HJAR Jul/Aug 2024

CTE 12 JUL / AUG 2024 I  HEALTHCARE JOURNAL OF ARKANSAS the next concussion, so a player does not die on the field from second impact syndrome. Football hits especially affect the cerebral cortex, the part of the brain controlling executive function, a set of cognitive processes that are necessary for the cognitive control of behavior, including tasks such as problem-solving, planning, attention, and time management. Thenwewonderwhy someof theseguys do really stupid things or can’t concentrate in school, not fully understanding their cerebral cortex has been smashed over and over again. I am beginning to ask which came first — the “dumb jock” archetype or the brain damage that happened to the boy? We all know the game is violent, but parents and providers should know that the years during and right after football ends are particularly dangerous times for young men. Because of this loss of executive function, they are more likely to become addicts, engage in violent or reckless behavior, and/or have suicidal ideation. If you really listen, you will hear stories of kids who killed themselves and left videos saying they were never the same after a particular game, some begging for their brains to be checked. Players who are aware of what is happening often kill themselves in ways to keep their brains whole. The “check my brain code” in the NFL is to shoot yourself in the chest. Parents of these children live in torment — they signed the waivers. Why on Earth our education systems still promote this game is now beyond me; we don’t have boxing teams anymore, and getting hit in the head does not make you a better student. There are so many other games we can sanction and promote. I encourage public health advocates with no association to the NFL or NCAA, or universities with no risk of losing football revenue, to take on short- and long-term effects of this game on the brain as a project. Ask CDC and the state and national departments of education about current football concussion rates at the college or high school level, and you will be shocked by the answer. The Arkansas Activities Association, which sanctions the game for high schools said Arkansas schools are not reporting concussion stats anywhere — the data does not exist. I wish some public health researcher would start asking what percentage of men in our prisons are former football players who may actually be suffering from chronic inflammation in a brain that took too many hits. And look into how many former college and/or high school football players from the ‘70s to today have died, the cause of death, and then ask family members if their mental health changed before they died; because that may not show on a death certificate. I also encourage coroners and funeral home directors to ask the family of every college or pro player they encounter to consider brain donation, regardless of cause of death. Boston University’s CTE Center, the leading football brain bank in the country, will do this with the utmost respect for free from most places in the country. By the way, BU just so happens to not have a football team anymore. Finally, as a healthcare provider, please know, you will probably be running into some of these current or former players with 20%of American boys having been or being groomed to play. They deserve, at minimum, to have providers who are at least aware that they may be dealing with a brain-damaged individual in front of them, who may be more likely than most to “go off the rails” as young men, and who might be feeling the effects of neurodegeneration decades before their peers. Look, everyone who smokes does not die of lung cancer; even so, we were compelled to remove cigarette machines a generation ago and raised the age to 21 to save people from the effects of Big Tobacco. But I ask — and ask you to ask — are we really okay with schools grooming young men to play a game where a percentage get demented, even if they are eventually paid to play it in college or the NFL? REFERENCES 1 https://www.nfl.com/news/nfl-pledges-to-stop-race-norming-review-past- scores-for-potential-race-bias 2 https://www.nih.gov/news-events/news-releases/mental-health-disorders- common-following-mild-head-injury 3 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789683 4 van Ierssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5-18 years? a systematic review and meta-analysis. Br J Sports Med. 2021;55(12):663- 669. doi:10.1136/bjsports-2020-102967 5 https://pubs.rsna.org/doi/full/10.1148/radiol.2016160564 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317186/# :~:text=High%20 school%20football%20athletes%20(14,in%20a%204%2Dyear%20 investigation.&text=Impact%20frequency%20at%20the%20player,on%2- 0a%20number%20of%20factors. 7 https://www.pbs.org/wgbh/frontline/article/high-school-football-players- face-bigger-concussion-risk/ 8 https://www.al.com/sports/2013/06/ncaa_chief_medical_officer_nfl.html