EWEN CASE RAISES CTE QUESTIONS
Todd Ewen checked all the boxes. He was a prolific fighter over 11 years in the National Hockey League. He suffered from depression upon retirement. He took his own life at just 49 years old. But he did not have CTE. The revelation that Ewen’s brain did not have evidence of chronic traumatic encephalopathy, the disease that in recent years has become the flashpoint in the debate over concussions and contact sports, came after his family donated it to researchers at Toronto Western Hospital. He believed he suffered from CTE; the examination would have confirmed that.
That it didn’t underscores how much remains unknown in the nascent study of the brainwasting disease, and it suggests that the narrative often thrown around — contact sport equals CTE — is too simple.
“None of us think hitting your brain over and over again is a good thing,” says Dr. Carmela Tartaglia, a neurologist at the Kembril Neuroscience Centre, whose Canadian Concussion Centre conducted the study of Ewen’s brain. But there’s a risk, she said, in assuming that someone who played contact sports, suffered concussions and has depression necessarily has CTE. There could be other causes that are left untreated.
“I think we have prematurely assumed we know more than we do,” Dr. Tartaglia said.
It is, for a host of reasons, a sensitive topic. For years now, a steady stream of former NFL players have been discovered, after death, to have suffered from CTE. Many committed suicide, which was also the case with several former NHL enforcers. Hundreds of other former football and hockey players have sued the professional leagues for damages. The NFL has settled, the NHL has not. The stories are heartbreaking, whether it is a once-proud giant of a linebacker whose life ends in agony and confusion, or an amateur athlete whose ordeal takes place well away from the spotlight.
And so, the leagues come off as callous and in denial whenever they attempt to say that the causal link between concussions and CTE has not been firmly established, as happened just last week at the Super Bowl. But just because league officials are well suited to play the villain — and they are — the actual science happens to remain muddy.
“Overall, the message should be that this is a problem that needs to be studied,” Dr. Tartaglia said. On the possible link between concussions and CTE, she said: “I’m concerned there is a relationship.”
That concern alone might be enough for many people, parents in particular, to conclude that the risk associated with contact sports is not worth taking. And repetitive brain trauma is, obviously, not desirable. But many questions remain.
“Diseases of the brain are very tough,” Dr. Tartaglia said, since it is inherently difficult to conduct tests while someone is still alive. (CTE has only ever been diagnosed post-mortem.) With something like diabetes, tests are conducted, the patient is diagnosed, and treatment is provided. But with the brain, it is a struggle to develop tests that can be administered on a live patient. Researchers are trying to identify the hallmark proteins associated with CTE on live brains, but they are not there yet. It could take years, as would properly blinded studies that would be able to measure the prevalence of CTE proteins in the brains of, for example, football players as compared with the wider population.
A Mayo Clinic study published in December indicated a much higher incidence of CTE pathology in the brains of those who played amateur contact sports against those who did not — 32 per cent versus 0 per cent — but the research was conducted through a brain bank, and it didn’t determine if the subjects who had CTE pathology had exhibited any signs of it while alive. Further study is required. With science, it tends to be.
The attention that CTE has drawn — countless articles, books, and now a Will Smith movie — is, Dr. Tartaglia says, on the whole a positive development.
“Whatever you do to your brain is important,” she said, whether the impacts will be felt a day from now or years from now. The wider knowledge that concussions carry long-term risks, she said, has “now been brought into the popular consciousness.” And that is good.
But saying that the links between blows to the head and CTE haven’t been scientifically locked down doesn’t necessarily make one an NFL apologist, though the statement does benefit the league. It makes one cautious.
Depression impacts countless people who have never played contact sports, and athletes who are struggling with mental illness could have other contributing factors: anxiety, chronic pain, sleep apnea, addictions. These are all things that could be overlooked if there is a rush to presume CTE. Similarly, someone could have cognitive impairment due to brain trauma as the result of blows to the head, and that would be worth knowing and treating even if CTE was never discovered.
“You know what, you can’t take the easy route,” says Dr. Tartaglia. “To make direct, causal relationships before you have the evidence is in nobody’s best interest.”