NFL and Prescription Drugs

The NFL is being sued by 1,300 former players for the way it distributed prescription pain medicines so players can get back in the game. The former players claim that they were not informed of the side effects of potent pain killers such as Percodan, Percocet, Vicodin, and Toradol. Percodan, Percocet and Vicodin are all opioid painkillers and Toradol is a strong non-steroidal anti-inflammatory (NSAID) drug.

Many of the former NFL players involved in the lawsuit played during the 1980s and 1990s when practices for administering powerful painkillers, both opioids and NSAIDs, were cavalier. Today they are, in theory, more regulated. The players state that the “NFL medical staffs routinely violated federal and state laws in plying them with powerful narcotics to mask injuries on game days.” They also claim that medical staff was negligent by keeping important information on the players’ medical conditions from them, such as markers for kidney disease or broken bones.

At issue are 1) whether doctors and trainers violated the law by illegally administering prescription drugs, and 2) whether players were adequately informed of the side-effects of the drugs as well as informed of any medical issues that doctors found that might affect their decision.

Doctors Behaving Badly?

In an attempt to investigate whether illegal practices were going on, the DEA paid unannounced visits to several professional teams in November (2014) in which they questioned team doctors and trainers after the game. This investigation was to ensure that doctors were prescribing and distributing drugs appropriately, that they were handling controlled substances properly when crossing state lines, and that they had a license to practice in the state. Thus far, the DEA has not found evidence of illegal activities in their investigation.

However, an investigation from Vice Sports into how and where NFL doctors acquired such large amounts of prescription drugs, shows that, at least in the past, they were likely obtaining drugs illegitimately. From 2009 to 2010, several NFL teams, as well as other professional and college sports teams, acquired large amounts of opioids and NSAIDs from a company called SportPharm, an illegal drug distributor operating behind the legitimate company, RSF Pharmaceuticals. RSF Pharmaceuticals eventually shut down, and SportPharm was re-branded as a subsidiary of Champion Health Services, which is still in operation. Many teams would fill prescriptions in player’s names without the player knowing so that the actual quantities would fly under the radar.

Informed Consent

The second issue has to do with players’ rights, and whether they were adequately informed of what drugs they were given, their medical options given their current medical situation, and the long-term side effects.

Many of the players received opiate drugs without being told about their addictive nature, and were often told to take them for longer or in higher dosages than what is recommended by the FDA. Furthermore, many players were given prescription pain medicine without a doctor’s evaluation or monitoring. One former player reports that while playing for one team, an assistant trainer would pass out unlabeled manilla envelopes with pain medicine for any player that raised his hand and said he needed them. Another former player said that envelopes with prescription pain medicine would be waiting in the seats on the airplane for the players.

Player testimonies from the class action law suit website show that many players were given powerful pain medicine instead of being told that they needed rest and recovery or that the problem was actually much worse and required surgery. Several players said that NFL doctors knew of existing health issues, but did not inform the players. Two players’ testimonies state that NFL doctors knew that they had indicators of kidney problems but did not tell the players. Both former players now have renal failure.

Another former player, Rex Hadnot, said in a Washington Post interview that he was given Toradol pills and/or injections once-per-week for nine years. He was never told that Toradol should not be administered for more than five days due to risk of kidney damage, heart attack, and stroke.  He said that sometimes he would receive both a shot and a pill on the same day, a much higher dosage than the FDA recommends.

The Mountain Climber Problem

Part of the problem with discerning the ethics of safety for football players is exemplified in what H. Tristam Engelhardt calls “the mountain climber problem.” In general, climbing a mountain is more dangerous than not climbing a mountain, but we do not consider it unethical to allow a mountain climber to scale a mountain if he so desires. Similarly, playing sports is inherently more dangerous than not playing sports. Football players take on additional risks by choosing to play the sport. Therefore, what protections, if any, are football players owed?

There is a tension between restricting someone’s freedom and allowing them to put themselves in harm’s way. Typically, with the mountain climber problem, ethicists will say that it is unethical to allow additional harm to come to the person such that he or she could not accomplish the stated goal of climbing the mountain. For example, while mountain climbing is inherently dangerous, the climber should still use a harness and ropes. In the case of football players, while it is an inherently dangerous sport, one can enforce safety precautions to ensure that players are not injured in such a way that they cannot play the sport. This is the motivation behind stricter rules to prevent concussions, helmet design, and padding.

