Paper Calls Out “Consensus” Statements on Concussion in Sport as Being Biased and Lacking Candour

Little argument can be had that combat sports and collision sports bring risk to participants. Leaving aside short term acute injury the most sinister of which is long term brain health harm from concussions, post concussive symptoms and CTE.

One theme readers of this site will be familiar with is informed consent. I routinely discuss these risks and suggest athletes, trainers, managers, seconds and others involved with the industry be strongly aware of the realties of long term health risks combat sports bring with them. This is the foundation of informed participation and consent.

To this end a useful paper was recently published in the Journal of Law, Medicine and Ethics echoing these views. The article argues that past ‘consensus’ statements on concussion in sport are biased, lack candour and have numerous other shortcomings.

In the article, titled Toward Complete, Candid, and Unbiased International Consensus Statements on Concussion in Sport, the authors note that past statements lack candour on the background of signatories, lack broad and needed inclusion of relevant voices, lack proper disclosure, lack proper vetting and peer review, lack procedural transparency, are watered down to minimize risks and exaggerate benefits of participation and ultimately deliver a picture that has “arguably compromised informed consent. We would suggest, too, that these guidelines have almost certainly avoided the candor required for informed consent to be complete and frank“.

The authors conclude as follows:

Improving the process of creating Consensus Statements will result in less biased content within the documents. For example, the section of the 2016 Statement
discussing chronic traumatic encephalopathy (CTE)
states perfunctorily that “the literature on neurobehavioral sequelae and long-term consequences of exposure to recurrent head trauma is inconsistent.” A more
responsible summary, we believe, might have instead
read “the literature on neurobehavioral sequelae and
long-term consequences of exposure to recurrent head
trauma suggests reason for serious concern, although
much remains to be clarified.” Similarly, the statement
that “A cause-and-effect relationship has not yet been
established between CTE and sports-related concussions or exposure to contact sports” is incomplete: a
more honest summary might have read “The strong
statistical associations found between CTE and SRCs
or exposure to contact sports may not represent a true

cause-and-effect relationship, but at present attempts
to attribute these associations to confounding, bias,
or artifacts have not been persuasive”. We also note
that prospective longitudinal studies of a well-characterized cohort, the claimed sine qua non of the
establishment of a causal link between repetitive head
trauma and later-in-life neurodegenerative diseases,
are not only impractical but also unethical in light of
the significant probability of patient harm. As many as
seven decades might separate a particular individual’s
exposure and the emergence of neurological signs and
symptoms. Waiting for results and conclusions from
studies that require many decades is unethical in light
of the significant probability of harm to at least some
nonzero proportion of any collision sport cohort.
We have offered several remedies that can help all
stakeholders resolve the challenge of concussions in
sports through the bulwark of science. For well over
a century the consequences of concussions have given
rise to public controversy. The nature of these injuries
is that they create adversarial points of view. Sports are

deeply ingrained in our cultures. As a rule, most people do not like to contemplate their risks. No harm
can be done by telling readers there are reasons for
interpreting and implementing guidelines in a more
precautionary way than the center of gravity of a consensus process unduly weighted by industries with a
vested economic interest in the outcome might prefer.

The full article can be found here and is worth a read for anyone interested in addressing the harms of collision and combative sports in a frank and fair way.

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