Concussion Research For Sale?

Contradictions and Conflicts of Interest in Concussion Research Exposed in Tatos Paper

January 16, 2020 (Updated)
Sheilla Dingus

In June 2019 University of Utah Economist Ted Tatos and Don Comrie of Neurolabs released a disturbing scholastic paper based on research conducted from documents released by the University of North Carolina as the result of academic fraud.  “Cognitive Disorders Among Incoming College Football Athletes: Legal and Medical Implications of Undisclosed Inclusion in Concussion Research”, published in The Journal of Scientific Practice and Integrity

The study formed the basis for a 9-month long investigation by The Athletic, a reader-funded site known for premium sports reporting.  The Athletic produced a documentary and an article authored by Christian Red based on the results of their investigation on the tainted research.  Though the academic paper largely flew under the radar until The Athletic published their work on October 8.  Once the information made the leap from academic circles to the mainstream an onslaught of backlash soon erupted.

Chancellor Kevin Guskiewicz, who leads the concussion research at UNC immediately fired back in a rebuttal attempting to discredit the work of Tatos, Comrie, and The Athletic that revealed evidence of LD/ADHD rates among incoming college football athletes at UNC of over 50% in some cohort-years and UNC’s failure to disclose these diagnoses as the football athletes participated in the school’s concussion research.  The academic paper, as well as the work by The Athletic, pointed to how the inclusion of athletes affected by LD/ADHD had the potential to minimize the seriousness of concussion—a fact detailed in hundreds of peer-reviewed scientific papers.

UNC’s rebuttal was soon followed by a letter of support signed by approximately 100 individuals who described themselves as “national and international leaders” in concussion research.  The second paragraph of Christian Red’s article sets the tone in which the rebuttal and support letter must be viewed.

“I’m proud to call Roger Goodell a friend and a colleague,” Guskiewicz said in his introductory remarks on March 6, 2013, “someone with whom I’ve sat at the table, rolled up our sleeves and tried to tackle some of the most serious issues around health and safety for players.”

Not only did Guskiewicz sit at the table with Roger Goodell, whose view of league integrity is defending the shield and protecting the bottom line as opposed to any moral view, but Guskiewicz is also the recipient of millions of dollars of NFL money for UNC’s concussion research.

On January 14, 2020, Tatos responded in a stinging rebuke, pointing out the numerous conflicts of interest and actual contradictions of their own work by those who signed the UNC letter of support.

While the UNC support letter, whose claims I discuss subsequently, may have placated UNC’s administration and fans of its storied sports program, it had no such effect either on the broader academic community or on journalists following this story. On November 6, 2019, approximately 250 international academics wrote an open letter (“the academic letter”) to the NCAA that was published in the Chronicle of Higher Education. The signatories included twenty-four (24) professors from UNC itself. The academic letter called for the NCAA and its members to release two decades of data on LD/ADHD rates within their athletic programs, properly anonymized.

The concerned scientists wrote:

The next day, November 7, 2019, the academic integrity watchdog association, The  Drake Group, called upon the U.S. Department of Defense Office of the Inspector General  to initiate an independent investigation into potential wrongdoing in UNC concussion research, stating:

While UNC and certain conflicted members of the scientific community attempt to refute the findings of Tatos and Comrie, Tatos in his reply, reminds then that all of his research is derived from their own documents.

Tatos notes how the Charlotte News and Observer published an op-ed urging the university to address the findings rather than attempt to throw shade at the bearers of bad news. He also notes that the editorial board of the Daily Tar Heel, UNC’s student newspaper also wants answers voiced in an op-ed published on November 19.

Tatos emphasizes that his work was independent and uncompensated, done entirely in the interest of personal concerns about the safety and well-being of college athletes and the disturbing conflicts of interest in concussion research.  His concerns were confirmed by Guskiewicz’s refusal to answer questions and the responses in support of UNC which he points to in his rebuttal.

In the apparent panic of having their secret discovered numerous scientists refuted their own research in an effort to discredit the research of Tatos and Comrie.  Tatos points to an enormous body of scientific literature cautioning against using players with ADHD in concussion studies or at least marking them as affected, pointing to numerous ways ADHD can skew the results and minimize the severity of brain injury.  The following are some of the conflicted signatories:

Brian Hainline, NCAA Chief Medical Officer

• Interviewed by The Athletic in their investigation, stating:

• Noted the relationship between LD/ADHD and concussion in the 2019 International Olympic Committee’s 2019 Consensus Statement, Mental health in elite athletes, which he co-authored.

