CTE: Media Continues To Be Ahead Of Science
On the other side of the media divide in reporting on CTE, not surprisingly, continues to be the New York Times, which, it is widely acknowledged, began the CTE=dementia and CTE= suicide memes ten years ago with the publication on January 18, 2007 of a now famous article about former Philadelphia Eagle André Waters, who, after committing suicide, was diagnosed by trailblazing pathologist Bennet Omalu with CTE. As far as the Times was concerned, Dr. McKee’s new study didn’t add to the debate; it ended it: “It is no longer debatable whether or not there is a problem in football — there is a problem,” Dr. McKee said.
Conspicuously absent from the article, however, was any mention of Dr. McKee’s concessions in the actual study that several other factors besides prior participation in football may influence CTE risk and disease severity, including factors other than cumulative hits to the head. Nor was there any mention of her startling admission that it was even “unclear” whether symptomatic hits (concussions) were “more important” than asymptomatic hits resulting in subconcussive injury” in CTE risk, disease severity, and progression.
If no one, including Dr. McKee, knows whether CTE is caused solely by concussions, solely by repeated blows to the head, or a combination of both, and there is evidence that genetic factors, use of alcohol, drugs (including opioids and PEDs), and pre-existing psychological problems might affect risk, one might reasonably ask why it was that the Times re-stated for the umpteenth time that scientists “believed [CTE] to be caused by repeated blows to the head,” and that what remained to be learned was not whether repeated blows to the head caused C.T.E., but rather “how many blows to the head, and at what levels, must occur for C.T.E. to take hold?” It is hard to draw any conclusion other than that such uncertainty didn’t fit neatly into the Times’ 10-year-old football=dementia meme.
The value of the study in determining the risk of developing CTE also appears to have been greatly exaggerated. While Dr. McKee admitted to the Times that there was a “tremendous selection bias” and that the brains autopsied were far from a random sample, the article nevertheless viewed 110 positives as “significant scientific evidence of an N.F.L. player’s risk of developing C.T.E.”
Most scientists, however, take issue with that assessment, including Dr. Samadani, the University of Minnesota neurosurgeon. “McKee saying that 110 of 111 brains she examined from NFL players have CTE is the equivalent of an emergency medicine doctor saying that 110 of 111 patients presenting to the emergency department with a tibia at right angles to a fibula have a fracture somewhere in the bones: she is seeking disease among those who report being symptomatic from it and therefore [she is not in a position to] estimate prevalence in a general population.”
Samadani also points out that, “totally lost in this debate are studies investigating the benefits of sports for children in particular. The average American 16-year-old boy who plays football has a BMI greater than 26. What sporting options exist for this child who, by virtue of his body build, is already at risk for premature hypertension, obesity, diabetes, cardiovascular disease, stroke, dementia, and 13 types of cancer? In the vast majority of people, the benefits of playing sports outweigh the risks of associated injury.” To Samadani, the focus should be on reducing risk in sports; increasing participation for all children; and understanding benefits.
In his 2017 journal commentary, Carson agrees: if sports governing bodies want to get serious about preventing dementia in their former athletes, he argues that it “might make more sense to follow the existing evidence base for dementia prevention.” Given consistent and robust findings on the value of being physically active into old age, Carson believes that “targeting defined risks rather than speculative ones seems a far better place to start.”
In the meantime, as the Times article reminds us, repairing the disconnect between the science on CTE and the media is a long way off.
Brooke de Lench is Founding Executive Director of MomsTEAM Institute, Publisher of MomsTeam.com, producer/director of the PBS documentary, The Smartest Team: Making High School Football Safer, and author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins) and Director of NCAA-DoD grant winning program Smart Teams Play Safe . Follow her @BrookedeLench Contact her at delench@MomsTeam.com
Lindsey Straus, JD has been Senior Editor of MomsTEAM.com since its launch in 2000. In May 2016, Ms. Barton Straus was honored by the American Academy of Orthopaedic Surgeons with its prestigious Media Orthopaedic Excellence (MORE) award for her article, Counting Pitches Can Save Young Players’ Arms But Not Always Used Consistently.
MomsTEAM is a 501(c)(3) non-profit which does not solicit nor accept donations from the National Football League, USA Football, or Pop Warner.
This article was originally published in Medium.com on September 20, 2017.
Randolph C, Karantzoulis S, Guskiewicz K. Prevalence and Characterization of Mild Cognitive Impairment of Retired National Football League Players. J Int’l Neuropschol Soc. 2013;19:1–8.
McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport: the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. Published Online First: 26 April 2017. doi: 10.1136/bjsports-2017–097699
Randolph C, Kirkwood, M.W. What are the real risks of sport-related concussion, and are they modifiable? Journal of the International Neuropsychological Society. 2009;15:512–520.
D’Alessandro D, “Scientists claim that link between concussions and CTE is “unproven” could impact NFL lawsuits.” NewJersey.com (March 17, 2013)http://www.nj.com/ledger-dalessandro/index.ssf/2013/03/scientists_claim_that_link_between_concussions_and_cte_is_unproven_could_impact_nfl_lawsuits.html (accessed March 20, 2013).
