Archive for June 2016
By: Valerie Miller, Ph.D.
Earlier this spring, before a congressional panel, the vice president for health and safety of the National Football League (NFL) admitted for the first time that there is a connection between head injuries sustained playing football and chronic traumatic encephalopathy (CTE), which causes devastating memory and psychological problems. Despite the NFL’s longstanding denial of the connection between head injuries sustained playing football and CTE, these comments were made based on the work of Dr. Ann McKee, professor of neurology and pathology at Boston University (BU). Dr. McKee leads the famed “Brain Bank,” which has been collecting and examining the brains of former NFL players, finding that nearly 100 former players brains’ exhibited the degenerative disease. However, the science behind CTE is still in its infancy, and many questions remain unanswered. For example, it is unknown how much risk of developing CTE each player faces, what percentage of players develop CTE or why some players may be more susceptible than others. Additionally, the link between psychological problems that some former players exhibit and changes in (their) brain pathology remains tenuous. Adding to the confusion, CTE can only be diagnosed after a person has died and their brain can be examined. Clearly, a number of larger studies are needed to begin addressing these important questions. Although it would seem that the NFL would be most interested in answering these questions in order reduce player injury and risk while protecting their industry and product, the NFL has been less than forthcoming regarding the risks of concussions and traumatic brain injury, and has attempted to control the science produced regarding concussions.
Flawed Concussion Research
In 1994, amid growing concerns regarding player safety and concussions, the NFL formed a “concussion committee” to investigate the rate of concussions and the long-term harm they may cause players. The committee, comprised mostly of physicians associated with NFL teams, began a study that tracked all concussions diagnosed by team physicians on all teams from 1996-2001, and published a series of 13 peer-reviewed articles in the journal Neurosurgery based on this data. The league has used these articles as evidence that there is no connection between concussions sustained playing football and long-term effects in players. However, a recent New York Times investigation showed that the NFL studies omitted over 100 diagnosed concussions that were reported to the league, more than 10% of the total number. The NFL’s studies, based on this incomplete data, gave the appearance of a reduced rate of concussion among its players. The NFL has long stood by its research, claiming the legitimacy of the published papers because they underwent rigorous scientific peer-review. However, the New York Times received pages of comments and questions between peer reviewers and the committee, showing that reviewers wanted to stop the publication of the papers, with one reviewer stating “many of the management of concussion suggestions are inappropriate and not founded on facts.” The committee rebuffed the criticism and the articles were published.
NFL Tries to Influence Independent Concussion Research
In 2012, the NFL donated $30 million to the Foundation for the National Institutes of Health to study the effects of traumatic brain injury (TBI), including concussions. The research would be overseen by the NIH, and the NFL stated at the time that they would have no influence on how the money was used. Five studies were to be funded, including a seven-year, $16 million grant that would be awarded to study the progression of CTE, with the goal of determining how to detect CTE in living patients. After a rigorous scientific review process and additional review by an NIH advisory council, the National Institute of Neurological Disorders and Stroke (NINDS) awarded the grant to a team of 50 researchers at 17 institutions, led by Dr. Robert Stern, the director of clinical research at BU’s CTE Center. However, as first reported by ESPN’s Outside the Lines, the NFL reneged on its deal to fund the study, and instead tried to lobby the NIH to fund a proposal submitted by the NFL’s own researchers. In response to these allegations, members of the House Committee on Energy and Commerce launched an investigation, and issued a 91-page report detailing the ways in which the NFL publically claimed to fund impartial studies, only to privately attempt to influence the direction of concussion research. BU researcher Dr. Stern has long been critical of the NFL and their denial of the relationship between head injury and brain degeneration. Claiming that Dr. Stern would be unable to perform unbiased research, the NFL instead suggested funneling the $16 million grant to a different project lead by members of the NFL’s brain injury committee, avoiding the peer-review process by the NIH. This plan was subsequently rejected by NIH Director Francis Collins. According to Dr. Walter Koroshetz, Director of NINDS, the actions by the NFL are unprecedented, and that he “was aware of no other instance” in which private donors lobbied the NIH or attempted to direct the grant funding process. Ultimately, the NIH determined that the NFL’s allegations against Dr. Stern were unfounded. The study, which launches this June, is still funded by the NIH, but is being paid for by US tax dollars.
Where Do We Go from Here?
