If the Members of the Chinese Women' Olympic Gymnastic Team are all 16, then so am I: Either way, is something being done to stop their growth?

Having just watched the preliminary rounds of the women's gymanstic's competition, I'm calling a foul. I may be just a law professor, not a pediatrician or an endocronologist or a gymnast or an Olympic official but I know what a sixteen year old looks like, and in my opinion, you just have to see the Chinese team and our team to know something is not right. Despite enough makeup to shame a drag queen, these girls are not convincing teenagers. Whether they're actually 16 and 17 or even if they're 15, 14, or 13--something is not right.
AFP/Getty Images
Deng Linlin, Jiang Yuyuan, He Kexin, Li Shanshan, Yang Yilin and Cheng Fei of China line up prior to a practice session in Beijing. http://www.nbcolympics.com/gymnastics/news/newsid=190870.html#bela+karolyi+incensed+about+underage+rules

I'm not exactly the first person to notice this. Much is being made in the press of accusations that not all the girls on the Chinese Olympic Team are 16--the legal age of competition. http://www.iht.com/articles/2008/07/27/sports/OLY.php. No less an expert than Bela Karoyli, who is still pretty sore about the U.S. Team's loss in 2000 has opined that “This is a joke,” Karolyi said last week. “We are people who have had children of our own, so we know what a 16-year-old should look like. They should not look like they are 7 and maybe still in diapers.“
http://www.nytimes.com/2008/08/10/sports/olympics/10age.html?scp=1&sq=chinese%20gymnasts&st=cse;

He told AP today that ""What kind of slap in the face is this?" he asked. "They are 12, 14 years old, max. And they line them up for the world ... and having the government back them." Sounds like he cares, doesn't it?
Well, don't give him the child advocacy prize yet. He's just mad that the Chinese have found a way to get around the rules. He explained that "The solution, he said, is to not have any age limit." http://www.nbcolympics.com/gymnastics/news/newsid=190870.html#bela+karolyi+incensed+about+underage+rules
Mary Lou Retton, who has seen a few young gymnasts in her day, also doesn't know whether the Chinese girls are underage. But it's clear what she thinks. "The girls are so little, so young," Retton said. Speaking of He, Retton rolled her eyes and laughed, saying, "They said she was 16, but I don't know.""The girls are so little, so young," Retton said. Speaking of He, Retton rolled her eyes and laughed, saying, "They said she was 16, but I don't know."http://www.nytimes.com/2008/08/10/sports/olympics/10age.html?scp=1&sq=chinese%20gymnasts&st=cse

While I'm as interested in the U.S. scooping up Gold Medals as the next American, it's not the unfair competition by the Chinese that bothers the most about underage gymnasts--it's the whole primacy that gymnastics puts on delayed puberty and the possibility that some of these girls are being medicated so that they remain small. [this is a close relative to the well studied issue of height enhancement for children who are of normal height, but shorter than what their parents aspire to]http://www.thenewatlantis.com/publications/human-growth-hormone-and-the-measure-of-man While it's certainly true that the Chinese present an exceptional case of not looking anywhere close to 16, they are not alone. It's also true, that the gymnasts we end up seeing at the olympics are the ones who, for whatever reason, have a late puberty and that's not necessarily because they have been given medication. The onset of puberty is not all that well understood. http://jcem.endojournals.org/cgi/content/abstract/82/4/1066 It is well documented that intense physical activity, such as that of a young athlete, will naturally delay puberty. http://http//jap.physiology.org/cgi/content/full/92/5/2146?ck=nckO.K., but what if there are programs that don't want to wait to see who has a delayed puberty and who doesn't? What's to prevent intervention?

Ironically, the evidence of some kind of doping is much stronger if the Chinese are telling the truth than if they are not. So whether we believe the Chinese that all these girls are 16 and over or we don't (and the evidence of faking passports is pretty good), they are some kind of young teen and they don't look it. Something is going on and I have to wonder if doctors are involved.


What makes it likely that there has been some medical intervention (in China and for all we know everywhere else) is that the stakes are very high. The New York Times quotes an expert who explained that: "An advantage for younger gymnasts is that they are lighter and, often, more fearless when they perform difficult maneuvers, said Nellie Kim, a five-time Olympic gold medalist for the former Soviet Union who is now the president of the women’s technical committee for the Swiss-based International Gymnastics Federation. “It’s easier to do tricks,” Kim said." http://www.nytimes.com/2008/07/27/sports/olympics/27gymnasts.html?no_interstitial And then she said something else which is obvious, but should be bone chilling: “And psychologically, I think they worry less.” http://www.nytimes.com/2008/07/27/sports/olympics/27gymnasts.html?no_interstitial Worry less, perhaps, about hurting themselves and cause permanent injury? Reporting on a study on the epidemiology of injuries in women's gymnastics, published in the April 2008 issue of Pediatrics, http://pediatrics.aappublications.org/cgi/content/abstract/121/4/e954 the New York Times quoted Dr. Lara B. McKenzie, one of the researchers, as explaining that “We found that gymnastics has one of the highest injury rates of all sports,” . http://www.nytimes.com/2008/04/22/health/research/22haza.html?scp=3&sq=injury%20rate%20gymnastics&st=cse

OK, I hear people shifting in their chairs and saying that this is interesting and no doubt an ethical issue, but how is it a bioethical issue?

