Science Vs - Football: Should We Cancel It?

Episode Date: September 27, 2019

America’s favorite pastime seems to be plagued by tragedy. Former NFL players have come forward to say they’re suffering from a serious brain disease. Others have ended their lives. So we wanted to know: how risky is playing football? Cornerback Isiah Swann, neuroscientist Dr. Kevin Bieniek, neurosurgeon Prof. Bob Cantu, and neurologist Dr. Ira Casson weigh in. Check out the full transcript here: http://bit.ly/2mWkuyR Note: In this episode we discuss depression and suicide. Please take care when listening to the show. National Mental Health Helpline: 1-800-662-HELP (4357). Selected references: The preliminary criteria for diagnosing CTE agreed upon in 2016: http://bit.ly/2m4YzW9 Kevin’s brain bank study: http://bit.ly/2mYNm9I The 99% study: http://bit.ly/2lVRyah The Lancet: Neurology letter: http://bit.ly/2lrugbQ and a response: http://bit.ly/2lnmU9c A survey of former NFL players to see how they’re doing: http://bit.ly/2n62JNr  Credits: This episode was produced by Rose Rimler with help from Wendy Zukerman, along with Meryl Horn and Lexi Krupp. Our senior producer is Kaitlyn Sawrey. We’re edited by Caitlin Kenney. Fact checking by Michelle Harris. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Emma Munger, and Bobby Lord. Recording assistance from Dennis Maler. A big thanks to Prof. Adam Finkel, Prof. Rudy Castellani, Assistant Prof. Robert Lynall, Dr. Eckhard Mandelkow, David Chalmers, Buddy Teevens, and many more. Plus a special thanks to Jim Grau, the Zukerman family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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and you're listening to Science Versus from Gimlet. This is the show that pits facts against field goals. And a quick warning before we get started. In this episode, we will be talking about suicide. So please take care when listening to this show. OK, it's September. And for the US, that means back-to-school shopping, pumpkin spice lattes,

complaining about pumpkin spice lattes, and, of course, football. We're on the field at Dartmouth College in New Hampshire, where the team is gearing up for the start of the season. How'd that feel? It felt great. That's Isaiah Swan. He's 20, with this big warm smile and hair past his shoulders. And he has loved football for basically his whole life.

I'm pretty sure my first memory is of football. I remember sitting on the ground in my living room, watching TV and my dad's on the couch to the right of me. Like that's literally my first memory. It's just ever since then, every Sunday, I've watched every football game. And you just grow to love it. Isaiah loves everything about this game.

The tackling, the tactics. And he wants to make football his career. And Isaiah is good. His coach reckons he's got a real chance of playing for the NFL. Isaiah talked to our producer, Rose Rimler, about it. I want to be on this TV. I want to be in the NFL. This is what I love to do. It makes you smile really broad. Yes, it does. I'm just thinking about if all of that happens, how great my life would be. There are thousands of college

kids like Isaiah playing their ass off in the fields, hoping that one day they might play in the NFL. But from what we've been hearing in the news, that dream might end up ruining their life. There's tremendous damage done to your brain while playing the game. Football, of course, is a violent sport, and there's mounting evidence it's putting players at risk of brain damage. We've heard that a debilitating brain disease called chronic traumatic encephalopathy or CTE is destroying the lives of players. It manifests in multiple ways. Dementia, aggression, difficulty thinking, even suicidal thoughts. There is no cure. And all of this has some people saying that we need to end football as we know it. People like Malcolm Gladwell,

who told a roomful of students that they should protest football at their school. I think all of you has to consider boycotting football games at Penn. And I think you have to convince your friends to boycott football games at Penn. And I think you have to pick it outside football games at Penn. Back at Dartmouth, Isaiah remembers the first time he heard about this disease. It was around seven years ago. Linebacker Junior Seau, who played for the San Diego Chargers, was a football hero, a father of four.

