Ex-Bear: Foot­ball’s con­cus­sion risk ex­ag­ger­ated

In­jury ended ca­reer, but he blames treat­ment, not game

Chicago Tribune (Sunday) - - LINE OF DUTY - By John Keil­man jkeil­[email protected]­bune.com Twit­ter @JohnKeil­man

Mer­ril Hoge said teams at ev­ery level now treat con­cus­sions with far more cau­tion, re­duc­ing the risk of long-term is­sues.

Mer­ril Hoge is an odd emis­sary for the mes­sage that foot­ball’s con­cus­sion risk has been ex­ag­ger­ated. Hoge, a bull-necked for­mer run­ning back for the Chicago Bears, saw his NFL ca­reer end be­cause of the in­jury, and later sued the team doc­tor for al­legedly mis­han­dling his care.

But Hoge, who went on to a 21-year ca­reer as an ESPN an­a­lyst, has just writ­ten a book whose ti­tle sums up his con­trar­ian take: “Brain­washed: The Bad Science Be­hind CTE and the Plot to De­stroy Foot­ball.”

Hoge and a con­trib­u­tor, Bos­ton Univer­sity neu­ropathol­o­gist Dr. Peter Cum­mings, ar­gue that some sci­en­tists have linked foot­ball and CTE, the de­men­tia­like dis­ease for­mally known as chronic trau­matic en­cephalopa­thy, with­out proper ev­i­dence. They also fault jour­nal­ists for re­peat­ing the find­ings with­out ac­knowl­edg­ing the lim­i­ta­tions of the science.

In a re­cent in­ter­view with the Tri­bune, Hoge, 53, said he sep­a­rates his per­sonal ex­pe­ri­ence from his con­vic­tion that CTE is over­hyped and has no proven con­nec­tion to foot­ball.

“The science com­mu­nity is scream­ing … ‘We don’t know what causes it, and we don’t know what it causes,’ ” he said. “But when you see a head­line, that is not what you see. … That is what drove me to write the book — the truth of the science ver­sus what you see in the head­lines.”

Hoge spent seven sea­sons with the Pitts­burgh Steel­ers be­fore join­ing the Bears as a free agent in 1994. He suf­fered one con­cus­sion in a pre­sea­son game af­ter col­lid­ing with Kansas City Chiefs de­fen­sive end Der­rick Thomas, and just over a month later got a sec­ond in a game against the Buf­falo Bills.

That con­cus­sion was so se­vere that Hoge blacked out and briefly went into car­diac ar­rest, he says. His mem­ory and cog­ni­tion were so dys­func­tional af­ter the blow that a doc­tor re­fused to clear him to play, forc­ing him into re­tire­ment.

His post-con­cus­sion symp­toms, which in­cluded de­pres­sion and “brain fog,” lin­gered for two years. He de­scribes hav­ing to tape notes to the bot­tom of a tele­vi­sion cam­era so he could keep his thoughts in or­der while work­ing for ESPN.

But Hoge views those prob­lems as a sign that his treat­ment was bun­gled, not that foot­ball is in­her­ently dan­ger­ous. He sued the Bears’ team physi­cian, say­ing the doc­tor had not con­ducted a proper ex­am­i­na­tion be­fore al­low­ing him to re­sume play af­ter the pre­sea­son con­cus­sion (he won a $1.5 mil­lion judg­ment, but says he ul­ti­mately set­tled for $500,000).

Hoge said teams at ev­ery level now treat con­cus­sions with far more cau­tion, re­duc­ing the risk of long-term is­sues. When it comes to CTE, which has been di­ag­nosed in more than 200 for­mer play­ers, Hoge and Cum­mings are skep­tics.

“Right now, all you can re­ally say about the pathol­ogy peo­ple are call­ing CTE is that it’s a stain­ing pat­tern from this pro­tein, tau, in the brain,” Cum­mings said. “We have no idea how it gets there, why it gets there and we have no idea what symp­toms, if any, it pro­duces in peo­ple.”

The two take par­tic­u­lar aim at re­searchers from Bos­ton Univer­sity’s CTE Cen­ter who have found the dis­ease in the brains of many high-pro­file play­ers. In one pa­per is­sued last year, the cen­ter di­ag­nosed CTE in 99 per­cent of the brains they re­ceived from de­ceased for­mer NFL play­ers, and in 91 per­cent of those from ex-col­lege play­ers.

