by Brian E. Moore, MD
Two neuropathologists are prominently spotlighted in an article by Malcolm Gladwell in the October 19 issue of The New Yorker. The article explores a provocative question raised by autopsy results on football players: namely, should football be illegal?
Featured are Dr. Ann McKee, neuropathologist at the Veterans Hospital in Bedford, Massachusetts and Dr. Bennet Omalu, forensic neuropathologist and San Joaquin Valley (CA) chief medical examiner. Drs. McKee and Omalu have done some interesting autopsy work which suggests that chronic traumatic brain injury leading to dementia suffered by football players is much more common, even among high school players, than previously realized.
What’s alarming is the presence of abnormal collections of a protein known as tau, one of the proteins one sees in cases of Alzheimer disease, in brains of young ex-football players. As an example, McKee provides photomicrographs from a case of an 18-year-old high school football player and says: “He’s got all this tau. This is frontal and this is insular…. This is completely inappropriate. You don’t see tau like this in an 18-year-old. You don’t see tau like this in a fifty year old.”
You might counter that this is simply the result of a few bad-luck hits on the field, but research involving the University of North Carolina football team suggests otherwise. Players at UNC wear impact sensors in their helmets throughout the season. Results from these investigations suggests that even routine hits during practice can add up to cause concussions and, theoretically, set the stage for chronic traumatic encephalopathy. (On the first day of training camp one UNC lineman was recorded as having been hit in the head thirty-one times!)
Back in 1905, Gladwell reports, the question of whether football should be played in our nation’s schools was raised to the level of the White House, when President Theodore Roosevelt called an emergency summit to discuss the issue. At the time, a professor at the University of Chicago called football a “boy-killing, man-mutilating, money-making, education-prostituting, gladiatorial sport.” And in December of 1905, presidents of twelve prominent colleges met in New York and came within one vote of abolishing the sport at their institutions.
What does this mean for football in America? Nothing. Fans are willing to spend a lot of money to see men slam into each other’s heads on the field. But, as a parent, you can do something.
You can forbid your son from playing football.
Brian E. Moore is a neuropathologist with Pathology Associates of Central Illinois and assistant professor of pathology at Southern Illinois University School of Medicine who blogs at neuropathology blog.
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{ 18 comments }
What about soccer? All that heading the ball. Any evidence on that?
What about boxing?
To the best of my knowledge, there is nowhere near the correlation with heading in soccer as there is with football. Not only is it a relatively rare event, but the mechanics are entirely different. Certainly players practice heading for extended periods, but in so doing, ball velocities are far below what you’d expect on game day. Unfortunately, I do not have the citations on hand for your reference, and therefore I am perfectly willing to allow for the possibility that I am wrong about this, though.
@Anonymous,
Oh, yes. Boxing is notorious for producing later chronic traumatic encephalopathy. Autopsies of former boxers, even at the amateur level, have yielded numerous neurofibrillary tangles of hyperphosphorylated tau and plenty of dense ABeta plaques.
…and physicians have a higher rate of suicide than the general public–female physicians even higher. Should we ban our daughters from going into medicine?
We all make choices that may have risks, benefits, and consequences. All sports carry risks, life is a risk – but sitting home watching TV is the biggest risk of all.
@Kathleen,
You’re comparing apples and oranges with the physician/suicide stat. Certainly the fact that suicide rates are higher for physicians — especially female — implies the need for measures to try and reduce that number. Does not McKee’s findings imply a need to investigate ways to reduce high school football head trauma?
An adult whose livelihood depends upon his or her ability to play a contact sport is making a choice, with all its attendant risks, benefits, and consequences. Can we consider a high-school football player in the same category? I’m not suggesting an outright ban on high school football, but certainly the rules ought to be looked at to discourage dangerous play that increases the likelihood of helmet-helmet contact, &c.
