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Re: An ethical argument prompted by gene manipulation and improvement of athletic performances

Dear Editor,

Prompted by Lippi & Guidi [1] and their discussion that drugs which modulate hypoxia inducible factors (HIFs) should soon be included in antidoping legislation, is an old argument from my undergraduate days. They state that HIFs stimulate red cell production and so could be used as an athletic stimulant or to treat pathological conditions that involve altered oxygen metabolism. On the flipside of the coin HIFs stimulate genes encoding proteins involved in cell division and survival which could ultimately promote the development of cancer [2].

This brings to mind an ongoing debate with an old lecturer. Silicosis is a group of lung diseases that develop following the inhalation of crystalline silica dust (SiO2)[3,4]. While for coal miners this may simply be an occupational hazard, should the side effects of steroids (or in this case gene manipulation) be an occupational hazard for athletes?

Every drug is potentially toxic if administered in high enough doses and drug use has increased in prevalence as athletes will “do anything, take anything, short of killing themselves in order to improve performance” [5]. In ancient Greece it was hallucinogenic mushrooms, 19th century boxers used heroin as a painkiller, amphetamines and cocaine were used together in the 50’s [6] and today athletes are using an even wider range of drugs and genetic manipulation.

This historical view raises the point that drug use is not new, so we cannot attribute it’s increase to financial rewards or increased media scrutiny. In reality there is no justification for cheating, the pressures and temptations are equal for all and any problem is of morality and ethical justification. So what if the aspect of cheating was removed and only the cost and availability limited the use of performance enhancing techniques?

The mere seeking of an advantage is not implicitly unfair, nor is the gaining of an advantage implicitly unfair [7]. In most cases any advantage comes from an external source (e.g. sharkskin swimming suits), so why should drugs or genetic manipulation be any different? So long as athletes are informed of the risks, then why not allow (for example) steroid use, it would certainly level the playing field. It would allow those athletes who have to work harder to acquire an advantage through training to easily achieve the same level as those who can gain a training advantage with less effort.

The side-effects provide a sufficient basis for prohibition alone, but is stopping competent adults from doing something an unwarranted intrusion of privacy? There is in comparison little or no debate about banning high-risk sports such as rugby or boxing and there is little difference between athletes who risk their health by competing when injured and those who risk their health to drugs. We admire those competing dosed up to the eyeballs with painkillers and then condemn them for taking other drugs to build muscle and relax after they have pushed their bodies too far. If we are prepared to accept concern for an athlete’s health as a basis to intervene over drug-use then logically we should look at other aspects of certain high-risk sports. Allowing performance-enhancing techniques may even decrease the risk for athletes [8]. Banning them places a reliance on black market operations (whose quality could not be guaranteed), there would be no advice on dosages and hygiene could be compromised. If a ban is lifted then these techniques could be controlled.

Any game is defined by its specific rules and if the rules are broken you are not really playing that game. For example if a soccer player picks up the ball and runs it is no longer soccer but branches off to become rugby union, by the same token if one lone athlete takes drugs or modifies their genes to express hypoxia tolerant characteristics then they are playing a different game. A more effective way to ensure maximum fairness may be to allow the free use of drugs. Consequently though, if unrestricted access to drugs was allowed would that be fair? Inequalities would exist between users themselves as well as users and non-users [9]. No two people can be guaranteed to respond in the same way to the same drug due to their individual physiology and no matter what drugs are used, someone is always going to be first to use those that are newly developed.

Whatever route is taken to justify or oppose drug-use they all seem to lead to a cul-de-sac of ambiguity and counter argument and therefore the answer to the original question is not simple. It is down to the individual athlete to consider all the risks involved and only then can they decide if using performance enhancing techniques is just an occupational hazard.

References

(1). Lippi, G, Guidi, G. Gene manipulation and improvement of athletic performance: new strategies in blood doping. Br J Sports Med 2004;38: 641.

(2). Marx J. How cells endure low oxygen. Science 2004;303: 1454-6.

(3). Beckett, W, Abraham, J, Becklake, M, Christiani, D, Cowie, R, Davis, G, Jones, R, et al. Adverse effects of crystalline silica exposure. Am J Respir Crit Care Med 1997;155: 761-765.

(4). Mossman, B, Churg, A. Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med 1998;157: 1666-1680.

(5). Connelly, H. cited in J.J. Coakley. Sport in Society: Issues and Controversies. Mosby, St Louis, Missouri, USA. 1994; 151.

(6). Todd, T. Anabolic Steroids: the gremlins of sport. J Sport Hist 1987;14(1): 87-107.

(7). Fost, N.C. Ethical and Social Issues in Anti-doping Strategies in Sport. In Landry, F., Landry M.,& Yerles, M. (eds.) Sport... The Third Millenium. Sainte-Foy, Les Presses de l’Universite de Laval. 1991.

(8). Black, T, Pape, A. The Ban on Drugs in Sport, The Solution or the Problem? J Sport Soc Iss 1997;21(1): 83-92.