Evidence of meeting #5 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was going.
A video is available from Parliament.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
We're moving over to the Conservatives, with Mr. Nuttall.
Barrie—Springwater—Oro-Medonte, CPC
Thank you, Mr. Chair. If you will just indulge me a quick moment here, I know that Mr. Lindros has a time schedule here.
Just before you have to go, is there anything we did not ask you that you would like to communicate to this table, so that we can include it in the report?
As an Individual
I think we covered the spectrum.
I was just thinking about the question to Chris in terms of media. If we had a plan, the media would love to cover this. The media has been going after this and they've tried to tackle it in many ways, but there hasn't been change. Why write stories about something when nothing is happening and they're getting away with it? If we had momentum and we got things going, they would be right back on board, and this could be a whole lot stronger than just talk. It's kind of my last thought with that.
Thank you very much for having me. I have a flight to get back home, but I really appreciate being here. It's an honour.
Good luck with everything, and if you need some help down the road, give me a shout.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you, Mr. Lindros.
Mr. Nuttall, you can continue.
Barrie—Springwater—Oro-Medonte, CPC
Thank you, sir.
Chris, thank you for making the trek here.
It was interesting.... I was just reading part of your bio, which has some awesome photos, by the way. I was a huge WWE fan growing up, so it's very cool. There are some pretty big cases where concussions have had incredibly terrible outcomes. You started to talk about that a little bit, and it kind of feels as if you don't want to go into individual cases and you want to stay in terms of the data.
Chief Executive Officer, Concussion Legacy Foundation
No, I'll go wherever you want to go.
Barrie—Springwater—Oro-Medonte, CPC
Okay. There was a Maple Leaf named Wade Belak. I'm not sure....
Barrie—Springwater—Oro-Medonte, CPC
I understood there was a scan done after his death. There was depression leading up to when, obviously, he took his own life. I guess my question is.... And there's another one that I'm going to put into the same question for you. I read on CNN—I can't remember how long ago it was—regarding Mr. Hernandez as well. I had a conversation this morning after caucus with a colleague of mine. We were talking about this committee tonight, and he said that he had read the same article about Mr. Hernandez's brain and the results there afterwards, and obviously the terrible things that happened surrounding him.
Can you give us some comments on the connection between the injury, the concussions, and wide-ranging mental health issues—not yours personally, because I'm going to ask you about that next—that you're seeing through the data you have?
Chief Executive Officer, Concussion Legacy Foundation
I've been so lucky to co-author some articles on this in terms of psychiatric symptoms. There's no question that concussions, especially when you're young, increase your risk of psychiatric issues later on, mental health issues. Suicide is a very complex act, but the literature is pretty clear in countries with socialized medicine. One big study and review of studies out of Canada recently showed that even with just one concussion, you have twice the risk of suicide, potentially for the rest of your life.
The two operating theories on that are, one, that it changes the way your brain functions, and two, that it impairs your life. It impairs your ability to work, your ability to do things you love, your ability to have relationships. That is a clear association in the data. The reality is that when we look at some of these stories, we're trying to piece together what's happening, trying to build a dataset from it. The issue of concussions leading to a larger risk of psychiatric symptoms, or a larger risk of suicide, is in the data.
Barrie—Springwater—Oro-Medonte, CPC
You say that professional sports are not doing a good job. We saw what I'll comment on as a ridiculously low-result lawsuit between the NHL and players here in Canada. The professional sports aren't doing a great job at dealing with this. Have you seen an increase in the support in terms of what you refer to as psychiatric help—I'll say mental health support—and professionals being deployed in circumstances surrounding concussion, or not really?
Chief Executive Officer, Concussion Legacy Foundation
I know it's being discussed a little bit more, and certainly the leading researchers on it are aware of this, but it's not a common conversation. I'll give you an example. We have a brain in our brain bank of a young man named Austin Trenum, who had a concussion on a Friday night. He didn't quite get great guidelines on how to spend his Saturday and had a stressful Saturday. He went out with friends to a concert, this and that, and on Sunday he took his life. We looked at his brain and we didn't, of course, see CTE, but we did see white matter changes. His suicide was preceded by an argument with his parents about doing his homework, and he went upstairs and took his life.
I'm sure there was no conversation about potential psychiatric symptoms, potential abnormal behaviours, potential emotional behaviours, with his parents when they left the emergency room. Preparing parents for their children not being themselves for the next few days is an important conversation to have, or at least we need to research whether that advice would lead to better outcomes.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
We're moving over now to the NDP, with Ms. Hardcastle.
Windsor—Tecumseh, NDP
I just wanted to ask a bit more, Chris, about the Concussion Legacy Foundation. You started with soccer and football, with a prevention program. What was your rationale? You must have had some data or evidence that told you.... Why did you start there? Maybe you can fill us in.
Chief Executive Officer, Concussion Legacy Foundation
Certainly. The effort to ban heading in soccer before a certain age.... Right now we're talking about banning all purposeful, repetitive hits to children's heads before age 14. That's a goal that we haven't reached. With soccer, it was based on studies. There's one important study showing that about one third of concussions that were happening to middle school soccer players were due to the act of heading, kids trying to put their head in the same space and competing for a ball. So we said, well, this is a skill they don't need to have when they're young. They can pick up heading when they're older.
