
Concussion doctor says he found CTE in living NFL player - CaliforniaKarl
http://www.mercurynews.com/2017/11/16/renowned-concussion-doctor-says-he-found-cte-in-living-nfl-player/
======
outsideoflife
For my American cousins I thought I would mention a little more about Rugby
Union. Concussion is less of a problem in Rugby than in American football, and
this is not an accident. Rugby is addressing this in several ways.

1) Years of rule changes, and stricter enforcement. Now a top level player who
tackles someone above the shoulder, or tackles without attempting to hold on
(so no clothes-linse or body checks) will be sent off (which in Rugby is
catastrophic to your teams chances). If you lift a player off the ground you
are responsible for putting them down again. Drop them on their head and
expect a lengthy ban. This hasn't changed the spectacle of Rugby much, if
anything the skill levels have improved.

2) Protection. Around your head Rugby only allows you to wear a small soft
'scrum cap' which protects from bruising and wounds from head clashes, like
the things boxers suffer with around their eyes. Their is a light collar bone
protector which seems to be about 1/5th of the thickness of the equivalent
Gridiron gear. That is all. The impacts are still impressive to see, indeed
are perhaps more impressive on an un-armoured body, but with lower G-force to
the head

3) The size of the people. In both sports their has been an increase in the
mass of the players. However US football players seems disproportionately
massive. In Rugby their are not rolling substitutions, so you have to carry
that mass around for 80 minutes, and therefore a compromise is necessary,
perhaps gridiron could restrict the number of subs, or the squad size so the
bruisers actually had to run. The _miracle of sports nutrition_ , with the
characteristic protruding jaw bones, seem to be producing bigger players than
they may if they had effective controls against doping. Yes I said it, from
across the pond, it looks like steroid abuse is rife in several US sports.

4) The concussion protocol. Any player that appears to have been knocked out
in Rugby gets sent from the pitch to be examined by a doctor for a minimum of
10 minutes. If concussion is detected there is a mandatory period off playing.
If concussion recurs this can be months! Welsh International George North
suffered repeated concussions and missed most of the following year.

During this same period Rugby has become a tougher sport than ever, but
without killing the brains of our young men

~~~
prodtorok
I'm sorry but as someone in the U.S. who played competitive rugby for 7 years
I have to completely disagree.

In rugby I myself had experienced concussions from collisions at least once a
season. Anyone I know who has played have experienced similar.

Less protection to the head means lower g-force hits sure, but still I've seen
players knocked unconscious by pure body collision hits or an accidental knee
to the head (this happens a lot more than you think) ... in fact in my 4 years
of high school football I rarely, if ever, saw anyone knocked unconscious...
where in rugby I can recall a handful of incidents.

Rugby has no room to outshine football in this manner. Such a foolish
arguement.

~~~
pnutjam
Might be US culture vs others. Football probably has an influence on how Rugby
is played in the US.

------
mobilefriendly
There's a lot of hate towards the NFL but the NCAA is an even worse actor on
CTE. 70,000 college players every year, and they aren't paid professionals
like the NFL. But NCAA programs make billions of dollars off of the players
(and their coaches millions). Destroying brains for profit, in the context of
the education system, is truly evil.

~~~
golergka
I don't understand these arguments. Are they forcing players to do it? If the
players are well aware of health risks and still make decision to play the
game, how is the sports organization to blame?

~~~
clort
Your premise is wrong. It _sounds_ as if it should be right, but the framing
is awry

The players are not really aware of the health risks, furthermore they are
young and foolish and impressionable and are following the path of glamour
which has been sold to them as youngsters.

The sports organization _is_ aware of the risks and are using the players to
make vast sums for themselves, they are pushing the glamourous path and they
are not supporting the discarded players. They are ignoring the debt to
society incurred generating their profit and that is not good unless you think
that their tax payments should cover it (do they? I don't know..)

~~~
FLUX-YOU
>The players are not really aware of the health risks, furthermore they are
young and foolish and impressionable and are following the path of glamour
which has been sold to them as youngsters.

I think a great deal of them would still choose to play despite knowing the
risks. There are likely neighborhoods where people raise families that are
less safe than playing in the NFL.

And I'm sorry, but 25 year olds are not "young and impressionable" any more,
so I don't buy that defense. These are adults making adult decisions:
[http://www.footballperspective.com/2016-av-adjusted-team-
age...](http://www.footballperspective.com/2016-av-adjusted-team-age-overall/)

What I would buy as a defense is that NFL has a serious amount of propaganda
and actively works to suppress medical knowledge which can fool anyone, child
or adult.

It is a very similar kind of propaganda for selling military careers by
associating it with video games to high schoolers except that you can actually
join the US military at 17 with parental consent.

~~~
azernik
This particular thread was about the NCAA, which _does_ recruit players at
17-18 (just entering college).

~~~
0x445442
The recruiting actually starts earlier than that for the most gifted players.

------
pizza
"I can't believe people were so dumb about smoking in the 1950s.. how were
they so dumb? did they not know it caused cancer?"

this is a kinda modern equivalent, imo..

~~~
code_duck
The thing is that both activities were always clearly likely to be harmful, if
you took a step back from the cultural perspective that accepted them so
thoroughly.

Smoking tobacco is inhaling an acrid a mix of chemicals that makes you cough,
kind of feel sick and lightheaded, smells awful and leaves a tan stain - it’s
not hard to guess that it’s not healthy. Remember that half of people who die
from tobacco die from heart disease, too, not cancer.

Same with football. I was never attracted to sports where participants beat
each other in the head repeatedly, whether it’s boxing or football. I don’t
think it’s surprising to find out that people who experience concussions every
week as part of their jobs and hobbies end up damaging their brains.

Edit to add, It’s a bit frustrating, because surely if one was to stand up 30
years ago and say “hey, I don’t think this high school football program is a
good idea because I’m worried about all these young people knocking their
heads together with full force”... The response would have been to mock you
and dispute it, if they paid any attention at all.

~~~
whyleyc
"Both activities were always clearly likely to be harmful".

With the benefit of 70 years of medical research this is an easy statement to
make, but at the time this was far less clear - smoking was for a long time
actively promoted as having health _benefits_ [1][2]

It's easy from a modern perspective to look back and apply our accumulated
wisdom, but it was not self-evident that smoking was necessarily bad.
Otherwise millions would not have signed up for an early death.

[1][https://www.healthcare-administration-degree.net/wp-
content/...](https://www.healthcare-administration-degree.net/wp-
content/uploads/2013/04/8-Philip-Morris–Scientifically-Proved-Far-Less-
Irritating-To-The-Nose-And-Throat.jpg)

[2][https://i.pinimg.com/736x/40/50/4f/40504f0de983d78f3c0f0b22c...](https://i.pinimg.com/736x/40/50/4f/40504f0de983d78f3c0f0b22c2de0a3b
--retro-ads-vintage-ads.jpg)

~~~
nol13
And yet the stereotype of the dumb football jock who's had his head knocked a
few too many times has been prevalent as long as I can remember. It's just
that previously it was used as a punchline in sitcoms rather than seen as a
serious health risk to our children.

Except for 'Varsity Blues' (1999) I guess, and I'm sure other examples, where
the evil coach telling the kid to play when another head injury could kill him
was a main plot line.

~~~
wils1245
That may be so, but the widespread knowledge that most/all football players
sustain serious brain damage was not there yet. Big hits that left the
opponent slow to get up or unsteady on his feet were celebrated, on the
assumption that he’d be able to shake it off after a day or so.

That said, I do think the destructiveness of football in knees and backs has
long been known. I remember them being detailed when reading “where are they
now?” articles in Sports Illustrated as a kid (I’m 30).

~~~
code_duck
The scientific knowledge was not there yet, but I feel like it’s not hard to
put together that football players and boxers suffer damage from being knocked
in the head to dozen times a day for decades. My guess is probably this would
have been figured out earlier if there wasn’t such a strong cultural desire to
keep playing these sports.

------
elchief
Aaron Hernandez (New England Patriot, murderer) had severe CTE when he died at
27

[http://www.cnn.com/2017/11/09/health/aaron-hernandez-
brain-c...](http://www.cnn.com/2017/11/09/health/aaron-hernandez-brain-
cte/index.html)

------
billmdsf
When NFL players can be diagnosed while they're still playing, or even
identify how much their Tau proteins increase after a big hit, that will have
a big impact. It seems like it's still easy enough to not think about dying
early when getting concussed.

------
isatty
CTE - Chronic traumatic encephalopathy[0] for anyone else who was confused.
The author uses it countless times without explaining what it is.

More details - Currently, CTE can only be definitively diagnosed by direct
tissue examination after death, including full and immunohistochemical brain
analyses.[15] The lack of in vivo techniques to show distinct biomarkers for
CTE is the reason CTE cannot currently be diagnosed while a person is
alive...[1]

[0]
[https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopat...](https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy)

[1]
[https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopat...](https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy#Diagnosis)

~~~
anigbrowl
The very first line of the story says what it is: _Researchers have identified
the degenerative brain disease known as CTE..._

It's a newspaper rather than a scientific journal so I think they can be
forgiven for not expanding the acronym, just as newspapers commonly report
heart attacks rather than myocardial infarctions.

