We appreciate Dr. Nelson’s interest in the potential complications of sickle cell trait (SCT) and in our unique data set, which substantiates that SCT can now be considered to be among the causes of sudden death in trained athletes. Recognition that these tragic events occurring in young, predominantly male, African Americans are potentially preventable with vigilance, a high index of suspicion, and effective treatment strategies only enhances the importance of a contemporary understanding of SCT. As we reported for a substantial group of 23 high school and college student athletes, sudden death due to SCT is associated with a distinct clinical scenario and epidemiology that permits recognition of the warning signs and potentially the prevention of catastrophe.

For all these important reasons, we are frankly mystified by the view expressed by Dr. Nelson that data such as ours does nothing more than “scare athletes” or that we are somehow disseminating “dangerous language.” We believe our data can only help future at-risk athletes by preventing sudden death, thereby making the athletic field a safer place for young people.

In addition to the accusation that such speech is “dangerous,” Dr. Nelson also believes (similar to the recommendations of the American Society of Hematology) that identifying the risks of SCT in those athletes known to be affected is somehow discriminatory and impairs the protection from sudden death for other athletes (presumably those without SCT).

With all due respect, we do not understand this argument at all. Of course, all athletes should be protected in the best way possible, but the evolving science indicates that some African-American athletes with SCT (largely male and engaged in football) are uniquely susceptible to a serious, but potentially reversible, form of noninstantaneous cardiovascular collapse. This is a medical fact (and a medical issue), the realization of which can save lives. This should be the overriding (as well as obvious) consideration for physicians in this evolving debate.