Concussion Inc. (16 page)

I point these readers and others to author-journalist-blogger Matt Chaney's January 28 post, “Brain Expert Omalu Wants Longer Rest for Concussed Football Players.”
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The subhead of Chaney's article is “Sideline concussed juveniles for three months, says the breakthrough neuropath; Neuropsychological testing lacks validation and might be harmful, critics caution; NFL players rebuke theory of ‘safer' football through their ‘behavior modification.'”

Here's most of the section headed “Critics Doubt Efficacy of NP testing for concussion diagnosis, ‘return to play'”:

Today's general view that concussion management works or can work in tackle football is rendered highly suspect, if not effectively discredited, by independent review and mounting adverse opinion of experts and witnesses like players.

Linebacker [Scott] Fujita notes he hasn't been measured on neural baseline for two NFL seasons. Might not matter, anyway, for NP testing has taken a systematic beating by reviewers of late. Observations and findings of medical literature from 2005 to 2010, listed without full author groups or first names, include:

• Randolph et al., 2005, for
  Journal of Athletic ­Training
  : “Despite the theoretic rationale for the use of NP testing in the management of sport-­related concussion, no NP tests have met the ­necessary criteria to support a clinical application at this time. Additional research is necessary to ­establish the utility of these tests before they can be considered part of a routine standard of care . . . ­until NP testing or other methods are proven effective for this purpose.”
  
• Patel et al., 2005, for
  Sports Medicine
  : “­Numerous guidelines have been published for grading and ­return-to-play criteria following concussion; however, none of these have been prospectively ­validated by research and none are specifically ­applicable to children and adolescents.”
  
• Mayers, 2008, for
  Archives of Neurology
  : “Current guidelines result from thoughtful consensus recommendations by expert committees but are chiefly based on the resolution of symptoms and the results of neuropsychological testing, if available. Adherence to this paradigm results in most ­injured athletes resuming competition in one to two weeks.”
  
• Duff, 2009, for
  ASHA Leader
  : “Indeed, the identification and management of concussion has become a growing public health issue. Considered to be the fastest-growing sub-discipline in neuropsychology, concussion management poses unique challenges and opportunities for those working with school-aged children… . There is no consensus on the best course of action for concussion management. In fact, there are as many as 22 different published guidelines for grading concussion severity and determining return to play… . Developers are working to collect data regarding reliability, validity, and clinical utility of these (NP) tools; independent replication is still forthcoming.”
  
• Echemendia et al., 2009, for
  British Journal of Sports ­Medicine
  : “Post-injury assessment requires advanced neuropsychological expertise that is best provided by a clinical neuropsychologist. Significant international differences exist with respect to the training and availability of clinical neuro­psychologists, which require modification of these views on a country by country basis.”
  
• Covassin et al., 2009, for
  Journal of Athletic Training
  : “little is known about the use of baseline neurocognitive testing in concussion assessment and management… . We found that the majority of ATs (athletic trainers) are interpreting ImPACT results without attending a neuropsychological testing workshop… . The use of baseline testing, baseline testing re-administration, and post-­concussion protocols among ATs is increasing. However, the ATs in this study reported that they relied more on symptoms than on neurocognitive test scores when making return-to-play decisions.”
  
• Maerlender et al., 2010, for
  The Clinical Neuro­psychologist
  : “Although computerized neuropsychological screening is becoming a standard for sports concussion identification and management, ­convergent validity studies are limited.”
  
• Piland et al., 2010, for
  Journal of Athletic Training
  : “Obtaining (self-reported symptom) statements before a concussion occurs assists in determining when the injury is resolved. However, athletes may present with ­concussion-related symptoms at baseline… . In other words, some post-­concussive symptoms occur in persons who have not sustained concussions, rendering the specificity of alleged post-concussive symptoms suspect.”
  
