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Re: NFL Concussion lawsuits
Cast of Characters
Elliot Pellman, M.D. - Chair NFL MTBI Committee (through 2007)
Ira Casson, M.D. - new MTBI Committee Chair
Paul Tagliabue (past NFL Commissioner)
Troy Aikman, Steve Young, Wayne Chrebet - Fallen soldiers
William Barr, Ph.D. - past NY Jets Npsych
Michael Apuzzo, M.D. - Editor, Neurosurgery, Jets Npsych Consultant
Mark Lovell, Ph.D. - Founder, Director NFL concussion program
Chris Randolph, Ph.D. - Chicago Bears Npsych
NFL MTBI Committee Findings
does not involve significant risk of a second injury either in the same game or during the season.
no evidence of worsening injury or chronic cumulative effects of multiple MTBIs in NFL players.
In practice, according to Pellman's committee, 51.7% of players who suffer concussions -- including a quarter of those who are knocked out -- return in the same game. Pellman has written that "many NFL players can be safely allowed to return to play on the day of injury" and that "the current decisionmaking of NFL team physicians seems appropriate for return to the game after a concussion."
NFL players did not show a decline in brain function after suffering concussions. Further analysis found no ill effects among those who had three or more concussions or who took hits to the head that kept them out for a week or more.
Authors of NFL article dispute the findings: NY Times
2003 NCAA study of 2,905 college football players found just the opposite: Those who have suffered concussions are more susceptible to further head trauma for seven to 10 days after the injury.
2003 report by the Center for the Study of Retired Athletes at the University of North Carolina found a link between multiple concussions and depression among former pro players with histories of concussions.
2005 follow-up study at the Center showed a connection between concussions and both brain impairment and Alzheimer's disease among retired NFL players.
"Pellman's committee has repeatedly questioned and disagreed with the findings of researchers who didn't come from their own injury group," says Julian Bailes, chairman of neurosurgery at West Virginia University.
The Second International Conference on Concussion in Sport met in Prague in 2004 and released the following statement: "When a player shows ANY symptoms or signs of a concussion ... the player should not be allowed to return to play in the current game or practice ... When in doubt, sit them out!"
...some of the findings from that NCAA study. He said the research indicated that the best time to do neuropsychological tests on players with concussions was after their symptoms had completely cleared, usually five to 10 days after the trauma.
Players who recalled one or two concussions were 11/2 times more likely to be diagnosed with depression, said Kevin Guskiewicz, research director of the University of North Carolina's Center for the Study of Retired Athletes.
(in response) NFL spokesman Greg Aiello told The Associated Pres that the study, while interesting, "does not prove anything, and we want to know more." Aiello said the league is spending $2 million to conduct its own study of retired players.
Pellman is a rheumatologist by training -- a specialist in the treatment of joints and muscles -- not a neurologist. For another, when he started out, he often professed ignorance about the subject in question. "I would hear him say things in speeches like, 'I don't know much about concussions, I learn from my players,' and, 'We as a field don't know much about concussions,' and it used to bother me," says one doctor. "We knew what to do about concussions, but he was acting like it was new ground." Their dismay has only increased since The New York Times revealed last year that Pellman attended medical school in Guadalajara, Mexico, and does not hold a medical degree from SUNY Stony Brook, as he once claimed. "When neuropsychologists sit around telling jokes, we call him 'Mr. Pellman,' " says a colleague.
Pellman, Lovell and the committee planned to look at baseline results and identify a normal range of scores for uninjured NFL players. Then, comparing postinjury scores to baseline data would show the effects of concussions. Comparing data from players with multiple concussions to that of all injured players would show whether concussive effects changed as injuries accumulated.
the first study ever to analyze the brain function of NFL athletes.
If it showed that concussions were significantly impairing players, the league might be forced to institute new rules for evaluating and treating head injuries.
Pellman and Lovell both say they invited all teams to participate in the research (Lovell says 11 teams elected to join the study) and tried to collect as many results as they could. As Lovell puts it, "More data is always better."
Barr, for example, conducted 217 baseline tests from 1996 to 2001. Periodically, he forwarded results to the league, but at the time Barr learned the committee was planning to publish its results, he had sent only 149.
Barr remembers finding Pellman in the Jets' training room in 2003 and saying, "Elliot, I haven't sent data for a year."