The difference between the mountain climber and the football player is that collisions are part of the sport. Pain is a given. The former players who are suing the NFL claim that their health was sacrificed in the name of sales. But, other players criticize the lawsuit as nothing more than a money grab on behalf of former players because they knew what they were risking by playing the sport.

Despite whatever motivations are behind the lawsuit or the NFL’s medical decisions, it is unethical to de-humanize athletes, even if they willingly chose to engage in de-humanizing activities. Let’s take a non-football example: If a woman choses to trade sex for money, she is willingly commodifying herself and ultimately engaging in a de-humanizing activity. While this may have been her free choice, it does not mean that if she goes to a doctor, the doctor is no longer ethically obligated to treat her with human dignity. In other words, even if she chooses to engage in activities that are de-humanizing, that does not mean it is okay for medical health professionals to treat her as less-than-human.

In the case of football players, even if they may choose short-term returns at the expense of long-term injury, they need to be given the opportunity to make an informed choice on the matter because, ultimately, they are the ones that have to live with the consequences.

In the latest issue of Salvo Magazine (Winter, 2014) I cover the larger issue of prescription pain medicine addiction, what opiate drugs actually do to the brain, and how one becomes addicted. The former NFL players’ claims about the over-prescribing of prescription painkillers may be part of a larger national problem that saw a peak in opiate drug prescriptions during the years that many of the former players were active in the NFL.

A Review of The Principle

Copernicus Conversations with God (2)

Copernicus, Conversations with God, by Matejko. In background: Frombork Cathedral.

By Terrell Clemmons

Shortly before his death in 1543, Nicolaus Copernicus published De revolutionibus orbium coelestium (On the Revolutions of the Celestial Spheres) in which he proposed that the motion of the planets could be better explained by assuming that the Sun, rather than the Earth, sits at the center of the universe (the Solar System being the extent of the known universe of his day). Up until this point, Western scientists had visualized the universe in accordance with Ptolemy’s geocentric model, which in turn traced its roots back to Aristotle.

Later, Enlightenment thinkers extrapolated the Copernican model into what is now known as the Copernican principle. The Copernican principle states that the earth is not in any specially favored or spatially central location in the universe. And although it has never been proven, and in fact is unprovable with current technology, the Copernican principle has become entrenched into an axiomatic presupposition of modern thought, as astrophysicist Michael Rowan-Robinson wrote in 1996, “It is evident that in the post-Copernican era of human history, no well-informed and rational person can imagine that Earth occupies a unique position in the universe.”

Baby boomers may remember Carl Sagan pontificating, “Who are we? We find that we live on an insignificant planet of a humdrum star lost in a galaxy tucked away in some forgotten corner of a universe in which there are far more galaxies than people.” What the Copernican principle generalizes into is a philosophy which says human beings are nothing, and human life is ultimately meaningless. If Copernicus disabused us of the geocentric view, the thinking goes, then why should earth or its occupants be considered as anything special?

Leaving aside the obvious non-sequitur in that question, the Copernican Principle became something of a godsend for nontheists. Because before Copernicus, the general assumption of all philosophy had been that the earth and mankind were the product of some kind of creator, and therefore were objects of special focus in the cosmos. The Copernican principle became the tool by which nontheists (later called materialists) would kick God out of their universe. It was “theological dynamite” in the words of atheist theoretical physicist Michio Kaku. “There’s nothing special about humans,” he continued. “We are nothing, absolute nothing.”