~~~
acchow
For the vast majority of their readers "Chronic traumatic encephalopathy" is
just as uninformative as "CTE".

~~~
anigbrowl
Well yes, that's the point of saying 'degenerative brain disease' instead.

------
vuyani
If anyone is curious, this is the doctor played by will smith in the movie
concusion
[https://www.youtube.com/watch?v=Io6hPdC41RM](https://www.youtube.com/watch?v=Io6hPdC41RM)

~~~
lstyls
From the article:

> Now the San Joaquin medical examiner, Omalu was featured in the movie,
> “Concussion.”

------
enraged_camel
I’ve never been a huge football fan but never avoided it either. Until, that
is, when we started hearing about CTE and how the NFL tried (still tries) to
cover it up and downplay it.

Today I find football unwatchable. Every time I see players slamming into each
other at full speed I feel queasy. I’m also ethically against watching it
because I don’t want to support the football industry. There are many other
sports in the world I’d rather watch.

~~~
jim-jim-jim
The rules of football make for a really interesting game, but the fact that
the NFL/NCAA are such awful organizations + the growing concerns about its
safety make it impossible for me to actually enjoy it. Hopefully we'll have
robots playing it for us one day.

~~~
edejong
Hopefully robots will eventually be intelligent enough not to willfully damage
their central processing unit.

~~~
throwanem
Thus leading to remotely piloted football bots and the Super Bowl wifi
eavesdropping scandal of 2079.

------
ekianjo
The article contradicts the title. The tau protein test using markers is
unable to diffentiate between CTE and Alzheimer. And by the way there are
already FDA approved Tau protein tests on the market so from the article it is
not clear what is the new discovery about.

------
snomad
Their is some measurable chance the NFL and football disappear w/in 30 years.
Sooner or later a college / high school will lose a lawsuit for a player
w/CTE, and schools will have no choice but to stop participation. Once that
happens, talent level and interest in the sport will die off. Kinda silly
cities are in such a rush to continue building new stadiums.

The unspoken elephant whenever these studies come up is skiing and
snowboarding. Lots more participants, and I bet the concussion rate is
similarly high over X number of visits. Damn well better not make me wear
helmet though, my worst injuries came when I had one on (overconfidence
syndrome)

~~~
tartuffe78
The NFL has a minimum salary of $450,000. 3-4 years in NFL at that will earn
you more than the average American earns in a lifetime. That's probably a
rational economic trade-off for the risk of CTE.

~~~
paulcole
NFL salaries aren’t guaranteed by default. That 450k is paid weekly during the
season and the player can be cut at any time. I don’t know what the median
amount of money earned by NFL players is but it is likely well below 1.5
million.

------
elhudy
According to the article, the doctors believed they had spotted CTE in a
living person, and confirmed that their research was correct upon finding CTE
after the person's death. I am having trouble understanding how finding CTE in
an NFL linebacker after his death is valid confirmation that previous tests
were accurate. What are the odds of finding CTE in an ex-NFL linebacker? One
in two?

~~~
dhimes
It's not valid confirmation- the doc said this. He is working on a diagnosis
and wasn't sure he was distinguishing between Alzheimer's and CTE. On death,
he examined the subject and it was CTE. He's just announcing that result to
those following the story. There's a lot more testing to do before he can
claim diagnosis.

------
joekrill
It's not conclusive:

> But the scan also identifies protein found in Alzheimer’s patients, making
> it difficult for a definitive conclusion. That’s one reason Omalu performed
> a postmortem exam of McNeill to confirm the results.

So it indicates you've either got CTE or early signs of Alzheimer’s -- bad
news either way.

------
madebysquares
This would be a game changer and potentially life saving for hundreds of
athletes in all contact sports but mostly American football. I they can find
the funding they need to further their research.

~~~
icelancer
The problem is that the NFL stifles and blocks as many methods as possible in
this regard. Though I'll admit it's rapidly changing, and for the better.

------
ulrikrasmussen
Does the difficulty in diagnosis stem from the fact that it is hard to
differentiate CTE from other degenerative brain diseases, or is it just hard
to diagnose in the living altogether? I mean, is the presence of
Alzheimer's-like symptoms a necessary but not sufficient condition? Being able
to rule out the condition would be very valuable to former contact sport
athletes worrying about the disease.

