NOTES TO GREYLOCKNEWS.COM BLOG POST, NOV. 15, 2016:
PREPARED REMARKS OF DR. NICHOLAS WRIGHT TO MGRHS BOARD:
“The Concussion Crises in Athletic Health in U.S. Colleges and Universities: Will the brains of our athletes be protected by the current Return to Play guidelines?” by Nicholas H. Wright, The Greylock Independent, Nov. 2014. (Page 3).
The real price of high school sports from an education standpoint
And whether rubber crumb sports fields are safe:
BELOW FROM: http://www.espn.com/nfl/story/_/id/15229132/appeals-court-upholds-1-billion-nfl-concussion-settlement April 18, 2016:
In Re: National Football League Players Concussion Injury Litigation Nos. 15-2206, 15-2217, 15-2230, 15-2234, 15-2272, 152273, 15-22990, 15-2291, 15-2292, 15-2294, 15-2304, 15-2305 Heimburger appeal of 2-14-cv-00029
PHILADELPHIA -- A federal appeals court has upheld an estimated $1 billion plan by the NFL to settle thousands of concussion lawsuits filed by former players, thereby potentially ending a troubled chapter in league history.
The decision released Monday comes nearly a year after a district judge approved the revised settlement. If there are no further appeals -- to either a full panel of the 3rd U.S. Circuit Court of Appeals in Philadelphia within two weeks or the Supreme Court within 90 days -- former players already diagnosed with brain injuries linked to repeated concussions could begin receiving benefits within three or four months, a plaintiffs' attorney said.
Senior U.S. District Judge Anita Brody approved the deal after twice sending it back to lawyers over concerns the fund might run out. The total NFL payout over 65 years, including interest and $112 million sought for lawyer fees, is expected to be more than $1 billion.
NFL actuaries project about 6,000 of the league's nearly 20,000 retired players could someday develop Alzheimer's disease or moderate dementia over the life of the deal approved Wednesday by a federal judge in Philadelphia.
The average award would be about $190,000. Awards could reach $1 million to $5 million for those diagnosed in their 30s and 40s with Parkinson's disease or Lou Gehrig's disease, or for deaths involving chronic brain trauma.
More than 98 percent of retired players approved the deal, which was originally struck in 2013, revised in 2014 to remove the cap on how much the N.F.L. might have to pay players over the 65-year life of the settlement, and revised again in 2015. In the settlement, the league admitted no fault for neurological diseases tied to head trauma.
The appeals court also said that the admission last month by a high-ranking N.F.L. executive of a link between C.T.E. and football-related head trauma was “not a ground for reversal of the settlement’s approval.”
==Verbatim excerpts from various articles li BELOW FROM: http://www.nytimes.com/2016/03/15/sports/football/nfl-official-affirms-link-with-cte.html?_r=0
N.F.L. Official Affirms Link Between Playing Football and C.T.E. March 15, 2016
The N.F.L.’s senior vice president for health and safety, Jeff Miller, acknowledged on Monday a link between football-related concussions and chronic traumatic encephalopathy. In a round-table discussion on Capitol Hill, Jeff Miller, the N.F.L.’s senior vice president for health and safety policy, was asked by Representative Jan Schakowsky, Democrat of Illinois, whether “there is a link between football and degenerative brain disorders like C.T.E.”
“The answer to that is certainly, yes,” Miller said.
Notably, the settlement does not require the NFL to address allegations that have dogged it for years that top executives knew the risks of long-term complications from repeated concussions and hid them from players.
The deal means the NFL may never have to disclose what it knew when about the risks and treatment of concussions. The settlement, Brody wrote, is not an admission of liability or wrongdoing or recognition of the validity of the plaintiffs' claims.
But the NFL has acknowledged the concussion epidemic publicly, changing protocols for evaluating injured players during games and launching an advertising and social media campaign to promote safe play at all levels of football.
But the estate of one deceased player did file a last-minute appeal to the high court by the deadline, a move that will hold up payments for thousands of former players covered by the settlement.
Lawyers are seeking to alter the settlement on behalf of former Buffalo Bills running back Cookie Gilchrist, who was found to have chronic traumatic encephalopathy, the degenerative brain disease linked to repeated head hits, after his death in 2011.
