Putting the NHS in Fortnite

Putting the NHS in Fortnite

Just before Christmas, I published an article which I have been developing for around 6 months. It is a first step in articulating a structure through which healthcare can be provided within digital environments, without having to require patients to relocate themselves into other spaces. I’m really excited about fleshing this out further and would welcome feedback. For me, it’s a crucial issue and makes a lot of sense given the habitualisation that goes into people’s use of digital worlds. There is still a lot to figure out, like what kind of relationship should exist between digital developers and healthcare service professionals, or what should be the format of intervening within such spaces, but here’s a starting point.

The X in Text

The X in Text

Putting the X in text: warm wishes or a kiss-off?

File 20181115 194506 1bqqjfv.jpg?ixlib=rb 1.1
lanych via Shutterstock
Andy Miah, University of Salford

Do you sign off texts and emails with an x? Have you ever thought what that x – shorthand for a kiss – means to you or the person who has sent it to you? It’s said that the liberal use of x in electronic correspondence, whether personal or professional, is feminising the workplace – and Labour MP Jess Phillips was told off for being unprofessional by a judge a couple of years ago for signing off an email to a constituent with an x. So how did we arrive at a situation where everybody gets one at the end of nearly every sentence we type?

Part of our answer is really simple – the x in correspondence conveys a special kind of empathy for the recipient. In a world where uppercase letters read like SHOUTING and where emojis are ambiguous, every element of a text message is easily misunderstood. The x serves as a catch-all device, telling your reader that all is well in your relationship.

The ubiquitous x can be applied to friendship, romantic, or even professional relationships when messaging. It is so versatile, revealing interest, affection and a general kind of togetherness which, if face to face, would be equivalent to some kind of non-verbal body language – a head tilt, or a sympathetic nod to show agreement and understanding. The x shows that you are in this together and that you seek to continue the conversation in a spirit of mutual and even jovial appreciation.

However, this still doesn’t fully explain why it is an x that has come to wield such power, or why it feels so essential to include one. After all, it could be – and sometimes is – a different symbol: an emoji perhaps, or a simple smiley face like this: :). Nor does it tell us about the journey taken by the x in becoming this multifaceted symbol.

Are you free with your emojis? Mego studio via Shutterstock

Making your mark

History tells us that the x has a long pedigree. In the middle ages, handwritten letters would end with an + to signify the Christian symbol of Christ. With most people being illiterate, a cross was deemed to be sufficiently accessible to verify identity. What’s more, there is evidence of such rituals of signing documentation to be accompanied by a physical kiss being given to the paper, as one might kiss a cross if of certain religious persuasions.

But, this still leaves a big gap between then and now. What happened at the beginnings of the digital revolution that explains this progressive encroachment into all of our correspondence, turning every message into its own letter? Equally, why did the x remain, while other elements of letter writing disappeared, such as writing: “Dear [name]”, or “from [name]” at the start and end of correspondence. We nearly never do this now when sending texts, because messaging has become an endless letter, a conversation that is always left open, to be picked up again at a later stage. It isn’t difficult to imagine that the cross at the end of letters evolved into the x just as words like “goodbye”, evolved out of “God be with you”.

Kissing culture

Yet, for today’s generation, the connection behind the x is likely to be completely lost – it is simply some kind of kiss and, just like a cross, using it could land you in big trouble. After all, the kiss is remarkably culturally specific and an x can mean something very different – or nothing at all in a different language. For instance, in Spanish, x is short for “por”, meaning “for”. Equally, a kiss in one culture means something different in another and, in some cultures, there is no kissing at all. There is also a gendered politics to a kiss, which can make it a highly risky undertaking to send, especially in professional settings.

Forgotten your phone? Monkey Business Images via Shutterstock

At the same time, the x can be a way of allowing somebody to express themselves physically without the pressure of actually having to touch somebody. Indeed, this is one of the web’s most amazing features; it can liberate us from the constraints of social conventions and provide a space for relating to others differently – a perspective that researchers have outlined since its inception.

