Football and head injury in youth

Today’s NY Times op ed from pathologist Bemmet Omalu “Don’t Let Kids Play Football”, compares the sport to public health menaces including tobacco smoke, asbestos and fetal alcohol exposure.  The stance he takes is far more extreme than even the American Academy of Pediatrics’ position on tackle football among youth, which reviewed the evidence and determined that the decision is an individual one: “players must decide whether the benefits of playing outweigh the risks of possible injury”.

Dr. Omalu states in his op ed: “If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name Chronic Traumatic Encephalopathy, or C.T.E., a disease that I first diagnosed in 2002.” Moving beyond anecdote to research, a recent and well-done review of the literature on CTE, concludes that “there are more questions than answers about all aspects of the CTE concept, from biomechanical substrates to molecular pathogenesis to the existence of CTE as a distinct entity.” Two other articles–here and here–by leading researchers in this area also found no association between football and CTE among retired football players.  Among the researchers investigating the association between concussion and outcomes in children are my two University of Colorado School of Medicine Department of Pediatrics colleagues Michael Kirkwood and Joe Grubenhoff; check out their research here.

A third colleague–Dawn Comstock–had her head injury epidemiology work featured in a different NY Times op ed piece.

Returning to anecdote, working in an emergency department in a children’s hospital, I treat plenty of sports-related concussions; however, the morbidity I treat among sedentary and overweight children is far more common. A recent article in the New England Journal of Medicine found that, among children starting 8th grade, 20.8% were obese and an additional 17.0% were overweight. Although these children have physical exercise options other than football, for those who love most of all to play football, it is hard to know whether following the New York Time’s op ed’s admonition is a correct balance of risks and benefits.