March 21, 2016 - Dr. David Chao
Monday Morning MD: Did the NFL flip-flop on a link between football and CTE?
If you believe the headlines, the NFL has reversed field and finally pulled its head out of the sand. If you listen to critics, this is the “smoking gun” plaintiff attorneys have been searching for. While it is true that the NFL has acknowledged a link between football and chronic traumatic encephalopathy (CTE), this is hardly equivalent to big tobacco’s late admission in 1997 that smoking causes cancer and heart disease. In reality, this was another round of politics and semantics. My hope is the NFL and its critics both stop the gamesmanship and get to some real answers. What happened in Congress last week did not get us closer to prevention, treatment, cure or a living diagnosis of CTE. This week, a senior NFL official did seem to contradict what the league’s own appointed medical personnel recently said during Super Bowl week. In fact, this league vice president was sitting on the same stage when the neurosurgeon denied a link between football and CTE just a month ago. Although the refutation and now admission of a link appear at odds, I do not think they really are. The recent acknowledgement of a link does not signal a big NFL policy shift. This is not the “gotcha” moment that some have made it out to be. Let’s examine the context of both statements to see why. Just before Super Bowl 50, Dr. Mitch Berger, the head of the NFL medical subcommittee on long-term brain trauma, denied any definitive link between football and CTE. Having attended that health and safety press conference where he said this, it was my impression that the neurosurgeon was answering the question as a medical professional using strict scientific guidelines of proof. He was indicating that there is no medically proven link of “cause and effect” for football and CTE. When Jeffery Miller, NFL senior vice president of health and safety policy, answered affirmatively that there was a link between football and CTE, he gave the obvious answer as a lay, non-medical person. If you watch the House of Representatives roundtable discussion, it seems clear that Miller is using the word “link” in the vernacular, acknowledging there is an association. Given the autopsy findings in former football players, colloquially no one can doubt there is some sort of relationship between football-related head trauma and CTE. Miller even tries to clarify his answer to that effect. The key is to find what that link truly is. This news was incorrectly heralded as the first time the NFL acknowledged a link. In 2009, an NFL spokesman told the New York Times that it is "quite obvious from the medical research that's been done that concussions can lead to long-term problems." To me, Miller’s opinion does not seem at odds with Berger’s earlier statement. This is not an axis shift coming out of the NFL. Medically speaking there is currently not conclusive scientific evidence of a direct link between football and CTE. On the other hand, common sense tells us that there has to be some associative relationship that links football related head trauma and CTE. The latest statements are not surprising at all. I don’t believe the NFL is flip-flopping or even has changed its stance. Of course, I don’t know how attorneys may use the latest statements and how it might impact the legal proceedings of the concussion lawsuit settlement. I have said many times, there is so much more we don’t know about concussions than what we do know. We are in our absolute infancy of knowledge and medicine needs to catch up. Lumping together all head injury as concussion is like diagnosing every knee injury as a sprain with no distinction for ACL, MCL, meniscus, articular cartilage, tendon, muscle or dozens of other specific structures. It would be silly to group all knee injuries as the same, yet that is where we are at with head injury. We know less about concussions today than we knew about treating ACL tears in the 1960’s Conventional thinking is that cognitive rest in a dark quiet room was the best treatment for a concussion and now some scientists say using your brain after a head injury is the better way to go. Not only is there no treatment for CTE, there is no way to conclusively diagnose it except by autopsy. We have come a long way in the last decade but we are just starting the quest for knowledge. The NFL has been the lightening rod for criticism from concussion and CTE advocates. They may have been slow to the party or let down by their medical advisors back in the day. Currently, the league is no longer in denial. The many rules changes have produced a new safer game. Just look at the recent ESPN 30 for 30 film: The ’85 Bears. The vast majority of the plays shown highlighting their defense would be penalized, fined and/or suspensions today. However, this protection does not apply to running plays or limit the routine head contact on every play. Why did Dave Duerson, who killed himself, have CTE and why does Jim McMahon have brain injury symptoms? Meanwhile, teammates Mike Singletary and Ron Rivera seem to be fine. New York Giants owner John Mara said Sunday that the long-term effect of concussions on players and the link between football and CTE represent the most serious issues confronting NFL owners at the league meetings which start today, "and I don't think anything else comes close." Let’s stop the rhetoric and focus on a solution. It doesn’t matter who first found or said there is a link between football and CTE. The focus should be on finding ways to diagnosis, treat, cure and prevent progressive brain disorders.