Friday, February 08, 2008

Where Have We Heard This Before?

"I don't think any of those claims are backed up by scientific . . . facts . . . I don't think any of has an answer to that, and we would like to get that answer, but we'd like to get it on a factual basis, rather than making a lot of charges that can't be supported."

Is this quote from:
  1. A tobacco company executive (circa 1970) calling into question claims that smoking causes cancer

  2. An oil company executive (circa 1999) calling into question claims that man-made activities are causing global warming

  3. NFL commissioner Roger Goodell (February 1, 2008) calling into question claims that concussions accumulated over the course of a professional football career can have a profound effect on the brain function of players

  4. All of the above

If you answered "d," then you are correct!

Before going on, in the interest of fairness, we offer both the question asked of Mr. Goodell and his complete answer (as contained in a transcript, provided by the NFL, of Mr. Goodell's press conference on February 1, 2008):

As you may know, in a forthcoming book,[here's a link to Amazon] a forensic pathologist, who did brain autopsies on Mike Webster, Terry Long and Andre Waters, suggests that there is a syndrome that some football players suffer from that is similar to the syndrome that some boxers suffer from, in terms of brain damage from repeated head trauma. He urges that the league and the union pay for continued medical follow-up for all retired NFL players to determine just how serious of a problem this is. My question is: do you acknowledge that this is an issue, and would you support that sort of comprehensive follow-up for all retired players?

“Two points: I think we’ve been very clear about concussions and the importance of dealing with concussions as a medical issue, making sure that we take a very conservative approach that would make sure that we are doing everything to benefit the players’ health and safety. I don’t think any of those claims are backed up by scientific or medical facts. That’s what we’re trying to deal with. We have a committee that has been dealing with concussions for 12 or 13 years now, which has done ground-breaking research. Certainly, I think we will continue to do this and focus on this. In fact, they are doing a study on former players to make sure they understand, from a scientific and medical standpoint, what is the long-term effect of concussions. I don’t think any of us has an answer to that, and we would like to get that answer, but we’d like to get it on a factual basis, rather than making a lot of charges that can’t be supported medically.”

We would never be so cynical as to question the authenticity of the commissioner's doubts as to the validity of so-called "gridiron dementia" -- clearly he has yet to be convinced, and points to the work of the league's own committee -- the Committee on Mild Traumatic Brain Injury (an oxymoron if ever there was one) -- as buttressing that doubt.

However, in a 2003 article in ESPN the Magazine, experts in the field are highly critical of the committee's work, with one going so far as to say "[The committee is] basically trying to prepare a defense for when one of these players sues . . . [t]hey are trying to say that what's done in the NFL is okay because in their studies, it doesn't look like bad things are happening from concussions. But the studies are flawed beyond belief."

Putting methodology aside, the most recent literature from the committee we could find ("Concussions in professional football, Neurosurgical Focus, 21(4), 2006) focuses on the causes of concussions (e.g. helmet design, spearing, "impact velocity"), which players are more at risk for concussions (quarterbacks and wide receivers), and the ability of players to return to the field after having suffered a concussion.

(We feel to compelled to note that the bibliography for this article lists sixteen articles that the authors used to support their claims. Of those, Dr. Pellman was the lead author, or co-author, of 15; and the one he did not work on was written by Paul Tagliabue. Though it is not unheard of for an author to cite himself, the lack of a thorough literature review contravenes a basic tenet of research and academic writing)

However in one section of this article/report the authors explicitly acknowledge the controversy that is swirls throughout this field of study:
"Another often-expressed concern underlying the development of mild TBI [traumatic brain injury] guidelines is the occurrence of chronic brain damage as a result of multiple head injuries . . . [c]hronic traumatic encephalopathy [also known as Dementia Pugilistica] in boxers is a well-accepted and documented clinical and pathological syndrome . . . [t]here was no sign of chronic traumatic encephalopathy in this group of active, contemporary football players [emphasis added]."

Did anyone expect to find this condition, which in boxers "develops over a period of years, with the average time of onset being about 12–16 years after the start of a career" (Wikipedia), in current players?

In answering the question at the press conference Mr. Goodell relied on the work of a committee that didn't study the cohort that some believe is suffering a profound ill-effect of playing professional football. Moreover, the work that the committee has done has a significant number of detractors; so it would seem that the basis for Mr. Goodell's answer is shaky at best.

But is Mr. Goodell's claim that there is no science to support claims of "gridiron dementia" correct? We'll have a review of some of the relevant literature next week soon.