Suppose Johns Hopkins were to release a study tomorrow claiming that blue-eyed motorists have a comparatively high rate of involvement in automobile accidents. Suppose it gets mainstream attention and gains traction on all the major social media platforms. Whether or not an individual agrees with the data is less consequential than their awareness of the finding and the authority it comes from.
Suppose in the months that follow, other research-intensive academic institutions publish additional, more sophisticated statistical studies that uphold the initial findings. The epistemology is unclear, but the raw data is irrefutable. On average, blue-eyed drivers are causing more accidents than those with alternatively colored eyes. How can this be?
Fast-forward a few years. Blue-eyed individuals undergo extensive testing. Their motor function mirrors that of the control group; judgment, rule comprehension, reaction speed — each test as average.
Most in the science community describe this trend as a bizarre but natural phenomenon, upheld by the laws of probability. Some in the public suggests that blue-eyed individuals stop driving and take public transportation. Others advocate for investment in pharmaceutical research.
Meanwhile, the auto-insurance rates increase for blue-eyed drivers. This pisses a lot of people off. It also legitimizes the problem.
One physician who maintains a private practice while also authoring a syndicated public health column for the Washington Post Writers Group suggests blue-eyed drivers should eat bananas. The blue-eyed patients of his who eat a single banana every morning rarely get in automobile accidents. In fact, none of them do. In fact, he’s instructed all of his blue-eyed patients to eat a banana each morning. And they do. And on days when they do, they don’t cause any accidents. Bananas have potassium, he reminds his readers.
This seems dubious to many but believable to some. While blood tests confirm blue-eyed individuals have normal levels of potassium, the idea of a daily natural dose of potassium inhibiting what’s causing blue-eyed motorists to crash their vehicles is plausible enough to gain a little momentum with the public.
Eventually NPR’s All Things Considered uses a segment to examine the idea that potassium in ordinary bananas might somehow alter the driving behavior of blue-eyed individuals. Good Morning America spends a few minutes discussing bananas and drivers with blue-eyes. 60 minutes interviews the physician who first suggested the idea.
Many bananas are eaten.
Slowly, steadily, incredibly, the rate of involvement in automobile accidents for blue-eyed motorists starts to decline. Scientists can’t explain why. The media attention surrounding the issue shrinks. Normalcy resumes.
* * *
Let’s review. What we have are a group of individuals within a system from which we can visibly distinguish a sub-group. We know something is special about this sub-group. We don’t know what it is that is special about them only that their uniqueness is linked to an involvement in dangerous incidents within the system.
We also know there is a public perception that validates all of this even though there’s very little evidence for the scientific community to explain this trend and, in addition, this trend has never been investigated or observed by anyone, ever, until very recently.
We’re dealing with hard truths. This is happening to a group of individuals. That’s all we have. No why or how. Only who and what.
Any solution offered is based strictly on anecdotal evidence. Everyone is speculating. So when the trend begins to diminish, there’s no clear causation.
* * *
Everything about that story is fictional and absurd, right? This is not a trick. The answer is yes.
Okay, so where are we with concussions again? Let’s break this down. Start with the basics. What do we know? We know concussions are injuries that afflict the athletes of contact sports and they have been occurring for many years. We know some of the long term effects of these injuries. We know that the concussion is a form of injury that has never been diagnosed more often than it is now. We know they are caused by collisions involving the head but not all collisions involving the head cause concussions. So we don’t really know what causes them only what can cause them (an important distinction).
The uncertainty surrounding concussions is due, in large part, to the internal nature of the injury. Nothing is visible. The event wherein a concussion may have occurred is visible but the event, the collision, only make players candidates for a concussion diagnosis. We don’t have the technology to measurably detect an occurrence of a concussion. Whether or not an athlete has sustained a concussion is, at this point, a matter of the symptoms the individual expresses verbally.
Another factor, another known, another undeniable truth is the massive amount attention on the issue of concussions in sports right now. Concussion has become a buzz word. They’re undoubtedly, no pun intended, on the minds of athletes.
In the NHL, athletes are very familiar with Marc Savard’s situation. Sidney Crosby’s recovery period from concussion was highly publicized. It seems like every organization has an athlete or two recovering from a concussion. Every division has a handful of high profile athletes who have sustained or are out of the line-up because of post-concussions symptoms. The degree of separation is very, very small.
Somehow the NHL needs to settle into a place where athletes think less often about concussions. That’s not to suggest some of the athletes’ symptoms are being fabricated or that some of the diagnoses are fraudulent. These injuries are very real, the symptoms are real, and the effects are real. I mean to suggest it’s counter-productive for players to be preoccupied with the safety of their heads before, during, and after collisions that involve a player’s head.
Everyone else involved with professional hockey, from the commissioner of the league to the training staff of individual teams, should be proactively thinking about concussions — specifically, ways to decline the concussion-rate and more effective techniques to treat concussions. Think of where we are in this timeline. We’re still years away from having the technology needed to adequately understand these injuries. Where does that leave hockey? What can be done in the meantime?
There are mountains of evidence supporting the placebo effect. Let’s start trying some new things. I don’t mean in place of what the AMA teaches. It’s foolish to use alternative medicine as a primary method for recovery but what’s wrong with trying something to supplement the traditional treatment plan?
Another quick hypothetical: what if a trainer was to manufacture something, some simple technique, and told players it may reduce the post-concussion effects? Perhaps putting ice packs on a few of the lymph nodes immediately after a potential concussion. Or, maybe, flushing an athlete’s systems with Vitamin C in the days that follow a potential concussion.
The value isn’t in the medical application because there is none; the value is in the diminishing the helpless feeling athletes surely regard themselves to these injuries. The idea is to keep athlete’s minds off resting. Keep them engaged in the treatment. Distract them, at least a little, from the injury and the potential for post-concussion symptoms to manifest.
