What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

Concussion: “The Movie”

in the dark

In the dark (not for long, I hope): Concussion has hit the theaters.

I was witness to two big events in the world of professional American Football this weekend:  I watched the movie Concussion and I saw the ugly contest which was the Pittsburgh vs. Cincinnati NFL playoff game.

Of the two events, the more damning, the more worrisome for the league, was the playoff game.

First, let me start with the movie, as I had intended on focusing on that in this blog post….until the playoff game happened.

The movie was well done overall, I thought.  I am no movie critic (I hope that goes without saying) and I rarely see things on the ‘Big Screen’ any more–I think the great movies came and went in the 60’s and 70’s, when I was growing up (Easy Rider, The Deerhunter, Apocalypse Now….).  Concussion (the movie) is largely a heroic story about one man’s personal struggle and vindication:  Dr. Bennet Omalu vs. the NFL, David vs. Goliath.  There are some typical Hollywood moments (e.g. the romancing of his future wife), but largely the film stays on track regarding the story of pathologist Dr. Omalu and his reintroduction of the term ‘chronic traumatic encephalopathy (CTE)’ into the medical lexicon after his autopsy on the brain of the deceased football player, ‘Iron’ Mike Webster.

And Will Smith does an excellent job, I think, with his portrayal of Omalu.

I approached this movie not so much looking for entertainment, but to see if there were anything new in this story I might learn, and to see how the movie might present the science to the general viewing public.  I don’t think I learned anything new regarding the basic story.  This is not so much a criticism of the movie as an endorsement of the PBS documentary, ‘League of Denial,’ which came out two years ago and went into much more depth than a dramatization ever could.  And as for the science?  Once again, you’re better served viewing the documentary.  You won’t have to hear a clunker of a line like this: “Three cases is the scientific burden of evidence.  We have four.”

Now, on to the playoff game.

I don’t think the NFL will be able to survive if the sorts of hits occurring in this game, regardless of their ‘legality,’ continue. Read more of this post

The 3 C’s of the Season: Christmas, Concussions & CTE


Merry Christmas, from two elves and potential movie-goers this holiday season.

Today is Christmas, and I hope for all of you who celebrate the holiday that you and your family have a wonderful day.

Some of you, over this holiday season that will extend through New Year’s Day, will probably be viewing the movie Concussion, which opened yesterday across the country.  I know I’ll be writing down my thoughts on the movie itself after I have viewed it.

The central story has been told (and many of the characters in that story were portrayed) a couple of years ago in a wonderful PBS documentary called ‘League of Denial,’ which I reviewed in October 2013.  I am looking forward to the ‘Hollywood version’ of the story.  I am also looking forward to the robust debate about the topic of head injuries in football that will ensue.

In the buildup to the movie that has progressed over at least the last month, that debate has already, in fact, begun [in truth for those of us in ‘the business,’ the debate over issues such as the association of concussions and chronic traumatic encephalopathy (CTE) has been on-going for some time].  The New York Times has, in particular, seemed to make a point of publishing several articles and opinion pieces on the ‘concussion epidemic.’

As a pediatric sports medicine clinician and researcher, I have been particularly concerned and involved with the concern over the hypothesized association between risk of developing CTE and exposure to head injuries in youth sports such as football.  I am particularly worried that there has been a rush to judgment in the media, and proposed decisions (for instance, to banish youth contact sports) are moving way ahead of the science.  Many of the Times’ articles had me wanting to engage in a conversation with the authors, and so, in that spirit, I drafted a ‘Letter to the Editor (LOE).’

The Times’ word restrictions for their LOEs are pretty tight, and what I am sharing with you below far exceeds their limits.  I wanted to post it here and engage you, my readers in this discussion.

CJSM will be a leader in the on-going publication and dissemination of evidence-based research on the concussions, CTE, and other such issues in the world of sport.  Continue to follow us as we, along with you, wrestle with the questions.


I have been reading with great interest the series of articles the NY Times has been publishing on the topic of youth football and contact sports, including the Op-Ed piece by Dr. Bennet Omalu[1] (“Don’t Let Kids Play Football”) and, most recently, the story of Peter Robinson, “How a Boy’s Concussion Death Changed British Sports.”[2] Read more of this post

League of Denial: A review of the PBS documentary

steve young

49ers legend Steve Young
one of the great interviews on the
documentary, “League of Denial”

I watched the PBS Documentary “League of Denial” this week, and I’m sure many of you did as well.

In one word:  Bravo.

I thought the folks at PBS’ Frontline did a fantastic job, touching on many facets of what is arguably the biggest sport public health story of the last two decades.  There were so many dimensions to the nearly two hour documentary, it’s hard to know where to begin my review.  In nearly two hours, PBS (with a ‘redacted assist,’ if that’s the phrase, from ESPN), covered a lot of ground.

I thought I would highlight some of the major personas that showed up, and divide them into the following four categories: “Winners,” “Losers,” “Meh,” and “In Memoriam”


Bennet Omalu, the neuropathologist who broke the story of chronic traumatic encephalopathy (CTE), is my pick for the most compelling figure in this documentary.  A physician of great training and accomplishment, he had the mixed fortune of conducting the post-mortem examination of Mike Webster, the Pittsburgh Steelers icon who died young and whose brain showed the pathologic changes of CTE, the first case documented in an NFL player and reported in this study.

Dr. Omalu’s story, both personally and professionally, is worthy of its own documentary.  Originally from Nigeria, he knows little about American fooball and nothing about the Steelers icon when he first meets the latter’s corpse and goes about his job.  He reports being thoroughly unimpressed with the gross morphology of the deceased’s brain:  how it looked ‘normal.’  It was only on conducting his histopathologic exam that he made his stunning discovery.

For this and further efforts in investigating CTE in deceased NFL players’ brains, he was smeared by the NFL and its affiliated physicians.  Omalu poignantly states as a result, he wished he had never ‘met Mike Webster.’

As an Associate Editor of a medical journal, I found the calls by some in the NFL medical community (see below) for Omalu to retract his CTE study and their ad hominem attacks to be the more egregious sins (among many) reported in the documentary.  The process of science, spearheaded by peer-reviewed literature, is one of openness; disagreements are cause for further study, not suppression.  Retraction should be reserved for outright fraud.  The calls for retraction in this case are shameful.

Ann McKee, another neuropathologist now with the Boston Center for the Study of Traumatic Encephalopathy, has picked up the baton and is continuing to carry on the research into CTE in former professional football players, despite further pushback from vested interests and more ad hominem attacks that insinuate that, as a woman, what might she know about football?

Steve Young who experienced five or six concussions in his career, is one of the former players interviewed for this documentary.  I remember Steve Young well, as I lived in the Bay Area for many of the seasons of his glorious career with the 49ers, and I remember too when he had his career-ending concussion. Read more of this post

%d bloggers like this: