Sport and Medicine, The Lancet

This week, the leading medical journal, The Lancet, Published a special supplement on sport and medicine. Its contents include a number of ethical commentaries including:

Essay: Prosthetics for athletes
McCarvill S
pages S10-S11

Feature: Gene doping
Pincock S
pages S18-S19

Viewpoint: Legalisation of performance-enhancing drugs
Kayser B, Mauron A, Miah A
page S21

Essay: Transsexual athletes—when is competition fair?
Ljungqvist A, Genel M
pages S42-S43

Gene Doping Stockholm Declaration

After a fascinating series of presentations at the Stockholm meeting, we concluded proceednigs with a drafting of a declaration on gene doping. I think of particular interest was the stance taken on the use of genetic tests. This might raise a number of challenges for those who are already using them, though the declration does not forbid the use of such tests.

WADA's Second Gene Doping Symposium

From 4-5 December, the World Anti-Doping Agency hosts its second Gene Doping symposium in Stockholm Sweden. They have already issues a press release for this meeting and, like the NYC meeting in 2002, the proceedings are closed to the media and by invitation only.

At the meeting, I will give a reply to Dr Thomas H. Murray, President of The Hastings Center as part of a session on the ethics and policy implications of gene doping for sport.

One of the greatest catalysts for media coverage at the first meeting was Lee Sweeney's statement that he had been contacted by coaches and athletes who wish to enrol in gene therapy trials, in order to boost their performances. For the media and many other interested parties, this made the issue real and present.

It is likely that this meeting will present some advance on whether detection will be possible and I will argue for a re-definition of the ethics of sport based on a couple of recent pieces I have written. The first - published in the journal Public Understanding of Science - will advance a critique on the way in which gene doping has been discussed in society; the second - published in the European Journal of Sport Science - will argue that anti-doping policy should be replaced with a 'performance policy'.

Together, my conclusion will state that a rejection of gene transfer on the basis of current arguments implied and explicit within anti-doping policy is not justified. The two references are as follows:

Miah, A. (2005). "Genetics, cyberspace and bioethics: why not a public engagement with ethics?" Public Understanding of Science 14(4): 409-421.

Miah, A. (2005). "From anti-doping to a 'performance policy': sport technology, being human, and doing ethics." European Journal of Sport Science 5(1): 51-57.

"Genetic Technologies Launches Sports Gene Test in Japan"

The launch of the SportsGeneTest in Japan was announced in the Washington Post in mid-September. Here is a quote from the press release:

"GTG director, Professor Deon Venter, himself a former British Ironman Triathlon champion, attended the launch. Professor Venter commented, "Japan represents a significant market for the ACTN3 SportsGene Test(TM), with highly influential sporting and government bodies keen to explore the relationship between genetics and sporting performance. Japan is an extremely technologically-sophisticated country and is now taking a leadership position in the science of optimizing a person's sports potential according to their inherited genetic capabilities."

Doping & the Child

In April this year, I published a brief commentary about the American Academy of Pediatrics statement on performance-enhancing drugs in sport. This commentary was extended and published in the Sept 10 issue of The Lancet. Full reference as follows:

Miah, A. (2005, Sept 10). "Doping and the child: an ethical policy for the vulnerable." The Lancet 366: 874-876.

UNESCO, Bioethics & Doping

I just saw this press release for the UNESCO General Conference:

15-09-2005 12:00 pm UNESCO’s supreme decision-making body, the General Conference, which meets every two years, will hold its 33rd session from October 3 to 21 at the Organization’s Headquarters in Paris. The session coincides with UNESCO’s 60th Anniversary celebrations and a special ceremony will take place on October 5.

Over 2,000 participants will attend the General Conference including a large number of ministers and several heads of state and of government. (A detailed calendar will be made available shortly.)

Three international standard-setting texts figure on the agenda of the General Conference: a Preliminary Draft of a Convention on the Protection of the Diversity of Cultural Contents and Artistic Expressions; a Draft International Convention against Doping in Sport; a Draft Declaration on Universal norms on Bioethics.

