Head Games

Unecessary Roughness

Concussions are the talk of sports these days.  Ex-NFLers are filing suits against the league saying it is clear that the league knew about the dangers of head trauma, knew them a long time ago but, did nothing.  Parents in the U.S. and Canada are starting to pull their elementary and junior high kids out of tackle football and hockey leagues that permit body-checking.  Even the President has talked about his own experience with concussions (mild he was quick to note!) and convened a high level summit at the White House of all the movers and shakers in the field to discuss the problem.

The NFL is so freaked out about the threat concussions pose to the long-term profitability of the sport that they are trying to calm worried moms with ad campaigns that tout the certification of coaches who teach the ‘safe’ way to play (good luck with that).  And arguments are breaking out about whether there is too much emphasis on football and men’s hockey when wrestling, lacrosse, soccer, martial arts, and women’s basketball have their own problems with keeping player’s heads intact (kind of an odd form of anti-discrimination).  Some sports experts are even bemoaning the fact that the emerging obsession with preventing, diagnosing and treating concussions is diverting too much attention and resources away from other serious health issues that athletes face including bullying, eating disorders, orthopedic injuries and the abuse of legal and illegal drugs.

What has not been acknowledged in all the fuss about concussions is how many people are starting to make money from them. A lot of money.

According to Variety, Will Smith is the biggest name in a parade of Hollywood film and television folk ready to transform bashed brains into big bucks.  And the number of companies who are now peddling concussion related products from designer mouthguards to specialized helmets to voodooesque headbands is staggering.

So is the number of medical centers who are opening concussion programs, centers and institutes (my own institution, NYU, among them).  The less scrupulous of these institutions are offering remedies which, to put it politely do not rest on a whole lot of evidence but, cost a tidy chunk of change.  These include hyperbaric oxygen (no evidence), EEG and other forms of biofeedback (next to nothing) to acupuncture, deep tissue massage, myofascial release trigger point injections and laser therapies (really?).

Add in a passel of lawyers with class action, malpractice and malfeasance suits in their eyes, those on the lecture circuit offering advice on what to do about concussions, and software designers eager to peddle quick concussion diagnoses via phone, computer or video and you have the makings of a full-blown, here-to-stay, big-time concussion industry.

What can be done to trim the sales of those looking to profit off of the legitimate worries about and all too real problems associated with concussions?  It is time for the medical, legal, insurance and athletic industries to call for evidence-based standards.  And it is time to insist that those involved with concussion in sports admit what they don’t know as well as what they might know.

Concussion promises to be the sports health issue of this decade.  Those involved in health care need to be called to account not to overpromise when it comes to concussions.


8 replies »

  1. I wonder if deceleration or acceleration is actually tearing away axons from synaptic connections so that one has fewer functioning synapses and thereby some variety of dementia. But I guess there is at least some recovery so that new connections are created. There were a few papers suggesting that SSRIs increase numbers of neurons– or synaptic boutons (I forget which.) So I guess these have been tried. But we would hear if there were excellent treatments. Has cryotherapy has been tried? It might give these highly metabolic cells a breather and a chance to heal.

    For awhile the symptoms are devastating. My adult daughter fell from a horse and was unconscious for a few minutes. She said it hurt her to “think” for several weeks.

  2. I agree with Al that disclosure and tranparency are critical. And, it’s not just about what people know or don’t know, but that knowledge that’s been accruing over time and never disclosed. Even if the NFL and other relevant leagues or sports organizations haven’t systematically collected data over the years, it’s very likely that they’ve had access to abundant anecdotal information, probably more than enough to identify patterns that were worth exploring but weren’t.

    I agree also that it is time to call this brain injury and not concussion.

    While there is no way to stop the brain injury profiteering, the whole enterprise is just begging for close review by state attorneys general who have the power to enforce laws against false and deceptive claims for products sold to consumers within their jurisdiction.

    One lever that I have not seen discussed before is whether to hold the NFL’s feet to the fire and force their hand to both disclose more historical information and take a more proactive stance going forward. The NFL has an antitrust exemption and is also organized as a tax-exempt entity. Both characteristics are anachronisms. Serious Congressional pressure threatening both would rattle more cages than a raging outside linebacker.

  3. Excellent article. Brain injury (and yes, “concussion is too soft a term, sort of like “CT scan” that makes them sound much more harmless than they are) and evidence and unsubstantiated claims are all things I’ve had experience with. One of my family members (an in-law, to be precise) was the second NFL player to have his brain studied, having endured 10 years on the line of scrimmage. As with any debilitating condition about which essentially nothing is known, quack cures (platelet transfusions for Alzheimer’s, anyone?) are legion and many people want to make a buck.

    I think your recommendations may need some asterisks, though. Even evidence-based standards can be wrong, and requiring evidence often makes it difficult for new approaches to gain traction. What you’d like to do, perhaps, is more in the area of disclosure. Peddlers need to be liable for false statements. If something has never worked and you say “This has never worked but here’s why it might” you’d be fine, whereas if you simply say it works, you could be liable for false claims.

  4. Where is the TBI movie about guys coming back from Iraq and Afghanistan?

    Another VA story we’ve not heard enough about. My sources – who include guys coming back from active duty tours – tell me there is a silent epidemic of TBI at VA facilities around the country. Many have difficulty convincing the military that their injuries are legitimate. I have no idea what their wait times look like but would speculate that they are very long given the severity of this problem ..

    I wonder what you’d find if you compare the brain injuries suffered by NFL players and soldiers who fought in Afghanistan ..

  5. Excellent article, thank you. So necessary. I became aware of the concussion industry in 2009 while working with a research organization in Eugene, Oregon. An ex-athlete was excited by our work (a simple program to teach coaches how to recognize the symptoms and the appropriate response) and said he thought what we were doing was great, necessary, he’d love to help.

    Only $60K per year to be a spokesman! Part time! Plus expenses!


    One other point: Concussion is too passive a word. It is not a concussion. It is a brain injury. The difference is non-trivial, especailly when dealing with adolescents. Tell someone their child/partner/friend has a brain injury, and you get their attention.