Is Football Bad for Your Brain?
The conversation about football and the future of the sport seems inextricably linked to concussions. Take former San Francisco 49ers linebacker Chris Borland’s decision to leave the National Football League after his rookie season, citing fear of brain damage from repetitive head trauma, for example, or the fact that 50 percent of Americans say they don’t want their sons to pick up the sport.
A growing body of research is linking continuous head trauma sustained by football players with neurodegenerative diseases. One of these is chronic traumatic encephalopathy, or CTE. Previously seen in boxers and once known as “punch-drunk syndrome,” CTE was thrust again into the public consciousness when forensic pathologist Bennet Omalu uncovered CTE during an autopsy of former Pittsburgh Steeler Mike Webster.
In her new book, Concussion, Jeanne Marie Laskas chronicles Omalu’s efforts to bring his findings to the NFL. Laskas and other researchers working on CTE join Ira Flatow to discuss what we do and don’t know about the disease and its link to repetitive head trauma.
It is important to note that media coverage has outpaced scientific inquiry into CTE at this point. And while the National Institutes of Health convened its first consensus conference to define “pathologic characteristics of CTE” in February 2015, some researchers question whether CTE is a distinct neurodegenerative disease. Several recent studies (two examples of which can be seen here and here) caution that additional work needs to be done to articulate what makes CTE a distinct disease.
*This copy was updated on November 6, 2015. An earlier version linked to a study on CTE that entailed a conflict of interest (you can read more about it on Retraction Watch). That link has been replaced with a different study.
Ron Hamilton is an Associate Professor of Pathology at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania.
Jeanne Marie Laskas is the author of Concussion, published by Random House, 2015. She is based in Scenery Hill, Pennsylvania.
Blake Ripple is a former high school football player in Marble Falls, Texas.
Robert Stern is a professor of neurology, neurosurgery, and anatomy and neurobiology at Boston University School of Medicine and the director of clinical research at Boston University’s Alzheimer’s Disease and CTE Center in Boston, Massachusetts.
IRA FLATOW: This is Science Friday. I’m Ira Flatow.
When it comes to playing football at any level, from high school and college to the NFL, you’re probably going to get hit in the head a lot. Whether it’s lunging head first into another player or catching that long pass and smacking your head into the ground as you land, repetitive brain trauma is part of the sport. But how bad is it to get hit in the head over and over again?
The intuitive answer you might come up with is, well, it can’t be any good for you. But this question of how bad concussions and sub-concussive hits are for the long-term health of football players is one that is fraught with controversy as science attempts to keep up with the explosion of public awareness and discussion about brain trauma and the future of football.
And today we’re going to take a look at one piece of this puzzle– chronic traumatic encephalopathy, CTE, as it’s called. A disease that some researchers have linked to contact sports, like football and boxing and history of sustaining repetitive brain trauma. And while this often contentious conversation has centered around the NFL, we need only turn to a former high school football player to get a sense of his experience with the physicality of the sport and whether or not he was aware of the health risks when he started playing.
Blake Ripple is a former high school football player in Marble Falls, Texas. Doctors have assessed that while he played football he sustained between 30 and 40 concussions. He is now disabled, living at home and has testified before the Texas Legislature about his experiences and he joins us from Marble Falls.
Welcome to Science Friday.
BLAKE RIPPLE: Thank you for having me, sir, very much.
IRA FLATOW: You’re welcome. Tell us about your disability. When did you first notice– have this disability?
BLAKE RIPPLE: It started my junior year in high school. Throughout the beginning of the season, I was suffering what they now considers sub-concussive hits, very small impacts to the brain. Later on down the season, I started experiencing much, much harder concussions, much harder hits until November or October of 2009. I suffered a very massive head-on collision, had what they call a– it’s where your spinal cord kind of comes up and cuts off some of the nerve stems that touch the bottom of your brain.
Went to the locker room and the coaches said– I told them how I was feeling. I couldn’t barely speak, couldn’t walk, couldn’t open my eyes. We were about 150 yards from the locker room, so I had to be walked, escorted. I was telling the coaches, you know, hey, I’ve got all these problems. I’m not feeling too good. They said, well, here’s some Tylenol. And my parents finally decided it was time to go the hospital.
We went that night and had CT scans and whatnot. They show that there was no brain bleed, no swelling. So we went home and subsequently throughout the week, we went to other doctors, neurologists, things like that. And that’s when the neurologists determined that I suffered all these problems as a result of the head injury that night.
