August 11, 2023 – Headlines about the health of American football players have largely focused on the potential link between head injuries and neurodegenerative diseases—in particular, chronic traumatic encephalopathy (CTE), a serious disease with no cure that causes cognitive and mood problems. While CTE in football players is certainly an important issue, the attention on one specific disease may be hindering the treatment of other conditions, according to Marc Weisskopf, Cecil K. and Philip Drinker Professor of Environmental Epidemiology and Physiology at Harvard T.H. Chan School of Public Health.
“That’s not to say that CTE is not a problem, that we shouldn’t be working on it and trying to figure out what’s going on—but we absolutely shouldn’t let that detract from an understanding of all the other types of symptoms that these guys have in spades,” Weisskopf said at an August 8 “Hot Topics” seminar organized by the Office of Educational Programs. Weisskopf shared his research about head injuries in National Football League (NFL) players. He also highlighted the players’ risk of cardiovascular disease, as well as conditions other than CTE that can lead to cognitive issues.
In a 2019 study, Weisskopf and colleagues compared the health of NFL and Major League Baseball players, to examine the two groups’ different risks for problems such as head injuries. They found that the football players had a higher overall risk of early death than the baseball players. As expected, the football players had a higher rate of death due to neurodegenerative diseases, including amyotrophic lateral sclerosis and Parkinson’s disease. The football players also had a higher death rate from cardiovascular disease.
“There’s something about football that seems to make you more likely to have a neurodegenerative disease. But the elephant in the room is cardiovascular disease—there’s much more of that going on,” Weisskopf said.
Weisskopf is also one of the faculty involved in the Football Players Health Study at Harvard University. Started in 2014, it is the largest study of living former players in the NFL—to date, the study has included around 4,200 participants. One aspect of the study measured how many times participants experienced concussion symptoms while playing football over the course of their careers.
The results showed that the more concussion symptoms the players had, the more likely they were to experience cognitive impairment and mental health issues, specifically depression and anxiety. Concussion symptoms were also linked with a host of other conditions, including difficulties with sleeping and pain management.
Importantly, some of the players reported that they had either been diagnosed with CTE, or believed that they had CTE—but in fact, CTE can only be diagnosed after death, by examining brain tissue during autopsy. Weisskopf said that some doctors and players might be mistakenly interpreting cognitive problems as CTE.
“The problem is, how many of those cognitive problems they’re having are actually related to the fact that they’re not sleeping, or that they have pain management problems?” he said. “There’s all this other stuff that may not be treated, because all the focus is on CTE.”
Weisskopf said that football players might experience what is known as the nocebo effect, where being told that they have CTE leads to a worse outcome than would otherwise happen—because an incurable disease diagnosis may lead players to develop a fatalistic outlook. Such fatalism could possibly lead to players dying by suicide, Weisskopf speculated.
Weisskopf said that his findings shed light on the importance of considering the overall health of football players, since many of the conditions associated with head injuries are treatable. “We’re trying to look at whole player health to say, ‘What can we do?’” he said. “Yes, CTE is a problem, but let’s make sure we’re not just looking under one lamp post and don’t think about all the other things.”
– Jay Lau