Let Harrison Bergeron Dance

by Patricia Mayer, MD, Bioethics Program Alumna (2009)

All I can think of when reading the case of Indian sprinter Dutee Chand is Harrison Bergeron, protagonist of a 1961 short story by author Kurt Vonnegut.

For those of you who don’t know who Dutee Chand is, she is a Indian sprinter who was banned from the 2014 Commonwealth Games because her testosterone level was “too high”. Unlike other athletes who use banned substances to achieve this, Ms. Chand’s testosterone levels were not artificially elevated. She was not “doping” by taking testosterone supplements, and there are no accusations of her “not being a woman”. She simply produces high levels of testosterone naturally.

Although testosterone is known as the male sex hormone. It plays a key role in male reproductive development, as well as such secondary sexual characteristics such as increased muscle and bone mass. But testosterone is present in all persons, both men and women. Men generally have higher levels than women, but levels can vary between individuals of both sexes. Some men have low levels and some women have high levels, and vice versa. In some cases in which men and women also have “abnormal” levels, it can be the result of genetic factors or other medical conditions. In Dutee’s case, she is reported to have hyperandrogenism.

The International Association of Athletics Federations (IAAF) prevented Ms. Chand from competing in the 2014 Commonwealth Games because it felt that her naturally elevated levels of testosterone gave her an unfair advantage over the other female athletes. But the link between testosterone level and athletic prowess is tenuous at best. There is no evidence that women with high testosterone are better athletes than women with lower levels. Many factors go into athletic success including training, drive, and determination, to name but a few. Still, the IAAF has set a testosterone level of 10 nmol/liter as the upper level at which they will allow women to compete in professional competitions.

So what if a woman like Dutee’s testosterone level are naturally higher? Should they be required to do something to lower it below 10 nmol/liter in order to compete? Will otherwise health women be forced to undergo surgery, use drugs or take hormonal suppressants in order to “level the playing field”?

The fact of the matter is that athletic playing field has never been level. It can’t be. There are, for example, genetic differences that make some people outstanding in one sport or another. Michael Phelps is said to have a “body made for swimming glory”. Usain Bolts’ height and high percentage of fast twitch fibres drive his speed in the track. Gabby Douglas’s diminutive stature contribute to her prowess in gymnastics. Shall we alter Phelps physique? Remove some of Bolt’s fast twitch muscles? Administer growth hormone to make Gabby taller? All these interventions would potentially “level the playing field,” but all are crazy.

Which brings me back to Harrison Bergeron. Kurt Vonnegut’s famous short story begins:

THE YEAR WAS 2081, and everybody was finally equal. They weren’t only equal before God and the law. They were equal every which way. Nobody was smarter than anybody else. Nobody was better looking than anybody else. Nobody was stronger or quicker than anybody else. All this equality was due to the 211th, 212th, and 213th Amendments to the Constitution, and to the unceasing vigilance of agents of the United States Handicapper General.

Each person in that society was required to wear handicapping contraptions to offset natural traits that might make him, in some way, “better than” somebody else.

Harrison Bergeron…is a genius and an athlete, is under-handicapped… scrap metal was hung all over him… Harrison looked like a walking junkyard. In the race of life, Harrison carried three hundred pounds.

And in case you’ve not read the story or have forgotten the ending, let me recap: Harrison throws off his handicaps and dances … until he is shot dead by the Handicapper General.

Let Harrison dance. And let Dutee run.

[The contents of this blog are solely the responsibility of the author and do not represent the views of the Bioethics Program or Union Graduate College.]

 

Tackling the Problem of Domestic Violence

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

The National Football League is in for a rough season, both on and off the field. In the past month, for example, America’s most popular sport has been rocked by allegations that league officials and team owners willfully ignored evidence that the Baltimore Raven’s star running back Ray Rice beat his then-fiancée unconscious in an Atlantic City elevator.

All-pro defensive end Greg Hardy of the Carolina Panthers and defensive lineman Ray McDonald of the San Francisco 49ers face similar allegations. Most recently, Minnesota Vikings’ Adrian Peterson was charged with criminal child abuse after whipping his four-year-old son with a wooden switch and a leather belt.

In response, beleaguered NFL Commissioner Roger Goodell promised to overhaul the organization’s policies on personal conduct, making it easier to penalize players harshly for egregious off-field behaviors, including domestic violence and child abuse. Commissioner Goodell also introduced a new initiative that would require all players and league staff to participate in regular educational programs on domestic violence and sexual abuse.

Unfortunately for Mr. Goodell, much of this is “too little, too late.” A growing number of women’s organizations and domestic violence advocacy groups are calling for his resignation. A number of commercial sponsors are also distancing themselves from the NFL, which makes Roger’s continued tenure as NFL Commissioner increasingly unlikely.

