Professional Football Researchers Association Forum

Published in the AMA Journal this week, a Boston University study of 202 former high school, college, semi-pro, CFL and NFL players found that most had CTE at time of death (177 of the 202).

For the former CFL players, CTE was found in 7 of 8; for the former NFL players, CTE was found in 110 of 111.

http://www.dnaindia.com/sports/report-b ... dy-2514379

https://www.nytimes.com/interactive/201 ... .html?_r=0

Hi Ron! There's no doubt that football is a dangerous sport but these statistics would mean more to me if there was more context. What percentage of regular Joes have CTE when they die?

JohnH19 wrote:Hi Ron! There's no doubt that football is a dangerous sport but these statistics would mean more to me if there was more context. What percentage of regular Joes have CTE when they die?

That's a very good question and a very tricky one, since CTE can be diagnosed only if the brain is autopsied, which generally happens only if death is believed to have been caused by some sort of head injury or, at least, that head injuries were a contributing factor. Since, by definition, CTE is caused by repeated head injuries, the "regular Joe" is highly unlikely to suffer from it. It was first diagnosed in boxers as "punch drunk syndrome" in 1928 and all known cases to date have been found in boxers, American and Canadian football players, hockey players, and veterans who suffered head trauma during their military service.

rhickok1109 wrote:

JohnH19 wrote:Hi Ron! There's no doubt that football is a dangerous sport but these statistics would mean more to me if there was more context. What percentage of regular Joes have CTE when they die?

That's a very good question and a very tricky one, since CTE can be diagnosed only if the brain is autopsied, which generally happens only if death is believed to have been caused by some sort of head injury or, at least, that head injuries were a contributing factor. Since, by definition, CTE is caused by repeated head injuries, the "regular Joe" is highly unlikely to suffer from it. It was first diagnosed in boxers as "punch drunk syndrome" in 1928 and all known cases to date have been found in boxers, American and Canadian football players, hockey players, and veterans who suffered head trauma during their military service.

Sadly, both Jerry and Mike Quarry died far too young. Mike died at the age of 55 in 2006 and this was part of the article noting his death:

"...the cause of death was pugilistic dementia, the same disease that turned Jerry Quarry into a confused, childlike man before he died at 53 in 1999."

JohnH19 wrote:Hi Ron! There's no doubt that football is a dangerous sport but these statistics would mean more to me if there was more context. What percentage of regular Joes have CTE when they die?

General public, not sure. But this - from the Times story - is telling:

"The set of players posthumously tested by Dr. McKee is far from a random sample of N.F.L. retirees. “There’s a tremendous selection bias,” she has cautioned, noting that many families have donated brains specifically because the former player showed symptoms of C.T.E.

But 110 positives remain significant scientific evidence of an N.F.L. player’s risk of developing C.T.E., which can be diagnosed only after death. About 1,300 former players have died since the B.U. group began examining brains. So even if every one of the other 1,200 players had tested negative — which even the heartiest skeptics would agree could not possibly be the case — the minimum C.T.E. prevalence would be close to 9 percent, vastly higher than in the general population."

(And ... hello, John! Hell of a good time in Green Bay last summer).

Even if we disregard selection bias, it seems like each study draws the same conclusion...every NFL player has CTE. That in itself just brings about more questions...if every NFL player has CTE, then why are the effects different for each player? Are there any consistent factors/indicators that can determine which players will suffer negative effects of CTE and which players will lead normal lives despite having CTE?

It still seems completely random to me, almost on a 'scare tactic' level, when some proclamation is made like "And its not even related to diagnosed concussions! You could get CTE from multiple sub-concussive impacts!"...which is a ridiculous thing to say if you are truly trying to find a cause for CTE, because you could play any sport and receive 'multiple sub-concussive impacts'. It would be like saying you could get lung cancer from breathing air.

I recognize that CTE is a problem, but I think the research thus far hasn't shed light on any possible solutions.

I can remember back in the 1980s, there was a news story on the NFL and the link between neurological issues which featured Mike Hazeltine who was dying from Lou Gehrig's at the time and former teammates Gary Lewis and Bob Waters, who also had ALS. Now, more families are allowing for studies on former player's brains and spinal cords including Frank Gifford's.

http://articles.latimes.com/1986-12-17/ ... -s-disease

Eagles One wrote:I can remember back in the 1980s, there was a news story on the NFL and the link between neurological issues which featured Mike Hazeltine who was dying from Lou Gehrig's at the time and former teammates Gary Lewis and Bob Waters, who also had ALS. Now, more families are allowing for studies on former player's brains and spinal cords including Frank Gifford's.

http://articles.latimes.com/1986-12-17/ ... -s-disease

Yes, I remember that issue with those older 49er players, and there have been other former players with ALS. Unfortunately, it wasn't until the 1990s when the knowledge about concussions really started to pick up steam. The equipment just wasn't as good, among other factors. For me, the study really doesn't move the needle in terms of understanding concussions. As has already been stated, many of the donated brains came from former players already experiencing symptoms, sometimes severe symptoms.

