It is sport's doomsday scenario: a new generation of bioengineered performance-enhancing agents that can transform also-rans into gold medalists. Imagine athletes injecting artificial genes right into their muscles -- a virtually undetectable act that would give them the sinewy muscles of a cougar, or endurance like that of an antelope. But this is not the science fiction of Hollywood, like the movie "Gattaca," or a long-lost chapter of H.G. Well's 1904 pharmacological fantasy "The Food of the Gods," about a superhuman race of young giants grown on drugs. This is the new reality in sports, and it is calling into question cherished beliefs about what is "natural" and "unnatural," fair and unfair, in the world of elite athletics.
At last month's Salt Lake City Games, a cache of blood transfusion equipment was discovered in a house rented by the Austrian Nordic team only a few days after three cross-country skiers who won six medals between them were sent packing after being nabbed as dopers. Elite athletes, who are always looking for the narrowest competitive edge, apparently gambled that they could beat the system by using the latest magic elixir, genetically engineered darbepoetin, which boosts endurance by enhancing the body's ability to churn out energy-producing, oxygen-carrying red blood cells.
By the 2004 Athens Olympics or shortly thereafter, sporting officials anticipate an explosion in the use of bioengineered performance-enhancing techniques. "Genetic engineering is accelerating and it's damaging sports," warns Norwegian speed skating champion Johann Olav Koss, who serves as an athletes' representative to the International Olympic Committee's World Anti-Doping Agency (WADA). "We can't be naive. We have to be realistic. This is not only an issue for sport, it's a broad ethical issue for human beings." Koss, who is also a physician, is one of 35 geneticists, doping experts and sport officials gathered in Cold Spring Harbor, N.Y., this week at the closed-door Genetic Enhancement of Athletic Performance workshop/summit, debating what should or can be done.
WADA president Dick Pound is one of many at the meeting who believes that genetic doping could "end sport as we know it." "We will look back on Ben Johnson with his Stanoloxol [steroid scandal in 1988 for which he was stripped of the 100-meter gold medal], and say that's like an ancient rock painting in a cave compared to what we face now with genetic engineering."
Genetic doping worries Pound and other sport officials because they see it as further undermining sports' bedrock ethical principle, fairness -- and doing so in a way that's infinitely harder to regulate than traditional performance-enhancing drugs. That concern is legitimate, but it runs up against three difficult realities. First, in the elite world of performance sports like track and field, cycling, power lifting and perhaps swimming, the use of performance-enhancing drugs is already so widespread as to make a mockery of the ideal of the pure, untainted athlete. Second, in the coming age of the cyber-athlete, detection of genetic enhancement will be all but impossible. And third, the advent of genetic interventions raises ethical dilemmas for which there are no easy solutions. There is no double yellow line separating genetic therapy, which conference participants by and large said was acceptable, from genetic enhancement, which they universally condemned. Is it ethical, for example, for an athlete who has injured himself after super-aggressive training to use genetic therapy to repair her body -- and gain an advantage over a competitor who was more judicious in her training program? What about athletes who use genetic technology to avoid a debilitating disease -- and also realize a side benefit of improved performance? Should they be banned from competition? Or only some kinds of competition?
And beyond victory and defeat, of course, looms the larger issue of athletes' health. The use of genetic enhancement poses health hazards, many of them still unknown and some of which may never be known.
To be sure, some concerns about genetic enhancement are overblown and futuristic. So-called designer babies, for example, are science fiction. It may be a decade or more before doctors can remove embryonic fluid and generate a readout of the predicted sporting accomplishments of our prodigies in waiting. But less distant are gene therapies, already proven on animals, that can regulate energy metabolism, alter blood flow to the tissues, modify pain perception, or even postpone sexual development to keep preadolescent females -- perhaps gymnasts and figure skaters of the future -- in their performance prime. As Pound noted, there are more than 500 active studies involving human clinical trials, with numerous therapies on the verge of federal approval. Scientists and athlete guinea pigs are also busy trying out gene enhancements to regenerate the body after cartilage damage, tears and fractures.
And synthetic drugs to boost endurance or increase strength and speed are already widely available. Confined to international cycling and weightlifting only a few years ago, gene doping is spreading to winter sports, track and field, the NFL and even World Cup soccer. FIFA, international soccer's governing body, has become so alarmed about the surge in use of the natural hormone erythropoietin (EPO), a favorite among endurance athletes, that it announced there would be testing for it at the upcoming World Cup. "I know that certain doping specialists have moved over from cycling to our sport because of the money it attracts," says Michel d'Hooghe, chairman of FIFA's medical committee.
