Brain damage in football players

Examinations of the brains of six deceased former National Football League players have shown damage indicating chronic traumatic encephalopathy, a degenerative condition caused by repetitive head trauma:

Using techniques that can be administered only after a patient has died, doctors have now identified C.T.E. in all six N.F.L. veterans between the ages of 36 and 50 who have been tested for the condition, further evidencing the dangers of improperly treated brain trauma in football.

“It’s scary — it’s horribly frightening,” said Randy Grimes, who played center next to McHale on the Buccaneers for several years. “I’ve had my share of concussions, too. More than my share. My wife says I have short-term memory loss. It’s really scary to think of what might be going on up there.”

News flash: getting your head battered about for years... is not good for your brain. Who knew?

Well, actually, technically, we still don’t know. This isn’t a controlled scientific study, and doctors on the NFL payroll remind us of this, and tell us that as far as they know, if your head gets kicked in every few games, there’s no cumulative effect as long as it’s “managed properly” each time.

Now, I’m usually among the first to look critically at incomplete, flawed, or hasty studies, and to question judgments made with insufficient evidence. I often point out when questionable conclusions are drawn from such evidence. And it’s absolutely true that this needs to be studied more in order to be sure of what’s going on.

But there’s another set of points here: the suspected cause is so closely connected to known causes of the condition, the damage is sufficiently severe that quick action is warranted, and a properly controlled study would take too long to carry out and would be ethically questionable. Let’s look at each of those:

1. We know that repeated brain trauma brings on CTE. We know these players are suffering repeated brain trauma. What we don’t know is whether prompt and correct treatment of the individual traumas is enough to ward off long-term damage, as the NFL doctors claim, so we don’t know that the players’ concussions are the cause of their CTE pathology.

   But we’re not talking about wondering whether the players’ diet of, say, more red meat than the average person is what’s causing the encephalopathy. If that were the question, I’d agree that the data don’t support it. We’re talking about a known connection, for which I think the existing data is sufficient cause to take action, pending more study.

2. As Lisa McHale says in the article, “We’re not talking about turf toe — we’re talking about a significant brain injury that has huge implications in terms of people’s health.” The fact that this is addressing a very serious, debilitating, non-reversible condition means that taking action even before studies are completed is warranted.
3. Because the condition develops over many years, and because even after it develops it’s degenerative over many more years, a controlled study would take decades to complete. What’s more, since they can only be sure of what’s happened post mortem, the decades would stretch out into the lifetimes of the studied players. It could well be fifty years or more before a properly controlled study could produce results. And the ethics of leaving players untreated for suspected brain pathology are questionable, to say the least.

Sure, study this more, by all means. But there’s enough evidence here as it stands to require action now, from an ethical point of view, even before further study.