The General Conference will examine and adopt the Programme and Budget for 2006-2007 and prepare the Draft Programme and Budget for 2008-2009. The Conference will also name a Director-General for the next four years and renew half the membership of the Executive Board.

Many other subjects will also be examined, including an assessment and future prospects for the Education for All programme, as well as a strategy for establishing a global tsunami warning system.

In conjunction with the work of the General Conference, a round table on Education for All, aimed at education ministers will be held on October 7-8. A second round table on basic science will be organized for science ministers on the afternoon of October 5. A Youth Forum will take place before the start of the General Conference from September 30 to October 2.


I wonder if there is any connection between the bioethics declaration and the doping in sport convention. I suspect not, but would like to be wrong!

Gene Doping: Human Genetic Technologies and the Future of Sports

Information about an event:

Please join us Oct. 11 for the inaugural talk in our new Genetics Perspectives on Policy Seminars (GenePOPS) series, designed to explore and illuminate some of the critical issues at the intersection of human genetics and public policy. Hosted by the Genetics and Public Policy Center, a partnership between Johns Hopkins University and The Pew Charitable Trusts, GenePOPS will feature some of the nations leading scientists, medical practitioners, policymakers, patient advocates, and ethicists as they discuss issues as wide ranging as genetic privacy, reproductive genetics, gene doping in sports, and safety and efficacy of commercial genetic tests.

Our first program features a panel discussion of the science, ethics, and regulation of genetically enhanced athletic prowess. Are the scientific tools available today to use gene therapy or germline modification to boost athletic performance, and if so, should they be used? Would the procedure be detectable through existing tests?

What kinds of pressures would athletes feel to use gene doping if it were available? Would parents be likely to choose genetic athletic enhancement for their children?

Tuesday, Oct. 11, 2005
Kenney Auditorium, Johns Hopkins University
1740 Massachusetts Ave., N.W.
4:00 p.m., reception to follow

PANEL:
Dr. Kathy Hudson, Director, Genetics & Public Policy Center (moderator)
Ms. Melissa Dalio Mierke, Exercise Physiologist and USA Triathlon National Champion
Dr. Tom Murray, Director, The Hastings Center (Chair, Ethical Issues Review Panel, World Anti-Doping Agency)
Dr. Bengt Saltin, Director, Center for Muscle Research, Copenhagen University (Member, Scientific Board, World Anti-Doping Agency)
Dr. H. Lee Sweeney, Chair and Professor of Physiology, Department of Physiology, University of Pennsylvania

Contact:
Rick Borchelt (202.663.5978); rborche1@jhu.edu )
Audrey Huang (202.663.5979); ahuang18@jhu.edu

Please RSVP to Rick or Audrey at the contact information above.

Gene Doping

Yesterday, I interviewed for The Kojo Nnamdi Show (Washington, USA) on the subject of gene doping. It was one of the more interesting, on-air debates I have had on this subject and we covered a lot of ground. Other guests included:

Dr. Gary Wadler, Sports physician, clinical associate professor of medicine at New York University and expert on sports doping

Richard Pound, Chairman, World Anti-Doping Agency

Jose Canseco, Former all-star baseball player and author of the book “Juiced: Wild Times, Rampant 'Roids, Smash Hits, and How Baseball Got Big”

Osagie Obasogie, Project Director on Race, Disability, and Eugenics, Center for Genetics and Society.

It was particularly nice to debate with Gary Wadler and Richard Pound whom I have not met in person. It appeared to me that the gene doping debate is a rich subject for society, in part for the reasons i have argued elsewhere. It does seem to provoke alarm bells which suggest that more is at stake than the usual concerns surrounding doping. Genetic science and technology does not have the same connotations for people as drug use.

This is quite useful from my perspective because it could yield a new kind of debate about doping and even transform the way in which anti-doping takes place.

Bioethics in Barcelona

Before I forget, I must mention something about the Barcelona meeting (Ethics and Philosophy of Emerging Medical Technologies, Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain), since sport appeared in a good handful of papers including:

Keynote paper on Therapy and Enhancement
Professor Ruth Chadwick

Argued in favour of the term 'improvement' rather than enhancement, as a basis for characterising the ethical issues arising from emerging technologies.