Is the Earth Moving?
The Principle, an expertly produced film narrated by Kate Mulgrew and featuring physicists Kaku, Lawrence Krauss (A Universe from Nothing), MIT’s Max Tegmark, and many others, reexamines the Copernican principle in light of recent cosmological discoveries. At the risk of oversimplification, The Principle makes the following points:

  • According to Isaac Newton, neither the sun nor the earth sits at the center of the solar system (or universe). The smaller body doesn’t revolve around the larger, but rather, both bodies revolve around whatever point is the center of mass. “So even in the heliocentric system, it’s not the earth going around the sun. Scientifically and technically, we would say that the earth and the sun are going around one point called the center of mass,” said Robert Sungenis, producer of the film.
  • Physicist Ernst Mach proposed considering the earth as the pivot point of the universe and said that if the universe were orbiting around the earth, it would create the exact same forces that we today ascribe to the motion of the earth. In other words, Mach’s principle said that we would see the same effects whether the earth was rotating in the universe or the universe were rotating around the earth. Mach’s ideas would influence and give way to Albert Einstein’s theory of relativity.
  • Einstein’s special theory of relativity said that the length, time, and mass of objects changed as those objects move through empty space. Echoing Mach, Einstein wrote, “The struggle, so violent in the early days of science, between the views of Ptolemy and Copernicus would then be quite meaningless. Either [coordinate system] could be used with equal justification. The two sentences, ‘the sun is at rest and the earth moves’, or ‘the sun moves and the earth is at rest’, would simply mean two different conventions concerning two different [coordinate systems]” (The Evolution of Physics, 1938).

From these and other points, the makers of The Principle suggest that we cannot definitively ascertain that the earth is in fact moving.

Is Earth the Center?
thePrinciple800x600v2From that basis, The Principle moves on to relate two aspects of Edwin Hubble’s 1929 discoveries. First, the universe is far more vast than had been previously believed – what astronomers had heretofore thought were stars were actually galaxies. And second, the universe is expanding – all those galaxies are moving away from the earth. In every direction, galaxies appear to be flying away from us, and the farther away they are, the faster they’re moving.

Could this discovery of galaxies moving away from earth in all directions argue in favor of a geocentric universe? Hubble found the thought most abhorrent. “Such a condition would imply that we occupy a unique position in the universe, analogous, in a sense, to the ancient conception of a central Earth,” he wrote. “This hypothesis cannot be disproved, but it is unwelcome and would only be accepted as a last resort in order to save the phenomena. Therefore we disregard this possibility … the unwelcome position of a favored location must be avoided at all costs … such a favored position is intolerable.”

Krauss was a lot more flippant about it, but he holds the same view. “Of course, that makes us look like we’re the center of the universe, but it’s not true. It just means the universe is expanding uniformly.” Perhaps it is. Or perhaps that conclusion is required in order to maintain the Copernican principle maxim of, “We’re nothing special.” In any event, The Principle and Einstein fairly well establish that motions are relative and must be spoken of in reference to some arbitrary fixed point.

The Principle touches on other concepts – dark matter, dark energy, quantum foam, the multiverse, and baby universes popping in and out of existence, hypothesized but thus far undetected entities put forth to explain observational data – and suggests that the need for some of these proposed entities could be eliminated by dispensing with the Copernican principle. A geocentric model, with the earth at the center of a spherically symmetrical universe, is a possible alternative, the filmmakers say. This, at the very least, is an intriguing thought.

Is Geocentrism the Central Question?
But is it a hill worth dying on? I don’t think so. The Copernican principle is a bad idea. It’s also a pet materialist concept, especially in its more generalized form implying that earth and human life are nothing unique. So it’s refreshing to see it reexamined in fresh light. Science advances by doggedly following data this way and asking tough questions.

But The Principle ventures needlessly into nuclear-reactive territory by positing a geocentric universe. Not only does this invite extreme derision from the scientific community (a snarkfest already underway), but a literal geocentric paradigm is not necessary to establish that the earth and human life are uniquely special.

The real divide isn’t between those who hold a geocentric view of the universe and those who hold some other non-geocentric view. The real divide is between those who adhere to philosophical naturalism – or materialism, the view that matter and energy are all that exists, and those who allow for the possibility of non-material causes. In simpler terms, the real divide is between atheism and non-atheism.

Look again at the quotes by Kaku, Krauss, and Hubble. Even in their denials of earth-exceptionalism, they give something away. Notice that they don’t argue against geocentrism in any physical sense, but against the view of earth and humanity as “unique,” “special,” or “favored” in a qualitative sense. This is a different kind of assertion. If earth and human life are uniquely special, there are certain theological implications that, for some, are “intolerable.” And therein lies the divide.