A number of pundits have also weighed in, not just on the question of Mr. Goodell’s career prospects but also on whether or not the recent spate of domestic and child abuse causes is directly linked to misogynistic and violent culture of professional football. Some of these armchair quarterbacks have linked the so-called “epidemic” of domestic violence in the NFL to increasing awareness of the physical and mental toll that football takes on professional (and even amateur) athletes.

Many players, for example, use anabolic steroids illicitly in order to get a competitive boost. It is well known that abuse of these drugs can lead to uncontrolled aggression and violent behavior (colloquially called ‘roid rage’).

Similarly, head injuries – particularly concussions – are also a common occurrence in high-speed contact sports like football. Players with a history of repeated concussive head injuries are at increased risk of developing a progressive neurodegenerative disease known as chronic traumatic encephalopathy (CTE), symptoms of which include mood and behavioral changes, dementia, tremors, impaired speech, and deafness. Actuarial experts hired by the NFL itself now estimate that as many as one-in-three professional football player will develop CTE or other long-term cognitive problems in their lifetime.

But it is important to remember that correlation is not causation. For instance, there is no definitive link between CTE and domestic violence in the NFL or other sports leagues. More importantly, despite the current spotlight on Ray Rice and Adrian Peterson, there is no link between professional football and domestic violence.

This is not to say that domestic violence is not a big problem in the NFL. Since 2000, nearly 100 players have been arrested or changed with domestic violence or child abuse. But this rate is actually slightly less than the US national average.

So despite what most Americans think, the NFL is not suffering from a “widespread epidemic of domestic violence”. Rather, it is the country overall that is in the midst of an outbreak.

At some point in their life, nearly a quarter of all women and 8% of all men will be the victim of a physical or sexual assault by a romantic partner or personal acquaintance. Many more will be the victim of more insidious forms of violence, including verbal, emotional and psychological abuse. Rates of abuse are particularly high among racial, ethnic and sexual minorities.

Similarly, over 10% of children will be abused or neglected by the time they are 18 years old. Over 6% will be raped or sexually assaulted by a family member. An estimated 1,500 children in the US die annually as a result of abuse or neglect.

This is the real tragedy, and the one that we need to address. In many ways, the spotlight on the NFL may do just that. In the past couple of weeks we’ve seen an increase in public discussion and debate about the problem of domestic violence. Victims of abuse – including celebrities like Meredith Vieira and Sarah Hyland – have also gone public with their stories on television, in the press, and via Twitter chats using the hash tags #WhyIStayed and #WhyILeft.

But increasing public awareness and discussion of the problem is just the start. We also need to reform relevant local and state laws to make the perpetrators of domestic violence or child abuse more accountable for their crimes. In many states, for example, a man can go to jail for up to five years for abusing his dog, but spend less than a month in jail for beating his wife, girlfriend or daughter. Existing abuse laws also often lack protections for gay, lesbian or transgendered individuals, even though these groups are at higher risk for physical abuse or sexual assault.

The epidemic of domestic violence and child abuse in the US will not end until the nation as a whole tackles this rampant problem head on.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on September 25, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Keep Your Head in the Game

by Sean Philpott, Director of the Center for Bioethics and Clinical Leadership

My hometown 49ers will not be playing in this Sunday’s Big Game. Despite my disappointment, I nevertheless will be joining millions of my fellow Americans in the hallowed tradition of watching the Super Bowl. I will put my feet up on the coffee table, drink a beer or two, and cheer on the Denver Broncos as they face off against the Seattle Seahawks. I will also cringe every time the quarterback is sacked or a wide receiver is brutally tackled, imagining the lasting damage caused to both body and mind.

The problem, of course, is concussions. A concussion — known clinically as an MTBI, or mild traumatic brain injury — occurs when a blow to the head or body, a fall, or some other impact causes the brain to smash into the skull. Depending on the severity of the blow, symptoms can range from a mild headache, blurred vision and some disorientation to a loss of consciousness, convulsions and amnesia. Often these symptoms subside in a few hours, but they can last for days or even weeks.

Moreover, the long-term effects of repeated concussions — common in football, hockey, boxing and other contact sports — are still unknown but seem to be associated with an increased risk of dementia, Parkinson’s, and mood disorders later in life. In some cases, patients may be diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease whose symptoms include tremors, impaired speech, deafness, and profound clinical depression. In one study of men who had histories of repeated concussions, 80 percent showed evidence of CTE. Most of these men were former football players.

The problem has become so pervasive that both the National Football League and the National Hockey League are facing a rash of individual and class action lawsuits filed on behalf of former players and their families. Those lawsuits contend that league officials knew about the link between repetitive concussions and neurodegenerative diseases for decades but never shared this information with the players.

In a 1994 Sports Illustrated article, for example, the head of the NFL’s Mild Traumatic Brain Injury Committee described concussions as “part of the profession” and “an occupational risk” of being a professional football player. Despite this admission, and despite mounting evidence linking frequent concussions with brain damage in later life, the NFL waited until 2009 to tighten up its rules on when a player can return to the field after suffering a concussion. Borrowing from the tobacco industry’s playbook, football league officials have also repeatedly said, including in Congressional hearings, that there is no connection between playing professional football and brain damage.

