Conversations about protecting athletes from concussions more often than not focus solely on football. But several incidents at this summer’s World Cup triggered questions about what FIFA, soccer’s governing body, does to keep players safe. Kojo explores the emerging science and policies behind debates about concussions and professional and amateur sports.

Guests

  • Stephen Haas Former Chairman, Department of Orthopedic Surgery, Sibley Hospital (Washington, D.C.); Former Team Physician, Washington Wizards, Washington Capitals, 1996 U.S. Olympic Men's Basketball; Venue Medical Director, 1994 FIFA World Cup
  • Juliet Macur Reporter, The New York Times
  • Robert Stern Professor of Neurology, Neurosurgery, and Anatomy and Neurobiology; Clinical Core Director, Boston University Alzheimer’s Disease Center; Co-Founder, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine

Transcript

  • 12:06:44

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. The whole world was watching. Earlier this month, one of the stars of Argentina's national soccer team knocked heads with a Dutch player during a World Cup semifinal game. It seemed obvious to most people in the television audience that Javier Mascherano had suffered a significant head injury.

  • 12:07:18

    MR. KOJO NNAMDIAfter the collision, he could barely walk straight, then he collapsed. His eyes were glazed over. None of this, however, was enough to keep Mascherano out of the game. In fact, he returned and played the rest of the match.

  • 12:07:29

    MR. KOJO NNAMDIThe incident threw into the spotlight the protocols that FIFA, soccer's international governing body, has in place to protect its athletes and opened up many of the same questions that American football organizations, professional and amateur, have been grappling with for years, as more and more science about concussions has been put before the public. Joining us to have this conversation is Juliet Macur. She is a sports columnist for the New York Times. She joins us in studio. Thank you for joining us.

  • 12:07:56

    MS. JULIET MACURYou're welcome.

  • 12:07:57

    NNAMDIAlso with us is Stephen Haas. He's a doctor who chaired the orthopedic surgery department at Sibley Hospital in Washington from 1996 to 2006. He served as the team physician for Washington Wizards and Washington Capitals, as well as the 1996 United States Olympic men's basketball team. He was a venue medical director when the World Cup was hosted in the United States in 1994. Steve Haas, good to see you.

  • 12:08:22

    DR. STEPHEN HAASThank you. Happy to be here.

  • 12:08:24

    NNAMDIAnd joining us by phone from Boston is Robert Stern. He is a professor of neurology and neurosurgery at the Boston University School of Medicine and co-founder of the Center for the Study of Traumatic Encephalopathy. Robert Stern, thank you for joining us.

  • 12:08:41

    DR. ROBERT STERNGreat to be on.

  • 12:08:43

    NNAMDIYou, too, can join the conversation. Give us a call at 80-433-8850. If you have questions or comments, you can send email to kojo@wamu.org or shoot us an email at kojoshow. Juliet Macur, I'll start with you. The collision that Mascherano was involved in was enough to make millions upon millions of TV viewers, let alone anyone in the stadium watching it in person, cringe.

  • 12:09:06

    NNAMDIBut after only a few minutes, he was back on the field competing. Why did you find this incident in particular so instructive about policies that were in place at the World Cup to protect the athletes on the field?

  • 12:09:20

    MACURWell, the problem for FIFA, which is the world governing body of soccer, is that millions and millions of people were watching Javier Mascherano basically be dazed after getting hit in the head and basically come right back into the game, which, as the other experts on the panel will discuss, is totally not the right way to handle a concussion.

  • 12:09:42

    MACURAnd the problem with FIFA is that they allow -- or their protocols call for their team doctors or team trainer to evaluate the athlete to see whether he can come back into the game or not and they obviously have a stake in the game when it comes to having that athlete come back into the World Cup, which is the biggest venue for soccer in the world.

  • 12:10:05

    MACURSo that's the problem. They don't have anybody independently looking at these athletes and saying, you know, you should sit out for a few more minutes or you need to sit out for a couple weeks. That's the problem.

  • 12:10:16

    NNAMDIWhat was the extent of the care that Mascherano received or was required to receive before he reentered that game?

  • 12:10:23

    MACURI'm not sure about the extent of the care that he received. We know that it was just a couple minutes before he was able to come back and that was the problem with many other players who have gotten concussions in the World Cup was that they came right back on the field. And FIFA requires a team doctor or -- really, a team doctor to say he's okay, to evaluate him and say, you're okay, go right back.

  • 12:10:48

    MACURIn a lot of the cases and in that case, Mascherano was begging the trainer to stay back on the field. He said, I'm fine, I'm fine. And I guess that was enough.