But then he shot himself in the chest and was later diagnosed with CTE. Isaiah said hearing about this, it really rattled him. That was the first one that I remember. Just that connection, like I could be, like CTE could drive me to do that to myself. It's like, whoa. My mom, she knows that the danger is there because she says she prays before every game.

She prays before every game that I don't get hurt. So huddle up. On today's show, are the stories we've been told about CTE right? How dangerous is this brain disease really? And what's the chance that a kid like Isaiah will get it? When it comes to football, there's a lot of... But then, there's a lot of... But then there's science. Science vs. Football is coming up just after the break.

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Scoring fashion and beauty for a fraction? This is winning. Winners find fabulous for less. Welcome back on today's show, football. How dangerous is it? There have been a lot of news reports lately saying that football players are getting this scary brain disease called CTE caused by hits to the head. We're hearing it can lead to memory loss, depression and even suicide. But it turns out that everything about this disease is more complicated than we've been told. Even just finding out if someone has it turns out to be really tricky. To find out more, we sent our producer, Rose Rimler,

to the University of Texas Health in San Antonio. And she's here to meet neuroscientist Dr. Kevin Biniak. Pleasure. Nice to meet you. It's nice to meet you. Rose takes it from here. All right, let's go to the lab. All right, let's go for a walk. Kevin is the director of a brain bank, and he has a bunch of brains with CTE.

At first, when I walked into his lab, I was a little disappointed. There were no brains floating in glass jars. But then Kevin opened up this massive freezer. Our minus 80 freezer is where we have all of our frozen material. It's just like full of Tupperwares of brain. Yep, yep. The reason Kevin collects brains is that when it comes to CTE, right now scientists can't diagnose this disease in living people.

They can only find out if someone has CTE by opening up their skull, cutting out their brain, and slicing it up. Slice it up. And what they're looking for are globs of protein called tau tangles. Scientists are pretty sure these tau tangles

interfere with how our brain cells communicate. But here's the rub. Tau tangles don't just show up in people with CTE. You can also find them in other diseases, and many of us get them as we get older. To a certain extent, tau tangles seem to be a natural part of aging. So when Kevin slices open a brain,

he has to figure out what's normal and what's damaged from playing football. And I, you know, So when Kevin slices open a brain, he has to figure out what's normal and what's damaged from playing football. And I, you know, kind of scratch my head a little and then I... And he showed me a couple of brain slices. I've got my microscope set up here. First, he whipped out a glass slide with a sliver of brain from an elderly woman, someone who had never played football. And Kevin pointed out these little brown blobs. Those are tau tangles.

Right off the bat, we can see a little bit of brown here and there. Little flecks of brown. Yeah, so we've got tau in that cell body around the nucleus, building up and looking really kind of brown and chunky. They show up brown because of chemicals that Kevin uses to stain the brain. So, that's a non-football player, a little bit of tau. After this, Kevin showed me a brain sample from a former football player. Now you start to see clusters of tangles.

And as we get further down, we get closer to the bottom. Oh, wow. And there's this hot spot, what we call epicenters of tau. So this is CTE right here, these brown tangles. That's what defines CTE. It's these epicenters of tau that are the problem. In CTE, they're found in the brain's grooves. So you know how the brain kind of looks like a big walnut?

The tau in CTE is found in the folds of the walnut. To some extent, it's all about the pattern in this disease. You know, it's tau in specific cell types and in a specific location that kind of sets this disease apart. This was actually controversial for a number of years, with scientists squabbling over what was unique to football players and what was something else. It was only a few years ago that a group, including Kevin, got together to nail down that this pattern is different from aging and different from any other disease. And scientists think that the tangles are created in these spots when people get hit

in the head over and over again. Because we also see the CTE pattern in people who get blasted off their feet in the military and in other athletes, like boxers and rugby players and hockey players. It's not that football specifically leads to CTE. It's not that hockey specifically leads to CTE. It's that within these sports, you can experience head trauma to some extent. When we find a brain and it's got this signature and we look back on their life, the kind of common underlying thread is that they got hit in the head a lot.

