On a rare break from his sabbatical from football, Matt Chaney added his incredible historical insight and commented on Bob Costa’s stance on youth football:
Great comments and position by Bob Costas, regarding juveniles and brain risk and outcome of tackle football. America’s child protection structure is faulty, even ridiculous without the prohibition of collision football, at least in the public sector. The institutions of medicine, education and law have head in sand–for at least 110 years, since JAMA editors declared ‘that football is no game for boys to play,’ backed by a significant group of medical professionals, football insiders, educators and more authorities of the period [see 1907 JAMA below/attached].1907.12.21 JAMA editorial ‘FB Mortality Among Boys’
The Council on Sports Medicine and Fitness policy statement, Tackling and Youth Football, assures that many young athletes will suffer debilitating brain injuries.1 As the Council acknowledges, little is known about tackling per se, so that a statement limited to tackling is misleading about the risks of football where the risk of concussion is greater than for any other sport.2 Further, football participation dwarfs other sports, so this one sport contributes 60% or more of sport-related concussions in high school.3 Dompier et al. estimate that 99,000 youth players experience at least one concussion annually.4 These facts alone should raise questions about our culture’s willingness to tolerate, not to mention encourage, this cause of harm. Add to this the acknowledgement by experts that we are as yet ignorant of the long-term consequences of concussions. Meehan notes that “medicine has not figured out how many concussions is too many. And in fact, it is likely no such number exists.”5(p.125)
The evidence supporting the effectiveness of the recommendations is meager. Indeed, there are over 40 uses of terms like “unclear,” “unknown,” “limited,” and “without scientific basis” in the statement, which, while adequately reflecting the state of an uncertain literature, do not support evidence-based recommendations.
It is important for pediatricians to empower parents and their young potential football players. Advising parents to “decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling”1(p.e1426) undermines the concept of empowerment, because of the absence of information. If parents wanted to make an evidence-based choice, to whom would they turn other than pediatricians? And yet, the Council advises that “participants in football must decide whether the potential risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.”1(p.e1426)
Perhaps the millions of dollars being devoted to the diagnosis, acute treatment, and long-term management of concussions will help us answer questions like “can we end tackling?” and “can we make tackling safer?” Until those questions are answered through rigorous research, pediatricians should advance primum non nocere, first do no harm, by advocating for the end of youth football.
1. COUNCIL ON SPORTS MEDICINE AND FITNESS. Tackling in youth football. Pediatrics. 2015;136(5):e1419-30. doi: 10.1542/peds.2015-3282 [doi].
2. Institute of Medicine (IOM) and National Research Council (NRC). Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press; 2013.
3. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42(4):495-503.
4. Dompier TP, Kerr ZY, Marshall SW, et al. Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatr. 2015;169:659-665.
5. Meehan WP. Kids, sports, and concussions. Santa Barbara, CA: Praeger; 2011.