According to Barr, Pellman didn't want the additional tests. "I don't want the data to be biased because I'm with the Jets," Barr recalls him saying, suggesting that additional results would skew the data because the Jets would be overrepresented in the sample. That made no sense to Barr. A scientific study should include, or at least address, all available data.
Barr's wasn't the only research that didn't make the cut. Over the period covered by the committee's research, Christopher Randolph, a Chicago neuropsychologist, collected baselines for 287 Bears players. He says Lovell never asked for his data, either.
Nor did the committee seek complete data from John Woodard, neuropsychologist for the Falcons and associate psychology professor at the Rosalind Franklin University of Medicine and Science in North Chicago. According to Woodard, in December 2003, Lovell said the league was pressuring him to compile team results. "I was asked to provide data on only concussed players," Woodard says. "I had data for slightly more than 200 baseline evaluations. I don't know why I was not asked for them."
In 2004, Lovell also asked Richard Naugle, consultant to the Browns and head neuropsychologist at the Cleveland Clinic, for data on just the players who had already suffered concussions, according to an e-mail Naugle wrote to a colleague in March 2005.
This means Pellman, Lovell and their colleagues didn't include at least 850 baseline test results in their research -- more than the 655 that ultimately made it into their 2004 Neurosurgery paper. At best, their numbers were incomplete. At worst, they were biased. "That's news to me," Lovell says now. "My job was to collect as much data as I could."
In an Oct. 22 letter to The Magazine he wrote that "at no point was there ever an attempt to exclude teams from participating. Not only is this counterintuitive with regard to the goals of the project, but this assertion seems to suggest that there was an effort to suppress the collection of data for the study." The letter continues, "This is completely baseless. If there is data that was not included, I either did not know about its existence, the team and/or neuropsychologist did not want to participate, or the data fell outside the time parameters."
In November 2003, UNC's Guskiewicz was scheduled to appear on HBO's Inside the NFL to discuss his research that showed a link between multiple concussions and depression in 2,488 former pro football players. Pellman, who was also going to be on the show, called Guskiewicz. "I had never spoken with him before, and he attacked me from the get-go," Guskiewicz says. "He questioned whether it was in my best interest to do the show. He was a bull in a china shop."... On the program, Pellman said flatly, "When I look at that study, I don't believe it."
Like most academic journals, Neurosurgery publishes work that has been peer-reviewed. Other scientists evaluate the design and execution of the studies, though they don't vouch for the accuracy of the data presented. Unlike most academic journals, though, Neurosurgery allows those peers to print their comments directly following the studies. In the case of the committee's sixth paper, even without any evidence of missing tests, the reviews were harsh. "When you look at the comments, what's striking is how strongly they are worded," says Chris Nowinski, author of Head Games: Football's Concussion Crisis. "They're full of phrases like 'perplexing,' 'obvious problems' and 'overinterpreted.' But the media reports what studies find, not what reviewers write."
The decision to publish the paper was controversial. "I highly doubt this study would have seen the light of day at this journal were it not for the subject matter of NFL players," says Robert Cantu, chief of neurosurgery and director of sports medicine at Emerson Hospital in Concord, Mass., and a senior editor at Neurosurgery.
Lovell Comments: link
Authors respond: link
I can't help but look at the concussions I sustained as a reason for the headaches, the depression, the blurred vision, the slurred speech that I might have at some times," Hall of Fame linebacker Harry Carson told Outside the Lines. Carson, who played for the Giants from 1976 to 1988, continued, "When I look back at the many hits I inflicted on people and at some of the hits I have gotten, it becomes clear to me that not only was I abusing my body, I was also abusing the gray matter in my skull."
"Six weeks after I was forced to retire, when I had started to feel better, I had an appearance at a wine-tasting event," says the ESPN analyst. "The moment the wine touched my lips, I went blind for the most terrifying 10 seconds of my life. My doctor later explained I had probably suffered trauma in the vision area of my brain. I think that speaks to the cumulative effects."
"I took a blow to the head during a Monday-night game for the Bears against the Chiefs, and I had amnesia on the plane ride home five or six hours later," Hoge says. "That's when the team doctors decided my return-to-play date. Four days later I was practicing, and I realized I was struggling with learning new plays." Five weeks into the 1994 season, Hoge took another hit, walked off the field and into the locker room, and passed out. For about 15 seconds, he even stopped breathing. "I had to learn how to read again," he says. "You could take me around the block and I'd never get home."
All generalizations are dangerous.