Well, it is if it involves medicine. There are many in bioethics who are interested in doping. Andy Miah just published an article in the Hastings Center Report about doping http://andymiah.wordpress.com/category/bioethics-and-sport/has a whole blog devoted to the topic. http://http//andymiah.wordpress.com/category/bioethics-and-sport.

Usually, we think of doping as enhancing performance by making athletes faster or stronger. What concerns me here is a different kind of intervention--one that makes girls stop growing. And these are girls. "Oxymoron" has become used to the point of cliche, but truly the phrase "Women's Gymnastics" needs to go in the oxymoron pantheon with "Peace with Honor" and "PATRIOT Act."

-Lots of people have problems with girls' gymnastics.

In a recent highly critical Op-Ed piece in the New York Times Buzz Bissinger finds women's gymnastics creepy because of the relationships between very young girls and their adult male coaches. He said he would be watching the women's gymnastic competition with particular care because "I can’t think of any competition in the Olympics, or all of SportsWorld, more creepy and disturbing: these largely shapeless girls in their leotards and flaxen-waxen hair and bouncy-wouncy ponytails. 'They look like girls from the neck up,” I was told by Joan Ryan, whose 1995 book, “Little Girls in Pretty Boxes,” blew a sky-high lid off the sadomasochistic training regimens that young female gymnasts were being subjected to. She continued: “From the neck down they look like prepubescent boys.'"http://http//www.nytimes.com/2008/08/09/opinion/09bissinger.html?_r=1&scp=4&sq=gymnists%20injury&st=cse&oref=slogin
But the creepiness extends further.

It's not hard to stop growth. There is a medical condition called "precoucious-puberty" in which children experience full puberty before the age of eight which may indicate a serious underlying condition but may also require treatment because of the emotional distress this causes children. http://www.mayoclinic.com/health/precocious-puberty/DS00883. The Mayo Clinic's website describes a treatment "called GnRH analogue therapy, [which] usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child stays on this medication until he or she reaches the normal age of puberty. Once he or she stops receiving the medication, the process of puberty begins again.This treatment, called GnRH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child stays on this medication until he or she reaches the normal age of puberty. Once he or she stops receiving the medication, the process of puberty begins again." http://www.mayoclinic.com/health/precocious-puberty/DS00883/DSECTION=treatments-and-drugs

I doubt that any of these Olympians have been diagnosed with this rare condition.

Could this be cultural? Are Chinese women just smaller and more delicate? Maybe. But to look at these girls and to look at the Chinese Women's Swimming and Diving Team its hard to imagine that's a complete explanation.

Back to the bioethics issue. If indeed these girls have received medication to slow puberty (which I don't know), then some doctor somewhere prescribed it for a reason that was not in the best interests of their health.

Given that the parents of Ashley X (the "Pillow Angel") were criticized to the point of near tarring and feathering for taking steps to stop the puberty of their severely handicapped little girl, this should be more of a big deal in bioethics.http://news.bbc.co.uk/2/hi/americas/6229799.stm


Before we all get too much on our high horses about what China is doing, listen to this. "Enrico Casella, the coach of the Italian women’s team, had an idea to do away with age questions: create weight classes. That way, gymnasts of similar weight could compete more equally against one another, and the age minimum could be scrapped.
Until then, he said, there will always be rumors that athletes are too young. Looks could be deceiving, he said.
“By looks, you could say that the United States is using doping,” Casella said. “They are so muscular. My gymnasts in Italy aren’t that big. You begin to wonder how they got that way.”http://www.iht.com/articles/2008/07/27/sports/OLY.php

I don't know what's going on in the world of gymnastics either here or in China and I have no basis beyond my own eyes and what I read in the paper to make any accusations. However, I do know that if doctors anywhere are giving any medical treatment to children that is not needed to preserve or improve their physicial or mental health , then it should be of great concern to all of us who care about how the power to medicine can be misused when doctors put anyone or anything but their patients first.

Postscript

It's certainly likely that some of them are not 16. The New York Times has come up with videos of the athlete's own statements about how old they were four years ago as opposed to the "offical" passports issued the girls by the Chinese Government Of course not everyone agrees that there's anything wrong. When asked about Yang's quote, [Bruno]Grandi [the head of the International Gymnastics Federation] said, "We have no basis to doubt the information the pasport [issued by the Chinese Government] of the athletes." http://www.latimes.com/sports/printedition/la-sp-olygymchina10-2008aug10,0,3941558.story. He was not asked about his beliefs in Santa, the Easter Bunny or the Tooth Fairy so it's hard to assess the depth of his credulity, but I digress.