With growing concerns about the long-term effects of concussions due to football, the medical community, especially pediatricians, are grappling with how to turn early scientific studies into real-world advice for parents, coaches and school boards.
In a commentary for the medical journal Pediatrics, physicians from multiple institutions, including the University of North Carolina and Children's Mercy Hospital in Kansas City, debate the merits and drawbacks of advising a ban of high school football.
The commentary focused on exploring the risks of high school football by having three experts give an answer to a hypothetical scenario where a small-town pediatrician has to decide whether to advise cancelling a football program.
Concussions and their possible role in the development of CTE, or chronic traumatic encephalopathy, has put a spotlight on the dangers of tackle football. In recent years, posthumous examinations of multiple professional football players have revealed the athletes had been suffering from the condition. Currently, CTE can only be diagnosed posthumously. However, the life-time risks for an average football player, especially one in high school, remain unclear.
CTE is a degenerative disease that involves a buildup of the abnormal protein called tao, which is also found in dementia patients and is associated with a breakdown of brain tissue. It's believed to be caused by repetitive trauma to the brain, especially concussions, according to the CTE Center at Boston University, and symptoms include memory loss, confusion, impulse control problems, aggression, depression, anxiety and progressive dementia.
Dr. Andrew Gregory, an associate professor of Orthopedics and Pediatrics at Vanderbilt University Medical Center, said new research and attention on concussions has been important to raise awareness, but that he didn't want parents to be so afraid that they keep children away from sports in general.
"I do worry about the anxiety in general. ... We don't want the message to be that kids shouldn't participate in sports because of risk of injury," Gregory told ABC News today. The question is "what can we do to make kids safer?"
In the commentary, Dr. Lewis Margolis, a pediatrician and epidemiologist at the University of North Carolina, argued that current evidence points to football as more dangerous to the brain than other sports and that there is not enough evidence that benefits, including character building and physical fitness, is enough to outweigh the risks.
"High school football players have, by far, the highest risk of concussion of any sport," Margolis wrote. "In football, the rate of concussion is 60 percent higher than in the second ranking sport, lacrosse."
Margolis wrote that he was also troubled by the fact that a large percentage of players are African American, and that as a result they "face a disproportionate exposure to the risk of concussions and their consequences."
He advised that pediatricians should advise "discontinuation of high school football programs" until there is proof that it will not lead to long-term consequences for players.
"At present, there does not seem to be a way to reduce the number of head injuries in high school football," Margolis wrote. "There is no question that football is deeply imbedded in this community, as in U.S. culture. Our society has, however, researched other harms, such as tobacco use, alcohol-related driving, and obesity-related unhealthy diets and exercise, and successfully changed social norms."
As a counter argument, Dr. Greg Canty, medical director for the Center for Sports Medicine at the the Children's Mercy Hospital in Kansas City, said that the medical community should push to make the sport safe but found there was not enough factual evidence to point to completely banning high school football.
"If we eliminate football, what sport is next and what is our threshold?" Canty asked in the commentary. "Who is going to be responsible for defining 'safe play?'"
While CTE is often cited as a concern for football players, Canty said the disease has only been found in relatively few players when compared to the millions who have played the sport.
"It has been found in a hundred or so deceased athletes when the sample size of former athletes is in the millions," Canty noted. "We have no idea how to apply current information about CTE to youth or living athletes. We have concerns, but no definitive answers."
Canty also pointed out that the U.S. Centers for Diseases Control and Prevention have reported a "10-fold increase in reported rates of sports-related concussions over the past decade," but that many in the medical community believe this is due to increased awareness and not increased injury.
If physicians decide to recommend banning football, they may then be forced to look at banning other sports, such as hockey, lacrosse or soccer, which also put players at risk for concussions, Canty said.
"I encourage pediatricians to look for ways to make all sports safer for our patients," Canty said. "Start by demanding certified athletic trainers at all sporting events. Be a resource for educating your community on sporting topics."
Dr. Mark Halstead, a sports medicine physician at Washington University, agreed in the commentary with Canty and said there are clear steps schools can take to reduce the risk of dangers from concussion. Among them is teaching key staff members to work with a licensed athletic trainer on site and develop an emergency action plan.
"I am often asked if I would allow either of my 2 sons to play football knowing what I do about concussions. Yes, I would," Halstead wrote in the commentary, qualifying it would only be in a program where safety was a priority. "I would only let them play in a program that encourages safety and puts an athlete’s health above winning."