As many such premier hospitals do, Mayo Clinic has an active research arm, with research ongoing in many areas of medicine and health.
It turns out that includes CTE. And people are not going to be happy about the results of this one.
In their study of 1,721 brains in their own brain bank, 66 turned out to belong to young men who had reported playing contact sports in their youth or young adult years -- i.e. through high school, maybe some college, but no pro sports. No former NFL players here.
The Mayo researchers were operating with a pretty broad definition of "contact sports" -- football, of course, but also boxing, wrestling, rugby, baseball (!), basketball (!!) and others played while in high school.
Two surprises: No mention of soccer, although that might be included among the "others," and no mention of hockey. It might also be among the "others," or it might be that the fact that the study was conducted at Mayo's Jacksonville campus might have steered fewer high school hockey players to the brain bank.
Of those 66 young men (apparently no young women were found; again, wondering about the absence of soccer, but you would have thought basketball might have showed up), 21 were found to have the telltale tau deposits that mark CTE. That represents about 32% of the brains attached to a record of contact sports during youth.
As a control group, 198 brains (three times the number of brains from the contact-sports group) were selected, age-matched to brains from the contact-sports group, but with no participation in youth contact sports indicated. (This group included both men and women). Of this group, however, 33 (half the size of the contact-sports group) did record incidents of single-incident traumatic brain injury (TBI), with falls, assaults, domestic violence, and car accidents. Of this sample of 198 brains, including the 33 TBI cases, the total number of brains showing CTE was zero.
Not the percentage, 0.1% or anything like that. No brains from that group showed CTE. None. Zeeeee-ro.
Of the contact-sports group, some of those brains were attached to diagnoses of Alzheimer's disease or similar disorders, but none of these brains had been identified with any claim or suggestion of CTE. Not all of that group had reported any symptoms of any such disease before death. We're not talking about persons for whom any CTE-based red flags had been raised, in other words.
Another note: maybe the most useful part of the Mayo Clinic's own report of this research is possibly the inclusion of an illustration that shows how the tau deposits associated with CTE differ from such deposits associated with Alzheimer's disease. There is a difference, and it is identifiable. Doctors have not been confusing the two when analyzing all these football-player brains posthumously.
This is new research in this area, based on brain bank-archived tissue rather than self-reported or self-selected cases, more typical of the research program at Boston University that seems to drop a new former NFL player with CTE on us every few months. What is perhaps startling is that the percentage of CTE-affected cases -- 32% -- is pretty strikingly similar to the percentage of cases of brain trauma the NFL expects to be found among players after their careers (this was before Monday's admission of a link between football and CTE by the league's chief safety officer, so only diseases like Alzheimer's or ALS are counted there).
It's hard to imagine this will be the last such study. This is of course is an ethical problem of sorts, in that it relies on continuing brain trauma in order to make such studies possible or viable. But scientists need verification and duplication of research results in order to make any confident claims about their results.
Question: do we non-scientists have to adhere to the same standard?
This study was published and reported this past fall. It got a bit of new notoriety this week in the wake of the roundtable in which the NFL's safety guy let slip an admission I don't really think he meant to make. The NFL, in the days since, has gone back and forth over whether that claim was going to be accepted for real or not. But perhaps the most striking part of that event, other than the NFL's loose lips, was in remarks from another source.
Dr. Walter Koroshetz is the director of the National Institute for Neurological Disorders and Stroke. In the wake of the Mayo Clinic research and other such reports, Koroshetz expressed concern for what seemed like a greater incidence of CTE in non-professional athletes than had previously been expected.
"That's what keeps me up at night," Dr. Koroshetz said in an interview, expressing concern about research seeming to indicate a greater prevalence of CTE among the amateur athletes of the country. Acknowledging that this expanded research is still at an early stage (one wonders why it took so long?), he noted that to see such results at such an early stage was cause for concern, and makes it all the more urgent to get answers on how the disease develops and why it develops in some and not others.
Dr. Koroshetz is a highly placed individual in the world of neuroscience, perhaps the most high-ranking such official to weigh in on the subject. For every Koroshetz, though, there is still some (willfully?) misinformed individual (such as the VCU chair quoted in this article, who gets refuted by Koroshetz) who somehow wants to claim that we must force kids to play football or else they'll all get obese (yes, I'm exaggerating, but my statement has about as much relevance to and coherence with the current state of the research as his does) -- seriously, has he never heard of running or swimming or tennis? When actual physicians are consistently being so inaccurate in their public statements (people who actually do the research are well beyond the idea that CTE is the result strictly of concussions, and even simpletons like myself can grasp this one) it's little wonder that fewer people grasp the potential trouble indicated by these new rounds of research.
And that's why I'll have to keep shouting into the void. The ethical grotesqueries cannot be limited to the NFL for long, folks. Being caught unawares is no excuse.
Image credit: Mayo Clinic. At left, tau deposits (brown) in a brain with CTE. Right: tau in an Alzheimer's brain. The deposits seem more widespread in the Alzheimer's brain, but are located more deeply in the CTE brain and affect the "white matter" of the brain as opposed to only the "gray matter" in the Alzheimer's brain.
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