Researchers Say a Brain Disease May Be Caused by Concussions
Update 2022 A panel of experts who oversee several of sports' top governing bodies disregarded the research at their conference while another significant medical institution confirmed the connection between concussions and the brain ailment C.T.E.
AMERICA — One of the most influential organisations advising physicians, athletic trainers, and sports leagues on concussions met last month for the first time since 2016 to discuss, among other things, whether it was time to acknowledge the causal link between repeated head hits and the degenerative brain disease known as CTE.
The panel almost came to the conclusion that it was not true despite accumulating evidence and a respected U.S. government agency recently confirming the connection. The International Consensus Conference on Concussion in Sport, which was meeting in Amsterdam, gave the impression that it will keep up its longstanding practise of challenging
C.T.E., or chronic traumatic encephalopathy, was first discovered in boxers in 1928 and shot to fame in 2005 when doctors revealed they had diagnosed the N.F.L. Hall of Fame centre Mike Webster with the disease posthumously. This diagnosis sparked an existential crisis for contact sports like football and rugby where players hit their heads thousands of times a year.
Researchers have spent the last ten years examining the brains of hundreds of athletes and veterans, and they have found that recurrent head trauma has been a key factor in almost every case of CTE. Researchers have also shown what they refer to as a dosage response between the duration of playing impact sports and the severity of CTE.
Brain research in the United States
The NFL finally admitted that there was a connection between football and degenerative brain illnesses like CTE in 2016 after years of downplaying the relationship between head injuries and brain damage. The National Institutes of Health, the largest supporter of brain research in the United States, stated just days prior to the conference in Amsterdam that C.T.E. "is caused in part by repetitive traumatic brain injuries."
However, one of the conference's leaders, a neuropsychologist who has received $1.5 million in research funding from the N.F.L., dismissed the work of researchers who have identified C.T.E. in hundreds of athletes and soldiers during one of the conference's final sessions because he claimed that the studies performed so far did not take other health factors like heart disease, diabetes, and substance abuse into account.
A recording of that meeting, which The New York Times was able to obtain, as well as interviews with attendees, provided a rare look into the divisions among the scientists who determine concussion policy in sports. It also revealed the reasons behind their ongoing refusal to take into account nearly all of the new research on the long-term effects of head trauma as they get ready to release guidance for sports leagues around the world.
Conference Organisers
But the group's composition raises questions about their hesitation to accept fresh concussion studies because of potential conflicts of interest. The conference is sponsored by FIFA, the IOC, the F.I.A., which oversees Formula One and other car racing leagues, World Rugby, and other sports' governing bodies. These organisations also collaborate with many of the conference organisers or support their research.
People who don't really have a good understanding of the pathophysiology of head injury at that level." He suggested limiting the periods of the conference organisers. "There should be a change in personnel so they won't be afraid of what they stated four years ago," remarked the speaker.
The N.H.L., the N.C.A.A., and New Zealand Rugby have all adopted previous consensus statements that claimed that the science was not conclusively established on C.T.E. This endorsement from scientists has helped some of these organisations fend off legal claims that they misled athletes about the risks of concussions.
Even still, proponents of the theory that head injury and CTE are causally related were originally hopeful that the group's leaders may be persuaded by the new evidence. Longtime group leader Paul McCrory, who publicly disputed the association between head hits and C.T.E., resigned in March after being found to have plagiarised.
Discussions
However, group leaders focused their discussions on what was unknown about C.T.E. in chats before and during the conference, emphasising that it was unclear why some athletes contracted the disease and others who played the same sport did not. How much head trauma is necessary to develop CTE is unknown. The disease won't have a viable test for surviving patients for at least five years, according to doctors.
Then, Iverson discussed the standards the organisation will use to evaluate concussions research at the start of one of the conference's final sessions, titled "Long Term Sequellae and Criteria for Retirement."
The authors of the consensus statement only took into account 26 of the over 7,500 papers on concussions that the panel had identified, leaving out all of the significant research studies on C.T.E.
The world's foremost authority on CTE, Dr. Ann McKee, a neuropathologist at Boston University, cancelled her attendance at the conference after learning that her work would not be fully incorporated into the statement.
The conference's organisers, Jon Patricios, Bob Cantu, Mike McNamee, and Kathryn Schneider, stated in an email that some C.T.E. material that was not included in the official evaluation was still presented at the session so that "a spectrum of opinions" could be heard. They further stated that they were unable to divulge facts regarding what was included.
Iverson outlined the shortcomings of the prior study and the reasons why a significant portion of it was not taken into account. He explained that the majority of C.T.E. study simply took into account one or two factors, such as age and sex, but not others, such as heart disease, diabetes, and alcohol misuse.
Scientists have not yet developed long-term studies that track living participants through their lifetimes while some are exposed to brain trauma and others are not because the disease can only be detected posthumously. In that case, researchers would need to collect brains from individuals who did not participate in collision sports and wouldn't learn the study's findings until the participants had passed away.
These are some factors that are crucial to take into account, according to Iverson, if we are thinking about the significance of brain health in later age.
Some audience members weren't persuaded that the dearth of such trials lessened the barrage of research demonstrating a link between brain injury and C.T.E.
It will take decades to do the kinds of studies they want to include in this fashion, according to Michael Grey, a rehabilitation neuroscience professor at the University of East Anglia in England. Are we meant to wait decades before taking action to prevent neurodegeneration when we could be helping thousands of individuals right away?
Only seven of the statement's 29 authors are permitted to object to certain terminology due to a conference regulation, which would be another obstacle to the group accepting language that connects head trauma to C.T.E. Numerous specialists who do not specialise in degenerative brain illness, but who nonetheless advise the National Hockey League, Australian Football League, and other leagues, are among the authors of the consensus statement.
Following Iverson, leading C.T.E. researcher Cantu gave a 15-minute presentation in which he informed the audience that the group's most recent two consensus statements, released in 2013 and 2017, had "kicked down the road" the subject of C.T.E. He said that many other diseases share the cognitive, behavioural, and affective problems linked with C.T.E., making a clinical diagnosis challenging.
But since 2016, he claimed, more than 100 publications on C.T.E. have been published annually, one of which he co-authored this year with Chris Nowinski, a behavioural neuroscience doctoral student who also co-founded the non-profit Concussion Legacy Foundation, and other researchers. They described their research, which indicated that C.T.E. is likely caused by recurrent head trauma. He said that their paper persuaded the N.I.H to modify its position.
As the conference's organisers arrived, Nowinski and his colleague Adam White from the Concussion Legacy Foundation mocked them by putting humorous artwork in their hands.
Their posters featured slogans that were parodies of doctor-sponsored smoking advertisements from the 1940s and 1950s, such as "Enjoy repetitive head hits" and "Don't worry about CTE!" The doctors carried smokes and grinned.
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