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Doehrman: Brain injury study not the touchdown it purports to be

September 19, 2018

 

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By Tom Doehrman

Every once in a while, a scientific study comes along that flies in the face of the dozen studies you’ve seen before, not to mention your own practical experience (and plain common sense).

When that happens, it is often the case, upon closer inspection of the study itself, that the findings don’t quite support the conclusion — or at least not the conclusion expressed in click-hungry headlines by the media.

Case in point: a study published in the August 2017 edition of JAMA Neurology, which appears to show that playing football in high school is not associated with cognitive impairment or certain other health risks later in life.

This struck me as odd, not only because I’ve seen no shortage of concussions among young people playing contact sports, but also because — like the rest of American newspaper readers — I’ve been inundated with high-profile studies demonstrating exactly the opposite over the last 10 years.

Consider, for examplåe, the 2017 Boston University study that found “playing tackle football under the age of 12 exposes children to repetitive head impacts that may double their risk of developing behavioral problems and triple their chances of suffering depression later in life.”

… Or a 2017 Virginia Tech study finding youth football causes more high-magnitude impacts to the heads of young players than previously suspected — greater than 40 times the force of gravity — with young quarterbacks, running backs and linebackers at especially severe risk.

… Or a 2017 study reported in the primary JAMA journal, which found that among 202 deceased former football players, 177 (a whopping majority) suffered from chronic traumatic encephalopathy, or CTE.

… Or a 2015 Acta Neuropathologica study confirming a correlation between CTE and a history of playing contact sports.

… Or the Centers for Disease Control and Prevention advisory that sustaining multiple concussions over time — even if they are minor — can result in “cumulative neurological and cognitive deficits” and may even be fatal when too many occur in a short period of time.

These are but a few of the many studies to sound an alarm in recent years, with public concern reaching a fever pitch after the revelation that murderous football player Aaron Hernandez suffered from Stage 3 CTE at the time of his suicide while serving a prison sentence after his years in the NFL.

So what’s going on in this latest JAMA Neurology report, which purports to turn common sense and consensus on its head?

The study

The researchers set out to answer whether “playing high school football [has] a statistically and clinically significant adverse association with cognitive impairment and depression at 65 years of age.”

They assembled a “representative sample of male high school students who graduated from high school in Wisconsin in 1957,” controlling for variables such as adolescent IQ, family background and education level. They compared their data to a similar group of non-athletes.

The conclusion: “Cognitive and depression outcomes later in life were found to be similar for high school football players and their nonplaying counterparts from mid-1950s in Wisconsin. The risks of playing football today might be different than in the 1950s, but for current athletes, this study provides information on the risk of playing sports today that have a similar risk of head trauma as high school football played in the 1950s.”

Problems with the study

To its credit, this latest study appears to have been thorough and well-intentioned, peer reviewed and published in a journal of note. I do not intend to question the researchers’ motives or their methodologies.

I do suspect, however, that the data available to them is too narrow to support the breadth of their conclusions — and I am concerned this sensational finding will send the wrong message to parents, high schools, insurance companies and even courtrooms.

The data is inherently limited: these are subjects who graduated within a single state during a single year, and we have limited information about whether they ever suffered concussions during youth and, if so, how often and at what ages.

For that matter, we know relatively little about the rate of concussions among high school players in the 1950s generally. This is pertinent because it is those students — the ones who suffer concussions or traumatic brain injuries during their youth — who we are most concerned about. A more helpful study might focus exclusively on the long-term trajectory of student athletes who sustained a TBI.

To make good use of the data given to us in this latest study, we would need to know whether concussions were sustained more or less frequently in the 1950s than they are today. To that end, by the study authors’ own admission, there is evidence to suggest the frequency and severity of head impacts may be much worse today than it was in the 1950s, owing to the much faster pace of the game. If that is true, the authors’ stated conclusion — that today’s athletes don’t have much to worry about — is untenable.

The authors further concede that, were they to narrow their study to student athletes who suffered a TBI prior to the age of 12, their results might look different — a hat-tip to the 2017 Boston University study that largely undercuts the researchers’ conclusions here.

Not your grandfather’s football

These researchers aren’t the first to hold up the 1950s as proof of football’s safety as a youth contact sport.

Researchers in 2012 made the same argument. It went like this: if anything, the older generation’s health outcomes should be worse because helmets weren’t as good back then, weren’t worn as consistently and concussions weren’t taken as seriously. So when we find a clean bill of health in elderly ex-athletes today, it means today’s kids are in the clear. “Football is even safer today! So why are you worried?”

The natural counter to that is that kids are bigger these days. They play harder, faster and longer.

Moreover, the notion that concussions are taken more seriously today is itself suspect — while doctors have certainly learned more about the danger of concussions in recent years (a fact that should cause concern for the public, not quell it), it does not necessarily follow that students, coaches, teachers or parents are nearly so cautious.

Indeed, as personal injury attorneys, we are forever waging a war on the pervasive myth that concussions are “minor” or “not serious.” It stands to reason that even in 2018, many cases go unreported, are inadequately treated or are not given proper follow-up care.

What you need to know

At the very least, there remain real questions about the safety and ethics of contact sports for children and high school students, and even for adults.

This latest study — no matter how big a wave it might make in the media — does little to meaningfully shift the debate. Attorneys, parents and student health advocates should be prepared to challenge it on the merits.

It is my hope that we will continue to raise awareness about the medical severity of concussions and TBIs, as well as the bevy of other long-term health complications that so many of our young athletes might be facing.

The more we challenge the reactionary narrative of “what was good enough for the old generation is good enough for the new,” the more we can anchor the debate in relevant facts and sound analysis.•

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Tom Doehrman is a personal injury attorney at Doehrman Buba in Indianapolis. Opinions expressed are those of the author.

 

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