UPMC Blazes Trail… Comes up with curious results

7 Jun

The University of Pittsburgh Medical Center and the University of Pittsburgh did something that has not been done up to this point; an intensive study on youth football.  Using geography as its selector the prestigious group looked into Pop Warner football and concussion rates.  The sample size is impressive, over 11,000 athletic exposures over an entire season of play (2011).

However, instead of heralding the work more questions have been raised about the conclusions drawn by lead researcher Micky Collins, PhD.  I don’t want to “lead the witness” before you had the chance to hear yourself, watch Dr. Collins below;

Interestingly enough Dr. Collins’ points regarding the depth and breadth of this investigation are spot on, it was both needed and welcome.  It is good to have a starting point and something to say “this is where we came from” at all levels of sport – with regards to concussions.  After that, I personally disagree with his sentiments and conclusions in the most professional way.  I am not the only one;

“Those who played and coached the game know that it’s very possible to still teach technique without going head-to-head full contact,” Dr. Bailes said. “If they’re implying you need head-to-head full contact to learn proper technique, I disagree and think they’re erroneous in that conclusion.”

“The very basic medical principle, research or no research, is: Do no harm,” Dr. Omalu said. “Anybody who tells me that willfully exposing the brains of children to repeated impact is something good, I would humbly disagree with that person. I am not an advocate for the idea that football should be banned or not played — I am not that extreme. I stand with Pop Warner, and I stand with caution. Limit the exposure of children from repeated blows to the head in whatever activity they do.”

The two gentleman above who disagree with Dr. Collins are not just “Joe and Schmoe” type nerds that don’t respect the game or sport, they are both men who encourage sporting activity and have done very good work/research in this area as well.  But they too did not sway my opinion on this, I have my own reasons on not agreeing with Dr. Collins (imagine that I am opinionated, ha), here it is as succinct as I can make it:

  • The research notes that there was no increase of concussion compared to HS/College, but there was not a significantly lower level either.  This is a problem in my mind; in HS you have better medical coverage in terms of athletic training and perceived better coaching/understanding of concussion.  In college you do have better medical coverage.  Youth exposed to the same amount of concussions as their older – “more protected” – counterparts could create more long-term recovery and general omission of actual injury.
  • Dr. Collins noted that there was nearly NO concussions in practice, GREAT!  If the changes that have been adopted have decreased the concussion rate to nearly zero in practice then how is that a bad thing?  What we don’t know is the concussion rate prior to the implementation of this rule.  What we do know from the numbers is that when the speed of the game increases (as it does from practice to games) then the incidence of concussion increases, which makes complete sense.  I am willing to hazard a guess that HS and college rates are close to this.
  • Finally, the biggest concern I have with the conclusions are that increasing exposure is increasing risk.  I only know of one way to prevent concussions – avoidance of activity that will cause the forces needed to create a concussion.  Simply put exposure limitation is the only way to prevent concussions in today’s sports.  I do not feel that suggesting that we allow for full speed and more contact more often will help decrease concussion incidence in games, I believe this to be counter-intuitive.

However, I would like to thank UPMC for taking on the task of creating a “baseline” for the region on youth football concussions, it was an important step.  But like Dr. Omalu we should not knowingly increase the risk or knowingly do harm to people, especially the youth.  I do think that Dr. Collins and I agree that the biggest issue in concussion is not the actual genesis of the injury, rather the mismanagement of the injury.  If there is one thing we all agree on, we want our children to learn to love a sport and make a lifetime commitment to it, the best way this can happen is if they have fun and stay healthy.

 

10 Responses to “UPMC Blazes Trail… Comes up with curious results”

  1. Stephen Thomas, PhD, ATC June 7, 2013 at 07:27 #

    The other issue is sub-concussive blows to the developing brain which will clearly go undetected. We do not know the long term effects of repeated low level head impacts but most likely there are structural and biologic effects to the developing brain.

  2. joe bloggs June 7, 2013 at 09:59 #

    Coaches were called to see if concussions incurred in practice, no ATCs, Docs, Nurse. We know that without a medical professional present many, if not, most concussions are missed. Also, Self-reporting is likely to be even worse in 8 to 12 year olds than older subjects. What constitutes a concussion in an eight year old. How would he or she describe it. The is junk research that clearly has a paid agenda/

    It should be noted that, yet again, Collins and Maroon have failed to report their conflicts of interest. It seems neither UPMC or their employees understand the definition of a conflict of interest . Peter Keating wrote and excellent article in Sports Illustrated on the authors ethical short comings in 2007. Pediatrics should immediately remove the article from publication as Maroon, Collins with Lovell own Impact, Maroon and Collins are referred patients by the NFL, Maroon and Collins are on the Steelers payroll, and UPMC is a paying medical sponsor of the Pittsburgh Steelers. Joe Maroon was a member of the disgraced NFL m-TBI committee. Maroon promoted Brain Guard a prophylactic nutritional concussion cure. He seems to have missed that at least three members of the Steelers he treated had CTE – Webster, Long, Strzelczyk. Do you think that heads up football, a marketing enterprise of the NFL, might have exercised a bit of influence to ensure the outcome of this landmark study? I would like to hear what the head of CDC has to say since it is in bed with the NFL and Heads-up.

