Concussion. Kester J Nedd DO

youth involved in an organization called “Golden Gloves.” This was a boxing movement that helped disadvantaged kids and even those not so disadvantaged. It was the kind of program that kept youths off the streets, while actually helping them to build character and a future. Despite wearing head and face gear, we saw knockouts, concussions, and on one occasion a more severe injury that resulted in a youth being hospitalized. Even for teenagers, the hits were palpable. You could literally feel a vibration in the air when some of the punches landed. Just following the career of Muhammad Ali and his subsequent development of what is believed to be pugilistic dementia and then Parkinson’s helped shape my opinions. As a neuroscientist, I was forced to hook my wagon to the issue of brain injury, its consequences, and the subsequent treatment and recovery. From the time I started in the field, it took approximately two and a half decades from my first interaction with this issue to this point where the industry now recognizes the connection between concussion and sports. Yet, compared to strokes, multiple sclerosis, and cancer, from a human manpower and resource standpoint, the allocation of financial capital and devotion to this cause remains in its infancy. The question here is “why.” More importantly, the second question is “what can be done about it.”

      Let’s first deal with the question of why.

      20:20 hindsight. We can all learn from the experiences of the past, and there is plenty of blame to go around. Now, many of you reading this book may have “an ax to grind” for whatever reason. I truly like the title of Dr. Omalu’s book The Truth has no Sides. But, for most of the stakeholders out there, it does have a side. This issue pertaining to sports in America is very complex, and while I do not have all of the answers, I will attempt to do my best to address them one by one. I know that I may get a lot of flak for even bringing up these issues, but so be it.

      In the book so far, I have been touching on the issues of concussion and TBI, in a way linking the issues to the challenges at hand. Bringing it all together is really what can move the needle and provide an overall picture of what we are facing.

      When I came to America, a history professor in college once said to me that if I wanted a thing to attract attention, belonging to one or more of the following categories might be helpful:

      • Either be rich or involved with someone rich and powerful or belong to a social class of the privileged;

      • Have political clout;

      • Be articulate and have the ability to recruit followers;

      • Have an interesting story, not just a rag to riches.

      Of course, some of this has changed with the advent of the internet and social media where the story of an “off-the-beaten-path Joe Blow” can raise awareness and call for attention. The world has now changed, and traditionalists are even left behind at times.

      So, here is the wake-up call. Consumers are the ones writing the script simply by the questions they ask. In my years working as a medical professional, I must admit, I see a tremendous difference in the way men and women handle the issue of concussion and TBI. I see women – mothers and grandmothers – at the center of this discussion. Here is a page from my experience. Together with my colleagues at the University of Miami Sports Medicine program and formerly at Jackson Memorial Ryder Trauma Center, I have been following high school, college, and professional athletes and trauma victims with concussions and TBI for over three decades. The truth is that there has not been a time that this issue was not brought up. I was speaking to a trainer at one of the high schools when he made the most profound statement about this issue, one I still carry with me to the exam room. He said, “It is the mothers and the grandmothers that are changing the face of the game.” Industry, the NFL, the NHL, the NBA, and all of the sports organizations out there, please take note because, in the next decade, the face of the game will change. I can feel this change out there as a clinician. Ask people at the Academy of Neurology what some of the most important reasons for being consulted are. Ask the pediatricians about what is being said and what families are concerned about. There is a groundswell occurring, and it has gone worldwide. We cannot stop it now. Check online social media and commentators out there, and well, the amount of attention that TBI/concussion receives is alarming. TBIs and concussions have not been a “sexy issue” until now. It’s been for years “kept under the rug,” but no more! Here are some of the reasons for which it has not received this much attention in the past:

      • The treatment of TBI and concussion did not have the characteristic of a drug in development, which can produce huge revenues for a pharma company. So, companies such as “Big Pharma” (large pharmaceutical companies) have not been interested in investing big dollars in an area from which they will not get large returns. Thus, capital investment has been limited.

      • Exposing the issue could have impacted the image of sports organizations, and like the tobacco industry, there was always a genuine fear that recognizing this issue would hit profits hard.

      • There is a perception that minorities are more highly represented in sports in America, and believe it or not, this is an issue.

      • A significant number of people with TBI and concussion belong to a perceived antisocial group, and many of them comprise the prison population and are least likely to succeed in society. They belong to a class of people who are considered to have mental health issues. We all know how little funding is devoted to mental health in America and around the world.

      • Persons with TBI, like persons in other mental health groups, are not able to advocate for themselves, and many of them are not in a position to vote or have political influence.

      The glory of sports offers individuals the chance for a rags-to-riches story to many athletes and many youths in high school and even elementary school with talent in sports. These youths are often conditioned to use sports as the way out of a bad situation or a situation of disadvantage. Therefore, there is a culture of pushing talented kids through the educational system in a manner that is somewhat a disservice to their future. How many stories have you heard about athletes with promise who never get to fulfill their dream of becoming successful and rich only because they suffered a devastating injury before they had an opportunity to cash in? The economic pressure in low-income communities to ride the wave of opportunity is incredible. For decades, I have been evaluating and treating professional retired athletes, especially ex-NFL players. Many of these ex-players have suffered injuries, the consequence of which they are now living a life of “pure hell.” I have heard those ex-players saying time and again, “I will never allow my kid to play the game.” In fact, their wives and mothers are on the frontline of the issue of kids in sports suffering concussions. I have heard several stories about high school or college athletes wanting to play in the next game right after an injury because the scouts for college or for the NFL are out there and watching every game. When you look at American football and most other sports, including basketball, the appeal of a full ride with all tuition paid to attend some of the most prestigious schools in America is overwhelming. Unitl my daughter went to the University of Michigan, I never understood how strong an incentive sports were to schools in recruiting athletes. In the process of applying to this school, I found that the tuition for an out-of-state student was incredibly expensive as my daughter was not from Michigan. One must ask, what family in America with humble beginnings can afford to pay $250,000 for a college education? Some of the brightest students apply to “Public Ivy” programs and although they are state-funded and may be inexpensive for in-state residents, it could be extremely costly for out-of-state residents. I have great admiration for the school and what they are doing. I can’t even fault them for what they charge, but it is also the politics and the economics of sports and education that drive this phenomenon. While visiting my daughter’s school, we were told something by one of the advisors that stuck with me: Most of the scholarships provided by universities, including the University of Michigan, are for sports and very few for academics. Some schools give out only 5% scholarships, and over 90% of those are for sports. So, if you are a parent out there and you want your kid to get an Ivy League education or even something in the middle, you do not have a prayer of a chance to get into such a school without having your kid in the top 5–10% of the graduating class or being involved as an athlete in a sport that gives them the edge. While I have no way of fully verifying this information, it emphasizes the significance