not a new concept because conventional doping has existed for a very long time; however, gene doping provides a new method of enhancement. All forms of doping were banned by the International Olympic Committee in 2003 (CyclingTips), but this has not stopped many athletes from partaking in it.
In this paper, I will focus on Erythropoietin (EPO) gene therapy and gene doping. EPO is a 30-kDa glycoprotein hormone that serves as the primary regulator of red blood cell production in mammals. When EPO levels are increased in an individual, it causes their red blood cell count to increase. In the medical field, EPO gene therapy uses Adenoviral vectors to achieve in vivo EPO gene transfer in order to treat anemia associated with renal failure (Franks). For gene doping purposes, the increase in the production of red blood cells leads to more oxygen being delivered throughout the body and increased endurance for athletes. It is not detectable through conventional means of doping testing. If the EPO is injected directly into the muscle, it is not detectable in the blood, but instead, a piece of the athlete’s muscle would need to be taken to detect it. Another issues with EPO gene doping is that the later effects are not known because EPO gene therapy is still in the research phase due to safety concerns mentioned before. EPO doping has been around for a long time and was even Lance Armstrong’s doping drug of choice, so EPO gene doping provides a new way to cheat, but also introduces many new ethical concerns.
Ethical Concerns: Fairness
One of the major ethical values that has been argued for and against gene doping is centered around the value of fairness. The conclusion that many people jump to immediately jump to is that gene doping is unfair. The majority of people claim that is is unfair because it gives some athletes an unfair advantage over others. This advantage spans over single athlete and group of athletes because it may create a larger disparity between socioeconomic groups depending on the availability of gene doping. Single athletes can partake in order to gain a leg up against their competition, but an entire teams may also partake. For example, a track runner may undergo gene therapy to be stronger and have better endurance or an entire olympic team for one country may use gene therapy to win more medals for their respective homeland. Additionally, as of 2016, the cost of playing an extracurricular school sports, on average, is around $200-$375 per child (White). In addition to school extracurricular sports, many athletes who want to get to the next level play on selective club teams and do additional training, leading to up to 10.5% of gross family income being necessary to sustain participation in athletics (Elmaleh). This proves that sports are expensive and are already hard enough for some parents to afford; however, with the addition of gene doping the price will increase more and become increasingly impractical for some parents to afford to give their children a chance against their competition. The argument of considering gene doping unfair is very similar to study drugs. Both gene doping and study drugs gives the person partaking in them a biologically better chance at succeeding by pushing them to above “normal” levels. Denoting gene doping as unfair is the most common belief, but it is also well backed by valid concerns.
On the other hand, others argue that gene doping is fair. This belief rests on the idea that sports are inherently unfair. For example, some teams have much more money and resources than others. Similarly, many of the best athletes have a built-in genetic advantage that gives them an edge over their competition; over two hundred genetic variants have been linked to increased athletic performance so far (Le Page). The use of gene doping would have the ability to level the playing field and help those with the drive to train hard be able to win against someone who has an inherent biological advantage. Furthermore, many forms of enhancement are already used in sports and are not restricted. The main example of this being caffeine, which is a proven and effective performance enhancer, but has no regulations. Another form of enhancement is race car drivers tinkering with their cars, which is allowed and very encouraged. People who believe gene doping is fair argue that someone changing their genetic makeup is essentially the same thing as a race car driver enhancing their car (Le Page). Both sides, saying gene doping is fair and unfair have well supported arguments, but it is not the only factor in the debate on gene doping.
Another main argument is that gene doping is not “natural” and is morally wrong because of the unfairness it causes. This argument stems from the idea that gene doping allows athletes to be above normal, but this is based on what normal is, which has a varying definition from person to person, city to city, country to country, and on many other levels. There is no governing body that decides what is normal and what is above or below normal, so the line between the two is very blurred. For example, Oscar Pistorius, an Olympic track runner, had both his legs amputated below the knee. Originally, he was not allowed to participate in the Olympics because of his prostheses, but after much debate, he was allowed to run in the 2012 London Olympics (Biography.com). Because of the debate on whether or not the prostheses gave him an unfair advantage by pushing him above normal or brought him up to normal, Pistorius was prevented from competing in the 2008 Olympics. Furthermore, some people believe that since gene doping cannot be stopped and it cannot be accurately tested for at the present moment, that it is therefore okay to do. However, this idea that just because it cannot be stopped that is automatically okay is not the usual way of thinking for humans. For example, for issues like cheating and study drugs or speeding, they cannot be easily stopped or always detected, but they are still not allowed. If natural was definite, permanent regulations would be able to be created and then gene doping be regulated.
Purpose of Sports
The purpose of sports is not something that people immediately think of when discussing gene doping, but it is very important when determine whether or not gene doping should be allowed. There are three main beliefs for what the purpose of sport is: to test the limits of human ability based on what is natural; to become more active, healthier, and stronger; or to determine the best person in a designated field.