    It is also useful to see what articles UPMC, Maroon and Collins (it should be noted the Mickey’s qualification are as psychologist not a neurologist or a neurologist – his primary qualification is as chief flunkey for Mark Lovell.):

    1) No cumulative effects for one or two previous concussions (REALLY)

    G L Iverson, B L Brooks, M R Lovell, M W Collins

    Accepted 12 July 2005
    . . . . . . . . . . . . . . . . . . . . . . .
    Br J Sports Med 2006;40:72–75. doi: 10.1136/bjsm.2005.020651

    2) CLINICAL STUDIES EXAMINING CONCUSSION RATES AND RETURN TO PLAY IN HIGH SCHOOL FOOTBALL PLAYERS WEARING NEWER HELMET TECHNOLOGY :A THREE-YEAR PROSPECTIVE COHORT STUDY – Neurosurgery – VOLUME 58 | NUMBER 2 | FEBRUARY 2006 – Riddell Helmets reduce concussions (Really)

    3) The unpublished NIH comparing MRI to Impact.

    4) All the NFL m-TBI committee publications.

    No credence should be given to any study that has Collins or Maroon’s name on it. UPMC should be ashamed of itself for having these people on its staff. Pay these guys and they will say anything. Much as they sold Impact as magic bullet, the only thing that matters to Maroon and Collins is how much profit they make.

    If you gave UPMC and these clowns enough cash, they would put infants on the field in magic concussion proof Riddell supplemented by an concussion attenuating dental appliance. Further, Mickey would make sure each child is given a gallon of corn syrup , a case of Red Bull and cartoon of unfiltered camels to make sure the baby is at peak performance. Of course, when the child is injured, you need to take you ImPact test (it just is not a very reliable test but Maroon, Lovell and Collins probably knew that years ago but needed to cash in with the support of Dick’s World of Sports and Drew Brees promoting it to children – see – ImPact Test-Retest Reliability: Reliably Unreliable?
    Journal of Athletic Training 2013;48(3):000–000 doi: 10.4085/1062-6050-48.3.09 by the National Athletic Trainers’ Association, Inc http://www.natajournals.org – Has Impact ever been properly validated in children below 13? As it was poorly validated in adults, it is doubtful).

    The NFL should be embarrassed.promoting an uninterrupted series of shoddy journal articles used to confuse the issue produced by ethically compromised hacks. I was shocked that Commissioner Roger Goodell, Elliot Pellman (NFL Medical Director), Jeff Pash, NFL GC, and Greg Aiello, NFL PR did not to take credit for inspiring this research.

    I can only imagine the instructions the NFL has given the NCAA, Harvard and the CDC to prove that football is safer than breathing.

    • ConcussionMCPS June 8, 2013 at 09:15 #

      Do psychologists like Collins usually wear white lab coats at work the like the one he wears in the youtube video? I thought only physicians did. Or did this come from the costume department of NFL Productions?

      • joe bloggs June 8, 2013 at 14:52 #

        Mickey and Mark Lovell pretend to be MDs in real life; they also pretend to be researchers. Joe Maroon is an MD although it is the title does not necessarily seem to indicate any degree of ethics or competence.

        Nonetheless, NFL Films can make the worst players look good so no big deal for people pretending to be MDs. Maybe it will follow up with the Dr. Chao story, a middle-aged inebriated MD being sued by numerous patients, including several Chargers, finds redemption after nearly killing Kris Dielman. The closing shot will feature Dr. Elliot Pellman of the NFL having drinks with Dr. Thom Mayer of the NFLPA laughing about how even if a NFL Physician killed someone we would make sure he is cleared. Elliot says to Thom, “who needs a cover-up, when you got us looking out for our guys. No one can second guess us with are NFL Physicians. We paid good money for that privilege.”

      • Concussion Fan June 10, 2013 at 19:05 #

        Yes psychologists are doctors and wear white coats..

    • Smarter than You June 10, 2013 at 19:10 #

      You continue your ad hominem attacks without evidence, obviously you have an axe to grind and grandstand without support

      • joe bloggs June 11, 2013 at 08:40 #

        Stupid is as stupid does.

        What constitutes evidence in your mind? Moving backwards, Elliot Pellman is a Mexican medical school product that put Al Toon and Wayne Crebet out of the league through a lack of concussion care (see the New York Times). He is still a medical adviser to the league (Sports on Earth). Dr. Chao’s California medical record would disqualify from treating animals (see Deadspin). He is still the Chargers doctor.

        The Pennsylvania Lystedt law needed to be altered because the initial qualifications necessary to treat concussions would have eliminated Mr. Collins (see Pennsylvania legislative record). Mr. Collins is a psychologist with special training (he has never disclosed what that training is or how it was accredited).

