Features Gene doping
Performance By Andy Miah (University of Paisley, UK)
Over the last 5 years, the world of elite sport has spent a considerable amount of time and money investigating the science behind the next generation of performance enhancements, i.e. genetic enhancement. While scientists are still struggling to develop effective therapeutic interventions based on gene transfer, it is anticipated that athletes will soon try to use the same science to enhance their performances. Some have even argued that it is happening already.
Š Daniel Lee
In the 2006 Olympic Winter Games in Turin, the genetherapy product repoxygen arose as a substance that athletes might already be using to bring about a genetic modification. While there were no confirmed reports about its use, it was the first occasion where a serious claim about genetic modification has been made in the context of sport. For the world of anti-doping, gene transfer can quite simply be characterized as yet another form of cheating. In 2003, this method of enhancement was added to the World Anti-Doping Agency (WADA) Code, which means that all competing athletes are prevented from using such technology. Yet, how did this judgement about its ethical status come about? And is it a judgement that will
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stand the test of time in an era where people are increasingly willing to modify biology? One might envisage a society where gene transfer becomes an integral part of optimizing health, which would result in an overall enhanced pool of competitors taking part within sports. Non-athlete adults might enhance themselves without being bound by the constraints of sporting rules, just to get an edge in society, rather like obtaining a good education. Others might use germ-line modifications to ensure their children have an advantage in life or, at least, help them to avoid any serious health risks by strengthening the resistance of the body to
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enhancement? illness and injury. While these prospects might still be treated as science fiction, they are being taken seriously by a number of legislative authorities both inside and outside sport. There are various candidate genes that might be modified in order to bring about a performance enhancement1. For example, insulin-like growth factor 1 (IGF-1) could be used by athletes for boosting muscle mass, even though its medical purpose is for treating muscle-wasting disease2,3. Using a form of IGF-1 called mechano growth factor (MGF) with mice, Goldspink’s team isolated muscle tissue and inserted the MGF gene. The results showed an increase in muscle mass by approximately 20% after 2 weeks3. Furthermore, genetically engineered erythropoietin (EPO) might be used to boost an athlete’s endurance capabilities, although its medical application is to increase the haematocrit level in patients with chronic renal disease. Research identifies the effects of inserting genes into a virus to produce a specific bodily effect, e.g. Svensson et al.4 who used an adenovirus to deliver EPO to mice and monkeys to observe whether it would render a difference in biological capabilities. By inserting the gene into a viral nucleic acid, it was transported throughout the body and increased the number of red blood cells. In performance, this produces a similar effect to that of blooddoping, which operates on a similar principle by re-introducing blood into the body to boost the amount of oxygen being transported to offset fatigue. Thus, genetically inserting EPO into an athlete could enhance
endurance when active, which would be useful for any long distance event. Alternatively, variations in the ACE (angiotensinconverting enzyme) gene have been associated with diff ering endurance capabilities and an anabolic response to intense exercise training5–10. Over recent years, these scientific discoveries have made those in the world of sport terribly nervous, particularly anti-doping organizations. One might suggest that the absence of detecting methods, coupled with shifting social values on the morality of enhancement, challenges the integrity and relevance of an antienhancement movement like anti-doping. Indeed, there are already indications of what this commercialized genetic world might look like. In 2004, the first genetic test for performance genes, the SportsGeneTest™ commercialized by Genetic Technologies (Australia), emerged on the market. Tests of this kind were condemned by WADA at its landmark meeting in 2005, during which it drafted the Stockholm Declaration. It is particularly concerned about the effect that such tests might have on discouraging young athletes from participating in sport, just because their genotype does not match the ideal type for a given sport. However, is it reasonable to believe that WADA can do anything to curb the use of these tests? Moreover, even if such tests are frowned upon (or meaningless), would the potential harm be adequately serious to warrant their prohibition? These ethical questions are the mainstay of contemporary bioethical debates about emerging technologies, particularly those that seem to take medicine outside of its traditional domain and towards the enhancement of humanity. Yet, while the ethical stance within sport against doping is often taken for granted by most people, it is not always obvious that a new technology should be characterized as morally wrong. For instance, in the summer of 2006, WADA considered whether hypoxic chambers should be added to the anti-doping list. This technology allows an athlete to enter an environment that simulates various levels of altitude by altering the density of oxygen in the air. The effect is similar to moving between different altitudes, but there were
