March 28, 2016 - Dr. David Chao
Monday Morning MD: The NFL should "Let it go"
I never thought I would relate the theme of the children’s movie "Frozen" to sports. Then again, Disney does own ESPN. “Let it go” should be the mantra for the NFL as it should stop trying to defend its defunct Mild Traumatic Brain Injury (MTBI) committee. The media and concussion critics should also “let it go” and stop looking backwards to critique the league’s decade plus old research. We all know the NFL attitudes toward concussion are historically far from idea. The league has essentially admitted the errors of the MTBI committee by disbanding the group years ago. There is a new Head, Neck and Spine committee in its place. The new committee is no longer run by the NFL’s often criticized medical advisor. It was a bad look to have a rheumatologist who is a league employee head the MTBI group and the league has seen the error of its ways. The chair of the MTBI committee being the lead author on head injury studies invited criticism based on qualifications and conflicts of interest. Even thought the MTBI papers have already been discredited, the recent New York Times article rightfully points out specific study errors. Publishing data with one team not reporting any concussions for six years clearly makes no sense. Add that during that time period, the team’s star QB Troy Aikman was publicly reported to have four concussions and was thought to retire because of head injuries makes the research look even worse. I have participated in NFL research as a team physician. Yes, it is hard sometimes to get busy team doctors to respond to questionnaires and surveys. However, this was a study performed on behalf of the league. The NFL has required all head team physicians and athletic trainers attend certain concussion symposiums in person and there are frequent directives for conference calls. It would have been simple to mandate that all teams carefully report concussions for the MTBI studies. [caption id="" align="alignright" width="535"] Lead Author on the field tending to Wayne Chrebet after concussion[/caption] Undoubtedly, there is recollection bias and it is difficult for a team physician to remember every concussion across a six-year span. However, the authors should have at least gotten their own team’s head injury data correct. Not reporting at least two concussions on the team for which the lead author worked seems inexcusable. Jets receiver Wayne Cherbet’s career ultimately ended over head injuries, yet his two concussions during the research period were not listed in the study by the authors which included Chrebet’s team physician. The MTBI committee said it analyzed all concussions diagnosed by team medical staffs during 1996-2001. All players were said to be included as well as all concussions, no matter how minor. That clearly was not the case as at least 100 additional concussions were identified by cross-referencing public reports. It is embarrassing that the NFL’s own injury reports were used to contradict and prove the underreporting in the NFL studies. The research was at best sloppy or at worst fraudulent. One member of the MTBI committee indicated he was unaware of the omissions but agreed: “If somebody made a human error or somebody assumed the data was absolutely correct and didn’t question it, well, we screwed up. If we found it wasn’t accurate and still used it, that’s not a screw-up; that’s a lie.” The NFL looks silly when trying to defend the research of the long ago disbanded MTBI committee when one of the authors has called the omissions a mistake. The excuse that the research was “necessarily preliminary” rings hollow. The paper is based on data up to 20 years old, the scientific community doesn’t put much stock into it and it is pointless to defend it. The NFL justifying the shoddy research perpetuates the criticism of its attitudes towards head injury. However, linking the NFL to big tobacco seems quite a stretch. Yes, some attorneys and lobbyists overlapped the two industries, but that hardly warrants the headlines of “ties to tobacco industry”. More accurately, the NFL had ties to some people who in turn had ties to the tobacco industry. If the New York Times is going to hold the NFL researchers to the highest scrutiny, the paper should do the same for its headline writers. The league official statement on the concussion research correctly refutes the ties. Media and critics should move on. We all know the NFL mishandled and underestimated concussions. Overall, the medical community has been slow to point out concussion dangers. However, it’s time to stop beating a dead horse. The best team doesn’t win every game. The best player misses a tackle now and again. Peyton Manning started his Hall of Fame career with 28 interceptions his first season. The NFL has made some early mistakes but has since done better; however, Jerry Jones calling any concussion link “absurd” doesn’t help the situation. The NFL should let it go and stop defending the research of a defunct MTBI committee. They already admit the new Head, Neck and Spine committee doesn’t rely on that previous research. Media should let it go and stop sensationalizing the story by bringing big tobacco into the headlines. I want to let it go and no longer write columns about the finger pointing and defensive posturing. Lets all let it go and work forward to find solutions. Follow David on Twitter: @profootballdoc Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.