By Dr. Peter Cummings

My name is Peter Cummings. I am a forensic pathologist and a neuropathologist, which means I study brain trauma for a living. I am also a football coach and I let my 11-year-old son play football. I may be the only neuropathologist on Earth who lets his kid play football.

Coming to this decision was a serious undertaking and the result of many hours spent pouring over medical journals and football rulebooks.

Before I began this journey, football was banned in my house. I wouldn’t even watch it on TV because I didn’t want my son to see it and develop a desire to play. Despite my efforts, he discovered football via a video game. He immediately fell in love with the sport and I was forced to do some serious soul searching: Should I allow him to pursue his interest and play?

Honestly, I was scared of CTE.

CTE stands for “chronic traumatic encephalopathy”; in real words it means damage to the brain caused by repetitive injury. The hallmark of CTE is the deposition of a protein called ‘tau’ in the brain. Tau has a number of functions, including stabilizing the structure of nerve cells. When nerves are injured, tau builds up and can cause problems.

You may have a read about a recently published paper reporting the presence of CTE in the brains of 99 percent of former National Football League players examined. The findings of this study sent the media into a frenzy and produced a lot of negative press toward football. As a result of the media attention, people are now saying there should be no more youth football; there are even people who are insinuating I am abusing my son by allowing him to play football.

People are coming away from the constant media barrage with the belief that concussions are the sole and direct cause of CTE, most or all football players have CTE, and CTE has led football players to become violent, commit suicide or develop dementia.

I had the same impression before I decided to look a little deeper. But when I dove into the published literature regarding CTE, I discovered the scientific evidence to support the media’s narrative was lacking; in fact, I found bodies of evidence to the contrary and a whole other side to the science that is largely ignored.

I’m not alone. A number of members of the medical and research communities are also voicing serious doubts about the current state of the science linking concussion and CTE.

In fact, it’s not entirely clear if CTE is unique to traumatic brain injury. CTE-like pathology has also been seen in the brains of people who’ve died of epilepsy, without any history of head trauma. There are also cases of opioid overdose deaths where the brains show signs of early aging, including tau accumulation. This might suggest other mitigating factors make some people more prone to developing CTE than others.

Replication and independent verification are two crucial steps in the scientific process. Yet many findings associated with CTE haven’t passed these tests. Contrary to what appears in the headlines, multiple researchers have found no significant relationship between playing football and increased risk of violence, suicide and dementia in the general football playing population. In fact, studies have shown a lower rate of death due to violence and suicide in NFL players as compared to the general population.

None of these studies make headlines, let alone even footnotes in most media reports. So when headlines state “CTE found in 99% of brains from deceased NFL players,” it only fuels people’s fear of CTE. They are assuming, like I did at first, that 99 percent of football players will get CTE.

But one has to be careful about interpreting the headlines, and I will tell you why:

The study population in the most recent CTE paper represents a biased sample, as stated by the authors themselves. This means only the brains of self-selecting people who displayed neurological symptoms while living were studied. This is important because this sample was not a reflection of the general football population. The study was based on 202 brains out of the millions of people who’ve played football – 111 of which are former NFL players.

So, when you hear “99 percent of football players had CTE,” that doesn’t mean that almost every football player will get CTE, and it doesn’t mean your child has a 99-percent chance of developing CTE if he or she plays football. It means 99 percent of a specifically selected study sample had some degree of CTE; not 99 percent of the general football population. This is an important distinction.

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