  • 12:10:57

    NNAMDIWhat made this situation so different from what you've observed in other sports?

  • 12:11:03

    MACURWell, as we know now, the NFL is much different. I mean, in the past, I'm sure it was somewhat of the same thing where NFL players would get their bell rung, which really meant that they had a concussion, or maybe even were knocked out and either stayed on the field or went back to the sideline for a couple minutes and were back.

  • 12:11:20

    MACURBut now, obviously, with all the problems that the NFL's had with concussions, including getting sued by thousands of players for brain injuries that might have stemmed from their playing days, the NFL has a much stricter policy than almost anybody now.

  • 12:11:35

    NNAMDI800-433-8850 is our number. What protocols do you think professional and amateur sports should have in place to protect athletes from traumatic head injuries? 800-433-8850. Steve Haas, you were a venue physician at the World Cup in 1994 when games were played in the United States in cities like right here in Washington. When it came to rules and the protocols in place to protect the athletes competing in that event, what did you see when you worked?

  • 12:12:01

    HAASI saw a very dictatorial FIFA, for one thing. They rule soccer like no other entity rules other sports in terms of the protocols and in terms of the procedures that are done, especially when the game's going on. Only three substitutions are allowed for a game. Once a player's removed from the game, they can't go back in the game.

  • 12:12:35

    HAASSo these really cover most of the injury management. There really is very little care that can be done under that circumstance. The question is, can a player go back and play? Yes or no? There really is not treatment for traumatic brain injury or for concussion that can be done on the spot that will allow a player to go back and play. If they need treatment, they're out and the pressures are enormous, particularly in World Cup context, for a player to go back into the game.

  • 12:13:12

    NNAMDIHow did that compare with other sports organizations you've worked with? You've served as a team doctor for pro basketball and hockey teams, for the U.S. Olympic basketball team.

  • 12:13:22

    HAASWell, first of all, the position of being a team physician for the teams in the United States in all the leagues, basically stipulate that the TB physician on the sidelines cannot be overruled by the player or by the coach. The decision is final as to whether a player can go back into the game or not. It's a very chaotic situation that we can talk about. It's really an unprecedented medical scenario in the middle of a game, particularly of the magnitude of the World Cup.

  • 12:14:10

    HAASAnd we can talk about that, but it really is a unique situation for the doctor that I don't think is duplicated anywhere else.

  • 12:14:19

    NNAMDIPeople are on high alert now about the risks that American football players, both pro and amateur, take when they play as far as head injuries are concerned. What do you see when you watch soccer in terms of the exposure those players have to concussions?

  • 12:14:33

    HAASThey have a tremendous exposure, particularly at the level of the international games. The World Cup games are much more violent. The collisions are much more frequent. They are basically all-out races for the ball, often trying to run through players, the opposition, to get the ball. The heading of the ball is a big issue and none of this happens at the same level of intensity at lower levels, even in our United States profession leagues and much less college, high school and the kid leagues.

  • 12:15:19

    HAASBut at the international level, it's quite a violent game with no helmets, with extremely difficult refereeing. And there's an element there that really doesn’t exist nearly to the extent in other sports and that's the theatrics of it, the flopping and diving that goes on, which adds some -- it makes sort of an opera atmosphere to some of it, the triumphant return to play after a devastating injury in the middle of the field, et cetera.

  • 12:15:58

    HAASBut it really makes it hard for the physician that is dealing with the situation and has to make the decisions about it.

  • 12:16:07

    NNAMDII was going to ask both of you Stephen Haas and, you, Bob Stern and Juliet Macur, you can also weigh in on this one, because the precise issue of, you know, it's a sport where faking injury is considered to be a part of the game. Anyone who watches soccer or watched the World Cup this summer learned that players do a lot of performing to draw fouls and gain advantage, sometimes to the point of rolling around in pain.

  • 12:16:31

    NNAMDIRobert Stern, from the perspective of a doctor, how challenging is it when you're trying to protect athletes who are competing in a sport where they might be faking an injury?

  • 12:16:41

    STERNWell, you know, one of the concerns that some critics have had about changing the rules in FIFA is that that's going to have all the time, that people are going to roll around. They're going to pretend to have a brain injury so they can stop the play, so they can go out and rest and then come back in. So if the regulations are changed such that people can have a longer time period on the sideline to be assessed, they can then come back in.

  • 12:17:07

    STERNSo there's this fine line between making sure that the players are protected, that their brains are protected, that we're not creating some incredible risk for them, and protecting the game. So I can see it both sides and it's in part because of the theatrics, that there's going to be people trying to do whatever they can to manipulate the game for their team's good.

