“I’m not sure if we, as athletes, know what a concussion is just listening to these doctors and researchers talk. Outside of me being knocked out, asleep, I went back in the game on all the other occasions. And 50 or 60 times, I’m in the huddle, I don’t know where I’m at, don’t know the call, and I’ve got a player holding me up. I’m not sure if athletes really know what a concussion is — get some smelling salts and back in the game.”

These words of wisdom came at a “Concussion Conference”, held by the league, on June 19^th in Rosemont, Illinois.

Each NFL team sent a physician and two trainers to discuss ways of limiting brain injuries from concussions. All attendees received a package filled with concussion research.

What Is A Concussion?

Princeton’s Wordnet defines it as: “injury to the brain caused by a blow; usually resulting in loss of consciousness”.

NFL’s Opinion

That sounds pretty serious to me, but not to the NFL, which seems to be more concerned about profits, than the welfare of its players. The NFL, founded in 1902, formed the “Mild Traumatic Brain Injury” (MTBI) Committee in 1994, which finally began to study concussions.

So, they did not consider concussions to be of any consequence for their first 92 years, and not serious enough to formulate any sort of policy on them since they began studying them, in 1994.

The main difference in this conference, was that the NFL invited Dr. Kevin M. Guskiewicz who as reported here, had previously conducted a study of 2,559 retired players, linking concussions to depression, despite the fact that Henry Feuer, a Neurosurgical Consultant to the Indianapolis Colts, called the study “essentially worthless.” However Henry is the same fellow, who was commissioned by the NFL in 2005, to conduct a study of concussions on High School football players, and concluded that “it might be safe” for players who suffer concussions to return to play in the same game, so in my opinion, his opinion is worthless to anyone but the NFL.

On June 10, 2007, Alan Schwarz reported in N.F.L. Study Authors Dispute Concussion Finding that Dr. Feuer had changed his mind, and high school (not professional) players should not return to a game after suffering a concussion. Quoting Mr. Schwarz’s excellent article:

Feuer said that he “would change that sentence; I’d eliminate it.” Regarding high school players, he added: “It’s been shown that they don’t seem to recover as fast. Period.”

Another one of the authors, Cynthia Arfken, a Ph.D. employed by Wayne State University, went even further. Arfken, who co-authored another gem, Decreasing Unnecessary Care in a Psychiatric Emergency Service, as well as my favorite, a study of 48 cocaine dependent adults with ADD, claimed that she was unaware of the contents of the study and claimed that it was published without her permission, and was given a proof to review, but, as Mr. Schwarz reported, ”did not examine it carefully.”

Less carefully than the check she received for contributing to the report?

Another author, the Co–Chairman of the MTBI committee, Dr. Ira Casson, had the best comment:

“The fact that someone may misinterpret what we wrote in that paper does not mean that what we wrote in that paper was inaccurate, incorrect or shouldn’t have been done. This paper was aimed at scientists and physicians. If people who are not scientists or physicians are misunderstanding it, then that is not the responsibility of those of us who wrote it.”

Curiously, Dr. Joseph Waeckerle, the emergency doctor for the Kansas City Chiefs said, “My recommendation is that we write an editorial, or we write a piece, that explains very clearly that there is no external validity to this paper.”

The semi–eminent Dr. Feuer, countered with:

“I’m happy that more is coming of this. We set out to study a finite period of time. Look at what’s coming from it — continuous arguments. That’s what’s important. We’re getting people’s ire up. That’s how you get good studies done. When people get critical of something, you look into it more.”

The NFL’s commissioner, Roger Goodell, was on the same wave length as Dr. Feuer, saying:

“Vigorous debate is part of advancing that agenda.”

Unfortunately, debates don’t accomplish anything.

What Will The NFL Do?

Players will be checked prior to the season for head injuries. A physician will measure their reaction times, and other data, which will then be used to determine if they are hurt badly enough during the season to be considered ”injured.”

Referees will make sure players are wearing their helmets correctly, and that their chin straps are secured.

The biggest change will be the introduction and implementation of an anonymous system for players and personnel to inform the NFL if they feel that a Coach is forcing a player, who might have a head injury to play.

Personally, I think that proposal is idiotic, because nobody likes a stool pigeon, and nobody wants to ruin their career.

What Do Players Say?

Joe Theismann was the starting Quarterback for the Washington Redskins, from 1978 through 1985. Lawrence Taylor ended his career by sacking him on a busted play, and accidentally falling on his leg, shattering it.

Jayne and I were at that game, and you could hear his bone snap in the stands.

In a recent interview, Theismann said he suffered between five and ten concussions.

“If you could identify fingers the trainer was holding up, you went back into the game. Our education on concussions was nonexistent, but what we did know was if you sat down and didn’t play, and another guy did well, your career was gone.”