We also know there are countless former pros doing relatively well in the business world and elsewhere, middle aged and beyond. They have the normal age-related issues, plus the expected wear and tear on their joints anyone would expect from playing such a violent sport. We'll need to find out what is the baseline for CTE, at what level is the serious damage occurring. Later, technology will enable us to check the brains of the living current and retired players, and we'll have a much better grasp on what is going on. Once this happens, we'll see some current players retire early, taking proactive action.

In terms of protecting players, I'm very confident technology, medicine, better coaching, and players reporting more symptoms will reduce the number of concussions, and long term problems. However, it's unrealistic to expect concussions to disappear from pro football.

Bryan wrote:Even if we disregard selection bias, it seems like each study draws the same conclusion...every NFL player has CTE. That in itself just brings about more questions...if every NFL player has CTE, then why are the effects different for each player? Are there any consistent factors/indicators that can determine which players will suffer negative effects of CTE and which players will lead normal lives despite having CTE?

It still seems completely random to me, almost on a 'scare tactic' level, when some proclamation is made like "And its not even related to diagnosed concussions! You could get CTE from multiple sub-concussive impacts!"...which is a ridiculous thing to say if you are truly trying to find a cause for CTE, because you could play any sport and receive 'multiple sub-concussive impacts'. It would be like saying you could get lung cancer from breathing air.

I recognize that CTE is a problem, but I think the research thus far hasn't shed light on any possible solutions.

I've long viewed this all very similarly.

One, the leaders in CTE research only get funding and make their name if they 'find' something. Which before even getting to selection bias we have that inherent bias. Then of course, the selection bias. Which even that aside, the majority of hockey, soccer, boxing, athletes in general that have been checked get diagnosed with CTE. Same with military and same with non-athletes/non-military that have been tested for CTE. Yes, CTE has been found in nonconcussed brains. Instead of doing anything with that they instead 'find' that essentially everyone who in theory was hit in the head at some point in their lives has and gets diagnosed with CTE.

We all know why "NFL" is the headline, from both the media and research perspective (profit). Though it's not just pro football, it's college and high school. Which to Bryan's point (changing his use of "NFL" to "football"), "every football player has CTE", then why are millions doing just fine and why do those with alleged issues have different symptoms?

These studies to me are horribly flawed, they don't take into account other factors (PED's, alcohol/drug abuse, etc) and make correlations such as linking ALS to CTE. Then we have to ask, because their bias won't allow them to, if playing football/sports=CTE is the cause of ALS then why are there so many cases of ALS with people who've never played sports in their life?

Overall, every finding/report boils down to circumstantial evidence, at best.

"Play football = get CTE" ... Yet other athletes have a high CTE diagnosis rate also and further, non-athletes have a high CTE diagnosis rate. Nearly everyone specifically checked for CTE gets diagnosed with CTE, no matter the background and no matter if they played sports or not.

"Football causes CTE which in turn causes ALS" ... Would get laughed out of any real scientific forum for making that leap.

And so on.

"Scare tactic" is a good way to put it, Bryan.

All things aside, for me it's common sense. Getting hit in the head likely isn't good for you. Play sports, race cars, fight, serve your country, etc., at your own risk -- which I'm a big believer in people being allowed to make decisions for themselves. We can either end most major sports around the world (good luck ending football in Texas, or soccer in Europe/South America, or hockey in Canada, etc.) or you can let people do what they want. Of course trying to make things better and find cures, all good. To date this CTE 'research' isn't that, it's fame and fortune 'science'.

Bryan wrote:Even if we disregard selection bias, it seems like each study draws the same conclusion...every NFL player has CTE. That in itself just brings about more questions...if every NFL player has CTE, then why are the effects different for each player? Are there any consistent factors/indicators that can determine which players will suffer negative effects of CTE and which players will lead normal lives despite having CTE?

It still seems completely random to me, almost on a 'scare tactic' level, when some proclamation is made like "And its not even related to diagnosed concussions! You could get CTE from multiple sub-concussive impacts!"...which is a ridiculous thing to say if you are truly trying to find a cause for CTE, because you could play any sport and receive 'multiple sub-concussive impacts'. It would be like saying you could get lung cancer from breathing air.

I recognize that CTE is a problem, but I think the research thus far hasn't shed light on any possible solutions.

The question of why effects are different for each player applies to just about any physical ailment you can name. Why do some smokers get lung cancer while some non-smokers do? Why does someone who has every risk factor for chronic artery disease not suffer from it while someone dies of it without having any of the risk factors? Someday, questions like this may be answered, at least partially, but it's quite possible that purely random factors are involved.

The statement, "You could get CTE from multiple sub-concussive impacts!" is not ridiculous; it's based on evidence. If that makes it harder to nail down a cause, of course that's a shame, but it's also a fact.

You have to bear in mind that CTE research is still in its infancy. Very few cases have actually been studied.