The Principle raises good questions, but simpler answers exist. The earth is already clearly special in that it has so many rare and unique properties that make it suitable for life. See The Privileged Planet. And life is special because it’s made by God. See also The Privileged Species. For the atheist that might be a revolutionary thought, but if you ask me, atheism is long overdue for a revolution.

Related:

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What Does Death Have to Do with Having a Happy Holidays?

Two Christmas stories that have stood the test of time are Charles Dickens’ A Christmas Carol and Frank Capra’s It’s a Wonderful Life. Both stories invite the main character to suppose he were dead. In A Christmas Carol, the ghost of Christmas future asks Scrooge to look at how people will talk about him once he has died. In It’s a Wonderful Life, George Bailey is taken to an alternative world in which he sees how things in his town would be different had he never lived.

Additionally, both main characters must look into the face of death, confronting their own mortality, before they are ready to see that their problems originate in their own hearts. In A Christmas Carol, before Scrooge faces his own death, he encounters Marley’s ghost who warns Scrooge that if he continues in this path, he will end up like Marley, chained to his idol.

In It’s a Wonderful Life, George sinks into such deep despair that he ends up standing on the edge of the bridge considering suicide, but instead rescues another jumper from the bridge. Incidentally, the other jumper was Clarence who, similar to Marley, was once alive but now is dead, and whose mission is to help George live a better life. Scrooge and George Bailey are vastly different characters, yet both are miserable because of the same seed of discontent growing within them, and both are cured through similar means.

Interestingly, what is different about George Bailey and Ebenezer Scrooge is telling. Scrooge is the lonely wealthy man who seeks to rob others of joy because he cannot feel it himself. George is the sympathetic family man who begrudges his tender-heartedness because it has left him poor and stagnant. Both the rich man and the poor man struggle with discontent, and both the rich man and the poor man believe that money is the key to their happiness.

Both men are plagued by the same disease, discontent. When a person is discontent in poverty, he does not see the mercies and blessings he has been given, but only his lack. Puritan writer, Thomas Watson, points out that a man who is discontent in this estate will think even bitter things taste sweet. We see this when George Bailey considers compromising his standards and partnering with Mr. Potter, the town tyrant.

When a person is discontent in wealth, he can never accumulate enough to satisfy his true needs. Scrooge hoarded his wealth as a kind of security. Marley warns that rather than a security it is a fetter. The discontented wealthy man can never acquire enough, and we see this in Scrooge’s bitterness. He left his loved ones to pursue wealth, but wealth proved to be a burden rather than a companion.

By the end of the story Scrooge and George Bailey are not in a different place than they were when they faced their supernatural reminders of their mortality. Yes, George got the lost money back, but his town didn’t change, his house still had the broken bannister, and he still had four children to feed.  Scrooge still lived in the same dark house and Bob Cratchit was still his employee. What changed was their state of mind. And that is the lesson. Contentment is a state of mind, not some perfect combination of annual income, a home’s square footage, stock investments, luxury car, or vacation experiences.

George Bailey and Ebenezer Scrooge may not be characters in our time and place, but their lesson applies now as it did then. Ours is a culture that thrives on us never having enough. There are noble things that we should not be content to endure, like children dying from leukemia, or grandparents whose mind has been ravaged by Alzheimer’s, or diseases that destroy the body and injuries that result in loss of function.

However, wanting to rid the world of innocent suffering is not the kind of discontent that haunted George Bailey or Ebenezer Scrooge and it is not the kind of discontent that is endemic in our own time. Ours is a discontent that says “You deserve the best.” It is a discontent that comes from a sense of entitlement and a lack of thankfulness.

Many people blame our cultural sense of discontent on commercials that tell us that you will be happier driving a particular car or technology industries selling newer and better products before the warranty is out on your old one or magazines with air-brushed models sporting impossibly perfect bodies. But George Bailey and Ebenezer Scrooge didn’t have Cadillacs, iPhone 6s, or Photoshop. These industries are not the problem; they just make a profit from it. The problem is as old as human nature. We are dissatisfied with what we have and instead of addressing the root of our dissatisfaction, we would rather strive for more and more like Scrooge, or sink into despair like George Bailey. Their lesson strikes a chord with us because we are like them, and perhaps, like them, our focus on our lack robs us of our joy in what we have.

