Another CTE study on American football

I linked to the Washington Post story because I like how it gives a balanced views of the pros and cons of the study. Still, it seems this is yet another step in what will begin the decline of American football. It will begin in the youth leagues and high school as they get more concerned about lawsuits. It also possible that an anti-football movement could start on university campuses.

The NFL is in serious trouble over the next 20 years. You can take heading out of soccer and the sport would still be almost the same. I can’t imagine the NFL being able to adapt in the same way, no is going to watch flag football or touch football.

This is silly. People who drink get brain and liver damage. Where are the lawsuits? Are people eliminating alcohol from their lives? Its about freedom of choice. And the freedom of a select few to earn millions in the sport.

But alcohol isn’t being sold by Pop Warner football or the Chicago School district.

The sport (just like pretty much any sport that’s big at the professional level in the US) relies on kids starting to play the game when they are in grade school, or high school at the latest. Those players are not adults, and not particularly capable (not to mention not being considered legally capable) of making an informed choice about those risks.

The more evidence that comes out that playing the sport (even at that level, much less the college or NFL level) leads to a significantly higher rate of brain dysfunction later in life, the more likely it becomes that parents will prevent their minor sons from playing the sport.

Finally, as you’re probably aware, the NFL stonewalled and denied on this topic for years, working hard to convince players and fans (and the parents of those future NFL players) that there was no elevated risk. It’s hard to make an informed choice when you’ve been lied to about the risk.

There’s also the important point of informed choice. If people are choosing to play football, knowing the risks accurately, because they feel the positives outweigh the benefits, that may be one thing. But if the risks are not accurately known, a reasonable judgement can’t be made.

Personally, I don’t drink at all. But when I did, or if I were buying alcohol for a friend, I’d want to know what the proof was before glasses start being poured. What level of effect am I accepting, or accepting on behalf of someone else?

Freedom of choice means nothing at all if you don’t know what the choice is between.

I’ll also note this: playing football (particularly playing it at higher levels) has been long known to increase the likelihood of physical damage to a player’s body – wrecked knees, arthritic hands and backs, etc. That’s been a known risk, and one on which players have been making those informed choices. We’ve always heard players say things like, “I knew that I was sacrificing my body for the sport.”

Part of the issue with what we’re learning about brain injury and the sport is that much of it is new news – not only the news that concussions can lead to permanent and degenerative brain conditions, but that repeated head traumas, even those which don’t rise to the level of actual concussions, can also have that effect on the brain.

And, now, we have decades’ worth of former players (not just NFL players, but college players and high school players) who may be suffering those effects, having not known, at the time that they chose to play football, that this sort of brain damage was a real possibility.

Not to mention that, since we’re talking about potential brain injury, there’s a chance that the things being affected include the decision-making and risk-evaluating systems.

Let me hit you on the head a few times with this two-by-four, young man, and then we’ll get to making some important decisions about your life. Cool?

I didn’t read the story because it’s behind a paywall, but does the story stay how many years each person played football? and what those years are?

It’s hard for me to buy into “the decline of American Football” on stories like this because while CTE is an issue, the information being presented is based on players who played during a time when there was no holding back on hitting, and when equipment was in its early form.

It would be like saying no one is going to be driving cars in 20 years based on statistics of fatal crashes in the 30s. Give me these same statistics in 10 years and then we’ll talk.

I would also want to know how long the players being checked played in the league. The average lifespan of an NFL player is 3-4 years. You can’t show me statistics of a wide receiver who played in the league for 11 years and tell me this is the norm. Most players have a cup of coffee in the league and then go on to work commentary for some MAC school or whatever. Yes, they’ve been playing football for far longer than that, but the statistics still hold.

Don’t get me wrong though, concussions and CTE are a big issue and by far the greatest risk when it comes to playing football. But CTE and football is simply something you can’t extrapolate to the future based on the results of the past.

From the article (I’m a Post subscriber):

The NFL stat (in a different paragraph) is that 110 out of the 111 brains of former NFL players studied had CTE. Most of the former players studied had started playing in the 1960s or later.

