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Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.
That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.
Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.
There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.
A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).
Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.
There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.
Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.
Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.
That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.
Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.
There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.
A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).
Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.
There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.
Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.
Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.
That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.
Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.
There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.
A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).
Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.
There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.
Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.