And we don't know how many hits to the head it takes to get CTE, but we do know that football players can get a lot of them. In one study that put sensors in the helmets of college football players, a lot of the players got hundreds of hits to the head over a season. Okay, I'm going to punt this to Wendy. Hut, hut, hike. Thanks. So, playing football can leave a mark on your brain, stamping it with these weird tangles. The next question we're tackling, head on, is how common is this? Like when you look at your favourite team on the field, how many players will get CTE? Because it feels like every time we turn around, there's CTE in the brain of another footballer. And then we hear stories like this.

The largest study to date on former football players found evidence of a brain disease in nearly all of them. 99% of deceased players' brains examined in a new study showed signs of CTE, a degenerative brain disease linked to repeated hits to the head. 99%. Could that be possible? Well, this number comes from one study out of Boston University, which analyzed the brains of 111 NFL players, and it found CTE in 110 of them. So that's actually a little more than 99%. Does this mean that basically all players will eventually get CTE?

For this question, we spoke to Dr Bob Cantu. He's a neurosurgeon at Emerson Hospital. He's been studying concussions for decades. And he's got this great nickname. A godfather of concussion. So we made him an offer he couldn't refuse. A chance to talk about science on a podcast. Now, Bob actually worked on that 99% paper.

So we asked him, will 99% of football players get CTE? 99% of football players, we don't think anything close to that, get CTE. Bob says that in that study, they weren't trying to find out how common CTE is in NFL players. They were just describing what they'd found in a bunch of brains. And the reason we can't repurpose this study is because his team of researchers, well, they weren't just studying any footballers' brains. They were actually donated, often from worried families who suspected that there was something wrong with their loved ones. The majority of those brains are being asked to be looked at

because someone in the family is saying, oh my God, why did Dad go off the bonkers? Getting brains from only worried people means you're way more likely to get brains with problems. You can think about it like this. If you wanted to know what percentage of Americans are fans of the band Creed, you wouldn't go to a Creed concert and start surveying the audience.

If you did, you'd be like, You wouldn't go to a Creed concert and start surveying the audience. If you did, you'd be like, whoa, 99% of Americans are Creed fans. Boop-de-doo. Bob says we're making the same mistake when we interpret this study as saying that 99% of NFL players have CTE. What we really need to do is get out of the Creed concert, as hard as that is, and talk to everyone. In Bob's world, that means we need the brains of players who weren't worried about CTE.

So I think we really desperately need those brains, but those are not the brains we get. OK, so if the number isn't 99%, then what is it? How many players will get this disease? I honestly don't know. Hmm. We also asked Kevin from the Brain Bank about this. If you were a betting man and you had to bet on what percentage of professional footballers get CTE,

what would you say? Well... Well I don't think even being a betting man I mean like I can't even say I would be taking an educated bet I really don't know One of the best studies we have to help us answer this question was published just a few months ago.

It comes from Kevin, and he looked at the brains of 140 players from all levels, and he got some of his brains from people who weren't worried about CTE. Kevin found evidence of this disease in 15% of them. 15%. And the longer people played football for, the more likely they were to have it. Now, this is just one study,

but if further work could line back it, it would actually mean that quite a lot of Americans are at risk. Here's Bob again. Even if the incidence of CTE, and we don't know what it is, but say it's as low as 15%, that is a huge public health problem because so many play football. After the break, what happens to those who do get CTE?

We've heard that it can send someone into a spiral, possibly ending in suicide. Could some tangles in the brain do all that? Welcome back. We've just hit half-time, and we found out that getting bonked on the head a lot, like when you play football, can cause these little proteins in your brain to clump together. Our next question is what do they do once they're there?

