November and December is always an especially busy time of the year in the life of a general surgeon (attributable to a large extent to the rise of b.s. high deductible insurance plans which everyone seems stuck with nowadays) and so I haven't been able to post much to the blog. But I have been taking notes on some recent developments related to head trauma, football and CTE. Let's get to some of them now.
1) Last week, Vice told the harrowing, heart breaking story of Zack Langston, a 26 year old former high school and college football player who spiraled downward, consumed by paranoia, depression and despair, ultimately taking his own life at the age of 26.
1) Last week, Vice told the harrowing, heart breaking story of Zack Langston, a 26 year old former high school and college football player who spiraled downward, consumed by paranoia, depression and despair, ultimately taking his own life at the age of 26.
Following his death, Zack's family had his brain studied by the eminent Boston pathologist Ann McKee. The post-mortem diagnosis was confirmed to be Chronic Traumatic Encephalopathy (CTE). The only surprising thing was the extent of pathognomonic tau tangles throughout his brain. According to Dr McKee, the disease was as advanced in Zack's brain as what she found in the brain of 42 year old former NFL star Junior Seau. "It's getting to be pretty common for us to see cases in twenty-somethings", McKee said. Further from the article:
McKee's brain bank found CTE in the brain of Patrick Risha, a former Dartmouth football player who committed suicide at age 32; in the brain of Michael Keck, a high school star who played just one year of college football and died at age 25; in the brain of Joseph Chernach, who played Pop Warner and prep football and committed suicide at age 25; and in the brain of Nathan Stiles, who died at age 17 from a brain injury suffered during a high school football game. In total, McKee says, she has found CTE in the brains of 41 of 50 former college football players her brain bank has examined, and six of 26 former high school players. As part of a proposed settlement of a class action brain trauma lawsuit against the National Collegiate Athletic Association, actuaries for the organization estimate that for a period covering college sports careers beginning between 1956 and 2008, approximately 50-300 former athletes per year will be diagnosed with the disease.
Questions certainly remain. Why are some younger people more susceptible to brain trauma and the development of CTE than others? What triggers this early onset form of the disease? And how can we do a better job of identifying those youths who are at an especially high risk of suffering the consequences of repeated sub-concussive trauma? The National Institutes of Health recently awarded $16 million in grants to physicians and researchers to investigate these questions and to develop better methods of diagnosing early CTE while athletes are still alive, whether using novel imaging techniques or blood tests. None of the $30 million allocated toward research the NFL agreed to pay as part of a class action lawsuit will be used for the studies (per ESPN) because of concerns from the NFL that the researchers will be "biased". Of course they would think that. For years, the NFL's modus operandi has been to attack the credibility of scientists who report objective findings counter to what the NFL would like the public know.
2) Somehow, the disgraced Elliot Pellman is still gainfully employed by the NFL in some capacity related to the health of its players. Recall that Dr Pellman, a trained rheumatologist (?!?!?!), was the chairman of the NFL's Mild Traumatic Brain Committee from the 1990's. This Orwellian "committee" functioned as a mouthpiece for NFL propaganda. Specifically, his group authored a series of 6 peer reviewed articles that trivialized the long-term impact of head trauma of players. Here is a conclusion from a retrospective 6 year study his group published in the journal Neurosurgery:
2) Somehow, the disgraced Elliot Pellman is still gainfully employed by the NFL in some capacity related to the health of its players. Recall that Dr Pellman, a trained rheumatologist (?!?!?!), was the chairman of the NFL's Mild Traumatic Brain Committee from the 1990's. This Orwellian "committee" functioned as a mouthpiece for NFL propaganda. Specifically, his group authored a series of 6 peer reviewed articles that trivialized the long-term impact of head trauma of players. Here is a conclusion from a retrospective 6 year study his group published in the journal Neurosurgery: