Frontline recently reported on data released from Boston University and the Department of Veterans Affairs demonstrating that out of 91 former National Football League (NFL) players, 87 had Chronic Traumatic Encephalopathy (CTE). This degenerative brain disease is believed to be the result of repetitive head trauma, and can lead to memory and mood disorders.  It is unclear why the disease develops in some players but not others.
The findings of the above study come with several limitations. In particular, the gold standard for CTE diagnosis is examination of brain tissue postmortem. The data comes from players who were concerned during their lifetimes that they showed symptoms of the degenerative disease and arranged, upon death, to donate their bodies and brains for analysis. As a result, the prevalence of CTE suggested by the data may be skewed due to selection bias. The brains examined post-mortem came from athletes already concerned about CTE because of their clinical symptoms, making it much more likely that the investigators would find evidence of the disease. The ongoing work at Boston University and the Department of Veterans Affairs is a retrospective analysis that cannot determine the cause of CTE. It is important, however, for the identification of factors that are correlated with the disease, which may spark more interest and lead to more focused research on the topic. Even so, the disease was present in 96% of those who were tested. This finding is both remarkable and eye-opening. It demonstrates a real concern for athletes in contact sports like football.
Organized football poses a risk of concussions. Chris Borland was a college linebacker and All-American drafted into the NFL in the third round in 2014. Although he only had two diagnosed concussions, one during eighth-grade soccer, and the other playing high-school football, he estimates that the actual number is closer to thirty. On March 13, 2015, Borland retired from the league via email.  He has since described the move as preventive and outlined his determination to prevent the degeneration of his own brain. The NFL is aware of the risk posed by concussion and has focused on decreasing the rate of this injury. In their 2015 Health & Safety Report, the NFL published a thirty-five percent decrease in regular-season concussions from 2012.  According to the data shared with Frontline, however, forty percent of those determined to have CTE were offensive and defensive linemen, players who have repetitive, sub-concussive hits on nearly every play.  This suggests that recurrent, lower-intensity blows may also lead to CTE.
Chronic traumatic encephalopathy is not unique to football players. It can be seen in other athletes, military veterans, epileptics, abuse victims, and circus performers who are shot out of cannons.  The scientific and medical communities should not delve into the controversy of any alleged cover-ups as discussed in the Frontline documentary A League of Denial.  Rather, our focus should be on furthering research, because our understanding of this condition is still in its infancy.
Rates of CTE in the general population or even in the professional football community have not yet been established. The gold standard of scientific experimentation, the double-blinded, randomized controlled trial is not an ethical or practical possibility in this case. Players without symptoms of CTE must be analyzed to allow for characterization of healthy persons as well as sub-clinical disease. This may help identify why some people are afflicted with the condition and not others. Those who suspect they may have CTE should be granted medical care and follow-up to help the scientific community better understand the degenerative progression of the disease. Research should not be limited to professional athletes, as college and even younger athletes may be at risk of developing CTE. It also should not be limited to football, as head trauma occurs in many sports. It is important for professional organizations and sports fans to support research and efforts to implement relevant safety measures to preserve the health of their favorite athletes and to enhance the quality of the sports they enjoy.
- Breslow, J. (2015, September 18). New: 87 Deceased NFL Players Test Positive for Brain Disease. Retrieved September 20, 2015.
- Fainaru, S., & Fainaru-Wada, M. (2015, August 21). Why former 49er Chris Borland is the most dangerous man in football. Retrieved September 20, 2015.
- 2015 NFL Health and Safety Report. (2015). Retrieved September 20, 2015, from http://static.nfl.com/static/content/public/photo/2015/08/05/0ap3000000506671.pdf
- Hanna, J., Goldschmidt, D., & Flower, K. (2015, October 11). 87 of 91 tested ex-NFL players had brain disease linked to head trauma. Retrieved October 12, 2015.
- Frontline. (2013). League of denial: The NFL’s concussion crisis [Motion picture]. United States: PBS
Football 10.18.08 by Mike Hoff