During this week’s Super Bowl, we all will get a chance to star in Gladiator–thankfully not as one of those Russell Crowe guys who gets ripped to shreds, but rather as an extra up in the bleachers: one of the wealthy, the drunk, the dudes with a hot date ready to watch the lions do their carnivorous stuff.
However than dismemberment and crushed bones, we Super Bowliators will witness a more subtle actuarial event—the early moments of chronic traumatic encephalopathy (also called CTE). It will be years till we know which players will be affected but one or two (or three or four) eventually will appear as the sad story on page 20 of the sports section.
CTE is a progressive neurologic syndrome that causes an array of symptoms, from dementia to severe headaches to suicidal depression. Only five years have passed since its first descriptions by pathologists and its bona fides in the most orthodox academic neurologic circles are not fully established. Yet the epidemiologic and neuroanatomic evidence is extremely compelling: it appears to be the direct product of frequent impact-related brain injury. To date, it has been found at autopsy in a variety of athletes, professional and amateur alike.
One and all seem stunned that repeated high impact trauma over years could actually cause a problem–though in boxing the association is so well-established (and self-evident) that they have bequeathed a Latin-ish name, dementia pugilistica (a.k.a., being punch -drunk), on the syndrome. But even for football the news is not new. More than 100 years ago, the doctors for the Harvard football team described a player who “still complains of difficulty in studying and concentrating his mind and of almost constant headaches” one to two years after his concussion.
So here we are with a real problem: behind curtain one, we have the greedy sports commissioners of various stripes who oversee the multi-billion-dollar sports industrial complex; behind curtain two, players who want to play, who are really talented, who want fame and fortune; behind curtain three, the drooling American public (including me) who loves it all—the violence, the danger, the incredible might of a great football game; and behind curtain four–way behind curtain four, the dithering doctors who meekly report these things, then run the other way to avoid the possibility of being yelled at.
The habits of this last group surely are not new: we doctors have been comparably pathetic through the decades, failing to stand up for the public health in issues such as cigarettes, firearms, automobile danger, obesity, nuclear war, and on and on. To be fair, we often have other public-health catastrophes with more immediate bite and for the acute we’re there: avian flu–count us in; SARS—where do I sign up? Katrina—next plane. Semper paratus.
But here’s how leading CTE scientific investigators want to approach the problem: “Data from helmet concussion monitors that are used on soldiers and football players can aid in predicting the character and location of lesions from an impact of a given force at given coordinates while improving the accuracy of diaries of people at risk for traumatic brain injury. Accurate diaries, in turn, should help in determining more accurately the number and severity of head injuries, allowing estimation of athletes’ cumulative risk.”
In other words, citizens—we will study the problem! For a few years! OK then!
Given this confluence of remarkable greed, desperation, and dithering, I have a very immodest proposal—let’s stop playing football till we can sort this out. That’s right—no Super Bowl XLVI and maybe no XLVII either! Why the long face? After all, we live in a country where no one seemed too bent out of shape over stopping the U.S. government. Just last year, we allowed a few pissed-off congressmen to have a tantrum or two over—wait, I can’t even remember the reason, and they drove the government to the brink before backing down. And football players themselves this very year decided their cut of the dough wasn’t quite right and were locked out until it could be sorted out.
We doctors have been comparably pathetic through the decades, failing to stand up for the public health in issues such as cigarettes, firearms, automobile danger, obesity, nuclear war, and on and on.
For physicians worried that the evidence on CTE just isn’t there, I say this: our job is not to oversee the conduct of a giant clinical trial on the entire human population, then prepare PowerPoint slides for the next meeting. We have allowed our pursuit of solid evidence to serve as an alibi for our collective professional paralysis: can’t intervene—no evidence. This stance conveniently provides us (and us alone) a double benefit: we both are ennobled by insisting upon clean data while being relieved of the pressures of decisionmaking or responsibility.
But please–it is not better, more-accurate helmet monitors we need or a new stain that can demonstrate tau protein more convincingly or a PET scan that can show CTE earlier or better or differently. It’s us doctors, all 500,000 of us saying enough already, thumbs down on Russell Crowe and Eli Manning and the lot of them. We should not allow the gladiatorial slaughter to continue. And remind me—just what additional data are we waiting for?