  • 12:17:32

    NNAMDIBut Juliet, you take issue with FIFA officials making demands to change the rules about diving, faking. You say this really misses the problem.

  • 12:17:42

    MACURIn terms of what?

  • 12:17:44

    NNAMDIThe fact that FIFA wants to change the rules about diving while, in your view, not paying as much attention to concussions.

  • 12:17:52

    MACURRight. For FIFA, the diving is the scourge of the sport. They spend a lot of time on thinking about how to eradicate the sport from it, how to make the sport more pure. Meanwhile, there are guys who are getting concussions in the middle of the World Cup where, in the final game, a billion people were watching when a German player sustained a concussion and then was right back on the field and was walking around like he had had one too many cocktails, until he fell down to the ground and was escorted off.

  • 12:18:20

    MACURI mean, that's a pretty obvious problem and the diving part of it, even the FIFA president, Sepp Blatter, said we have to get rid of this. This is the biggest problem in our sport. And I think he's missing the biggest problem, which everybody saw in the World Cup for several weeks, players getting hurt left and right and coming right back into play.

  • 12:18:39

    NNAMDISteve Haas, when you worked the World Cup in 1994, who was the onus on to make the medical decision about whether a player was healthy enough to return to a match? Was that solely on the doctor provided by the team itself?

  • 12:18:53

    HAASAbsolutely. And there was no question that the team's own doctor was the last word. My role was to organize the logistics of medical treatment for the group of teams that were here. But when it came down to making the specific decisions about the games, this is absolutely in the realm of the team's own doctor.

  • 12:19:25

    NNAMDI800-433-8850 is our number. You can send email to kojo@wamu.org. Robert Stern, we got this email from Shannon who writes, "My friend, Patrick Grange, Albuquerque, New Mexico," and Juliet obviously knows who that is, "was a long-time soccer player. He was diagnosed with ALS at 27 and died two years ago at the age of 29. After his death, doctors found that he had CTE, chronic traumatic encephalopathy. Has there been any more links made between CTE and ALS? Would preventing kids from heading the ball as children have any effect on the amount of trauma to the head long term?" Robert Stern?

  • 12:20:06

    STERNWell, those are all the big questions. It was our group here at the U that examined Mr. Grange's brain. And I know the Grange family quite well. And they've gone through a real period of hell. You know, they saw their son start heading the ball at age three. And was this just incredible soccer player. Played at Arizona, but then in his 20s developed clinical Lou Gehrig's disease. And after his very young death, it was found by my colleague here, Ann McKee, that his brain did indeed have chronic traumatic Encephalopathy.

  • 12:20:52

    STERNAnd as far as we know the only way one can get CTE is by having an exposure earlier in life to repetitive brain trauma. So the thing that I think your listeners need to know, that might address your question, is that there's this big continuum, in terms of the type of brain trauma that occurs and what the consequences might be. And so what we're talking about with someone like Patrick Grange, who did develop this neurodegenerative disease of CTE that was associated with is ALS, we're talking about repetitive mild hits through a long period of time, including heading.

  • 12:21:35

    STERNAnd that's what the concern is now, that heading itself has been shown to have a tremendous amount of g-force to the brain. Every time someone hits the ball. And that's around 1,000 to 1,500 times per season, usually, for an active soccer player. And that repetitive hit to the brain has been found now to result in both short-term and long-term consequences.

  • 12:22:03

    STERNThere's been studies from my colleagues here in Boston, at Brigham and Women's Hospital, that showed dramatic changes in the white matter of the brain in semi-pro and pro soccer players in Germany, who headed the ball all their career, but never had concussions. And so they never had any significant major symptoms following a big hit, but they headed the ball throughout their career.

  • 12:22:32

    STERNThey had significant changes to the white matter of their brain compared to other athletes who never had any head trauma. Other similar studies are now coming out. So that repetitive subconcussive type of trauma can lead to changes in the brain. What we're talking about with FIFA right now is not even anywhere near that. We're not talking about heading. That's another story, perhaps another year, another World Cup.

  • 12:22:58

    STERNFor now we're talking about the short-term and long-term consequences of these big hits that lead to these cases like we've all seen down in Brazil. And these big hits can lead to significant short-term problems, such as the inability to perform well for your team, the inability to go back to normal life afterwards, and even perhaps, in some of the younger players, death. There's something called second impact syndrome that occurs when you return to play too soon after an initial concussion.

