I have been closely following the topic of chronic traumatic encephalopathy (CTE) because of the evolving diagnostic aspects of the disease and also because of the large stakes involved with regard to the NFL and college football. I think that I already know how this story is going to turn out. Neurologists, pathologists, and radiologists are going to develop tests and imaging procedures that will provide earlier evidence of concussive injury for both amateur and professional football players. This will result in many players having to sit on the bench for longer periods of time after such injuries. This will cause some fans and league owners a lot of anxiety. Meanwhile, the NFL will do whatever it can to delay the development of faster and more accurate CTE diagnostic tools. One facet of this story was revealed in a recent newspaper article an excerpt of which is shown below (see: N.F.L. Doctor Says Disease Is Overstated):
When a government agency [NIOSH] prepared a workplace safety fact sheet based on a study of degenerative brain disease in retired N.F.L. players, the organization invited several people to comment on a draft. This seems too much like when tobacco companies denied the link between cancer and cigarettes. According to a memorandum obtained by The New York Times, most of the reviewers suggested simplifying the fact sheet so that players without a scientific background could better understand the findings. But one response stood out: a doctor on the N.F.L.’s head, neck and spine committee asked that a mention of chronic traumatic encephalopathy, or C.T.E., be removed....[T]he [NFL] has expressed skepticism about the possibility of a link between on-field head injuries and C.T.E., a sentiment captured in the league doctor’s request to the federal safety agency. The doctor, who was not named in the internal memo, said references to C.T.E. should be removed because it was “not fully understood” and because it was not listed on the death certificates of the retired players in the study and thus lacked “epidemiological validity.” He suggested that traumatic brain injury, or T.B.I., be used instead because it “may accomplish what you want to say in more established medical terms.” Researchers from the National Institute for Occupational Safety and Health, which wrote the fact sheet, rejected the league doctor’s proposed change. Independent medical experts said such a request was inappropriate and not in line with prevailing research.....But [a neurologist] said the [NFL] doctor was correct in wanting to include a reference to traumatic brain injury. T.B.I. is a clinical diagnosis that can be identified in living patients, [he] said, while C.T.E. is a pathological diagnosis that so far can be found only through autopsies....."I’m agreeing with the [NIOSH] study, but we just have to be more careful to make clear that C.T.E. is a pathological diagnosis and T.B.I. is a clinical diagnosis.”....The medical experts also expressed dismay that an N.F.L. doctor would point to the death certificates of former players in the study. C.T.E. is often diagnosed months after death, when brain samples are examined.
To summarize, an NFL-salaried physician requested that the term chronic traumatic encephalopathy (CTE) in a National Institute for Occupational Safety and Health (NIOSH) report be replaced with the more non-specific diagnosis of traumatic brain injury (TBI). He said that the former term was not well understood and lacked "epidemiologic validity" because it was not listed on the death certificates of retired NFL players who had undergone autopsies. He is thus drawing a distinction between a clinical diagnosis such as TBI that is diagnosed in living patients and the pathological entity of CTE that is being confirmed with tissue examination at the time of autopsy.
It's true that, given the current state of the art, that traumatic brain injury (TBI) is a more general term than chronic traumatic encephalopathy (CTE). However, the latter is gaining favor as more cases are studied post-mortem. That's the way that things work in medicine. So this reaction to the use of terms in the NIOSH report is hair-splitting designed mainly to buy time. I suspect that as CTE becomes better defined and rapidly diagnosable, more attention will be paid to protecting the heads of players and the nature of professional football will need to be greatly modified.
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