CTE: Media Continues To Be Ahead Of Science

Push-back

The Randolph study, co-authored by no less a concussion authority than Kevin Guskiewicz, Kenan Distinguished Professor, Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill and Director of UNC’s Center for the Study of Retired Athletes, was heavily criticized at the time as being flawed by those who identified CTE as a distinct condition and saw a clear cause-and-effect relationship between repetitive head impacts and CTE.

Chris Nowinski, co-director of the CTE Center at the Boston University School of Medicine and co-founder of the Concussion Legacy Foundation (f/k/a Sports Legacy Institute), told PopSci.com in 2013 that it was “preposterous” for Randolph to conclude that CTE might not be its own disease because the retired football players had impairments similar to those of other patients with mild cognitive impairment.

It was not surprising that the conclusion of the Fourth International Consensus Statement on Sports Related Concussions in March 2013 — a conclusion left essentially intact in the Fifth Consensus Statement issued in March 2017 — that the causal link between repetitive brain trauma and CTE had not been established — was met at the time with a sharp push-back from the research group at Boston University’s CTE Center, the group most associated with the position that CTE is a distinct neurodegenerative disorder suffered only by athletes in contact and collision sports, and that repetitive trauma can in some cases be the sole cause of the disease.

Typical was the reaction of one of Zurich 2012’s co-authors, Dr. Robert Cantu, the CTE Center Director, who told NewJersey.com at the time that, “When I saw that [it said] we need more data in terms of CTE, I wrote to the other authors, in essence, ‘What the hell do you mean that we need more data?’ The whole breadth of the document is large, and 99 percent of it I strongly support. But that part of it, I don’t support at all. Frankly, it stunned me.”

Dr. Cantu’s colleague, Dr. Ann McKee, likewise expressed befuddlement at the Zurich 2012’s treatment of CTE, telling NewJersey.com, “This is a time that calls for immediate action to reduce the amount of head trauma experienced by athletes in all sports to prevent CTE.”

Dr. McKee asserted that it would be “irresponsible to justify inaction by requesting a level of scientific proof that will take decades to acquire,” expressing the fear that, to suggest that CTE “may not be part of the impact exposure, but rather due to other yet unidentified factors,” could give tacit permission to those who play collision sports to proceed as if there is no urgent problem when concussions arise. (Interestingly, Dr. McKee said much the same thing when interviewed by The New York Times four years later for its article on her 2017 study reporting on the results of her team’s examination of all brains donated to the Concussion Legacy Foundation to date: “It’s no longer debatable whether or not there is a problem in football — there is a problem.”)

The Zurich 2012 statement wasn’t intended to have such an implication, argued Dr. Rosemarie Scolaro Moser, Director of the Sports Concussion Center of New Jersey and MomsTEAM.com’s sports concussion neuropsychologist, when interviewed by NewJersey.com in 2013. Instead, she cautioned that it would be jumping to conclusions to say, ‘If you play football, you’re probably going to get CTE.’ Which is not the case. So what differentiates those with CTE from those who don’t have it? That’s what we need to know.”

Skepticism growing

The number of those in the medical, scientific, and concussion research communities voicing serious doubts about whether a direct cause and effect relationship between repetitive brain trauma and CTE existed, as Drs. McKee and Cantu initially claimed, or that proving scientifically that it can be caused solely by such trauma is inevitable, has been growing, even in the face of thousands of media reports reporting the purported link as scientific fact.

“Her study of brains with CTE appear to be all former NFL players, 1 from high school and 1 from college, but what about soccer players?” wondered Scott L. Bruce, MS, ATC, co-author of the 2004 NATA Position Statement on Sports-related Concussions and Founder of the Chattanooga Concussion Prevention Initiative, after viewing the 2013 PBS Frontline documentary “League of Denial” featuring Dr. McKee.

“Or what about athletes from other sports? What about females vs. males? What about those players who play college football, but never go on to play in the NFL? Of the number of high school players who never play college football? Are any of their brains examined for CTE? If so, what were the findings?”

(It should be noted here that some of Bruce’s questions, at least with respect to football, were answered four years later. Dr. McKee’s most recent study, published in the Journal of the American Medical Association in July 2017,while focused exclusively on American football, reported on the autopsies of 2 pre-high school, 14 high school, 53 college, 14 semi-professional, and 8 Canadian Football League football players, in addition to 111 NFL payers. Of those, Dr. McKee and her team diagnosed CTE in 0 of 2 pre-high school football players, 3 of 14 (21%) of high school players, 91% who played football through college, 88% of those who played in the CFL, and 64% who played semi-pro football.)

Significantly, though, other researchers have not been able to replicate Dr. McKee’s findings in other autopsy studies. In a 2013 study, researchers in Canada autopsied the brains of six former CFL players with a history of multiple concussions and significant neurological decline. Only 3 of the six had post-mortem neuropathological findings consistent with CTE. The other 3 had pathological diagnoses of AD, ALS and PD. Even in the athletes whose brains post-mortem showed signs of CTE showed evidence of cancer, vascular disease, and AD.

The case studies, said lead author, Lili-Naz Hazrati of the Tanz Center for Research in Neurodegenerative Diseases in Toronto, “highlight that not all athletes with history of repeated concussions and neurological symptomology present neuropathological changes of CTE.” In other words, “a history of participation in professional football and a history of multiple concussions, combined with positive clinical signs and symptoms of progressive neurodegenerative disease, were not inevitably associated in each of the 6 cases with a post-mortem diagnosis of CTE.” (emphasis supplied).

Likewise, a study by a different group of Canadian researchers published in December 2016 reported that 35% of the adult population less than 60-years old who underwent a medicolegal autopsy were found to have at least minimal CTE-like changes in their brains, which were usually, but not always, associated with histories of head injury and/or substance abuse. The authors, pathologists at the University of Manitoba, viewed their findings as “broaden[ing] the susceptibility to CTE beyond athletes and military personnel toward the general population” and “raise[d] the possibility that CTE might represent a public health issue in vulnerable populations (e.g. those with chronic substance abuse).