Concussion expert calls Gary Bettman's CTE comments 'lawyer speak'

In the recent past, the NHL has seen a few tragic tipping points for head injuries and player safety. 

Enforcer Derek Boogaard’s overdose death was one, which initially led to the question of hockey players taking prescription pills. When it was found his young brain had Chronic Traumatic Encephalopathy (CTE), a degenerative disease linked to head trauma for which there is no known cure, this created another wrinkle and questions about fighting’s place in the game – a query that still lingers.

The passing of former Blackhawks defenseman Steve Montador was the most recent hockey tragedy. His death, and subsequent findings of CTE in his brain, have led to more questions about how the NHL and NHLPA protect their players in this dangerous game.

Daniel Carcillo’s heartfelt video on Players’ Tribune brought up questions about post-retirement preparedness for players by the NHL and the NHLPA. 

A lawsuit by 60 former NHL players has made us wonder if the NHL or hockey culture is to blame for head injuries amongst some of the game’s top players. 

When NHL commissioner Gary Bettman met with reporters in Chicago on Thursday night, he was asked about Montador, head injuries and how they contribute to CTE, he said via CBS Chicago:

“From a medical science standpoint, there is no evidence yet that one necessarily leads to the other…”

“I know there are a lot of theories, but if you ask people who study it, they tell you there is no statistical correlation that can definitively make that conclusion.”

This struck a nerve with Chris Nowinski, the co-founder and executive director of the Sports Legacy Institute a “non-profit organization dedicated to solving the sports concussion crisis through education, policy, and research.”

He quickly fired back at Bettman on Twitter for his comments and made a poignant statement in 140 characters or less. 

Nowinski also works with Boston University CTE Center.

“The people who are actually doing the work on CTE are far more convinced than people who are lobbing grenades from the sidelines,” Nowinski told Puck Daddy. 

Contact is always present in hockey. Some believe the hits and crashes (and for a few the fights) are part of what make the game great. Others believe it can still be a fantastic product without the rough stuff. 

It’s a business, it’s trying to make money, but it also needs to protect its players. Montador’s death has made this apparent. The league has made strides with the Department of Player Safety. But when the commissioner makes a comment like that, it could bring some level of confusion.

We chatted with Nowinski over the phone and brought up a number of topics including Bettman’s words, why they struck a nerve and how the NHL (and NHLPA) can do more for their players.

Q: What led to you tweeting about the commissioner’s comments?

NOWINSKI: You get tired of the clever lawyer-speak that completely misleads the average person, which is why I sort of hedged what I said. Basically everything the commissioner said was sort of meant to create confusion. 

A lot of folks in professional sports like to use the words ‘no evidence’ and like to say ‘there’s no evidence from a medical or scientific standpoint’ but then they create a straw man statement that no one is making, and so you get frustrated because when they say there’s no evidence that one 'necessarily leads to the other,’ no one is saying that one necessarily leads to the other in all cases. The same thing goes for smoking. It doesn’t ‘necessarily’ lead to lung cancer, so people will remember ‘no medical or scientific evidence.’

But that’s just not true. We have plenty of medical and scientific evidence that brain trauma leads to CTE. In fact the experts from the Department of Defense and the National Institute of Health are both on record saying they personally believe that CTE is caused by brain trauma. That’s not known by the average person, and he (Bettman) made another claim just like that. I know there are a lot of theories where people study it and say there is no physical correlation that can definitively make that conclusion. And that is also true, but there’s no statistical correlation, again, for most diseases that have been studied far longer. We can’t diagnose in living people so we can’t make a physical correlation for how many people are living with this right now.

Again, that doesn’t mean there’s not a very, very large base of evidence that connects concussions to CTE and brain trauma to CTE and the experts believe it’s causing CTE. 

When the commissioner says this, does it hurt the ability to become more vigilant and aware of head injuries and long-term effects?

It certainly sends a confusing message to all the players and everybody involved in the efforts to make the game safer because why would we make the game safer if there’s no medical or scientific evidence that there’s real long-term problems? 

