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Degenerative Brain Disease Found In Nearly All Donated NFL Player Brains, Says Study (npr.org)

A new study published Tuesday in the journal American Medical Association found that 110 out of 111 brains of those who played in the NFL had degenerative brain disease chronic traumatic encephalopathy (CTE). NPR reports: In the study, researchers examined the brains of 202 deceased former football players at all levels. Nearly 88 percent of all the brains, 177, had CTE. Three of 14 who had played only in high school had CTE, 48 of 53 college players, 9 of 14 semiprofessional players, and 7 of 8 Canadian Football League players. CTE was not found in the brains of two who played football before high school. According to the study's senior author, Dr. Ann McKee, "this is by far the largest [study] of individuals who developed CTE that has ever been described. And it only includes individuals who are exposed to head trauma by participation in football." A CTE study several years ago by McKee and her colleagues included football players and athletes from other collision sports such as hockey, soccer and rugby. It also examined the brains of military veterans who had suffered head injuries. The study released Tuesday is the continuation of a study that began eight years ago. In 2015, McKee and fellow researchers at the Department of Veterans Affairs and Boston University published study results revealing 87 of 91 former NFL players had CTE.

40 of 213 comments (clear)

  1. Sample bias by Anonymous Coward · · Score: 2, Insightful

    Why would someone donate their brain if they didn't think they had damage?

    1. Re:Sample bias by ShanghaiBill · · Score: 3, Insightful

      Why would someone donate their brain if they didn't think they had damage?

      Why not? Why do you need to keep your brain if you're dead?

      I am an organ donor, and they are welcome to use any parts they can for anything useful. It may help someone, and it is less that my family has to pay to cremate.

      Disclaimer: I don't play or watch football.

    2. Re:Sample bias by arth1 · · Score: 2

      Why not? Why do you need to keep your brain if you're dead?

      Conversely, why do you need to donate anything when you're dead?
      You won't get a warm fuzzy feeling from it, because you're dead.

      And they don't give a discount on cremation for missing organs.

    3. Re: Sample bias by JoeRobe · · Score: 5, Informative

      The BBC version of this story actually discusses the sample bias, and the director of the CTE center is quoted fully acknowledging that there's enormous bias.

      http://www.bbc.com/news/world-...

      --
      The best way to predict the future is to invent it.
    4. Re:Sample bias by Anonymous Coward · · Score: 3, Insightful

      Because it gives you a warm fuzzy feeling whilst you're alive.

      It is satisfying to me to know that when I die, there is a possibility someone else might be able to benefit from that. Rather than it just being an entire waste.

    5. Re: Sample bias by BarbaraHudson · · Score: 4, Insightful

      The media understand it here - they literally used the term self-selection bias on the news this evening. Then again, Canadian news tends to cater to a more literate crowd, not those with an attention span of 140 characters.

      --
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    6. Re:Sample bias by fluffernutter · · Score: 4, Insightful

      Oh my lord, I think you just nailed all that is wrong with America in that one statement.

      --
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    7. Re:Sample bias by sjames · · Score: 2

      Because they believe they're fine and want to defend their beloved sport.

    8. Re:Sample bias by TechyImmigrant · · Score: 3, Funny

      >Why not? Why do you need to keep your brain if you're dead?

      Why do you need a brain if you are an NFL player?

      --
      I should use this sig to advertise my book ISBN-13 : 978-1501515132.
    9. Re: Sample bias by 93+Escort+Wagon · · Score: 2

      And a separate study came to a significantly different conclusion - that chronic traumatic encephalopathy is a leading cause of organ donation.

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      #DeleteChrome
    10. Re: Sample bias by interkin3tic · · Score: 5, Interesting
      The journal article itself can be found online, open access here.

      The methods section (emphasis mine)

      Study Recruitment In 2008, as a collaboration among the VA Boston Healthcare System, Bedford VA, Boston University (BU) School of Medicine, and Sports Legacy Institute (now the Concussion Legacy Foundation [CLF]), a brain bank was created to better understand the long-term effects of repetitive head trauma experienced through contact sport participation and military-related exposure. The purpose of the brain bank was to comprehensively examine the neuropathology and clinical presentation of brain donors considered at risk of development of CTE. The institutional review board at Boston University Medical Campus approved all research activities. The next of kin or legally authorized representative of each brain donor provided written informed consent. No stipend for participation was provided. Inclusion criteria were based entirely on exposure to repetitive head trauma (eg, contact sports, military service, or domestic violence), regardless of whether symptoms manifested during life. Playing American football was sufficient for inclusion. Because of limited resources, more strict inclusion criteria were implemented in 2014 and required that football players who died after age 35 years have at least 2 years of college-level play. Donors were excluded if postmortem interval exceeded 72 hours or if fixed tissue fragments representing less than half the total brain volume were received (eFigure in the Supplement).