• Co-authored an article in Concussion titled “Summary of the 2015 University of Michigan Sport Concussion Summit” with Green Bay Packers delegate to the NFL Head Neck & Spine Committee Michael McCrea, Steven Broglio, Sara Chrisman, Christopher Randolph, and Tamara McLeod, as well as Kevin Guskiewicz. The article is particularly notable because of another co-author: concussion defense attorney Steven Pachman, who has also previously co-authored with Kevin Guskiewicz.  This article features the familiar echo from industry interests about “increasing sensationalism” regarding concussions.  Omitted along with the other co-authors’ disclosures of financial and competing interests.

Margot Putukian, chief medical officer of Major League Soccer and a member of the NFL Head Neck & Spine committee

• Co-author of IOC Consensus Statement with Dr. Hainline.

William Barr, NYU Langone Medical Center

• Worked as the team neuropsychologist for the NY Jets for nearly ten years.
• Interviewed with The Athletic during their investigation and sent the journalists a copy of a 2018 paper by Poysophon and Rao titled “Neurocognitive Deficits Associated with ADHD in Athletes: A Systematic Review” in which the two authors found, “Overall, athletes with ADHD demonstrated lower scores on neurocognitive testing such as the ImPACT (Immediate Post Concussion Assessment and Cognitive Test)—The exact opposite of his position in the UNC support letter.

Christopher Giza, UCLA Steve Tisch Brainsport Program (Tisch is the co-owner of the NFL’s NY Giants)

• As an expert for the NFL stated in a sworn declaration, “Persistent symptomatology after a single concussion is heavily influenced by premorbid risk factors such as migraine, learning difficulties, anxiety, and other neurobehavioral diagnoses.”
• Co-authored with Michael McCrea and Stephen Broglio,  “The Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes,” that published in Sports Med one week after he signed the UNC support letter.  The article stated,  One of the co-variates they include in their analysis was attention deficit disorder/attention deficit-hyperactivity disorder.

Michael McCrea, Green Bay Packers delegate to the NFL Head Neck & Spine Committee

• One of the principal investigators for NCAA-DoD Care Consortium
• Co-Authored with Christopher Giza and Stephen Broglio, “The Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes.”
• Co-authored with Steven Broglio, a 2019 paper that studied cadets at US service academies that found, “Academy training related concussions were associated with sport level, sex, freshman status, previous concussion, headache, diagnosed ADD/ADHD…Previous concussion, headache, and diagnosed ADD/ADHD also significantly increased the risk of an academy-training-related concussion”
• On Kathryn Van Pelt’s doctoral committee that produced a dissertation titled, “Concussion Among Military Service Academy Members: Identifying Risk Factors, Recovery Trajectories, And The Role Of Mental Health” addressed both ADHD and the differences between the cadet and athlete populations.
• Co-authored with Sara Chrisman, Kimberly Harmon, Thomas Kaminski, Thomas Buckley, Jay Clugston, and Stephen Broglio, a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion,” that stated:

Co-authored with  NCAA Chief Medical Officer Brian Hainline, Steven Broglio, Sara Chrisman, Christopher Randolph, and Tamara McLeod, as well as Kevin Guskiewicz who also is part of the NFL Head, Neck, and Spine Committee, “Summary of the 2015 University of Michigan Sport Concussion Summit” in which blatant conflicts of interest were not only undisclosed but denied.

Stephen Broglio, University of Michigan Professor of Kinesiology

• One of the principal investigators for NCAA-DoD Care Consortium
• Co-Authored with Christopher Giza and Michael McCrea, “The Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes.”
• Co-authored with Michael McCrea, a 2019 paper that studied cadets at US service academies that found, “Academy training related concussions were associated with sport level, sex, freshman status, previous concussion, headache, diagnosed ADD/ADHD…Previous concussion, headache, and diagnosed ADD/ADHD also significantly increased the risk of an academy-training-related concussion”
• On Kathryn Van Pelt’s doctoral committee that produced a dissertation titled, “Concussion Among Military Service Academy Members: Identifying Risk Factors, Recovery Trajectories, And the Role Of Mental Health” addressed both ADHD and the differences between the cadet and athlete populations.
• Co-authored with Sara Chrisman, Kimberly Harmon, Thomas Kaminski, Thomas Buckley, Jay Clugston, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”
• Co-authored with  NCAA Chief Medical Officer Brian Hainline, Green Bay Packers delegate to the NFL Head Neck & Spine Committee Michael McCrea, Sara Chrisman, Christopher Randolph, and Tamara McLeod, as well as Kevin Guskiewicz who also is part of the NFL Head, Neck, and Spine Committee, “Summary of the 2015 University of Michigan Sport Concussion Summit” in which blatant conflicts of interest were not only undisclosed but denied.

