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CTE: Is Media Narrative Ahead Of The Science?

Prevailing media narrative is "scientifically premature" say many researchers

 

The prevailing media narrative is that concussions or repetitive subconcussive blows "cause" chronic traumatic encephalopathy (CTE), that CTE "causes" former athletes to commit suicide, and such causal links are proven scientific fact.

It thus may come as a surprise to many that, despite widespread media coverage and speculation regarding the late-life or post-retirement risks of cognitive impairment in athletes who engaged in sports involving repetitive trauma and that CTE causes them to be a high risk of suicide, there has been little to no peer-reviewed scientific literature involving data that establishes, much less quantifies, such risks. [1,2,14-17] Football linemen at line of scrimmage

No consensus on causation   

Rejecting the blanket conclusion that there is a definitive causal and effect connection between repetitive head trauma and CTE, a growing number of peer-reviewed scientific papers, including the most recent international consensus statement on concussion in sport ("Zurich 2012"),[2] caution that a relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.[14-17]    

Zurich 2012 notes that "there are no published epidemiological, cohort or prospective studies relating to modern CTE. Owing to the nature of the case reports and pathological case series that have been published, it is not possible to determine the causality or risk factors with any certainty."

"As such, the speculation that repeated concussion or subconcussive impacts cause CTE remains unproven," the statement continues. "The extent to which age-related changes, psychiatric or mental health illnesss, alcohol/drug use or co-existing medical or dementing illnesses contributed to this process is largely unaccounted for in the published literature. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously."

Remarkably, Zurich 2012 concludes with a direct shot at the media, in which it recognizes the importance of addressing the "fears of parents/athletes from media pressure related to the possibility of CTE."

Media stoking CTE fears?

Such a view has been subsequently echoed by a growing chorus of researchers, including Christopher Randolph, PhD. of Loyola University in Chicago.  In a follow-up study of retired NFL players[1] - who largely comprise the highly limited, self-selected universe from which the case studies of brains showing the presence of CTE have been drawn (what scientists call a "convenience sample"), and who the media have widely reported as being at high risk of CTE - Randolph laments that "the media attention to this issue continues to far outweigh any meaningful results from sound experimental science."

Randolph found that, when compared with healthy controls and with non-athlete patients with a clinical diagnosis of mild cognitive impairment (MCI) commonly presumed to reflect the earliest stage of Alzheimer's disease, the patterns of impairments of the retired NFL players in the study were virtually identical to those exhibited by non-athletes with MCI. The finding lead him and his colleagues to conclude that CTE might not be a distinct neurodegenerative disorder at all. 

The study appears to lend support to Randolph's theory, first proposed in a 2009 paper,[3] that a long history of repetitive head trauma in contact sports does not cause CTE, but might eventually result in a diminished cerebral reserve leading in some unknown percentage of cases to an earlier-than-normal expression of other common, age-related neurodegenerative diseases, such as AD and Parkinson's (PD).  His theory was that the ways in which such diminished cerebral reserve would be expressed (e.g. MCI, AD, PD, ALS) would not differ from individuals with those diseases who lacked such a history of head trauma, which is precisely what his 2013 study suggests.   

Pushback

The Randolph study, co-authored by no less a concussion authority than Kevin Guskiewicz,  Kenan Distinguished Professor, Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill, and Director of the Center for the Study of Retired Athletes at UNC, has been heavily criticized as being flawed by those who have identified CTE as a distinct condition. 

Chris Nowinski, co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine, told PopSci.com [9] that it was  "preposterous" for Randolph to conclude that CTE might not be its own disease because the retired football players had impairments similar to those of other patients with mild cognitive impairment. 

Not surprisingly, when Zurich 2012 questioned the causal link between repetitive brain trauma and CTE, it was met with a sharp push-back from the research group at Boston University's Center for the Study of Traumatic Encephalopathy (CSTE) most associated with the position that CTE is a distinct neurodegenerative disorder suffered only by athletes in contact and collision sports, and that repetitive trauma can be in some cases the sole cause of the disease. 

Typical was the reaction of one of Zurich 2012's co-authors, Dr. Robert Cantu, CSTE's Director.  Dr. Cantu told NewJersey.com: [4] "When I saw that [it said] we need more data in terms of CTE, I wrote to the other authors, in essence, 'What the hell do you mean that we need more data?' The whole breadth of the document is large, and 99 percent of it it I strongly support. But that part of it, I don't support at all. Frankly, it stunned me."

Dr. Cantu's colleague, Dr. Ann McKee, likewise expressed befuddlement at the consensus statement's treatment of CTE, telling NewJersey.com, "This is a time that calls for immediate action to reduce the amount of head trauma experienced by athletes in all sports to prevent CTE."  

Dr. McKee asserted that it would be "irresponsible to justify inaction by requesting a level of scientific proof that will take decades to acquire,"  expressing the fear that, to suggest that CTE "may not be part of the impact exposure, but rather due to other yet unidentified factors," could give tacit permission to those who play collision sports to proceed as if there is no urgent problem when concussions arise.

It wasn't intended to have such an implication, Dr. Rosemarie Scolaro Moser, Director of the Sports Concussion Center of New Jersey and MomsTEAM.com's sports concussion neuropsychologist, told NewJersey.com.  Instead, she cautioned that it would be jumping to conclusions to say, 'If you play football, you're probably going to get CTE.' Which is not the case. So what differentiates those with CTE from those who don't have it? That's what we need to know." 

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