Preamble
Today, one of the world's leading journal Science published an essay by Ted Friedmann, Olivier Rabin and Mark S. Frankel on the likely use of gene doping in sport (Friedmann et al. 2010, Is Gene Doping a threat to sport?, Science). Over the years, I've been on numerous panels, interviews and projects with Friedmann and Rabin and even reviewed this article – favourably – before it was publised. Both authors work with the World Anti-Doping Agency (WADA); Rabin is on staff as their Science Director, Friedmann is Chair of WADA's Gene Doping Expert Group and has performed research sponsored by WADA. Frankel, the third author and lead correspondent is staff at the American Association for the Advancement of Science (AAAS), the publisher of the journal Science. We have not met.
Compared to these authors, my views on the nature of sport are quite different, but we each agree that a) the use of gene transfer in sport is likely and b) the broad societal use of gene transfer in society would bring into question WADA's mandate. My interactions with Ted Friedmann, in particular, have been the kinds of exchanges one would always want from colleagues, particularly adversaries. So, it's with great pleasure that I offer an update on my views about gene doping, as a counter point to their essay.
I was tempted to contact Science directly and ask them to publish this, but it surely wouldn't come out until after the Vancouver 2010 Olympic Games, which is the most immediate landmark when this conversation will have currency. The timing of Friedmann et al. is thus perfectly placed to do WADA's work of indicating that it is going to solve the gene doping problem, but there needs to be a counter argument in place.
Forgive me if some sentences are a little sketchy, this was put together in a couple of hours.
PS: My book Genetically Modifed Athletes (2004) has just been translated into Portuguese by the Brazilian publisher Phorte – roll on Rio 2016.
Gene Doping: A reality, but not a threat
by Professor Andy Miah / +44 7891 850 497 / email@andymiah.net / in Vancouver from 17-26 Feb [feel welcome to republish this essay]
The world of elite sport has spent nearly 10 years investigating the science of gene doping. Back in 2001, they were very much ahead of the game, as therapeutic gene transfer was only just beginning to demonstate efficacy, though over this period, achievements in gene therapy have been limited. Nevertheless, the modus operandi of WADA over this decade is that gene transfer presents a real, technical possibility that requires scrutiny and action. Indeed, it is anticipated that athletes will soon try to use the same science to enhance their performances. It may even happen at the Vancouver 2010 Olympic Games.
Within anti-doping policy, genetic enhancement has been characterised as an illegal form of performance enhancement since 2003, in large part, because it would constitute an illegal use of medical technology for a non-medical purpose. In this sense, gene doping is treated in the same way as other doping methods. Yet, will this decision to treat it as morally impermissible stand the test of time, in an era where people are increasingly willing to modify themselves?
Such a speculation has no place in clinical practice and has only limited value for regulatory authorities who are, rightly, focused on making the practices they govern as safe as possible. Yet, the broader questions that gene doping presents are about how humanity envisages its future. Moreover, how we attend to this imminent technology today will affect how we regard it in years to come. As such, we cannot simply retreat to the view that genetic enhancement is mere science fiction. Indeed, it is widely recognized that the science of gene doping is already a technological reality.
I envisage a future for humanity where gene transfer – and many other forms of human enhancement - is sufficiently safe for its widespread use and where it becomes an integral part of our pursuit of good health. Indeed, undertaking such modifications would be considered as normal as body piercing or cosmetic surgery. Such attempts to promote our health will become increasingly important in an evermore-toxic world and will create a scenario where the population is, as a whole, more capable of performing in extreme conditions – such as elite sports competition.
Yet, this isn’t just a matter for sports to decide, as the legitimate use of gene transfer in sport will undoubtedly be preceded by its legitimate use in society more generally. Thus, non-athletes would also be using gene transfer to improve their competitive edge in the world or their overall functional capabilities, rather like obtaining a good education, eating the right food or stimulating our cognitive abilities by mental exercises.
An important ethical distinction in medicine is made between decisions that are made on behalf of someone and those that we choose to do for our own potential gain. The forms of genetic enhancement I have discussed thus far are broadly self-regarding, in that they only after the biology of the person to whom the modification has been made. In contrast, we might decide to genetically modify our hereditary genes – the germ-line – to ensure that subsequent generations have an advantage in life or, at least, are not made to suffer serious illnesses. This raises additional ethical concerns, which have yet to enter the radar of WADA, due to their seeming even more remote.