  • 12:23:38

    STERNSometimes in younger players, youth and up to the early 20s the brain can swell so dramatically that an individual can actually die. So we've got some major changes that occur in the short-term. And we've got some major changes that can occur later in life, in terms of neurodegenerative disease. That's why FIFA and pretty much any sports organization really has to pay attention to this now.

  • 12:24:04

    NNAMDI800-433-8850. We're going to take a short break, but you can still call. Have concerns about head injuries affected any decisions that you've made about whether your children should be allowed to compete in certain sports? How so? 800-433-8850. You can send email to kojo@wamu.org or shoot us a tweet, @kojoshow. I'm Kojo Nnamdi.

  • 12:26:15

    NNAMDIWelcome back. We're talking about concussions in the wake of what so many million -- billions of people saw during the last World Cup, and taking your calls at 800-433-8850. Juliet Macur joins us in studio. She is a sports columnist for the New York Times. Stephen Haas, also joins us in studio. He's a doctor. He chaired the orthopedic surgery department at Sibley Hospital, in Washington. He's also served as team physician for Washington Wizards, Washington Capitals and the United States Olympic Men's Basketball Team.

  • 12:26:45

    NNAMDIHe, as I mentioned, joined us in studio. Joining us by phone from Boston is Robert Stern. He is co-founder of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, where he's also professor of neurology and neurosurgery. You can call us, 800-433-8850. Let's go to Betsy, in Washington, D.C. Betsy, you're on the air. Go ahead, please.

  • 12:27:09

    BETSYYeah, good afternoon. Hi, Kojo. This is a great discussion. I wanted to know if anyone on your panel could address the difficulty of telling, in the moment, after an impact, how severe the concussion will be. I have a 15-year-old, played goalie, was hit in a practice, felt a little bad, but went on and played the game. Nine months later he has headaches constantly. We're seeing a specialist. There's no end date in sight for when he'll recover from this concussion. But nobody knew in the week or two after the initial hit, how bad it was going to be.

  • 12:27:49

    NNAMDIStephen Haas?

  • 12:27:50

    HAASWell, you make a very good point. And that is that it's extremely difficult on the spot, in the instance, to determine whether or not there was a significant traumatic brain event. Sometimes the symptoms are delayed in onset. They're not immediate. Everything looks all right, only to be revealed later, as a significant injury. In a sideline situation, at the moment of the injury, this is not like a nice structured environment in an office where time's not an issue. There are no frantic coaches, crowds, TV cameras, whatever.

  • 12:28:38

    HAASThe office situation is relatively open-ended, a lot of testing is available, easily -- it's completely different to make that decision instantly at the time of an impact or at the time of an injury. It takes experience and even in the best of hands it's still a judgment call in many cases. Therefore, the answer to your question is that it is not and cannot be foolproof, just because of the circumstances where the judgments are made for playing.

  • 12:29:19

    STERNIf I could add, it's important to note that there's still a lot of people out there who think that a concussion requires a loss of consciousness, that we may have seen in down in Brazil. And that's far from the truth. A very small percent of people with concussions have a loss of consciousness. It's -- as was stated, it is a traumatic brain injury. And it has a variety of symptoms. But the best type of definition for it is the most simple, which is when one has their head hit or their body struck in a way that moves their head violently.

  • 12:29:58

    STERNAnd then there's any kind of change in mental status, meaning thinking, feeling, being confused, having double vision, being -- poor balance, having memory difficulties, being in daze. Those are all the symptoms of a concussion. And so they happen much, much more commonly than people think. And so the best recommendation across all levels of play, but especially for the caller's 15-year-old son, is always when in doubt, sit it out.

  • 12:30:34

    NNAMDIBetsy, thank you very much for your call. Good luck to you with your son.

  • 12:30:38

    BETSYThanks, Kojo.

  • 12:30:39

    NNAMDIJuliet, earlier this month you wrote about a soccer player people in D.C. know pretty well. Alecko Eskandarian played for D.C. United. He suffered several concussions throughout his career, including one in his very first professional season for D.C. United. He eventually had to walk away from the game. What happened?

  • 12:30:56

    MACURYeah, his concussion has gotten so bad that actually at the very end doctors said, "You cannot play soccer anymore because the next hit you have might be your last." So unfortunately he had to stop playing the game and it's been years. I think he retired in 2009. And he still has daily headaches. He gets really tired out of the blue, enough that he has to just go to sleep. He said recently he's stopped riding in the backseat of a car because he was getting so nauseous just riding in the backseat of a car.