Sara Chrisman, MD, MHP at Seattle Children’s Hospital

• Co-authored with Stephen Broglio, Kimberly Harmon, Thomas Kaminski, Thomas Buckley, Jay Clugston, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”
• Co-authored with  NCAA Chief Medical Officer Brian Hainline, Green Bay Packers delegate to the NFL Head Neck & Spine Committee Michael McCrea, Steven Broglio, Christopher Randolph, and Tamara McLeod, as well as Kevin Guskiewicz who also is part of the NFL Head, Neck, and Spine Committee, “Summary of the 2015 University of Michigan Sport Concussion Summit” in which blatant conflicts of interest were not only undisclosed but denied.

Gary Solomon, Professor at Vanderbilt University School of Medicine, Department of Neurological Surgery

• Gave a presentation at the Tennessee Psychological Convention in October 2013 in which he observed, with regard to the Collins (1999) study, “Since this 1999 study with collegiate football players, athletes with LD and ADHD have been excluded from most concussion research studies.”

• Tatos notes, “Rather ironically, the signatories of the UNC support letter criticize us for ‘relying’ on the Collins study while they do so themselves. Further, as anyone who reads our paper can observe, we not only cite Collins et al. for support, but we also cite multiple other papers that have been published since that time.”
• Listed as having created/edited/reviewed the Tennessee Department of Health’s June 20, 2017, Return to Learn/Return to Play: Concussion Management Guidelines  that specifically noted LD/ADHD as “conditions or ‘modifiers’ of concussion that we know may prolong the recovery process.”

Kimberly Harmon, Section head of Sports Medicine at the University of Wisconsin, Professor of Medicine at UW, and orthopedic surgeon

• Co-authored with Sara Chrisman, Stephen Broglio, Thomas Kaminski, Thomas Buckley, Jay Clugston, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”

Thomas Kaminski, University of Delaware Professor of Kinesiology and Applied Physiology

• Co-authored with Sara Chrisman, Stephen Broglio, Kimberly Harmon, Thomas Buckley, Jay Clugston, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”

Jay Clugston, University of Florida Athletic Association team physician and MBI member

• Co-authored with Sara Chrisman, Stephen Broglio, Kimberly Harmon, Thomas Buckley, Thomas Kaminski, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”
• Jointly published a paper with Breton Asken and Russell Bauer in 2019 that analyzed symptom reporting differences in two versions of the Sport Concussion Assessment tool (SCAT), noting, “We excluded individuals with several medical history factors (ADHD…)” in contrast with the claims in the letter.

Thomas Buckley. University of Delaware School of Kinesiology

• Authored a Univ. of Delaware article titled “Landmark concussion study” that discussed the NCAA-Department of Defense “Care Consortium” grant.
• Quoted in the article as stating, “We know that people with a history of depression, anxiety, ADHD and migraines have worse outcomes in terms of concussion”, opposite of what the UNC letter he co-signed claims.
• Co-authored with Sara Chrisman, Stephen Broglio, Kimberly Harmon, Jay Clugston, Thomas Kaminski, and Michael McCrea  a 2018 study in the Annals of Biomedical Engineering in which they analyzed the impact of factors that affect reading skill on the King-Devrick baseline test, which is often used “a part of a multimodal assessment to screen for sport-related concussion.”

Breton Asken, fellow at the UCSF Memory and Aging Center in the Department of Neurology

• Jointly published a paper with Breton Asken Jay Clugston and Russell Bauer in 2019 that analyzed symptom reporting differences in two versions of the Sport Concussion Assessment tool (SCAT), noting, “We excluded individuals with several medical history factors (ADHD…)” in contrast with the claims in the letter.

Russell Bauer, Professor of Psychology at the University of Florida

• Jointly published a paper with Breton Asken and Jay Clugston in 2019 that analyzed symptom reporting differences in two versions of the Sport Concussion Assessment tool (SCAT), noting, “We excluded individuals with several medical history factors (ADHD…)” in contrast with the claims in the letter.

Christopher Randolph, Professor of Neurology, Loyola University Chicago

• Co-authored with  NCAA Chief Medical Officer Brian Hainline, Green Bay Packers delegate to the NFL Head Neck & Spine Committee Michael McCrea, Steven Broglio, Sara Chrisman, and Tamara McLeod, as well as Kevin Guskiewicz who also is part of the NFL Head, Neck, and Spine Committee, “Summary of the 2015 University of Michigan Sport Concussion Summit” in which blatant conflicts of interest were not only undisclosed but denied.

