Why the latest round of daunting CTE reports should come with an asterisk

The story was posted early on Tuesday and the headline was alarming: “The latest brain study examined 111 former NFL players. Only one didn’t have CTE.”

That was from the Washington Post. The New York Times had special graphics, and this line: “A neuropathologist has examined the brains of 111 players – and 110 were found to have CTE, the degenerative disease linked to repeated blows to the head.”

Pretty scary, and social media chimed in:

“The beginning of the end for football…”

“When will the NFL stop burying their heads in the sand?”

“Will football as we know it be changed?”

“Duh. This is what happens to brains that get smashed 1,000s of Xs.”

Democrats in Congress offered a press release with this statement: “We know that there is a direct relationship between football and CTE, and we cannot afford to wait to take substantive action to protect players of all ages from the risks of head trauma in contact sports.”

It’s great that elected officials are paying close attention to player safety. But the “direct relationship between football and CTE,” while backed by strong evidence, isn’t yet universally accepted in the scientific community. And this latest study, while important, doesn’t move us a lot farther in what we know about the effects of football on later-life clinical symptoms.

“This study adds little new science,” says Jeffrey Kutcher, the national director of the Sports Neurology Clinic. “It provides a larger number of cases and a better description of their problems during life. Other than that, there isn’t much here that we didn’t already know.”

Kutcher isn’t alone in his caution. This summer, Yahoo Sports interviewed dozens of doctors, from neuropathologists to neuropsychologists to physical therapists, and the response was overwhelming: We just don’t know enough yet about CTE to make any conclusions.

“With trauma and CTE, nothing has been proven,” said Lil-Naz Hazrati, a neuropathologist who studies athletes’ brains in Canada. “That link is very circumstantial. We’ve taken a bunch of people and the only thing we have out of there is blows to the head.”

Even Chris Nowinski, who helped on the new study, tweeted on Tuesday: “To my football buddies: today’s study doesn’t mean your risk of CTE is 87%. Biased sample. But if you have symptoms, see a doc – they can help.”

The latest round of stories about CTE in football players seem damning, but it's still too early to tell. (AP)
The latest round of stories about CTE in football players seems damning, but there’s still so much we don’t know about it. (AP)

The study itself admits “several limitations.” It explains: “public awareness of a possible link between repetitive head trauma and CTE may have motivated players and their families with symptoms and signs of brain trauma to participate in this research. Therefore, caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample.”

Does this mean the study isn’t important? Not at all. This new frontier of research is making the sport safer and making parents and athletes more aware of risks. But the “public awareness” of troubling stories far outpaces the public awareness of reassuring stories, and that creates an imbalance in conventional wisdom. Even political journalists, usually fixated on Donald Trump and Russia, tweeted about Tuesday’s study.

Now consider another study earlier this month from the exact same publication, the Journal of the American Medical Association. The title: “Association of Playing High School Football With Cognition and Mental Health Later in Life.” It studied a group of nearly 4,000 former athletes who played football in the 1950s, and it found this: “There was no statistically or clinically significant harmful association between playing football in high school and increased cognitive impairment or depression later in life, on average.”

Granted, this study also has its limitations. Football in the 1950s is far different from football now. The athletes are faster, and larger, and the hits are therefore harder. That matters. But both studies should be considered as we move closer to the understanding of football’s risks. As the latter study states: “Without population-level samples, it is difficult to estimate the base rate of long-term dysfunction among professional football players, much less among high school players.”

Dr. Mark Herceg, the Westchester County Commissioner of Mental Health and Concussion Task Force chairman, added this in an interview Tuesday: “It would be great to study the brains of all the famous musicians and actors who killed themselves and battled depression/addiction/medication. We need comparisons to the general population and others with mental illness to really tease this issue out and make better assumptions.”

The JAMA study on football players from the 1950s has 16,000 views in three weeks on the journal’s site, while it’s safe to say Tuesday’s news received far more views just from Twitter in a single day. Dr. Ann McKee, the leading author of the CTE study, was interviewed on ESPN. The other study’s authors were not.

CTE is serious and worth further attention. But for every major news story you see on CTE, there are several studies that aren’t as widely circulated.

Headlines travel fast. Science takes time.

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