Get Your Head Out of the Game
“Dr. Pellman is not a neurosurgeon, he’s not a neuro-anything. He’s a rheumatologist.”
-League of Denial, 2013
When faced with the task of investigating concussions in football, the National Football League (NFL) did not choose a neurologist to head the committee; they did not choose a neurosurgeon: they chose a rheumatologist. The documentary “League of Denial: The NFL’s Global Concussion Crisis” chronicles the period of time following the death of NFL Hall of Fame player Mike Webster in 2002, when concussions—also known as mild traumatic brain injury (mTBI)—became a central theme of public debate.
Webster, whose brain is pictured above, was diagnosed with a neurodegenerative disorder called chronic traumatic encephalopathy (CTE), which results from repetitive mTBIs; and a 17-year career in pro football will result in quite a few mTBIs, that’s for sure. CTE is characterized by tauopathy–pathological protein aggregates that form and slowly spread throughout the brain, deteriorating brain tissue. This deterioration results in many deficits: confusion, disorientation, dizziness, headaches, memory loss, social instability, impulsive behavior, poor judgment, as well as depression and even suicidal thoughts (17,18). But the damage does not have to get as extreme as that in CTE to have lifelong effects: a research article found that patients may have persistent consequences, such as fatigue, attention deficits, and inability to return to work, even after suffering a single mTBI16.
Traumatic Brain Injury, the Silent Epidemic
Mild traumatic brain injury is often overlooked as a serious condition because of the misinformation that we are fed by a plethora of sources: sports leagues, medical professionals, government officials, sports fans in high places, you name it. We have developed a nonchalance to mTBI–which is demonstrated in everyday language, when we say “oh, it’s only a concussion” (1)–because of how these sources have disregarded mTBI. Trust me, before I began researching mTBI and its effects, even I was guilty of saying “only” –and I’m a brain injury survivor myself! But the effects are many, and the implications for people’s lives are too great to be ignored and brushed off as “only a minor concussion” (1). Because of this misconception, researchers believe that “mild traumatic brain injury” is the only term that should be used, because “concussion”, as Sharp and Jenkins put, “lacks any diagnostic precision and at worst encourages a lazy diagnostic approach” (5). The use of the term “concussion” not only makes it difficult for healthcare professionals to accurately diagnose someone, but also invites a dismissive attitude that leads to lackluster responses to mild traumatic brain injury by the media, as compared to other prominent diseases in today’s world.
Ailments such as cancer and human immunodeficiency virus (HIV) are two of the most impactful, researched, and well-known diseases in the world, but mTBI should be just as important. In 2015, there were 17 million new cases of cancer worldwide, and in that same year, there were nearly 38 million individuals living with HIV (11,12). However, according to current research, an estimated 69 million traumatic brain injuries occur annually worldwide, 81% of which (55 million) are mTBIs4 Because of the severity of cancer and HIV, there has been a public outcry and billions of dollars funneled into research to help treat and hopefully one day cure these malicious illnesses. In 2017, research funding by the US federal government alone for both cancer and HIV reached a combined total of $38 billion (13,14); however, also in 2017, funding for TBI research was only $216 million (15). That is only approximately half of one percent of the amount of research funding for cancer and HIV. Cancer and HIV devastate the lives of patients and loved ones worldwide; so it is not to say that we should disregard or even take the funding away from cancer and HIV. However, mTBI, while not as life-threatening, impacts the lives of more individuals than those two illnesses combined, and does not receive as much media attention or research funding. It is because of this unsettling fact that some scientists and public health officials have named the catastrophe of TBI the “silent epidemic”.
Propagation of Lies
The risks of damaging the brain–one of the most vital organs in your body–go unheeded, even though brain injury devastates the lives of millions of people across the globe each year. The risks of mTBI especially go unheeded in contact sports, in motor sports, and even in our everyday lives while driving our cars down the street. Crippling capabilities, possibly paralyzing completely, and in turn devastating friends and family, mTBI is an epidemic in this country and in the world. There is too much mystery and misinformation about mTBI, propagated by the media and other sources and reinforced by the public’s indifference to and lack of awareness of the real risks. We need to educate, educate, educate, or we risk the lives of millions of people every year.
In sports, the media and sports organizations such as the NFL still disseminate misinformation about mTBI and risk players’ lives everyday. The media continues to use misleading terminology–such as “slight concussion”, “mild concussion” and “minor concussion” (1)–and misrepresents mTBI by hosting ex-sports athletes who play off injury as “a part of the game”, claiming they have “no regrets” (3), even if they suffered life-altering injuries. The NFL’s current commissioner, Roger Goodell, continues to downplay the effects of mTBI on NFL players, even after numerous studies have shown the impacts of mTBI on players. Some even provide an explicit link between CTE and football in particular. Researcher Dr. Ann McKee studied the brains of 111 former NFL players, and 110 of those (99%) came back positive for CTE (6). A small study, yes, but with a strong correlation, and no question of the statistical significance. So, when CTE results in possibly devastating outcomes, and even a single mTBI has lifelong implications, the question is not if we should support the awareness and prevention of mTBI in the world, it is how.
