Orthopedic surgeons should not professionally involve themselves with football at any level of the sport, given research that the sport is associated with chronic traumatic encephalopathy (CTE), argues an editorial in Clinical Orthopaedics and Related Research.
Earlier this year, researchers released a study examining the brains of deceased men who had played football in some capacity and who had displayed symptoms while alive suggesting that they may have suffered from CTE. The study found that the brains of 110 of 111 men who had played in the National Football League (NFL) had CTE, as did the brains of 48 of 53 men whose highest level of football was college level.
The study did not provide an estimate on what proportion of professional football players might suffer from CTE. However, the New York Times calculated a rough minimum estimate of about 8.5 percent by dividing the number of all NFL players who had died over the study period—about 1,300 players—by the number of NFL players who had confirmed cases of CTE in the study, 110. Chris Nowinski, a co-author on the CTE study, said such a calculation provided a reasonable "ballpark" on the low end of the number of players who might be affected by the condition.
Doctors: Is supporting football 'consistent with the best values of our profession'?
Seth Leopold—a professor at the University of Washington School of Medicine and lead author of the editorial—and his co-authors wrote that while orthopedic surgeons should continue to care for injured football players off the field, they should not associate themselves with the sport in any professional capacity. Specifically, the researchers said orthopedic surgeons should not conduct physicals for football players at any level of the game or stand on the sidelines, nor should health care institutions sponsor professional teams.
And while the researchers acknowledged that football is not the only sport that is associated with CTE, they said football "merits special attention" because orthopedic surgeons are uniquely embedded in the sport on a professional level.
"In light of the known risks, we suggest that surgeons evaluate whether continuing to support this sport is consonant with the best values of our profession," the researchers wrote. "Is it right for us to support a game—through our presence on the sidelines or in the form of marketing and advertising dollars that splash [orthopedic] logos on practice jerseys and football stadiums—that causes grave harm to at least 9 [percent] of those who play it professionally?"
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The researchers continued, "Typically, physicians do not support the continued exposure of patients to known, severe, avoidable harms while approaches to risk-reduction are evaluated. ... Our first responsibility is the health and safety of our patients."
The researchers acknowledged that brain research is not their area of professional focus. However, Leopold and his colleagues said that the CTE study from earlier this year provided sufficient evidence to withdraw professional support. "When we sat down to write this, it wasn't to convince anybody that we know everything there is to know," Leopold said. "It was simply to make the point that with what little we know now, we have enough already to be really concerned."
Leopold said he anticipated two main objections to the recommendation: first, that players could suffer if orthopedic surgeons did not stand on the sidelines of games, and second, that surgeons could lose an opportunity to make the game safer.
To the first objection, Leopold pointed out that trainers and other medical personnel often stabilize and transport injured players to the hospital, meaning a lack of surgeons would not undercut standards of care. To the second objection, he said while research investigating safer methods of play should be supported, there is no indication that using different helmets or playing by different rules would curb CTE risk—and in the meantime, "we're continuing to run this experiment on human beings" (De Graaf, Daily Mail, 9/12; Avril, The Inquirer, 9/12).
Caring for concussion patients
According to the CDC, approximately 1.3 million people sustain a form of concussion each year, while many more go unreported. Recently, concussions have received a sharp increase in national exposure. Public attention is translating into active legislation mandating considerations in concussion care for students in almost forty states.
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