Sir, – As an inspiration to graduating young doctors, Dr Bennet Omalu was an apt choice to have delivered the keynote speech on the eve of the graduation ceremony for the medical school class of 2017 ("How head injuries will end sport as we know it", June 3rd). His struggle, persistence and willingness to put his reputation on the line in order to overcome the scepticism and occasional hostility from the authorities involved in American football are admirable characteristics to which all young doctors should aspire.
Like Dr Omalu, we too have been involved in the care and investigation of head injuries, in our case for the best part of 40 years, and have had to witness deaths from head injury in all sports including hurling, Gaelic football, horse racing, showjumping, cycling, motor racing, etc. Risk is a key feature of all contact sports, with few, if any, free from the risk of death through head injury. The continuing efforts by physicians, therapists, administrators and researchers go a long way to reducing the risk of fatal head injury and are a key factor in ensuring the continued popularity of all contact sports.
That repetitive mild brain injury in the form of repeated concussions leads to a progressive degenerative brain disease has been suspected since the 1920s and was expertly documented in British boxers as far back as the early 1970s. Since then, the list of sports known to be associated with risk of developing this progressive dementing disorder has lengthened and includes professional American football, as shown by Dr Omalu in a number of important case reports. One of us was involved in the recognition of the condition in an Irish rugby player, the first occasion on which the condition was documented in a rugby union player.
Important as these contributions may be to the scientific literature, they are simply case reports or series of case reports. The key questions as to the number and severity of concussions required in players in order to bring about this dementing disorder in later years, and in how many players, are exceedingly complex. Many years of careful study involving large groups of sportsmen and sportswomen participating in contact sports coupled with sophisticated genetic, neuropsychological and brain imaging studies will be required to answer these questions and will cost millions of euro.
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To suggest that the brain does not have any reasonable capacity to regenerate itself is an affront to those of us who have witnessed remarkable recoveries among survivors of stroke and head injury and who have seen at first hand the incredible abilities of all those involved in the care of the brain injured to maximise brain recovery which continues for years after the initial injury.
At the end of our long careers, in which we have witnessed spectacular advances in stroke and head injury that have brought about massive improvements in outcome, we prefer to be optimistic about the brain’s ability to recover. We recognise the great efforts by many to make all sports safer in order that they may be enjoyed for maximum benefit of participants of all ages and for spectators. – Yours, etc,
MICHAEL FARRELL,
Neuropathologist,
JACK PHILLIPS,
Neurosurgeon,
Beaumont Hospital,
Dublin 9.