On April 8, 2009, Dr. Hunt Willard and four of his students met Duke football coach David Cutcliffe in his office. The topic of the 90-minute talk was not game plans or football strategy, but genetics: how to predict athletic success by studying gene codes, and how to prevent injuries by identifying particular genes.
The discussion was new to the Yoh Football Center, and it promised a collaborative—if improbable—future between Duke’s football program and the Institute for Genome Sciences & Policy.
“[Cutcliffe] was very forthcoming and said he was a big believer in it,” said Willard, the Institute’s director. “He said he can sort of see the kids who have an in-born talent.”
Few tangible results for Duke Football, though, have come from the meeting. The more immediate issues awaiting the football program and the rigors of a 12-game season have taken precedent with the program and the athletic department.
But a unique opportunity awaits Cutcliffe and his team. One day, given the Institute’s early data, the football program will be able to look at athletes’ gene codes and identify the injuries to which they are most susceptible. This information could change the way all of Duke’s varsity teams train, practice and play.
“[Hunt] is a pretty phenomenal individual,” Cutcliffe said. “If [the plan] prevents injuries then I’m all for it.”
From success prediction to injury prevention
Willard is a lithe man with a body more suitable for a running track than a football field. He was a realist about his football talent, knowing it would take him no farther than high school, and he would have to get his football fix in the future by rooting for his beloved Boston (now New England) Patriots.
All of this—other than the rooting allegiances, perhaps—would not change if he had been dropped on the doorstep of, say, Archie and Olivia Manning as an infant, he said. He would have grown up in an environment that fostered football excellence, but his body would never allow that level of success. Willard’s genes simply are not supportive of someone who is a high-level football player.
He denied, though, that simply looking at genes allows someone to see whether an athlete will be successful. Intelligence and work ethic, not to mention the sheer number of human genes, ensure that.
“I think genetics plays a role in our physical abilities, but I think there are thousands of genes that contribute to that,” Willard said. “So testing for them is naive.”
Predicting the degree of success an athlete will have in a given sport is such an imperfect science, in fact, that Willard and his students began to move away from it early in their studies. Instead, they began focusing on injury prevention.
“[The genome sciences] have limited capability for predicting athletic ability,” said Sally Liu, a student in Willard’s capstone class and Marshall scholar who is now a first-year medical student at the University of Pennsylvania. “I think from a medical standpoint, it can have an impact on the type of training you can do.”
Around the same time that Willard’s students set up a meeting with Cutcliffe, the doctor identified 18 genes with variants related to athletics. Willard found the gene C0L1A1 relates to ACL tears—it manufactures collagen, the protein crucial to keeping ligaments strong. If an athlete has a “wonky” version of this gene, in the words of Willard, he has an increased risk of injury.
“They’re not going to bother you walking around,” he said. “But when you’re putting stress on [the knee], there’s an increased risk that it might tear.”
Another gene identified by Willard was the AP0E gene, which has implications for athletes suffering from head injuries. A variety, TT, may increase the risk of dementia and long-term neurological damage, especially if a football player takes repeated hits to the head. Another variance, AP0E4, may contribute to early-onset Alzheimer’s.
Willard said he never sees a day when those who test positive for the variance are not allowed to play football. He does, however, believe that if testing becomes common, these athletes would have to sign a liability waiver.
“The genetics angle is much trickier with concussions,” he said. “If someone came to me and said, ‘Your kid is at a genetically increased risk for suffering early memory loss or early dementia,’ I’m buying the kid a tennis racket.”
Possible drawbacks
The scientific findings had the athletic department excited. The overall health of the athletes could rise with the project, and the school would have an impressive recruiting tool.
“He got me fired up… on a level of the welfare of the kids and doing what we can to prevent injuries,” Deputy Director of Athletics Chris Kennedy said. “It’s a lot cheaper to prevent injuries than it is to treat them, and it’d be a heck of a recruiting thing. High school kids and their parents see we’re on the cutting edge of this stuff, and that’s attractive.”
High costs, however, have contributed to that attractive idea from becoming a reality. Like other projects, including some detailed in the 2008 strategic plan, the injury-prevention program has been curbed, in part because of the economic recession.
“For us right now, everything is about cost. We got out of the last budget year in the black, which is a miracle,” Kennedy said. “Since Hunt did his initial blitz, I haven’t had much to do with it so I’d have to go back and look and see where we are and what’s changed…. But in theory, I’m pretty excited about it.”
The sum of the program’s costs are difficult to calculate. Athleticode, a company that Willard co-founded with former NFL player Jim Kovach, charges $450 for a whole-body genetic test. It identifies the AP0E gene involved with concussions and looks for gene variances related to other muscle tears. Giving a test like Athleticode’s to 100-plus football players would give the athletic department a significant new cost.
As with testing for the sickle cell trait, some have privacy concerns about athletes’ genetic information becoming known for the wrong reasons.
“I think that if we lived in a world where this information was only used for the good, then it wouldn’t be a problem at all,” said Doraine Coleman, co-director of the Duke School of Law’s Sports and Law Center. “If it doesn’t mean the athlete doesn’t get the job, it just means accommodations are made…. I think what people worry about is that is not the world we live in.”
Privacy concerns also hit home for retired NFL player Lennie Friedman. Friedman was a three-year starter for Duke in the late 1990s and played for eight seasons in the NFL as an offensive lineman. Now a student at the Fuqua School of Business, Friedman was a part of a sample group tested by Willard for genetic predisposition to injuries. He admired the study but worried about how private the findings would be for others in the future.
“You certainly want to be careful about the privacy issue,” he said. “You don’t want athletes not getting playing time or not getting drafted because of their injury tests.”
After all the privacy concerns and controversies about genetic testing are put aside, though, one fact remains: Injuries will still never be fully eliminated from football. It is simply the nature of the sport.
“Football is an extremely violent game,” Friedman said. “I think there’s a genetic component, but anytime you play a sport like football, there is the risk of injury. That’s just the game.”