The maximum award for players with ALS is $5 million; families of players who had CTE, $4 million; and $3.5 million for those with Parkinson’s or Alzheimer’s.
The settlement would cover more than 20,000 NFL retirees for the next 65 years.
Tom Girardi, who also represented players in the settlement, said he expected between 1,000 and 1,500 players would be eligible for payments now.
Bennet Omalu's piece in the NYTimes, 12-07-15: "Don't Let Kids Play Football" http://www.nytimes.com/2015/12/07/opinion/dont-let-kids-play-football.html Chronic Traumatic Encephalopathy first diagnosed in 2002. "Why, then, do we continue to intentionally expose our children to this risk?"
"In 2011, the two leading and governing professional pediatrics associations in the United States and Canada, the American Academy of Pediatrics and the Canadian Pediatric Society, published a position paper recommending that children should no longer be allowed to engage in high-impact contact sports, exemplified by boxing, and willfully damage their developing brains."
"However, as a society, the question we have to answer is, when we knowingly and willfully allow a child to play high-impact contact sports, are we endangering that child?
Our children are minors who have not reached the age of consent. It is our moral duty as a society to protect the most vulnerable of us. The human brain becomes fully developed at about 18 to 25 years old. We should at least wait for our children to grow up, be provided with the information and education on the risk of play, and let them make their own decisions. No adult, not a parent or a coach, should be allowed to make this potentially life-altering decision for a child."
Bennet Omalu is the chief medical examiner of San Joaquin County, Calif., and an associate clinical professor of pathology at the University of California, Davis. He is working on a memoir.
BELOW FROM: http://www.sacbee.com/news/local/health-and-medicine/article68142587.html March 24, 2016
Dr. Bennet Omalu, the UC Davis pathologist who achieved big-screen fame for his discovery of chronic traumatic encephalopathy among NFL players, has received the United States Sports Academy’s highest award in sports medicine, the Dr. Ernst Jokl Sports Medicine Award.
CTE, as the condition is called, is a neurodegenerative disorder that can develop after repetitive blows to the head, which jostle the brain against the skull. Omalu first spotted it while examining the corpse of former Pittsburgh Steelers center Mike Webster in 2002. Webster, like several other NFL players who have died in recent years, suffered dementia and depression in the months leading up to his death – symptoms that the medical field now associate with CTE.
In 2008, he published a book titled, “Play Hard, Die Young: Football Dementia, Depression, and Death.”
BELOW FROM: http://www.cbsnews.com/news/nfl-studying-how-to-tackle-alarming-increase-in-concussions/ Feb. 2, 2016
""I believe that 90 to 100 percent of professional players will suffer from CTE," said Dr. Omalu.
SAN FRANCISCO -- Five days ahead of Super Bowl 50, the NFL is studying how to deal with an alarming increase in concussions. The increase is from 115 concussions during the 2014 season to 182 in 2015. That's a 58 percent increase, and it came after the league cracked down on dangerous helmet-to-helmet hits.
After former New York Giant Tyler Sash died at 27 years old, doctors were shocked to discover he had a degenerative brain disease unusually advanced in someone so young. His mother Barnetta blames football.
Since 2009 every state has passed a concussion reporting, but there is no federal registry.
BELOW FROM: http://bennetomalufoundation.org/get-involved/
Though CTE was originally discovered in boxers and professional football players, it can affect any contact-sport athlete at any level,including wrestlers, hockey players, rugby players, and others. Alarmingly, reports of CTE have increased steadily in younger athletes. CTE’s prevalence also goes far beyond sports: it has been found in veterans and military personnel suffering blast injuries and post-traumatic stress disorder, in domestic abuse victims, in people suffering from chronic seizures, and in virtually anyone exposed to repeated head trauma.
The film is based on an article by Jeanne Marie Laskas that appeared in GQ magazine in September 2009. . . . . Like many Hollywood films, “Concussion” combines real events with fictional flourishes. For example, the film suggests that Omalu was the first to diagnose chronic traumatic encephalopathy and was the first to refer to it as C.T.E., but neither is true.
the gq story: Sept. 14, 2009: http://www.gq.com/story/nfl-players-brain-dementia-study-memory-concussions
Brown and red splotches. All over the place. Large accumulations of tau proteins. Tau was kind of like sludge, clogging up the works, killing cells in regions responsible for mood, emotions, and ecutive functioning.
