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| Peter Cummings, MD |
1. Chronic
traumatic encephalopathy has been considered
by many to be a distinct nosologic entity since 1928, when Dr. Harrison
Martland published the article “Punch
Drunk” in JAMA. Do you believe that CTE is a distinct entity?
If so, what, in your opinion, defines CTE?
That's a good question! If you look at the totality of the
literature in a historical context, you see the 'classic' boxers
neuropathological changes followed by the Omalu cases and then the McKee cases.
Looking at all of these cases you can see that there is a wide spectrum of
changes considered to be "CTE". Right now I think all we can say is
CTE is a pattern; we don't know what causes it and we don't know what it
causes. There are cases of CTE-like pathology in people who have never been exposed
to repetitive head trauma and never had a head injury. The answer is probably
more complex than we're able to say right now. There are extremist views (such
as that expressed in a 2015 BMJ editorial) that suggest CTE doesn't exist
outside of boxing and CTE as described in football players is an American
social phenomenon. There is a lot more work to do in this area and we
discuss that in the book.
2. What’s your opinion of the work of Bennet Omalu as it pertains to
CTE?
It's certainly historically important. After all, it's what really
launched this whole conversation. We talk a little bit about it in the book. I
do think there is some debate on whether or not some of his cases are CTE, but
that might be a factor related to the wide spectrum of patterns said to be
present in these individuals. I've always been curious
as to why none of his football player cases were examined
in the process to develop a consensus diagnosis. Again, that is something we
discuss in the book.
3. What
conclusions drawn by Dr. Ann McKee regarding CTE do you have issue with?
I take issue with a number of things. First, I think the way the
cases are portrayed in the media is disingenuous.
In the CTE Center’s scientific papers, they assert that one cannot imply or conclude prevalence but then will go on to state in the media that
they think every player has this. The CTE Center has also clearly stated in
their papers that findings of a study should not be used to inform safety and/or policy decisions
in youth football but then proposes publicly in the media and in testimony
before state legislatures that tackle football should be banned for kids under
14. It also bothers me when they put up a photo of an atrophic brain and claim
it's severe CTE without any other qualifier. Over half of the 'severe' cases of
CTE have another primary neurodegenerative disease, so when you look at those
nice photos of atrophic brains, you have to wonder what other disease is
lurking in there. Is it also Alzheimer’s disease? As stated by their very own
consensus recommendations, if another neurodegnerative disease is present, it
excludes CTE as the sole diagnosis. So, when the photos are shown in the media
and they don't tell you it's Alzheimer's disease with CTE, it's disingenuous at best. Science
doesn't stop at the paper, it continues into the public arena where it is used
to educate the public. Here, it's not educating, it's fear mongering. I also
have great concerns over the lack of transparency with information coming from
the CTE Center. I described some of this in great detail in the book. For
example, not turning over documents when presented with a signed release from a
family; requiring a subpoena and then failing to turn over all the records; when
I demand the missing records I am asked 'why am I drilling so hard? The NHL
didn't drill this hard,'; and when I finally get the records, the names of the
clinicians who reached the diagnoses are blacked out. Why? Additionally,
the public should know that there exists cases where neuropathologists have
looked at brains prior to the CTE Center and failed to find CTE, but when the
brain arrive at the CTE Center, they all have CTE. This diagnostic
discrepancy is alarming. There are many other examples
in the book.
4. The
title of your book is rather sensational (“the plot to destroy football”). Are there actually people
plotting a plan? If so, who are these conspirators?
I
think we paint a pretty clear picture in the book of what is going on and how
football has been targeted. For example, with the recent proposed legislation
to ban youth tackle football in California, I found it outrageous that if the bill
would have passed, an 8 year old in California wouldn't be able to play football, but
could box or fight in MMA--sports designed to target the head. If this bill was
really about brain health in kids, the coverage would encompass all areas of
potential brain injury in all sports—not just football. The PR campaign
accompanying the public release of the various CTE studies intentionally
generate undue fear in parents and in the general public. The PR has
intentionally tried to definitively link youth football to subsequent CTE-- and
there is no scientific evidence of that. And for scientists involved in CTE
research, who mind you, have no training, certification, or experience in youth
football, to call out the sport for not responding is deceptive-- it's one of
the reasons why I did become certified and I started to coach both flag and
tackle and I would argue that no other youth sport has made a more radical
transformation than youth football in response to safety concerns; I know this
because I coach! Another example from the book is how some at BU have tried to
silence me and discredit my opinions.
In the end
"Brainwashed" is a very optimistic book full of hope and information
which we hope will empower people. We wrote it as two dads asking the same
questions a lot of other parents are asking and I think people who read the
book will see that and realize it’s our journey for the truth for our own kids.
In the end, we really hope people will have more information and be in a better
position to make an informed decision as to whether or not a particular sport
is right for their family.
