Experts Warn Gene-doping on Horizon, Urge Public to Discuss Ethical Implications

From left to right: Ted Friedmann, Tom Murray, Mark Rothstein, and John Feinstein

Ancient Olympians were known to seek potions from astrologers to gain victory on the athletic field. But speakers at a AAAS co-sponsored Capitol Hill briefing warned that modern-day athletes may soon look for an advantage from a different sort of potion-maker: geneticists.

By deliberately altering their genes to increase muscle mass, quickly recover from a sprint, or more efficiently use oxygen, athletes may seek to gain an edge against their opponents.

But while the allure of running a sub-4:00 minute mile or throwing a 110-mile-per-hour fastball may lead some to overlook the obvious dangers of altering one's genetic make-up for athletics, commonly called gene-doping, science cannot make super-athletes, the speakers said. At least not yet.

"There will soon be companies peddling products for genetic doping and people will buy them," said Tom Murray, president of the Hastings Center, a bioethics research institute. "But the chance that they will improve their performance is not high."

Because the technology remains several years off, Murray, who chairs the Ethical Issues Review Panel of the World Anti-Doping Agency (WADA), said that athletes at the 2008 Summer Olympics will probably not have genetic doping to thank for their world-record performances.

Still, he said, it is important for scientists, policymakers, and the public to openly discuss genetic doping research, its risks, and its implication for sports and society.

"Good ethics begins with good facts," Murray said.

The 22 October briefing, co-sponsored by AAAS and the Hastings Center, was moderated by Mark S. Frankel, director of the AAAS Program on Scientific Freedom, Responsibility and Law. It was the first in a series of collaborations between the two nonprofit organizations, reaching out to policy-makers, the media, and the public for an open discussion on science and bioethics.

"The science of gene-doping is still in its infancy and policies are in flux," said Frankel. "The time to consider the implications of gene-doping is now, as competitive pressures, national pride, public adulation, and financial inducements have all coalesced to create a 'perfect storm' for performance enhancement."

Genetic therapy is the deliberate alteration of the kinds of genes that are expressed to treat a disorder caused by a missing or defective gene. For example, by placing altered genes into a patient's cells, scientists hope that medical gene therapy can eventually lead to treatments battling sickle cell disease, blindness, cystic fibrosis, cancer and more.

In early November, scientists at Case Western Reserve University in Cleveland, Ohio, reported that they created a strain of mice with increased physical abilities by genetically-modifying a metabolism gene. By injecting an active form of the gene PEPCK-C into an embryo, the scientists found that the mouse more efficiently burns body fat for energy and produces less lactic acid during exercise.

Although humans share the same metabolism gene, The Independent reports that the scientists stated that it is not currently possible to replicate the gene modification in humans, nor would it be ethical, because the study used subsequent breeding of the mice to increase the group size.

Ted Friedmann, a professor of pediatrics and member of the Center for Molecular Genetics at the University of California, San Diego, said that while medical gene therapy has enjoyed early successes, it is relatively risky and still "experimental and immature."

For example, while medical gene therapy has proven effective in helping some young patients with severe combined immunodeficiency (SCID) resume a normal childhood, Friedmann said that other patients have developed a form of leukemia.

"In 16 years, medical gene therapy has gone from the bench to the bedside," said Friedmann, who also serves on the WADA Health, Medicine and Research Committee. But, he continued, there are still severe costs including potentially adverse affects and death.

Because of the hazards, Friedmann believes that the risks of medical gene therapy are only acceptable for life-saving issues, not "cosmetic traits like athletic ability."

Friedmann highlighted two potential ways that genetics will impact sports: genetic transfer and genetic screening.

In the first process, a gene is manipulated to help an individual increase or decrease a trait to gain athletic ability. For example, gene transfer could be used to provide athletes a source of erythropoietin (EPO), a hormone that promotes the formation of red blood cells that is already widely abused in sports.

Although a competitor could gain the athletic benefit through EPO treatments, scientists believe that the same therapy could lead to advances in treating anemia, a medical deficiency of red blood cells or hemoglobin.

Because the drugs would modify somatic cells, not reproductive cells, the gene changes would be restricted to specific tissues like muscle, and would not be hereditary.

The second way that genetics might affect sports is through genetic tests. By allowing someone to screen themselves, or others, for genetic variants that suggest an increased athletic ability, athletes would be able to select a sport that best meets their strengths.

For example, through the Australian company Genetic Technologies, customers can order a $100 test that, according to the company, can determine if they are "naturally geared toward sprint/power events or towards endurance sporting ability." By testing cotton swab samples sent by the customers for the fast-twitch muscle function gene ACTN3, the company can help athletes "optimize [their] training to make the most of [their] natural ability within a wide range of sports."

While Genetic Technologies does not offer additional athletic tests, other genes associated with athletic ability include PPARdelta, a gene that controls slow-twitch muscle growth; IGF-1, a gene that controls human growth; and genes that regulate erythropoietin, a hormone that affects the production of red blood cells.

Friedmann said that among the most troubling aspects of these tests is that "they are over-hyped, over-sold, and portray complex characteristic like athletic ability as something that can be reduced" to a simple gene.

Murray added that there are many stories on new "athletic genes" that make the front page of newspapers, but stories on the gene's inability to deliver on the hype almost always get buried.

Mark Rothstein, director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine said that the performance-enhancing genetic testing and screening can lead to increased non-medical uses of the technology, posing issues with laboratory standards and privacy.

"The country is woefully behind in policy regarding new uses of genetic testing and screening," Rothstein said.

For example, genetic testing is commonly regulated by governmental and professional bodies when used in crime scene investigation, paternity testing, and health-care settings.

But, Rothstein said, some entrepreneurs are now offering neutra-genomic analyses—tests they claim can tell patients everything from what vitamins they are genetically deficient in, to what shampoo they should use. Of course, many of the companies also offer supplements.

Rothstein said that the companies are unregulated, adding that there is no one to certify the validity of the tests, no chain of custody for the samples, and no education and training requirements for the employees.

In addition, because cosmetic genetic testing is preformed in a private, non-medical facility, there is no guarantee of confidentiality because the Health Insurance Portability and Accountability Act regulations, laws that protect personal medical information, do not apply.

John Feinstein, a sports writer at the Washington Post and frequent contributor to National Public Radio, said that athletes will continue to take steroids, and perhaps eventually alter their genes, "as long as it is worth the risk."

Feinstein cited baseball player Barry Bonds as an example: Although most people believe that he has used steroids, he is paid a high salary, his home runs are on TV highlight reels, and the commissioner of baseball was in attendance for his record-tying 755th home run.

Feinstein said that there is an intense pressure on athletes to succeed even from a young age. He cited a study that showed 70% of young athletes surveyed would be willing to die 10 years prematurely for a 10-year career in the National Football League.

"I even have friends who swim in masters' division leagues who take supplements even though they have little at stake," he said.

Feinstein predicted that steroids and genetic doping could eventually lead to fans becoming disinterested in professional international sports. "The reason we care about sports is because it is real," he said.

Benjamin Somers

9 November 2007