Chiang Mai, Thailand
Monday 14th October 2013
Whilst elbow deep in organising the inaugural Asian Sports Emergency Medicine Conference, I have been somewhat immersed in the field of sporting concussions & those publishing the research.

It was, therefore, rather timely that I received an email from my Pittsburgh colleague, John Geist with a link to the PBS aired, Frontline produced documentary, "League of Denial:  The NFL Concussion Crisis", that was broadcast in two parts on October 9th & October 15th, 2013.

For those of you reading in the USA, I doubt you will need much of a back story to the programme as it has certainly hit the headlines on your side of the Atlantic.  For those of you with a more global orientation, the documentary exposes the decade-long alleged cover-up & accused negligence on behalf of the NFL in relation to the effects of concussions & sub-concussive incidences on the long-term health of those playing American football in their league.

Even before it ran, the programme was the subject of publicised controversy, as ESPN, who initially partnered with Frontline to support the production, pulled their name & branding from the final cut.  Conspiracy theorists & journalists alike suggested that this was the result of ESPN (holders of the broadcasting rights to Monday Night Football) being pressurised by the NFL itself to withdraw its support.  Fact or theory, the move effectively slashed the viewing figures due to ESPN's wide reaching sports audience.

The documentary, helmed by investigative journalists Mark Fainaru-Wada & Steve Fainaru, sets the scene with the story of Pittsburgh Steeler legend Mike "Iron Mike" Webster, a former center (well, it is American football) in the team that won 4 Superbowls between 1974 & 1979.

Following an incredibly successful career in the NFL, Webster's life spiralled downwards out of control, suffering from dementia, amnesia, depression, mood swings in addition to debilitating physical degeneration.  Homeless & divorced, Webster passed away at the age of 50.

The curiosity & suspicion of the pathologist that performed the autopsy on Webster's body, Dr. Bennet Omalu would lead to findings that have since been observed time & time again by the Boston University's CTE research team, lead by Dr Robert Stern, Dr Robert Cantu & Dr Ann McKee.

The documentary presents individual case studies, results of the research investigations & poses the million dollar question, "what other predisposing factors might be contributing to the presentations in retired or experienced athletes demonstrating markers of Chronic Traumatic Encephalopathy (CTE) or early changes in younger athletes that had suffered relatively few concussive episodes or in one case simply repeated sub-concussive collisions?".   

The investigation also explores the lengths that the NFL & employed medical advisers went to to try & challenge, reject or even discredit the research produced by Omalu & McKee.  

Dr Elliot Pellman, a rheumatologist, was initially the medic in charge of the NFL-backed research that was published on traumatic brain injury, however, once the NFL realised the potential hand grenade they were holding, Dr Ira Casson was appointed in his place by Commissioner Goodell.  

Despite the protestations of Dr Robert Cantu, the section-editor of the Neurosurgery journal at the time, the journal's editor Dr Michael Appuzzo (the then New York Jets' neuro consultant) published 16 papers submitted by the NFL's concussion committee.  A highly unusual move by a journal given the drive for new knowledge.

Because I would highly encourage anyone interested in sporting concussion to watch the documentary, I will limit my synopsis of the programme & implore you to click the link below & make up your own mind based on the evidence presented.

I would further suggest reading around the site's other resources that have been posted on the topic.

I found other reflections, perspectives, resources & discussions from various media sources, both sporting & medical very interesting too.  Bearing in mind, that this investigation could, in years to come, affect the number of players playing American football, it is important to consider both sides of the story, again based on the evidence that is currently available.

There are also references steadily accumulating in the legal community that are certainly worth flicking through...

I look forward to hearing your thoughts & views on the information & beyond all else would like to thank PBS for at least keeping the awareness of concussive incidents in the forefront of the news for a while.  

There is much more research that needs to be conducted in this field but the fact that the questions are being widely asked by the sporting public at least ensures that greater caution will hopefully be taken by physiotherapists, trainers, medics & coaches dealing with players at all levels of the game.

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