Ethical norms for research on biomedical enhancement susing human subjects
Professor Max Mehlman

Max has written considerably on genetic enhancement and regularly uses sport as a case study in his work. The military was also a theme and there are some great analogies between sport and the military.

Honorary session for Lennart Nordernfelt

Thomas Schramme developed a case to inquire into the concept of 'health' the focus of this session and a tribute to Nordenfelt who gave an introduction and reply. Schramme's case discussed Lily, an athlete who wanted to jump 2m. He argued that Nordernfelt's work would argue that her inability to jump this high would qualify as failing to meet a vital goal and that, therefore, we could characterise it as an illness that should be alleviated by medicine. In short, we would characterise her less than healthy.

Schramme rejected the idea that this inability should be characterised as an illness and rejected the idea that the realisation of all vital goals falls within the proper role of medcine. Nordenfelt agreed with Schramme's conclusion, but did not accept that Lily's interest to jump 2m could be described as a vital goal. Being the best is not a reasonable expectation, but being good is.

Athlete or Guinea Pig? Sports and Enhancement Research
Nancy M.P. King and Richard Robeson

Argued that medicine for the athlete should be characterised as enhancement research, but currently it is not. This led to some interesting debates about whether sport technology should go through a more rigorous liability check and whether this should be connected to anti-doping policy. I argue for this in my 2005 piece in the European Journal of Sport Science, though their emphasis is on medical procedures. I wonder whether blood spinning might fall within this category.

Finally, there was my wee paper

Posthuman Medicine & Imagined Ethics
Developed posthuman theory in relation to transhumanism and cyborgology and subsequently argued for the need to consider imagined ethical issues. Used the gene doping case as an example of an 'imagined ethical' debate.

Is 'Gene Doping' Wrong?

This is the title of an article I recently published with Project Syndicate. Rather than repeat the entire article here, I will just paste links to its various translations:

Is 'Gene Doping' Wrong? (English, by Andy Miah)

¿Es inaceptable el “dopaje genético”? (Spanish, Translated by Carlos Manzano)

Что плохого в «генетическом допинге»? (Russian, Translated by Николай Жданович)

Faut-il condamner le dopage génétique ? (French, Translated by Bérengère Viennot)

Ist „Gendoping“ verwerflich? (German, Translated by Anke Püttmann)

Je „genetický doping“ nesprávný? (Czech, Translated by Jiří Kobělka)

“基因兴奋剂”错了吗？ (Chinese, Translated by 许彬彬)

هل "تنشيط الجينات" خطأ؟ (Arabic, Translated by Ibrahim M. Ali

SportsGeneTest.com and ACTN3

I have just returned from Belgrade, where I presented a paper in an invited symposium at the 10th European College of Sport Science meeting. The title of the paper was 'Ban Drugs, Permit Gene Transfer'. Upon my return, I was updating the GMathletes website and discovered the SportsGeneTest website.


To my knowledge, this is the first site to indicate commercial tests for athletic performance. I noticed they have a policy statement, but it is only in German. If anyone can read German, perhaps you would tell me if it is an interesting statement or not!

More information is available through the Australian site 'Genetic Technologies'. In fact, at this page, the 'ethical tell' is a little clearer from their advice for coaches. I quote:

"It is important to note:

• this test is primarily aimed at elite athletes, serious competitors and teenagers already involved in sport and considering the next steps in terms of professional sports development;
• this test provides a complementary insight into a person's natural sport gearing and should only be considered as one aspect of a range of elements that go into being a champion, such as determination and the desire to win, enjoyment of the sport, coaching, nutrition, ability and level of fitness;
• the test may only be beneficial for those children already involved in and enjoying their sport who desire some direction as to their optimum sport or event if considering sport as a career or serious hobby;
• Genetic Technologies does not recommend or condone using the results of this test to pressure children into any sport or event. Children should only participate in sports that they enjoy for the purpose of fun and exercise."