      It sounds like they selected from donated cadavers for people who had played football. This is quite different from football players who suspected they had brain damage from football donating their brains. There would still be bias, as families who were convinced their loved ones were suffering from brain damage would be more likely to say yes to being in the study. But that's likely NOT NEARLY as big a bias as what GP is suggesting.

    11. Re: Sample bias by tlhIngan · · Score: 5, Interesting

      The problem with CTE is it's cumulative. The more trauma, the more damage. Some of the more aggressive players have unfortunately succumbed with devastating results. Basically, who was once a family man suddenly has behavioral changes which include sudden outbursts of anger and violence that are unprovoked. Who if they weren't football players, we may have normally had jailed or committed.

      Some are even suicidal, which is a shame because most take a bullet to the head, which destroys any evidence. (Some do have enough presence of mind left to avoid damaging the head and thus allowing researchers to diagnose CTE).

      The only reason for doubt is because the NFL is rather self-interested in not promoting tackle football causes CTE. Two reasons. First, they are worried - yes, scared sh*tless - that if the association is made, parents will withdraw their kids from football programs. This may lead to lowered interest in football, which means the millions of dollars it brings in could dry up.

      The second reason is the players associations - they have successfully sued the NFL over hiding or discounting the medical issue which is more than career ending, it's life changing.

      Before CTE was even discovered, it was thought brain damage happened as a result of a major event - it was thought the brain could handle getting hit and recover, when instead it recovers irregularly. CTE is the result of repeated minor brain damage caused by the brain banging against the skull causing scarring and bruising, and which builds up over time.

      The sports associations are heavily into discounting CTE because it really affects their bottom lines. It's also why there's a ton of research going into smart helmets that can indicate when a potentially damaging event occurs, and why at least at the college level and below, the threshold for benching someone has gone from knockout or concussion to a blow that exceeds 75Gs or so, even if the player is still conscious and lucid. And after a concussion, the bench time has a fixed minimum - no longer you wake up and you're in the next game, it's minimum 4-6 weeks benched, and only the doctor can clear you. Heck, some teams have even banned tackling during practice to avoid causing more damage than necessary.

      The link between football (and other contact heavy sports) and CTE has been long proven. There are many well regarded papers behind it. The only question left is what percentage of the football playing population has CTE.

      And finally, this is a VERY recent discovery. Bennet Omalu discovered this in 2002, and the NFL reluctantly acknowledged CTE's existence in 2009, after 7 years of trying to discredit Omalu. It's just like leaded gas, cigarettes, CFCs, and global warming all over again.

    12. Re: Sample bias by JoeRobe · · Score: 3, Interesting

      But then there's this quote from the BBC article, which makes it sounds like it was from families who suspected that the deceased had CTE

      "Dr Ann McKee, director of Boston University's CTE Center, which led the study, cautioned against drawing any immediate conclusions.
      "There's a tremendous selection bias," she said, explaining how many of the brains were donated specifically by families who had suspected that their loved ones were suffering from CTE, which researchers believe is caused by repeated blows to the head."

      --
      The best way to predict the future is to invent it.
    13. Re:Sample bias by hey! · · Score: 2

      While this is true, 87 of 91 is an astonishingly high proportion.

      Under the "no effect/sampling bias" hypothesis, the brains donated for NFL players would be reflective of the general population of people who suffer from dementia. That would mean that Alzheimer's and vascular dementia would account for the vast majority of cases. The chances of a random sampling of 91 dementia brains turning up 87 cases of traumatic injury is vanishingly small, meaning that it is quite reasonable to conclude that playing football professionally had something to do with the rate of CTE in this sample. So given that these results hold up, the next logical question is whether the difference in this sample are due to the obvious hypothesis -- that they resulted from playing football -- or some confounding factor as yet unidentified.

      Real-life data is never perfect, which is why we do laboratory experiments -- where such experiments are feasible and ethical. But "imperfect" is far from useless, and if this study holds up, then I'd say the burden of proof is on the hypothesis that there was some kind of confounding factor.

      That really is the essence of science; it's not about establishing truth, it's about establishing burden of proof.

