All Division I student-athletes will be required to undergo genetic testing for sickle cell trait beginning in August.
HISTORY HIGHLIGHTS
- NCAA requires genetic testing for sickle cell trait in all Division I college athletes
- Nine college football players with the genetic trait have died since 2000
- Critics say players could face discrimination and differential treatment
(CNN) — A controversial new rule from the National Collegiate Athletic Association took effect this month, requiring all Division I athletes to be screened for a sickle cell genetic trait.
While some have applauded the new requirement, critics say it could expose players, primarily African-American, to genetic discrimination.
The rule requires all incoming student-athletes to be tested for sickle cell trait, show proof of prior testing, or sign a waiver if they decline testing.
The mandate was part of an agreement between Rice University and the parents of college football player Dale Lloyd, who had sickle cell trait and died during practice in 2006.
Unlike sickle cell disease, this trait is usually harmless and is inherited from a faulty gene passed down from one parent.
People who inherit copies of the defective gene from both parents have sickle cell disease. Instead of being shaped like a round, flexible donut, red blood cells look like stiff rods or sickles. This abnormal shape can block blood vessels and deprive the body of oxygen.
But people with sickle cell trait alone “have a normal lifespan and can perform as well as other people in athletics,” said Dr. Martin Steinberg, director of Boston University. Center of Excellence in Sickle Cell Disease.
Although they rarely see complications, their bodies can deteriorate during intense or heat-related exercise, doctors said.
Sickle cell trait is present in approximately 8 percent of African Americans. It appears in less than 1 percent of white people, although Mark Richt, head coach of the University of Georgia football team, whose son tested positive for the trait, is one example.
The deaths of nine college football players have been linked to sickle cell trait since 2000, making exercise-induced sickle cell disease the leading cause of death among NCAA football players this decade.
While the American Sickle Cell Association supports athletes knowing their genetic status, Chief Medical Officer Dr. Lanetta Jordan called the latest testing mandate embarrassing.
“What we don’t support about the NCAA’s decision is that the decision is based primarily on someone being sued,” she said. “So this is not related to screening for genetic counseling or parenting purposes. This is screening for the protection of the universities, not for the protection of the athlete.”
Schools and coaches might treat athletes with sickle cell disease differently, she said.
“Will recruiters be as quick to recruit someone with sickle cell disease? » asked Jordan. “It’s too early to tell, but will these students have the same opportunities as some without sickle cell disease? We don’t know.”
The NCAA should follow the military’s lead, Jordan said. In the 1970s, the U.S. Army screened for sickle cell disease, but decided to abandon testing in favor of overhauling the training protocol to eliminate the risk of heat-related illness and exhaustion for everyone.
“The NCAA did not choose this path,” Jordan said. “The path they have chosen is to identify everyone. If they test positive, those students will benefit from an alternative practice protocol, which will once again identify them as different.”
Student athletes have been screened for sickle cell trait for more than a decade at the University of Oklahoma. Scott Anderson, the school’s head athletic trainer, said modifications tailored to an individual’s health needs do not create divisions or fuel discrimination.
“Changes within the sport are not unique to sickle cell trait,” Anderson said. “We know and understand that there are contexts and circumstances that create risks for them.”
For example, some players do not participate in certain conditioning or use heavy loads due to health needs such as sickle cell trait, diabetes, asthma, or musculoskeletal syndromes.
The NCAA guidelines “emphasize that student-athletes with sickle cell disease should not be excluded from participation in athletics,” an association spokeswoman wrote to CNN.com.
The medical field is divided on whether there is enough evidence to justify mass screenings (outside of newborns), said Dr. Jeffrey Hord, medical director of the Showers Family Center for Childhood Cancer and Blood Disorders at Akron Children’s Hospital in Ohio.
The exact mechanisms of the relationship between sickle cell trait and deaths during strenuous exercise are unclear, he said.
“Are there other conditions that have contributed to this? Perhaps it is a sickle cell trait associated with asthma? Are there factors we are not recognizing at this point?”
Players with this trait need to hydrate, pay attention to their bodies and communicate with coaches and trainers, Hord said.
Devard Darling and his twin brother learned they carried the trait when they were drafted before joining the Florida State University football team, but were given no further information.
At a football practice in February 2001, Devard saw his twin, Devaughn, with his head slightly bent with an ice pack on his neck. They exchanged a look, acknowledging how exhausting soccer practice had been, and separated as Devard played offense and Devaughn played defense.
Devard and Devaughn Darling dressed the same until they were in 10th grade and signed up to play for Florida State.
Devaughn went to the mat workout, a series of exercises that included drops to the ground, rolling and repeated sprints.
“It wasn’t really air-conditioned,” Darling recalls. “It’s so hot and humid in there. You have trash cans that people can vomit into. People vomit, pass out or pass out.”
The next time Darling saw Devaughn, the linebacker was on his back, with trainers pumping his chest, trying to revive him. Hours later, Devaughn, 18, died.
“I have no idea why this happened to Devaughn,” Darling said. “It was in the Lord’s plan.”
Nine years after his brother’s death, Darling supports NCAA scouting.
“I think it’s time,” he said. “In recent years there have been too many deaths linked to this trait. Children need to know that they have this trait.”
After his brother’s death, Darling starred at Washington State University and played for the National Football League for four seasons without any sickle cell-related incidents. He is currently a free agent.
Complications are “easily preventable for people with sickle cell trait,” Darling said. “The first thing is to stay hydrated and know when to take breaks. It’s about knowing your body.”
