Head-on tackle

NFL doc leads Pentagon into battle on brain-injury crisis

Saturday, September 24, 2011

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The Pentagon and the NFL are becoming unlikely allies, as both struggle to deal with a health crisis that plagues troops and athletes alike.

Inspired by the National Football League’s comprehensive research program into the long-term impact of concussive injury, the military is funding a blockbuster “brain bank” to be led by one of the doctors behind the NFL’s own initiatives.

Called the Military Brain Injury Studies Program, the initiative will be run out of the Uniformed Services University of the Health Sciences in Bethesda, Md.

With a price tag of $60 million over the next five years, and the expectation that the program will endure for decades, Pentagon brass are asking that every troop commits to help: Program leaders will soon ask all troops and new enlistees to will their brains to be studied posthumously, and hope to eventually collect hundreds of thousands of samples.

“The NFL is likewise concerned about the concussive injuries suffered by players,” said Gen. Peter Chiarelli, the Army’s vice chief of staff, at the annual Military Medicine Symposium Thursday in Washington. “What’s discovered in the years ahead will undoubtedly transform health care in both groups.”

Football players suffering from increased rates of dementia, depression and substance abuse first catalyzed research into the effect that jarring tackles might have on brain tissue.

A collaborative brain bank, established by Boston University and the NFL, has allowed researchers to study the brains of more than 40 deceased NFL players. These evaluations have established that dozens of former football superstars, including Chicago Bears player David Duerson and Pittsburgh Steeler Justin Strzelczyk, suffered from chronic traumatic encephalopathy, or CTE, a degenerative brain disease caused by repeated blows to the head.

“We’ve seen what a career in football will do to the brain,” said Dr. Daniel Perl, who will lead the new Military Brain Injury Studies program and was involved in the NFL’s brain research. “The big question now is, what’s happening to combat veterans?”

Experts suspect that NFL players and soldiers, though involved in markedly different activities, share a similar diagnosis. In fact, they’re warning that the traumatic brain injuries suffered by troops exposed to blasts will cause the same lifelong health problems as those afflicting athletes.

An estimated 220,000 traumatic brain injuries have been diagnosed among troops since 2000, and the Pentagon is hardly equipped to contend with the problem: The first mandatory brain injury screening wasn’t established until last year, and even military doctors admit the test is imperfect and easy for troops to dupe.

“Peyton Manning admitted he low-balls the preseason baseline concussion test, with the expectation that it may help him remain in the game if he suffers a concussion during the season,” Chiarelli said. “Sounds like some soldiers I know.”

Experts are even starting to wonder if some of the troops diagnosed with post-traumatic stress disorder — an estimated 20 percent of those deployed to Iraq and Afghanistan — actually suffer from CTE, as a result of multiple bomb blasts reverberating into their brain cells.

“Is there a bigger risk that having lost consciousness [due to a blast] will mean getting PTSD? Absolutely,” said Dr. Stanley Prusiner, director of the Institute for Neurodegenerative Diseases at the University of California, San Francisco, who will participate in the research.

In fact, Prusiner noted that 40 percent of soldiers who lost consciousness were later diagnosed with PTSD, adding weight to the idea that symptoms attributed to the traumas of war could, in fact, be caused by the impact of explosions.

Both ailments are accompanied by similar problems. Depression, substance abuse, anxiety, rage and an increased risk of suicide are all attributed to both PTSD and CTE. In the military, the prevalence of those symptoms started to increase a few years after the incidence of traumatic brain injuries (also known as TBI) did, and both have risen steadily ever since.

Doctors leading the NFL program are actively sharing data with Pentagon brass, and have already studied the brains of 20 deceased military veterans to compare them to the samples from football players.

In particular, they’re looking for tangled protein fibers within brain tissue — the hallmark of CTE among deceased football players — that would confirm the similarity between athletes and troops. That could be an eventual target for pharmaceutical treatment.

With decades of research to come, however, Pentagon brass are acknowledging that their brain bank won’t soon make a dent in the health of today’s troops. For now, they’re starting with the basics — first and foremost, getting troops to acknowledge their injuries.

“Athletes and soldiers are very similar — neither wants to let his teammates or buddies down, or leave the game or fight,” Chiarelli said. “We’re seeing more and more admit to this fact.”