World sporting organizations, the Olympic movement in particular, have proved hapless over the years in screening for dopers. The genetic revolution presents even more difficult challenges. Unlike classic drugs such as steroids, bioengineered substances are chemically identical to the body's natural hormones, making detection difficult at best. The problems will increase exponentially in the next wave of genetic enhancement, the direct injection of viruses or other delivery agents that carry DNA that can turn genes into energy factories or activate dormant muscles.
"If direct injection is used, the DNA will only be present in that specific muscle," notes Peter Schjerling of the Copenhagen Muscle Research Center. "A positive test would require coring out actual muscle tissue. Not many athletes would allow that. And the sample would have to be at the exact spot of the injection."
Certainly genetic engineering is becoming an ever more attractive option for those inclined to cheat. "Why would anyone use stimulants and steroids when they can use genetically engineered drugs or therapies, which are virtually undetectable?" says Charles Yesalis, a Penn State University epidemiologist and world expert on doping. "If things spin out of control, it could be a freak show in athletics."
Some geneticists and sporting officials believe that we only have to look to China to catch a glimpse of this freaky future. While Britain and other Western countries fret over the ethics of genetic engineering, China is holding science fairs displaying a rabbit with human ears jutting from its head, and a tail-whipping monster fish that exploded into adulthood in half the normal time. "Genetic research is like unlocking the secrets of the atom," enthuses Chen Zhang Liang, vice president of Beijing University, which is bidding to become a world center of genetic engineering. "We need to push forward."
China's next great leap forward may already be producing extraordinary rabbits and fish of the human variety. Last November's Chinese Games in Guangzhou featured some eye-popping results for the rest of the world to ponder. Fifteen-year-old girls finished second in the 400-meter hurdles and the grueling, four-hour 50-kilometer walk. And just 11 days past his 14th birthday, Li Huiquan won the 800 meters in world-class time, only a few days after nearly cracking 3:45 in the 1,500-meter. This was not the junior games, mind you, but the quadrennial showcase of the best Olympic athletes China has to offer. The results in swimming by a band of unknown teenage girls, most not listed in the world's top 200, were equally mind-boggling. If the Chinese females perform at the Athens Olympics like they did in these games, they will win two out of three medals in every freestyle event from the 100-meter to the 800-meter.
Those suspicious about previous unexpected record-busting performances by Chinese athletes see the fingerprints of doping. But China now has a vigorous drug-testing program. Since most observers believe that these results are at the edge of natural human performance limits, speculation has focused instead on genetic engineering. After all, it was only four years ago that Australian police nabbed Chinese swimmer Yuan Yuan red-handed with 13 vials of genetically engineered human growth hormone (hGH).
That the crisis conference is being held in Cold Spring Harbor is no small coincidence. The Long Island genetics laboratory has been the center of biological research in the United States for more than a century. It was here in 1953 that James Watson presented his and Francis Crick's double helix model of the structure of DNA. A generation later, geneticists here helped turn theory into practice by showing how RNA splicing could work -- the research that led directly to the genetically engineered drugs that are now roiling sports.
Conference organizer Ted Friedmann, a University of San Diego geneticist, is the consummate deliberate scientist who eschews the more frantic projections of some of his colleagues. By day he works on various techniques to move genes around in the body; by night he is a rabid sports fan worried about the future. "I'm concerned that the scientific community is not aware of how their gene transfer methods, which can do so much good, can present so many dangerous temptations to athletes."
Genetic engineering is an issue, like stem cell research or Bill Clinton's future, that stirs an immediate and powerful gut reaction. In recent years, biomedical researchers have made small but measurable strides in gene therapy, which involves injecting the body with artificial genes to help block diseases such as hemophilia and cystic fibrosis. The technique, while still being polished experimentally on humans, has been used successfully in animals. Many look forward to an age when many diseases will have been wiped out and hospitals will be obsolete except to treat trauma. But such revolutions invariably result in collateral damage. Friedmann and others gathered in Cold Springs have wrestled this week with the slippery issue of whether it's medically harmful or ethically wrong for athletes to take advantage of this new technology -- not for treatment but enhancement.
The genetics revolution has certainly changed how we view sports and the desire to challenge human performance limits. Since the dawn of the original Olympics in ancient Greece, it had been assumed that training and discipline were the heroic qualities most critical to athletic success. But recent research into population genetics and physiology has battered the myth that sports is a level playing field where athletes who work the hardest go on to glory. The fact is that humans are not equally endowed. The new axiom in sports, especially performance sports like track where skill and technique are comparatively less important than in ones like tennis, is that choosing one's parents is far more important than choosing a coach. The belief in the power of the environment has been superseded by the reality that much of human nature, and certainly a great deal of the performance potential of elite athletes, is hard-wired and measurable.