Nevertheless, in both cases, genetic enhancement should, first, be seen as an attempt to increase the resilience of the body to illness and injury, rather than as a radical shift towards transhuman enhancements. We wouldn’t be genetically design high-jumpers, but would instead amplify a range of biological parameters – such as height - which may translate into characteristics that would be optimal for certain kinds of physical activity. As such, the more radical prospects of gene transfer – such as genetically enhancing an embryo to be a good athlete - should be treated as science fiction.
In any case, it is not just these clear-cut instances of non-medical enhancements that will present difficult moral issues to solve. Even harder cases arise when considering whether gene transfer could be used to treat modestly debilitating conditions, such as asthma. Overall, we may conclude that a person would be better of without such conditions, but in the case of selecting embryos, we would be hard pressed to justify the use of pre-implantation genetic selection for such purposes. Any woman to have gone through pre-implantation cycles, in order to avoid passing on some heritable condition, will know that it makes no sense to talk of going through such an ordeal were it not to avoid only the most severe health risks for the prospective child.
Yet, when it comes to individuals modifying themselves – rather than their offspring, other forms of argumentation are required to justify their prohibition.. In actual fact, WADA’s precedent for permitting therapeutic use means that genetically modified athletes can compete; they just need a doctor to approve the medical use of the doping substance. This is why WADA is particularly anxious about monitoring whether athletes are enrolling into gene transfer clinical trials. It is also why the world of sport is anxious when there appears to be a higher rate of therapeutic use within the athlete population, compared to the general population, as it may imply that athletes are either gaining fake prescriptions or that there is some more sinister medical collusion to enhance athletes.
The challenge for the sports world is not just that gene transfer would be used to break the rules, but that the therapeutic use of gene transfer may create athletes who are even more capable than the so-called healthy athlete. Intimations of this shift are occurring in the context of Paralympic sport, where the prosthetically enhanced athlete is beginning to surpass the so-called able-bodied athlete, as in the case of South African sprinter Oscar Pistorius.
One of the big challenges that will determine whether WADA's gene doping problem can be solved is their ability to detect it. Yet, the present absence of detection methods, coupled with shifting social values on the morality of enhancement challenges the integrity and relevance of an anti-enhancement movement like anti-doping.
There are already indications of what a sports world full of commercial genetic products might look like. In 2004, the first commercial genetic test for a performance gene emerged on the market, the SportsGeneTest™ commercialised by Genetic Technologies (Australia). Tests of this kind were condemned by WADA at its landmark meeting on gene doping in 2005. WADA is particularly concerned that such tests might discourage young athletes from participating in sport, just because their genetic profile doesn't match the ideal type for a given sport.
Yet, it is unlikely that WADA's advice on the use of genetic tests will have any wider societal impact on the use of tests for more general use. Moreover, even if such tests are frowned upon – in part because their validity is dubious - it is doubtful that the potential harm from their use would be sufficiently serious to warrant their prohibition.
While the same analysis is not likely to hold for medically invasive modifications, like gene transfer, it will be for society to decide how it permits people to accumulate biocultural capital via human enhancements. Yet, rather than devaluing sports, I suspect that there will be considerable interest to witness and experience the extraordinary achievements of genetically modified athletes whom will still be worthy of our admiration. They will still train, struggle and achieve as athletes do today. The only difference will be that their edge over each oither will be determined by chosen genetic differences, rather than those wrought by the genetic lottery. On this basis, gene doping should not be seen as a threat to sport, but an opportunity for it to redefine its boundaries and, potentially, work towards the development of safer forms of performance enhancement.
On this final point, I was quoted today in the Edmonton Journal and Vancouver Sun for saying that gene doping my be safer than other doping practices and that it might not be that bad. The critical point here is that, if we are able to develop the technology under controlled conditions, then there's a greater chance of ending up with a safer form of enhancement since, unlike synthetic products, genetic augmentation will be more closely aligned to our indviidaul biochemistry.
I see nothing morally problematic about utilizing genetic technology to promote health and if the consequence of such actions is that we all become as capable of sprinting as Usain Bolt, then all the better. Admittedly, he may have to work a little harder to win the race, but, as we saw from his performance at the Beijing 2008 Olympic Games, that wouldnt be such a difficult task.