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Concussion - the elephant in the room by Derek Wyatt

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Concussion - the elephant in the room by Derek Wyatt

We know a little about the brain. About 8% which is a pity given how important it is to us all. Whilst research spending on cancer, on heart disease and on AIDS has seen an upward J curve over the past decade, on the brain it has merely flat-lined. This must change. 

We know a little about concussion but we need to know much more. We think about concussion when we watch rugby tackles where the recipient is either hit in the head or worse lands on it. We see jockeys fall off their horses but the cameras do not follow them to the hospital unit. We flinch when boxers wander back to a corner but not always the right one. 

But concussion is not limited to sport. You can be badly concussed in a car accident. Worse, if there is worse, is what happens when you have been out patrolling in Afghanistan or Iraq. For there is a new form of sport in warfare called the improvised explosive device (IED) which is laid indiscriminately on roads, by bridges and elsewhere. It is the ultimate booby trap.

When one of these goes off the chances are sometimes that one of you is killed, another loses his legs and yet another seemingly survives. But, actually both the soldier who has lost his legs and the soldier who has survived intact will have received powerful shocks waves to their heads. Concussion is a sleeping giant. It may take five or ten years before any damage is understood. 

The soldier who starts to hallucinate, scream or be depressed for no obvious reason may no longer be in the army five or ten years later. He no longer has the Army security blanket around him just the overstretched NHS. His concussion may go un-diagnosed. This is no longer a situation any soldier should have to stomach. We need to provide a comprehensive support system but we have fallen short to date. 

Over Christmas in New York and in London in February a major Hollywood film called "Concussion" starring Will Smith tells the story of a pathologist called Dr Bennet Omalu. An autopsy of Iron Mike a former NFL footballer showed evidence of a trauma related disease which was the direct result of years of blows to his head in games. Mike had the most terrible case of Alzheimer's. 

The NFL hid the truth about Mike and hundreds of other players. The NFL even went about buying the brains off of widows of their dead husbands to stop the truth coming out. Well it is out now and for the first time in its history a player cannot use his helmet as an offensive weapon. There have also been a number of class actions by former NFL players against the NFL mounting to over $4b with more to come.

But for Mike in the NFL, there was soccer's Tommy Smith from Liverpool and Jeff Astle from WBA. And what is a trickle now in rugby union and rugby league will become much worse in due course unless we act now. Of course rugby could act immediately by changing the tackle law. Anyone tackling above the nipple line would automatically be red-carded. Rugby needs to act quickly. It could have done this in time for last year's Rugby World Cup but its world body sat on its collective hands. 

There are a number of solutions. The first is to bring in for all contact sports a national testing scheme. On the first day of training for cricketers, soccer and rugby players, jockeys, boxers, bikers et al, every player is scanned so there is a record of a healthy brain. Then where there is an injury both the medic in attendance and the player have a recorded measurement. For sport ditto soldiers. 

Compulsory scanning should be the order of the day. The Ministry of Defence needs to act and stop its dithering.

Head injuries can no longer be ignored. Ideally, all international matches and all war zones should have portable scanners with satellite links to hospital treatment rooms. The trouble is there is no centre of excellence for concussion in the NHS.

It is time for a Concussion Institute - attached to Imperial and UCH - to be created in London for research, for teaching and for information. Watch this space. 

Further reading:
League of Denial: The NFL, Concussions and The Battle for the Truth by Mark Fainaru-Wada and Steve Fainaru (Crown)
Concussion by Jeanne Marie Laskas (Penguin)


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