Rugby and CTE

By Ken Quarrie 

I have been seeing claims that some people are “sowing doubt” with respect to CTE (Chronic Traumatic Encephalopathy) and are thus acting like tobacco companies did with respect to heart diseases and lung cancer. I want to make a few comments about this. Before I get to the CTE issue, it is worthwhile that I put some background about me on the record, so that people are able to judge whether I am likely to have biases that might sway me to one position or another.

I was brought up in New Zealand, in a family where rugby was *very* important. Dad played rep rugby for Wanganui and Waikato, and was an All Blacks triallist. As a kid I was a fan and obsessively read books about rugby and the All Blacks. I played the sport from childhood until my late 20’s. I had some really enjoyable times along the way. I also sustained (at least) five concussions. I was immersed in the Otago Uni/Dunedin rugby heavy drinking culture.

I found that as I got older there were fewer aspects of the “rugby” culture with which I identified – @XTOTL captures some of that here: https://www.rnz.co.nz/news/the-wireless/374305/the-pencilsword-in-the-bin. I also had a good friend injured at the age of 15 in a scrum. He has been in a wheelchair since 1984.

As well as rugby, as a kid I loved science. I have managed to combine those two loves into a career. I wouldn’t call myself a rugby “fan” anymore. I am a rugby scientist, and it helps to have a little distance from your object of study. Nevertheless, I still work for NZ Rugby (conflict of interest klaxons!). Having worked on independent research studies examining risks for injury in the 1990’s, I took a role with NZ Rugby in 2000 as their first “Injury Prevention Manager”. I realised that, as a scientist, my employment represented a conflict of interest, but I believed I could have a greater impact on improving player safety and welfare from within rugby than from the outside.

I have been adamant with NZ Rugby and World Rugby that I must be allowed to conduct research without interference about what I can study, how I can analyse it, and what I can say about it. A look at my research outputs will reveal an eclectic mix of rugby studies. So when people “poison the well” by implying that any research funded by or conducted by sports organisations must necessarily be “suspect” I feel personally attacked. Doing good science is what I care about.

Doing good science is what I care about.

From a personal level, the welfare of players has, and does, take precedence for me over considerations of “tradition” or “maintaining the essence of the game”. But managing risks does not imply “eliminating all risks”. Reasonable people can look at an issue and disagree about it.

So – the “tobacco company line”. Tobacco companies systematically downplayed the risks of their products, and attempted to “sow doubt” in the public mind. How is the CTE/concussion debate different? A key difference is that, despite there having been strong claims made about what causes CTE, how it develops, and what clinical outcomes it leads to, the reality is that the science of CTE is very young. There really *is* a lot of doubt about a number of the issues!

The issues include whether CTE is, as has been claimed by some, a primary, progressive neurodegenerative disease. Questions remain about the cause(s) of the pathology. Questions remain about the “pathognomonic lesion” – i.e. what distinguishes CTE from other pathologies. Questions remain about the prevalence of the pathology. MAJOR questions remain about the relationship between having CTE pathology in the brain and any given clinical outcome. Do I think brain injuries are bad for health? Yes, undoubtably. I also think that the public perception of the strength of the evidence, and the prevalence of CTE as a public health issue doesn’t match the scientific understanding of it *at this point*.

So to accuse “rugby” as having acted like tobacco companies to sow doubt about CTE is simply a smear, and a lazy and demonstrably false one at that.

If former rugby players are struggling – for whatever reason – my heart is with them. I pledge to do my best to understand more about the long term health outcomes of playing rugby, so that people can better understand the risks and make informed choices about play. People involved in rugby, like Colin Fuller, @Sharief_H, @drkeithstokes, @drsimonkemp, @mattjcrossie, @Scienceofsport and yours truly and many others have identified and documented risks in rugby via research studies and injury surveillance. Many changes to rugby have been made as a result of that work. RugbySmart, BokSmart and other injury prevention programmes have been widely recognised within the sports science/sports medicine communities as having had positive effects on the risks of injuries. Likewise, the @NZRugbyFound has done great work on tertiary prevention. So to accuse “rugby” as having acted like tobacco companies to sow doubt about CTE is simply a smear, and a lazy and demonstrably false one at that.

Ken Quarrie is the Chief Scientist for NZ Rugby. All views expressed are his own, and do not necessarily represent the position of his employer. The above article was compiled, with permission, from a thread of tweets by @KenQuarrie. For more on the topic, you can follow Ken at @KenQuarrie. You can also view Ken’s publications here – Ken’s Google Scholar Profile. 

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