US Department of Health and Human Services collision sports lead to landmark change to CTE | concussion in sports

In a move that will have implications for collision sports, the US National Institutes of Health has officially recognized a causal link between repetitive hits to the head and the neurodegenerative disease chronic traumatic encephalopathy (CTE).

The NIH is the largest biomedical research agency in the world, and the decision to rewrite its official guidance on CTE has been described by campaign groups as a turning point in the debate about the risks of collision sports. According to the NIH, the research to date indicates that the causal relationship between recurrent traumatic brain injury and CTE is clear and unequivocal.

This position is at odds with that of the Concussion in Sport Group, which is supported by Fifa, World Rugby and the IOC, among others. The concussion consensus documents released by CISG have consistently downplayed the link between CTE and brain injuries sustained in sport. The most recent, from 2017, states that “to date, no cause-and-effect relationship has been established between CTE and concussion or contact sports,” a position cited by several sports federations as they defend themselves against both legal challenges and calls for reform .

The change in NIH guidelines came after a group of 41 leading scientists, physicians and epidemiologists co-signed a letter to the National Institute of Neurological Disorders and Stroke (NINDS). The letter cited a recent review of CTE research published in Frontiers in Neurology in July, which found a clear causal link to the types of recurrent brain injuries sustained by abuse victims, military personnel and athletes in particular. There is evidence that this has been the case since the disease was first recognized in the 1950s. Ninds’ director said the causal link was “fairly clear” in 2014, but their official guidance had not reflected this until now.

The change brings the NIH into line with the US Centers for Disease Control and Prevention, which stated in their 2019 council, “Most research suggests that CTE is caused in part by exposure to repeated traumatic brain injury.” This means that two of the world’s leading independent medical research organizations agree on the causes of CTE. It remains to be seen whether the next CISG concussion consensus will reflect this. The group is holding a conference in Amsterdam on Thursday and Friday to draft the latest iteration of the consensus, which will be released early next year.

CISG is already under more intense scrutiny after its chairman and lead author, Dr. Paul McCrory resigned earlier this year amid allegations that there had been multiple instances of plagiarism in his own work. At the time, McCrory was quoted on Retraction Watch as apologizing that his failure to attribute was “not intentional or intentional.”

“Now that causality has been established, the world has a tremendous opportunity to prevent future cases of CTE,” said a spokesman for the nonprofit group Concussion Legacy Foundation. “The only known cause of CTE is an environmental exposure and, in most cases, a choice – the choice to play contact sports.

“Our goal is to reform all youth sports so that they no longer involve avoidable repetitive headbutts before the age of 14 – no header in football, no tackle [American] football and rugby. This change, combined with logical restrictions on repeated sport headbutts for people over 14 (e.g. no batting in football/rugby practice, strict restrictions on headballs in practice), would likely account for the vast majority of future CTE cases impede.”


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