There may be many people who sign off with an x who would not think of kissing the person when face to face, but feel comfortable expressing such affection through a symbol. At a time when the world wide web’s inventor, Sir Tim Berners Lee, has called for more love online, this is surely a good thing.

So, while seemingly one of the most uncomplicated things we do when messaging, the x in texts has far wider implications than perhaps we first thought. A good rule may be to only send an x to people who would be comfortable with you kissing them face to face. Would you actually kiss that person, if they were in front of you? If not, then perhaps drop the x.The Conversation

Andy Miah, Chair in Science Communication & Future Media, University of Salford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You have been upgraded

You have been upgraded

It was amazing to take part and support the realisation of Jon Spooner’s live event, ‘You Have Been Upgraded’. This was a really special experience, especially as it took place at the Science and Industry Museum. Lots of conversations about human enhancement!

Manchester Science Festival

Manchester Science Festival

Another year and another amazing festival. We did so much stuff, it’s hard to know where to begin. So, here’s a quick glimpse of our programme.

Olympism in Action

Olympism in Action

Last weekend, I was in Argentina for the Olympism in Action Forum, invited by the International Olympic Committee to speak about doping. The event took place in advance of the Buenos Aires 2018 Youth Olympic Games. Here’s a quick overview of what took place, but it doesn’t really capture what I said in full.

Broadly speaking, I discussed how society must decide how far it is prepared to push health and longer lives, in order to come to terms with the doping dilemma. We live in times of profound experimentation with biotechnological changes, which make any notion of the natural athlete as a criterion of value within sport an historically redundant notion. This wider cultural shift is what calls into question the anti-doping mandate and is among the biggest problems our society has yet to solve.

Athlete 365

Athlete 365

A few years ago, I developed a course for Olympic athletes, as part of the International Olympic Committee learning initiative. I’m delighted to say that I’ll be developing a new version of this, which will feature all things digital. As a teaser, check out this Dos and Donts list for using social media as an athlete.

The future of the eSports experience

The future of the eSports experience

Ahead of the Blooloop Live event next week in London, I gave an interview about where we are headed in the world of esport. Check it out here.

The Prospect of Immortality #BlueDotFestival

The Prospect of Immortality #BlueDotFestival

On 21st July, I spoke in a panel with Prof Kevin Warwick, Prof Mike Stubbs, and Gina Czarnecki about the future of death, as part of a series of talks within BlueDot Festival. 

The prospect of immortality has long been a fascination for me, an extension of the pursuit of human enhancement and the logical consequence to expanding the potential of evolution.

While there are many big challenges to dealing with death in a technological age, the possibility of extending life means we are confronted with some completely new questions about our lives. How would we organize ourselves if we lived to even 200 years? Would we go to school for longer? Would we procreate at the same time? Would we think about our careers as singular paths in life? Would we transform our political regulations to ensure nobody had too much power? All of this is up for grabs and needs thinking about, if we continue to pursue longer and healthier lives.

The BioDigital Athlete #TNW2018

The BioDigital Athlete #TNW2018

My keynote for The Next Web conference in Amsterdam brought together my years writing about digital and biotechnological change in performance. Here's the video...

The Next Web does eSport

The Next Web does eSport

Last week, I was in Amsterdam for The Next Web, a major digital/tech festival with 15,000 delegates. The first of my contributions to the programme was a dream team panel of experts on digital sport. We invited Shireen Hampdan from the groundbreaking architecture company Populous, Oliver Weingarten from Virtually Live, which is pioneering gaming and virtual reality sports event integration, and Bill Martens, from the amazing BamTechMedia. Here's the video!

Digital Health in the House of Commons

Digital Health in the House of Commons

Last week, the Digital Health Generation project I have been working on with Emma Rich, Sarah C. Lewis, and Deborah Lupton had a major event in the House of Commons, sponsored by Lisa Cameron MP.

The evening was a culmination of our work over this last year and aimed to kickstart a conversation about how the future of healthcare ensures that young people are at the heart of plans. 

Here are some of the slides from the evening.


Understanding transhumanism

Understanding transhumanism

Last weekend, I featured in an article by Robin McKie on transhumanism, following Wellcome awarding their annual book prize to Mark O'Connell for his 'To be a machine'. It's a really great article, but I've a few things to add based on some of the responses I've seen online and will make a podcast about it over the next couple of weeks. In the meantime, here's the article. 