The pa­per noted that the find­ing can’t be ex­tended to all foot­ball play­ers, given that the brains might have come only from peo­ple who showed signs of neu­ro­log­i­cal prob­lems. But Hoge says that caveat was lost in the me­dia cov­er­age.

“That’s a lit­tle like walk­ing into an Alzheimer’s dis­ease brain bank, test­ing the brains for Alzheimer’s, and then say­ing, ‘99 per­cent have Alzheimer’s!’ ” he writes in the book. “That tells you noth­ing about the cause or the risk of me or you get­ting Alzheimer’s if we play foot­ball.”

A spokes­woman for the CTE Cen­ter said the re­searchers were un­avail­able for in­ter­views. But ex­perts out­side the cen­ter, in­clud­ing those at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, the Mayo Clinic and nu­mer­ous uni­ver­si­ties, agree with the same premise — that the lead­ing cul­prit be­hind CTE ap­pears to be repet­i­tive head trauma.

“It has thus far only been re­ported in peo­ple who’ve re­ceived hun­dreds or thou­sands of blows to the head,” said Dr. Ju­lian Bailes, direc­tor of neu­ro­surgery and co-direc­tor of NorthShore Univer­sity HealthSys­tem Neu­ro­log­i­cal In­sti­tute. “It’s cer­tainly as­so­ci­ated with that, with the pro­vi­sion that there’s a lot that hasn’t come to­gether to com­plete the pic­ture.”

Still, Bailes said Hoge’s book “adds to the dis­course” — he even con­trib­uted a blurb — and is a help­ful re­minder that there are mul­ti­ple view­points on CTE.

Crit­ics point to one study “Brain­washed” doesn’t men­tion: a 2015 pa­per from the Mayo Clinic com­par­ing peo­ple who played con­tact sports and peo­ple who didn’t.

Us­ing brain sam­ples from sub­jects who suf­fered neu­rode­gen­er­a­tive dis­or­ders be­fore death, re­searchers found CTE in about a third of peo­ple who par­tic­i­pated in con­tact sports, par­tic­u­larly foot­ball. They didn’t find it at all in the brains of nonath­letes.

Cum­mings said the study was flawed for two rea­sons: It re­lied on obit­u­ar­ies to con­firm a sub­ject’s sports his­tory, pos­si­bly miss­ing ex-ath­letes whose par­tic­i­pa­tion wasn’t noted; and it used brain sam­ples of dif­fer­ent thick­nesses to make pre­lim­i­nary and fi­nal judg­ments on who had CTE.

“If you talk to any neu­ropathol­o­gist, they will say that us­ing that a (thicker) sec­tion cre­ates … a real high risk of false pos­i­tive stain­ing,” Cum­mings said.

But the re­searcher who led the study, Kevin Bie­niek, dis­puted those cri­tiques. He said re­ly­ing on obit­u­ar­ies was meant to avoid “re­call bias,” in which fam­ily mem­bers in­ac­cu­rately re­mem­ber de­tails of a per­son’s life. And the thicker brain slices were used only to con­firm CTE cases the Mayo Clinic had al­ready di­ag­nosed.

Bie­niek did agree, though, that foot­ball should not be viewed as the sole risk fac­tor for CTE. He said it has been found in peo­ple who par­tic­i­pated in other rough sports, in mem­bers of the mil­i­tary, and even in peo­ple who were the vic­tims of re­peated do­mes­tic vi­o­lence. “It doesn’t nec­es­sar­ily mat­ter how (the head trauma) is be­ing sus­tained,” he said.

None­the­less, Hoge says foot­ball un­fairly gets most of the blame for CTE, even though its rules, cus­toms and equip­ment have evolved to min­i­mize the num­ber and sever­ity of head im­pacts.

The game is safer now than it has ever been, he said, but that has gone un­ap­pre­ci­ated by those who have at­tempted to curb the sport, in­clud­ing Illi­nois leg­is­la­tors who ear­lier this year tried un­suc­cess­fully to im­pose a ban on tackle foot­ball for kids younger than 12.

“There are just some kids that are born and love to play foot­ball,” Hoge said. “And not just boys — girls too. Why rob them of that op­por­tu­nity when there is no sci­en­tific ev­i­dence what­so­ever that says they are go­ing to be harmed by play­ing a con­tact sport?”


Mer­ril Hoge tes­ti­fies in 2009 be­fore the House Ju­di­ciary Com­mit­tee about brain in­juries in foot­ball.

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