IRA FLATOW: When you decided to play football, did anyone talk to you about the possibility of getting a concussion or any of the health risks?
BLAKE RIPPLE: Not really. We did have a– at the beginning of every season, our coach would read a sticker off the back of our helmets that said that it will not prevent a head injury. It’s only there to prevent a head fracture. And that was kind of just about it, saying that if you get a headache, then let us know.
All the concussion-related things, all these discoveries were made almost exactly six months after my season ended my senior year. I kind of decided to stop playing football that I’d suffered too many issues. And I thought that college football would probably kill me. Or if that didn’t kill me, if I had the talent to proceed any further, maybe that would kill me.
IRA FLATOW: What is your health like these days?
BLAKE RIPPLE: It’s not very good at all. I have constant headaches, nausea, vomiting. I go through a procedure every six months called a nerve ablation. They stick a needle into your spinal cord, into the nerve center. And they burn off the ends of your nerves to trick the brain into thinking that there’s no pain. There’s still damage and pain there. It’s just trying to trick the brain.
And I have nausea all the time, vomiting. I have the ulcers and tears in my esophagus. I have a very bad hiatal hernia. I have to take around-the-clock pain medication. I have to take other medications. My life is kind of regulated to the medication and how to split my day without using too much thought or energy, without getting too tired.
IRA FLATOW: I want to thank you very much for taking time to talk with us today, Blake, and for recounting your experience and wishing you the best of luck in the future.
BLAKE RIPPLE: Yes, sir. Thank you.
IRA FLATOW: You’re welcome.
Blake Ripple, former high school football player in Marble Falls, Texas.
We’re going to turn now to a discussion of the history of chronic traumatic encephalopathy, CTE, which has been described by some scientists as a neurodegenerative disease linked to repetitive brain trauma when it was first associated with football.
Joining me to discuss the discovery of CTE in former football players is Jeanne Marie Laskas. She’s author of the forthcoming book Concussion from Random House. Her 2009 article in GQ also inspired the upcoming movie, also entitled Concussion that is coming out in December. She joins us from her home in Pennsylvania.
Welcome to Science Friday.
JEANNE MARIE LASKAS: Thank you very much. It’s my pleasure to be with you.
IRA FLATOW: I also want to bring on Ron Hamilton. Associate Professor of Pathology at the University of Pittsburgh School of Medicine. He joins us from WESA in Pittsburgh. Welcome to the the program.
RON HAMILTON: Thank you, Ira.
IRA FLATOW: Jeanne Marie, how was CTE first linked to football?
JEANNE MARIE LASKAS: Well, you know, first my heart goes out to Blake, your guest. I’m really sad to hear that story and I’m sad to say we’re hearing that story so often. I’m so glad you’re addressing this topic, because, frankly, one of the things I’m even trying to do in this book is to invite America to have this conversation we keep almost having but not having.
And, honestly, this dates back to 1982, at least, when the Wall Street Journal called brain injury in sports a silent epidemic. It remained silent through the ’90s. In ’94 three NFL players on one Sunday– Troy Aikman, Vinny Testaverde and Chris Miller– on one Sunday were knocked out cold by concussions. So the NFL started to say, OK, we better answer for this and put together a committee called the Mild Traumatic Brain Injury Committee.
And so that was maybe an act of responsibility. However, those were paid scientists by the NFL. So march forward, what I’m trying to tell in this book is the story of someone who enters this conversation, not as a paid scientist and not as an unpaid scientist, who’s crying out about the dangers of concussions.
A guy named Bennet Omalu, who’s a neuropathologist from Nigeria, who enters the scene knowing nothing. Nothing about football. Nothing about the NFL. No axe to grind whatsoever. He’s a neuropathologist who gets a body on the slab just like any other day. And it’s the body of Mike Webster. Everyone is worked up that it’s Mike Webster. And Bennet Omalu says, who? And they laugh at him and say, he’s a famous Steelers center? And Bennet says, what’s a Steeler and what’s a center?
Mike Webster had died of a heart attack. Bennet’s job was to do the autopsy on his body and find that pathology and he did. But he raised the question, what happened? Everyone was talking about how this football player, at age 50, had gone stark raving mad. Living in his car. Super gluing his teeth. Using a taser on his leg to get to sleep. Really degenerative disease of some kind. But what? What was it?