Also, if you want a deep dive into this, check out something I wrote a few years ago, which draws together some related ideas on posthumanism and cyborgs.


The Olympic Games Drone Show

The Olympic Games Drone Show

With over 35,000 views, this video is my most watched on YouTube, but aside from being an amazing display, what was especially beautiful was the fact that Intel made its show a daily feature within the Olympic park, taking place after the medals ceremonies.

In so doing, it may have achieved another Olympic first, by making part of the Opening Ceremony freely available to anyone who happened to be in the park. 

It's well worth another watch....

CNN on gene doping

CNN on gene doping

Last week, I featured in a CNN article on the future of doping. It was great to chat with the author about all of the things that can be brought to bear on this subject, but there's so much more to be said than is covered in the final edit. Take a look and then return to here, if you'd like more.

For me, at the core of this subject are questions about evolution, transhumanism, and how we make sense of our place in the world. Modern sports have always been pursuits that test the limits of our human capacity physically, through a combination of mental, physical, and technological synthesis. Gene doping remains emblematic of a brave new era in which I believe our currently held views on doping will come under question and make little sense to uphold. That doesn't mean there is an easy solution to the problem of cheating in sport. Whether it is doping or other means, these tendencies to break rules in order to gain an unfair advantage will occur, regardless of what those rules are.

The argument on behalf of supervised doping has been espoused by a number of my peers, since I published first on this around 10 years ago. Over this time, I have become less convinced that it will be an effective way of securing either a level playing field - of any kind - or that it would significantly reduce the potential harm that the collective athletic population will be exposed to, when compared with the present system.

The details of this argument are within a manuscript I am currently writing, which updates my perspective on the subject, but the key message I would like to get across is that we are moving rapidly into an era of gene editing whereby the means by which we determine what counts as human or even achievement in sport will need substantial revision.

Moreover, we will find there to be strong moral arguments in favour of doping like practices in society more widely, which will then urge anti-doping to re-position its value system. These conditions are why we need a fresh look at the problem, not just to solve the next few Olympics, but to ensure that it is fit for purpose for the next century.


Stephen Hawking as a Science Communicator

Stephen Hawking as a Science Communicator






The Digital Health Generation

The Digital Health Generation

In February, we ran our first webinar focused on the Digital Health Generation. Find out about what we are investigating for this Wellcome Trust funded project, trying to make sense of what digital health means to young people. Here's what we covered.

My PyeongChang 2018 Olympic Winter Games

My PyeongChang 2018 Olympic Winter Games

The PyeongChang 2018 Olympic Winter Games was my 10th in total, Winter and Summer, 11th if you include the Youth Olympic Games, which I attended in 2014. Each Olympic Games is unique and, like a good novel, has story after story which characterise them in extraordinary historical terms. With Sydney 2000, it was the controversy around the contested land of Homebush Bay, juxtaposed against the eventual lighting of the Olympic cauldron by Cathy Freeman.

In Athens 2004 it was the feeling of the Games coming back to their origin with the shot put taking place within the Ancient stadium of Olympia, with Beijing 2008, China's first Olympic Games as host, it was the magnificence of the Opening Ceremony, set against the concerns about media freedom and human rights.

For London 2012, there was the transition from media to social media as the tipping point in content consumption, along with its controversial logo which made strides to transform how branding operated around the Olympic programme.

For Rio 2016, the first South American Games, discussions ensued around resident rights to remain, alongside concerns about corruption and the political turmoil surrounding the nation. These are just some of the stories that operate around the Games, some of which are matters of deep social concern, while others are snapshots of a society that help us understand more about a location, its people, and how the world makes sense of their values and political history.

PyeongChang 2018 was perhaps the most extraordinary of all in recent times, in terms of political discussions about how the Olympic Games contributes to global diplomacy. While sports officials are modest in their claims and expectations for Olympic participation to lead to significant political change, there does seem to have been an important series of outcomes from the conversation between North and South Korea, resulting from Olympic participation. I anticipate that this will be studied for many years to come, but watching what happens within this region for the next 5 years - and for future Olympic Games - will be fascinating.