      --
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  2. Well yeah of course by rsilvergun · · Score: 4, Funny

    you think somebody's gonna donate a perfectly good working brain? You can sell those on eBay or Craigslist for, like $30 bucks. I gave up trying to get human brains from thrift stores back in the early '00s. It wasn't worth my time to raise a corpse from the dead only to have the local villagers come round just because I used an "Abby Normal" brain.

    --
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  3. Re:Hmmmm by PsychoSlashDot · · Score: 4, Insightful

    Correlation does not imply causation.

    Is the implication that playing football causes brain damage, or that having brain damage causes playing football?

    As a lifelong nerd, I've often suspected both are likely, but I suppose you're right that we need to study this more before declaring "I knew it!"

    --
    "Oh no... he found the .sig setting."
  4. Do not assume causation by gurps_npc · · Score: 2, Interesting

    Correlation does not equal causation. Just because all professional NFL players appear to have brain damage, it does not mean that football causes brain damage.

    It could also mean that only a brain damaged person would play tackle football.

    --
    excitingthingstodo.blogspot.com
    1. Re:Do not assume causation by arth1 · · Score: 2

      It could also mean that only a brain damaged person would play tackle football.

      Or that one way of getting through college if you have problems with your brain is through athletics programs.

      But most likely, the major bias here is that players with brain damage are the ones who are asked to donate their brains.

  5. Post hoc, ergo propter hoc. by Anonymous Coward · · Score: 2, Interesting

    Or, perhaps it's just that those with bad brains have a propensity toward football as a career choice. There's a reason for the "dumb jock" stereotype. Which is the cause, which is the effect?

    1. Re: Post hoc, ergo propter hoc. by ravenshrike · · Score: 2

      No, most of the players have vastly reduced complexity in what they have to learn. The smartest player on the team is generally the quarterback. He also has to learn the most plays and variations, as well as read the entire field during each play.

    2. Re: Post hoc, ergo propter hoc. by Megol · · Score: 2

      I'd argue that being focused is more important than intelligence in most line of work. If one can't apply that intelligence it is mostly useless.

  6. Re:Hmmmm by rtb61 · · Score: 5, Informative

    Every single concussion comes with an extent of brain damaged aligned to the severity of the concussion, every single one https://www.brainline.org/arti.... The more concussions you suffer and the worse they are, the greater your accumulated brain damage. The reason you are concussed is because, yes you brain suffered sufficient impact to cause it harm, that is why you feel concussed. It's like never damaged, bruised nerves, means in those millions of nerve bundles some where broken, severed, ceased to function, resulting in diminished capacity, as for the brain. As different parts of the brain do different things, the direction of the impact has a significant impact on the outcome, some being much more dangerous than others. What probably saves jock straps from more behaviourally visible reduce cerebral function is smaller brains in thicker skulls, with fewer neuron connections and the types of activity they indulge in, not much mental function is required for the activity, in fact reduced mental function is desirable for repetitive training behaviours.

    --
    Chaos - everything, everywhere, everywhen
  7. Not Prove, but Yes IMPLY by DumbSwede · · Score: 5, Insightful

    Correlation does not PROVE causation. It can however strongly imply causation, especially as we can plainly see and infer the other mechanisms at play here. Let's not be like the cigarette companies here and turn a blind eye to the likely health dangers with misdirection. As for sample bias, when you are 110 for 111 I don't care what your bias is, the likelihood is that far over half of serious football players suffer brain damage of some sort or severity. Football and boxing are not likely to go away in our generation, but they will have to be modified greatly or they will eventually be considered a sport only us ignorant ancients would engage in.

  8. True... but there is other evidence of causation by Roger+W+Moore · · Score: 4, Informative

    While what you say is true but there is considerable evidence showing that the correlation is due to causation. It only occurs in sports where there is repetitive head injury and the effect is apparently similar to those produced when a head is subject to a "blast" and has not been immobilized first according to the Wikipedia page.

  9. Re:Hmmmm by PsychoSlashDot · · Score: 2

    Every single concussion comes with an extent of brain damaged aligned to the severity of the concussion, every single one https://www.brainline.org/arti.... The more concussions you suffer and the worse they are, the greater your accumulated brain damage. The reason you are concussed is because, yes you brain suffered sufficient impact to cause it harm, that is why you feel concussed. It's like never damaged, bruised nerves, means in those millions of nerve bundles some where broken, severed, ceased to function, resulting in diminished capacity, as for the brain. As different parts of the brain do different things, the direction of the impact has a significant impact on the outcome, some being much more dangerous than others. What probably saves jock straps from more behaviourally visible reduce cerebral function is smaller brains in thicker skulls, with fewer neuron connections and the types of activity they indulge in, not much mental function is required for the activity, in fact reduced mental function is desirable for repetitive training behaviours.

