Science-Policy Controversies in Brain Disease and Pro Football

The term “chronic traumatic encephalopathy” (CTE) has been much in the news over the past 10 years, largely due to the growing number of deceased professional football players who have been diagnosed with CTE at autopsy.  Many of these players had a history of repeated head impacts (RHI), some severe enough to result in a concussion, along with other “sub-concussive” impacts; many of them had decreased cognitive function and mood disorders in the final years or decades of life.  Contact sports are far from the only occupation where RHI occurs—police and military personnel, commercial loggers, and other worker populations face similar exposures—but the U.S. Occupational Safety and Health Administration has issued no regulations or guidance about the risks of CTE.

The growing concern about a progressive and grave brain disease possibly resulting from RHI raises many issues of concern to bioethics, among them informed consent, the role of compensation both during the working lifetime and in litigation brought by retired workers or their next of kin, and the extent to which jobs in an entertainment industry can/should be made safer even if rule changes affect the “product.”

However, this lecture will focus on a particular issue in this controversy that raises special concern: the profusion of published studies about CTE that make fundamental mistakes about how evidence can properly be interpreted, leading to bizarre conclusions and policy prescriptions.  Very few research groups writing about CTE include any authors with epidemiology, public health, or risk assessment expertise, so although many other controversies also involve “manufactured doubt” by special interests, this one suffers further from relationships between academia and industry that exclude experts who arguably should be guiding science and policy in this realm.