  • 12:31:25

    MACURAnd can't concentrate when he's either on his iPhone, on the computer. So he's feeling these symptoms of these concussions that he had over the years. And it's really a sad story. It's something that could have been prevented, I think, with obviously people paying more attention and being more careful when it comes to these things. And I know Dr. Stern mentioned that there are two types of concussions. There's the ones where you get knocked out, which Alecko Eskandarian had a bunch where he was knocked out and then kept playing, even though he was knocked cold on the field.

  • 12:31:56

    MACURHe just kept on playing and a trainer basically asked him, "Are you okay?" And he would say, "Yeah, I'm fine." Because he obviously wasn't thinking right because he'd just had a brain injury. And then there's also these other head injuries that come from heading, which, you know, Alecko was heading the ball since he was very young. His father had played for the Cosmos, was a pretty famous player back then. And so, you know, it could be a combination of the both, but I think when it comes to FIFA, it's better safe than sorry. And I don't think they -- I don't think they understand that saying yet.

  • 12:32:25

    NNAMDII can only wonder what was going through his mind when he saw what we saw when we watched the World Cup this year.

  • 12:32:32

    MACURYeah, he thought it was crazy. He thought it's unbelievable that this could happen in 2014, when he retired five years ago with all these problems. And several other MLS players have had these problems and have made a big deal out of it. And it's amazing that FIFA is completely blind to this problem that can be prevented. But it seems like they're more concerned, as most teams are concerned in the World Cup, and most players are concerned in the World Cup. They're concerned about winning first, winning even over their own safety.

  • 12:33:00

    NNAMDI800-433-8850. You can also go to our website, kojoshow.org, ask a question or make a comment there. Have you ever suffered a concussion while competing in sports? What kind of medical care did you receive and who ultimately made the decision about when it was safe for you to compete again? 800-433-8850. If you have called, stay on the line. We will get to your calls. Stephen Haas?

  • 12:33:23

    HAASI just wanted to make a point that, far be it from me to defend FIFA. They are extremely political, extremely entitled and they really are virtually autonomous in most ways. But I must say that unlike every other sport, significant changes to help with the problem of concussions and head injuries is going to require a fundamental alteration of the sport. We tinkered with other sports and have made progress with football, with hockey, with basketball, etcetera. But it hasn't really changed the essence of the sport.

  • 12:34:13

    HAASIf problems are solved only by helmets, for instance, that's going to change the whole situation with heading. Changing the substitution rules will have a fundamental issue. The whole issues of the doctors being overruled by players or coaches, again, all of these are going to be very slow to come about and are going to have a tremendous impact on the overall game, much more in excess of the changes that have made in the more common sports in the United States.

  • 12:34:59

    NNAMDIHere is Mark, in Frederick, Md. Mark, you're on the air. Go ahead, please.

  • 12:35:03

    MARKHi, Kojo. Thank you for taking my call. I'm calling from Frederick. I'm a child neurologist and work in the Washington, D.C. area. And I just -- I want to point out that, you know, although that, you know, any kind of serious injury in a sporting event, whether a head injury or otherwise is obviously catastrophic and terrible. I would be cautious about speaking too definitively about (unintelligible) concussions.

  • 12:35:30

    MARKThere is a literature that basically talks a little bit about the, again, controversy related to return to play, activity after a concussion, and there's even a literature that it talks a little bit about the consequences of moving somebody from play or work or school that may have a very similar manifestation associated with concussion.

  • 12:35:54

    MARKSo depression, difficulty thinking, headaches, difficulty sleeping, all may be associated with the removal from these kind of activities. So, again, I just want to sort of insert a little bit of a cautionary note that we don't know everything there is to know about concussions.

  • 12:36:12

    NNAMDII'm glad you brought that up, because that's clear. Robert Stern, to what degree, in your view, are we still learning about the science of traumatic brain injuries that we see in sports, whether in football or in others? Robert Stern?

  • 12:36:24

    STERNWe are at the very, very early stage. We're really in the infancy of our understanding of concussion. I completely agree with the caller, that care needs to be taken to overstate and overblow some decisions based on knee-jerk reactions. What we do know, though, is that hitting your head can't be good for you, you know. We take for granted that, you know, throwing a baseball over and over again, as a young pitcher, might hurt your tendons and therefore make it difficult for you to go on to be a major league baseball player.

  • 12:37:02

    STERNSo we count every single pitch and get someone out of the game. But what we don't do is take care of our athletes' brains in appropriate ways. The caller made a big point that we need to make sure we don't over-do it and take people out of school, out of work, without really considering what the implications are. But I think that's different from what was being discussed today, which is the FIFA rules and other rules about taking someone out of the game, right then and there, to assess them appropriately, to make a decision whether they should return to that game.

