Tuesday, January 29, 2013

CTE: Beginning of the End

Researches at UCLA announced recently that they've discovered a way to detect chronic traumatic encephalopathy (CTE) in living humans.

CTE can cause memory loss, dementia, physical symptoms reminiscent of Parkinson's Disease, and  mental disturbance verging on psychopathy.  It's really bad.  While we can't quite say it's common, it seems to occur more frequently among former NFL players and others who've taken part in collision-type sports. Some players suffer from CTE after a lifetime of blows to the head -- though notably, CTE isn't caused by concussions. It seems to be caused by repeated "sub-concussive" blows to the head over a long period.

Until this study, the only way for a doctor to conclusively determine that you'd suffered from CTE was to take your brain out of your skull, slice it up, and look for physical signs of the 'tau' protein that is CTE's signature.

You might imagine that this limits doctors' ability to diagnose living players with CTE, and indeed it has only been tried on Terry Bradshaw* thus far.

But now... well this changes things immensely.

Within a couple of years -- or, I hope, sooner -- we'll begin to learn just how common CTE is among active football players.   This analysis may start at the pro level, but given the example of the late Chris Henry (a Bengals wide receiver who died at age 26, whose brain showed evidence of widespread CTE) we can expect studies of college players to come on the heels of the pro testing.

There are a couple of possibilities here.

One Possibility: Pro-Onset CTE Only
Maybe we don't see much sign of CTE until a player turns pro and starts to experience really galaxy-class physical abuse.  In that case, hey, carry on. We're all adults here. You want to expose your brain to that kind of damage in return for a shot at tens of millions of dollars? It's not a bargain I'd take but I respect your right to try it for yourself.

The NFLPA, in this scenario, will probably push for safety-related changes, but considering the schizophrenia** of the NFLPA (an organization dedicated to protecting the safety of the individual player who will deny that he's injured even as his fibula sticks out of his sock), they won't make much progress.  Owners will remind players that they made this choice of their own free will, and we'll all nod sadly and then cheer the next big hit.

More Likely: Amateur-Onset CTE
This is scarier.  If college players are shown to have CTE, we're going to have to take a look at high school players. And Pop Warner players.  A whole lot of parents are going to tell their kids to start playing soccer*** or running cross-country in the fall, instead of playing football.

As Gregg Easterbrook has said more than once, "there is no law of nature that says football must be popular."  Once large numbers of nervous parents start forbidding their kids to play football, the NFL's days are numbered.  It turns into boxing. (Remember boxing?)

A recent interview with President Obama suggests that Easterbrook isn't the only one who feels this way; Obama said, "I'm a big football fan, but I have to tell you, if I had a son, I'd have to think long and hard before I let him play football."

Before football starts a slow decline into boxing-with-shoulder-pads, the football-industrial complex will step up. We'll see rule changes and equipment changes at all levels to reduce or eliminate CTE risk.  David White, a commenter at Ta-Nehisi Coates's excellent blog at The Atlantic,  made some excellent suggestions for simple rule changes that could reduce CTE risk:
-- Doctors work for the league, not for the teams. And each doctor has a clear checklist on the sideline that a player must pass if they're suspected of being concussed...
[...]
-- Ban the 3-pt and 4-pt stance...
(and so on. Lots of good ideas there -- go check it out!)

I can imagine the NFL Player's Association working closely with the NFL, NCAA, and NFHS on this.  There's an enormous amount of money in football at all levels.  The sport needs to be made safe at all levels or it will vanish.  As Easterbrook pointed out in the article linked above, there's no law of nature that says football must be legal, either.

But I Want My Foobaw
A caller on last night's Pittsburgh AM drive-time sports show provided a rebuttal to all of these concerns about player safety.  Paraphrased, the caller said, "If you change football to make players safe, it won't be football, and I won't watch it."****

The NFL, NFLPA, NCAA, etc, must genuinely worry about this attitude.  NFL players are like sword-swallowers, stunt drivers, or fire breathers. The viewing public wants to watch football players do awesomely dangerous things at incredible speeds. That's why ESPN's "Jacked Up" segment was so popular a few years back. (ESPN removed "Jacked Up" because of player safety concerns -- players were committing dangerous, flagrant plays in order to get onto the segment.)

You must provide big high-speed hits if you want to stay in business; if you continue to encourage big high-speed hits you won't have any employees left.  This must keep Roger Goodell up at night.

The league was incredibly popular 25 years ago, when the average player was smaller, weaker, and slower than he is now. The hits were a little smaller. But the fans were there. Maybe you lose a few percent of your fan base if you limit the most dangerous plays, and "wussify" the league. But this is the way you must go if you want to have a robust player base in ten or twenty years.

Longer Term
If we can detect it, can we cure it? It's impossible to say right now, because until this month it wasn't possible to detect CTE in a living brain. If doctors can't detect it, they can't treat it.

Sports medicine has led medical science to some very impressive advances in surgical repair and physical therapy. Fixes to the ligaments in the knee, repairs to damaged shoulders, and so on have all been enhanced and refined by doctors who solved problems for athletes and sports teams.

But brain cells and structures aren't shoulders or knees.  I am skeptical of medical science's ability to cure CTE. I suspect that in the short-to-medium term, our best bet is going to be investment in prevention, rather than cures or repairs.

Hopefully that prevention can come without putting an end to football entirely.


* not really
** maybe this isn't the best choice of word here but let's carry on
*** yr obdt corresp helps run a youth soccer league and feels that this would not be the end of the world
**** my esteemed colleague Mr. Dansky refers to this as "the Golic defense"
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