Breaking the Silence
Many organizations contribute to mTBI awareness. The World Health Organization (WHO) has a campaign, the WHO Helmet Initiative, that fights to prevent head injury by promoting the use of helmets when riding a bike or motorcycle (8). Additionally, the United States Centers for Disease Control and Prevention (CDC) started a campaign in 2003 called the Heads Up initiative, spreading awareness and preventive measures of mTBI in youth athletes (7) Heads Up first started educating healthcare professionals on the risks of mTBI, and then later added initiatives to educate schools, coaches, parents, and players themselves. Success and audience aside, these are only two programs on a global and national scale, when–given the impact that TBI has on the world annually–there should be many, many more. Until the deaths of ex-football players like Mike Webster and Aaron Hernandez, which piqued national interest and made headway for documentary films such as League of Denial and Head Games, not much was being done to spread awareness and prevention of mild traumatic brain injury. Given the statistics provided and public attitude, there is still much work to be done to adequately protect our communities against TBIs.
Awareness and prevention do not take place in a vacuum or with little help. There are organizations that provide excellent resources for awareness and prevention of TBI, as well as providing resources and services for TBI survivors. In San Diego, these include the San Diego Brain Injury Foundation (SDBIF) and Beyond Concussion. The SDBIF and Beyond Concussion are both non-profit organizations that were created to help educate the public about brain injury and also to provide resources for parents, caregivers, as well as brain injury survivors themselves. The SDBIF hosts many events to help increase TBI awareness, support TBI survivors, and showcase the stories of survivors (9). A partner organization, the Howard House, provides services for brain injury survivors who cannot support themselves and teaches them independent living skills. Beyond Concussion, co-founded by mothers Miriam Allsop and Peggy Khayamian, who both have children who suffered brain injuries, coordinates groups to connect TBI survivors, groups to connect caregivers, and hosts monthly educational workshops given by experts in the field (10). These are two wonderful organizations here in San Diego, and undoubtedly there are many more worth mentioning, but they cannot take on the world–not without help. Unfortunately, the federal government–especially the current one–is unlikely to increase funding for TBI research. Without the help of smaller organizations and the public’s support, we will only see an increase in TBIs in the coming years.
It is time for the silence to be broken surrounding the epidemic of traumatic brain injury, and that starts with all of us.
1) Ahmed, Osman Hassan & Hall, Eric E.”’It was only a mild concussion’: Exploring the description of sports concussion in online news articles.” Physical Therapy in Sport, Volume 23, pp. 7-13, ISSN 1466-853X, https://doi.org/10.1016/j.ptsp.2016.07.003. Web. Jan 2017.
2) Kirk, Michael et al. “League of Denial: The NFL’s Concussion Crisis.” pbs.org. Produced by Michael Kirk, Jim Gilmore and Mike Wiser; reported by Jim Gilmore, Steve Fainaru and Mark Fainaru-Wada; written by Michael Kirk, Mike Wiser, Steve Fainaru and Mark Fainaru-Wada. 8 October 2013.
3) Furness, Zack. “Reframing concussions, masculinity, and NFL mythology in League of Denial,” Popular Communication, 14:1, 49-57, DOI: 10.1080/15405702.2015.1084628 Web. 01 Feb 2016.
4)Dewan, Michael C. et al. “Estimating the global incidence of traumatic brain injury”. Journal of Neurosurgery JNS 130.4: 1080-1097. . Web. 15 Mar. 2020
5) Sharp, David J., and Peter O. Jenkins. “Concussion is confusing us all.” Practical neurology 15.3 (2015): 172-186.
6)Ann C. McKee et al. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury, Journal of Neuropathology & Experimental Neurology, Volume 68, Issue 7, July 2009, Pages 709–735, https://doi.org/10.1097/NEN.0b013e3181a9d503
7)Sarmiento, Kelly et al. “A 10-year review of the Centers for Disease Control and Prevention’s Heads Up initiatives: bringing concussion awareness to the forefront.” Journal of safety research vol. 50 (2014): 143-7. doi:10.1016/j.jsr.2014.05.003 Web.
16) Vander Werff, Kathy R. & Rieger, Brian. “Auditory and Cognitive Behavioral Performance Deficits and Symptom Reporting in Postconcussion Syndrome Following Mild Traumatic Brain Injury.” Journal of Speech, Language, and Hearing Research, vol. 62, pp. 2501–2518. Web. July 2019.
17) Gregory, Hollin. “Making a murderer: Media renderings of brain injury and Aaron Hernandez as a medical and sporting subject.” Social science & medicine, vol. 244: 112598. doi:10.1016/j.socscimed.2019.112598. Web. Jan 2020.
18) Bieniek, Kevin et al, “Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study.” Brain Pathology, 30, pp. 63-74. doi:10.1111/bpa.12757. Web. 14 June 2019.