  • 12:37:40

    STERNReturn to play, return to activity decisions, that's something that definitely is in the works right now, with science trying to figure out what's the appropriate way to do it. But right now I think there's a universal agreement that if someone has an apparent concussion, they need to be assessed immediately and assessed appropriately with the decision made whether they should go back into the game or not.

  • 12:38:06

    NNAMDIAnd I'm glad you juxtaposed return to play and return to activity, because Paul, in Washington, D.C., on the phone, wants to talk about priorities in that regard. Paul, you're on the air. Go ahead, please.

  • 12:38:18

    PAULThank you. I'm a brain-injury survivor. And I'm also on the board of the Brain Injury Association of D.C. And, you know, while I think it's very good that focus has been placed on concussion and, you know, talking about this issue and sort of having a kind of a more textured view of brain injury. The overwhelming interest is about return to play. And for -- if we're talking about children and students, in part I think that the overwhelming interest should be in return to school.

  • 12:38:57

    PAULBecause, in fact, playing football is optional. Return to play is optional. It is not optional to go to school. And there are a host of cognitive and emotional issues and social issues and changes that people who have brain injury undergo. And it would be nice if the discussion about concussion, could also generate an equal discussion about what it's like for people who have brain injuries, and then what services are available for them.

  • 12:39:33

    PAULWe seem to still keep the subject in the realm of athletes that are injured or soldiers that are injured. And it doesn't feel like we talk very much about what services do those individuals actually need to live their lives.

  • 12:39:50

    NNAMDIOkay. Thank you very much for your call. Care to comment on that at all, Stephen Haas?

  • 12:39:56

    HAASWell, the -- yeah, it points out how vast the whole issue is. Dr. Stern and his group are doing really great work. I was, until recently, the head of the National Football League's program that evaluated players that were and are applying for benefits, much of which was for traumatic brain injury. This was a neutral position, by the way. I was not an advocate for the league. This had to do with a negotiated panel of neurologists around the country that were working on this program.

  • 12:40:37

    HAASAnd he just points out how multifaceted the whole issue is, the return to school, the whole program involving kids in peewee sports league is a completely different issue than the professional athletes are concerned. And then there's a whole continuum that runs between those two poles. It's very difficult to get all of this together because there are so many competing interests beyond just the pure medical part of it.

  • 12:41:13

    HAASThere's billions and billions of dollars that flow back and forth that are affected by these decisions. That shouldn't have anything to do with the pure medical aspects. But, unfortunately, it does. And all this will slow things down. More work like that Dr. Stern and his group are doing is really -- is necessary and it's slow, it requires meticulous evaluation and long-term follow-up. And there's no way to really duplicate the situation and manipulate and answer like there is with so many other medical conditions.

  • 12:41:56

    NNAMDIGot to take a short break. When we come back, if you've called, stay on the line. We'll try to get to all of your calls. If the lines are busy, send us an email to kojo@wamu.org or shoot us a tweet @kojoshow. I'm Kojo Nnamdi.

  • 12:44:00

    NNAMDIWelcome back. We're talking about concussions with Robert Stern. He is the co-founder of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine, where he's also a professor of neurology and neurosurgery. Stephen Haas is a doctor who chaired the orthopedic surgery department at Sibley Hospital in Washington, D.C. He's also served as team physician for Washington Wizards and Capitals and as the 1996 United States Olympic men's basketball team physician.

  • 12:44:28

    NNAMDIHe was a venue medical director when the World Cup was hosted in the United States in 1994. And Juliet Macur is a sports columnist for the New York Times. Juliet, one person who researches head trauma told you that part of the problems that athletes need to be educated more about the seriousness of head injuries. From what you can tell, is this changing at all?

  • 12:44:48

    MACURI think it is changing with the number of stories that have been reported, especially in the NFL where you hear these players are retiring and they're getting neurological diseases or neuro-degenerative diseases that normally wouldn't happen to people that young. And it's pretty scary. I've interviewed a few -- several of those players and, of course, some of the soccer players who I've interviewed that have had head injuries over the years.

  • 12:45:14

    MACURAnd I think that FIFA would be able to see these guys and look them in the eye and explain to them why they haven't had a better policy on protecting the players, basically, from themselves. The would probably change their mind or move quickly -- more quickly in terms of changing their policies if they would see those people and how they've been affected.

  • 12:45:34

    NNAMDIHere is Henry in Washington, D.C. Henry, you're on the air, go ahead please.

  • 12:45:40

    HENRYThank you. Great discussion. I have one comment about FIFA reform and a question about my five concussions between the age of seven and 14. First, on FIFA reform, if we go in saying that the game has to be radically altered, we will achieve nothing. But FIFA, it has been shown, can be reformed but it's very, shall we say, incremental.