For scientists who struggle to measure the real-world relationship of genetics to human behavior, sports offers the refreshing possibility of quantifying differences. Genes matter, and performance sports offer a great way to figure out just how much. Consider the mystery surrounding the cross-country skiing exploits of Eero Mdentyranta. For decades after the Finn won two gold medals in the 1964 Winter Games at Innsbruck, and seven medals over three Olympics, he was dogged by rumors of deceit. Mdentyranta was not noted for his dedicated training habits, which prompted many of his competitors to accuse him of blood doping -- adding red blood cells before the race to increase his oxygen and stamina, a not-uncommon practice of cheats of his era. He was tested and shown to have 15 percent more blood cells than normal. But with no evidence of doping, the controversy morphed into one of sports' most intriguing long-running mysteries.
Although Mdentyranta never failed a drug test, the rumors that he had an advantage turned out to be true. Whether the advantage was unfair depends on what you think of the gifts of fate. By 1993, Finnish researchers were able to conclude that Mdentyranta and his family carry a rare genetic mutation that produced the EPO hormone and loaded his blood cells with 50 percent more red cells than the average man's. Certainly many elite athletes, especially those in the performance sports, are freaks of nature, but Mdentyranta's genetic advantage was huge and unique. His body was a natural energy factory. Unlike most people, he had no shutdown valve, so his red blood cell count continuously soared and his endurance never flagged. The extra cells bathed his laboring muscles in energy-producing oxygen, providing the boost to glide past competitors.
Mdentyranta's case may seem extreme, but only by degree: Many superstar athletes in highly competitive sports are outliers on the distribution of human possibility, the product of accumulating genetic mutations as rare as those that produce a 150-IQ chess champion or a violin-playing toddler. Randy Johnson is a Gulliver among the Lilliputians, a giant with a rocket arm and the constitution of a machine - a genetic rarity if there ever was one. The next "world's fastest runner" and Shaquille O'Neal are no less genetically unique, beneficiaries of nature's serendipity.
"Very many in sports physiology would like to believe that it is training, the environment, what you eat that plays the most important role," says Bengt Saltin, director of the Copenhagen Research Center and a pioneer in the study of the relationship between genes and muscles. "But we argue based on the data that it is 'in your genes' whether or not you are talented or whether you will become talented. The extent of the environment can always be discussed but it's less than 20, 25 percent."
"You can't change human nature" may be one of the wisest of adages, but today, even a merely good athlete can be turned into a superstar by engineering "genetic defects" -- creating future Eero Mdentyrantas. We are confronted with the reality that we can harness random acts of nature. Athletes often are willing guinea pigs, willing to gamble their health and maybe even their lives for the euphoria and glory of victory -- and the genetic revolution will doubtless prove irresistible. And why not? From aging offensive linemen to Kenyan-chasing distance runners, athletes will know that their prospects will be brighter with an injection from the right DNA-filled test tube.
A dark basement laboratory at the University of Pennsylvania offers a peek at what that the future cyborg athlete might look like. There, running tireless circles on a wheel inside a cage, is He-Man. A few years ago, physiologist H. Lee Sweeney injected a tiny white mouse with a synthetic version of a gene called Insulin-like Growth Factor 1 (IGF-1), a protein that makes muscles grow and repair themselves.
As Sweeney tries to remove him from his pen, He-Man clings stubbornly to the cage bars. "He's just showing off," jokes Sweeney, who is only partly kidding. This rodent is ripped. The IGF-1 boosted his muscle mass by more than 60 percent. Today, deep into old age, when most mice would be drawing up their last will and testament, this gene-modified giant looks like "Pocket Hercules," Turkish weight-lifting icon Naim Suleymanoglu. He-Man can still climb a ladder carrying three times his body weight. The rodent-athletes in a similar experiment conducted at London's Royal Free hospital and University College London's medical school balloon to four times their natural muscle mass but weigh only 30 percent more. And all this with no exercise and no detectable health problems.
"We call them the Schwarzenegger mice," says Harvard geneticist Nadia Rosenthal, who teamed with Sweeney. "I'd be totally surprised if it was not going on in sports. Those with terminal cancer and AIDs want to know 'What will keep me alive?' Athletes want to know 'What will help me win?'"