If you’e career is “gone” by sitting down, imagine what will happen when you (anonymously?) complain about your coach. And how can it be anonymous if you are the subject of the complaint?

What Does The Commissioner Say?

This is how NFL Commissioner Roger Goodell, summarized his position, and lack of action:

“No one has all the answers in this area so I don’t think anybody is being irresponsible. I think they want to be extremely responsible in trying to bring awareness and proper medical care to not only our players but to people who suffer concussions, which happens increasingly outside the NFL.”

My Opinion

1. Anyone who complains about their coach will never play again.
2. Nothing will happen until a player with a concussion returns to a game, gets hit in the head again, and is permanently disabled on the spot.

3,683 surveys were sent to retired players and 69% (2,552) were returned. The New York Times, in Concussions Tied to Depression in Ex-N.F.L. Players by Alan Schwarz, described the study as “the most comprehensive study of football players to date.“

Whom Can You Trust?

The NFL has billions of reasons to discount the results of this study, even though it was conducted by The Center for the Study of Retired Athletes, at The University of North Carolina, which is partly funded by the league.

The NFL’s Opinions

The NFL version of the study, quoted Dr. Kevin M. Guskiewicz, the lead author of the study, which was published by The American College of Sports Medicine in Medicine and Science in Sports and Excercise, who said:

“The findings of this study are not simply relevant to 50-, 55-year-old, 60-year-old retired athletes” [but to those currently playing].

Other NFL “experts” also discounted the results:

Dr. Amparo Guiterrez, professor of clinical neurology at LSU did not say when the survey was done (the CSRA said 2001), but according to the league’s version, “Gutierrez said he has been collecting data since about 2001.” Dr. Gutierrez said:

“the study’s biggest problem is that it relies on athletes’ memory, unverified by doctors’ records.”

If that is true, then why has he been working on this since 2001?

Two members of the NFL’s mild traumatic brain injury committee also downplayed the results.

Dr. Henry Feuer, a neurological consultant for the Indianapolis Colts, said the findings were “virtually worthless.”

Dr. Ira Casson, co-chairman of the MTBI committee, said:

“They had no objective evaluations to determine whether or not what the people told them in the surveys was correct or not. They didn’t have information from doctors confirming it, they didn’t have tests, they didn’t have examinations. They didn’t have anything. They just kind of took people’s words for it.”

The CSRA reported it differently than The National Football League, and The New York Times, saying:

“Retired NFL players who sustained three or more concussions during their professional playing years had a nearly three-fold risk of being diagnosed with Mild Cognitive Impairment (one precursor to Alzheimer’s disease).”

They didn’t even mention depression! And the NFL never said anything about “impairment” or “Alzheimer’s!”

Another View

The Times article gave a more balanced perspective, quoting Dr. John Whyte, director of the Moss Rehabilitation Research Institute, who has no ties to the National Football League, or the CSRA:

“To the person who says this is worthless, let’s just discard a third of the medical literature that we trust and go by today.”

“Here, the response rate was good and not a relevant issue to the findings. We have some pretty solid data that multiple concussions caused cumulative brain damage and increased risk of depression, and that is not in conflict with the growing literature.”

“Do I think this one study proves the point beyond doubt? No. Does it contribute in a meaningful way? You bet.”

My Opinion

• The results would have been higher if more than 69% of the retired players responded.
• The NFL needs to quit pretending that, when two 300 pound football players, running at full speed, collide, the worst that can happen, is a mild traumatic brain injury. This MTBI committee is a joke. Football is a rough game, and it should be rough, but it’s time that the league came up with some guidelines to at least place players with concussions, or MTBI, on an injured reserved list as soon as they are taken out of a game.

Congress responded by cutting the annual funding of his center in half, from $14 million to $7 million.

Dr. Zitnay had requested $19 million. On August 8, 2006, USA Today reported Center for war-related brain injuries faces budget cut which included two memorable quotes:

“I find it basically unpardonable that Congress is not going to provide funds to take care of our soldiers and sailors who put their lives on the line for their country,” says Martin Foil, a member of the center’s board of directors. “It blows my imagination.”

“Honestly, they would have loved to have funded it, but there were just so many priorities,” says Jenny Manley, spokeswoman for the Senate Appropriations Committee. “They didn’t have any flexibility in such a tight fiscal year.”

The article concluded by saying:

Preliminary research by the center shows that about 10% of all troops in Iraq, and up to 20% of front line infantry troops, suffer concussions during combat tours. Many experience headaches, disturbed sleep, memory loss and behavior issues after coming home, the research shows.

The center urged the Pentagon to screen all troops returning from Iraq in order to treat symptoms and create a database of brain injury victims. Scientists say multiple concussions can cause permanent brain damage.

The Pentagon so far has declined to do the screening and argues that more research is needed.