“Tell the truth! Tell the truth!” (3). In the 2015 film, Concussion, Dr. Bennet Omalu’s words represent one of the greatest crises of our time–the issue of seeking truth in an age of alternative facts. With his 2005 discovery of Chronic Traumatic Encephalopathy, or CTE, Dr. Omalu found himself entrenched in a battle for truth against one of America’s largest corporations: the National Football League. After fighting for his research for years, the scientific community achieved a small victory with the NFL’s public acknowledgement of CTE in 2016. In a hearing of the U.S. House Committee on Energy and Commerce on March 14, 2016, Representative Jan Schakowsky of Illinois asked, “Mr. Miller, do you think there is a link between football and degenerative brain disorders like CTE?” Senior Vice President of Health and Safety Policy for the NFL, Jeff Miller, responded, “The answer to that question is certainly yes” (4).
Many Americans may think of this moment as a conclusive victory of science, and of truth, over an unbelieving corporation. A battle was fought and won, then America moved on. However, the American public seems to suffer from a severe case of tunnel vision, focusing on the questionable ethics of the NFL to the exclusion of all other pro-football organizations. Most notably, the National Collegiate Athletic Association, an organization that claims to support and protect student-athletes, still fails to recognize the possible consequences of contact sports, even as evidence of CTE in athletes mounts. While we currently have more hope for CTE prevention and treatment than ever before, it is of the utmost importance that the American population does not forget the failure of the NCAA to defend the health and safety of its student-athletes.
Chronic Traumatic Encephalopathy was discovered by pathologist Dr. Bennet Omalu when he examined the brain of a former NFL player. The football player in question had suffered from a history of cognitive impairment, mood disorder, and Parkinsonian symptoms. When examining this athlete’s brain, Dr. Omalu identified diffuse amyloid plaques, neurofibrillary tangles, and tau-positive neuritic threads in neocortical areas–all of which indicated a possible neurological explanation for the athlete’s behavior in life (6). More importantly, this case suggested that there might be a connection between mild, yet repeated, brain injuries sustained while playing football and neurodegenerative outcomes for the athletes. While this study presented groundbreaking findings, Dr. Omalu suggested that further research be done in order to be sure that the findings in this sample of one were truly connected to brain injuries sustained while playing football (6).
Further research into CTE brought to light features of its pathology, in addition to notable clinical indicators. In its pathology, CTE is represented by progressive brain atrophy, accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, protein aggregation, microvasculopathy, myelinated axonopathy, neuroinflammation, protein aggregation, and white matter degeneration (2). Currently, these features are only identifiable with study of the brains of deceased subjects. Clinically, symptoms of CTE include behavioral changes, executive dysfunction, memory deficits, and slow cognitive impairments that progress over decades (2). Similarly, individuals suffering from CTE might present with hopelessness, explosivity, being verbally or physically violent, suicidality, or substance abuse (5).
One of greatest advancements in CTE research was a study published in 2017. This study analyzed brain samples from 202 former football players, spanning all levels of involvement in the sport, including pre-high school, high school, college, and professional. The greatest criticism of this study is its potential for selection bias, as family members who suspected CTE may have been more likely to offer their deceased family members as samples for study. Still, there remained a clear distribution of neuropathological severity, with more severe cases of CTE identified among college, semi-professional, and professional players. CTE was identified in 3 of 14 high school athletes (21%), 48 of 53 college athletes (91%), and 110 of 111 NFL athletes (99%)4 (2). While this study was widely regarded as further support of CTE research and further condemnation of football itself, there seem to have been few consequences for the NCAA. While this one study should rightfully not represent the entire picture of CTE in football players, the results of this study suggest that nearly as great of a percentage of college football players as NFL players have been subjected to irreparable brain trauma and that little has been done by the NCAA in response.
While the NFL has acknowledged CTE and taken a few steps toward preventing and treating it, the NCAA has not only failed to combat CTE, it has failed to recognize its existence entirely. In March of 2017, the NCAA settled a class action lawsuit brought against it on behalf of current and former NCAA student-athletes. The case awarded athletes “medical monitoring” up to two times over the next 50 years, in response to concussions sustained by NCAA athletes throughout their time in college sports (8). Shockingly, this scant concession represents the greatest step by the NCAA to compensate its athletes for any kind of brain injury. While more needs to be done for student-athletes at risk of CTE, this medical monitoring is an important first step, as the only methods for identifying CTE in living people are still in the nascent stages of development (7).
In July 2017, the NCAA awarded researchers a $399,999 grant in order to study the long-term effects of head injuries in college athletes. In the announcement of this research, the NCAA wrote: “Tracking these former student-athletes over such a lengthy period of time–they plan to study this group for years to come–and comparing them to data collected from retired NFL players will shed new light on the long-term effects, or lack thereof, of both concussions and repeated head impacts in college athletics” (1). This step by the NCAA certainly appears benevolent; however, the fact that the funding is from the NCAA presents a conflict of interest for the researchers. Additionally, the mention of the possible “lack” of long-term effects of head injuries flies in the face of existing CTE research and suggests an obvious bias on the part of the NCAA.
The mission of the National Collegiate Athletic Association is to promote student athletes in their quest for both academic and athletic excellence. However, what purpose does a higher education serve to an individual who potentially faces a life of cognitive impairment and devastating behavioral consequences due to playing football. If the NCAA truly seeks to care for its athletes, it will start by acknowledging the mounting research for the causes and consequences of CTE, then it will take concrete steps to institute policies for concussion protocols and protective equipment usage that will best protect its athletes against repeated brain injuries. The NCAA can spend hours upon hours and countless dollars arguing its devotion to the success of its athletes, but, ultimately, the NCAA has not been adequately ensuring the health, safety, and wellbeing of its athletes and it is essential that fans of football and science alike hold the NCAA accountable.
- Burnsed, B. (2017, July 18). NCAA funds study examining the long-term effects of concussions in sports. Retrieved February 18, 2018, from http://www.ncaa.org/sport-science-institute/ncaa-funds-study-examining-long-term-effects-concussions-sports
- Daneshvar DH, Goldstein LE, Kiernan PT et al. Post-traumatic neurodegeneration and chronic traumatic encephalopathy. Mol Cell Neurosci 2015;66:81–90.
- Landesman, P. (Director), & Scott, R., Facio, G., Cantillon, E., Shuman, L., & Wolthoff, D. (Producers). (2015). Concussion [Transcript]. United States: Columbia Pictures.
- Martin, J. (2016, March 16). NFL acknowledges CTE link with football. Now what? Retrieved February 18, 2018, from http://www.cnn.com/2016/03/15/health/nfl-cte-link/index.html
- Mez J, Daneshvar DH, Kiernan PT et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. Jama 2017;318:360–70.
- Omalu BI, DeKosky ST, Minster RL et al. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 2005;57:128–33.
- Omalu B, Small GW, Bailes J et al. Postmortem Autopsy-Confirmation of Antemortem [F-18]FDDNP-PET Scans in a Football Player With Chronic Traumatic Encephalopathy. Neurosurgery 2017, DOI: 10.1093/neuros/nyx536.
- Student-Athlete Concussion Injury Litigation. (2017, March 22). Retrieved February 18, 2018, from http://www.ncaa.org/sport-science-institute/topics/student-athlete-concussion-injury-litigation