Definition of PANACEA: a remedy for all ills or difficulties. Even though there are many products and claims out there finding a panacea for the concussion issue is impossible at this point. Recently we have been examining the faulty claims made by companies about how they feel they can solve the concussion issue, mainly in sport. Realistically it is an exercise in misinformation and even borderline fraud; and the reason why is simple.
Every brain and individual is exactly that; unique. How can a product or protocol even come close to addressing the billions of people on this planet, let alone the millions that play sport. Bluntly, the only panacea for mTBI is to live in a bubble and don’t move, seriously, don’t move.
Peter Keating of ESPN has been on the forefront of the concussion issue in the NFL and everywhere else since at least 2007 and as part of the World Wide Leader’s series on concussions he recently wrote what me and other feel is a pure journalistic masterpiece. Before anyone starts claiming that I am against neurocognitive testing remember that I utilize this platform as well. The most decisive point I can make is that what we have now at our disposal are just a myriad of tools that can help us do the job.
Let us break down the Keating article a bit here;
Concussions have become big business in the football world. With 1,700 players in the NFL, 66,000 in the college game, 1.1 million in high school and 250,000 more in Pop Warner, athletes and families across the country are eager to find ways to cut the risks of brain injury, whose terrifying consequences regularly tear across the sports pages. And a wave of companies offering diagnostic tools and concussion treatments are just as eager to sell them peace of mind.[...]
There’s just one problem. Many scientists who are unaffiliated with ImPACT don’t think the thing works.
“Through amazing marketing, the ImPACT guys have made their name synonymous with testing,” says William Barr, an associate professor of neurology and psychiatry at New York University and former team neuropsychologist for the New York Jets. “But there’s a growing awareness that ImPACT doesn’t have the science behind it to do what it claims it does.”
Marketing is a huge business, affecting the thoughts and processes of potential customers drive sales, period. The issue becomes evident when what we are being told by business and individuals falls in the gray area. The oft utilized part of advertisement that allows the consumer to decide what is true or not, even if the audience is not educated. As Keating states there is plenty of research and public sentiment that back up claims (his focus in the piece being ImPACT), yet there are contradicting claims as well;
Yet a study — really a study of studies — published last year in Current Sports Medicine Reports reviewed the entire span of research on ImPACT and concluded: “[T]he false positive rate appears to be 30 percent to 40 percent of subjects of ImPACT … the false negative rate may be comparable. … The use of baseline neuropsychological testing … is not likely to diminish risk, and to the extent that there is a risk associated with ‘premature’ return-to-play … may even increase that risk.”
The overriding issue with some companies is that some of the bedrock research used to tout information is often littered with conflict of interest (COI). Reading this blog you will find many, many references to this by Don Brady, PhD of New York; it was an entire section in his dissertation (I am hopeful he will post some sections of his COI in the comments). In Keatings article he devoted and unshrouded information not fully understood by the public;
These overlapping roles have sometimes led ImPACT’s executives into dubious, industry-funded research. Lovell is a co-author of the notorious 2004 paper in which the NFL’s concussions committee found there was “no evidence of worsening injury or chronic cumulative effects” from multiple concussions in NFL players. And Collins, Lovell and Maroon cowrote a 2006 paper that found the Riddell Revolution helmet reduced the relative risk of concussions in high school football players by 31 percent. Riddell has trumpeted that research ever since. But the helmet maker had given grant money to UPMC, its vice president of research and development cowrote the paper, and reviewers blasted the work, using phrases such as “serious, if not fatal, methodological flaw” and “substantial conflict of interest.”
Moreover, Lovell and other scientists affiliated with ImPACT have often failed to identify their potential conflicts of interest when publishing research. In 2007, an ESPN.com investigation found that “on at least seven occasions since 2003, Lovell has authored or co-authored studies on neuropsychological testing, including papers directly evaluating ImPACT, without disclosing his roles in creating and marketing ImPACT.” In one case, the journal Brain Injury strengthened its conflict-of-interest policy after getting a complaint about Lovell’s work. In another, Maroon and Collins reviewed a paper Lovell wrote for the journal Neurosurgery without ever disclosing their roles as fellow corporate officers at ImPACT Applications.
Why does this matter? It matters because everyone needs to be aware of what they are getting into and signing on for. Take for example a school who buys a product that has the claims and excellent marketing that create belief in said product. Only to find out later that what they believed to be a remedy or panacea is not working. Not only did it cost money for them up front, but down the road it could cost them money by implementing a practice or protocol that endangered individuals. This can be the case for eleventybillion different products for a multitude of different things that a school does.
What needs to be recognized in this ever-changing landscape of concussions, particularly in sports, is that being safe is the best option; but getting there and definitions of “safe” are to different and subjective. I truly believe that no one wants to end sports, hell we NEED sports for many more positive reasons. What we need to do with the concussion problem is to gather facts, implement best practices at the current time, based on as much science as possible. In lieu of hard fast science, then a conservative approach must be taken. This is a brain injury and the brain is not very good at healing itself; slogans like “when in doubt – sit them out” are great ideas. Only if sitting them out includes more than 12 hours. Keating ended the article with great advice and echos how I feel on the subject;
The bottom line is this: Neuropsychological testing in general, and ImPACT in particular, can be part of an overall exam. Any athlete suspected of having a concussion needs to see a healthcare professional trained extensively to deal with brain injury and not just trained to administer a test. Those professionals should examine athletes’ symptoms, balance and medical history along with his or her cognitive function and should have the final say in return-to-play decisions in the interests of athletes’ long-term health. “The confluence of symptom assessment, balance assessment, physical assessment, neurocognitive assessment and clinical interview is the ‘best practice’ approach,” says Philip Schatz, professor of psychology at St. Joseph’s University.
That might seem unrealistic or expensive. But when it comes to concussions, as Mayers puts it, “There are no simple answers.”