Sportmed body drags feet on CTE-concussion link • The Medical Republic
Sports Medicine Australia is still resisting proof of a causal link between recurrent head injuries and a rare dementia.
Australia’s leading sports medicine regulator says it is still evaluating the evidence linking repeated blows to the head and chronic traumatic encephalopathy (CTE), years after major US sports laws and public health officials accepted the link.
During this week’s Senate Community Affairs Committee hearing on concussion and recurrent head injuries in contact sports, Sports Medicine Australia CEO Jamie Crain admitted that the organization had about 12 months to release an update to its 2019 position statement on the issue was.
SMA represents practitioners from various health science disciplines, including orthopedists, physicians, physical therapists, exercise physiologists, nutritionists, and chiropractors.
There are other affiliates representing health professionals in the sports sector such as the Australasian College of Sport and Exercise Physicians (ACSEP) and Exercise & Sports Science Australia (ESSA) but SMA is the oldest and largest.
Its position statement, last updated in 2019 but based on a 2017 consensus statement, recognizes only a “tentious” link between sports-related concussion and CTE, a rare form of dementia that can only be diagnosed posthumously.
Additionally, the lead author of the 2017 consensus statement was Dr. Paul McCrory, who has since been accused of several plagiarism.
CTE is known to mainly affect people who have suffered repeated traumatic brain injuries, and several US organizations, such as the CDC, National Institutes of Health, officially recognize a causal relationship between the two.
The US National Football League is one of the few sports codes to officially recognize the link between concussion and CTE. Back in 2014, it settled a class action lawsuit with a final damages award of $1 billion.
“Is ‘poor’ the word we would use now? Possibly not, but there is still work to be done,” Mr. Crain told the Senate inquiry.
“It is important that we go through this process of full refresher research before coming to a formal conclusion.”
Both ACSEP and the AMA were co-signatories to SMA’s 2019 Statement.
No representative from ESSA or ACSEP testified at the Senate hearing, and no further hearing dates have been announced.
Both organizations are expected to co-sign the forthcoming, revised SMA position statement, which Mr. Crain said would be released in early 2024.
Mr. Crain also said that SMA hasn’t “done much” to educate members specifically about CTE over the past two years, although it has run about eight concussion-focused events.
Associate Professor Alan Pearce, a neurophysiologist and research manager at the Australian Sports Brain Bank, said he’s surprised SMA is still relying on 2017 research to guide its position.
“In 2017 we didn’t have a brain bank, but in 2019 we had CTE cases in rugby league and rugby union,” he said The Doctors’ Republic.
“Then in 2020 we announced the first case of CTE in an Australian football player.”
The posthumous diagnosis of CTE in AFL player Graham “Polly” Farmer in 2020 was a particularly significant win for the brain bank considering AFL officials have long downplayed the risk of CTE by insisting that the sport less physical than NFL.
“We have since published the first cohort of 21 brains in which we showed CTE not only in elite or professional athletes but also in club players,” said Professor Pearce.
For too long, Professor Pearce said, organizations like SMA and the AFL have relied on lack of evidence as proof of absence.
“I’ve been in this field of research for almost 15 years now, and until the brain bank came along, I thought I was fighting a losing battle,” he said.
“Because [those organisations] could easily say, “Well, you’re showing pathophysiological changes, but that’s not CTE and you can’t prove it’s CTE.”
He said fears of tarnishing the sport’s reputation were behind much of the opposition to the mounting evidence of a CTE and head trauma link.
“It was never about quitting the sport or being against the sport for us, we just want to make the sport safer,” he said. “But that entails some changes… to reduce exposure.”
Family members of people who have died from CTE echoed Professor Pearce’s words and called for sports codes to improve concussion management and education.
“[Rugby Australia] I didn’t even come to see Daniel in the hospital,” said Sandy King, whose son died of CTE at 33, 10 years after suffering a stroke in the field.
“Daniel was nothing [to them]and that really ripped his heart out.
“Don’t stop a game where this can happen, not just rugby league, but make those responsible – the coaches, the doctors, the psychologists, the psychiatrists – aware of the impact of a concussion on these people.”