While I was in PyeongChang, I made a series of videos, which cover subjects from virtual reality to Olympic diplomacy. You can find these on a dedicated page here.

A fresh look at anti-doping

A fresh look at anti-doping

Last November, I was asked to give a talk for a legal summit examining the doping dilemma in sport. It was a chance to reflect on 15 years of immersing myself in this complex subject. You can download the entire book publication from this event here but here's my manuscript pasted below for ease. 


I.    Overview of a Current Ethical Challenge in Anti-Doping, by Professor Andy Miah
Thank you to the WADA commentary team for inviting me here to give a talk. It has been a long journey for me in anti-doping and, to some extent, I want to take you through that 15 years or so within which I have often found myself on, for many people, the wrong side of the argument, for want of a better phrase. I was asked to talk about a current ethical issue around anti-doping. I think there are many, but I want to give you a glimpse of one particular topic through that journey that I have had in this world and outside of it. I began in this field from a sports science background. My PhD was in bioethics and sport, where I looked at genetics in particular, and my work expanded into bioethics more broadly. It is that interface between sport’s use of performance enhancement and the wider societal  uses of technology that I want to address. 
Forgive me reading a bit of the manuscript. Often I give talks just by talking, but I sometimes also write a manuscript that I develop through the talk. With this one I'm going to read a bit and hopefully give you an insight into the challenge, I think, with identifying what constitutes a current issue  around ethical concerns in anti-doping.

Around 20 years ago I gave a talk at the first International Conference on Human Rights and Sport which took place in Sydney. I don't know if there was a second International Conference on Human Rights and Sport, but the issues were quite significant. My talk was titled, quite simply, “The Human Rights of the Genetically Modified  Athlete”. Most people, as you can imagine thought: “What the hell is that about?” Especially people in sport thought this must be something like doping  but just on a genetic level; that's how we should regard it and how we should think about the ethical issues around this topic. For most people in that world, this was simply another case of “bad hombres” using things they shouldn't be to compete  in sport. But it was much deeper for me than just that. I was interested in thinking about a world in which there were genetically modified people whose enhancements were decided for them by the genetic selection or enhancement decisions of their parents or ancestors and how the world of sport might deal with that kind of person.

I wanted to imagine athletes who had not, themselves, done anything to achieve their genetic advantage but whose parents, who had sought to optimise their child’s chances through genetic selection  or genetic enhancement, would have an impact on  their lives. Their existence would not violate any rule within anti-doping, even though their being permitted to take part in elite sport would certainly mean that anyone who was not genetically modified or selected would be less competitive.

This was a time of considerable change in the world more broadly. This talk found itself one year before the completion of the Human Genome Project. I want to take you back to that moment.
The Human Genome Project was nearing completion, and in fact was creating an incredibly challenging set of ethical issues for the world at large. It seemed to me particularly challenging for the world of sport. How will it deal with a world in which this technology was used? But all of a sudden the work of Crick, Watson and Franklin came to life. We found ourselves in the middle of a new era in human evolution. This was what was at stake at the time: this feeling that we are transcending those biological limits and remaking humanity in quite controversial and challenging ways. We hadn't figured out how this would operate. So I wondered how would the world of sport deal with an era where genetic information and even gene transfer found its way into sport.
Looking back, I suppose I also thought that this was a game-changer for the subject and that intrigued me, certainly. Gene doping was going to bring about the collapse of anti-doping, a system which I had studied and found to be left wanting philosophically and practically as a project interested in sustaining a moral framework to sport that I thought was unjustified, undesirable, and ineffective.

Now, some 20 years later, and also 20 years since New Scientist published its first article on performance genes, I'm left wondering: “Is this still a current issue?”

In 2001, in September that year, there was a conference scheduled at Cold Spring Harbor where the World Anti-Doping Agency would talk about gene doping and the prospects. 9/11 happened, that conference was cancelled and  postponed to the following year, but this was the time at which Professor Lee Sweeney began to say  that he was being contacted by athletes and their entourages with a view to them being enrolled into clinical trials using gene therapy. This brought the issue to life for the world. Lee Sweeney saying this made it a live issue, made it a current issue.

