Saturday, April 30, 2011

'Slug Nutty' Boxers, 'Head Scrambled' Football Players, and the Role of the Neuropathologist in Protecting the Public

American boxer John Heenan (1835-1873)
As part of National Lab Week activities, I delivered a presentation yesterday to staff at the College of American Pathologists headquarters in Northfield, IL on the topic of chronic brain injury among football players. Repetitive brain trauma in sport was first recognized among boxers, and thus the early-onset dementia -- and, in some cases, parkinsonian symptoms -- associated with this kind of trauma was named dementia pugilistica. Since the recognition of this phenomenon in other sports, most notably football, the entity has been renamed Chronic Traumatic Encephalopathy (CTE). Among the first papers describing repetitive traumatic brain injury in sport was one authored by neuropathologist Harrison S. Martland, MD, who published his results in the Journal of the American Medical Association in 1928 (Punch Drunk: JAMA 91:15, [1928] p. 1103-1107). Dr. Martland -- who worked in the pathology department of the City Hospital in  Newark, NJ and the office of the Chief Medical Examiner in Essex County, NJ -- wrote that "fighters in whom the early symptoms are well recognized are said by the fans to be 'cuckoo', 'goofy', 'cutting paper dolls', or 'slug nutty'." Dr. Marland concluded his report of 23 cases of dementia pugilistica with a call-to-arms to neurologists and neuropathologists:

"The condition can no longer be ignored by the medical profession or the public. It is the duty of our profession to establish the existence or non-existence of punch drunk by preparing accurate statistical data as to its incidence, careful neurologic examinations of fighters thought to be punch drunk, and careful histologic examinations of the brains of those who have died with symptoms simulating the parkinsonian syndrome. The late manifestations of punch drunk will be seen chiefly in the neurologic clinics and the asylums, and such material will practically fall to the neuropathologist connected with such institutions."

As was the case 100 years ago with boxing, chronic brain damage in "head scrambled" football players is now being widely acknowledged. It is the obligation of every blue-collar neuropathologist to advance our knowledge of CTE by recognizing it in our autopsy cases and supporting the work of the two white-collar neuropathologists most involved in bringing football-related CTE to public attention: Dr. Ann McKee of Boston Univeristy and Dr. Bennet Omalu of West Virginia University. With more than four million children and young adults playing football in this country, it is our moral obligation as neuropathologists and as citizens to become active participants in the public discussion surrounding this important social and public health issue.


Anonymous said...

Hi, Doc. I very quickly found that this problem extends to probably include high school girls lacrosse. To wit:

Anonymous said...

The U.S. simply cannot afford to ignore the financial impact of further taxing an already taxed medical system with a completely preventable disease process for the sake of entertainment. While it may be difficult to suggest change to an entire popular culture, responsible practitioners realize we are well into an era that will result in the extreme rationing of healthcare. Brain damage is expensive to treat. It is the duty of all physicians and the institution of medicine to promote good health practices. Maintaining a healthy neurological system is enough of a challenge in today's world. Direct and preventable insults are something we can't afford to add to the ballooning burden of dementia in this nation. We have a duty to reserve limited healthcare resources for those that have incurred brain injury in the line of duty to the country not the alma mater. I'd like to see the Surgeon General to step up to the plate and comment here. What is their role in this scenario?

Brian E. Moore, MD, MEd said...

I wholeheartedly agree with "anonymous". In response to his inquiry as to whether or not the Surgeon General has taken a position on this issue, I recently called the Surgeon General (Vice Admiral Regina M. Benjamin, MD, MBA) in Washington. A spokesman for her office told me that although she certainly takes an interest in and is following developments surrounding this issue, the Surgeon General has not taken an official position on it. Thanks for your comment, "anonymous"!

Anonymous said...

[I]t is our moral obligation as neuropathologists and as citizens to become active participants in the public discussion surrounding this important social and public health issue.

This is unnecessarily timid.

Neurologists of all skill-levels should call for an outright ban on football.

If the public chooses to ignore you, you should keep presenting the evidence. It's the only way that progress can be achieved.

If the nation chooses to ignore you, so what? You people are not politicians. You are professionals with expertise, a functioning moral sense, and a code of ethics to uphold.

Nick said...

I'll go a step further than chuquito:

Neurologists and the neurology associations are acting IMMORALLY by failing to publicly call for a ban on football...particularly at the youth and high school level.

This September, uninformed parents and coaches are instructing millions of young boys to charge into one another - sloshing their brains against the side of their skulls - causing long-term structural damage and impairment. Meanwhile, the medical community stands by with folded-arms, seemingly indifferent, refusing to speak out.

Are we really waiting for more scientific data? Or, are we just failing to live up to our ethical responsibilities?

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