Archive for May 12th, 2011

Sure, ‘Change the Way Football Is Played.’ But Also Change Who Is Allowed to Play It.

Readers of this blog should know two things by now: (1) I have the highest regard for the people who have done and are doing the serious work in the trenches on sports brain injury research; and (2) While reasonable people can disagree on when the tipping point was reached, we need fewer angels dancing on the heads of pins, in exchange for more concrete steps to prevent chronic traumatic encephalopathy on the front end and, if possible, develop cures at the back end.

For the former, I’m pretty dubious that helmet reform is much of an answer, and I’ll explain why with an analogy. A lot of people have the perception that the end of bareknuckles boxing made the sport less brutal, when the opposite was actually the case. Gloves protect the hands that hit, not the heads that get hit. Relieved of much of the fear that they would break their hands, gloved boxers started punching harder than ever. Mandatory eight counts, three-knockdown rules, limiting the number of rounds, stopping bloodbaths, and other measures did civilize boxing to a degree, but mostly at the level of image. No one who understands how these things work really believes that as a live-and-death matter, boxing is less, rather than more, dangerous than it used to be.

The focus on football helmet safety might very well be a similar public-health trap. The industrial demands of modern football make the helmet as much a weapon as it is a piece of protective gear.

Of course, we can and should do our best with helmet design. We also need changes in rules and in coaching culture. But jeez, the volume of accidents happening with athletes of this size and speed is well beyond acceptable, even if we assume that they’re accidents. The confidence with which some experts project threading the needle here is, intuitively, as absurd as that old Hawaii Five-O episode in which an assassin created a decoy by arranging to have himself shot at long range exactly one-eighth of an inch from his heart.

The reform that needs to get sustained discussion is not the installation of National Football League and World Wrestling Entertainment doctor Joseph Maroon’s ImPACT concussion management software in high school athletic departments. The national conversation we need to be having is about is whether the sport of football should be played at all before age X. I don’t pretend to know what “X” should be; only that the current murmur about the subject is so tossed-off as to be far short of a paradigm shift.

Today’s Chicago Sun-Times has an article about a speaking appearance by Dr. Ann McKee, a doctor of pathology at Boston University who did the Dave Duerson brain study and probably has received fewer mentions here than she deserves. See http://www.suntimes.com/sports/football/5329586-419/doctor-football-must-change-rules-to-protect-players.html.

The headline on the story is “Doctor: Football must change rules to protect players.” Yet the last paragraph of the story has this quote from McKee:

“I don’t think 10-year-olds need to play tackle football. I’ve already told my son he’s got to stop playing.”

I look forward to stories that stop burying the lead and give us headlines like this: “Doctor: Youth football must be banned.”

Irv Muchnick

A Rose Is a Rose Is a Rose – Until It’s CTE in a Football Player

Yesterday I apologized for falsely suggesting that Dr. Robert Cantu had airbrushed the history of chronic traumatic encephalopathy research in his remarks last week at the Dave Duerson brain study press conference.

Today I offer an extended P.S. on the nuances of that research and its political landmines. The story of CTE involves maimed and prematurely dead athletes, of course. But it also includes egos, grants, media coverage … in sum, careers. The behind-the-scenes rivalry between the Boston research group, led by the Sports Legacy Institute’s Chris Nowinski and Boston University Medical Center’s Cantu, and the West Virginia research group, led by Drs. Julian Bailes and Bennet Omalu, is a glimpse into that world. The stakes are high for the parties – and for the rest of us.

Let’s stipulate that any controversy over the origins of the naming of this brain disease is a sideshow in comparison with the substance of what Omalu brought to the table – unfortunately, it was literally the autopsy table – over the last decade. I would summarize it thusly:

– For many years, there was an understanding that boxers suffered various symptoms resembling Parkinson’s Disease, accompanied by dementia.

– There was also an escalating appreciation that people in all walks of life who suffered major traumatic brain injury could develop a disease that resembled Alzheimer’s.

– Beginning with Mike Webster in 2002 and continuing through to the Nowinski group’s initial and breakthrough finding, on pro wrestler Chris Benoit in 2007, Omalu put what we now call CTE on the map. Omalu determined that minor blows to the head, over time, with or without documentation – notably in football, hockey, lacrosse, and wrestling – could result in a disease distinct from Alzheimer’s. Omalu is publishing an overview on all this in the journal Neurosurgery; it is available in advance in electronic form, and I wrote about it here on March 9. See “Concussion Research Pioneer Bennet Omalu Returns to ‘Neurosurgery’ Journal,” https://wrestlingbabylon.wordpress.com/2011/03/09/concussion-research-pioneer-bennet-omalu-returns-to-%E2%80%98neurosurgery%E2%80%99-journal/.

Omalu has defined CTE as a disease entity. He also has confirmed that what we used to think of as Parkinson’s or Alzheimer’s or their offshoots are not these diseases in victims of CTE, which has distinct pathognomonic diagnostic features.

Nomenclature aside, there was no media attention given to CTE until after the publication of the Mike Webster paper in 2005.

About that nomenclature:

  • There is evidence that “punch drunk syndrome” in boxers, or dementia pugilistica, was also being called “traumatic encephalopathy” as early as the 1930s.
  • A 1996 paper in Pathology, “Dementia Pugilistica in an Alcoholic Achondroplastic Dwarf,” by David J. Williams and Anthony E.G. Tannenberg,” says that dementia pugilistica is “otherwise known as chronic progressive post-traumatic encephalopathy of boxing.” Not exactly the same as CTE – though so close that I probably would have felt compelled yesterday to clarify and apologize to the Boston folks even if they hadn’t also shared with me …
  • A 1966 paper from Proceedings of the Royal Society of Medicine, “Mental Sequelae of Head Injury,” by Henry Miller, has a subsection headed “Chronic Traumatic Encephelopathy.” Though Miller did not seem to go anywhere with this term in the body of the article, nor give it the abbreviation CTE, the exact sequence of the three words clinched at least the minimal point that great minds prior to Omalu had thought at least somewhat alike. And it confirmed that I’d stubbed my toe in my May 3 story on Duerson.

I haven’t yet gotten to my promised oration on how fetishized peer-review literature too often amounts to trees falling in a forest with no one around to hear or act on them. I’ll get to that next, I think.

 

Irv Muchnick


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