Lee's work on IGF-1 in particular revealed a proof of principle in the science and he spoke of an appetite among athletes to enroll within his trials. This was about as current as it got, or so I thought. Also at this time the IOC set up a gene therapy working group and soon after WADA did the same. We've now had a good 15 years of talking about this matter, but what has really changed? Well, we have research like this (indicating video of mouse on treadmill) https://www.youtube.com/watch?v=RcXuKU_kfww coming out of Case Western Reserve University, which gives you a sense of how genetic interventions may have an impact on performance.

So over this 15 years or so there have been discoveries, findings, that suggest a proof of principle that could have applications for humans. And since every Olympic Games from Sydney onwards the media has published stories claiming that  gene doping is the next big threat for sports while many other threats have also come and gone. Tthink of THG, the ‘clear’ or designer steroids more generally. And there have been examples of how genetic interventions can dramatically affect performance capacity, at least within animal models.

So it has been current for at least 15 years. Fast forward now to 2016 and we see how this becomes manifest within public discourse.
I was in a meeting with our chief science adviser in the British government this week where we talked about trust and expertise, and I gather it came up a little bit yesterday. But here's how it happens. Scientists were asked about what's going on in the world of science, and they tell them. They are then asked about what's going to come next, and they tell them again.

“We don’t know yet whether this has been done anywhere, but…it will be used sometime”

This is a quote from Carl Johan Sundberg [WADA Gene Doping Panel] from just last year, before the Olympic Games began in Rio,        which tells you how this discourse is propagated within the media, how current issues are formed through the opinions of expertise but, crucially, through the requests of them to make predictions about what's coming next. So it is a discourse that's facilitated by experts. One of the predicaments, I think, of anti-doping not specifically, but it certainly is one that it needs to deal with, is the ethics of communication around emerging technology issues. It is a real challenge.

You can find quotes like these from every single Olympic Games period. Usually about a month before WADA puts out its big statements about the fact that no one is going to get away with it this time, we have some fancy new test that is going to catch everybody, which happened last year with a genetic test for EPO, and you  have these claims about whether in fact gene  doping is here and here to stay.

Personally I experienced this directly. In 2004, I published a book called Genetically Modified Athletes, and just before the Athens Olympic Games, the BBC asked me on to their flagship Newsnight programme to talk about these  implications and we had a good debate about where we were and where it might go. Eight years later, during the London 2012 Games, I had exactly the  same debate on the same television programme about gene doping. It was almost word for word. So there's a real challenge here in terms of how we think about what is current and how we deal with it.

If this is a current issue, what was it 20 years ago when I started writing about the subject, when New Scientist published its first article on the subject? What is the difference between an emerging technology and a current technology when thinking about what we should be doing within our ethical investigations and policy making?

Some of my learning in bioethics were shaped by time at the Hastings Center in New York, where conversations with Dr Thomas Murray, who was involved with WADA at various levels, led me to conclude that sport would not deal with this  matter head on since bioethics, it is often said, must deal only with the present-day reality of scientific possibilities, not what might be here in five or ten years' time. Genetic enhancements weren't possible scientifically, at least we didn't know that they would work and be safe, and so did not deserve our time, even if they were rich philosophical debates. Instead we focused on gene tests and selection, and soon after such tests were becoming available. Here's one screen shot of a genetic test that was made available commercially. You could buy this test over the Internet. It simply takes a mouth swab and gives you some data on whether you are more likely to be a power-based on endurance-based athlete. Every scientist in this field has criticised this test, but the point, I think, from a policy perspective and from an intervention perspective is that it has become a social reality. The test is out there. The language of genetic tests as being determining of capacities or likely life achievements became a reality. So this led WADA to focus on genetic tests, and it published the Stockholm declaration in 2005, based on our talks.