I appreciate reading Brian’s comments regarding this issue. Indeed, the research is showing that the damage seen in football players is similar to that seen in boxers. It is important to recognize a distinction between sports wherein injury is intrinsic to the game (such as football and boxing) and sports in which there is simply a risk of injury (such as basketball, Nascar racing, and cheerleading). I have no problem with my kid taking risks; but I cannot allow him to do a sport that — even in practice — causes brain cells to die. I am not talking about criminalizing football, but I do plan to make playing it ‘illegal’ in my household. Life is long, and the football season is short.
Something’s fishy here. Couldn’t these physician-scientists get their research published somewhere other than “The New Yorker”?
I don’t put much stock in their findings or their recommendations.
You don’t go attacking an American institution on such flimsy grounds.
“Doctor” means “teacher,” not “dictator.” Educate people, then give them freedom to make their own decicions.
-Steve
Dr. Parker,
You aren’t serious, I hope? Surely you recognize the difference between a research article and an article that mentions that research?
That does it! My kids are enrolling in Brazilian jiu jitsu instead.
as an er doc, I see football player with concussion sx all the time. after the first injury, I recommend no football for 6 months or until cleared by neurology. after the second injury, I recommend parents take their kids out of the sport. You would not believe the anger I see with this, but I clearly document this on all of the charts, and in the discharge instructions.
@Kathleen-
ha! i for damn sure will discourage my children from pursuing a career in medicine. for a multitude of reasons.
My kids didn’t play, but they had something to lose–they were smart. Life is full of risks and people have the right to pursue happiness according to their own inclinations as long as they don’t interfere with others. That means the kids so inclined have the right to, by mutual consent, go out and bash each other on the head. It also means that doctors don’t have the right to force their worship of health on others anymore than footballers have the right to bash non-participants in the head.
Gamecocks, rutting bucks, and adolescent boys like to smash into each other. Let them. Otherwise you might as well just geld them at birth.
So what if they kill some cells, most of the public school kids around here are beating the odds if the actually graduate and work up to fry cook anyway. How many neurons do they need? Let them have their moment of glory.
Great idea! Physicians should encourage the banning of a popular sport that young people love to play based on flimsy research. That will really encourage people to listen to us when we talk about real public health threats like smoking.
Outlawing highschool football due to some pro players developing dementia is like outlawing bumper cars because NASCAR driving is dangerous. The difference in magnitude is significant. The Prohibition was a similar public health strategy: if a lot of something is bad we should just outlaw all of it! Heck we should stop all children from running because running slightly increases the risk of falling and hitting one’s head!
There are lots of former highschool football players out there. I would like to see a well design study conclusively proving a correlation between high school play and later life dementia, before I consider banning a sport young men love. And no, the presence of proteins in a single student’s autopsy and impact sensors in helmets may be fun anecdotal data but they don’t prove clinical dementia will occur.
But just forget sound research–doctors love hysteria bandwagons just as much as anyone! Let’s ban highschool football!
Drs. D & Stone:
Guys, did you bother actually reading either of Dr. Moore’s or Malcolm Gladwell’s articles?
Yes I did. Why the snarky question?
It seems that if one follows every anti-freedom movement back far enough, it always leads to a doctor who can not be satisfied with identifying a health concern and persuading other to appropriate consideration of the risks but who must introduce the notion of using legal coercion to improve the public health. Sure we rid ourselves of a high burden of water and mosquito borne illness that way, but enough is enough. We should never forget that medical men, in the quest to use power to force “improvements” in the world, were also behind the start of the Holocaust, the genocide in Bosnia, and even played a role in the murderous Muslim Brotherhood.
The above is a bit of a rant, but I am sick of everytime I come to this site, there is a new list of what ought to be “banned” or made “illegal”. What ever happened to freedom? Is the secret web site of the American Medico-fascist League?
Doc, I can see where you’re coming from. However, Dr. Moore’s post was in no way arguing that football ought to be banned entirely, much less by any official route (though he did mention it would be banned in his house). Parents can and will allow their kids to take risks, including football, if they so choose. Nevertheless, there are abnormal histopathological findings that result from it, the significance of which is not yet fully understood. So if a parent chooses to allow his or her child to participate nevertheless, that choice ought to be made responsibly.
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