IRA FLATOW: And, Ron, Omalu asked you to examine Mike Webster’s brain to see what was going on in there. What did you see?
RON HAMILTON: Yeah, that’s correct. Bennet had just finished his training in our Neuropathology Fellowship Program here you UPMC, and I had basically been teaching him most of the neurodegenerative disease aspects of the neural pathology, because that was my area of expertise. I was already internationally recognized in that field.
And so I think it was natural for him to look at this and say, I don’t believe my eyes. I’m pretty sure what it is, but I better have somebody who’s more experienced. Now, at that time Bennet had maybe looked at 100 brains for neurodegenerative disease, whereas I had– at that time– looked at over 5,000 brains for neurodegenerative diseases.
So he brought the case to me one day and didn’t tell me anything about it. Just said, Ron, here’s some slides I want you look at. Now this was months and months and months after Mike Webster. I had– if I noticed it all, I had completely forgotten about it. And he gave me the slides. I looked at them very, very carefully and the first thing I said to myself, well, it’s clearly not Alzheimer’s disease. And then I looked for all the other different kinds of diseases that cause dementia and the only one that was left on the list– and it fit perfectly– was dementia pugalistica.
So I said, well, that kind of makes sense. Bennet’s at the coroner’s office. Boxers die. He probably wanted to bring me an interesting case of dementia pugalistica.
So I told him, I said, so this is a boxer’s brain, right? And that’s when he kind of smiled and he said, no, football player. And I wasn’t too surprised at that. I said, OK, football players, that’s pretty violent. You know, boxers with helmets on is the way I described it.
And then I asked the pertinent question, which was has it been published before. And when he said no to that– I knew Bennet was careful enough to have looked over the literature very, very carefully. And that’s when I nearly fell out of my chair. That’s when I knew that this was going to be a really important case and that it wasn’t going to be the first one. And so Bennet got me to agree with him without even telling me what he wanted me to agree with.
IRA FLATOW: Jeanne, how did Omalu approach the NFL with his findings and what reaction did he get? I mean this– you hear Ron talking about he thinks he’s looking at a boxer’s head, which gets punched a lot in his career. It looks just like that. And now you go to the NFL. What did they say?
JEANNE MARIE LASKAS: Well, Bennet published his findings in the journal Neurosurgery and the NFL came back at him with their MTBI committee with the request that that article be retracted. Saying that it was completely wrong, that it was a failure, that this was speculative and unscientific. So there was no chance of them embracing Bennet’s work.
In fact, that was a surprise, because Bennet actually thought they would welcome this research. He thought that he had something to offer that they would want to further, but that was not the case. And then subsequently he– immediately, actually, found the same pathology in another football player, Terry Long, who died at age 54 in 2005.
IRA FLATOW: Hmm.
I’m Ira Flatow. This is Science Friday from PRI, Public Radio International. Talking about Jeanne Marie Laskas’s new book called Concussion, talking about how brain injuries to football players, boxers, hockey, people– anybody that gets concussions. Also with Ron Hamilton, Associate Professor of Pathology at the University of Pittsburgh School of Medicine.
So let’s continue. This is a very interesting story. Ron, at one point you only saw that one brain, one individual. Jeanne has told us about others since then, but did this first time seem scientifically significant to you?
RON HAMILTON: Yes. Having looked at thousands of brains of both demented and non-demented patients, I immediately recognized this as a unique case. So sometimes you’ll hear the criticism that those cases that are in Boston, it’s a skewed study. Well, it’s not really, because both Ann McKee and myself have looked at thousands and thousands of brains, and we only see this pathology in brains that have had a history of chronic repetitive head trauma. We never see it in any other circumstance.
So it’s scientifically valid. It’s just as valid as it was 30 years ago when they found it in boxing. And if you read the NFL’s request for retraction, they fully agree that it occurs in boxing, but completely disagree that it occurs in football, and somehow they’re not making that connection.
IRA FLATOW: Jeanne, why did you decide you had to write this book, Concussion?
JEANNE MARIE LASKAS: The more I looked at the research, the more I looked at the conversation that was going on in the scientific literature between the unpaid scientists and the paid NFL scientists, I thought there was a moment here where, wait a minute, scientists, you are confusing America. America does not understand who’s paid and who’s not. Tell us what is going on.