That strategy probably won’t work. Just as lawsuits against cigarette manufacturers lead to radical changes in the tobacco industry, lawsuits against the NFL and other professional sport leagues could lead to changes in the way the football, hockey and other games are played.

One class action lawsuit, brought by more than 4,500 retired football players against the NFL, was settled in August for $765 million. Most of that money would be used to provide medical monitoring, benefits and compensation for injured players, but $10 million would also be set aside to fund additional health and safety research. Earlier this month, however, US District Judge Anita Brody rejected that settlement. Judge Brody’s concern was that $765 million — an average of $170,000 per plaintiff — was inadequate.

In her ruling, Judge Brody expressed a concern that “not all retired NFL football players who ultimately receive a qualifying diagnosis or their [families] will be paid.” She’s probably right. Some health economists and insurance industry experts have estimated that the medical costs alone could top $2.5 billion.  Furthermore, the settlement could indemnify the NFL from future liability, leaving the rest of us to pick up the tab.

Unfortunately, time is running out for many retired players. I would not blame them, their families, the player’s unions, or Judge Brody for accepting a woefully inadequate settlement. Many of these retired players need medical treatment and care, and they need it now.

The real problem is the continued reluctance of the NFL and other professional leagues to take the problem of concussions seriously, rather than treat it as a PR problem to be solved. The proposed settlement includes the unfortunate disclaimer that it is not “an admission by the NFL of liability, or an admission that plaintiffs’ injuries were caused by football.” It also doesn’t require any meaningful reforms in how the league, the teams and the players deal with concussive injuries on the field. There are no fines, for example, for teams, coaches or players that willingly ignore the rules on when an athlete can return to the field after suffering a concussion. Finally, it provides little support for additional research in preventing or treating mild traumatic brain injuries.

Until we tackle this problem head on, protecting the health and safety of our athletes will remain a sideline issue.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on January 30, 2014. It is also available on the WAMC website. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Dear Jhonny

by Theresa Spranger, Bioethics Program Alumna (MSBioethics 2012)

So, it’s been an interesting week in Major League Baseball; an historic take down of steroid abusers and one of my Tigers is among them.  It’s a 50 game suspension for Tiger’s shortstop, Jhonny Peralta, and over 200 games for New York Yankee, Alex Rodriguez (A-Rod).

In total, 13 players were suspended for purchasing performance-enhancing drugs (PEDs) through a Miami clinic.  This was the largest PED suspension in the history of baseball and many are praising Major League Baseball (MLB) management for their vigilance in cleaning up the sport.  I am not among those heaping praises.  Personally, I think the whole thing is for show and these players drew the short straw.

As fans we insist that our favorite sports get faster, better, and more exciting every year.  We want athletes of super human ability, but certainly don’t want them to take PEDs to get these abilities.  Dear sports fans…we can’t have it both ways.

Therefore, we must choose: do we want a pure, clean, wholesome sport with potentially fewer home runs, and less excitement, or do we accept the use of PEDs?

Until we answer this question honestly the game will never be “clean.”  Personally, I wouldn’t mind a PED free baseball game.  I tend to like sports in their non-enhanced form.  For instance, I find college basketball far more energetic and entertaining than the NBA games.  Is this true for the majority of fans however?

We say we don’t want PEDs in sports because they are unhealthy for the players.  The following is a list of side effects copied from the MayoClinic website:

Men may develop:

• Prominent breasts
• Baldness
• Shrunken testicles
• Infertility
• Impotence

Women may develop:

• A deeper voice
• An enlarged clitoris
• Increased body hair
• Baldness
• Infrequent or absent periods

Both men and women might experience:

• Severe acne
• Increased risk of tendinitis and tendon rupture
• Liver abnormalities and tumors
• Increased low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol)
• Decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
• High blood pressure (hypertension)
• Heart and circulatory problems
• Prostate gland enlargement
• Aggressive behaviors, rage or violence
• Psychiatric disorders, such as depression
• Drug dependence
• Infections or diseases such as HIV or hepatitis if you’re injecting the drugs

Having read the effects, what are your thoughts?  Do we downgrade the game to protect the health of our boys?  Do we openly accept and endorse the use of steroids, sacrificing the health of our players and potentially teaching bad lessons to young impressionable fans?  Or do we maintain this “don’t ask, don’t tell” approach to steroid use, every so often catching a player or two for a sacrifice?

I am a woman of clear opinions, lines, and values.  I do not like half-hearted solutions and problems being swept under the rug.  If we do not care about steroid use we should stop looking for it.  If we do care, we should crack down hard and rid the game of PEDs for good.  This short term suspension for players involved with a single supplier being lauded as the great clean-up of baseball is garbage.  MLB, do it right or not at all.

[This blog entry was originally posted in a slightly edited form on Ms. Spranger’s blog on August 9, 2013. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]