CTE: Media Continues To Be Ahead Of Science

Reductionist formula

In a paper published in the journal Behavioral Sciences and the Law, scientists at the University of Colorado School Medicine (UCSM) acknowledge that, while “it simply makes good clinical sense to continue practices to minimize the number of concussions sustained and that allow for adequate recovery after any concussion” while awaiting the results of further studies on the possible link between contact sports and CTE, it is “essential to avoid embracing preliminary results derived from relatively small case numbers and methodologically problematic studies as undisputed medical fact, and to allow such results to redirect clinical practice away from established standards.”

The authors noted that, all too often, the “sensational media attention” surrounding CTE “divorce discussion of CTE from the well-established natural history and typically favorable prognosis of mTBI,” while, at the same time, such reports — and the scientific reports about CTE to which they are connected — imply direct connections between complex, multi-determined behaviors such as murder and/or suicide and mTBIs occurring in the remote past of individuals engaging in those behaviors.”

“The widespread media attention to these reports,” wrote lead author Hal Wortzel, MD of the Department of Psychiatry at USCM, “appears to have primed the public to accept highly reductionist formulations regarding the neuropathological bases of neuropsychiatric illness and complete human behaviors among persons with remote histories of [brain trauma].”

Other scientists agree. “What is tempting is to assume a reductionist approach that directly links all collisions in all contact sports with the development of long-term degenerative brain disease,” write Jon S. Patricios, MD and Michael Makdissi, MD in a recent editorial in the British Journal of Sports Medicine.“While CTE may be well defined pathologically and some association with sport has been identified — it still needs a significant amount of work to understand who is at risk and why.”

“Moreover,” they write, “too many questions remain before we can fill the aetiological chasm that exists between contact sports participation and CTE. These include the clarity regarding the number of blows, the effects of subclinical impact, the influence of other noxious influences on the brain, potential underlying genetic susceptibility and specificity of such histological changes to sport.

In literally focusing the histopathologist’s microscope on the CTE slide, what is magnified is only one pixel which should not distort the entire concussion picture.”

Is There a Doctor in the House?

To counter the misinformation in the media, Wortzel and his colleagues recommended that a concerted effort be made to educate medical professionals and the public at large regarding the state of the science of mTBI and CTE in order to avoid “catastrophizing” mTBI, to mitigate the “collective anxiety” that has resulted, and to reduce the likelihood that outcomes after mTBI will be actually be made worse as a result of the media frenzy around CTE.

Patricios and Makdissi used the metaphor of a television screen to make substantially the same recommendation: “What is needed in all sports is to pull the pixels together into a flowing, plasma-quality picture that encapsulates the context of every concussion injury. The challenge in effective implementation is to have law makers, administrators, coaches, referees and players as well as medical staff all understanding that it is NOT acceptable to play while any of the clinically determined parameters have yet to be fulfilled.”

They answer the question of “How can we constructively harness the heightened mindfulness of concussion albeit as a result of sometimes pixelated and distorted media sources?” by arguing that it is “Medical doctors with an understanding of the evolution of concussion knowledge as well as the research horizon [who] remain in the best position not only to assess and manage the concussed athletes but also to disseminate the information required to facilitate a global implementation of consensus protocols.”

Using only a single tool or drawing conclusions from seeing only one perceptible aspect of concussion management creates a distorted, ‘pixelated’ image. Similarly, neither the clinicians nor the media should react to only one aspect of a player’s presentation.

Following the Berlin 2016 guidelines, better implementation and greater, consistent dissemination should be the areas of emphasis. This will allow the concussion ‘picture’ to look more like that on an HD ‘plasma’ rather than the isolated ‘pixels’ that have been the focus of so much attention. As doctors,” they say, “we need to lead in management and broader implementation of the best guidelines we have — Zurich 2012. Social media may be an essential ally in conveying the ‘whole picture’.”

Repairing the disconnect

More recently, the authors of a September 2016 BJSM editorial proposed a three-pronged approach to repair the obvious “disconnect” between the science on CTE and the way the subject is reported by the media.

To begin with, they say, scientists and members of the media need to begin by acknowledging three biases they bring to the discussion of sports-related concussion and CTE:

1. a ‘belief bias,’ causing them to stubbornly hew to the most intuitively attractive conclusions and their own beliefs, rather than attempting to reconcile conflicting or contrary evidence;
2. an ‘illusion of validity’ bias, which falsely equates research quantity and quality; and
3. the tendency to see oneself as less biased than others. (what they term the ‘bias blind spot’)

Only by acknowledging such cognitive biases, they argue, can both scientists and journalists entertain and reconcile the empirical evidence about SRC in its entirety.

Second, given the crucial role the media play in providing information to the public, the scientists call for researchers and medical professionals to spend more time educating the media and encouraging members of the media to attend and actively participate in large academic meetings or conferences.

Third, acknowledging that some of the blame for the biased and one-sided media reporting on head injuries rests with some members of the scientific community who issue one-sided press releases and feed cherry-picked results about their findings to selected members of the media, the authors look to a day when the “harsh division and polarization” in the research community (an almost inevitable byproduct, unfortunately, of the intense competition for grant money in Concussion, Inc.), gives way to greater collaboration among researchers and a more “cordial discourse” between scientists via letters and responses to journal editors and back-and-forth debates at large academic conferences.

Troubled by the media’s reporting on the 2017 McKee CTE study, Uzma Samadani, an Associate Professor in the University of Minnesota Department of Neurosurgery, would go further. “In my opinion, there should be consequences from the journal (up to and including retraction of the article) when the primary author blatantly encourages and allows the media to misinterpret findings of a paper.” Perhaps ineligibility for state and federal research funds, Samadani said, would help curb the current trend towards “rabid sensationalizing” of what she characterized as “biased and uncontrolled studies” on CTE.