Sometimes it comes to just the plain old storytellers to step in and say, OK, let’s step back and let’s have this out. Let’s have this conversation. What’s happening? The NFL scientists repeatedly– they published 16 papers in one journal, Neurosurgery, trying to refute this evidence. That’s a lot of papers.
IRA FLATOW: Well, with all the attention paid to concussions now, certainly some minds must be changed by now? No? Or is this–
JEANNE MARIE LASKAS: No?
IRA FLATOW: No.
JEANNE MARIE LASKAS: Go ahead, Ron.
RON HAMILTON: Oh, yes, no. It’s very clearly the vast majority of the scientific community, especially neuropathologists, see this as a very important completely preventable kind of condition. And that’s where we are.
I think the storytelling is absolutely critical, because as scientists, we’re dealing with just facts and pictures and using lots of words that nobody understands. But the storytellers tell it in a way that brings out the emotions of it. And, although scientists always argue about everything– whether drink whole milk or not– it’s always going to be there. There’s always going to be some discussion about it, because you can always dig up somebody on the other side.
But it’s not a question of whether this is a disease process. It’s question of how many people get it and how often they get it.
IRA FLATOW: So do you think people have it, football players have it now and they just don’t know it or it’s not showing up yet?
RON HAMILTON: Absolutely. Because this is a progressive disease, generally what happens is they have symptoms about 10 years after they retire, they begin having the symptoms. So in our young man, Blake Ripley, his problems are mostly stemming from the acute injury and re-injury as opposed to this tau build-up that takes years and years and years. He’s probably having some of that occurring at this stage, but it won’t begin to affect his cognition until about 10 years from now, if indeed he gets it. We just don’t know because we don’t have the follow up on all these high school players. That’s really where the question comes.
IRA FLATOW: All right. We’re going to follow that up after this break.
Thank you, Jeanne Marie Laskas, author of the forthcoming book Concussion and Ron Hamilton, professor of pathology, University of Pittsburgh School of Medicine.
After the break– what about the diagnosis? Can we do it before death? We’ll be right back.
This is Science Friday. I’m Ira Flatow. This hour we’re talking about CTE and its potential link to sustained brain trauma.
As of right now, CTE is primarily diagnosed via autopsy, but scientists are working on a way to identify the disease while people are still alive. And one of those people who is working on it is Robert Stern. He’s Director of Clinical Research at Boston University’s Alzheimer’s Disease and CTE Center in Boston. He joins us from WGBH there.
Welcome back to the program.
ROBERT STERN: Terrific to be back. Thanks, Ira.
IRA FLATOW: Can CTE be diagnosed before death without the need for an autopsy.
ROBERT STERN: Not yet. And it’s important for people to know that all of those other important neurodegenerative diseases, like Alzheimer’s disease, also right now can’t formally, accurately be diagnosed before death. But we’re working on it. And there’s a lot of great science that’s been happening across all these diseases to help us with our effort to try to figure out how to diagnose CTE while someone’s living.
IRA FLATOW: Is it a well accepted diagnosis? We heard that the NFL is sort of denying that this can happen or is happening in their players.
ROBERT STERN: Well, it is not a clinical diagnosis yet. There is the clinical diagnosis of dementia pugilistica that was used previously by Doctor Hamilton. That was the clinical diagnosis used for boxers.
IRA FLATOW: Being punch drunk.
ROBERT STERN: Punch drunk, same thing. Punch drunk, dementia pugilistica And then the term chronic traumatic encephalopathy started being used around 1940 to describe it more generally.
But right now it’s not able to be diagnosed really while someone’s alive, because there’s just not enough known about it. And so we have to go through a very rigorous process to figure out what the clinical presentation is like. To differentiate that from other disorders and diseases. And then, most importantly, we have to have what’s called a biomarker, an objective biological test.
And that’s a really important thing, because think about all other organs in our body and all other illnesses and diseases. If we’re sick with something, we have a test for it. But not the brain. The brain is this wonderful, protected organ that makes it harder to come up with objective diagnoses. So that’s where we are now.
IRA FLATOW: You work with Alzheimer’s disease and other– when we talk about Alzheimer’s, we have like sort of a bunch of symptoms, right?
ROBERT STERN: That’s right.
IRA FLATOW: We give tests to people and then we look for some of the nerve degeneration after their gone. Do we have those tests, yet, that is good enough for CTE?