Following the belief that the purpose of sport is to test the limits of human ability based on what is natural, could support and oppose the belief that gene doping should be allowed based on how natural is defined. If natural is anything that already exists within the human body, then gene doping would be seen as permissible since it is increasing a substance that is already present within the human body. On the other hand, if natural is seen as something that is “not made or caused by humankind” (Oxford), then gene doping would be considered unnatural and therefore should not be allowed. This is the most common argument because people say that it is elevating the human body to a level above what people are born with, which makes it unsafe and unfair. Dr. Thomas Murray, former president of The Hastings Center, has a very powerful statement in one of his articles about the purpose of sports, in which he agrees with the purpose of sports being to test what is natural, natural being based on the last definition:
“I’m an amateur cyclist. I don’t race, but I do set challenges for myself. Would EPO or blood transfusions allow me to go faster and farther? Sure. An electric motor on my bike would work even better. But what’s the point? The meaning of cycling, like the meaning of every sport worth the name, is in the values it fosters, the particular forms of human excellence it exhibits and the dedication each individual shows in perfecting his or her natural talents.” (Murray)
This quote encompasses the idea that gene doping is simply a newer, more technologically advanced way of cheating because the point of sports is for athletes to learn values like perseverance, dedication, discipline, and much more, and gene doping is cutting corners to get athletes to the same abilities without them having to put in the hard work and time. Similarly to how there is no governing body to determine what is normal, there is not one to determine what is natural. Without it, there will still be confusion between whether or not gene doping should be allowed based on this belief that the purpose of sports are to test the limits of human ability based on what is natural.
The second belief, that the purpose of sport is to become more active, healthier, and stronger, is supported by the use of gene therapy. Currently, gene doping will not have the ability to do this because, as mentioned previously, many of the safety risks are still unknown and being researched right now. However, the technology is rapidly developing and will have the ability to make athletes healthier once gene doping has completed all research. Therefore, until gene doping has cleared the research stage, it may not be safer for athletes, but once it does, it has the ability to make athletes stronger, faster, and more athletic in general, which will reduce injury and lead them to be healthier.
Finally, the last belief of what the purpose of sports are is the determine the best person in that designated area, which could more simply be stated as determining a winner. For many athletes, especially professional athletes, winning is absolutely everything and has become the focus of sports. For younger athletes, winning affects if they can continue on to the next level of their sport and for professional athletes, it affects if they get to keep their job, since all professional athletes are receiving money and sponsorships to win. The drive to win in professional sports has a large affect on what the purpose of sports are because the purpose may be subject to change depending on the level of play. For example, the purpose of a young child playing sports may be to stay active and have fun with their friends, but the purpose of a professional athlete representing their team is to win. However, following this belief of what the purpose of sports are would lead to the allowance of other forms of cheating and doping. This drive to win connects to the idea that competition is inherent in humans and sports are a continuation of human primal instinct to want the glory and spoils of winning (Sammel). If the purpose of sports is simply to determine a winner, then gene doping would be allowed because gene doping is giving athletes the means to have a leg up and win.
Regulation and Detection Issues
Both the ability to regulate and detect gene doping play a critical role in determining if preventing gene doping, if it is deemed unethical, is even possible. The World Anti-Doping Agency, also known as WADA, is the leader in the field of research to regulate and detect gene doping. WADA was formed out of the International Olympic Committee in 1999 (Sports Illustrated). They state that they are “committed to increasing the volume of research dedicated to developing new and improved detection methods for prohibited substances and methods. WADA is also responsible for studying energy doping threats, such as gene doping” (WADA). Despite all the time, money, and resources WADA dedicated to finding a way to detect gene doping, they have still been unsuccessful.
This issue of doping being incredibly hard to detect is already an issue and with the addition of gene doping, it will become exponentially harder. An anonymous survey done in 2011 suggests more than one third of athletes dope, while tests only catch less than two percent (Le Page). The detection rate of doping is already dismal and will continue to decrease as gene doping gains popularity. Additionally, the majority of athletes that are in the two percent that are caught are caught years later or never caught at all, but admit years later. For example, in May of 2007, the 1996 Tour de France winner Bjarne Riis admitted to using performance-enhancing drugs to win his title; in January 2010, Mark McGwire, a major league baseball player, admitted to using steroids during his career, which was from 1996 to 2001 (CNN). Clearly, detecting and regulating the use of conventional doping methods is something that still cannot be done accurately and effectively, so it would be nearly impossible to detect gene doping. It will be a lot more expensive to test for and use a greater amount of resources to detect the gene doping and prove that the genetic advantage is actually due to the gene doping and not something the athlete is born with. This brings up the question of who would pay and provide the resources for the testing. Continuing to consider gene doping as illegal will create even more issues with regulating and detecting it, since it is rooted in the person’s DNA, it not detectable through drug test, and would require invasive testing that would never be allowed. Despite WADA’s best efforts, gene doping will most likely continue to charge ahead in front of the technology that is trying to be created to regulate and detect it.