In the press, we keep hearing these reports of football players who were once happy and healthy falling into a deep depression and then killing themselves. The Super Bowl winning safety Dave Durson took his own life. Helinski's brain showed signs of CTE. Junior Seau, 10-time All-Pro linebacker, over a 20-year career, but his medical exam has just concluded. It was the injury we couldn't see that led to his untimely demise. So is this true? Can CTE make you depressed and kill yourself? Well, Kevin Beniak, our brain lab guy, told us

that one reason this might be true is because in CTE, those tau tangles pop up in this part of your brain, which is known to be important for how we think and how we control our impulses. A lot of these individuals, you'll see symptoms that kind of mirror this, where you get behavioral issues. These people might change. They might become more aggressive, more explosive, more violent. And their decision making is impaired. But this doesn't mean that having CTE is a one-way ticket to destruction. And in fact, we have some good reasons to think that it's not. So when we look at depression, here's what we know.

In a study where Kevin looked at the medical records and brains of more than 700 people, he found that the rates of depression were no different in people with CTE and those without it. And when other scientists study football players who are still alive, they don't see a clear signal that football players are more likely to get depressed than the rest of us. The research is actually totally mixed. So one interpretation of the evidence we have so far

is that often people with CTE actually don't get depressed. And on the question of suicide, we asked Kev, can CTE make you suicidal? It's a very widely debated area in the field. I can't look at a brain and say, oh, they've got a tangle here in this region, they're going to commit suicide. I don't know if CTE makes you do anything.

And from the evidence we have, it's rare for NFL players to kill themselves. One big study of more than 3,000 former NFL players found that 12 died by suicide, which is actually significantly less than you'd expect in the general population. Kevin's work also couldn't find evidence that CTE made people kill themselves. We did not see higher rates of suicide in our cases with CTE pathology compared to those that did not. So from the data that

I've studied and looked at, I haven't seen those relationships. While all this research is very much a moving target and CTE probably affects different people in different ways, what we know so far suggests that, on the average,

this disease might not be as horrifying as we've been hearing, which is why some scientists want us to pump the brakes on how we talk about CTE. Because they're saying that it's very possible that when a football player does get depressed, or maybe has suicidal thoughts, it could have nothing to do with this disease. If a football player retires, gets any kind of symptoms,

the first thought is, it's CTE. It's just not right. This is Dr Ira Kasson, a neurologist who's worked with NFL players. And he says that like a lot of us, players can get depressed for all kinds of reasons. Of course they get depressed. There's a lot of reasons to get depressed. all kinds of reasons. Of course they get depressed. There's a lot of reasons to get depressed.

Look how common depression is in this country. Iris says all this jumping to conclusions might be causing another problem. Football players who need help might not get it because they think that their depression and suicidal thoughts are caused by an incurable brain disease. I mean, imagine you used to play football. Now you start feeling crappy, having these horrible thoughts. You've seen all these news reports about CTE. And you think, oh, no.

Now you say, oh, my God, it's progressive. Look what's going to happen to me. I'm going to die. Then, at the end of the day, they could have been treated and got better. Now, Ira is a bit of an infamous character in this field. So for a long time, he questioned the link between football and CTE. But the point that he's making here about news reports constantly linking suicide to CTE is one that we heard from others.

In fact, earlier this year, more than 60 doctors and scientists wrote an open letter in Lancet Neurology, calling for the media to chill out on the way they talk about CTE's symptoms. So we don't have good evidence that playing football, on average, increases someone's risk of depression and suicide. But where we do have some evidence that something is rotten in the state of football is when it comes to dementia. Some footballers are getting it when they're young. A survey of more than a thousand retired NFL players found that almost two percent of the players in their 30s and 40s said they had been diagnosed with dementia. That is almost 20 times higher than you'd expect in the general population.

Other work has found that footballers are more likely to forget things or have trouble thinking clearly. Here's Bob again. Just can't remember what you had for dinner last night. Can't remember where you left your car keys. Can't go to the store without a list of what you want to buy. The fact that we're seeing these memory issues could be the canary in the coal mine when it comes to CTE. But the truth is, we're just really starting to scratch the surface on what this disease can do and what it can't. And Kevin says that that makes sense when you think about how new this field is. Other neurodegenerative diseases have been studied for, you know, over 100 years. CTE, we're only looking at, you know, really thoroughly the last 10 years. So,

I mean, it's, I feel like, you know, the questions that we're still asking are still very basic. So when it comes to football, how worried should we be? Well, some of the hype about CTE has run ahead of the science. Basically, all we know at this point is that a bunch of people who take a lot of hits to the head get this weird clump of tangles in their brain. But we don't know exactly what those tangles will do just yet. And we may not know for decades. So what do we do in the meantime?