Creepy Critters in Our Gut

What is the microbiome?

The microbiome is the bacteria that reside within and on our bodies. Often these bacteria do more than just hang out with us. Some bacteria fight off disease, while some cause disease. Others will help us digest foods or reject bad food. For this post, I am going to focus on the gut biome, the bacteria that live in our large and small intestines, because the gut has made for some interesting headlines lately. The “microbiome” refers to all of the bacteria on the body.

The small intestines have a plethora of bacteria that act symbiotically with us to help us digest and process foods. Scientists have been studying the gut biome for many years, but it is only recently that it has garnered public attention. There have been several theories lately that have suggested the gut biome is responsible for everything from food allergies to autoimmune diseases to autism. Furthermore, new diet fads, fecal transplants, and probiotic supplements have emerged as a result of the gut biome hype, many of which are untested or whose claims are unsubstantiated. As is the case with pop-science trends, the microbiome is becoming the poster child for pseudo-scientific claims and grandiose promises.

What does the research show?

Let’s start with some facts because the gut biome does affect our health and well-being. The National Institute of Health is currently working on the Human Microbiome Project. This project seeks to identify and characterize the bacteria (and fungi) that are associated with the human body. Similar to the Human Genome Project, the original plan was to characterize the microbiome of healthy individuals and then to compare it to unhealthy individuals in hopes of understanding the role the microbiome plays in disease. However, those goals may need to be adjusted.

The Human Microbiome studies have revealed two things: 1) no two human microbiomes are alike, and 2) the microbiome is dynamic. Because each person has a unique microbiome, there is not a gold-standard, “healthy” microbiome by which to compare “diseased” microbiomes. Also, because the gut biome changes with diet and environment, it is difficult to determine a particular signature for a person. It’s composition is just too dynamic.

Additionally, the microbiome’s composition (the types of bacteria that make up the biome) are different at different times depending on the individual’s diet and environment. This is especially true with the gut biome. There are hundreds of different species of bacteria that could potentially live in our digestive system, and those species may be in different abundances at different times. Furthermore, sometimes studying two different parts of the same sample will show different results. This is a classic sampling problem. Imagine that you wanted to find the amount of lead in soil in a field. You could collect soil from the top of the ground, which might give you a different lead concentration than if you took soil that was one foot underground or you might get different results if you took samples that were 100 feet away from each other.  The gut biome has a similar problem. Apparently, the biome composition is different depending on where in the digestive tract you retrieve the bacteria (e.g., from a fecal sample or from the small intestines).

With these caveats, scientists have still observed some trends. For one, an individual’s gut biome changes after taking antibiotics. This makes sense because antibiotics are meant to kill bacteria. What is unclear is how long the changes persist and how this affects a person’s health.

Scientists also know that the gut biome plays a role in aiding digestion of certain hard-to-digest foods, such as carbohydrates. Furthermore, they have found differences between the gut biomes of obese people and non-obese people and between people with digestive diseases, such as Crohn’s disease. However, whether the different gut biome is the cause or is the result is unclear.

Healthy skepticism

There are several other correlations between the microbiome and physiological effects.  The difficulty is whether these are merely correlations or causation. William Hanage has an excellent article in Nature, “Microbiology: Microbiome Science Needs a Healthy Dose of Skepticism” in which he discusses five key questions to help discern the truth from the hype:

  1. Can experiments detect differences that matter?
  2. Does the study show causation or just correlation?
  3. What is the mechanism?
  4. How much do experiments really reflect reality?
  5. Could anything else explain the results?

Many studies show that the gut biome is very responsive to diet and environment, which means the differences we see in people with a certain disease (or condition) may be the gut responding to the disease rather than causing it.