~~~
tmh79
from what I understand, it is currently a chemical test that requires a biopsy
or tissue sample, which is difficult to get from the brain because well, you
remove part of the brain, which is bad.

~~~
ulrikrasmussen
Right, that is to diagnose CTE post-mortem. But does CTE also cause other
phyiscal symptoms which are just indistinguishable from regular Alzheimer's?
For instance, would a person with CTE also have visible plaques on an MRI, or
is the disease really invisible in the living?

The fact that they found CTE in 110 out of 111 NFL players post-mortem should
indicate that they had a pretty good idea about which players to pick for
autopsy. Was those picks based on their history of psychological issues alone,
or were there other indicators such as definite signs of Alzheimer's?

~~~
ddorian43
Many brain disease don't show on MRI (schizophrenia, depression, bipolar etc).

------
jjie2221
Question for football fans: Would the game suffer that much if we changed the
rules to reduce contact? Say, like flag football?

~~~
dlp211
Yes, significantly. One of the biggest draws of football, for better or worst,
is the tackling. People watch to see the big hit and the great escapes to
evade the tackling. Here is just a single example:
[https://www.youtube.com/watch?v=s8geJp5mVLA](https://www.youtube.com/watch?v=s8geJp5mVLA)

If the game used flags, the quarterback would have almost certainly been down.
Instead he runs for a first down and keeps his offense on the field.

~~~
wils1245
Spot on. As further example, check out Barry Sanders highlights:

[https://youtu.be/eygZLsdKGQM](https://youtu.be/eygZLsdKGQM)

The NFL in slow motion can be beautiful to watch in slow motion. These plays
aren’t nearly as exciting without the risk of contact and Sanders’ opportunity
and ability to break tackles.

That doesn’t mean the game as we know it shouldn’t go.

------
horungefitta
most of the damage is done in practice, off season, claims former pro football
player Brendan Schaub. (they butt heads over and over again).

sohatever rule changes are suggested to the game it needs to adress the off
season practice as well.

------
nerglish
common table expression?

~~~
LearnerHerzog
Chronic Traumatic Encephalopathy

[https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopat...](https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy)

------
rurban
More importantly "110 of the 111 brains of former NFL players examined had
CTE". So how stupid can you be?

In a healthy society this sport would be forbidden by law.

~~~
kakarot
> In a healthy society this sport would be forbidden by law.

Give me a break.

Are we going to ban football at home, too? Or just at school? What about
community leagues?

In a healthy society, the dangers would be well-known, minors would always
have a right to refuse and forcing a minor to play would be considered child
abuse, and children would have to be old enough to form rational opinions
before being eligible for leagues or scholastic play.

It is not the role of law to keep people from being able to do dangerous
things. Law exists to keep people safe from others, and to keep people from
being a danger themselves, but not from being a danger to themselves.
Consciously choosing dangerous behavior in exchange for some reward is an
inalienable human right.

Such a draconian law has no place in a healthy society.

~~~
rurban
It has. Compare to healthy societies.

~~~
kakarot
Could you elaborate?

~~~
rurban
Well first, football trainers in highschool and college would face a lot of
lawsuites, supporting and even causing death threatening concussions on
innocent teens. Which would lead to reforms, like amateur boxing helmets.
Which would not be enough, given the football rules and mindset. But loosing
the support from amateur sports would lead to less support in the professional
killing game. Mom's have a lot of power.

------
basicplus2
CTE

Chronic Traumatic Encephalopathy (degenerative disease)

------
lamename
Paper: [https://academic.oup.com/neurosurgery/advance-
article/doi/10...](https://academic.oup.com/neurosurgery/advance-
article/doi/10.1093/neuros/nyx536/4616608) (maybe paywalled)

------
wdewind
I didn't grow up playing or really understanding sports. I was one of those
guys who joked about "sportsball" and stuff like that. When I started really
taking weight training seriously I started having a frame of reference for
understanding sports and started really appreciating them. Football is a sport
that is designed to really allow people to showcase the limits of the human
body. The most impressive athletes in any sport in the world are in the NFL
and when you think about the things that happen in any single game, they truly
are spectacular. OBJ's "The Catch" is one of the most impressive things in the
history of sports period.
[https://www.youtube.com/watch?v=818_M8gOnqQ](https://www.youtube.com/watch?v=818_M8gOnqQ)

But the NFL is finding itself in a really tough position. I love this sport,
but I find it ethically difficult to watch now. It would be one thing if the
NFL was doing everything it could to protect its athletes, but it's absolutely
clear they are trying to bury their heads in the sand on this one:

> “We need a couple million of dollars. What is stopping us is the money.
> We’re ready to roll.”

Think about this: we currently have no way to diagnose CTE in living people,
we think we may have a way, the "we" in that is pretty credible as its the
person who discovered CTE, and it will cost roughly $2mm, and the NFL isn't
tripping over themselves to write the check for some reason. It would cost 12
seconds of superbowl ad revenue to fund this, and in fact the NFL has pledged
$100mm to investigate CTE, but basically they just aren't doing it:
[http://www.espn.com/espn/otl/story/_/id/20509977/nfl-
takes-c...](http://www.espn.com/espn/otl/story/_/id/20509977/nfl-takes-
control-brain-research-100-million-donation-all-ending-partnerships-entities)

This is kind of shameful, and as a fan of this sport I really hope they figure
out how to have a better position on this issue, because what's going on right
now is not sustainable.

