‘It is just ridiculous’: International concussion group, AFL at odds over CTE link

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The AFL’s chief medical officer has contributed to a published consensus paper by the world’s leading experts on head trauma in sport which stops short of rubber-stamping the AFL’s own stance on the link between concussion and degenerative brain disease.

The powerful Concussion in Sport Group (CISG) has not definitively linked chronic traumatic encephalopathy (CTE), a brain disease diagnosed after death through autopsy, with repeated head trauma, contradicting the stance taken by the AFL, including its chief medical officer Michael Makdissi, at a senate inquiry in April.

Question time: Michael Makdissi, the AFL’s chief medical officer), incoming chief executive Andrew Dillon and AFL general counsel Stephen Meade at the senate inquiry in April.Credit: Jason South

The Concussion in Sport Group’s statement, which is used by the AFL and other major sports competitions around the world for guidance on protocols, has sparked outrage among concussion experts in Australia and abroad.

“The CISG statement on CTE, and their refusal to clearly acknowledge a causal relationship between contact sports participation and CTE, is a danger to the public,” Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, said in a statement to CNN.

“On the question of CTE causation, we urge the public to listen to the statements of independent organisations like the National Institutes of Health (USA), Centres for Disease Control and Prevention (USA), and National Health Service (UK), all of whom have concluded that CTE is caused by repeated traumatic brain injuries.”

The sixth and latest International Consensus Statement on Concussion in Sport, published in the British Journal of Sports Medicine on Thursday (AEST), found “it is reasonable to consider extensive exposure to repetitive head impacts, such as that experienced by some professional athletes, as potentially associated with the development of the specific neuropathology” described as CTE.

Makdissi, the former Hawthorn club doctor, a concussion consultant for world rugby, and now the AFL’s chief medical officer, contributed to the paper, and was a guest speaker at the international conference on concussion in Amsterdam in October, which contributed findings to the just-released report.

However, at a senate inquiry in April into concussion and head trauma in contact sports, Makdissi sat alongside incoming AFL chief executive Andrew Dillon and new AFL general counsel Stephen Meade, the latter also a key figure in defining the league’s concussion protocols, when Meade was questioned about CTE by senator Lidia Thorpe.

“In our submission we set out the position that we acknowledge there is an association between head trauma and neurodegenerative disease, including CTE, and that we support and adopt the statement on CTE by the National Institutes of Health, a US Department of Health and Human Services department,” Meade said.

“The AFL is investing in a number of research programs. In particular, the AFL Commission has approved funding of $25 million over at least the next 10 years to undertake a longitudinal study that will provide very comprehensive insights into the impacts of concussion and head trauma in Australian football.”

The AFL was contacted for comment on Friday. The league has repeatedly pointed to the 30 match review and tribunal changes it has made over the past decade in a bid to mitigate head knocks.

The league is facing two class actions from 100 former players, including John Barnes, Darren Jarman, Chad Rintoul, Shaun Smith, John Platten, Jay Schulz and Daryn Cresswell, and which the Supreme Court of Victoria this week said it wants to be heard as one, over the treatment of concussion through the decades and the long-term impact this has had on former players.

Smith, the former Melbourne and North Melbourne high-flyer who won a $1.4 million insurance pay-out for concussion, said the consensus report was “ridiculous”.

“The NFL didn’t cough up a billion dollars in payouts for no reason. American brains are the same as Australian brains, and they wear helmets. If the NFL says there is an issue, why is our game different?” Smith said.

Former AFL players Shaun Smith, Darren Jarman, the late Shane Tuck, John Platten and John Barnes are among those names in a new class action being taken against the league over the lasting effects of concussion from their playing careers.

“It’s just ridiculous. They [Concussion in Sport Group] are just playing the deny game – deny, deny, deny – as the NFL did, but the science was there. I have seen the damage done to guys.”

Four former AFL players, Collingwood champion Murray Weideman, Geelong great Graham ‘Polly’ Farmer, St Kilda great Danny Frawley and former Richmond player Shane Tuck, were found with the presence of CTE in their brain after they died with the disorder linked to mood swings and depression.

Neurophysiologist and concussion expert Dr Alan Pearce, the Victorian manager of the Australian Sports Brain Bank, said the Concussion in Sport Group’s findings on CTE were disappointing.

“Is this insulting to the families of those who have had loved ones die, and were found to have CTE?” Pearce said.

“This report promised so much, yet delivered so little. We thought it would go this way anyway because, at the meeting in Amsterdam, they were alluding to this. But, even then, we thought it would have more acknowledgement.”

The report said future studies into links between sport and cognitive impairment needed to also include “educational attainment, socioeconomic status, smoking, hypertension and cardiovascular disease, diabetes, sleep apnoea, white matter hyperintensities, social isolation” of those assessed.

Concussion awareness advocate Peter Jess said the report’s findings were “embarrassing”. Jess said scientific data was irrefutable, and insists the AFL needs to introduce a concussion passport, complete with pre-season and post-season baseline findings, and all in-season head knock details.

“If you look at CTE from purely a medical point of view, it’s impossible to have a purely 100 per cent medical answer because there may be a minute variable involved, but science, with the evidence presented, outweighs the medical point of view,” Jess said.

The AFL has a minimum 12-day return to play protocol for concussed players, which Jess and Pearce have maintained is too short, arguing a break closer to a month is needed. The consensus report says a minimum of one week is needed to complete its return-to-sport recommendations, but a “typical” recovery can take up to one month.

Jess said the AFL had belatedly acted on improving tackling technique, in the hope this reduces the threat of concussion, and said coaches even had to alter game plans to reduce the risk of head knocks.

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