- The Washington Times - Thursday, May 9, 2013

ANALYSIS/OPINION:

Over the past year and a half, 60 retired NFL veterans traveled to Boston in search of an answer.

Each faced two days of spinal taps to measure proteins, scans, logic examinations, electrophysiological studies, testing for movement and motor skills, cognitive assessment, psychiatric and behavioral interviews, and more.

They’re part of a quiet effort by Boston University’s Center for the Study of Traumatic Encephalopathy to develop biomarkers to diagnose and eventually treat chronic traumatic encephalopathy in living patients, the first such study of the disease funded by the National Institutes of Health.

“My sense is, and I say this a lot, I am very confident that within five years we will have the ability to diagnose CTE during life,” said Dr. Robert Stern, the center’s co-founder who directs the study. “That would allow us to answer many critical questions like, is CTE even common? We don’t know. We have no idea if this is really a big public health issue or not.”

There are former players, thousands of them, suing the NFL over head injuries, and public relations campaigns pledging football forever and rules changes and concussion protocols to accompany an army of committees, panels, advisers, partnerships, subcommittees, ambassadors, initiatives, donations and grants.

And never far from the uncertainty swirling around football’s head injuries are those stomach-turning letters: CTE.

The brain-shredding neurodegenerative disease took root in Junior Seau’s brain before he shot himself in 2012. Same with Ray Easterling, who also took his own life last year. Dave Duerson pulled the trigger in 2011. Dozens of other former NFL players were diagnosed.

This is the face — the fear, really — of football’s crossroads. Lives ripped apart. Slides of decimated brain tissue. A disease that robs personalities, damages impulse control, prompts aggression and, in its later stages, resembles Alzheimer’s. A disease that can only be diagnosed by examining brain tissue after death. A disease surrounded by questions.

“Research into CTE is really in its infancy, in spite of what the media portrays,” Stern said. “We know very, very little.”

There’s one nagging constant: Every case of CTE diagnosed after death includes a history of repetitive brain trauma. But not everyone who hits their head repeatedly gets the disease. What is the trigger?

“There’s such a fear out there amongst players, parents that getting your head hit is going to result in your becoming demented,” Stern said. “And yet we don’t know enough about this disease to educate parents, athletes, physicians, policymakers.”

The study isn’t talked about much. But the efforts to unravel CTE’s mysteries could help transform how we view football.

Imagine, for a moment, if a reliable living test is developed. Sure, logic dictates that getting whacked in the head isn’t good. But such a test could provide an objective measure, not educated guesses, of football’s repercussions from youth to high school to college to the pros. When does CTE start? What, if any, genetic factors increase risk? Who is most susceptible? What positions? Length of career? How does concussion history and treatment factor in? Do different tackling techniques or rule changes actually help?

And the ability to diagnose during life, Stern believes, would lead to clinical trials for medication to treat or even prevent the disease.

The questions and possibilities and consequences (never mind the possibilities for the spiraling head injury-related litigation), really, have no end.

Another year of data collection remains for the project dubbed DETECT (Diagnosing and Evaluating Traumatic Encephalopathy Using Clinical Tests), though Stern’s team will start preliminary analysis in the next few months. The more urgent hurdle is finding a control group of 50 former professional athletes who played noncontact sports and don’t have a history of head trauma who are willing to endure the same battery of tests as the retired NFL players.

Boston University declined to make any of the retired players available because of privacy concerns.

Funding, as always, is an issue, even with the much-publicized flood of money pledged in recent years to study brain injuries. Stern’s original NIH grant was halved, though the organization pointed to the project as an example of the sort of projects it hopes to solicit with the first wave of the NFL’s $30 million donation. The NFLPA and an airline chipped in to defray travel costs, something the grant didn’t cover. But adequate assistance is the asterisk Stern hangs on every sentence.

Word of mouth and a bit of help from the NFL Alumni Association gathered the group. They’re eager for an answer Stern can’t yet provide.

“They want to make sure this research moves forward as quickly as possible,” Stern said. “Many of them … want to make sure we’re able to diagnose this disease while we’re still alive. Some of them want to make sure they’re doing something for their brethren and some for all those millions of kids out there who are playing football.”

That day grows closer.

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