Tamara McLeod, Professor at School of Health Sciences, A.T. Still University, Mesa, AZ

• Co-authored with  NCAA Chief Medical Officer Brian Hainline, Green Bay Packers delegate to the NFL Head Neck & Spine Committee Michael McCrea, Steven Broglio, Sara Chrisman, and Christopher Randolph, as well as Kevin Guskiewicz who also is part of the NFL Head, Neck, and Spine Committee, “Summary of the 2015 University of Michigan Sport Concussion Summit” in which blatant conflicts of interest were not only undisclosed but denied.

Update: Another notable signer was Dr. Elizabeth Pieroth

Well, this is a scary revelation for the brain injury world, specifically in #Chicago

Dr. Elizabeth Pieroth had a hand in clearing Steve Montador for #concussions # 16, 17, 18 & 19 in a span of 12 weeks while he played for the #Blackhawks @DrEPieroth @NHL @NHLBlackhawks #TBI https://t.co/BgDbixobol

— Daniel Carcillo (@CarBombBoom13) January 16, 2020

Pieroth has been involved in the assessment of players in the @NHL since 1997 & is the Head Injury/Concussion specialist for the @ChicagoBears @NHLBlackhawks @whitesox @ChicagoFire & the @USWNT as well as numerous colleges and high schools in Illinois

Yikes 😳#TBI #concussion

— Daniel Carcillo (@CarBombBoom13) January 16, 2020

While The Athletic raised questions about Guskiewicz’s failure to disclose his conflicts of interest, Tatos observes that it appears that the practice of failing to do so is widespread among individuals with significant industry ties, which may help explain their support for UNC’s concussion research.  “The fact that the co-signatories of the letter offered claims that stands in such stark contrast not only to the literature but also their own position statement raises questions regarding whose interests these individuals truly serve.”

As if this list isn’t exhaustive enough, Tatos writes, “To examine every instance in which the claims of the signatories of the UNC letter refute claims they made previously would require an article of significant length and would test the limits of any reader’s patience. Indeed, neither I nor anyone else should have to re-acquaint these self-professed ‘leaders’ in sports-related concussion with their own research or perhaps introduce them to the breadth of literature on the subject outside the boundaries of industry-funded ‘research.’”

To me, the most disturbing signatory to the UNC support letter was BU researcher Dr. Robert Cantu, who has served as a plaintiffs’ side expert witness in both the NHL Concussion Litigation and the NCAA Concussion Litigation.

Robert Cantu, Boston University CTE Center

His signature to a letter dismissing is in sharp contrast to his sworn declaration in the NHL lawsuit, a position he also held in the NCAA litigation.

As the premier CTE research center in the world, and having testified on behalf of plaintiffs in concussion litigation, and often speaking publicly about the dangers of contact-sport brain injury I find his presence on the list of signatories alarming causing leave for questioning when or if the NFL and DOJ partnership might further influence the university’s vital research and generally critical perspectives on the dangers of contact-sports induced brain injury.

Industry influence has completely permeated pharmaceuticals, leaving the public at risk of being endangered by unsafe drugs and medical devices, often unhampered and accepted by the FDA.  For decades, those with a monetary interest in sports have sought to minimize public awareness and concern regarding the dangers of concussive and sub-concussive brain injury, and despite actions taken to make sports “safer” they continue to minimize and deflect the risks to this day.  Often safety measures seem little more than litigation strategy to mitigate liability when more inevitable lawsuits are filed, as the NFL, NHL, NCAA, and other bodies seek to deny compensation to damaged brains and lives.

Kudos to Comrie, Tatos, and The Athletic, for calling their hand.

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Sheilla Dingus

Editor at Advocacy for Fairness in Sports | Website

Sheilla Dingus founded Advocacy for Fairness in Sports in October 2016, after a stint with Defenders of the Wall, a New England Patriots based blog where she dived deep into the legal aspects of Deflategate. Along the way, she observed many inequities in sports and felt a need to address some of the under-reported stories in sports law. She draws from her background as a former professional dancer, who like many of the athletes she writes about, took an early retirement due to orthopedic injuries. After a return trip to college she worked for a legal software company, with seven years as a Project Manager and Analyst. She brings her analytical skills to the table in breaking down complex lawsuits, and enjoys pursuing her longtime interest in journalism.