Informed consent has just become much more complicated.
I wrote about this issue in a post in December. The occasion of that post was meeting a young man on a plane who was playing football and only superficially aware of the concussion issue.
My argument was and remains that someone making a commitment to anything needs to understand the risks associated with that commitment. That still seems to make logical sense.
However, an article published on 4 January only by JAMA Neurology complicates this discussion. Doctors McKee and Mez of the Boston University School of Medicine and their co-authors document the case of a young man, deceased at age 25, who suffered from chronic traumatic encephalopathy (CTE) due to repetitive head impacts.
The young man had started with football at age 6 and played into his junior year in college in a Division I program. Symptoms of brain injury — including headaches, neck pain, difficulty with concentration and memory, and depression — led to the end of his football career as a junior and to his dropping out of school as a senior.
He experienced “more than 10 concussions while playing football.” The kicker is that the first concussion came at age 8, way too young for informed consent in anything. The parents need to be informed about these risks.
Recent rule changes designed to avoid head injuries in 10-12 year olds are helpful, but this case shows that focus should include younger children. Further, those rules are only valuable to the extent that coaches and parents understand the risks and actively support enforcement. There are too many stories of parents trying to relive glory days through their kids and both exhibiting and encouraging overly aggressive behavior on the field in the younger grades. There remain some coaches who are overly concerned with winning at younger ages.
I’m not against American football. I believe there could be
- Further changes in rules and equipment to protect players
- Education for parents and players and
- Better training or coaches and league administrators.
The young man died from a heart attack related to Staphylococcus aureus endocarditis. That’s an infection of heart tissue found among recipients of prosthetic heart valves, hospitalized patients, and drug users. Substance abuse may have been a byproduct of family history and his brain injuries. Age 25 is just way too young.