Now I may have an erroneous definition of the word current, but it does matter how we define this term. I consider it essential to the work of ethics that we do mid to long-term speculative work. Space, time, and money is required to undertake such enquiries or else we lose sight of the bigger problems and lose time to determine our resolve. Failing to dialogue with speculative matters also limits the duration of our convictions and undermines our capacity to avoid problems that we may face in the future. In any case it is critical to distinguish between different forms of that word current. And we can have quite simple distinction between what is happening right now, so for example cases that come up in the world of sport or actual gene doping that's taking place that we know about, this is one way of thinking about what's current. But a lot of the conversation around anti-doping  focuses on a second definition which talks about the sorts of things that preoccupy our time - the worries we have about the future. Certainly for nearly 20 years now, gene doping has been a "current" issue in that respect. 

While it makes sense that we focus our efforts on the first of these, focusing on: Well, if it's not here yet, let's focus on the stuff that's here and deal with that. We need to think about the second one to avoid having to deal with the first one. If we don't deal with these longer-term implications, then we have a harder time dealing with the stuff that comes at us at crisis points.

Here's an example of the problem. We are moving into a world where these technologies are talked about not as a means of distorting nature or corrupting some internal essence or jeopardising a moral framework to how we recognise talent or effort in sport, and the like. Rather, it  actually has something much deeper to do with how we are changing as a species and as individuals. This terribly long quote is a good indication of that. 

A quote from Lee Sweeney's work, who I mentioned earlier, who has been working with WADA trying to find ways of detecting gene doping. But he says, and I'll read it out:
1.    “From my own work with the mice, I also know that earlier you intervene, the better off you're going to be when you get old. So once you go down that path, I think it's unethical to withhold from someone something that would actually allow their muscles to be much healthier now and to the future. As long as there's no safety risk, I don't see why athletes should be punished because they're athletes. So I'm on the other side of the fence from Wada on this one, even though we're on the same team right now” 
2.    Lee Sweeney, Jan 2014
At the moment the direction of travel for genetics is that, for it to be an effective public health intervention, we need to intervene before  an athlete even becomes an athlete.
These technologies that, at the moment, are within the WADA Prohibited List and rejected by the sports community generally, are seen as kind of discrete doping problems, but they are part of a wider change in the  circumstances of our biological condition.

A lot has happened over 20 years or so. We have now an article that covers gene doping  within the WADA Code, even if our knowledge of what is taking place is limited. Over the years there have been indications of gene doping at Games but nothing confirmed. We've heard talk about specific genetic products being used at different Games; but, again, it is all very  unclear. My concern is that the present strategy doesn't really address the problem that I wanted to consider back in Sydney in 1999, which was to do with the way in which genetics enters the population in a much deeper sense, perhaps through germ-line transfer of enhancements.

People in the world of sport, when asked this question about that germline modification or these wider questions about society and how it  uses technology will shrug their shoulders and  say, well, what can we do? We have nothing to do as a sporting organisation to address this. We have to see how society changes its values and, if it does, we may respond to it. Others will talk about it as just complete nonsense, that germ-line genetic engineering is just pie in the sky and akin to science fiction, and it is then also quickly dismissed. But then I'm often reminded, and have often been reminded over these years, as to how quickly these things change, how technology is taking us into new realms of capability. And year after year I have seen examples of that.
For example, this is from the TED Conference happening this week in Vancouver.


Sports find themselves at a time of tremendous change in the sorts of things that people want to do with their lives. Numbers around many sports, traditional sports, are diminishing. People are inventing alternative forms of physical practice which have alternative values and relationships to this problem of anti-doping.

One of the big areas that I wasn't going to get into but just to mention it very briefly is the rise of E-sports - competitive computer game playing - which has risen in the last few years significantly. It has so many profound implications for the world of sport. I could give a whole presentation on just that. However, the key thing here is that sport is losing generations to other kinds of activities, where the approach to the questions of doping is very different. So, we need to look at these and understand really what is going on and where it leaves us with regard to the ethical dilemmas that sports face.