At this point, the general public has been made aware of the potential risks that concussions pose. The issues regarding repeated TBIs were brought to the forefront with the release of the 2015 movie Concussion, detailing the work of Dr. Bennet Omalu, who first discovered CTE. An increasing number of NFL players have been speaking out about player safety and are retiring early due to injury. Also, players have expressed interest in donating their brains to CTE research after death. In addition, rules are changing at all levels of play to reduce the incidence of concussions, and, as parents are becoming more wary of the risks of injury, participation in youth football is declining, although a great deal of questions surrounding concussion and CTE remain unanswered. Most importantly, the public is also now aware that the NFL has been less than forthcoming regarding the risks to player health. It can only be speculated what changes to the sport of football we will see in the upcoming months, years and decades, but for now, the NFL has been put on notice.
By: Melissa Pegues, Ph.D.
On February 1, 2016 the World Health Organization (WHO) declared the Zika outbreak a public health emergency, meaning that the response requires the coordination of global partners to detect infections, control mosquito populations, and develop vaccines and diagnostic tests to prevent the spread of the disease. With concerns that Zika will move into the US as summer begins, there is an urgent need to contain the epidemic. Congress, however, has been slow to respond and continues to debate how exactly to fund the fight.
Zika infection is rarely fatal and is commonly accompanied by symptoms such as rash, fever, and joint pain, but some do experience more serious symptoms including Guillain-Barre syndrome, a rare form of paralysis. However, Zika gained significant publicity when medical professionals in Brazil and other Latin American countries noticed a frightening association between Zika virus infection in pregnant women and babies born with microcephaly. Microcephaly is a rare birth defect where infants are born with underdeveloped brains and smaller than average head size. Although only considered an association for many months, studies of Zika infection in pregnant mice and monkeys have found evidence supporting the link between Zika infection and microcephaly. In support of the mounting evidence, Tom Frieden, the director of the Centers for Disease Control (CDC), recently stated that “It is now clear that the virus causes microcephaly.”
While research moves quickly to demystify the Zika virus, the political system has failed to gain a foothold amongst the confusion. The White House had requested $1.885 billion towards the Zika fight in February, and in a rare bi-partisan effort, Marco Rubio (R-FL) and Bill Nelson (D-FL) topped Obama’s request with a $1.94 billion proposal that included $144 million for vaccine research that would also include funding for research into dengue fever and chikungunya. That proposal ultimately never came to a vote. The Senate has approved $1.1 Billion in emergency funds and the House of Representatives has offered a bill that would reallocate just $622 million from existing programs for the Zika response, but neither measure has been passed by both chambers.
The Capital Hill battle over Zika has revealed a number of underlying political viewpoints that each affect how politicians respond to this crisis. Republicans worry that abortions may increase due to the severe birth defects associated with Zika infections in pregnant women, and with evidence mounting that Zika can be sexually transmitted, Republicans are debating whether the better message is use of contraception or abstinence. Federal public health officials have countered that they do not believe their role is not to tell women if they should become pregnant, but rather focus on preventing spread of the disease. Pope Francis has weighed in and suggested that the use of contraception is acceptable to help prevent the spread of Zika.
On the other hand, Democrats have expressed concern over use of pesticides. In a proposal meant to help control mosquito vector populations, Senator John Cornyn (R-TX) suggested easing regulatory restrictions on pesticides. Democrats have accused Republicans of trying to exploit fears and countered that exceptions for use of pesticides already exist. The White House also commented that the Republican-led House’s proposal removes Clean Water Act protections that are not acceptable during this emergency. Democratic representatives Peter DeFazio (D-OR) and Grace Napolitano (D-CA) stated “Over the years, proponents of exempting pesticide spraying from the Clean Water Act have used the crisis of the day as the reason to support their legislation.”
While Congress debates how to best combat Zika, the CDC reports that the number of cases of pregnant women in the US with the virus has climbed to 279 as of late May, and multiple models are predicting the spread across the US. Furthermore, WHO chief, Margaret Chan, has cited a number of policy failures that allowed for lapses in mosquito control and the spread of Zika. At a recent World Health Assembly meeting, Chan said Zika took the world by surprise and revealed fault lines in the world’s collective preparedness. In addition, the spread of Zika, resurgence of dengue, and the emerging chikungunya threat are prices paid for “a massive policy failure that dropped the ball on mosquito control in the 1970s.”
With the outbreak of Zika spreading, many concerns have arisen over how to respond to Zika and prepare for other emerging threats. In a recent essay, Ronald A. Klain, the White House Ebola response coordinator from 2014 to 2015, urged Congress to put aside their differences and fund preventive measures for new epidemics. He stated that the threat of emerging disease is “not coming to the United States: It is already here.” In support of this, the Senate recently voted 93-2 to move forward with negotiations with the House of Representatives. Public officials have continued to urge politicians to focus on controlling the disease, but Chan stated that for now “all we can offer is advice. Avoid mosquito bites. Avoid pregnancy. Do not travel to areas with ongoing transmission.”