    Friend, I have a policy of not shooting for +5 Funny twice in the same discussion, but man... reading your post makes me feel like maybe I've been playing too much football and it's time to donate my brain to science.

    --
    "Oh no... he found the .sig setting."
  10. Not correlation vs causation by sjbe · · Score: 4, Informative

    Correlation does not equal causation. Just because all professional NFL players appear to have brain damage, it does not mean that football causes brain damage.

    Snark all you want but in this case this isn't mere correlation. The condition in question Chronic Traumatic Encephalopathy. Key word there is traumatic. You get that by being hit in the head and receiving brain damage as a result of being concussed. It's the exact same condition seen in boxers and MMA fighters and hockey players and rugby players and soldiers who get concussed repeatedly. So yes it absolutely does mean that playing football in the NFL is a cause for many players of serious brain injury. The fact that some players manage to avoid such injury does not mean that a cause/effect relationship is not in play. It simply means that some managed to avoid getting concussed during their playing career. Your claim is similar to saying smoking doesn't cause cancer because not every smoker gets cancer.

  11. CTE doesn't come from drug use by sjbe · · Score: 2

    What about soccer and baseball players?

    What about them?

    How can we tell drugs were not a cause?

    Because CTE has a well known and understood cause - namely getting hit in the head. Getting hit in the head happens a LOT in american football. There is no known case in medical science of anyone getting CTE from drug use.

  12. Causation has been proven by sjbe · · Score: 5, Insightful

    Correlation does not PROVE causation.

    It's a distinction without a difference in this case. CTE comes from being hit in the head which demonstrably happens a lot in football. CTE is relatively rare among the general population who do not engage in contact sports or who haven't been violently assaulted. It is quite safe to say that playing football is a common cause of CTE. Causation is not really a question in this instance and the causal chain is well understood. Some players manage to avoid being concussed but that doesn't mean that playing football was not the cause in those who do get CTE. There is no other reasonable explanation for their condition aside from head blows received while playing a violent professional sport.

  13. Ask yourself! by s.petry · · Score: 3, Interesting

    If I could be paid millions of dollars a year to exercise for hours every day, travel the country, and play a game a weekend for a few months a year, and I knew the paycheck came with the risk of brain damage, would I? Yeah, probably. Would you? I'm guessing you have would have a price not much different that what NFL players make.

    As long as players are aware of risks, it should be their decision to accept or turn down contracts. I think the problem many have with the current situation is that the NFL and other agencies (allegedly) attempted to hide the risks from players.

    The "allegedly" means that I don't know for fact, and don't care to debate the allegation. If they did, it's wrong but I believe it has been since corrected.

    --

    -The wise argue that there are few absolutes, the fool argues that there are no probabilities.

    1. Re:Ask yourself! by fluffernutter · · Score: 4, Insightful

      Except the brain damage doesn't start after you sign the contract. It starts just after your dad tells you 'tough kids play football' and you suddenly find yourself on the other side of the scrimmage line from all the freakishly huge kids from the other side of town. Parents are basically volunteering their kids for this in order for their kid to have a change at the big time. That's an awful big risk.

      --
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  14. Don't be stupid by sjbe · · Score: 4, Informative

    Correlation does not imply causation.

    Getting hit in the head is a proven cause of CTE. Professional football players get hit in the head commonly. Professional football players have CTE commonly. There is no other known cause of CTE aside from getting hit in the head. QED playing professional football is a common cause of CTE. The causal chain is quite intact here. The fact that some players manage to avoid brain injury while playing football does not change that causal chain.

  15. Control group is non-football players by sjbe · · Score: 4, Insightful

    Why would someone donate their brain if they didn't think they had damage?

    Plenty of people donate their brains for research who do not have CTE or other brain damage. This has been studied among the general population quite thoroughly. There is no need for every football player to donate his brain to avoid sample bias. We have a control group in everyone who doesn't play that sport.

    1. Re:Control group is non-football players by guises · · Score: 3, Informative
      It's a minimum of 9%. This problem was, of course, recognized by the researchers. From the NYT article:

      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.

  16. The Report Says Exactly This. by robbak · · Score: 4, Informative
    Quote:

    This study had several limitations. First, a major limitation is ascertainment bias associated with participation in this brain donation program. Although the criteria for participation were based on exposure to repetitive head trauma rather than on clinical signs of brain trauma, public awareness of a possible link between repetitive head trauma and CTE may have motivated players and their families with symptoms and signs of brain injury to participate in this research. Therefore, caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample.