“League of Denial” Wrap Up and Reax, http://theconcussionblog.com/2013/10/09/league-of-denial-wrap-up-and-reax/ (accessed October 9, 2013).
Gardner A, Iverson G, McCrory P. Chronic traumatic encephalopathy in sport: a systematic review. Br J Sports Med. Published Online First: June 26, 2013. doi: 10.1136/bjsports-2013–092646.
McCrory P, Meeuwisse WH, Kutcher JS, Jordan BD, Gardner A. What is the evidence for chronic concussion-related changes in retired athletes: behavioral, pathological and clinical outcomes? Br J Sports Med2013;47:327–330.
Shaunacy Ferro, “Does CTE, The Brain Disease Found In NFL Players, Really Exist?”; http://www.popsci.com/science/article/2013-08/does-cte-brain-disease-found-nfl-players-really-exist (accessed October 19, 2013)
Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS. Estimation of Head Impact Exposure in High School Football: Implications for Regulating Contact Practices. Am J Sports Med 2013;20(10). DOI:10.1177/036354651302458 (epub September 3, 2013).
Giza C, Kutcher J, Ashwal S, et. al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013 (published online ahead of print March 18, 2013): DOI:10.1212/WNL.ob013e31828d57dd (accessed March 23, 2013)
Hazrati L-N, Tartaglia MC, Diamandis P, et al. Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology. Frontiers in Human Neurosci. May 2013; Vol. 7/Article 222; doi:10.3389/fnhum.2013.00222.
Daniel J. Flynn, “Punked: ESPN, Sports Reporters Falsely Report Tony Dorsett Has ‘CTE’. Brietbart.com (http://www.breitbart.com/Breitbart-Sports/2013/11/14/ESPN-Got-Punked-CTE-Flynn)(accessed November 15, 2013)
Wortzel HS, Brenner LA, Arciniegas DB. Traumatic Brain Injury and Chronic Traumatic Encephalopathy: A Forensic Neuropsychiatric Perspective. Behav. Sci. Law; 2013; doi:10.1002/bsl.2079 (epub on line).
Iverson GL. Chronic traumatic encephalopathy and risk of suicide in former athletes. Br J Sports Med. 2013; doi:10.1136/bjsports-2013–092935 (epub October 31, 2013).
Karantzoulis S, Randolph C. Modern Chronic Encephalopathy in Retired Athletes: What is the Evidence? Neuropyschol Rev 2013; doi:10.1007/s11065–013–9243–4 (epub November 22, 2013)
Tator CH. Chronic traumatic encephalopathy: How serious a sports problem is it? Br J Sports Med. 2013; doi:10.1136/bjsports-2013–093040 (epub November 22, 2013).
Patricios JS, Makdissi M. The sports concussion picture: fewer ‘pixels’, more HD Br J Sports Med 2014;48:71–72 doi:10.1136/bjsports-2013–093285
Burnsed, B. “A Gray Matter.” Champion Magazine. Spring 2015 (accessed on April 23, 2015 at http://www.ncaa.org/static/champion/gray-matter/#sthash.fLCUdxnT.bLfliN0N.dpbs).
Iverson GL, Suicide and Chronic Traumatic Encephalopathy. J Neuropsych & Clin. Neurosciences. 2016;28(1):9–16.
McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250–258.
Mez J, Daneshvar D, Kiernan P, et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360–370.
Kuhn AW, Yengo-Kahn AM, Kerr ZY, Zuckerman SL. Sports concussion research, chronic traumatic encephalopathy and the media: repairing the disconnect. Br J Sports Med. 2016; doi:10.1136/bjsports-2016–096508 (epublished September 1, 2016)(accessed September 6, 2016).
Kutcher JS, Gerstner J. Back in the Game: Why Concussion Doesn’t Have to End Your Athletic Career (Oxford University Press, New York 2016).
Noy S, Krawitz S, Del Bigio M. Chronic Traumatic Encephalopathy-Like Abnormalities in a Routine Neuropathology Service. J Neuropathol Exp Neurol. 2016;75(12):1145–1154)
Stamm J, Koerte I, Muehlmann M, et al. Age at first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84(1):1114–1120.
Solomon G, Kuhn A, Zuckermann S, et al. Neuropsychological Findings in Later Life: A Study of 45 Retired National Football League Players. Am J Sports Med. 2016 May;44(5):1106–15. doi: 10.1177/0363546515626164. Epub 2016 Feb 17.
Alosco ML, Kasimis AB, Stamm JM, Chua AS, Baugh CM, et al. Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Trans. Psychiatry (2017) 7, e1236; doi:10.1038/tp.2017.197.
Maroon JC, Winkelman R, Bost J, et al. Chronic traumatic encephalopathy in contact sports: a systematic review of all reported pathological cases. PLoS One. 2015;10:e0117338.
Carson A. Concussion, dementia, and CTE: are we getting it very wrong? J Neurol Neurosurg Psychiatry 2017;88:462–464. Doi:10.1136/jnnp-2016–315510 (originally published online April 10, 2017).