Nothing was welcoming, nothing was collegial, about the NFL’s reaction to Omalu’s article that appeared in the July 2005 edition of Neurosurgery. In a lengthy letter to the editor, three scientists, all of whom were on the NFL payroll, said they wanted Omalu’s article retracted.
What the NFL couldn’t have known then, of course, is that by the time Omalu’s article was published, he had already gotten a second brain, that of former Steelers guard Terry Long, who died at 45 after drinking antifreeze.
Omalu did not like the education he was receiving. He felt he was learning something very ugly about America, about how an $8 billion industry could attempt to silence even the most well-intentioned scientist and in the most insidious ways. He was becoming afraid. Friends were warning him. They were saying, "You are challenging one of the most powerful organizations in the world. There may be other things going on that you’re not aware of. Be careful!"
In the summer of 2007, Roger Goodell, the new NFL commissioner, convened a meeting in Chicago for the first league-wide concussion summit. All thirty-two teams were ordered to send doctors and trainers to the meeting. It would be a chance for the NFL to talk about this and hear from independent scientists, many of whom they also invited to the meeting—300 participants in all. They asked Bailes to come. They did not ask Omalu.
The meeting was closed to media, but Bailes remembers it well. "They didn’t say, ’Thanks, Doc, that’s great.’ They got mad at me. We got into it. And I’m thinking, ’This is a new disease in America’s most popular sport, and how are its leaders responding? Alienate the scientist who found it? Refuse to accept the science coming from him?’ "
Bailes: ""Here we have a multibillion-dollar industry. Where does their responsibility begin? Say you’re a kid and you sign up to play football. You realize you can blow out your knee, you can even break your neck and become paralyzed. Those are all known risks. But you don’t sign up to become a brain-damaged young adult. The NFL should be leading the world in figuring this out, acknowledging the risk. They should be thanking us for bringing them this research. Where does their responsibility begin?"
"Look, there was a seminal study published by the University of Oklahoma two years ago. They put accelerometers, which measure acceleration, in the helmets of University of Oklahoma players. And they documented the g-force. So we know the g-force for a football player being knocked out is about sixty to ninety g’s. To compare, a fighter pilot will pass out at five or six g’s, but that’s over a long period of time. These football g-forces are just a few milliseconds, very brief—boom! And they found that in the open field, the dramatic cases of a receiver getting blindsided is about one hundred g’s. It knocks them out. Very dramatic, everybody sees it. But the linemen? They were actually getting twenty to thirty g’s on every play. Because they start out and they bang heads. Every play.
"Helmets are not the answer. The brain has a certain amount of play inside the skull. It’s buoyed up in the cerebral spinal fluid. It sits in this fluid, floats. When the head suddenly stops, the brain continues, reverberates back. So when I hit, boom, my skull stops, but my brain continues forward for about a centimeter. Boom, boom, it reverberates back. So you could have padding that’s a foot thick. It’s not going to change the acceleration/deceleration phenomenon. And a lot of these injuries are rotational. The fibers get torn with rotation. You’ve got a face mask that’s like a fulcrum sitting out here: You get hit, your head swings around. That’s when a lot of these fibers are sheared—by rotation. A helmet can’t ever prevent that.
"And have you seen helmets lately? In the old days of football, you had this leather cap to protect your ears. That was it. You’d never put your head in the game. You’d be knocked out after the first play! Even in the ’60s, the helmet was a light shell. The modern helmet is like a weapon.
"So I told the NFL, I said, ’Why don’t you take the head out of the game? Just take it out of the game! Let the linemen start from a squatting position instead of getting down for head-to-head. Have them stand up like they do on pass protection. So there’s not this obligatory head contact.’
The sixth case was Tom McHale, offensive lineman for nine seasons, most of them with the Tampa Bay Buccaneers. Depression and chronic pain in his joints had led him to discover oxycodone and cocaine. On May 25, 2008, at age 45, he died of a lethal combination of both.
The Blanchette Rockefeller Neurosciences Institute opened a year ago in Morgantown, W. Va., across the street from Bailes’s office—a slick building, 78,000 square feet of state-of-the-art laboratory space. It’s the only nonprofit independent institute in the world exclusively dedicated to the study of human memory and memory disorders, a partnership with West Virginia University and Johns Hopkins University.