Genetic engineering will no doubt result not just in outsized performances but outsized risks. Endurance-boosting drugs like EPO cause the blood to thicken, which has led to the death of more than 20 cyclists. Human growth hormone, which is widely used by strength athletes and some sprinters, can result in enlarged organs and uncontrollable bone growth in the face, feet and hands. Called acromegaly, it is irreversible, crippling, and a killer. According to "The Steroid Bible," "People with excess levels of hGH in their blood rarely live past 60."
The spreading use of hGH may help explain the unusual times by Chinese sprinters and swimmers, women in particular, and even shed some light on another sporting mystery, the extraordinary success and untimely death of Florence Griffith-Joyner. Before she startled world sport with her four-medal, three-gold performance at the 1988 Olympics, obliterating the 100- and 200-meter records, Griffith-Joyner had been a solid but not brilliant sprinter. Her best effort over 100 meters did not rank in the top 40 marks of all time, and her previous best at 200 was not in the all-time top 20. Then came an overnight transformation of physique and performance. FloJo turned up in Seoul looking sleek and muscular. The records she went on to set were so extraordinary, almost superhuman, that even today's best female runner, Marion Jones, would find herself trailing FloJo like a basset to a coyote, by nearly three meters.
Keenly aware of the limitations of the human body, athletes and journalists at the Olympic Village speculated on her redefined body and extraordinary performances. Griffith-Joyner angrily dismissed the allegations and volunteered to take a drug test "anytime, anywhere," but it turned out to be an empty promise. There would be no more tests, no more races. She abruptly retired. Darrell Robinson, FloJo's former training partner and national quarter-mile champion, has publicly stated that shortly before the Seoul Games, she had paid him $2,000 for 10 cubic centimeters of human growth hormone, which would not have been picked up in any drug test. She dismissed Robinson as a "crazy, lying lunatic," but she never took legal action against him, and never raced again. After FloJo died suddenly in September 1998, the coroner's report showed that she suffered from "mild cardiac hypertrophy," an unusually enlarged heart, and "occasional interstitial fibrosis" of the heart muscle.
In the years since her death, the suspicions and circumstantial evidence have grown substantially. In 1987, a huge cache of hGH was stolen from London's Great Ormond Street Hospital for Sick Children, only to turn up that summer in the Santa Monica black market. A few months later, Flo-Jo's training partners began noticing dramatic changes in her appearance and performance. "I am astonished by the way Flo-Jo changed from the slightly overweight, sluggish sprinter I was easily able to beat in training in California," says British hurdler Lorna Boothe. Boothe also claims she met a nurse from a San Fernando Valley hospital that claimed Griffith-Joyner was being regularly injected with a steroid-like compound.
Whether such accusations amount to anything more than professional jealousy is an open question. But many prominent doping experts with no axes to grind have expressed serious suspicions about Griffith-Joyner. German scientist Werner Franke, who is credited with exposing the drug and sports machine that turned the former East Germany into a world athletic powerhouse, says flatly that Griffith-Joyner's seizures, which first occurred in 1996, were "symptomatic of the abuse of anabolic drugs or hGH." Former world champion power lifter Mauro Di Pasquale, who was medical director to the World Wrestling Federation and World Bodybuilding Federation and now holds a similar position with NASCAR, says the details of her heart condition and death are consistent with the side effects of such drugs. Even one of Griffith-Joyner's former physicians, sports specialist Robert Kerr, who treated her for an ankle injury, has weighed in on the scandal. "From the combination of her physical appearance and her increased performance," he says, "I believe she was on drugs."
While FloJo's grotesque death dominated headlines, she was not the only Los Angeles area track star to die under suspicious circumstances or suffer from questionable medical ailments. For more than a decade during the 1980s and '90s, the Santa Monica Track Club, led by Carl Lewis and Leroy Burrell -- who have both publicly campaigned against performance-enhancing drugs -- dominated world track. After nine SMTC athletes took home medals at the 1991 World Athletic Championships in Tokyo, doping experts pointedly noted the unusual fact that seven of those medal winners, Lewis most prominently, wore dental braces. Less than 1 percent of the adult population wears braces, but crooked teeth is a common side effect of using hGH. Lewis, who never failed a drug test, now suffers from chronic, degenerative arthritis. The SMTC's coach, Joe Douglas, has denied that any of his athletes used performance-enhancing drugs.
Should athletes be allowed to use genetic techniques to improve performance? Most physiologists, ethicists and sport authorities say no. Saltin says, in effect, that messing around with genes is playing God -- and only God should play God. "Biological variation is fundamental to sport," Saltin asserts. "You could say it's what gives a person their talent. This can now be radically affected with bioengineering, and this must be wrong."
