Pearls and Irritations

Much of the health reform urgings I have presented over the years have emphasised the importance of “prevention” and the paucity of attention it receives. Less than 1.2% of our health budget is spent on preventing health problems. OK, but what has this to do with the Soccer world Cup?

Excited as I was with the ‘nail biting’ tensions associated with the fierce competition, I winced every time I watched these outstanding young athletes ‘heading’ the ball. In a number of incidents a player was visibly hurt after heading but in the matches I watched not once was a player removed for medical examination for possible concussion. If the player wanted to continue they were allowed to do so.

Now, well known to FIFA, is the fact that much research has been done in recent years into short term and particularly long term neurological problems faced by soccer players caused by ‘heading’. In general any repeated trauma to the head which can cause the brain to ‘bounce’ of the front and back of the skull, causes damage with the accumulated effect putting one in grave danger of chronic neurological defects including problems with logical thinking, memory and even dementia. Scientists studying the problem have found unique brain proteins released into the blood stream after head trauma including soccer ‘heading’.

In July, a published study found that retired professional soccer players in Britain who’d reported heading the ball more than 5 times a match or practice session during their careers, were far more likely to experience cognitive decline later in life than did those who headed less.

Last year scientists studied female college soccer players and measured the “G-force”, a gauge of linear acceleration of the brain during heading, using sensors in a player’s mouthpiece. Heading could produce a G-force not much less than that associated with a car hitting a wall at 35 mph! Other studies found 4 times higher levels of dementia than is the community norm among 8000 retired professional soccer players.

I could go on and on but the evidence suggests that soccer should abandon ‘heading’. In Australia youngsters are not allowed to start heading till they turn 12. Soccer is after all, “football” and as a casual observer I can’t see the game being less exciting if heading disappeared.

Of course it probably won’t, at least in medium turn but it should.

Parents in particular should be asking is it worth the risks involved? As is true for much accumulated but not applied wisdom about prevention, we need to continue to press the case.

Well, while some may be surprised by the risks soccer players face no one should be surprised at the very significant neurological problems experienced by amateur and professional boxers. An abundance of evidence shows that men who boxed in early life are at greater risk of early onset dementia, with the onset of dementia starting on average five years earlier than those who had never boxed.

Chronic traumatic brain injury in boxers, results in three types of neurological symptoms.

Motor defects— slurred speech a lack of coordination, slow movements, a weakened voice, rigidity, poor coordination, poor balance, and tremors.

Cognitive— poor concentration, memory deficits and slowed mental speed. profound attention defects, prominent slowness of thought, and impaired judgment, reasoning, and planning,

Behaviour— irritability, a lack of insight, paranoia and violent outbursts.

I have noted that Foxtel’s promotion of its ‘pay per view’ boxing, attempts to attract viewers with feature clips of bloodied battered men collapsing to the canvas while audience excitement surges as brain damage is inflicted. Not much different from the behaviour of ancient Romans! I should emphasise that all efforts to make boxing safe have failed.

However none of the above triggered this contribution. No, it was the announcement by an excited NSW Premier that ‘Cage Fighting” was returning to Sydney that catalysed this contribution. This would be good for the economy and Sydney’s attractiveness as a tourist destination, declared the Premier. The last time we saw Cage Fighting in Sydney attendance at events numbered some 18,000! That such dangerous savagery should be embraced as exciting entertainment by thousands of Australians I find distressing.

Perhaps too few are aware of the physical damage experienced by so many participants in ‘Mixed Martial Arts’, (MMR), claimed to be the fastest growing spectator sport in the world. The MMR website explains that “to win, a fighter (both sexes participate) must punch, kick and wrestle their opponent into submission or unconsciousness”.

A recent MMR review noted that there is an extremely fine line between entertainment and disaster. “On too many occasions it’s more about survival than performance. It gets brutal a lot of times with blood gushing out of fighters heads and eyes swelling up”. At least 22 fighters have died as they fought in the cage! As with many boxers, MMA participants are now being found to frequently develop symptoms of chronic brain damage.

As is true for brain injury and cognitive decline from any cause, the suffering associated with the injuries described here extends to family and friends and consumes health care dollars we would rather spend on prevention.

Any serious attempt to minimise let alone eradicate these risks will no doubt generate disparaging comments about “Nanny States” interfering with personal liberties etc, etc. Yes, you can fall of a bike, be hit in the head by a golf ball or have a heart attack while running a marathon but none of these activities have ‘in-built’ risks for serious injury because of the very nature of the activity.

We are living in an age where we can quantitate risk and scientifically establish causal links to brain damage as discussed herein. I believe this ability and the knowledge provided, creates a moral imperative to focus determinedly on ‘Prevention’ rather than the management of ‘Consequences”. This basic principle should dominate all our health system programs for a lack of emphasis and infrastructure to champion prevention in our health care system is its greatest weakness.

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