There have been some tipping points that have led to more awareness. Derek Boogaard’s death was one, but that more seemed to involve enforcers. Steve Montador’s death seems to be another. Why has Montador’s death pushed awareness to a new level?

It’s difficult to know. I think Steve was well liked and respected. A lot of players in the league now played with him. His brain was studied by a different group than ours, so no one can make the claim that it’s just BU finding CTE … So we’re starting to see a trend. 

One of the issues brought up with his death was post-playing transition to the real world after suffering head injuries. Do some players fear CTE without knowing all the facts about it, and does this lead to increased anxiety and other mental problems involved with fear of CTE?

That’s a good question, and I think it speaks to the need to continue to educate players with what we know when we know it.

For example, I dealt with post-concussion syndrome for many years, and really still do from my concussions. But thinking of them as post-concussion syndrome at the beginning helped me appreciate that I would eventually feel better. If I had categorized them in my early 20s that it was CTE, I may have been more concerned that I wouldn’t start to feel better. But I was properly educated in my early 20s that it was post-concussion syndrome. But you have to remember the reason why, specifically I got into this, was because of a series of suicides by players before they ever knew the word CTE who were young, including Andre Waters and Terry Long, Chris Benoit, three of the first five cases diagnosed.

It’s always very important to try to message CTE accurately, but it’s also very important for athletes to … not go too far one way or the other. When athletes were in the dark about CTE, they thought the symptoms they felt were unexplained or had to do with their character, and some of them took their lives. Now that we have CTE awareness, some may be overly concerned or drawing conclusions that are appropriate.

But it’s important we have a conversation about this and to continue to try to do our best to be accurate about what we know, and that sort of … that’s partially why I sent the tweet out last night, because I didn’t think what the commissioner said accurately reflected the state of the science.

How much blame can we heap on hockey culture versus NHL rules in regards to head injury prevention?

Well, it’s a hard question to answer. I think every sports culture needs to continue to evolve around concussions. And all sports cultures will take time. We also have to appreciate at the professional level there’s a lot of money riding on decisions to report concussions and therefore there will always be incentive to not report a concussion. That’s not culture, that’s financial.

On the other side, every sport also can continue to change its rules and adapt how the game is played to continue to lower the risk. It’s hard to say in what sport, which is having more of an effect. 

How much does a players association need to be held accountable, such as with hockey and the NHLPA or in the NFL, with the NFLPA?

I don’t have the insight into the NHL Players’ Association. 

I know a lot of the changes we give the NFL ‘credit’ for have been driven by the Players Association. They’re very aggressively trying to create a safer work environment for the players and I think they’ve succeeded in a lot of ways. 

Overall, does the NHL do enough to curb head injuries? In your estimation what more does it need to do?

There’s no question that some of the moves that have been made have made the game safer. I think back to the first time I saw Brendan Shanahan giving the explanation for a suspension for an intentional hit to the head and I thought ‘this is huge progress.’ That being said there’s still going to be … there’s always room for improvement and we haven’t tackled the issue of fighting in the NHL. It’s still a huge source of brain injuries for the athletes, and it’s hard to still make the case it’s necessary. From a sports perspective, it might be more of an entertainment question. I think it’s worth mentioning one of the larger strides taking place in hockey that’s different than football is youth hockey has gotten safer in the United States, especially with USA Hockey’s change at the age of introduction of checking. In theory, that pays dividends all the way down the line to the pros that you have athletes coming in with fewer concussions historically. That hasn’t happened in football. The NFL has taken the opposite approach. They sort of doubled down the idea that it’s good for 5-year-olds to be hit in the head hundreds of times every year, so in their perfect world, their players are going to be coming in with more historical concussions because they’re trying to convince us tackle football is safe for 5-year-olds brains, when most concussion experts would disagree with that statement. I think that’s an interesting way to look at the sports.

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Josh Cooper is an editor for Puck Daddy on Yahoo Sports. Have a tip? Email him at puckdaddyblog@yahoo.com or follow him on Twitter! Follow @joshuacooper

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