First, we said, let's cut one third of concussions out of middle school soccer. Second, we found our first case of CTE in an American soccer player. He was a young man who died in his late twenties of Lou Gehrig's disease, ALS, which we have now found is linked in some way to CTE. We used that case to say, look, they don't need to have this exposure to repetitive head hits. Try this when you get home: Find a kid who has never played soccer; throw a ball at their head and they'll usually duck. That's because they're smarter than we are, and we're the ones who tell them to stick their forehead in the way and hit it back to us. It's not a natural thing.
That was the idea. We were led by a bunch of great American soccer players like Brandi Chastain and Taylor Twellman. We were actually able to get this through.
With football, we actually have much stronger data now, with hundreds of cases of CTE in football players that.... The old way of doing things is wrong, and it's been destroying lives. The best solution we have is reducing the exposure of children to hits to the head.
One interesting thing about the history of American football is that youth tackle football wasn't a thing until maybe the 1960s and 1970s. We're now seeing some of those athletes get older, and what we're finding very clearly in our data is that those who started younger have worse outcomes. So, if they play 20 or 30 years of football, and they're basically destined to have CTE, why don't we cut out those first few years? Tackle is not a skill.... Football is a unique situation. Having played it, I know it's not a skill-based sport. It's about being an athlete; they don't need to start banging their heads.
When they're young, based on the research we've seen, we're actually recommending that parents choose flag football: cut out those 300, 400 or 500 hits to their kid's head every fall, but still let them learn the rules of football and have fun. Then, when they're older, their brains are more mature. They've gone through puberty and they can build their upper body strength. They can be at a high school level that has trained coaches and athletic trainers, and then maybe it's okay to play. But before that, it's not.
To get into the big picture discussion we're having in the U.S.—and you may have watched this on HBO Real Sports last week—part of the issue is that the NFL is underwriting this game in our country to the tune of over $200 million invested in youth tackle football in this century. It's partially driven by the fact that their data shows that if they play youth tackle football while young, they're more likely to become a fan later on. It's driven by a financial decision. Even if you talk to leaders in football, pro coaches, college coaches, ex-players, you hear them say that kids should not be playing this. You can't take a 40-pound kid and put a four-pound helmet on their head and ask them to run into each other and expect good outcomes.
Windsor—Tecumseh, NDP
Can you share with us a little more about what you assume is common knowledge now about concussion? We do get some briefing notes before witnesses come. When you were saying, in passing, that you're trying to prevent this because you know they shouldn't have contact under the age of 14, I didn't know that. You heard Eric talk a bit about promotion and education.
I guess what I'm asking you is not necessarily whether we should be educating, but what you think are the big, undisputable findings now about the developing brain—the top three. I don't know if there are three; there might be a dozen. But it sounds like we can hit the ground running with education, with really solid evidence, and I'd like to hear a bit more of that.
Chief Executive Officer, Concussion Legacy Foundation
Sure. If you want to talk about things we all agree on that are actionable—and some of this is built on some of the laws we have in the States—we all agree where a concussion occurs. Your brain changes function. There are 40 symptoms you could have, but you need only one to assume a concussion. We know that the person should rest and be gradually returned to sports in their life. That's agreed upon, but not always done.
We agree upon the fact that we don't diagnose most concussions, and this is a critical point where we have an opportunity. Athletes are still hiding most concussions, if they're old enough to understand that they have a concussion. If they're young, they don't understand that they have a concussion and they're not going to tell you. You'd have to be a doctor to recognize a concussion in a seven-year-old by examining their behaviour, because a seven-year-old's behaviour is all over the place.
We know that concussions are an important enemy, but there's something called a subconcussive impact. Imagine that it took a 100G hit in the head for me to have double vision for 10 minutes, and I also got hit in the head a bunch of times at 99Gs. Even though I didn't feel anything because it was below the threshold of causing double vision, it was still potentially damaging my brain microscopically, and those add up over time.
Therefore, it's very clear that it's not just a concussion issue, but the more hits to the head and the harder they are, the worse off you are, even if you don't have symptoms.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
We'll move on to Madame Fortier, from the Liberals.
Ottawa—Vanier, Lib.
Thank you, Mr. Chair.
Mr. Nowinski, thank you very much for being here with us today.
Since you do research, I'd like to know whether you also study the brains of young female athletes, or whether your subjects are mostly males.
Chief Executive Officer, Concussion Legacy Foundation
That's a great question.
We work very hard to recruit female brains to the brain bank, but of 700 brains, I believe the number of female brains is just over 10. Part of that is because our brain bank is heavily football-related, a sport that very few women play, but the other reason is that, in America, we didn't allow women to play contact sports until Title IX. It wasn't equal opportunity; therefore, we don't have a lot of older female athletes.
We're very aggressively trying to raise awareness that we need female brains because we need to understand those differences. There's no question that we expect to find CTE in former female soccer players, ice hockey players, and players of other sports.