Americans have heard one too many cases of the town’s star high school football player suddenly collapsing at a practice, then dying before his teammates even get a chance to carry him into the locker room. Displaying no phenotypic indicators, those who carry the sickle cell trait can often go their entire life without knowing they have the disease. Often times, it may not have any negative impacts on them. But, the tremendous athletic conditioning and training high school and college players go through can trigger sickle cell symptoms. How can we work with this genetic epidemic keep our athletes safe and still involved competitively in their sports?
History
Sickle cell anemia is a genetic disease, but what is interesting about it and how it applies to athletes is more than just simply having sickle cell or not having sickle cell. Sickle cell anemia is a condition in which there are not enough healthy red blood cells to send enough oxygen through the body, which can result in frequent dizziness, fatigue, shortness of breath, abnormal breakdown of red blood cells and even a yellow tint to the eyes and skin. The cells which are not delivering oxygen are rigid and sickle or crescent moon shaped, hence the name (Mayo Clinic Staff). People with double recessive alleles, also known as homozygous recessive genes, do not have sickle cell and are not carriers, meaning they have no chance at all of passing it on to their children. Those who have sickle cell anemia have homozygous dominant genes, which means they have the disease and will pass on their genes to their children. But, if one has heterozygous sickle cell genes, this means they carry the trait but do not exhibit any of the detriments; this is where most of the affected student athletes lie. Because heterozygous people, also known as carriers of sickle cell, do not exhibit the traits of sickle cell at birth they can often go their entire lives without knowing they are a carrier. Although carriers do not exhibit the traits of sickle cell from birth, the intense conditioning and training athletes go through can trigger sickle cell traits in carriers, putting them “at high risk of dehydration, heat-related injury, exhaustion, painful episodes, and hip joint problems” (Centers for Disease Control and Prevention 1). What is considered the discovery of Sickle Cell was when two American scientists, Dr. James B Herrick and Dr. Ernest Irons discovered sickle shaped cells when a young man who originated from Grenada and was studying in Chicago came to them complaining of pain. Although, despite them making this discovery and publishing it in a medical journal in 1910, there is evidence of this disease existing in Africa for up to 5000 years prior (Winter). Since then, many have been making advances on determining how to deal with this disease, including discovering that lack of oxygen can cause cells to react and sickle, and how to educate the public and encourage people to get tested.
Effects
The exact number of those affected by sickle cell is unknown because so many people never get properly diagnosed, but it is estimated that sickle cell currently affects approximately 100,000 Americans, 1 of every 365 Black of African-American births, and about 1 of every 16,300 Hispanic births (Centers for Disease Control and Prevention 1). Sickle Cell anemia is particularly common among those who descend from Sub-Saharan Africa, South America, Saudi Arabia, India and some mediterranean countries. The reason for the increased frequency of sickle cell in these regions and ancestral families is because sickle cell actually has something called a heterozygous advantage. In the case of Sickle Cell, this means those who are carriers but do not exhibit the detriments of the disease strangely have immunity to Malaria. This is a tremendously positive trait to have in Sub-Saharan Africa where Malaria is a widespread cause of sickness and death and is “home to 90% of malaria cases and 92% of malaria deaths” (WHO 1).
Despite some of the positive traits that come along with these disease, Sickle Cell can still pose a very big threat to student athletes. So, in 2014 the National Collegiate Athletic Association, also known as NCAA, started making testing for Sickle Cell a requirement for all college athletes during the recruitment process. Athletes are required to either go get tested, show documentation of testing from birth, or Division III students can choose to opt for a waiver which allows them to not be tested, but they will go through a series of educational classes in order to know how to keep themselves safe when training. Regardless of which option they pick, all student athletes are required to “receive mandatory education regarding the risks, impact and precautions associated with SCT if they plan to participate while awaiting the results of a screening or exercised the waiver option” (NCAA 1). Once research came out raising concern from the public of the conditions students athletes were placed under that could potentially harm them, the NCAA decided to take action to not only put the public to ease, but also to protect their athletes at all costs while not restricting them. Along with this new policy, they also released that “Between 2000-09, a reported seven football student-athletes with sickle cell trait died during conditioning activities” (Schedule A) but that cases have been reported in various other sports as well. The NCAA does not discriminate against players for having Sickle Cell, they do not view it as a weakness, and do not use it as a deciding factor for recruitment. Testing before recruitment is purely taken so the association can properly cater to the needs of the athlete. Without this testing, Geno Atkins, former Division I football player for University of Georgia and Defensive Tackle for the Cincinnati Bengals in the NFL would have never discovered he had the disease, and is thankful for his college for making him get tested. He always noticed that he got fatigued faster than his teammates, but never really knew why. He now is an advocate for this disease and talks to kids with the disease, pushing his message that “Not being able to go out there and being able to play at a high level I think is a misconception. You still are able to do that as long as you are aware of it and take the proper steps. It’s very important to get the word out and get tested” (Fox Sports - Geno Atkins and the Sickle Cell Trait). The education the NCAA provides to all student athletes can make a big difference, especially when they get the message across to students like Atkins. These workshops about how to recognize signs of extreme fatigue and to inform athletes on how to protect themselves from getting hurt in training or in a game are also paired with training of the coaches. Coaches are trained to know about the disease itself, how to take precaution in initial training with athletes with Sickle Cell, and what to do in an emergency situation if an athlete were to collapse. With this national organization taking action to spread awareness, it can use its resources to reach great audiences and spread their message far and wide.