  • 12:46:04

    HENRYFor example, they just touted -- with great fans there -- the addition of cameras in the goal to make sure that there were no goals that were disallowed because they, quote-unquote, "did not go in" when, in fact, in the prior World Cup that's exactly what happened and a team was eliminated on that -- due to that. But FIFA, on the concussion front, could be persuaded, it seems to me, to do the following.

  • 12:46:29

    HENRYIf someone gets a knock to the head, someone on the other team, along with that person, goes out until such time as the concussion sufferer or the head injury sufferer is replaced by another player or...

  • 12:46:46

    NNAMDIAnd we should explain to people, and that's one of the reasons that teams are reluctant to send out players because until that player -- until a decision is made about that player, that team has to play with 10 players.

  • 12:46:56

    HENRYRight. And that's why you reduce the other team to 10 players from the same position that the guy was knocked out of. So if the head injury sufferer is a forward, you take a forward out for the same length of time from the other team. That would make the other team more careful on these high-impact situations that were being discussed a minute ago.

  • 12:47:15

    NNAMDIOkay. What else?

  • 12:47:17

    HENRYAnd then my question is, as a kid, I suffered four concussions that I remember and apparently one that I just don't. And the issue is, should I be doing something now in, you know, as an age 50-something that, you know, relates to the diagnosis of my own brain and, I don't know if there's any treatment that can be done for some of the symptoms that I may have.

  • 12:47:48

    NNAMDIRobert Stern?

  • 12:47:49

    STERNWell, you know, you're raising a very important issue that now, with all of the craze about sports concussion, everyone is really concerned going back, saying, oh, my goodness, I hit my head so many times as a kid or I played this sport. We don't know enough right now to be really concerned that having five concussions as a kid will have any impact at all later on. But it's always good.

  • 12:48:15

    STERNI think no matter what one's history is to try to do whatever one can to improve overall health and brain health in particular given my bias and to try to help research move forward. And so, there are no treatments right now because we don't know what to diagnose. In my field, what I'm working on is the specific disease, neurodegenerative disease called chronic traumatic Encephalopathy.

  • 12:48:42

    STERNAnd right now we're really at such an early stage we don't even have the ability to diagnose it during life. But we do have research going on for a variety of individuals with especially sports-related brain trauma in their past or just involvement in sports. So one way to find out about it, you can visit our website at Boston University. You can just Google CTE Center at Boston University and see what research we have.

  • 12:49:10

    STERNBut there are so many good research programs all around the country now focusing in on this area. And your willingness to help may move our knowledge forward more quickly.

  • 12:49:19

    NNAMDIHenry, thank you very much for your call. Stephen Haas, you're a member of the National Football League. You mentioned Medical Benefits Council. You've served as a consultant to the players' association. I'd be interested to know what are the kinds of conversations that you have now with former athletes. Have those conversations changed during the past several years since more research about CTE has come out and since former football players have taken legal action against the NFL?

  • 12:49:45

    HAASI would have to say that I have never dealt with a National Football League player who was having problems who said, you know, I really wish I never played, not one. There are varying issues of compensation about how they were handled when they were injured about possible changes in the rules of the game. But I think it's important that these people want to play. There's an issue of informed consent in some way.

  • 12:50:26

    HAASNobody has to play a professional sport at the highest levels, they elect to do that. And I doubt if there's anybody that showed up to play a professional sport that was very surprised to find out that you can get injured, sometimes seriously. The other sign of that is that notoriety, the finances involved. Where else could they make this kind of money, get the lifestyle that they get if they're one of the few that's lucky enough to make it to the top.

  • 12:51:01

    HAASSo this definitely enters into the whole situation. It's not purely a question of passive players who are being dictated to by the rules of the game or by the doctors or the lawyers or whoever else it may be.

  • 12:51:20

    STERNI guess I would take a little bit of exception to one of the statements you just made, Dr. Haas. And that is that the players in professional sports know that they're going to risk injury by playing. Yes, in some ways, but for many, many years, I think the big issue right now is that the long-term consequences of repetitive hits to the head were really either unknown or, in the case of football and the NFL, what the allegations are was that the NFL withheld information and did not inform the players about the potential consequences of brain trauma.

  • 12:52:08

    STERNAnd so I think that's at the root of this current controversy and the NFL settlement. And I think for everyone it all goes back to what was stated earlier that education is really at the root of it. People need to be told what currently is known and what is currently unknown, and then make informed decisions based on that. But for years, I think the players were not fully informed.

