Amsterdam — One of the most influential groups to guide doctors, trainers and sports leagues on concussions for the first time since 2016 met last month In particular, to determine whether it’s time to recognize the causal link between repeated head blows and a degenerative brain disease known as CTE.
Despite mounting evidence and a highly regarded US government agency recently approved a link, the group almost decided otherwise. Leaders of the International Consensus Conference on Concussions in Sport in Amsterdam have signaled that they will continue the long-standing practice of questioning the link between head trauma injury and sport.
CTE, or chronic traumatic encephalopathy, was first identified in boxers in 1928 and rapidly gained prominence in 2005 when scientists announced the postmortem diagnosis of the disease on Mike Webster of the NFL Hall of Fame Center. rice field. Rugby players hit their heads thousands of times a year.
Scientists have analyzed the brains of hundreds of athletes and veterans over the past decade, and the variable that is evident in nearly every case of CTE is exposure to repeated head trauma. The researchers also established what they called a dose-response between CTE severity and years of impact sports.
After years of downplaying the link between head injuries and brain injuries, the NFL acknowledged in 2016 a link between football and degenerative brain disorders such as CTE. The highest order of US brain research states that CTE is “partially caused by repeated traumatic brain injury.”
But in one of the final sessions of the three-day conference, one of the conference leaders, a neuropsychologist, said: Received $1.5 million in research funding from the NFLhe dismissed the work of scientists documenting CTE in hundreds of athletes and soldiers because he said previous research had not accounted for other health variables, including heart disease, diabetes and substance abuse. did.
Dr. Grant Iverson, a neuropsychologist at Harvard University, said, “It is the human condition to think that there is one factor contributing to their current problem, and that factor can be seen under a microscope after death. It’s a very naive position when you think about it.” He ran the session and was the lead author of the conference statement on the long-term effects of repeated head injuries.
Head injuries and CTE in sports
Permanent damage from a brain injury in athletes can have devastating effects.
- CTEs., explanation: Degenerative brain disorders have become most commonly associated with NFL players, but are also found in other athletes. Here’s what you should know:
- One Man’s Crusade: Dr. Christopher Nowinski uses his ring-honed confrontational style as a WWE wrestler to call on sports leagues to acknowledge the link between concussions and CTE.
- Hit after hit: Kathleen Byglowitz’s son and former NFL player has died at age 38. Doctors have concluded he had CTE. A related settlement would have provided some comfort.
- Soccer Stardom Toll: At least four fixtures from Alabama’s great teams in the 1960s experienced CTE at the time of their death. Researchers hope other athletes do the same.
Transcripts of that session, obtained by The New York Times, and interviews with those who attended, offer a rare glimpse of the rift between the scientists who set policy on concussions in sports, and how they know almost everything. It became clear why I kept refusing to consider it. As it prepares to release guidance for sports leagues around the world, new research into the long-term effects of head injuries emerges.
Central to the group’s purpose is a consensus statement, a regularly issued concussion guidance that most of the group’s dozens of members have agreed to. It is the basis for many of the protocols of the world’s top professional sports leagues. A number of medical advisors from these leagues, including the NCAA and World Rugby Chief Medical Officers, helped develop the statement in Amsterdam. The latest iteration he was due to release in 2023.
But the composition of the group itself raises apparent conflicts of interest, calling into question the slow acceptance of new research on concussions.FIFA;IOC;FIA, which governs the auto racing leagues, including Formula One. World Rugby; and other sports governing bodies sponsor the conference, working with many of the conference leaders and providing research funding.
Willie Stewart, a neuropathologist in Glasgow who has diagnosed CTE in many athletes, said: “This group has been led by people who do not fully understand the pathology of head injuries at that level. He said conference leaders should have limited tenure: “We need rotation so that they are not afraid of what they said four years ago.”
Previous consensus statements argued that the science was not settled in the CTE and that the language has been adopted by sports leagues such as the NHL, NCAA and New Zealand Rugby. Hiding the risk of concussion from athletes.
Still, researchers seeking recognition of a causal link between head injuries and CTE were initially optimistic that the group’s leader could be affected by the new research. and Paul McCrory, who had voiced skepticism about the link between head hits and CTE, resigned after the plagiarism was discovered.
However, in pre- and during-meeting conversations, the group leaders centered the discussion on what is not known about CTE and why some athletes get the disease and others playing the same sport. did not become a CTE. No one knows how many head injuries it takes to get a CTE.Reliable tests to diagnose the disease in the living are at least five years away, experts said.
Then, in one of the final sessions of the conference, “Long-term sequelae and retirement criteria,” Iverson began a one-hour meeting to discuss the criteria the group uses to review concussion studies.
Of the approximately 7,500 papers on concussion identified by the group, the consensus statement authors considered only 26 that did not include any of the major research papers on CTE. The expert withdrew from the meeting after being told that his work would not be fully integrated into the statement.
Conference leaders John Patricios, Bob Cantu, Mike McNamee, and Kathryn Schneider said in an email that some studies on CTE that were excluded from formal review continued to be presented at the session, leading to a “variety of views.” ‘ may be obtained. heard. They added they were unable to share the details included.
Iverson explained the limitations of existing studies and why many were excluded from consideration. He explained that most CTE studies only consider one or two variables, such as age and gender, and not other variables such as heart disease, diabetes, or alcohol abuse.
Because the disease can only be diagnosed after death, some people have been exposed to brain trauma and others have not, so scientists have yet to produce long-term studies that follow living subjects for life. In that scenario, scientists would have to collect brains from people who hadn’t participated in collision sports and were unaware of the study’s results until after the participants had died.
“Given the importance of brain health in old age, these are important variables to consider,” Iverson said.
Some of the session attendees were unconvinced that the lack of such studies had mitigated the avalanche of research establishing a causal link between brain trauma and CTE.
“It’s going to take decades to do the kind of research they want to do in this way,” said Michael Gray, who teaches rehabilitation neuroscience at the University of East Anglia, UK. said. “We can wait decades and tens of thousands of people suffer from neurodegeneration, so what can we do about it now?”
Conference rules allowed only seven of the 29 authors to block language in their statements, potentially creating another barrier to groups agreeing on phrasing linking head injuries to CTE. there is. We advise the NHL, Australian Football League and other leagues.
Cantu, one of the leading researchers on CTE, followed Iverson in a 15-minute presentation that “postponed” the CTE issue with the final two consensus statements published in 2013 and 2017. told the group. He said the cognitive, behavioral, and mood problems associated with CTE overlap with many other disorders, making it difficult to diagnose clinically.
But since 2016, more than 100 papers on CTE have been published annually, including one I co-authored with Chris Nowinski, who received his PhD this year. A non-profit PhD in Behavioral Neuroscience, he co-founded the Concussion Legacy Foundation, and other researchers. In it, they detailed their findings that repeated head injuries are more likely to cause CTE. Their paper, he said, helped persuade the NIH to change its stance.
Nowinski and his Concussion Legacy Foundation colleague Adam White mocked the conference leaders with a satirical picture when they arrived.
Their poster featured a smiling doctor in a lab coat holding a cigarette and read, “Enjoy repeated blows to the head” and “Don’t worry about CTE!” rice field. A parody of advertisements in the 1940s and his 1950s that encouraged doctors to smoke.
“I’m there to remind them that if they don’t acknowledge causality, more people will be hurt and their reputations will be ruined.” Speaking of which, the organizers of the conference will be costing a lot of money in litigation.”