• Schatz, 2010, for
  American Journal of Sports ­Medicine
  : “Computer-based assessment programs are commonly used to document baseline cognitive performance for comparison with post-concussion testing. There are currently no guidelines for how often baseline assessments should be updated, and no data documenting the test-retest stability of baseline measures over relevant time periods.”
  
• Comper et al., 2010, for
  Brain Injury
  : “Despite the proliferation of neuropsychological research on sports-­related concussion over the past decade, the methodological quality of studies appears to be highly variable, with many lacking proper ­scientific rigor. Future research in the area needs to be carefully controlled, repeatable, and generalizable, which will contribute to developing practical, ­evidence-based guidelines for concussion management.”
  
• Eckner et al., 2010, for
  Current Sports Medicine Reports
  : “The sports medicine practitioner must not rely on any one tool in managing concussion and must be aware of the strengths and limitations of whichever method is chosen . . .”
  

Unfortunately, software packages like ImPACT, long criticized for its direct connections to the NFL, are widely employed as
cornerstone
for concussion evaluation and typically by untrained clients, as literature and news reports confirm.

17 June 2011..........

New York Times
reporter Alan Schwarz, May 27 email to me: “As far as I know your concern with the coverage stems only from your Maroon-connection-to-Riddell-study issue. [I know that is not an issue] for reasons of which you are totally unaware …”

New York Times
columnist George Vecsey, June 14 email to me: “The
NYT
has led that story for three years. What are you talking about?”

We all realize that the
New York Times
is the worldwide leader in worldwide leadering. But on the story of the pandemic of traumatic brain injuries in sports and entertainment, exactly where is the
Times
trying to lead us?

An examination of the Newspaper of Record's coverage over the past six months suggests that the answer is it is leading us to a world made safe for the NFL and its $9-plus billion in annual revenues.

Pay plenty of lip service to the alleged mental-health toll for the thousands upon thousands of professional and amateur athletes employed by the NFL or in its orbit — but also make sure all the opinion-making honor and commercial benefits are reaped by the very league-connected doctors whose corrupt research and false public statements brought us to this pass.

Last December 8 the
Times
led a story headlined “NFL Invites Helmet Safety Ideas” with these words: “With the federal government, state legislatures, and football helmets' regulatory body already focusing on concussions and head protection, perhaps the most influential group of all — the NFL — convened its own summit of experts Wednesday to discuss possible reforms.”

Try to imagine a
Times
story in the 1960s, subsequent to the ­surgeon general's report on the dangers of cigarettes, with a lead characterizing the Tobacco Institute as “perhaps the most influential group of all.”

One of the NFL's “summit of experts” — quoted in paragraph three of the
Times
account with the searing insight “there's still more questions than answers” — was Dr. Joe Maroon. (The line in Maroon's résumé about being the medical director of WWE is scrubbed in
Times
coverage.)

There are already plenty of answers about Maroon himself, one of the root liars of the concussion saga. Yet the
Times
continues to inflict unfiltered Maroon on the concussion education of its readers. Most recently, Maroon, who says he welcomes the federal investigation of his NFL-funded safety study of Riddell football helmets, has been given
Times
news real estate for the lame explanation that he studied good but Riddell promoted bad.

Meanwhile, Dr. Bennet Omalu, who overcame Maroon's obstacles to identify chronic traumatic encephalopathy in dead football players, has not appeared even one time this year in print editions of the
Times
. On February 26, the
Times
did run a blog item by Toni Monkovic, which allowed that Omalu once upon a time “figured prominently” in a breakthrough finding of brain damage in NFL players. Monkovic also quoted author-blogger Matt Chaney's report on Omalu's call to sideline all concussed athletes for three months.

In lieu of conducting this threshold debate in print, however, the
Times
has chosen to go yawn and on about football helmets and neurocognitive testing. The latter is a field that Maroon and his UPMC colleagues, with their NFL affiliation, dominate via their for-profit concussion management software, ImPACT. This despite a substantial body of research — also unreported in the
Times
— arguing that neurocognitive testing in general, and ImPACT in particular, are at best ineffective.