So, it would seem they are concerned about:

1. These tests being used too early in a competitors life. Perhaps parents might wish to try them on their kids first, as a means of deciding whether it is worthwhile for them to play sport.
2. Genetic determinism - coaches/parents might conclude that the test result is the dominant predictor of performance capacity.
3. Tests might be imposed upon (young) athletes - though notably, they do not demonstrate a concern for adults being tested.

Well, I cover some of these issues in GMA, so perhaps no need to go over old ground. Still, genetic testing has yet to really hit home in the world of sport. It seems to be seen as merely an extension of talent identification, though I am not convinced that the principles are the same.

More on Genetic Tests for Performance

A few months ago, I posted on the use of genetic tests in the AFL. Since my very first talk about genomics and sport in 1999 at the First International Conference on Human Rights and Sport, I have been arguing on this subject. In 2003, the Australian Law Reforms Commission wrote about the potential for discrimination arising from genetic tests in sport.

This issue has arisen again in the context of the Australian Football League. Reports indicate that Port Adelaide and Essendon are considering the use of genetic tests to 'predict' the capacity of 'natural physical attributes'. The Age (Sydney) reported that each test would cost around AU$750 and AFL Players' Association president, Brendon Gale, has argued that such tests would be contrary to privacy laws in Australia. This issues seems about to, ahem, 'kick off' in Australia and few other countries have yet to really think it through.

Certainly, employment law might be a reasonable avenue for action within the UK, though where this takes place with young athletes, it seems likely to fall within the realm of parental consent.

Some of this relates to a piece I published a few years ago on this subject:

Miah, A. (2001) Genetics, Law & Athletes' Rights, Sports Law Bulletin 4(5), pp.10-12
Available here: http://www.media.paisley.ac.uk/andymiah/Miah2001GeneTest.pdf

Cosmetic Surgery & Wings

Next week, I will give a paper in Sweden titled 'Designer Steroids, Cosmetic Surgery, & Wings'. The paper will explore a range of modifications and, for now, I am particularly intrigued by the use of surgery for sport performance. So far, I have spoken to a range of doping experts about this and, each time, they are perplexed. The first responses is 'Well, what kind of surgery would an athlete benefit from?'. A couple of weeks ago, I posted something about Tiger Woods and laser-eye surgery, but I am sure there are other examples worth thinking through. So, until I have an answer about this one, I thought I'd through it out there and ask 'Why don't athletes use elective cosmetic surgery to enhance their performance?'

By the way, I will also mention that such modification is NOT banned by the World Anti-Doping Agency and I doubt that it could be.

(Maybe this relates a little to a paper I published a couple of years ago: Be Very Afraid: Cyborg Athletes, Transhuman Ideals & Posthumanity, Journal of Evolution & Technology, 2003)

Sport, medicine, ethics, Sweden

Sport Medicine Ethics, 23-24 May, 2005
On Monday 23rd and Tuesday 24th of May 2005, the Stockholm Center for Bioethics, together with the Department of Philosophy at the University of Stockholm and the Oxford Centre for Applied Ethics will organize an international conference on sport medicine ethics, an area still undiscussed within the field of bioethics.

The conference site is Stockholm, and the title of the conference is

"Legitimate and illegitimate enhancements, where to draw the line?".

further details will be posted at the website of the Forum for the Analysis of Sport Technology

First clone of champion racehorse revealed

New Scientist (among others) recently discussed the work of Italian scientist Cesare Galli, whose cloned horse might begin to cause problems for the world of horse racing:



However, it is not just the sports community that is concerned about this matter:

"William Allen, head of the team at the Equine Research Unit in Newmarket, UK, accuses the government of capitulating to animal welfare groups. Animal Aid, a British-based animal welfare lobby group, opposes cloning of horses on the grounds that cloned embryos are often deformed or grossly over-sized, and so should not be created for what they argue is a leisure activity."