In that context, the second the act of this talk is to men tion a few examples. Just to give you a glimpse of some of these challenges that we face

The first one I want to talk about is CRISPR, this technology that will allow a much  more sophisticated approach to gene editing. CRISPR has been discussed at length in the press in the last couple of years, where there is concern that, in factk that era of gene transfer for  potential enhancements that was dismissed 15 years ago as pie in the sky, as not quite here yet, is around the corner. The quotes again from scientists working in this field will say that this is easy to do, it may not be safe, but this is something that is now within our grasp. We also have projects that are changing those capacities we have as people. One of the nicest examples, I think, is North Sense. Here's a quick glimpse of it.

Now, many nonhuman animals have a capacity to know which direction is north, and this project is giving humans this sensorial capacity, which can change the sorts of things we can do in our lives. My proposition to you is that, in fact, this describes the future of sport much more than the older problems of doping that we see played out in the world of sport today. Creating people with different functions, different capacities, will lead to the creation of different kinds of sports and we'll see how this will change that approach that we have to the doping problem.
We also have the rise of ingestible sensors. A patent was awarded for this for the first time a year ago in the US, and we now begin to see this technology being rolled out. Here is, again, a sense of how it works.

This is here now. You can see how athletes might wish to use something like this to fine-tune their doping to avoid detection and so on, but you can also see how, perhaps, it can be used in a much wider sense as well.

The next one is prosthetics. Prosthetics are changing the sense of what biology can do by transforming it into artificial apparatus. We saw this around the London 2012 Games with Oscar  Pistorius, who became the first person to complete in an Olympic Games with a prosthetic device. But it was really only the beginning of this and we see ourselves at the cusp of an era where prosthetic devices on both significant levels like an artificial limb, but also on nanoscale levels, can be transforming that boundary between nature and technology to the point where it makes no sense to think about these as separate things. 

So in different ways, each of these examples, I think is a problem for sport as they are not really covered by the Code not even its catch-all article which indicates the capacity to encompass other forms of enhancements that aren't listed specifically. But the Code fails the concern that medicine is slipping into the realm of enhancement rather than therapy, calling into  question the role of medicine. Many people who work in this field coming from the medical perspective are worried this enhancement era  transforms the act of providing medical care in a way that undermines it and so are pushing back against it. Yet, we exist in a world where we are increasingly comfortable with this slip and where some even argue that we have moved into a post-human era where the conventional assumptions about healthcare are no longer relevant.
I mentioned one example at breakfast this morning where, in the UK the NHS, our National Health Care Service, is beginning to experiment with artificial intelligence as a diagnostic tool  within primary care. So you can see how these technological changes are coming. The dilemma, I think, to go back to the task I was set today, which was to talk about a current dilemma, can be articulated thus. How can anti-doping protect its social mandate, when human enhancement is allowing the general public to      become more capable of performing acts of physical endeavour than the anti-doping compliant athlete?

The point at which the general public is more enhanced than the athlete is the point at which anti-doping becomes a failed project. As you will anticipate, I don't think that anti-doping can succeed, and what we will see steadily is an erosion of public interest in the unenhanced athlete and the expansion of alternative sports that will not operate by the same kinds of rules.
The answer, however, I think is found within the Code, which has a fundamental flaw  within it. The Code is somewhat tautologous; it is a very self-contained set of directives and principles, self-referential in many ways. It asks the signatories to protect doping-free sport because that is the rule. It does not allow the signatories to question the rule. Even more worrisome is that within Article 18 on Education, it does not seek to undertake education in any meaningful sense.
As an educator myself my role is to guide students in the pursuit of certain ideas but to  allow them to arrive at their own conclusions.

Anti-doping prescribes the end point of that    educative route and it is to be in the service of the Code's purpose. In my view that is far from being education.
Thank you very much.

PROFESSOR KAMBER: Thank you, Andy, for your talk. I always enjoy your talks very much. I remember the first talks about gene doping and then we were on the brink, everybody is telling gene doping is around the corner, but I don't think so. But I'm convinced that we have to discuss this technical enhancement, these products helping people. But I think it is not a problem because we already have it in sports. We have all the sports equipment, already you have the bobsleigh, you have the Formula One cars. And so I think this direction is not such a problem. But I guess the discussion about gene doping, changing your genes, is over. I'm not sure it's coming to the sport. Because if you look at medical enhancement, medical improvement, in the last years, it didn't exist. But I agree with you that we have to discuss these enhancements with the technique, with this equipment we have. Maybe we have mixed races, as we have shown. This we have to discuss but no longer gene doping.