Solutions
The next steps to be taken for Sickle Cell in student athletes is to push for awareness and precautions in organizations outside of the NCAA. The NCAA, as a leader of collegiate level sports, should work to encourage high school level athletic organizations and club sports to enforce similar policies in order to keep their players safe. A possible solution high school athletics could do is including Sickle Cell testing on the physical forms athletes are required to turn in before they can participate in any school-sponsored athletics. As of now, the National Football League, also known as the NFL, has no policies requiring the testing of its players before recruitment. Although, when recruiting from colleges they may see in the information provided to them from the NCAA if a student does or does not have the trait (NCAA). Another important policy which should be enacted by the NFL is the protection of discrimination against athletes in the recruiting process for having Sickle Cell. Since it has been proven that players are capable of playing the sport with the disease and still be successful, it should not be a reason a recruiter might pick an athlete without Sickle Cell over one who does. The American Football Coaches Association has began to help spread awareness to its members about this epidemic and is actively working with the NCAA and the National Athletic Trainers Association to educate themselves further to help keep their players safe.
Beyond the new acts we could pass on the national sports level, there are basic solutions which anyone can achieve on their own to help battle the effects of this disease. When Geno Atkins, the Defensive Tackle for the Cincinnati Bengals, found out about his disease and how it could affect him on the playing field, he shared that “I kinda made the proper changes diet-wise on not really drinking soda, staying hydrated and getting rest. So that I could kinda combat it a little bit so I wouldn’t get as fatigued or tired as quickly” (Fox Sports Feature - Geno Atkins and the Sickle Cell Trait). Many doctors agree with Geno, sharing that with proper hydration, becoming aware of one’s own limits, and care of your body on and off the field, no student athlete should feel like they are being held back from reaching their full potential.
Camus
The Sickle Cell epidemic is one that we will always be fighting to manage and cure. There is no way to stop this genetic disease as far as modern science knows today, so we are forced to learn how to deal with it. With genetics, everything is up to chance, and anything left up to chance is usually not very forgiving. This leads us to confirm Albert Camus’ teachings of reflecting on the truly random, purposeless chaos that is human existence, also known as absurdism. The sheer magnitude and frequency of this disease by itself is overwhelming, and when you add in the component of complete genetic chance, we see the random cruel nature of human existence. Albert Camus has explored the great lengths absurdism incorporates itself into our everyday lives, and how unforgiving these epidemics are in such in this world. He explains that, “This world in itself is not reasonable, that is all that can be said. But what is absurd is the confrontation of this irrational and the wild longing for clarity whose call echoes in the human heart. The absurd depends as much on the man as it does on the world.” (Camus). The fight against Sickle Cell is absurd especially because there’s no way for us to completely stop it from a genetic standpoint. So, instead of working against it, we work with it. We acknowledge the fact that we can’t control the chaos and the random, and with that in mind, we do everything we can to manage with what we are left with.
We as humans are afraid of death, and are constantly fighting against it with whatever we have at our disposal. People always turn to reason, religion, modern medicine, and when all else fails us, we have hope at our side. Camus teaches that in this massive universe we are but a tiny speck. He teaches that we as individuals cannot truly leave a lasting mark on the world we will leave behind, and any attempt to do so is a desperate attempt and a waste of the little time we have here. It is important we acknowledge the teachings of absurdism, but this essay shows that if we were to embrace it fully, we would be doing a disservice to one another. Sickle Cell carriers are more than capable of living a full and fulfilling life, as long as they recognize the reality of the risks they face. But while the risks are very real, so is the ability to try one’s hardest from allowing any of the barriers you face to impede on your performance in life. These things that Albert Camus sees as silly - religion, medicine, and hope - are what get us through our daily lives and allow us to live fully, and with an epidemic such as Sickle Cell in hardworking young athletes, we have to take a little of reality and a little of hope to be able to succeed in battling it.
Works Cited
Camus, Albert. "A Quote from The Myth of Sisyphus and Other Essays." Goodreads. N.p., n.d. Web. 17 Apr. 2017.
Centers for Disease Control and Prevention. "Sickle Cell Disease (SCD) Data & Statistics." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, 31 Aug. 2016. Web. 27 Feb. 2017.
Fox Sports Feature - Geno Atkins and the Sickle Cell Trait. Dir. FOX. Perf. Geno Atkins. FOX Sports, 2013. Youtube. Kurt Anthony, 29 Oct. 2013. Web. 27 Mar. 2017.
Mayo Clinic Staff. "Sickle Cell Anemia." Sickle Cell Anemia Overview - Mayo Clinic. Mayo Clinic, 29 Dec. 2016. Web. 20 Feb. 2017.
NCAA. "NCAA Sickle Cell Trait (SCT) Testing - What You Need to Know." PsycEXTRA Dataset (n.d.): n. pag. NCAA. National Collegiate Athlete Association, 17 Jan. 2014. Web. 19 Mar. 2017.
WHO. "Malaria." World Health Organization. World Health Organization, Dec. 2016. Web. 19 Mar. 2017.
Winter, William P., PhD. "A Brief History of Sickle Cell Disease." A Brief History of Sickle Cell Disease. Sicklecell.howard.edu, n.d. Web. 27 Mar. 2017.
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