Medical perspectives on the NFL's concussion protocol Transcript

Geoff Bennett: (00:00) The NFL and NFL Players Association have agreed to update the league's concussion protocol following a joint investigation into the league's procedures. That's after Miami Dolphins' quarterback to a Tua Tagovailoa crumpled to the ground last week, showing a telltale sign of a traumatic brain injury. Tua started in that game despite being sacked four days earlier and suffering an apparent head injury. The severity of his injuries reignited debate around the effectiveness of the NFL's concussion protocol. I spoke with Dr. Bennet Omalu, the neuropathologist who's credited with discovering the brain disease known as CTE. He says over the years, the NFL, instead of seeking his counsel on how to handle concussions, never contacted him, and instead tried to undermine his work. Dr. Bennet Omalu: (00:46) Nobody has ever reached out to me. In fact, what they have done is that they've gone on this smear campaign to delegitimize me, sometimes very racist. Now, every time they mention my name, they say the Nigerian-born, so that people in their subconscious will begin to associate me with these [inaudible 00:01:06] you get from Nigeria. So it's a shame, in my opinion, but again, it doesn't bother me, it doesn't truly bother me. I still have to speak my truth and help save lives. Geoff Bennett: (01:21) Dr. Omalu also says that Tua should retire from the league. Dr. Bennet Omalu: (01:26) With the two documented concussions, he must have suffered thousands of repetitive impacts to his head. Now remember, the brain is not like the liver. The liver, you damage it, it regenerates. The brain doesn't do that. The injury is permanent, and there is a reasonable probability that at some point the damage becomes progressive and becomes a new degenerative disease. My advice would be, "Hey, it's time to hang up your helmet." Sometimes the stronger person and the smarter person is he who walks away Geoff Bennett: (02:07) For more on the league's new procedures, we're joined now by Dr. Ann McKee, the director of Boston University's CTE Center. Thank you for being with us. And the league and the union agreed to change the league's concussion protocol to include the term ataxia. What is that exactly? And do these new rules go far enough? Dr. Ann McKee: (02:28) So ataxia is imbalance or difficulty maintaining your position in space, and they added that to the concussion protocol. I'm not sure that that's a major improvement, they already had gross motor incoordination, which to me covers ataxia, so I'm not sure the extra word really makes a lot of difference. Geoff Bennett: (02:52) What should the NFL be doing then when it comes to handling these concussions? Dr. Ann McKee: (02:58) Well, every concussion is different, and they need to take everyone quite seriously. They need to identify players that have concussions, and those include a lot of the signs that Tua was showing during both games. To me, looking just at the replay, it did look very concerning that he'd had a major blow to the head. And as far as return to play, it's a very individual process where the individual goes through steps gradually, with increasing exertion, increasing activity, until they're finally cleared to resume the game. Geoff Bennett: (03:36) Your work, as I understand it, really studies the risks of playing football over a long period of time. And a lot of the effects don't show up while these players are still active. Is that right? Dr. Ann McKee: (03:48) That's right. Although it can show up while they're active, much more often, it shows up after they've retired from the game. Geoff Bennett: (03:55) And so how does CTE manifest? How does it show up? How does it display itself? Dr. Ann McKee: (04:01) Well, first, let me just say that CTE is not just from concussion. That seems to be a misunderstanding of the disease. It actually is triggered by the hits to the head, many of which are non-concussive and many non-concussive hits occur during the play of football. It's the accumulation of those hits over time that leads some individuals to develop CTE. The manifestations tend to be behavioral, personality and mood changes early on, but it can lead to dementia and severe cognitive impairment in older individuals. Geoff Bennett: (04:39) What would you say to people who might say football is a violent sport, it always has been, always will be, and that these players knew what they signed up for? Dr. Ann McKee: (04:49) I don't think it's true that the players knew what they signed up for because there's been such an emphasis really on denial and just ignoring the evidence. There's overwhelming data from our work and many other researchers' work that the risk for CTE is dependent on the number of years of playing football. There's a direct dose response between number of years of playing football and your risk for CTE. And I don't think that that message is getting across to younger athletes, to families, to parents. And I don't think it's coming across to professional players either. I don't think they are educated in what their real risks are. Geoff Bennett: (05:33) Dr. Anne McKee is the director of Boston University's CTE Center. Thanks again for your time. Dr. Ann McKee: (05:39) Thank you.