What would be a good reason to clone an animal or a human, if not sport? Perhaps one might suggest that medical research is the only justified context, but only out of necessity. It is not that we want to clone anything at all, but doing so would be incredibly valuable to our understanding of biology and, specifically, disease. Indeed, this is the kind of argument used to defend animal research more broadly. If there were alternative means to advance research, then they would be used. While I don't think this is an adequate position, it might explain why 'leisure' is not important enough.

This news can be traced back to an earlier creation of Galli's team, discussed here:

Galli, C., I. Lagutina, et al. (2003). "A cloned foal born to its dam twin." Nature 424: 635.

The Beam in Your Eye - LASIK

Here is an news article about the use of laser-eye surgery on athletes, in this case the golfer Tiger Woods. The basic premise of this piece is that laser eye surgery is also a performance enhancement for athletes, but it is not banned. why not?

"A week ago, Tiger Woods was celebrated for winning golf's biggest tournament, the Masters, with the help of superior vision he acquired through laser surgery." (link)

Here is an extract from an article I have written on this theme, which will be published in a Dutch book on gene doping (edited by Bernike Pasveer and Ivo Van Hilvoorde):

"To articulate the differences between the various uses of medical technology for sport, one can draw three categories of human modification: therapy, non-therapy, and enhancement. To understand the conceptual differences between these categories, it is useful to consider an example of medical intervention where these boundaries appear to be blurred. Laser eye surgery is a medical intervention intended to relieve the deterioration of eyesight. If this technique is applied to someone who has severe or even mild eyesight problems, then it can be considered therapeutic, since it will rectify any imperfection that might inhibit vision. In this capacity, it is tempting (and usual) to describe this as a ‘therapeutic’ medical intervention. It also matters that the definition is underwritten by the existence of a physician’s authority here. Yet, what are the defining characteristics of this ‘therapeutic’ guise? Is it important that the individual’s eyesight is being restored to a previous level of vision? If this were true, then we might wonder about the relevance of this conclusion. How would we feel if the intervention were applied to a person who was born without eyesight? The surgery would not return the individual to any previous state and, in that sense, s(he) would not be restored. In this case, the person would be restored only in the sense that there exists some species-typical state of function, where the treatment is characterised as therapeutic based on some typical functionality that a given species should possess. It could be said that humans have evolved to utilise the capacity for vision. This could also account for an individual who is born with partial vision – for whom we might also argue that restoration to perfect human vision is justified on account of a species-typical level of functioning to which we are comparing the said capability.

Each of these methods of intervention is generally considered acceptable. While there is some disagreement about the legitimacy of interventions that appear to suggest certain ways of being human are preferable over others, let us assume for the moment that eliminating dysfunction, however troubling we might find its definition, is ideologically sound. So, the interest to ensure deafness is corrected is defended on account of it offering an ‘open future’ (Feinberg, 1980), where this entails maximising the possibilities any individual might encounter (for further elaboration see Savulescu, 2001 and Shakespeare, 2001). These examples can be contrasted with an intervention that would raise the level of capability beyond both an individual and species-typical level of normal or even perfect function. So, if laser eye surgery leads to better than perfect vision, we might have quite different concerns and feelings about it.

Yet, it is also possible to think of circumstances where there is not much resistance to such super-human capacities. For example, there do not seem to be particularly strong moral convictions about the use of binoculars, telescopes, magnifying glasses, or even satellites and cameras, which radically re-define our capacity to see beyond our physical constraints. Yet, how would we feel about super-human vision? What if laser eye surgery could enable humans to enjoy the vision of, say, birds of prey. Alternatively, what if it enabled some additional functionality, such as a zoom capability? What should be our moral stance to such modifications and would such modifications be accepted in competitive sporting cultures? (FN: while not specifically tied to a sporting example, ‘super vision’ has been discussed in the context of sport recently (Alderson, 2001))