The gut biome is a new area of research that may shed some light on digestive disorders and the effects of antibiotics on the body. However, Hanage cautions us to not fall into the same kind of non-discretionary, cure-all thinking that we’ve seen in other new areas of science such as the Human Genome Project, stem cell research, genetic engineering, or nanotechnology. He also remind us not to blame the microbiome for all of our ills: “In pre-scientific times when something happened that people did not understand, they blamed it on spirits. We must resist the urge to transform our microbial passengers into modern-day phantoms.”

Is It Cheating or Discrimination?

Dutee Chand (Manjunath Kiran/AFP/Getty Images)

Sprinter Dutee Chand has been banned from competing in track-and-field because her body produces abnormally high levels of testosterone as reported in The New York Times. Chand is India’s 100-meter, under 18 champion and was an Olympic hopeful, but after an official or a competitor at the Asian Junior Athletics Championships in June requested that Chand be tested for hyperandrogenism, she was pulled from the sport. Chand had won two gold medals at the event.

It was found that Chand has a condition which causes her body to produce more testosterone than what is considered the normal range for women. Chand’s case is not unique. Recent studies have shown that hyperandrogenism may be overrepresented among female athletes compared to the general population. Four female athletes were pulled from the 2012 London Olympics and taken to France for testing. All of them, like Chand, came from rural regions of developing countries. The London athletes were told to undergo surgery if they wanted to compete. The International Association of Athletics Federations (I.A.A.F.) deemed that Chand cannot compete unless she takes hormone suppressing drugs or has surgery. Chand is contesting this stating that she should not have to change her body.

From a bioethics standpoint, there are several issues that are cause for concern regarding Chand’s case: 1) It is one thing to ban performance enhancers. It is another to require performance “diminishers” to change someone’s natural abilities. 2) Elite athletes are, by definition, not within the range of normal. Why are some genetic abnormalities allowed, but others are not? 3) What is the purpose of sport if it is not to celebrate God-given abilities coupled with training and hard work?

Chand has always considered herself a female and for all intents and purposes is female, but her body produces more testosterone than most females do. Her diagnosis of hyperandrogenism does not necessarily mean that she had an additional Y chromosome, as in Klinefelter syndrome, or a segment of a Y chromosome attached to one of her X chromosomes, as in De la Chappelle syndrome. It just means that her body produces significantly more testosterone. Furthermore, while synthetic testosterone, often taken for doping, confers an unnatural athletic advantage, the science on how naturally produced testosterone caused by hyperandrogenism and some of these other syndromes is still unknown. David Epstein, in his book The Sports Gene, cites Spanish hurdler Maria Jose Martinez-Patino as an example of this. She had De la Chappelle syndrome so her body was producing male levels of testosterone. However, she developed fully female because her body also had androgen insensitivity, which means her body does not respond to testosterone. Hormones, like testosterone, are chemical signals, and in people with androgen insensitivity, their body does not seem to read the signal. Her success as a hurdler, Epstein argues, is likely due to something else.

Epstein spoke with two endocrinologists who believe that androgen insensitivity is likely overrepresented in both sports and modeling. Even though their bodies do not respond to testosterone, they do seem to exhibit certain physical features. In women with high testosterone but androgen insensitivity, their arms and legs tend to be longer than the average female, and they tend to be a couple of inches taller than average female height. Because they do not respond to testosterone, they are feminine, but this added height and limb length can be an athletic advantage in certain sports.

Epstein interviewed Jeff Brown, an endocrinologist who works with top athletes in the U.S., several of whom are Olympic gold medalists. Dr. Brown reports that several of his female athletes have partial 21-hydroxylase deficiency, which is genetically passed down from the parents, and can cause an overproduction of testosterone. Women with low-level 21-hydroxylase deficiency develop normal ovaries and uterus, but their bodies produce more testosterone. How that testosterone is read by the body is still unclear. As a note, men can have 21-hydroxylase deficiency, but its effects are less dramatic.

Interestingly Dr. Brown points out that the endocrine system of elite athletes, in general, differs noticeably from those of most adults. He points out that there are many things about the bodies of elite athletes that are different from most people. This brings up the second issue with Chand’s case. By definition, elite athletes are rare. Once we start talking about the upper echelons of athletic performance, it is often the rare combination of genetics, work ethic, and opportunity that allows an athlete to become elite.

