Informed consent. Few can argue against its value. People can choose to do dangerous things. But they should know about the known risks of their choices. People profiting from those choices should not hide or obfuscate these risks.
In the world of combat sports CTE is a real risk of participation. Many athletes are not aware of the extent of the risk. Many coaches are grossly ignorant about brain health knowledge and perpetuate misinformation and dangerous practices.
Research shows that better educated athletes have lower rates of CTE.
Education helps. And to this end a recent article was published in Frontiers of Neurology arguing athletes deserve “the most complete available information” about CTE and its connection to repetitive contact in order to better serve public health interests.
In the article, titled “Chronic Traumatic Encephalopathy as a Preventable Environmental Disease” the authors make the following sensible points that the combat sports community would do well to listen to:
Over the last few decades many studies have shown that a history of traumatic brain injury increases the risk for neurodegenerative disease…Such increased risk is seen across various neurodegenerative diseases including AD,…Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS).
The debate on CTE and RHI is reminiscent of controversies on tobacco use and lung cancer risk that were fostered by tobacco companies intending to protect their business, as recently discussed in an exchange of letters. In current times, individuals who continue to play games with high rates of head trauma deserve to have the most complete available information regarding the long-term risks. Arbitrary dismissal of evidence for those risks will impede a fuller understanding that could lead to measures that mitigate or even eliminate the risk. There are acknowledged uncertainties around CTE, mainly in its clinical description, which is currently impeded by the inability to diagnose CTE in life. However, the strong association of CTE with RHI and a range of neuropsychological symptoms that appear progressive warrants widespread recognition, and intensive research investment…
In our opinion, weighing of evidence in relation to CTE and repetitive head injuries, like any environmental risk, needs to be performed in the framework of public and occupational health methodologies, independently of professional bodies that oversee risk management. As elegantly discussed by Brand and Finkel , even well-accepted causal associations in public health, such as smoking and lung cancer, still have unanswered scientific questions and encompass examples of disease incidence without exposure (lung cancer in non-smokers), as well as absence of disease despite exposure (inveterate smokers without lung cancer). None of these ambiguities negate the important causal association.
While no study has yet been performed that has precisely determined the prevalence of CTE in the general population, available evidence suggests that it is rare outside of the context of previous head trauma ..
Dismissal or downplaying of the evidence for the long-term consequences of RHI in sport, or elsewhere, does nothing to advance our understanding of either CTE, or neurodegeneration more broadly. The costs incurred by ignoring, downplaying, or denying CTE are likely to be far greater than the costs of acknowledging, researching, and acting on this preventable environmental disease as a matter of urgency.