Jonah Lehrer has a big article at Grantland on concussions in high school football that paints a fairly bleak picture:
The sickness will be rooted in football’s tragic flaw, which is that it inflicts concussions on its players with devastating frequency. Although estimates vary, several studies suggest that up to 15 percent of football players suffer a mild traumatic brain injury during the season. (The odds are significantly worse for student athletes — the Centers for Disease Control and Prevention estimates that nearly 2 million brain injuries are suffered by teenage players every year.) In fact, the chances of getting a concussion while playing high school football are approximately three times higher than the second most dangerous sport, which is girls’ soccer. While such head injuries have long been ignored — until recently, players were resuscitated with smelling salts so they could re-enter the game — it’s now clear that these blows have lasting consequences.
The consequences appear to be particularly severe for the adolescent brain. According to a study published last year in Neurosurgery, high school football players who suffered two or more concussions reported mental problems at much higher rates, including headaches, dizziness, and sleeping issues. The scientists describe these symptoms as “neural precursors,” warning signs that something in the head has gone seriously wrong.
It’s a pretty good read, as is usually the case with his stuff, but it leaves me wondering about a number of things. The biggest question is just how meaningful this really is, given the other big long Jonah Lehrer article I’ve read recently, on how it’s damnably difficult to make clear determinations in medical science.
In particular, I wonder if the new research on concussions described in the Grantland piece isn’t going to turn out a little like the back pain section of the Wired article:
The view afforded by MRI led to a new causal story: Back pain was the result of abnormalities in the spinal discs, those supple buffers between the vertebrae. The MRIs certainly supplied bleak evidence: Back pain was strongly correlated with seriously degenerated discs, which were in turn thought to cause inflammation of the local nerves. Consequently, doctors began administering epidurals to quiet the pain, and if it persisted they would surgically remove the damaged disc tissue.
But the vivid images were misleading. It turns out that disc abnormalities are typically not the cause of chronic back pain. The presence of such abnormalities is just as likely to be correlated with the absence of back problems, as a 1994 study published in The New England Journal of Medicine showed. The researchers imaged the spinal regions of 98 people with no back pain. The results were shocking: Two-thirds of normal patients exhibited “serious problems” like bulging or protruding tissue. In 38 percent of these patients, the MRI revealed multiple damaged discs. Nevertheless, none of these people were in pain. The study concluded that, in most cases, “the discovery of a bulge or protrusion on an MRI scan in a patient with low back pain may frequently be coincidental.”
Now, obviously, some of the brain issues they talk about sound pretty serious, but at the same time, this is a new enough area of study that I wonder if they really have a solid enough baseline to draw conclusions. After all, kids have been playing high school football for decades without people particularly noticing lingering ill effects from that, but these brain and concussion studies are fairly new.
I suppose you could argue that advances in athletic training have made high school football players of today significantly stronger and faster than years ago, making concussions a bigger problem. I’m not sure this wouldn’t be countered by a general improvement in overall safety, though– football coaches twenty or thirty years ago used to do some crazy shit that they would never get away with these days.
I worry a little that this is part of the same general trend of panicking about the safety of things that aren’t really that serious a threat. Kids are awfully resilient, often more resilient than they’re given credit for. It might be that this sort of brain injury is less serious than the words “brain injury” make it seem. I think that before you talk about ending high school football, you really need the sort of baseline study you got with the back pain business: look closely at the brains of a lot of high school athletes who didn’t get concussions, and a bunch of non-athletes as well.
I say not so much because of any deep attachment to high school football, but because I’m not sure it would stop there. I mean, you could probably make a case that there are lots of other problems associated with the culture of high school football, so that losing it wouldn’t be that big a deal, but number two on the concussion list is girls’ soccer, which isn’t exactly renowned for its pernicious effect on society. And yeah, the difference between the two is pretty big, but it’s not hard to imagine overprotective parents deciding that there’s no level of concussion risk that is acceptable, at which point the only acceptable sports become chess and videogames (G-rated non-violent games, of course).
(This is a little like when car accidents or whatever are cited the “second leading cause of death among 18-21 year olds.” Which sounds really scary, but you also have to recognize that something is going to be the second leading cause of death for any demographic group you choose, and there just aren’t that many natural causes that kill 18-21 year olds. What matters is less the ordinal rank than the absolute rate. Unless, of course, you’re deliberately trying to scare people in order to achieve some policy goal.)
I also end up wondering about those statistics, specifically why girls’ soccer ranks so highly. The source of those numbers is probably one of the studies used for this compendium, which doesn’t really clear anything up. Yeah, football is a clear (and unsurprising) outlier, but girls’ soccer seems oddly high. What’s particularly odd is that the concussion rate for girls’ soccer is almost twice that of boys’ soccer, which really makes no sense at all. Especially since the rates for basketball (the only other really clean sport pair) are comparable for both genders.
So, in the end, my impression of all this, as always, is that I’m really glad I don’t work in medicine, where everything always looks like a hopeless muddle.