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The NFL Fumbles the CTE Issue Again

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Just when you thought the NFL finally got their public relations campaign in sync with the "we care about our players" message on perpetual loop, along comes a NFL doctor to temporarily derail the process.

According to a memorandum obtained by The New York Times and reported by Ken Belson, an unnamed doctor on the NFL's head, neck and spine committee, in response to a questionnaire by a government agency, asked that a mention of chronic traumatic encephalopathy (CTE) be removed. The agency was preparing a safety fact sheet on a study of degenerative brain disease in retired NFL players, and this doctor was one of a number of people asked to review the document.

Instead, he felt that traumatic brain injury (TBI) should be used since, among other issues, CTE was not listed on the death certificates of players. The fact that these players were all subsequently autopsied and found to have the disease didn't seem to be relevant to him. Nor did he deem relevant the fact that his esteemed colleague, Dr. Robert Cantu, gave the following presentation at the first CTE conference held six months ago in Las Vegas, NV on Sept. 30 - October 1, 2012:

CTE in the NFL: What Changes Have Been Made and What More Needs to be Done?

You don't need to be Sherlock Holmes to understand this doctor's misguided motivation. Thinking a bit too concretely, he concluded that by omitting the disease, it would suggest that it had not reached a sufficient level of clinical importance to be recognized as something worthy of inclusion in the document. In other words, let's pretend CTE isn't really that serious an issue.

It seems somewhat shocking to see the Tobacco industry's old playbook being employed by a doctor serving on, arguably, the NFL's most important committee.

The connections between chronic head trauma and CTE are now well documented in the medical literature. Moreover, even casual football fans have knowledge of the disease due to the media coverage of the suicides of former players, most notably, Junior Seau.

Fortunately, on the recommendations from independent medical experts who said the proposed changes did not reflect the current state of knowledge, the committee putting the fact sheet together rejected the NFL doctor's suggestion and left CTE in the document.

Blindsided by the release of the memorandum, the NFL now had the difficult task of commenting on the unnamed doctor's inappropriate request.

Dr. Richard Ellenbogen, co-chair of the head, neck and spine committee, did his best to both agree with the agency's study while sidestepping the request made by his colleague. Through focusing on how research is still in its early phases and that TBI should be mentioned, he emphasized that CTE is a pathological diagnosis that, currently, can be determined only through autopsies.

Actually, this is not entirely true. In January of this year, a landmark study by Dr. Gary Small, published in The American Journal of Geriatric Psychiatry, showed the presence of CTE in retired NFL players. While this was just a pilot study with a small sample, it brought CTE to life - literally, and underscores how important this issue is for both former as well as current NFL players.

By now, it's safe to say that that the name of the doctor at the center of controversy is clearly known within the league and certainly by Dr. Ellenbogin, who is the co-chair of the committee this mysterious doctor serves on.

And, it is highly likely that Dr. Ellenbogen and this unnamed doctor have already had a conversation that began with the following:

"What in the world were you thinking?"

It is also highly probable that this doctor will remain unnamed, since the last thing the NFL wants is to have this conversation continued.

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