Consider the example of arm span in the NBA. It is a given that a six-foot male is considered “short” in the NBA. In general, most NBA players are taller than average. But being over six-feet tall is not as rare as having an arm span that is longer than height. This rare trait is overrepresented in the NBA. Normal adults have an arm span that is roughly equivalent to their height. In the NBA, most players have an arm span that is significantly longer than their height. For example, Kevin Durant is 6’9” but has a reported wingspan of 7’4”. LeBron James is 6’7.25” with a wingspan of 7’0.25”. Michael Jordan is 6’6” with a reported wingspan of 6’11.5” (Statistics are from NBA.com and wikiepedia.org). Longer arm span means that these athletes actually have a taller effective height.

Pertinent to the topic, NBA players are not asked to do something about their arm span in order to compete in the Olympics or play competitive, professional basketball. One possible exception is Baylor University’s Isaiah Austin. His basketball career was cut short when pre-draft testing found that he had Marfan syndrome, deeming him ineligible to play basketball competitively. One of the symptoms of Marfan syndrome is tallness and an elongation of arms and fingers due to weak connective tissues in the joints. It also gave Austin a longer wingspan than height, likely giving him an advantage on the court. However, the difference between Austin’s case and Chand’s is that the effects of Marfan syndrome are well-known. Marfan syndrome can endanger an athlete because it affects the heart, eyes, circulatory system, and the skeletal structure. Austin was told that he had an enlarged heart and extreme physical exertion could kill him. Chand’s condition does not pose a known health risk.

The NBA is only one example. Genetic aberrations are seen in many other sports, yet these people are not asked to undergo chemical or surgical alterations to conform to certain notions of “normal.” Indeed, in the case of using performance enhancing drugs, which are illegal, the point is to synthetically procure what one was not given naturally. The point is to become “like” someone who is rare so that you can win.

Finally, Chand’s case brings up a larger philosophical question of the purpose of sport. Pierre Coubertin, who was instrumental in re-inventing the modern Olympic movement, considered athletic training part of the cultivation of virtues. He takes a post-Enlightenment, humanist perspective that stems from the pre-modern Judeo-Christian idea that all people are of equal moral worth, although not all are of equal capability. For Coubertin, the point was not winning-at-all-costs, but becoming a better person through discipline, integrity, self-control, hard work, and perseverance. However, given equal training and opportunity, if one athlete has bad knees and the other does not, then the one with better knees will prevail. Coubertin’s perspective would have little to say about an athlete like Chand. Presumably, the emphasis would be on whether she was cultivating a virtuous character.

For some, sport is about showing off technological prowess, which is often tied to a sense of nationalism when played on a global stage. Oftentimes, this view does not see using performance enhancers as a problem because it is considered part of training with the best technology possible. The competition is not just between individual athletes, but between countries. The question isn’t which athlete won the gold, but how many gold medals did a particular country receive. The accumulated successes reflect back on the country’s resources, politics, training, and technological capabilities. From this perspective, it is in the competing countries’ interest to make sure that the competitors are homogenous. This would mean that an athlete like Chand would be excluded because she does not fall within the “norm” and therefore provides one country with an unfair advantage over another.

Finally, another perspective is that sport is about admiring individual differences and God-given abilities. From this perspective, demanding that an athlete chemically or surgically “normalize” herself would constitute cheating because she would be altering herself from how she was born in a way that is meant to change her athletic performance. Incidentally, using performance enhancing drugs would also be unethical for the same reasons, but rather than attempting to normalize the athlete, those that use PEDs are intentionally trying to make themselves above the norm. This perspective would include Chand in world-class competition. Whether she should compete with men or women is another debate, perhaps one that calls into question some notions of gender segregation in sports.

Sports is an age-old social sphere that, in many ways, reflects something about our cultural values. Chand’s body is not within the “norm,” but most elite-level, world-class athletes are not, in one way or another, within the norm either. It is unfortunate that rather than celebrating her distinctive qualities and abilities as a sprinter, she is treated as less-than-adequate for physical qualities that are not under her control. Furthermore, one has to wonder why Chand’s particular physical qualities are considered something to be “fixed” rather than a gift to be celebrated.