And it's not as if Omalu hasn't been heard from lately in the CTE field: after several years of effective exile from the pages of the NFL-doctor-controlled journal
Neurosurgery
, he returned there under new management with a recent major article.

There's no new management at the NFL itself. For the
New York Times
and reporter Alan Schwarz (whom the
New Yorker
quotes the corrupt Dr. Maroon praising), that seems to be what counts most.

19 June 2011..........

Let's move beyond my criticism of Alan Schwarz and the
New York Times
. I want to impress upon everyone not just that the Gray Lady recently has fumbled the ball in the red zone, but also how to regain the lost momentum of its generally excellent coverage of the concussion crisis prior to this year.

The
Times
website's March 13, 2010, interactive timeline, “The NFL's Embattled Concussions Panel,” with references dating back to 1994, remains a great historical resource.
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Several things have gone wrong since then, in my view, beginning with the subtle co-optation of Schwarz, an inexperienced investigative reporter, which has paralleled that of his friend Chris Nowinski. It is hard to hear people nominating you for a Pulitzer Prize in Schwarz's case, or to find yourself brokering a $1 million National Football League grant in Nowinski's case, and retain your outsider's edge. Someone whom the
New Yorker
quotes corrupt NFL doctor Joe Maroon calling “the Socratic gadfly” of concussion discussion is receiving accolades with strings: he also is being unofficially appointed the amanuensis of the ruling class.

Add to all this last fall's loss of Democratic control of the House of Representatives, whose Judiciary Committee had conducted the most penetrating public hearings drawing the parallel between the NFL and the tobacco industry, and you have a recipe for tepid and hyped measures like helmet reform, along with acquiescence in spurious and cost-shifting post-concussion “management.”

I am not the only observer who, in his own mind, damns the
Times
with such faint praise. I am just one of the few doing so out loud.

Coincident with the
Times
' squishy coverage of the past year has been the NFL's appointment of new co-chairs of its concussion policy committee. I'm still searching for the new leaf that the league has claimed to turn via its association with Drs. H. Hunt Batjer and Dr. Richard Ellenbogen.

29 June 2011..........

Word is leaking to the general public that “concussion management” software systems are magic shows, not public health solutions.

The
Chicago Tribune
's solid health reporter, Julie Deardorff, was the first major newspaper journalist I noticed writing about the clinical journal research which casts doubts on programs like ImPACT (developed by Dr. Joe Maroon's UPMC team).

Today Fox News picked up the story of the new
American Journal of Sports Medicine
article
finding that an athlete undergoing a computerized neuropsychological evaluation, which is designed to measure the effects of a traumatic brain injury, could get low marks because he was depressed about a sprained ankle.
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Meanwhile, the
New York Times
remains silent on the controversy over the reliance on neurocognitive testing. Indeed, of late the
Times
has been strangely light on concussion issue coverage in general, even as the NFL lockout has ended and pro football training camps have opened.

Dr. Bennet Omalu discovered chronic traumatic encephalopathy in football players. The last time a print edition of the
Times ­
mentioned Omalu was more than a year ago, June 29, 2010.

2 August 2011..........

Alan Schwarz seems to have been taken off the concussion beat. Was it a promotion or an exile?

I just received the following email:

Irv—

My move out of Sports has been in the works since December. After four years of covering concussions — and after my entire 20-year career being spent in Sports, mostly baseball — I requested a new challenge, and the
Times
masthead was wonderfully supportive, to the point that they encouraged me to tackle one of the more important beats on the paper, National Education. I did not make the switch until July 5 because there were many loose ends to be tied up — the Duerson situation, some helmet things, some other non-­concussion stories, and various personnel shuffling. I also took some time off to recharge my batteries. But the wheels began turning on this in late 2010 and were essentially rolling by February.