Well, everyone who studies this told us that we know enough to make some changes on the field, to cut down the number of hits to the head that players might get. And some of those changes have already been made by the NFL. Kevin is on board with all of that. He thinks it's the way to go. But in a perfect world, he might take it even further. So Kevin, if we made you like Lord of the NFL, would you cancel football? Is it only cancel or not cancel? Do I have any other options?

Like, can I turn it into Professional Flag Football League Association? Yeah, you're allowed to. Okay, I'd probably do that then. Just make everybody run around with flags. While even flag football isn't risk-free, in Kevin's league, players get helmets and no head-bashing allowed at all. I hope everybody can enjoy watching professional flag football teams. I'm thinking like different colored flags, different lengths,

you know, attached to different places. I mean, we can go all out. More elaborate halftime performances, you know. There's no end. I think this will be a huge industry. Players like Isaiah Swan from Dartmouth are less excited about this flag football idea. No, we can't make it flag football.

Why not? It's going to make the game more boring, I would say. You grow up with this game. You grow up watching it on TV. You grow up playing it. I didn't know about CT when I was five. I didn't know about CTE when I was five. I didn't know about it when I was eight. You know, like, this is what you end up loving to do.

And that's, you know, that's the dream. Do you ever, like, what would it take to change your mind, like, about going into football? Is there any news story you could hear, any science revelation, or anything that could happen that would make you say like you know what not football honestly now that i'm so close to the nfl there probably wouldn't be but i mean if you told me that 75 of the football players right now in today's game are gonna die like junior seau and you just knew that somehow, then I'd probably be like, all right, let me not. But it would have to take some crazy discovery for me to figure it out. And right now, we don't have any crazy discoveries.

I'd love to be a Monday morning quarterback on this one telling America, just play badminton. Have you seen what a shuttlecock could do? But the evidence is so incomplete here that if I love the game like Isaiah does, I honestly wouldn't know what to do. That's science versus football. Hello, Rose Rimla.

Hi, Wendy Zuckerman. How many citations in this week's episode? This week, I believe it's 99. 99? Yeah. You didn't want to just add one more to make it 100? No, I would never do that. No, that would be citation hacking.

And we have full integrity here at Science Versus. We do. If people want to go see these citations, where should they go? They can look in our show notes. There will be a link to the transcript there. Great. You can also head to our website, scienceversus.show, and follow the links to get to the transcript.

Thanks, Rose. Thanks, Wendy. Da-da-da-da-da-da. Is that good? You know what I'm making a little noise? Da-da-da-da-da-da-da-da. Next week, heartbreak. Why is getting dumped so damn hard?

Neuroscientists said, oh, it's too messy, too much emotion. You can't study it scientifically. It seems magical. We said, oh, we think maybe we can. This episode was produced by Rose Rimler, with help from me, Wendy Zuckerman, along with Meryl Horn and Lexi Krupp. Our senior producer is Caitlin Sorey.

We're edited by Caitlin Kenney. Fact-checking by Michelle Harris. Mix and sound design by Peter Lennon. Music written by Peter Lennon, Emma Munger and Bobby Lord. Recording assistance from Dennis Mailer. A big thank you to Professor Adam Finkel, Professor Rudy Castellani, Assistant Professor Robert Lionel,

Dr Eckhart Mandelkau, David Chalmers, Buddy Teevens and many, many more. A special thanks to Jim Grau, the Zuckerman family and Joseph Lavelle-Wilson. I'm Wendy Zuckerman.

Back to you next time.