        I posted a series easily obtained citations that should make anyone wonder how these people are given an audience. I will add Maroon, Lovell and Collins magnum opus, Sports Concussions, published in 1998. See how that stands up with the publications such as the m-TBI committee’s (Maroon and Lovell were members of the disgraced and discredited entity – the new staff including Richard Ellenbogen and Mitch Berger said everything it produced was garbage) high-jacking of the Journal Neurosurgery in 2006 that constitutes some of the most laughable scientific work in the history of medicine. Not a pretty picture. Review the gang of three’s follow-up articles. You should inquire with the NIH to see what happened to your tax money since nothing was published.

        I am sure you see no conflicts of interest either. Riddell pays the NFL $16MM a year to be the official helmet of the NFL (I hope no believes anything a NFL player is compelled to use by the League is based on quality; it is simply how much a sponsor can pay) . Riddell pays Collins, Lovell, and Maroon to author a bogus study to sell more Riddell helmets (FTC is looking into this and lawsuits are being brought by individuals). UPMC pays the NFL $600,000 or more per year to be the official doctors of the Steelers. The NFL sends case to UPMC. The NFL promotes the use of ImPact to children with Dick’s Sporting Goods to sell more Riddell helmets. It is a virtuous circle. Of course, as Peter Keating of Sports Illustrated showed, no one bothered to list their conflicts.

        Stop drinking the Kool-aid. Read up and the picture is indisputable. If the NFL was not backing this nonsense, none of it would be funded, promoted, or published. You seem have mistaken clever marketing and litigation management for science.

        I guess the New York Times, Sports of Earth, Sports Illustrated, PBS, EPSN, Scientific American all have axes to grind.

        4000 retirees are suing the league. Many are severely impaired from brain injuries likely to have occurred because of poorly injury management. It is unclear how many NCAA players are in that boat but it is more than a hand full. Manufactured science retards solutions from being identified. This is the true threat to football not identifying the injury.

  3. The Knockout Project June 7, 2013 at 11:02 #

    Great piece, Dustin. Aside from the fodder for discussion, It illustrates that you’re committed to showing all sides of a story, even ones that we tend to disagree with. So important to be a neutral, but knowledgeable party to the discussion, which you excel in. Nice work. -Jay

  4. joe bloggs June 13, 2013 at 20:53 #

    Chao is resigned this evening. At least, he could figure out it was time to go. On the other hand, some other quack could have bid more for the privilege of committing malpractice on unsuspecting Chargers.

    Let’s see if any of the other quacks will exercise the same degree of judgement and step down. Perhaps Pash, that is, Goodell’s brain, is finally sobering up after the Collins embarrassment and is ordering the bodies to start being buried.

    Jeff, it always the cover-up never the crime that takes institutions down.

    Remember NFL docs, medical staff, and so-called researchers; outside counsel will throw you under the bus.

  5. Re the recent Journal of Pediatrics article:

    Having been afforded an opportunity to review a copy of the above referenced J of Pediatrics article, it is NOT surprising there is free flowing confusion re the published article content.

    Data is highly suspect and corresponding article interpretations / and concliusions appear to be a quantum and unjustified leap… due to concerns that follow.

    For what ever “ reasons ” or perhaps “ biases ” are more correct…

    there seems to be a rush to accept this sole article’s single research “ data ” and corresponding interpretations of the data as ” fact ” without replicating the research…

    to ascertain if similar findings occur in follow-up and independent research.

    Research replication is an oft-neglected cornerstone of valid and reliable ” research ” and strongly emphasized.

    The need for research replication is essential to ensure the initially reported research is consistent with similar follow-up research…

    Furthermore, there is a cloud over the data collection & interpretation due to the apparent and continuing non acknowledgement of interwoven conflicts of interests to reported NFL funding of this research.

    Using a critique of research model acquired in my graduate school training, below is listed some further significant concerns:

    1) Operational construct (definition of concussion) is poorly defined in the article.

    2) Data collection for practice and games do not use the same procedures or raters…
    Actual number of concussions may be underestimated due to inconsistent data collection procedures and different raters used between practices and games.

    Data collection procedures lack adequate documented reliability among raters (persons whom determined that a concussion occurred during their observation times).

    Training procedures for each of the raters on how to assess a concussion occurred was not discussed.

    Data collection during practice included self-report from coaches.

    Limited access to medical care during practice times was acknowledged… thus further concern that injury rate in practice… may have been underestimated…due to the “ lack of a more medically trained eye / person “ during practices.

    Thus an appearance of a bias to have observed less concussions in practice…is present.

    3) Concussion Injury data may also be further inaccurate due to exclusion of certain particulars that follow:

    – “head injury” excluded any structural damage or abnormality… (use of term head injury & not brain injury was utilized in this research)

    – excluding youths with a current concussion or concussion within the past 6 months

    ————-

    An argument may be made that this sole article is creative PR for Pop Warner and the NFL to “sanction” more football practices at the youth level….

    This article would be severely criticized in a quality graduate research design course…

    ———————————————————

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