PROFESSOR MIAH: Wow, I can't believe you said that, Matthias, really. I'm staggered! I am given, you know that this is something that experts from your position say at every Olympic Games: This is something we need to discuss. It seems it is part of maybe it is part of the rhetoric. Maybe I misunderstand this. Is it simply about generating a sense of the fact that  WADA is doing something, we're forward thinking, we're thinking about these problems and making clear to the public that this is what we're doing. But at every year over the last 15 years people  within WADA have said: This is a problem we have to deal with. And the funding going into from their side, but also our side of it, suggests this is a serious concern. So I am surprised that you would say this, but I accept what you have said about the fact that gene therapy hasn't been particularly effective or successful in any medical sense, and the assumption is that until it is at least effective in a medical sense we wouldn't even dream of using it in a non-therapeutic context. 
The caveat to that is there is no capacity to embrace its use within a non-therapeutic purpose because, as with other  medical devices or methods or treatments, the limits of their regulation is in the precise terms of that therapeutic application. So, by implication, anything used out with those terms is  considered to be unethical and unreasonable for  scientists to be involved with. But the reason to put Lee Sweeney's quote up there is to show that people working within this field regard that the effective use of these next-generation therapies requires stepping back from the idea that there is something called "the natural course of aging" and intervene much earlier in life to benefit from  those interventions later in life. When you get into that, for me that is a completely radical point for many people who think that, no, we get old and we die, and that's it. We might do some fixing along the way with some medicine, but the direction of travel for the project of western medicine [PAUSE] I was going to say "is immortality", but the less radical way to put that is this ongoing pursuit of interventions. And hopefully these interventions will be safer, but they need to happen earlier in life rather than later. You don't get to 70 and then start your gene therapy to deal with the problems you face, it has to be earlier on, and that is a big shift, I think, in how people will feel about it.
Sorry, that was a long response.

PROFESSOR SANDS: One more question and then we'll break to our panel. Right at the front over here.
JEAN-PIERRE MORAND: I must say that when we are listening to you it is like an abyss is opening in front of us. My reflection was the following. Sport is one aspect of life. What you are showing is touching on many, many, many more severe and more serious aspects, including who is going to be  mortal, etcetera, etcetera. Then you say the Code is a failure. But I say, looking at this, sport as a concept becomes a failure. Because sport is based on comparison of people who are more or less having an equal field, otherwise it loses completely its function and sense and a competition will like a technical fair: which is the best matching? Which was designed the best by the best genetician then, and this is our product. There I think therefore doping becomes a detail and irrelevant in such a big, vast array of ethical problems.
PROFESSOR MIAH: I'm more optimistic. 

I think that even with these technological interventions the human role in performance remains crucial and it is our task to decide which things are relevant to the test of competition and which things are not.

One of the central points of the presentation, and I was trying to draw attention to this mindful of the purpose of this event, is that there is no mechanism for that interface  between sport and society within the Code itself.

Now that might be straightforward to many people. The Code is supported by governments and other organisations and their support implies a kind of assumption that this is what we want to do. But there needs to be an interface where people are able to discuss the ideology and the values behind it. And this is especially concerning when, within the Article 18 that talks about education, there is no statement about creating or nurturing critically-engaged athletes who can defend their position and understand what it is that matters to them about doping. It is entirely, I mean, for want of a better word, propagandist in how it approaches the concept of education. Without that interface within the Code, without some provision for a dialogue interface within that Code, it is destined to  fail, I think. It doesn't fail, sport kind of happens and it takes place reasonably well, although we have these problems with it, but I do think the key point is that interface. At the moment the Code is pretty self-contained and it is about sport deciding what it wants to do and society accepting it. We need to look more broadly, I think.

PROFESSOR SANDS: Andy, a big thanks from the entire audience and from me. I think we take a moment to thank Andy for his very interesting and challenging outline of issues that we have faced and that we will face.
Andy, thanks a lot.