Response to 'Stop blaming football for concussions'

While I would not denigrate Dr. Schaller's experience in any way, I must distinguish between his anecdotes and the kinds

In Dr. Schaller’s Sept. 13 op-ed (“Opinion: Stop blaming football for concussions”), he takes issue with the suggestions my colleagues and I made in an editorial published in Clinical Orthopaedics and Related Research.

In that editorial, we recommended that orthopaedic surgeons distance themselves from the sport of football. Dr. Schaller, a concussion specialist, calls our recommendations “shortsighted” based on his professional experience, saying that only 5 percent of concussions in his practice come from football. He suggests that the solution lies not in “blaming football”, but in improved diagnosis and treatment for concussed patients.

While I would not denigrate Dr. Schaller’s experience in any way, I must distinguish between his anecdotes and the kinds of information that informed our recommendation.

It seems relevant to point out that our editorial wrote about the disabling condition of chronic traumatic encephalopathy (CTE) in football players, and so associating the injury with that sport is difficult to avoid. Of the NFL players studied in the Journal of the American Medical Association (JAMA) report that prompted our editorial, 110 of 111 had both clinical evidence of CTE and evidence at autopsy.

Additonally, we limited ourselves to evaluating rigorous research from leading institutions around the country, published in prominent journals like JAMA. While it might be true that only 5 percent of the patients Dr. Schaller treats were injured playing football, that statistic is driven more by his practice profile than anything to do with the risks associated with that sport. After all, he also says that he treats patients injured in car accidents and at work. So the proportion of football-related concussions in his practice may not be as illuminating with respect to football’s risks, as, say, data from the NCAA, which demonstrate that football causes far more concussions than any other sport—about as many as the next four sports on the list combined. A large epidemiological study of high school athletes painted an even bleaker picture; in that study, football caused nearly as many as the next 10 sports on the list. Notwithstanding Dr. Schaller’s practice experience, the scientific studies we have leave little doubt that football causes more concussions than any other sport.

Finally, I am especially confused by Dr. Schaller’s repeated use of the adjective “shortsighted” to describe our recommendations. I can hardly imagine something more shortsighted than to encourage athletes to continue playing a sport that causes permanent cognitive impairment, dementia, and death while doctors try to work out ways to make that activity safer. How do we know that any of the changes to the game or the new equipment Dr. Schaller proposes will have the effects he desires? The cost of being wrong is steep, and it will not accrue to Dr. Schaller or to me; this penalty will be charged to the athletes, and it won’t be measured in yards or downs.

Our purpose in writing is not to cause fear, but to raise awareness of a serious problem in a popular sport, and to suggest an action that team physicians can take—withdrawing their support for this dangerous activity—that would cause the sport to change.

Seth S. Leopold, MD is Editor-in-Chief of Clinical Orthopaedics and Related Research. He is also a Professor of Orthopaedics and Sports Medicine at University of Washington School of Medicine.

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