It’s important to note that the brains studied were those which were donated by the former players, or their families, and those donations were nearly always the result of the players and / or their families having concerns about brain damage. Thus, it’s a self-selected group – while virtually every NFL player’s brain in this study showed CTE, it doesn’t necessarily follow that virtually every NFL player has (or will develop) CTE>

Even the well-known physical injuries aren’t given as much attention as they should be. My 40-something brother-in-law has bad knees, as a result of injuries playing high school football. Now, it’s one thing for a pro player to be maimed for life as a result of their playing: They’ve been well-compensated for that. If a pro player has a reasonable career, he won’t need his knees after he retires, because he can life his whole life on the proceeds from a few seasons. But my brother-in-law hasn’t really gotten any tangible benefit from his time playing. Maybe he got some exercise from it at the time, but in the decades since he’s gotten less exercise than he should, because his knees can’t take it, and I’m sure that that’s had more negative impact than the few years he was playing had positive.

And that’s hardly a rare outcome.

Speaking unscientifically … doesn’t it though? It’s just a matter of how much? Isn’t it basically understood that all brain trauma is bad brain trauma? I can’t imagine helmets have come so far that those guys are still not shaking their brains all the time.

So the rational thing to happen next is for parents to not let their kids play in the starter leagues. But yeah … the rational thing can go sit on the bench like a wimp. Football ain’t going anywhere, brain trauma and all. It’s too American to be stopped, or to have to make sense.

I know a guy with this same story … and he had both his sons playing. I’m not sure if it was hoping they’d win the lottery to the big leagues, or just plain machismo (on the part of either/both dad and sons).

Sure enough, my nephew plays, too. They just take it for granted that that’s what boys do.

Or maybe they wanted to play?

Plus there’s another bias there-they can only be part of the study if the player had already died. Those still alive, perhaps with no brain damage at all, would not be included.

It was a given that my nephew was going to end up playing some sport or another (he’s the most kinesthetic person I know), but I’m sure that his parents could have guided him to some less-dangerous sport if they had so chosen.

Speaking as another non-scientist: it wouldn’t surprise me at all to learn that nearly every player who spends any time playing a contact sport has some level of brain trauma / injury, but CTE is a particular affliction / condition.

And, as I understand it, improvements in helmets might help some, but the issue is what goes on with the brain inside the skull during collisions (brain bouncing against inside of skull, and brain twisting within the skull) – and that’s something that I don’t think even a superior helmet can prevent.

There are also plenty of former NFL players that have gone on to successful broadcasting careers after years of concussions, like Troy Aikman and Steve Young and seem to suffer no ill effects.

Which to me, begs the question: can you have CTE and not necessarily suffer from all or most of the symptoms of it, like dementia, depression, uncontrolled anger or suicidal thoughts? Maybe just have a few bouts of forgetfulness?

This is likely so, though I don’t think we know with certainty if Aikman and Young aren’t suffering any lasting or progressive effects at this point.

That said: similarly, there are many long-time cigarette smokers who never suffer lung issues, and many people who live on fatty junk food, but have healthy hearts. Playing football, and suffering concussions while doing so, probably don’t carry a 100% likelihood of developing CTE.

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Sample bias is a VERY important issue here. While there is no amount of damage that is good for any brain (especially a developing brain), and there is every reason to believe repetitive head trauma leads to long-term deficits, there is no causal link established. They have no base-rate of CTE in football players, as they have not (yet) studied the brains of NFL retirees who did not have symptoms. However, saying “99% of NFL players studies had CTE” is misleading and inflammatory… The authors do not know the incidence of CTE in anyone other than symptomatic (behavioral dysfunction, drug abuse, dementia, parkinson’s tremors, etc) NFL retirees. How many NFL players have no symptoms?

One important study on this was conducted looking through the NIH Brain Bank. They looked at brains of individuals with and without a history of contact sports participation. They found that “21 of 66 former athletes had cortical tau pathology consistent with CTE”. So, it appears that a conservative (or liberal) starting point is 1/3 will show changes in the brain consistent with CTE. HOWEVER, no one knows if having tau in the brain means you will have the clinical presentation (symptoms) of CTE.

It is a dangerous study on correlation versus causation, being played out on seemingly willing, vulnerable, economically disadvantaged young athletes.