ROBERT STERN: Not good enough to be accurate for CTE, because we’ve just started looking at it. I completely agree with Doctor Hamilton that the scientific field is pretty confident– the ones who really understand these types of disorders and focus on neurodegenerative disease– the scientific field is pretty together that this is a disease. It’s kind of a sister disease to Alzheimer’s disease, but it’s a unique disease. But we’re still in our scientific infancy of the study of the disease. And so we have a lot more to learn.
We’ve been studying Alzheimer’s disease since the early 1900s, but CTE has only really taken off in the last five or six years, because of the focus of football players getting it.
IRA FLATOW: Is there a cohort of football players you can assemble and follow them?
ROBERT STERN: Well, yeah, indeed, I have been doing that. I was fortunate enough a few years ago to get a grant from the National Institutes of Health to try to develop ways of diagnosing CTE during life. And that was very exciting, because it was actually the first grant ever funded by NIH to study CTE. That was great. It’s kind of sad that it took that long for funding to come through for this important problem.
But when we got that grant, the study that we refer to as the DETECT Study just finished collecting data like three weeks ago. And it involves around 100 former NFL players, all between the ages of 40 and 69, all who played positions with a lot of hits to the head. And they all came to Boston over around a three-year period, along with a control group with same age men who never played contact sports, never hit their heads, never had any brain trauma.
And when they came to Boston, they went through so many different types of tests, including incredible neuroimaging techniques by my colleagues, Dr. Shenton and [? Curta ?] and Lin over at Brigham and Women’s Hospital. Electrophysiological studies. Lumbar punctures with spinal taps so we could look at proteins in the spinal fluid. Blood tests so we can do these great experimental tests now to try to pick up these types of diseases in the blood. As well as genetic studies and then very extensive cognitive testing and psychiatric interviews and measures of mood and behavior.
And then, more recently, we were fortunate to start adding to the study this exciting new PET scan that is aimed at picking up the abnormal tau protein that is seen in this disease.
So we’ve now started to publish some of these findings. We’re getting closer to looking at all the data now that we just finished it. And we’re getting close. But it’s still only the beginning. My hope is that within the next five to 10 years, we’ll have a very good, accurate diagnosis for the disease during life.
IRA FLATOW: There was a play recently, we covered it on Science Friday called Headstrong. It was produced by the Ensemble Studio Theatre here in New York and it was about football players donating their brains to science after they died, because that was the only way, as you say, that the diagnosis could be made. Do you think that the sheer prominence of the coverage that CTE is getting could skew the diagnosis of the disease, perhaps even leading people who are alive to believe they have it when they may not have it?
ROBERT STERN: I think there’s two different things. I think the media coverage and media hype about this whole issue leads people to think that we know more about it than we do. But I don’t think that leads to the science being skewed. I think the science has to be done in an appropriate way to avoid the bias, avoid the skew.
But you brought up a very important thing. It’s that there may be some folks out there who have played football or other sports and hit their heads a bunch and they are so afraid that they’re going to get this disease or they have it or they’re going to have this or that symptom. And the reality is is that not everyone who hits their head a bunch is going to get this brain disease.
It’s very important, I think, number one to clarify that concussions are not the issue. People talk about concussion all the time with this disease, but for me personally, and professionally, when I think of this disease, I’m not as concerned about concussions as much as I am about the overall repetitive head impacts, including what we refer to as sub-concussive trauma, the types of hits to the head that don’t result in the symptoms of concussion. And those things can happen 1,000 to 1,500 times per season in various sports.
Those things seem to be what is associated with the beginnings of this disease. So we need to make sure that people are educated that just because they play these sports they’re not going to get this disease for sure. We have to figure that out.
And so a big part of our research, while we’re trying to understand how to diagnose it during life, is to also be able to figure out what the real risk factors are. Are there genetic susceptibility types of risks? What is it about the type of exposure that people have to repetitive hits to the head?
We know at this point that having that kind of exposure is a necessary variable to get this disease, but it’s not sufficient. Not everyone who hits their head is going to get it. So we have to figure out why one person gets it and another person doesn’t.
IRA FLATOW: Robert Stern, thank you very much. It’s a pleasure to always have you coming back on Science Friday. Director of Clinical Research at the Boston University’s Alzheimer’s Disease and CTE Center in Boston. Thanks again for joining us today.
ROBERT STERN: Thank you very much, Ira.