Neuropathologist Peter Davies of the Albert Einstein College of Medicine in New York has been studying Alzheimer’s and tau proteins for more than thirty years. He receives no money from the NFL, not even parking fare . . . . It was far more severe than anything they’d ever seen in the most advanced Alzheimer’s cases—and in completely different regions of the brain.
"There is no doubt there is something there," Davies said. But he differs on the conclusion. He does not believe the main cause of CTE is concussion or trauma. He has even designed studies, principally on rats, to test his own hypothesis that the main cause is steroid use. He admits freely, however, that he is not a trauma expert, like Bailes, that he has not spent his career, like Omalu, looking at brains that have suffered repeated trauma. He’s an Alzheimer’s guy who believes that there has to be some reason he’s never seen brains like this, and he believes the reason is steroid use. Plenty of people, after all, suffer concussions—not just athletes. Wouldn’t he have seen some evidence of CTE in brains of regular folks over all these years? But only athletes take steroids, and so that is the link he is following.
“We are encouraged by the ongoing focus on the critical issue of player health and safety,” the league said in a statement when asked to comment on the film. “We have no higher priority. We all know more about this issue than we did 10 or 20 years ago. As we continue to learn more, we apply those learnings to make our game and players safer.”
League announced Dr. Elliot J. Perlman's retirement. He was team doctor for the Jets and chief medical officer for the league.
Dr. Pellman led the influential Mild Traumatic Brain Injury Committee, which was established in 1994 by Paul Tagliabue, then the commissioner.
In a 2012 study, 85 people who had histories of repeated mild traumatic brain injury, showed 68, nearly all of whom played sports, showed evidence of C.T.E. Fifty were football players, including 33 who played in the N.F.L. Among them were Ollie Matson, Cookie Gilchrist and John Mackey.
The study, published in the scientific journal Brain, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury . . . Of the group of 85 people, 80 percent (68 men) — nearly all of whom played sports — showed evidence of chronic traumatic encephalopathy, or C.T.E., a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.
Among the group found to have C.T.E., 50 were football players, including 33 who played in the N.F.L. Among them were stars like Dave Duerson, Cookie Gilchrist and John Mackey. Many of the players were linemen and running backs, positions that tend to have more contact with opponents.
Six high school football players, nine college football players, seven pro boxers and four N.H.L. players, including Derek Boogaard, the former hockey enforcer who died from an accidental overdose of alcohol and painkillers, also showed signs of C.T.E. The study also included 21 veterans, most of whom were also athletes, who showed signs of C.T.E.
The study was conducted by investigators at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, in collaboration with the Sports Legacy Institute.
“All concussions are not created equal,” said Robert Cantu, a co-author of the study and a co-director of the encephalopathy center. “Parents have become paranoid about concussions and connecting the dots with C.T.E., and that’s wrong. The dots are really about total head trauma.”
The darkened area at the bottom of the image shows the disease spreading to the amygdala and surrounding temporal cortex.
BELOW FROM: New York Times Magazine http://www.nytimes.com/2014/11/09/magazine/how-one-lawyers-crusade-could-change-football-forever.html
By Michael Sokolove is a contributing writer for the magazine. His most recent book, “Drama High,” has just been published in paperback.
In 2011, Jason Luckasevic filed suit against the N.F.L., at first on behalf of 75 players.
But what if the template for football’s future is not the fate of boxing but rather that of the tobacco industry? The parallels, of course, are not perfect. But tobacco, like football, was once deeply embedded in the American economy, culture and mythology. His firm’s elders did not want to challenge the N.F.L., but Luckasevic could not abide the thought that it was too big to take on. With his firm’s O.K., he teamed up with prominent plaintiffs’ lawyers, one in Miami and another in Los Angeles, who functioned as mentors. They signed up their own players. Luckasevic’s own roster of clients grew to 535.
Under the terms of the proposed settlement, the N.F.L. will compensate retired players (or their heirs) based on the severity of their impairment, sorted into such categories as “early dementia,” “moderate dementia,” “Alzheimer’s disease,” “Parkinson’s disease” and “death with C.T.E.” The maximum payout, for those given diagnoses of Lou Gehrig’s disease, or A.L.S., is $5 million. The NFL initially agreed to set aside $765 million for brain-injured players or, in the case of those who died, their heirs.
