"You see all those brown little things?" Ann McKee asked as I looked through a microscope. I was viewing a slide sample of the brain of Dave Duerson, the Notre Dame All-America defensive back who won Super Bowls with the 1985 Chicago Bears and the 1990 New York Giants.
Duerson was a Notre Dame trustee, a NFL Man of the Year for community service and an economics major who completed a management program at Harvard Business School. Early in his football retirement, he nearly tripled the annual sales of a meat supply company to $63.5 million.
The glory and fortune disappeared in the last dec-ade. An onset of memory loss, hammering headaches, spelling problems, blurred vision and hot temper led to spousal abuse, divorce, bankruptcy and, finally, suicide last February at age 50. In the most eerie recognition yet by an ex-football player as to why he was losing his mind, Duerson shot himself in the chest to preserve his head for research. He left behind the now-famous note, "Please, see that my brain is given to the NFL's brain bank."
That brain was sliced open by McKee, a co-director of Boston University's Center for the Study of Traumatic Encephalopathy. The "brown things" were nerve cells filled with tau protein, prevalent in degenerating brains like those in Alzheimer's disease. There were so many brown spots, with tails curling off them, that the slide looked like a muddy negative of spinning galaxies.
In that microscopic universe, we were looking into the black hole of contact sports: Chronic Traumatic Encephalopathy. This was the hole likely blown into Duerson's head in a career of at least 10 recognized concussions and countless subconcussive hits. This is the void we still let our kids fall into, cheering them all the way.
"If it were a normal person, you would see absolutely none of that," McKee said in her lab at the Bedford Veterans Administration Medical Center, where she also runs brain banks for research on military injuries, Alzheimer's and heart disease.
She pointed out how the tails of the tau-infested cells made long projections to make contact with other cells, causing short circuits and disordered thoughts. A slide from a healthy brain would have had a far more clear background with blue spots, she notes.
The difference in an injured athlete's brain is so dramatic that the comparisons should be required viewing for parents and youths contemplating high-contact sports and the coaches, athletic directors and school principals in charge of them. These images just might scare parents and officials into keeping children away from such sports until the sport is changed to minimize head injury.
The urgency grows with each new brain analyzed. In an interview with McKee and her BU Center co-directors, Robert Cantu and Robert Stern, all three say they fear that today's hard-earned concussion awareness, won only in the last couple of years against the prior denial of the NFL, is already being outstripped by new scientific findings.
Chief among them is that the biggest culprit for CTE for many athletes may not be the massive blows that cause concussions but the thousands of lesser ones that do not. "It gets very scary," McKee said. "I think we have some very concerning information."
It is scary enough that Cantu, who has a book coming out this year on concussions and children, believes that children under 14 should not play collision sports like football, ice hockey, soccer and lacrosse until they are modified to eliminate head blows in routine practice and play.
The BU Center has now analyzed the brains of more than 75 deceased athletes. It has found CTE, originally diagnosed in 1928 in "punch drunk" boxers, in more than 50 of them, including at least 14 of 15 NFL players and four of six National Hockey League players. Evidence of early CTE has now been found in former high school and college football players who died when they were 17, 18 and 21.
The evidence to date has forced significant recent changes in contact sports. The NFL, colleges and state high school athletic associations, including in Massachusetts, have revised or instituted new protocols for taking concussed players off the field and not returning them to play until medically cleared.
The NHL also has improved its treatment protocol and now penalizes deliberate hits to the head during play. Hockey Canada now penalizes all hits to the head during play, even accidental ones, in the minors (5 to 17 years old) and for females.
But while reporting of concussions is way up, there is yet no proof that blows to the head are dramatically down. The NFL and the NCAA face multiple lawsuits from former players — including those in their 20s, 30s and 40s who claim to be suffering from all the hits — who say the organizations were negligent in addressing brain trauma. The NFL last year gave the BU Center an unrestricted $1 million to further its research, but the league also continued to rack up concussions, 260 last season compared with 200 in 2008, according to the Associated Press.
The league recently decided to put an independent trainer in the press box to survey the action. But that change falls short of the critics' call for an independent neurologist on the sidelines. For a $9 billion enterprise, that would seem to be a small price to pay for medical credibility.
Play remains so violent in the NHL that at one point in mid-December, 23 players were out with concussions. Three weeks ago, Rajendra Kale, the interim editor-in-chief of the Canadian Medical Association Journal, called for the banning of fighting in hockey, citing BU's research that repetitive head trauma of any kind may contribute to CTE. Three of the four deceased hockey players found to have CTE were "enforcers," known for fighting, including 28-year-old Derek Boogaard.
The Journal's editorial came two weeks after NHL Commissioner Gary Bettman dismissed connections between concussions and CTE, and downplayed head trauma in fighting, saying, "Our fans tell us they like the level of physicality in our game."
Even as calls to end fighting are growing from within the NHL, the reality is that nothing the NFL or NHL does can begin to address where brain trauma actually starts in many cases: youth sports. A Centers for Disease Control and Prevention report in October found that virtually the same number of youths ages 10 to 14 (60,272) annually go to emergency rooms for nonfatal traumatic brain injuries as youths 15-19 (61,851).
Emergency-room visits for youth sports-related traumatic brain injuries went up 62 percent from 2001 to 2009. Much of that rise likely represents much better concussion awareness. But researchers also believe it represents athletes continuing to get bigger, faster and stronger — and sports officials not adjusting their rules fast enough to mitigate the damage. This makes no sense when, according to the CDC, "younger persons are at increased risk for TBIs with increased severity and prolonged recovery."
In November, an Albert Einstein medical school study also found subconcussive trauma among adult male and female amateur soccer players who frequently headed the ball. In an amazing parallel to the estimated number of head hits to football linemen, significant trauma was seen in soccer players who headed the ball 1,000 to 1,500 times a season.
With scientific restraint, McKee, Cantu and Stern cautioned against panic. As sports fans, they are not at all interested in banning contact sports. They just want to get the head out of the way.
But that isn't happening. Despite the media spotlight on concussions, brain safety is so lightly regarded in daily life that 85 percent of high school youths told federal researchers in 2009 that they rarely or never wore a helmet while bicycle riding, a percentage unchanged from 10 years ago. That is surely why bicycling is the second-leading cause of emergency brain injury treatment for boys and girls of all ages, after football.
It all adds up to a major course correction for collision sports. Banning collision sports for youths under 14 makes good sense, as Cantu suggests, but there also should be a federal commission to find ways to get head trauma out of normal high school play.
With no new football helmet yet in sight that would prevent both skull fractures and concussions, it would mean re-teaching the techniques of tackling to end any leading with the head, launching off the feet and helmet-to-helmet hits, even accidental ones.
In soccer, that means eliminating heading from high school on down and setting a maximum number of times a college player can head the ball in practice and in games. In hockey, that means banning all fighting and penalizing even accidental hits to the head. It means ending body checks that crush and rattle players against the boards.
It means the NFL, NHL and Major League Soccer must lead by example in making it clear that the brain comes before brutality. The NFL must end all launching of players and must penalize all helmet-to-helmet hits. The NHL must ban fighting and slamming against the boards. The MLS must set limits for heading.
Yet to be done is research that better identifies concussions and subconcussive damage. Cantu said that for every recognized concussion, seven or eight are probably missed.
Couple that with McKee's belief that the data are "only going to get stronger." That should make the constellations of tau in her slides the center of the contact-sports universe, before another generation of pee-wee football, soccer and hockey players enter this black hole.
Contact the writer: jackson@globe.com
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