I'll try to be as concrete as possible.
From a policy perspective, what's in Rowan's Law is very similar to what is in the laws that exist in every state in the U.S. If you're going to play sports, everybody needs to be educated on concussions. That means we require it for coaches, and we require it in many states for the athletes. In some places, we even require it for parents, because parents don't realize that the average concussion isn't going to be diagnosed at practice. Those symptoms may show up when the person gets home that night. If they don't know what to look for, they won't piece it together. Mandating education through sports organizations, I think, is absolutely appropriate to do.
In the U.S., in most states, we mandate that you have to be cleared by a medical professional to return to sports after a concussion. I've heard about the backups for going to doctors as a reason why people don't get medical clearance. Finding a way to fix that issue, whether you need more trained doctors, or whatever.... It's absolutely appropriate to say that you have to be treated by a medical professional and cleared before you can return to sports, because returning to sports too soon is often how lives get derailed.
On the research side, it's hard to mandate specific things, but certainly convening a group to potentially put together a research road map and investing that time in getting scientists together to say where the gaps are and how we close them....
I mention that second just because, when I look at this issue as a public health problem, it's going to take decades to develop treatments for this or new ways to diagnose it using biomarkers on the sideline. That's an investment of time and effort, but right now we can draw a line in the sand and stop a whole lot of these problems on the prevention side, whether it's preventing the impacts in the first place, preventing mismanaged concussions or preventing a child from hiding a concussion, because we educate them better.
In terms of changing the culture, I would add that, if you're going to do education for athletes, it can't just be asking athletes to self-report, because asking a 10-year-old to diagnose their own brain injury in the moment they have a brain injury is an insane plan.
One program we've put together, which we do up here as well, is called Team Up Speak Up, where the primary message we give to children is not that you need to look out for yourself—that's the message they have already received—but looking out for your teammates. Your teammate is probably not going to know they're concussed, so if you see something, it's your responsibility to speak up to a coach or to a parent and say, “I'm worried about them; check them out.”
Prevention-wise, I think looking into the idea that there should be minimum ages before it's open season on a child's head in sports is important. Again, I look at that like lead exposure. We have five-year-old kids in America, again, 40-pound kids putting on a four-pound helmet and running into each other, and we know they're getting hit in the head hundreds of times. We also know that, at the NFL level, we have guys walking away from the sport and turning down millions of dollars because they don't want to take that risk. The idea that we put kids at this risk when they don't understand what the long-term effects could be, because they're not old enough to understand what the long-term effects could be.... We usually don't assume they can predict this until they're 18.
When Eric mentioned checking at 15, to me that's an obvious one. When we brought checking down to young ages, we weren't thinking about the brain; we were thinking about preparing them for the money down the road. From a public health strategy, it's absurd that we encourage kids to run into each other.
Does anyone here play in any adult sports leagues? Are there any ice hockey players? Do any of the men here play in checking ice hockey leagues as adults? Of course not. We would never do that to ourselves. We're too smart for that. You know you need your brain down the road, so the idea that we'd put 13-year-olds in that situation without giving them an option to not check is cruel, I think.