Friday, June 17, 2011

Are stem cells medical treatment, or cheating?

By Tom Grant
PhD student, Center for ETHICS*

The comeback of New York Yankees pitcher Bartolo Colon has been phenomenal. So phenomenal that Major League Baseball is investigating whether his rehabilitation surgery may have been cheating.

Colon was the Cy Young Award winner in 2005, when he went 21-8 for the Anaheim Angels. But he tore his rotator cuff during the playoffs, and his career went downhill rapidly. His best season since then was 4-2 with the Boston Red Sox in 2008. He didn't play in 2010.

When the Yankees signed him to a minor league contract in 2011, he was 37 years old and 25 pounds overweight. He's 38 now. But his record is 5-3 and he's throwing his fastball in the mid-90s.

The secret of his recovery, according to The New York Times, was stem cell treatment. 

Stem cells, according to the National Institutes of Health, serve as sort of an internal repair system. The doctor who treated Colon in the Dominican Republic says he used a pioneering technique of removing stem cells from Colon's bone marrow then injecting them in his elbow and shoulder to help repair his ligaments and rotator cuff.

Was this just good medical treatment? Or is it cheating? The line is not clear. Here's what ESPN columnist Howard Bryant wrote:

The real question is where on the continuum of available therapies rehabilitation and recovery ends and gaming the system begins. One end of the spectrum is Gatorade and aspirin, which are legal, available to everyone and widely used. But it gets murkier as the treatments grow more aggressive, experimental and scarce: from ibuprofen to cortisone, glasses to laser eye surgery, Tommy John surgery to stem cell procedures. What of cloning and gene therapy and the ideas doctors and scientists are just beginning to explore in labs? It is a question that has never been answered, and the league's attempts at regulation -- such as limiting the number of cortisone shots a player can receive in a given season -- disappear in a pennant race or contract drive.

If Colon's doctor had used human growth hormone (HGH) to supplement the stem cell treatment, as he has done for other patients, the case would be clear. Major League Baseball has outlawed HGH and can test for it.

But neither Major League Baseball nor the World Anti Doping Agency (WADA) have a position on the use of stem cell treatments. Is using stem cells to rehabilitate a pitching arm like using laser treatments to improve eyesight or getting Tommy John surgery? Or is it more like using HGH in baseball or blood doping in bicycling, which are both illegal. After all, doctors can use HGH treatment for non-athletes and blood doping is just taking an athlete's own blood and transfusing it back at a later date.

One way to look at it may be to consider whether the treatment is truly for rehabilitation, or whether it is being used to gain an advantage. Athletes should be allowed to rehabilitate. But even that line seems blurry sometimes.  HGH can be used for rehab, but it's illegal. And anabolic steroids can help healing, too. And they're illegal. In fact many medicines are banned in competition. Even beta blockers, a common heart medicine are banned in some sports. Should the old guy in a curling match be forbidden to use his medicine? WADA says those beta blockers are cheating in curling.

Another way to look at it may be to consider whether the athlete is being honest. If Colon or his doctor lied about whether there was HGH in the treatment, that would clearly be a violation of Colon's agreement with Major League Baseball. But what if they told the truth about the treatment, but lied about whether it was being used to gain advantage. What if he used stem cells not merely to rehabilitate but to strengthen this arm. What if anyone could use stem cell treatment to create a stronger throwing arm? Would that be honest and fair?

And what about the other athletes the doctor has treated with stem cells. No one noticed until Colon made this dramatic comeback. But now many are noticing. Major League Baseball will have to address that issue as more athletes try to for the Colon effect. Should stem cell treatments be allowed or outlawed?