  • 12:52:35

    STERNAnd I interact with them on a daily basis. I have a NIH-funded research project looking at former NFL players and trying to figure out how to diagnose CTE during life. I'm on the Mackey-White Committee for the NFL Players Association focusing on brain trauma. And every day I deal with these former players who I would agree would not go back and say I didn't want to play. I wouldn't -- I'd change it. But what a lot of them were saying is, boy, am I angry that I didn't really that I might have these things going on later.

  • 12:53:11

    NNAMDIAlso, Juliet Macur, do some players that you talked to, whether they played soccer or any other sport say, I may have responded a little differently when I knew I had a concussion in the past to the way I would respond today?

  • 12:53:25

    MACURAbsolutely. I think that times have changed a lot, like I said with the NFL settlement and all the stories coming out. But earlier this year on the Super Bowl, I interviewed the Hall of Famer Rayfield Wright who's a former Dallas Cowboys player, who's suffering from early onset Alzheimer's.

  • 12:53:43

    MACURAnd he basically said, if I -- if somebody had told me that I would not know where the kitchen was -- when I was 68 years old, I couldn't find my way to the kitchen or forget things that are boiling on the stove or couldn't drive anymore, if somebody asked me that when I was -- or told me that when I was playing, I would not have played football. But he said that he didn't know and he said, like many other NFL players have said, that the NFL has basically hid some of the facts of repetitive head injury.

  • 12:54:11

    MACURAnd these guys were not told. In his case, it wasn't even written on his medical records that he ever had a concussion or even after he was knocked out several times over his career or many times over his career. Not one -- there was not one notation of a head injury. So I'm not sure if that being said he would go back and play football right now. I think that when we had a discussion, he said he should have stuck with basketball.

  • 12:54:34

    HAASI think you're right. This is one aspect that is absolutely improved and is going to improve more so. I don't mean to convey that there shouldn't be a full disclosure of the risks. But it's a question of -- at this point, it's a question of degree. But I absolutely agree that particularly in the past there was no minimal disclosure. Fortunately, that was before my time of being involved with the league.

  • 12:55:08

    NNAMDIHe is Rob in Arlington, VA. Rob, you're on the air, we're running out of time, but go ahead please.

  • 12:55:14

    ROBThanks, Kojo. First and foremost, the discussion about FIFA and the NFL and just a glancing reference to wounded warriors makes it critical that all of your listeners as well as people on the panel understand that there is a treatment for traumatic brain injury. I am part of an organization, treatnow.org, you can go online and see the decades of research using hyperbaric oxygen therapy that currently, as we speak today, is saving lives and giving people a quality of life...

  • 12:55:57

    NNAMDIWell...

  • 12:55:59

    ROB…you're reporting (unintelligible) ...

  • 12:55:59

    NNAMDIThat's not the topic we're discussing, but I'd like to hear some other expert opinions on that specific treatment. Care to comment on it, Robert Stern?

  • 12:56:09

    STERNYou know, there is such a desire and such a need to do something now for our wounded warriors, for our athletes, for others with any kind of severity of traumatic brain injury. People really, desperately, want something. And, unfortunately, the research to date has not really shown...

  • 12:56:32

    NNAMDII'm glad you're going there because we're running out of time. And it's my understanding that a lot of scientists think that there will be a way to detect CTE in living people in the next decade or so. What say you?

  • 12:56:44

    STERNYeah, that's what every day of my life is about. We just ran a wonderful former player, NFL player, yesterday in a brand new type of PET scan that is geared toward picking up the abnormal protein that we see in this disease. So we are getting closer every day. And so, there is indeed lots of hope.

  • 12:57:06

    NNAMDIThank you very much. And thank you very much for your call, but I did not want to promote any specific treatment here today at all. Robert Stern is the co-founder of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine where he's also a professor of neurology and neurosurgery. Robert Stern, thank you for joining us.

  • 12:57:25

    STERNThanks very much.

  • 12:57:27

    NNAMDIStephen Haas is a doctor who has chaired the orthopedic surgery department at Sibley Hospital in Washington, D.C. He served as the team physician for Washington Wizards and Washington Capitals, as well as the 1996 United States Olympic men's basketball team. He was a venue medical director when the World Cup was hosted in the United States in 1994. Stephen Haas, thank you for joining us.

  • 12:57:47

    HAASThank you.

  • 12:57:47

    NNAMDIAnd Juliet Macur is a sports columnist for the New York Times. Juliet, thank you for joining us.

  • 12:57:53

    MACURThank you very much.

  • 12:57:53

    NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.

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