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some concerns about whether the new technology offered an unfair advantage to those athletes who could afford it or whether it compromised some inherent ‘spirit of sport’. These debates divided the scientific community, which, in the end, led to their remaining a legitimate performance-enhancement technology. However, this example reminds us that technologies have no prior moral status, but that their morality is located in the specific cultural circumstances within which they arise. So understood, our moral concern about drug use is inextricable from the concerns we have about it diminishing individual agency and the capacity to lead a healthy life, in the broad sense implied by the World Health Organisation (i.e. not merely the absence of disease). Yet, during the hypoxic debate, I felt that the WADA Code is striving to protect something more like a ‘moral way of life’ for an athlete, rather than merely ethical competition. This is relevant for the genetics case, since I suspect that such a moral justification might be possible to apply to sports (and might even be necessary), but this would mean a radical transformation of the WADAs institutional stance. Over the last 2 years, I have encountered many people who have sought to develop justifications for permitting or prohibiting genetic enhancements in sport. This has led to my developing a justification for enhancement based on an idea that I describe as the ‘accumulation of biocultural capital’. This position offers a retort to claims that permissive enhancement environments would lead to the mere homogenization of human traits and, in sport, dull competitions between the same kinds of athletes (everybody seeking the same traits and using the same technologies to achieve them). It also offers a response to claims that human enhancement does not actually improve anything about social practices such as sport and, for this reason, that we would be foolish to undertake such modifications. This rejection of enhancement pervades debates about the value of genetic enhancement in particular. My response to these ethical arguments against
genetic enhancement in sport explains that our selection of enhancements (within sports and outside of them) does not correspond with some prescribed value system. Indeed, even if we can identify trends in consumption that suggest many people will select similar modifications, the range of characteristics that we might modify through genetics would be sufficiently varied so as to be meaningfully distinct. Some people would choose to be taller, some shorter. On this basis, one need not disvalue enhancement and can look forward to it yielding greater diversity among the human population. Moreover, one cannot easily reject enhancements for sport as too narrow a choice, since people will arrive at their enhancement decision after having considered a wide range of possible enhancements that they might value – in the future there will not merely be a test for athletics genes, but genes associated with all kinds of careers. Genetically modified athletes will simply be those people who gave value to enhancements that are most suitable for athletic performances. Importantly, there need be no claim that sports themselves have been improved, but the mere act of taking a decisive action over one’s biological character offers a way of affirming one’s place in the world, of cultivating one’s authentic and unique life. Moreover, I rather suspect that there will be considerable interest in witnessing and experiencing the extraordinary achievements of genetically modified athletes whom, I claim, will still be worthy of characterizing as achievers. On this basis, the ethics of gene transfer in sport should not be written off as a simple case of doping, but must be seen as a potentially legitimate form of altering biology for the benefit of humanity and the individuals who comprise it.
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Dr Andy Miah is Reader in Ethics, Technology and Culture at the University of Paisley, UK. He is the author of Genetically Modified Athletes: Biomedical Ethics, Gene Doping and Sport (London & New York, Routledge).
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7. Montgomery, H., Clarkson, P., Barnard, M. et al. (1999) Lancet 353, 541–545 8. Plata, R., Cornejo, A., Arratia, C. et al. (2002) Lancet 359, 663–666 9. Taylor, R.R., Mamotte, C.D.S., Fallon, K. et al. (1999) J. Appl. Physiol. 87, 1035–1037 10. Gayagay, G., Yu, B., Hambly, B. et al. (1998) Hum. Genet 103, 48–50