Rugby must play it safe on concussion danger

MARK REASON
Last updated 05:00 08/05/2013
Conrad Smith
Photosport
RECOVERING WELL: Conrad Smith has recovered so well from concussion he won the team quiz night in South Africa.

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OPINION: Conrad Smith is a head case. The All Blacks centre has just received his second serious concussion of the season. There are probably more that we have not seen highlighted on TV. So is Smith endangering his long-term health by playing rugby? And if he is, who will tell him to stop?

This is a huge moral question facing rugby. Who has a duty of care to protect the players? Is it up to the individual? Is it up to the NZRU? Or does this go all the way to ACC and the Government? One thing is for sure, you and I will be paying tax for these guys' long-term treatment if they develop Alzheimer's or other degenerative brain conditions.

Ian Murphy, the medical director of the NZRU, says of the duty of care:

"It's a fair question. It's a difficult question for me to answer. Firstly we must ensure that Conrad is fully recovered from this episode. Then we will have the opportunity to sit down with Conrad and talk through these issues It's a case-by-case decision. We ensure the player is fully informed about his condition. Ultimately it is up to the player. I am very comfortable for an educated young man like Conrad to be taking that decision."

That begs the question of whether Murphy would be so comfortable about a less educated man taking the decision, but I also have a problem with the key phrase "fully informed". That is not possible at the moment, because we just do not have all the information about concussion, head impact and any causal link there may likely be to cognitive degeneration. We are not fully informed.

So what do we do in the meantime? Do we acknowledge that American studies have shown that the brains of deceased NFL players frequently look like "defecated fruit"? Do we conclude that there is enough evidence to suggest a link with impact sport and brain deterioration and extend that link to rugby?

We know there are players like Steve Devine, the former All Black, stumbling about and suffering headaches, tiredness and reduced co-ordination after a series of concussions. But we cannot yet absolutely prove the causal link.

Should we require that absolute proof before we take decisive action, knowing that by waiting we may be endangering the health of some of our kids? That is not as easy a decision as it sounds because rugby is a huge part of New Zealand society. It has become economically and socially much more important than just a game.

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Malcolm Gladwell, the author of Tipping Point, Blink and Outliers, recently outraged some students at Penn University by suggesting that their students should boycott and picket the college's American Football games.

Gladwell cited the case of a German immigrant called Hoffman, who worked for Prudential Insurance in the 1920s. Hoffmann went around a number of mining communities carrying out a survey of mortality rates.

Hoffman concluded from overwhelming evidence that dust inhalation was causing premature death. But the mining companies and the medical authorities said, "You have no proof." Over 50 years later the mining community finally admitted to black lung disease.

Gladwell draws a comparison with American football. We have no proof. We don't know if traumatic concussion or repetitive sub-concussive impact is more important. We don't know how many times a player has to be hit. We don't know if drug-taking is a factor. There is a whole heap of stuff we don't know. But we do have a lot of evidence. Gladwell argues that calling for proof is an excuse for inaction.

Gladwell says pro athletes can do what they like, but college kids could be protected by a waiver programme. His waiver reads, "In agreeing to play college football you are taking a real but unknown risk of dementia, depression and early death. There is no known cure for this condition . . . If evidence of CTE is found we promise to compensate your estate accordingly for wrongful death."

What's wrong with that? If we are so comfortable with the lack of risk in rugby, what university would not be willing to sign such a waiver? Well, I suggest Auckland University of Technology would be most unwilling to sign such a waiver.

It is undertaking a study into the possible link between rugby and brain degeneration in 40 to 60-year-olds. It is testing 200 ex-elite rugby players, 200 ex-community rugby players and 200 ex-sportsmen who didn't play rugby.

Ian Murphy and I cheerfully disagree about the NZRU's current position towards the evidence. I urge more caution, Murphy says that a cause and effect has not been established. But we are absolutely agreed on the urgent need to hurry the science along. At the moment the AUT programme is well short of numbers. I underwent the test yesterday and it is a tiny amount of time to give up for such an important study.

So if you fall into one of the above categories please sign up at sprinz.aut.ac.nz/ourresearch/rugby-health. You could be saving the life of one of your grandkids.

In the meantime, maybe Conrad Smith could retire for the good of the game. He has done it all. What better example could the Canes' captain set?

Just this weekend a severely concussed player was urged back on to the field in the big Wairarapa derby.

Maybe Conrad Smith, heroic lawyer and All Black, is just the man to put a stop to this type of Neanderthal thinking.

- © Fairfax NZ News

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