Archive for January 23rd, 2011

Sports Concussion Scandal Ground Zero: NFL and WWE Doc Joseph Maroon’s Hype Article in ‘Neurosurgery’ on Riddell Football Helmets

Alan Schwarz of The New York Times, who all but owns the major-media coverage of the concussion story, has another good one today: “Oversight Group Vows to Pursue Updates to Football Helmet Standards,”

But oddly, The Times fails to make the important connection to its own recent big story: the Federal Trade Commission investigation of safety claims by Riddell, the official helmet supplier of the National Football League, for its Revolution model. Reporter Schwarz leads today’s account of action by the National Operating Committee on Standards for Athletic Equipment by stating that it was spurred by the Consumer Product Safety Commission. Yet the piece doesn’t mention at all the FTC probe of Riddell initiated earlier this month by Senator Tom Udall.

The concussion story is more than the sum of the blocking and tackling by dueling experts. It is also the story of a process: the ecosystem of clinical research, an interdependent web of leading doctors, research journals, and commercial interests.

Today ground zero is an article in the February 2006 issue of Neurosurgery, “Examining Concussion Rates and Return to Play in High School Football Players Wearing Newer Helmet Technology: A Three-Year Prospective Cohort Study.” One of the co-authors was Dr. Joseph Maroon, a team physician for the Pittsburgh Steelers, a member of the NFL’s traumatic brain injury policy committee, and the medical director of World Wrestling Entertainment. Two of Maroon’s three co-authors were University of Pittsburgh Medical Center colleagues Micky Collins and Mark Lovell; they are also partners in the concussion-management software company imPACT Applications, Inc. The article’s other co-author, Thad Ide, is chief engineer at Riddell. The Pittsburgh research was underwritten by NFL Charities.

As news of the FTC investigation broke, Maroon threw Riddell under the bus, claiming that the company’s promotion of the Revolution helmet emphasized the blue-sky findings of the Neurosurgery article while ignoring its disclaimers. But is that explanation good enough?

Here is the full text of the abstract of the article:

OBJECTIVE: The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design.

METHODS: This was a three-year, prospective, naturalistic, cohort study. Participants were 2,141 high school athletes from Western Pennsylvania. Approximately half of the sample wore the Revolution helmet manufactured by Riddell, Inc. (n = 1,173) and the remainder of the sample used standard helmets (n = 968). Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study. Following a concussion, players were reevaluated at various time intervals until recovery was complete.

RESULTS: In the total sample, the concussion rate in athletes wearing the Revolution was 5.3% and in athletes wearing standard helmets was 7.6% [[chi]2 (1, 2, 141) = 4.96, P < 0.027]. The relative risk estimate was 0.69 (95% confidence interval = 0.499- 0.958). Wearing the Revolution helmet was associated with approximately a 31% decreased relative risk and 2.3% decreased absolute risk for sustaining a concussion in this cohort study. The athletes wearing the Revolution did not differ from athletes wearing standard helmets on the mechanism of injury (e.g., head-to-head strike), on-field concussion markers (e.g., amnesia or loss of consciousness), or on-field presentation of symptoms (e.g., headaches, dizziness, or balance problems).

CONCLUSION: Recent sophisticated laboratory research has better elucidated injury biomechanics associated with concussion in professional football players. This data has led to changes in helmet design and new helmet technology, which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players.

(Next on this blog: Timeline of Dr. Joseph Maroon’s work as medical director of World Wrestling Entertainment.)

Irv Muchnick

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January 2011