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Science: When Leveling the Playing Field Creates Potholes

Like many teenage boys growing up in the ’60s and ’70s, I was a Kurt Vonnegut nut. I read, reread and re-reread everything he wrote, and no doubt his humorously cynical take on the human condition played a big role in forming my sensibilities. I particularly loved his short stories, of which “Harrison Bergeron” may have been my favorite. Set in the year 2081, it envisioned a typically Vonnegutian dystopian future but with a special hook: an America where the search for fairness and equity led to a constitutional amendment that declared that anyone with special abilities—by dint of being born with greater intelligence, talent, good looks or the like—was required to use specially designed “handicaps” to counterbalance such “unfair” advantages.

As someone who blogs about health-related evidence, why on earth am I describing that story? Because it immediately came to mind—with chilling portent—as I listened to the BBC Newshour on my radio the other day. The story that evoked it was reporting a new rule of the International Association of Athletics Federations (IAAF)—the world’s governing body for track and field events—stating that self-identified female athletes with hyperandrogenism may no longer participate in middle-distance women’s races unless they take hormone treatments to reduce their serum testosterone to “acceptable” levels.

Is It 2018 or 2081?

Listening to this, I was stunned. I was infuriated. I thought of “Harrison Bergeron” and wondered: is it 2081 already? Have we really reached a point where we see all biological advantages as intrinsically unfair? And should science and medicine be used to negate those advantages?

Perhaps I was especially primed to react to this story because it’s so intertwined with issues of sex and gender, which have moved front and center in recent years after decades of inattention. Certainly, those issues are complex and multifaceted—and, as I’ve admitted to anyone who will listen, really hard for me and others of my generation to get our heads around. I grew up at a time when we used the terms “sex” and “gender” largely interchangeably; when sex was a binary construct that was determined by biology; and when we referred to a person as “he” or “she” (no other options) based entirely on what we thought that person looked like. (If you’re too young to imagine a world like this, check out any of the old Saturday Night LiveIt’s Pat” sketches and think about a time when something like this would not only get on TV but become a popular recurring sketch.)

Like many well-meaning people of my generation, I’m really trying to get this, and to get it right. I am especially fortunate in that regard because I have guidance from my children, students and younger colleagues—and those I’m closest with seem willing to give me the benefit of the doubt when I get things wrong or ask dumb questions that reflect my struggle. And these same people advise me as I try to come to understand such things as equity versus equality, the need for “trigger warnings” and all the stuff that generations after mine seem to be both more sensitive to and more sensitive about.

Science and the Leveled Field

So perhaps it’s this particular intersection of sex and gender and fairness and equity with sports—an arena where some are clearly more talented and capable than others, where those differences are objectively assessed and where hundredths of a second can separate winners from losers—that really caught my attention. How can we possibly square our desire for equity (or, as the IAAF says, “a level playing field”) with the clear and indisputable fact that some people are better at some things than others are, and that biology is almost certainly one among the many underlying reasons for this inequality?

I recognize that the issues here are complex, and the complexity is increased because we have already accepted (at least tacitly) that “equity” requires separate sports competitions for men and women. With that backdrop, shifting views on sex and gender means we’ve got to be open to creating just these sorts of conundrums. And in this case, the IAAF rules were based on something that I would ordinarily find reasonable: a careful review of the scientific evidence. In this case, though, I can’t see how science can get around some basic principles of right and wrong—especially because the scientific study on which the IAAF policy is largely based is almost certainly flawed.

But look at me: I’ve fallen into the trap of debating the quality of the science, when the question here isn’t really empirical. It’s not about whether a self-identified and biologically classified woman with hyperandrogenism has an “advantage” with respect to certain types of track and field events (statistically significant or not); it’s about whether it is right to take those women and subject them to testing, and then require them to undergo a medical treatment (which, like all medical treatments, must have some risk of harm) in order to compete in the sport they have spent many years training for. If this seems even vaguely “right” to you, then you have a very different view of “justice” than I do.

Even if (like me) you don’t pay attention to sports, we must take notice of these issues and ask ourselves what they say about our values and where we’re going as a society. If we don’t, we will find ourselves heading quickly into the world inhabited by Harrison Bergeron. Given the changes we’re already seeing, there must be some people out there who see that world as a better one than ours. For me, it’s a terrifying prospect.

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Paul Marantz, M.D., M.P.H.

Paul Marantz, M.D., M.P.H.

Dr. Marantz is a physician-epidemiologist. He is associate dean for Clinical Research Education at Albert Einstein College of Medicine.

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