    --
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  17. Glad we didn't give the Chargers a billion bux by Snotnose · · Score: 2

    I have a feeling the NFL is on the way out. Thank god we told Spanos to take his ball and go home, let the saps in LA build his new stadium. Oh wait, it's some billionaire from St Louis who's gonna let Dean camp in his basement.

    Whatever, I'm glad we aren't on the hook for an expensive ego booster to some dinky dicked millionare.

  18. Re:Needs more samples. by Aighearach · · Score: 2

    Soccer players who frequently use their heads to hit the ball may be at even higher risk than football players. Luckily, heading the ball is not very useful at the teenage level and most of the players are receiving many fewer head strikes than football players. However, some studies have suggested that a minority of players, presumably the most skilled, are already taking a large number of head strikes in high school.

    It is worth doing that sort of study, but because of macho societal stereotypes soccer players are less likely to admit concern. Soccer isn't perceived as being as dangerous, so they'd have to be pretty whiny to worry about it. But football is seen as really dangerous, so it is more accepted by the players and their families to ask those types of questions.

    Very few rock stars take lots of blows to the head. Drug use tends to damage the heart/liver/kidneys primarily. Opiates damage pleasure receptors, but you wouldn't see visible damage like you have in CTE. CTE is physical damage. It is like asking if smoking weed causes blisters. The answer is no. And when rock stars fall down, they're more likely to break an arm or to merely cut their head than to actually get a concussion. It certainly isn't normal to get repeated concussions, because if you party that hard you learn to party that hard, and if you can't even learn not to fall down and split your head open, you almost certainly already OD'd.

  19. Re:How about a control ? by Aighearach · · Score: 2

    I don't where all these dill weeds came from, but this isn't some blue-sky study to try to prove anything.

    It is a study to gather information about a known harm that is affecting people, that has clear and unquestioned causes, but where the extent of damage is not well known.

    Like for example if I neglect to water my tomatoes, and it hasn't rained, and I know there is damage from lack of water, I'm not doing a study to find out why the plants are turning yellow. Instead, I'm looking at how many of them are yellow, how yellow are they, what can recover, etc.

    There is not just one type of study in the world. That is something to consider if you love talking about studies in a way that would imply you read them or otherwise understand them.

  20. Physics is a bitch. by ledow · · Score: 2

    "People who risk smashing their heads into the floor for a living can have noticeable differences in their brains"

    Not really surprising, is it? All the padding in the world doesn't absorb the shock of decelerations like that and your brain is a squidy thing inside a bit hard thing, with a bit of leeway and fluid.

    No matter how hard the eggshell, you can still break the yolk inside.

  21. Hmmm by John+Allsup · · Score: 2

    Reminds me of a religious conservative taking the age-at-death of a number of porn stars, taking its average, and comparing that with the average age-of-death in the US, totally oblivious to those pornstars who are still alive and the contribution of their ages-at-death, which are presently unknown.

    From an epidemiology perspective, the 99% is, of course, useless. It's like saying that 99% of people who had terminal cancer died of cancer.

    On the other hand, (and why the fuck isn't this angle being spelt out more??), you have a reasonable number of brains to look at, from which you can infer ways to recognise where the brain injuries come from, and use this to better understand how often these problems occur in general. For example the questions that should be asked are about what sort of tests can we come up with to detect this sort of brain injury sooner.

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    John_Chalisque
  22. Academic distinctions by sjbe · · Score: 2

    Yes, but it doesn't give accurate percentages of those affected.

    That's kind of an academic point of interest. Once they develop an in-situ test on a live brain then we'll get accurate counts of percent of players affected but that's not particularly important data. The important fact is that playing american football unambiguously and substantially increases the risk of CTE particularly among professionals. The exact percentage of affected players is academically interesting but not clinically important to those affected. The important fact is that the rate of affected patients is substantially higher than in the general population. The only people that might care about the exact percentages are probably lawyers.

    Near 100% in those donating their body to science, but that might account for only a small percentage of those involved in the sport (also, what about other sports with high-speed impact, such as hockey)

    What about them? It's already known that hockey players get CTE as well and similarly the exact percentages aren't the important fact. Again, whether most football players or just some have CTE the important fact is that substantial percentages of these athletes (well above the general population) are affected. The cause of their injury is no more a mystery than the cause of a torn ACL.