~~~
robbiep
That’s a highly cultural-specific viewpoint. For example Rugby union, league,
AFL etc are all contact sports with huge followings - I can’t understand let
alone (and probably because of my lack of understanding) stand NFL which I
personally think culturally encapsulates an American approach to the world -
this is the offence team, this is defence, let’s pad up and beat the shit out
of the opposing side. Compared to the other three which display to my way of
thinking a fluidity and flexibility that I believe to be more skilful and also
a reflection of a deeper cultural flexibility. But now my cultural biases are
flooding out heavily.

What is interesting however is that neither rugby union, league or AFL have
anywhere near the level of concussive damage, maybe because the lack of
protection leads to a different approach to bodily harm. Full disclosure, one
of the products my company makes and is commercialising in Australian Rugby
Union is a concussion monitoring system so this is a deep interest of mine
both from the tech/commercial side but also the medical side.

You are right though, greater awareness of the risks is going to endanger
these sports. A parting word of hope - we still allow boxing, and CTE is
medically known as ‘punch drunk syndrome’ from the first reported cases of the
medical literature.

Concussion management is a rapidly evolving field and my sister (for whom I
built the side project which we are now commercialising) thinks that being
able to have a biochem test like we do for heart attacks would totally change
the field - big head knock, troponin-like test, then follow up and treatment
as appropriate. It’s super interesting and we need to put players first
whatever we do

~~~
icelancer
>>That’s a highly cultural-specific viewpoint.

What is? That the NFL has the best athletes in the world?

If the NFL athletes trained for a year to do anything else, or you put all the
athletes in the world into a decathalon of power/speed/strength specific
events, it would be an insane blowout.

NFL players would crush every other group of athletes individually and
probably combined, and I say this as someone who has worked with Rugby Union
and AFL players in Australia. There is no comparison, they are the best
athletes in the world for any fair value of _athletics_ you want to use.

~~~
ascorbic
Are you saying that almost all of the best athletes in the world just happen
to be born in America? Or are you claiming that the NFL training regime is so
good that it allows them to beat everyone else in the world? Why would that
be? It can't be the money. There's a lot more money in soccer, and unlike NFL
it has a pool of talent that covers the whole world.

~~~
eru
And no salary caps, and no closed-shop leagues.

------
donquichotte
"The most impressive athletes in any sport in the world are in the NFL"

What a ridiculous statement to make! Even probabilistically this makes no
sense, since the players are selected out of 3e8 out of 7e9 humans. Check out
socker players, marathon runners, climbers etc and you will see that every
sport has their very own geniuses.

~~~
naeem
Marathon runners, climbers, etc you mentioned have a pretty narrow field of
physical competence. No way in hell a climber can compare athletically to
LeBron James.

------
aviv
> Researchers are working to develop a test for people still alive so they can
> begin to study the disease more comprehensively.

What more is there to study? Getting knocked in the head for years is bad for
you. Do we really need scientists to tell us this? Who in their right mind
thinks getting hit in the head on a regular basis will have no negative
affects on their well-being? The solution is not some new treatment - it's
to... uhm, stop getting your head knocked on a regular basis.

~~~
coliveira
That will be the logical thing to do, but you know... money... the NFL doesn't
seem to care about anything else.

~~~
aceofspad3s
Why blame the NFL? It's not like the players are doing it for free.

~~~
saboot
Because the NFL could "easily" change the rules to minimize the effects of
CTE. Easily is in quotes because it's easy except for a fear of losing money.

~~~
slg
It really can't. There are many potential smaller changes that could shave a
percentage point or two of the risk factor (and the NFL has already made a
handful of those type of changes), but the game of football is setup in such a
way that head trauma is a guaranteed byproduct. As other pointed out, the
cigarette argument is apt. You can make things marginally safer, but there is
never going to be such a thing as a "safe cigarette".

