Controversy over sickle cell testing of athletes in US

The US National Collegiate Athletic Association (NCAA) has introduced new legislation requiring all incoming students at the highest level of intercollegiate athletics to be tested for sickle cell trait. The testing, which will affect approximately 170,000 incoming student-athletes, is being watched closely as a case study of modern large-scale genetic screening.

The NCAA mandated the testing in April 2010 after a lawsuit was filed by the family of a 19-year-old African-American freshman at Rice University, Texas, who died after an intense football training session in 2006 and was later discovered to have the sickle cell trait. Since 2000, ten Division One college football players, at the time unaware they carried the sickle cell trait, have died suddenly following intensive training sessions.

'This could be a tip of an iceberg of genetic screening as we go forward', said Dr Vence Bonham of the National Institutes of Health (NIH)'s National Human Genome Research Institute to The Washington Post. 'Getting it right is important, especially this one being the first one out of the gate'.

But there is growing concern that student-athletes who test positive may be denied opportunities and identifying someone as a carrier could be discriminatory. People of African descent are disproportionate carriers of the sickle cell trait. 'This amounts to a massive genetic screening program, with tens of thousands being screened', said Troy Duster, professor of sociology at New York University to The Washington Post. 'This could have an extraordinarily heavy impact on black athletes'.

Professor Duster warned that: 'the stigma and its consequences - both self-imposed and done by coaches, peers, and the institution - are likely to be far, far out of proportion to the actual risk'. But officials have said no one would be excluded or restricted in training or playing. Instead, athletes who test positive will be conditioned more carefully and closely monitored to ensure they drink enough water and avoid overexertion.

The magnitude of the new policy has also been criticised. Many athletes carrying the trait experience no complications during intense physical training and athletes without the trait have suddenly died for other reasons, such as heart problems.

'What doesn't exist is scientific data to support the screening', said Dr Elliott Vichinsky, director of the Northern California Sickle Cell Center to The Washington Post. 'There are a lot of other people at risk for heat-related illness from exertion', she added. While the National Athletic Trainers' Association (NATA) is encouraging institutions to screen incoming student-athletes, it also advocates a healthier approach to training for all athletes, with a slow build-up of conditioning activities and frequent rest-and-recovery periods.

'If you want to protect people, there's an easy way to do that: change the training protocol for everyone', Dr Lanetta Jordan, the Sickle Cell Disease Association of America's chief medical officer, told The Washington Post.