Larry Fedora ridiculed for speaking the truth about CTE

Larry Fedora went out on a limb, or off the deep end, depending on your point of view. The North Carolina coach said his beloved sport of football was “under attack” by those who are calling out the perils of head trauma, and furthermore, “our country will go down, too” if football succumbs to this assault. It was Vince Lombardi meets Jack Nicholson in “A Few Good Men.”

Fedora went on, sending Twitter into a frenzy in real time and giving columnists a sure-fire soapbox to stand on.

“I don’t think it’s been proven that the game of football causes CTE. We don’t really know that. Are there chances for concussions? Of course. There are collisions. But the game is safer than it’s ever been.”

It’s heresy. It’s also backed up by some people who know the subject well.

“I totally agree with him,” says Peter Cummings, a neuropathologist and associate professor of anatomy and neurobiology at Boston University School of Medicine. “Association is not causation. CTE has also been found in individuals not exposed to contact sports. It’s not a settled matter by any means. And football is safer today than it has ever been. In fact, I would argue that no other sport has made a more radical transformation in response to safety concerns than football. His comments reflect the reality of the scientific uncertainty surrounding CTE.”

Nevertheless, USA Today called Fedora’s comment “a coup de grace of stupidity” and said, “If Fedora actually believes what he said, he’s too dumb to coach college football and should be fired immediately.”

The problem is that the media at large has made conclusions that science has not. It’s assumed that football causes CTE (chronic traumatic encephalopathy) and CTE causes terrible later-life symptoms when, in fact, CTE still cannot be confirmed except through autopsy and scientists are not yet at the stage when they can state CTE’s effects as fact. This is what Fedora tried to convey, albeit inarticulately.

Fedora didn’t say CTE doesn’t exist. He didn’t say there is no link whatsoever between football and CTE. He didn’t say football is totally safe. Nobody believes any of those things. We are at the point now where everyone who cares about football is worried about the long-term health of players.

What he suggested is what dozens of respected doctors are saying: the onslaught of negative media coverage has skewed the reality. If you’re a football coach, it probably feels like an “attack.” (It may also feel like an attack when a North Carolina columnist suggests Fedora “might have had one Red Bull too many.”)

Studies expressing caution about “settled” assumptions regarding CTE are largely ignored by the media – a mere speed bump on the way to the inevitable conclusion that football kills. Only a couple of weeks ago, two leading CTE researchers came out with a study that said this: “Recently there has been a significant amount of media attention surrounding the commonness of CTE in professional athletes, particularly American football, based on several postmortem case series. However, despite the persuasive claims made by the media about CTE, research on the disease and the effects of mTBI [mild traumatic brain injury] in general remain in its infancy.”

The study goes on to state that “clinical analysis of CTE cases are fragmented, making potential risk factors for developing CTE impossible to determine with confidence. Despite these limitations, media coverage of CTE is giving the impression that developing symptomatic CTE is almost inevitable if you are a long-term contact sports player.”

Most members of the media do not quote these experts, or even seek comment from them.

No one is saying football is devoid of risk. No one is saying football cannot lead to brain damage. Fedora said “repeated blows to the head” cause CTE, and he even said tackle football should not be played before middle school.

But there are many other factors that can lead to the frightening outcomes we fear, including drug use, opioids, genetics and even poverty. Multiple studies link economic status to later-life mental health problems. It’s currently impossible to control for all of those factors.

“It’s very likely there are people who have the [CTE] pathology and who don’t have a behavioral impact,” says Dirk Keene, an associate professor of neuropathology at the University of Washington. “Some people are more resilient to pathology than others. It could be that all football players after certain exposure get CTE, but not all will get behavioral symptoms.”

How widespread is CTE in the football population? We don’t know that either.

“CTE has been seen in college athletes and high school athletes, but these are a few anecdotal cases,” says Daniel Perl, a neuropathologist at the Uniformed Services University of the Health Sciences in Maryland. “How extensive this problem is, we don’t know. The concept that a kid who gets a concussion is at risk and on the way to developing CTE is a real stretch.”

In fact, one of the nation’s concussion experts is at the University of North Carolina, Fedora’s school. Kevin Guskiewicz would ban boxing but he has sons who played football. He told the News & Observer, “There’s probably no better time to play sports, including contact sports, than right now because of how much more we know today about concussions.”

Yet caution is treated as callousness. Anyone who wants to wait for more information is shouted into submission, cast as a Neanderthal who is on the wrong side of history. Fedora had an opinion that is not without merit, yet there were immediately calls for his ouster. It’s as if he said children should pick up smoking because he has a friend who smoked all his life and never got lung cancer. The result is that we have a completely one-sided discussion that ends up being misleading. Then every head injury can lead to fear and anxiety, which then can lead to some of the mental illness symptoms doctors are trying to prevent.

Saying football is “under attack” seems like something out of an overwrought movie preview. But then again, look up “Larry Fedora” on Twitter and come up with a better description of the reaction to his comments.

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