Now that the N.F.L. has acknowledged that its product comes with dire health consequences, the sport, below the professional level, faces legal and regulatory challenges that will most likely intensify in the coming years.
California recently passed a law barring state middle-school and high-school teams from conducting full-contact practices for more than three hours a week during the season; contact is not allowed at all in the off-season. California is always something of a trendsetter when it comes to lawmaking, as it has been with auto emissions, climate change and smoking bans.
And as history has shown in the cases of smoking and other hazardous practices, regulation tends to expand over time: If a state can ban blocking and tackling in practice, what’s to prevent it from prohibiting those activities in games by banning football entirely or turning it into flag football? (Several other states, including Alabama and Texas, have similar restrictions on football practices.)
It is not easy in most locales to sue school districts, and in many cases, the dollar amounts on liability are limited. Nonetheless, schools are increasingly being sued over football. Parents of a high-school junior in Tampa who suffered a concussion on the sidelines after jumping for a pass have sued the Hillsborough County school district; he drove himself home, but later was put in a medically induced coma for nine days to reduce brain swelling.
It’s possible that the very thing meant to protect players — new protocols that define how they should be evaluated for a possible brain injury, and how long they should be kept out of play if one is diagnosed or suspected — will actually put school districts, administrators and coaches at more legal risk.
Now that they have, in a sense, been forewarned, what happens if they don’t follow the protocols or don’t have certified athletic trainers on staff or coaches smart enough to deal with possible concussions while they are also deciding on the right third-down play? What’s more, insurers may in time deem the sport too risky. Health insurers might treat it as a costly risk factor like smoking or a bad driving record. As football becomes more and more regulated, many districts may reasonably conclude that it’s more than they can handle.
It appears the league may already be losing the argument with a segment of the nation’s parents. Between 2010 and 2012, Pop Warner, the nation’s largest youth-football program, experienced a 10 percent drop in participation after years of steady growth. It attributed the decline to concerns over concussions. There’s no reason to think its numbers won’t continue to fall.
Chris Nowinski, 28, a former Harvard football player and professional wrestler, contacted Dr. Bennet Omalu after he read about Mr. Waters’s suicide. Mr. Nowinski was one of those tough kids. As an all-Ivy League defensive tackle at Harvard in the late 1990s, he sustained two concussions, though like many athletes he did not report them to his coaches because he neither understood their severity nor wanted to appear weak. As a professional wrestler he sustained four more, forcing him to retire in 2004. After he developed severe migraines and depression, he wanted to learn more about concussions and their effects.
That research resulted in a book published last year, “Head Games: Football’s Concussion Crisis,” in which he detailed both public misunderstanding of concussions as well as what he called “the N.F.L.’s tobacco-industry-like refusal to acknowledge the depths of the problem.”
THIS PIECE REALLY SUMS IT ALL UP: http://theweek.com/articles/600502/should-kids-play-football
THIS piece reports on American Academy of Pediatrics Report saying to change tackling tactics rather than ban it: http://www.medpagetoday.com/pediatrics/generalpediatrics/55426
Robert Cantu, MD, of Boston University, and author of the book, Concussions and Our Kids, said that research has demonstrated structural damage to the anterior fiber tracts of the brain, based on MRI studies done in individuals that started playing football under the age of 12 compared with those who started later in life. They also discovered the rate of CTE among high school football players is 23%.
"All the research I've seen indicates that youth brain injury is a bigger thing than the same amount of brain trauma to an adult," he said in an interview with MedPage Today. "There is quite a robust literature that points out that youth recovers from brain injury, on average, more slowly than adults, that they can have quite profound changes in cognitive, behavioral and mood problems later in life from brain injury early on."
3 Fast Facts
1. With 1.1 million participants, football is the nation’s most popular sport for high school boys. Track and field is a distant second, with just 580,000 athletes.
2. The danger isn’t limited to games. Fifty-eight percent of concussions in high school and college football players happened during practice.
3. High school football players can undergo significant brain changes after just one season—even if they don’t get a concussion.