Saltin looks to a future -- perhaps before the Athens Games, he suspects -- in which an ambitious sprinter who is tired of running in Maurice Greene's tailwind turns to a renegade geneticist for help. This scientist would be familiar with new research that has pinpointed genes that can activate dormant human muscle fibers -- fibers that resemble muscle from breathtakingly fast animals like cheetahs, and that fire far more quickly than human fast-twitch muscles. Humans only lack a genetic trigger to activate them -- and those genes can be turned on. Just a few injections of the right DNA into the quadriceps, hamstring and gluteus, and the muscle fibers would start cranking out Velociphin, activating the fast myosin gene. Within weeks, the muscles bulge and burst with energy.
As Saltin spins the tale, this desperate athlete faces his long-awaited race into Olympic immortality. BANG! The genetically doped athlete dashes into the lead, extending it with every stride. Then at 65 meters, far out in front of the field, a sudden twinge tickles his thigh. Saltin picks up the story:
"At 80 meters," he says, "the twinge explodes into an overwhelming pain as he pulls his hamstring. A tenth of a second later the patella tendon gives in -- because it is no match for the massive forces generated by his quadriceps muscle. The tendon pulls out part of the tibia bone, which then snaps, and the entire quadriceps shoots up along the femur bone. The athlete crumples to the ground, his running career over."
I gulp as he concludes his tale, nervously fingering the vitamin pill that sits undisturbed next to my morning coffee. "This is not the scenario that generally comes to mind in connection with the words 'genetically engineered super athlete,'" he adds, "but it is very much a part of the reality."
Without question, there is a high potential cost to playing God, even if genetic spigots can be developed and therapies perfected. The issue is homeostasis. While many of us naively view the human body as an invincible machine, it is an integrated combination of tendons, cartilage, bones, nerves, muscle, and fat. All living creatures are in delicate balance. One small change can have extraordinary and unanticipated consequences. For example, the same University of Pennsylvania researchers who came up with He-Man have genetically altered a housefly with muscles 300 percent stronger than normal. That may sound promising, but "the fly actually lost power because it couldn't make its wings move fast enough" to support the added muscle weight, notes Dr. Sweeney.
Olympic authorities take a hard line: Genetic engineering to improve performance is wrong. "Anything you did not get from God is illegal," asserts Tim Conrad, a U.S. Olympic scientist. "We're not trying to see what country has the best engineers." According to new IOC president Jacques Rogge, "Genetic manipulation is there to treat people who have ailments, not to treat a healthy person. I am very clear on this."
While I agree that the issue of genetic performance enhancement is troubling, both because of health concerns and because allowing its use would unfairly benefit the privileged, I don't see it as nearly so black and white. First, there's the question of what is "natural" and "normal" -- and why those who benefited by a lucky throw of the genetic dice should not have to face equal genetic competition. Many newly developed drugs and therapies are identical to natural chemicals made by the body. What should be considered "normal" levels of such naturally occurring hormones? Since many great athletes are in effect an accumulation of favorable (for that sport) genetic mutations, at what point do we disallow certain athletes as being too far from the "genetic mainstream"? Should we deny the sons of daughters of Eero Mdentyranta to pursue their dreams of becoming Olympic cross-country skiing champions because they have a huge advantage that is "natural" but no less decisive than an athlete who takes a synthesized version of natural EPO?
The most powerful argument for allowing genetic interventions, however, is that there is a hazy and debatable line between "health restoration" and "performance enhancement." Genetic enhancement offers promising health benefits -- as do any number of treatments that are the result of medical breakthroughs. Imagine an athlete using gene modification to overcome congenital asthma or another genetic abnormality. What about aiding someone who is destined to be short, say below 5 feet? Should they be disallowed from playing competitive sports if genetic manipulation will allow them to lead richer lives by making them 5 feet 10 inches? How about 6 feet 10 inches? Should people be punished because the roulette wheel of genetics did not land on their number?
World and Olympic champion sprinter Maurice Greene believes that the anti-genetic engineering orthodoxy is fueled by hysteria, and raises an intriguing point about personal responsibility. "What if you're born with something having been done to you?" he asks. Should manipulation of an embryo be considered cheating? Is it fair to disqualify an athlete if the genetic changes were made before she was even born, perhaps even to save her life?
Finally, there is the pragmatic point. It seems overwhelmingly likely that, whether we like it or not, many world-class athletes in the future will have "had their genes done" the way they now get their knees scoped -- and no one will know. What can or should we do about that?
There are no easy answers to these questions. The debate over genetic engineering is just beginning: It is certain to rage for years. The Pandora's box is open. There are cyborg athletes among us.
This story has been corrected.
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