Concussions are physical injuries with growing psychological hurdles, especially in professional hockey. Can we agree on that? Something else is happening here besides players bumping their heads. There’s a pervading concern with head related injuries. It goes beyond precaution. It’s an anxiety. It’s a terror.
I love the idea of the NHL initiating and sponsoring an annual conference to discuss head-related injuries that Ken Dryden put forth in this fantastic essay. It’s a proactive approach to finding answers.
I’m willing to pay attention to anyone with ideas for preventing or recovering from concussions. Mine is very simple: reshape the mentality of the players with regards to heads injuries. It’s a stupid cliché, and I apologize for using it here, but I respect the power the mind has over the body. Let’s explore those limitations in a injury prevention/recovery capacity. For an injury with so much uncertainty surrounding its diagnosis and treatment, isn’t this an avenue worth exploring?
It seems to me that sports doctors (until the last few years, at least) have been using almost nothing *but* the placebo to treat concussions. The last thing we need is team doctors telling a player (or even worse, that player’s coach) “put this ice pack on your lymph node and you’ll be fine.” (I know that’s not what you’re suggesting, but it doesn’t seem that far off.)
Pretty much every medical condition has someone out there treating it in a non-traditional way. NHL players and medical staffs would be foolish not to be trying every single thing out there. I’d be shocked if Sidney Crosby hasn’t seen a half dozen acupuncturists/herbalists/homeopaths in the last year. But for this particular injury, it seems to me that the NHL/NFL has certainly exhausted the value of “mind over matter” over the course of their collective histories.
And we DO know exactly what cause concussions. The brain knocks against the skull and gets bruised. We don’t know why some hits cause concussions and some hits don’t, but this isn’t like blue eyed people being inexplicably bad at driving. We know exactly why this is happening.
I absolutely agree that every single possible avenue for recovery should be exhausted. If bananas fix the concussions, then by all means, NHLers should be eating bananas by the bushel.
Personally, I think we’ve only begun to scratch the surface of the concussion situation. I’d bet the farm that concussions are STILL being wildly under-reported. So, I guess I think this period of fear is ultimately healthy. It might require a little bit of terror for the sports industries and athletes to face this problem.
Kate,
I have to believe that we’re past the “tape it up and you’ll be fine” method to concussion treatment otherwise we’re nowhere. I’m not sure what they did for concussions back in, say, Barnaby’s day. Maybe they did a lot of homeopathic techniques but that’s of no consequence for how someone like Nate Gerbe views that technique (which is literally all that matters).
Also, I think in order for something to qualify as an effect of a placebo, something must be administered to a patient. There must be some treatment — a drug, a nutrient, an exercise. Concussions and potential concussions are treated with rest. It’s sort of the absence of treatment. If you’ve come across any examples of an athlete doing something, anything, other than rest to treat a concussion please pass it along.
On what causes a concussion. Okay, the brain knocks against the skull and gets bruised. Yes, but follow me on this. An unprecedented, remarkable number of athletes in hockey are being diagnosed with concussions. Why? Why are more athletes being diagnosed if all that causes them are brains knocking against skulls? Has the requirement for a concussion diagnosis become less strict, thereby changing the definition of a concussion? I haven’t read that anywhere. Are athletes revealing symptoms they’ve experienced in the past but only now are starting to admit? Definitely, but does this explain why they’re being diagnosed so much more often now than in the past? I think there’s more to it than that.
Why is it that concussions are so seldom diagnosed in football? Long answer, obviously, but at least part of it is that there isn’t a fear of concussions in football like there is in hockey. Tom Brady and other stars haven’t been out of the line-up for 10 months dealing with post-concussion symptoms. That fear is a potential cause, right? I certainly wouldn’t rule it out. I’m being technical because you called me on it and because it’s important to my point.
I should also note (and regret I didn’t specify) that in my entry when I say concussions have “never been diagnosed more often” I mean like the Jeff Skinners and the Claude Girouxs and the players that have us all shaking our heads in the last few weeks. Super, super short term and it could just be weird misfortune but I don’t think so. I think we’re all freaked out, including the players, and it’s contributing to more concussions.
You seem to be suggesting that there might be a psychological component to contracting concussions, and while I certainly think that’s possible, I also think at this stage it’s a real stretch. You’re assuming a lot of things about how the threat/fear of concussion actually affects “concussion-like symptoms.” Personally, it’s my inclination to make assumptions in the other direction.
Long answer, obviously, but at least part of it is that there isn’t a fear of concussions in football like there is in hockey.
Of course this is just opinion, but I think a more likely reason that NFL concussions are not as widely reported is that they don’t show up on an x-ray and NFLers don’t have guaranteed contracts. There is tremendous pressure on these men to play. When it comes down to $, there is no motivation for a team to care about the long term health of their players. I don’t agree with you at all that we’re past the “tape it up and you’ll be fine” stage, especially in the NFL.
The situation with Sidney Crosby has changed so much about how the NHL deals with concussions, but it’s only because this happened to Crosby. Do you think ANY other player in the league would get the kind of leeway he’s received? Do you think the Sabres would treat Jochen Hecht the way the Penguins have treated Crosby? I don’t. (Hell, Hecht played in the playoffs last year, conveniently “healthy” after Pominville and Connolly went down. Then, he missed the first month and a half of the new season with a concussion.) Crosby has changed everything. To me, rather than assuming that fear is contributing to the uptick in concussion symptoms, it makes more sense to assume that more guys are speaking up about symptoms they would’ve ignored even last season.
Your point that fear is a factor is interesting, and there is probably some validity there. I just think it’s a dangerous approach, especially when you factor in that these teams have no monetary motivation to take concussions seriously.