When a 2008 paper proposed that athletes be kept out of play for four weeks following a concussion, three doctors wrote in to say that the recommendations were “irrelevant and ill advised.” One thing the trio failed to disclose, however, was their own financial ties to the National Football League.

With the release of the 2013 Frontline documentary “League of Denial: The NFL’s Concussion Crisis” and the publication of Concussion by journalist Jeanne-Marie Laskas, the evidence is growing that the NFL — with the help of doctors working as paid consultants or expert witnesses for the NFL or individual teams — has downplayed the potential of football to cause long-term brain injuries.

In a 2008, Lester Mayers of Pace University in Pleasantville, New York, published a review paper in Archives of Neurology (now JAMA Neurology), that summarized evidence from tests such as balance and gait testing, along with MRI and PET imaging studies. Mayers, who is now deceased, concluded in “Return-to-Play Criteria After Athletic Concussion: A Need for Revision” that it takes at least four weeks — rather than one or two — for the brain to heal following a concussion:

This idea is a significant departure from current practice and will probably provoke concern and resistance at all levels of sport. Nevertheless, given the prevalence of sports head injury and the numbers of young brains at risk, a postconcussion RTP [return-to-play] interval of at least 4 weeks is imperative. Future studies that use longer follow-up periods may conclude that even this time requires extension to permit complete healing.

In response, three doctors then-serving on the NFL’s committee on brain injuries — neurologist Ira R. Casson, rheumatologist Elliot Pellman, and biomechanics expert David Viano — wrote in to voice their criticism. Here’s an excerpt from “National Football League Experiences With Return to Play After Concussion:”

Dr Mayers’ assertion that team physicians are currently not using evidence-based medicine in making RTP decisions is incorrect and omits relevant, contemporary mild traumatic brain injury clinical data that have been published in a series of articles. The data from these studies suggest that within this specific patient population of professional football players with mild traumatic brain injury, there is a large subset that makes full and complete recovery within a short time and safely returns to play on the day of the injury or within a few days. . . We believe that Dr Mayers’ attempt to substitute basic science research, despite all of the limitations he states, for actual clinical data on concussed players is irrelevant and ill advised.

At the time of the 2009 letter, Casson and Viano were the current NFL committee co-chairs, and, according to the New York Times , Casson “has consulted for and taken occasional referrals from teams.” Pellman, the NFL’s paid medical director, had been the chair from 1994 to 2007 and was also the team doctor for the New York Jets. The only affiliation they list, however, was Viano’s consulting firm, ProBiomechanics LLC. Under the heading “Financial Disclosure,” the authors wrote:

None reported.

The only clue readers have to their affiliation is the authors’ reference to a series of NFL-financed papers by “team physicians,” on which they are listed as co-authors.

When Retraction Watch asked if JAMA Neurology planned to publish a correction, the journal’s editor-in-chief, Roger Rosenberg suggested that we write to the authors:

I’m not going to get into the middle of that one.

Viano, the corresponding author on both papers, has failed to respond to an email and phone message from Retraction Watch.

This isn’t the first time an author failed to reveal relevant ties to the NFL – earlier this year, PLOS ONE corrected a review article that suggested the degenerative brain disease striking football players may not stem from contact sports, noting that the first author had worked for the NFL for decades.

Hat tip: Steven Miles

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