Tuesday, March 22, 2016

Chronic Traumatic Encephalopathy – Huh?

It’s a super-hot topic at the National Football League these days, and the above photograph really brings it home. Wikipedia: “Chronic traumatic encephalopathy (CTE)… is a progressive degenerative disease found in people who have had a severe blow to the head. The disease was previously calleddementia pugilistica (DP), i.e. ‘punch-drunk’, as it was initially found in those with a history of boxing. CTE has been most commonly found in professional athletes participating in American football, association football, ice hockey, professional wrestling, stunt performing, bull riding, bicycle motocross, rodeo, and other contact sports who have experienced repeated concussions or other brain trauma. Its presence in domestic violence is also being investigated. It can affect high school players who have played for just a few years…
“Symptoms of CTE generally begin 8–10 years after experiencing repetitive mild traumatic brain injury. First stage symptoms include deterioration in attention as well as disorientation, dizziness and headaches. Further disabilities appear with progressive deterioration, including memory loss, social instability, erratic behavior, and poor judgment. Third and fourth stages include progressive dementia, slowing of muscular movements, hypomimia [reduced facial expressions), impeded speech, tremors, vertigo, deafness, and suicidality. Additional symptoms include dysarthria [motor speech disorder], dysphagia[difficulty swallowing], and ocular abnormalities - such as ptosis[droopy eyelids].
“Currently, CTE can only be definitively diagnosed by direct tissue examination, including full autopsies and immunohistochemical brain analyses [looking for a buildup of tau, an abnormal protein that strangles brain cells].” In short, it’s really serious, problems often do not surface for years, and there is a strong feeling in the NFL that CTE is likely to impact a majority of players, particularly the longer they play. And even as the NFL has paid out millions of dollars to settle player claims, no one at the NFL has simply come out and declared a clear and direct link between concussions sustained during professional training and play… and CTE. Until now.
“After years of the N.F.L.‘s disputing evidence that connected football to chronic traumatic encephalopathy, the degenerative brain disease found in nearly 100 former players, a top official for the league for the first time acknowledged the link. To many, it was an echo of big tobacco’s confession in 1997 that smoking causes cancer and heart disease.
Representative Jan Schakowsky, Democrat of Illinois, asked during a round-table discussion about concussions whether ‘there is a link between football and degenerative brain disorders like C.T.E.’
“Jeff Miller, the N.F.L.’s senior vice president for health and safety policy, said, ‘The answer to that is certainly, yes.’ His response signaled a stunning about-face for the league, which has been accused by former players and independent experts of hiding the dangers of head injuries for decades.” New York Times, March 15th. Some high schools have abandoned tackle football as an on-campus sport, and there are many who question whether there will come a day, for America’s most popular professional sport, when we will look back at tackle football the way we look back at Roman gladiators today.
Certainly, the legal position of the NFL has changed. “Lawyers for some players involved in a lawsuit with the N.F.L. over its handling of brain injuries quickly seized on the league’s admission.
“A settlement was approved by a Third Circuit district court judge last April but is on appeal. The players argued that the league should pay damages to all players found with C.T.E., not just those found to have the disease before the settlement was approved a year ago.
“In a letter sent early [March 15th] morning to the United States Court of Appeals for the Third Circuit, Steven Molo, their lawyer, said Mr. Miller’s comments on Capitol Hill were ‘a stark turn from its position before the district court.’
“‘The N.F.L.’s statements make clear that the N.F.L. now accepts what science already knows: a ‘direct link’ exists between traumatic brain injury and C.T.E.,’ Mr. Molo’s letter said. ‘Given that, the settlement’s failure to compensate present and future C.T.E. is inexcusable.’
The N.F.L. rebutted those claims. In its own filing to the Third Circuit late [on the 15th], the league said that the settlement compensates players if they have symptoms “allegedly associated with C.T.E.” The league added that it ‘previously acknowledged studies identifying a potential association between C.T.E. and certain football players.’
“More broadly, the league’s public position could influence other levels of football because many college, high school and youth leagues take their cues from the N.F.L.
“Others in the sports world, including parents of young athletes, ‘have trusted the N.F.L., and the N.F.L. was on the fence for a long time,’ said Chris Nowinski, a co-founder of the Concussion Legacy Foundation. ‘We now have a significant confirmation from the N.F.L., and that could have ripple effects around football and sports.’
“The N.F.L. has spent millions of dollars in efforts to tamp down fear among parents over football’s physical toll. It has directed millions of dollars to research C.T.E. and head trauma. It gave $45 million to USA Football, a formerly obscure nonprofit, to promote safe tackling and reassure jittery parents that football’s inherent risks can be mitigated through on-field techniques and awareness. The league has hired experts to monitor games.” NY Times.
With television’s most lucrative per game contracts, ratings soaring through the roof, the NFL recently moved from being a non-profit league to one with full for-profit status with the IRS. That also suggests that there is a very deep pocket with an ability to pay the millions of dollars that might result from new claims. While helmet technology is creeping along – the big issue is the sudden deceleration of the brain as it slams into the skull itself – and treatment requiring very early detection of concussion damage, the league has a long way to go. Spotting a concussion instantly and pulling a player off the field immediately is just a beginning. Careers may end a lot earlier than those in the profession might like… but the risks of long term damage are seemingly exceptionally high. At least folks are admitting where causation truly lies.
I’m Peter Dekom, and while I recognize how deeply tackle football is ingrained into so many American communities, we really do owe it to our kids to be particularly watchful and wary of this rather horrible long term risk.

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