SOURCES: 1. National Federation of State High School Associations; 2. May 2015 JAMA Pediatrics study; 3. Wake Forest University research
Between 2001 and 2009, the most recent years of CDC data, football sent about 25,376 kids under age 19 to the emergency room for traumatic brain injury each year, which was second only to bicycling.
Kim Gorgens, clinical associate professor in the Graduate School of Professional Psychology at the University of Denver.
One study, published in the journal Neurology in July, found that right after a concussion, study participants performed 25 percent worse on memory and cognition tests when compared to healthy people. And one year later, even though test scores were the same between both groups, those who had a concussion still showed signs of brain damage on imaging scans. "We are beginning to better understand the functional consequences of even a single concussion,” Gorgens says. “We see changes in brain function for weeks and months after an injured athlete identifies themselves to be symptom free.”
Even Mild Concussion Can Cause Thinking, Memory Problems: Study July 16, 2014, at 4:00 p.m. MORE Even Mild Concussion Can Cause Thinking, Memory Problems: Study MORE By Barbara Bronson Gray HealthDay Reporter
WEDNESDAY, July 16, 2014 (HealthDay News) -- A mild or moderate concussion may have longer-lasting consequences than previously realized, a new study suggests. \
And, Dr. Michael O'Brien, director of the sports concussion clinic at Boston Children's Hospital, pointed out that "it's really good for people to know -- those who are suffering with school performance, physical performance and even social issues -- the fact that there is actual structural damage, even a year after the injury."
The research was published online July 16 and in the Aug. 5 print issue of Neurology.
By comparing brain imaging studies and thinking tests between healthy people and those with relatively minor concussions, the researchers found that the recovery of thinking skills can take a long time. Minor concussions can be caused by events such as falling off a bike, being in a slow-speed car crash or being hit in a fist-fight.
Initially, those with concussions had thinking and memory test scores that were 25 percent lower than those in healthy people. One year after injury, however, while the scores for those with and without concussions were similar, those who had had brain injuries still had evidence of brain damage on imaging tests, with clear signs of continued disruption to key brain cells.
The findings are especially important because 90 percent of all traumatic brain injuries are mild to moderate, said Andrew Blamire, senior author of the study and professor of magnetic resonance physics at Newcastle University, in the United Kingdom.
Cantu at Boston University has called for a ban on tackle football before the age of 14. While he agrees with Omalu that it would be safer to wait until players’ brains are fully developed, he sees this as an impractical suggestion. He points to a study published this year in the journal Neurology of retired NFL players that shows those who started to play before the age of 12 had greater cognitive impairment than those who started later. He says by 14, adolescents’ brains have developed most of the myelin, a protective sheath that coats neurons, that they will have as adults.
Dr. Lewis Margolis, a pediatrician at University of North Carolina, agrees with Omalu, but his argument against football is a precautionary one until the evidence is clearer. He published an article in the July-August issue of the North Carolina Medical Journal arguing that permitting patients to play football in high school violates the physician’s “do no harm” obligation.
“I say, enough is enough,” he said. “There's a risk here and it's not a trivial risk so that we should step back and say, ‘Wait. we need to look at this more closely.’”
“I think Omalu's a bright guy, but he's often a loose cannon and has opinions that aren't based on practicality or science,” said Dr. Robert Cantu, a neurosurgeon and co-director of Boston University’s Center for the Study of Traumatic Encephalopathy.
Since researchers have only recently begun to study the link between football and mild traumatic brain injuries including concussions, they remain unable to answer questions that would give parents and young players a clearer picture of the game’s risk. Those questions include: What is the chance that any given youth football player will develop long-term brain damage? Could a single concussion cause CTE? Are repeated sub-concussive blows to the head endured by football play likely to result in permanent brain damage? Why do some people develop CTE and others do not?
Those benefits have to be balanced against the risk of brain injury. Coaches and teams have gotten better at monitoring the health of their players, which has resulted in a 35% reduction in concussions since 2012, according to NFL’s 2015 Health and Safety report. With dozens of rule changes to protect players, a new “medical timeout” option and additional studies of new technologies to reduce injury, it has never been safer to play professional football. And the youth game is following suit.For young players, there is a focus on the immediate consequence of the injury. The symptoms of concussions make it dangerous for players to return to the game, and they may interfere with basic daily living, including academics. That alone is reason to follow guidelines closely.