Last Tuesday, the NCAA approved a measure that requires mandatory testing of all Division I athletes for the genetic mutation that causes sickle cell disease. An article by Katie Thomas and Brett Zarda that appeared in the online version of The New York Times last Monday outlined the pro/con arguments for such testing, and Thomas reported the NCAA’s adoption of this policy the next day (both NYT articles are recommended reading). Those articles focused on college football, but the new rule will affect Division I athletes in all sports. But…there’s a catch.
Sickle cell disease is found in about 1 in 5,000 people in the United States. As you probably know, when you’re (*ahem*) conceived, you get half of your DNA from your father and half from your mother, and pretty much everything about you from your hair color, or your ability to go left, to the shape of some of your wonderful oxygen-carrying red blood cells is determined by that DNA. The gene for sickle cell disease is actually a mutated version of the gene that helps you make normal red blood cells, which are shaped like round disks but a little thinner in the center. If you have the disease, you got two bad, mutated copies of this gene from your parents, so you can call them up and give them a sarcastic thanks. If you don’t have the disease, then you either got two good copies of the red blood cell gene, or you got one good and one bad. If you’re in this latter group, you’re called a “carrier,” meaning there’s a chance that you could pass this trait on to any kids you have even though you don’t have the disease yourself (because your good gene dominates your bad one). All good? Fine. Enough with the genetics.
If a person has this disease, they make a lot of red blood cells that don’t assume the usual round disk-like shape, but rather take on a crescent moon or sickle shape. This type of red blood cell is often sticky and doesn’t squeeze through small blood vessels like normal ones do, so people with the disease can sometimes have episodes where arteries get clogged and restrict blood flow, thereby depriving of oxygen whatever organ or part of the body is just down the line. Depending on the part of the body affected, these episodes (called “vaso-occlusive crises”) can range from being intensely painful to even lethal. Some things that can cause these crises to occur are dehydration, physical exertion, and heat — conditions in which college athletes find themselves all the time, in both practices and games.
Yes, college athletes have died from this. The opening line of the pre-vote NYT article cites the fact that of the 21 football players who have died in the last decade as a consequence of their training, eight of those were due to SSD. Those who approve of mandatory testing for the disease state that such testing will save the lives of the student-athletes who are found to be positive. This is intuitive, at least — though there’s no evidence-based research that proves it. The testing itself costs anywhere from $50 to $300, and cheaper versions are being developed, not that the chance to save lives should be concerned with a price tag. And the test — a simple blood draw — only needs to be done once in a student-athlete’s life.
There are, however, opponents to mandatory testing. The loudest argument comes from those who feel that, because prevalence of the disease in African-Americans is eight times that of white Americans, a disproportionate number of African-American student-athletes could conceivably have the “athlete” dropped from that hyphenate, and therefore possibly the “student” part as well. Some also feel that athletes who test positive for SSD could be discriminated against in other ways by coaches, fellow athletes, media, and so on. On a more philosophical level, consider this — the median age at death for people with sickle cell anemia is 42 years for males and 48 years for females (it’s in the 70s for the American population as a whole). How would you like to be 18 years old, about to start life as a student-athlete, and find out it’s almost time for a mid-life crisis? When you were 18, how would you have handled the news that there’s a good chance that you’ll die 30 years earlier than you thought?
So, here’s the aforementioned catch: players can opt out of testing. A version of the measure without this option failed to pass, but the policy was adopted after this opt-out provision was added. In other words, it’s a mandatory test…that you don’t have to take. Not really mandatory, is it? Another question is what the schools are supposed to do with this information? Since this is a medical issue, are the players notified confidentially of their results? If they test positive, is it up to them to tell their coaches? And if you’re a coach, if you knew one of your players had the disease, could you in good conscience subject that player to strenuous practices and/or extended minutes? Are coaches supposed to make their practices less taxing in general, and therefore risk limiting what their team could become?
No matter which side you take on the matter, there’s one positive aspect of it about which everyone can agree — if a player wants the test, at least now they have the opportunity to take it. Even with cheap testing, most players probably wouldn’t ever have had the occasion to check themselves for this disease. And hey, if giving student-athletes this chance is something that’s being financed by some extra revenue you expect to have lying around — say, from a new TV contract and a 96-team basketball tournament — well, even we can’t be mad at that.