Although gene doping has not begun taking over the athletic world yet, it may begin soon. It may start with EPO gene doping since it is relatively easy and then progress to more drastic forms of gene doping. Looking back through history, many medical technologies developed to be used personal enhancement, and then moved on from there to become more and more extreme. A good example of this is plastic surgery. Plastic surgery was originally intended for medical reasons during World War I, when it was used for soldiers who had facial injuries. When it began being used for cosmetic reasons, many people looked down upon it. However, as we see in our current society, plastic surgery has become increasingly popular and a normal occurrence. Additionally, the surgeries have become more extreme as they have become more popular. The number of cosmetic procedures performed in the United States has almost doubled since the start of this century . Out of all the surgeries performed, 1.2 million are reconstructive procedures and 1 million are cosmetic (History of Plastic Surgery). Gene doping is already following the same pattern, and, if it continues down this path, it will begin being used by anyone that can afford it.
This leads to the issues of the possible abuse of gene therapy and the question of where it will stop. The use of gene doping may have negative effects on athletes of all levels, from kids to professional athletes. For example, with conventional doping methods, it was determined in a confidential survey done in 2013 that out of 3,705 high school students, eleven percent reported using synthetic human growth hormone, which is up from five percent in the four previous annual surveys. Additionally, that teen use of steroids increased from five percent to seven percent over the same period (Crary). More and more frequently athletes at younger levels are feeling the need to partake in doping in order to get to the next level of athletics. If gene doping becomes allowed, there is a major concern that what happened with conventional doping will happen with gene doping and athletes of all levels will feel the need to partake.
Despite the unknown future of gene doping at this time, there are a few possible solutions. The first would be to set a maximum permissible red blood cell count based on safety. In order to do this, the maximum red blood cell count that is safe would need to be determined in addition to a faster and less expensive way to determine an individual’s red blood cell count. This would allow the playing field to be more level while also keeping athletes safe. The second option would be to allow doping, but separate the athletes into groups based on doping and non-doping athletes. If this option was chosen, it would allow people who do not want to have to dope to not feel pressured to dope. On the other hand, it will divide sports even more and could possibly lead to a division between privilege and socioeconomic status because some athletes may want to gene dope, but may not be able to afford the gene doping technologies and resources needed. Additionally, if sports today are any indicator of the trust that we can put in athletes to be honorable to whether or not they have doped, than there may be an issue of athletes who have doped entering the non-doping group in order to win. The third solution is to keep the current ban and just continue researching ways to detect and regulate gene doping. Once a quick, inexpensive, and noninvasive method is found, the ban can be kept and ensured. However, this last option is essentially just continuing the present system that we have now, which does not seem to be working effectively. The current climate of doping and sports needs a solution desperately or else the future of sports may become very chaotic and increasingly unfair.
Out of the possible options and the current state we are in with gene doping, I feel as though the first option of setting a maximum permissible red blood cell count based on safety may be the best way to go forward. I would ideally like to say that we should keep the ban, but if it cannot be properly enforced and the majority of athletes who dope are getting away with it and their gold medals, than it does not seem feasible to keep allowing the athletes who do not dope to come out on the losing end.
As an athlete myself, I think that the purpose of sports is to test the limits of human ability based on the genetics of how you were born; therefore, allowing those with the motivation to work hard and persevere to become the winners. Gene doping could ruin this purpose and lead to people no longer working hard and training, but instead taking a shortcut of using gene doping. Contrastingly, I also realize that sometimes people who may not have a biological advantage have more heart and determination to become the best, but may still never be able to beat out the person with the genetic advantage, which is why gene doping could help them. There are both positives and negatives to allowing gene doping because it can help level the playing field, but it also can divide sports more.
In addition to current dilemmas with gene doping, it may lead to many future issues in our society. One issue would be genetic design younger in life. This could mean parents designing babies for specific athletic traits or parents making children go through it when they are still at the age when their parents have authority over their medical decisions. This would completely alter our society because parents would be creating superhuman athletes when they are a fetus or a young child, which gives the child no say in the situation. Another issue that may arise is with the use of germline therapy. Germline therapy is the incorporation of the gene therapy into gametes, which makes the change heritable, meaning that it will be permanent change that is passed down from generation to generation. One major issue with this is that there could be major health issues that occur down the line that researchers do not know about yet. If issues do arise, every person that has the genetic change will have to undergo gene editing again to reverse the original change. If gene doping were to lead us down this path, our society as a whole would be completely changed in a way that I do not believe would be beneficial to the human race.
Gene therapy techniques may give the human race unlimited ability to alter humans once the entire genome is unlocked. Gene doping has the ability to do the same for athletes, but at what cost? Gene doping is a very sharp double edged sword that has the ability to either revolutionize and improve sports or drive a larger separation between athletes. Right now, I believe that until we can find a way prevent and detect gene doping, we must find new ways to regulate it because they current system is not scaring away many athletes from doping. If not way to prevent it is found, it must be heavily regulated so that it does not trickle down into younger athletes and change the way that sports are played at every level because they purpose of sport to test the limits of what is natural based on what you were born with must be preserved in some way.
By Gaby Branin