The curious case of dementia pugilistica

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Many people flock to stadiums and arenas where uniformed warriors compete in strenuous physical activities. Team sports require athletes be clad in all sorts of armor—some more than others—to prevent injuries. Contact sports like football and hockey demand heavy padding and helmets, while non-contact sports like basketball and soccer call for little more than modest uniforms.

Does it not seem slightly strange that boxers or mixed martial artists aren’t obliged to wear protective gear save for a mouth guard? Or is it because the goal is to injure and maim?

The importance of brain for daily living cannot be stressed enough. We use 100% of our brains. However, I suppose a compelling case could be made that some individuals indeed only use 10% of their brain. Nevertheless, traumatic brain injuries have seen more coverage lately as former football players gradually slip into depression and suicide and their families bring legal grievances against organizations like the NFL. Let’s discuss that.

What is CTE?

Chronic Traumatic Encephalopathy (CTE) is a progressive degeneration of the brain—distinct from Alzheimer’s—caused by repeated injuries to the brain. Although not a complete pathological description, the disease is most commonly characterized by the atrophy of all lobes of the brain, brainstem, and cerebellum. Additionally, the corpus callosum—the band of nerve fibers which connects the two hemispheres of the brain—thins out.

This degeneration wasn’t always called CTE. Physicians and boxing fans alike were vexed by the “cuckoo” and “goofy” demeanor of fighters who took “considerable head punishment.” The first description of the condition—then colloquially referred to as punch drunk—came in a 1928 article published in the Journal of the American Medical Association. In 1937, the condition was renamed dementia pugilistica, dementia of the pugilists (boxers). And in 1949, to reflect the broadened understanding of neuroscience—and that other types of athlete were susceptible—the term chronic traumatic encephalopathy supplanted the former names. (The transition of punch drunk to chronic traumatic encephalopathy reminds me of the George Carlin skit where he bemoans the transformation of shell shock to post-traumatic stress disorder.)

Initial symptoms of CTE include confusion, unsteady gait or impaired equilibrium, attention deficits, and memory disturbances. More severe cases result in behavioral changes, speech problems, tremors and postural instability (like those seen in Parkinson’s disease), and loss of cognitive function.

Although CTE is most commonly associated with contact sports, CTE has been documented in epileptics and domestic abuse victims. Most alarming is that all definitive diagnoses of CTE can only be made post-mortem. Unfortunately, no known imaging methods permit a diagnosis while the individual is alive and there are no known biomarkers associated with the disease.

Denying the Evidence

On March 14, 2016—a day that should have received more coverage—the NFL’s senior vice president for health and safety, Jeff Miller, made the spectacular public admission of the link between football-related brain injuries and CTE. I could imagine that concession was not easy for the NFL considering all the assurances by Roger Goodell, the commissioner of the NFL, that “medical considerations [of the players] must always come first.”

The video of the admission begins with a scathing—yet serious—remark by Rep. Jan Schakowsky.

“I’m concerned that the NFL has a very troubling record of denying and discrediting scientific inquiry into the risks of playing football.”

Schakowsky—in the video I suggest everyone watch—briefly outlines the very public vilification (and attempted defamation) of Dr. Bennet Omalu by the NFL, as well as the attempt by the NFL to quash all scientific investigations that made them look bad. (Fulminations of this kind are common when research introduces unwelcome ideas or proposes unwelcome conclusions.)

Here’s some backstory: In 2002, Omalu conducted the autopsy of Mike Webster, former center for the Pittsburgh Steelers. Omalu’s findings confirmed that Webster had chronic traumatic encephalopathy and he published his findings in Neurosurgery in 2006. As one would expect, the NFL was furious. It dispatched its servile and obsequious doctors to condemn Omalu’s findings and demanded the article be retracted—which thankfully never happened.

Scientific inquiry isn’t the only thing the NFL—an organization beleaguered by controversy and scandal—is willing to deny or discredit or overlook.

We all remember the Ray Rice assault case, right? The one where former—thankfully so—Baltimore Ravens running back Ray Rice savagely assaulted his fiancée in an elevator and dragged her seemingly unconscious body out. Fret not, the pair were married the following month. May they live their own bizarre love life in obscurity and away from my newsfeeds. Nevertheless, I recommend a quick refresher on the Ray Rice assault care and the simpering tones of Roger Goodell as he handed down an exiguous punishment. This is the same commissioner who reinstated Michael Vick, a contemptible little sycophant who served 18 months in prison for operating a dogfighting ring.

But I digress.

Anyway, a congressional report, released in May of 2016, entitled “The National Football League’s Attempt to Influence Funding Decisions at the National Institutes of Health,” should say it all. The report alleged that the NFL withdrew $16 million of a $30 million “gift” in an effort to “improperly [attempt] to influence the grant selection process.” (The NFL had originally pledged this money to the NIH to support research on “serious medical conditions prominent in athletes…”) This shameful withdrawal came after a study conducted by Boston University published that a total of 87 out 91 former NFL players had tested positive for CTE.

To leverage funding in such a way threatens the very foundations of scientific investigation.

Admittedly, the NFL has to its credit their admission that brain traumas are linked to CTE. That’s the first step, no? And so were the public service announcements in conjunction with the NO MORE Project. But the NFL has a long way to go when one considers its record of direct interference with scientific inquiry, using flawed data to fabricate studies, its dubious ties to the tobacco industry, and its dreadful handling of domestic violence and animal abuse cases. Let’s hope they continue to help mend the wounds and prevent future ones

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