In the world of sport, the ethical reaction to such innovations would be clearly expressed by a certain moral community, which argues that the ‘natural’ athlete must prevail in sports contests. Where a modification places an athlete over and above their natural level of functioning or some species-typical level of functioning, this constitutes doping and is considered to be unacceptable because it provides an enhancement of the natural. On one level, it is possible to understand why anti-doping exists and why some would seek to justify such rules on the basis of naturalness. In some sports, an athlete with the capacity to ‘zoom’ their vision would be at a considerable advantage to an athlete who does not have such capacity (though in others it might actually be an inconvenience and a skill to be able to modify one’s eyesight to optimise performance). In one very important sense, a contest between two athletes would not be of much interest where one of them has super-vision, since the enhanced athlete will be more successful. However, from another perspective, sport intends to reveal the most capable human. An athlete born with some ‘zoom’ capability is, in one very important sense, the most capable human. Why should an athlete not receive their gold medal, if they are the most capable? These matters raise questions about what is just in sport and the legitimacy of enhanced capabilities."

LifeWaves - Not Doping?

One of the questions at the Harvard symposium was about the ethical status of LifeWaves, the new technology that is designed to boost energy. There is no official WADA position on this one yet, but it is unlikely that it will be considered a method of doping. However ,it is performance enhancing and does offer a 'short-cut' to better performances. To that extent, one might argue (mistakenly) that is compromises the 'spirit of sport'. Here we have a further indication that there is a need for more joined-up thinking in the world of sport, about performance. In a paper I am due to have published in the Journal of Sport Sciences, I argue that it is necessary to ditch the anti-doping framework and replace it with a 'Performance Policy', which makes clear the connections between a range of technologies and how they challenge the ethical status of performance in sport.

Here are some details about the LifeWave patches from The California Aggie:

"The product consists of two patches, which the company claims will boost energy by 20 to 40 percent, and contains a vague list of ingredients known as 'orthomolecular compounds.' The NCAA and the U.S. Anti-Doping Agency tested the patches and found no illegal substances. The NCAA went a step further by announcing that the patches do not fall under the category of nutritional substances because nothing is ingested.

While LifeWave's patent is still pending, and no details can be given about the composition of the patches, it is important to note the overall trend that is taking place in sports: an increase in cases of performance-enhancing products or supplements on the market. The fact that athletes at the collegiate and professional levels are looking for any advantages they can gain over their opponents is a distressing sign.

Gone are the days when athletes gained their advantage by just working harder than their competitors. In today's era of sports, money and results are what matter and some athletes seem to be willing to accomplish their goals by any means necessary.

While very few collegiate athletes gain the notoriety that often accompanies professional sports, it is important to note that Davis youths admire UCD athletes. Youngsters often emulate what they see performers doing and it is not far-fetched to believe kids will start using supplements in their adolescent years when given their favorite athletes as examples of a product's success.

LifeWave seems to be the latest in a string of performance-enhancing products. With the rise of such products, athletes are often faced with the tough decision: losing the competitive edge or compromising their athletic integrity."

Of course, I totally reject the stance of this paper, but what's new!?

From BALCO to Bioethics, Harvard

Details of a meeting where I will give a presentation on gene doping:

Venue: Boston, USA: E.LaB Event Description

The Harvard Law School Ethics, Law & Biotechnology Society (E.LaB) in conjunction with the Harvard Committee on Sports and Entertainment Law (CSEL) & HL Central are proud to present “From BALCO to Bioethics: The Present and Future of Performance Enhancement in Sport.” The ongoing and highly publicized BALCO controversy has made the topic of performance enhancement among athletes one of substantial current interest and debate. While BALCO controls the headlines of today, and poses difficult questions for professional and amateur sports, we pause to speculate about what the future of performance enhancement in athletics may hold.

This panel discussion will feature Dr. Olivier Rabin, Director of Science for the World Anti-Doping Agency, Dr. Dan Brock, Director of the Division of Medical Ethics at Harvard Medical School, and Dr. Andy Miah, Lecturer in Media, Bioethics and Cyberculture at the University of Paisley, Scotland. The panel will be moderated by Dr. Gil Siegal, visiting professor and Medical Ethics Fellow at Harvard Medical School.



Please join us for an open dialogue about the present and future state of performance enhancement in sport.

Where: Harvard Law School, Langdell South Classroom

When: Monday April 11, 2005. 7-9pm.

Contact: Dan Vorhaus (dvorhaus@law.harvard.edu) for more information.

Marathon Mice and PPARd

Press release from The Salk Institute. It is intriguing that any connection is made between this work and athletic performance. Clearly, the scientist's work is aimed at medical intervention and yet the prospects for athletes are implied through the communication. It is a further indication of how the application of pharmaceuticals to sports is sexy enough to spice up scientific research, but that most scientists are not really alarmed by how their work might be used for non-therapeutic purposes. Equally, perhaps Dr Evans is working with WADA to ensure they have tests for any future product that might arrive on the market. While I don't think that this would be enough to deal with the use of dangerous substances in sport, it would be an important development.

Altering steroid receptor genes creates fat burning muscles, resistance to weight gain, and lowered inflammation.

April 04, 2005 La Jalla, CA — The Salk Institute scientist who earlier discovered that enhancing the function of a single protein produced a mouse with an innate resistance to weight gain and the ability to run a mile without stopping, has found new evidence that this protein and a related protein play central roles in the body's complex journey to obesity and offer a new and specific metabolic approach to the treatment of obesity related disease such as Syndrome X (insulin resistance, hyperlipidemia and atherosclerosis).

Dr. Ronald M. Evans, a Howard Hughes Medical Investigator at Salk Institute's Gene Expression Laboratory, presented two new studies Monday, April 4, at Experimental Biology 2005 in the scientific sessions of the American Society for Biochemistry and Molecular Biology.

The studies focus on genes for two of the nuclear hormone receptors that control broad aspects of body physiology, including serving as molecular sensors for numerous fat soluble hormones, Vitamins A and D, and dietary lipids.

The first study focuses on the gene for PPARd, a master regulator that controls the ability of cells to burn fat. When the "delta switch" is turned on in adipose tissue, local metabolism is activated resulting in increased calorie burning. Increasing PPARd activity in muscle produces the "marathon mouse," characterized by super-ability for long distance running.

Marathon mice contain altered muscle composition, which doubles its physical endurance, enabling it to run an hour longer than a normal mouse. Marathon mice contain increased levels of slow twitch (type I) muscle fiber, which confers innate resistance to weight gain, even in the absence of exercise.

Additional work to be reported at Experimental Biology looks at another characteristic of PPARd: its role as a major regulator of inflammation. Coronary artery lesions or atherosclerosis are thought to be sites of inflammation.

Dr. Evans found that activation of PPARd suppresses the inflammatory response in the artery, dramatically slowing down lesion progression. Combining the results of this new study with the original "marathon mouse" findings suggests that PPARd drugs could be effective in controlling atherosclerosis by limiting inflammation and at the same time promoting improved physical performance.

Dr. Evans says he is very excited about the therapeutic possibilities related to activation of the PPARd gene. He believes athletes, especially marathon runners, naturally change their muscle fibers in the same way as seen in the genetically engineered mice, increasing levels of fat-burning muscle fibers and thus building a type of metabolic 'shield" that keeps them from gaining weight even when they are not exercising.

But athletes do it through long periods of intensive training, an approach unavailable to patients whose weight or medical problems prevent them from exercise. Dr. Evans believes activating the PPARd pathway with drugs (one such experimental drug already is in development to treat people with lipid metabolism) or genetic engineering would help enhance muscle strength, combat obesity, and protect against diabetes in these patients.

Link to site

American Academy of Pediatrics on Doping

Today, the AAP published a Policy Statement on the Use of Performance-Enhancing Substances.

It dismisses 'scare tactics' of health care professionals, suggesting that denying the performance-enhancing effects of substances to the young athlete is ineffective, as a means of prevention. The pediatrician must 'have an understanding of the incentives for use' and they define the problem as due to the drive for success in our contemporary society.

Of particular interest is that they identify 'limitations of current definitions' of doping, calling for a more restrictive definition that takes into account the possible different kinds of users. Specifically, they want a definitin that protects the most vulnerable kinds of users, in their case, a concern for minors.

They also dismiss the strategy of testing, as a method of prevention, identifying the need for education and evaluation of education programmes, which rarely happens.