CTE: Media Continues To Be Ahead Of Science

Making headway?

Are the years of criticism from the scientific and research community having any effect on the prevailing media narrative about CTE? Some, but not much.

It is a given that some journalists in the popular press — perhaps most — will continue to get ahead of the science on CTE. Typical were news reports in November 2013 by numerous media outlets, including CBS News and The Atlantic, stating as fact that eight former NFL players, including Hall of Fame running back Tony Dorsett and fellow Hall of Famer Joe DeLaumielleure, had been diagnosed with CTE, when it appeared that the tests they underwent, while finding signs consistent with the presence of the disease, made no definitive diagnosis of CTE, because, as TauMark, the company that made the test, itself noted on its website, “A definite diagnosis is only possible with autopsy when tau proteins are found in distinctive brain areas,” and all of the 8 were still very much alive.

“Just as the press touts an unpublished, nonexistent study by researchers standing to profit from the claims [that their test has been proven to diagnose CTE in living patients], actual peer-reviewed science clashing with the … claims … goes overlooked,” wrote Dan Flynn, author of The War on Football: Saving America’s Game.

In a lengthy, well-researched, and powerful article in the Spring 2015 issue of the NCAA’s Champion magazine, many top concussion experts remained critical that the media narrative about sports-related concussion continued to be dominated by media reports on the work of Dr. McKee. In a classic case of too little, too late, Dr. McKee provided a belated mea culpa, conceding that, “There [was] no question [that her autopsies finding evidence of CTE in the brains of most of the former athletes were] a very biased study,” that they involved “a certain level of … sensationalism”, that there were “times when it’s overblown” and went “a little too far.” Why? Because, Dr. McKee admitted, because “it’s what sells.”

Perhaps surprising is that it has been Dr. McKee’s colleague, Dr. Robert Stern, appears to be on a one-man crusade to try to get the media not to get ahead of the science. Typical of Dr. Stern’s efforts were statements he made to USA Today for a December 23, 2015 article in which he admitted that, “There has been a lot of hype about CTE that has gone beyond the science. We need to have the science move forward so we can answer … important questions like, ‘What are the symptoms of CTE exactly? When someone has symptoms, what can we do to have a better understanding of whether it’s due to CTE or not? Just because someone has depression doesn’t mean it’s CTE. Just because someone has problems with impulsivity doesn’t mean it’s CTE. Just because someone develops memory impairment and eventually dementia, that doesn’t mean it’s CTE.”

At this stage, Stern said, the science shows “repetitive head impact exposure is a necessary variable for getting the disease, but it’s obviously not sufficient, because not everyone who hits their head is going to get this brain disease. That’s pretty much all we know. … I’m the one person who says over and over again we have no idea what’s going on yet. People should not overreact and be fearful that they’re going to develop CTE, especially our youth athletes.”

Sign of the Times

Most recently, it was heartening to see that the publication in the Journal of the American Medical Association in late July 2017 of Dr. McKee’s CTE case studies of athletes participating in American football — a study finding CTE present in 99% of the brains of former NFL players study — prompted a significant amount of push-back from many scientists, clinicians, and researchers to the way in which the media covered the story, accompanied by continued reminders that the facts about CTE are far more nuanced and uncertain that many in the media would have us believe.

Typical was an op-ed in the San Diego Union-Tribune by orthopedic surgeon, sports medicine doctor, and former NFL head team physician, David J. Cho, writing under the byline, ProFootball Doc, who said it was time “to get to the truth about concussions and CTE,” to “stop the media and public hysteria,” and for both sides to “stop campaigning for their agenda and to let science take the lead.”

Pointing to a concussion meeting of the American Academy of Neurology at which researchers and clinicians contradicted the media and public narrative on CTE by stating that the association between trauma and CTE was “unclear” and the association between CTE and symptoms was “unknown” (positions which, even such true CTE believers as Dr. McKee and her BU colleagues, Drs. Cantu and Nowinski, now are on record as sharing), Cho’s bottom line was this: “the media/public narrative is much different than the scientific narrative.”

In the same vein, Russell M. Bauer and Michael S. Jaffee, professors at the University of Florida, asserted in a recent blog that “the massive attention given to concussion management and prevention has produced a level of public pseudo-awareness about CTE that currently outstrips what is scientifically known about the disorder.”

They go on to point out that the results of the McKee study, as reported by the media, lead many people to think that “CTE is an all but inevitable outcome of playing football or other sports.” “But is it?” they ask. “And most importantly for parents, coaches, and fans, what is the actual risk to my kids, my players and my team?” The answers to these questions, they argue, while not yet known, are likely to be “considerably less than would be suggested by available research findings.”

A blog from the Alex Berezow of the American Council on Science and Health noted that, while the headline writers, predictably, went crazy in reporting on Dr. McKee’s new study, implying that 99% of football players who make it to the NFL will develop CTE, the implication “couldn’t be further from the truth.” As for the study itself, Berezow’s view was, unfortunately, it added little, “except more confusion, to the current debate.”

For her part, Dr. Hazrati continued to be critical of the conclusions being drawn from Dr. McKee’s most recent study. In an interview for a lengthy article in the Toronto Sun under the headline, “Conclusions drawn after Boston University CTE study are misleading, troubling”, she continued to point to her own examinations of brains of deceased professional athletes, in which she has detected less prevalence of CTE, and less severe cases, than her American counterpart.

“What I’m seeing, in ballpark numbers, is 30% of our cases have some CTE pathology,” Hazrati told the Sun. “Most are basically very low-stage pathology. I’ve got CFL players, I’ve got hockey players and I’ve got brains from some other athletes — rugby players, wrestlers, boxers, sports like that. So it’s a mix. But they’re all professional athletes. We don’t see that volume of advanced cases that have been reported (by McKee). Only 30% of our brains have CTE. And about 30% don’t have anything.”

Hazrati’s bottom line: “None of these post-mortem brain autopsies are going to solve the CTE (mystery), at all. You cannot solve the cause of CTE by looking at brains of deceased people.” Since there is still no way to detect CTE in the living, Hazrati asked, “How can you even think about who’s the most susceptible? Who’s not? What age is the worst? Just looking at these brains (posthumously), you cannot say any of that. It’s just impossible at this point.”