Just How Dangerous Is Football? A new study suggests that the brutal hits NFL players take may be linked to a much higher risk of cognitive impairment. While the study focused only on dementia-related illness, the various bodily injuries football players suffer in the game can have lasting effects.
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Just How Dangerous Is Football?

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Just How Dangerous Is Football?

Just How Dangerous Is Football?

Just How Dangerous Is Football?

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A new study suggests that the brutal hits NFL players take may be linked to a much higher risk of cognitive impairment. While the study focused only on dementia-related illness, the various bodily injuries football players suffer in the game can have lasting effects.

Jon Hamilton, science correspondent for NPR
Christopher Nowinski, author of Head Games


This is TALK OF THE NATION. I'm Neal Conan, in Washington.

Yesterday, the New York Times reported on a study that found that former professional football players run a higher risk of Alzheimer's or dementia-related illness. The study was commissioned by the National Football League and surveyed more than a thousand retired players. The NFL itself and others raised questions about the way the study was conducted. More on that in just a minute.

But its conclusion seems to make sense. Head injuries are all too common at all levels of football. Tim Tebow, the Heisman Award-winning quarterback with the Florida Gators is currently trying to recover from a concussion he suffered on a devastating sack that sent him to the hospital last Saturday night.

Head and spinal injuries, of course, are the most serious, but knees and shoulders and hips and all the other joints can cause problems later in life, too.

Later in the hour, actress Juliette Lewis on her new roller derby epic, "Whip It" But first, how dangerous is football? If you've been in the game as a player, a coach, a trainer or as a doctor, what effect do you see? And how does the culture of the game play into this? Tell us your story. Our phone number is 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

And we begin with NPR science correspondent Jon Hamilton, who joins us here in the studio. Nice to have you with us today.


CONAN: And explain this NFL study. What did it tell us, and what did we learn that's new?

HAMILTON: Well, it's the kind of study that has a lot of limitations. It's not that the study was done badly, but it was a telephone survey. They called up 1,000-plus people and , you know, who had been NFL players, and they said how are you doing? I know they asked them about prostate disease, lots of things. And one of the questions had to do with dementia.

Now, the problem with a study like that is that it's not really how you'd want to diagnose something like dementia or Alzheimer's.

CONAN: It's all self-reporting.

HAMILTON: It's all self-reported. And so maybe a doctor has examined them and told them yes, you have this, or maybe they're just saying yeah, I think I do. But that's a major shortcoming of the study.

Other problems with this study are that even though they called up a thousand people, you're still dealing with pretty small numbers of people with these conditions, you know, maybe a few dozen who were reporting dementia. So it's hard to say, you know, what percentage of all these players might have the problem. And then, of course, this is a study that has not been published anywhere, and it has not been peer-reviewed.

CONAN: And there is also a question: Do concussions or even repeated concussions cause dementia? Do we know that?

HAMILTON: I think that among neuroscientists and neurosurgeons, people who treat head injuries, there is no question that people who have repeated head injuries, repeated trauma to the head, their brains pay a price for that. And so I don't think any neuroscientist would question that the conclusions of this are probably correct, even if the study wasn't such a great study.

CONAN: Mm-hmm. So again, the conclusions seem to make sense, even if the methodology might be improved.

HAMILTON: Absolutely.

CONAN: All right. So how dangerous is football? What do we know about it?

HAMILTON: Well, there have been a number of studies that have tried to look at that question. They come up with very different results. In this case, you know, they found that at one age group, that you might be six times more likely, and at an earlier age group, I think it was 19 times more likely. I would take those numbers with a grain of salt.

Other studies have shown everything from it might be twice as likely to figures more in this range. But they all seem to conclude that you're at a much greater risk of developing these type of mental problems later in life. And we should say that this is something that often will take 20, 30, 40 years. But in somebody who - in an age group where a small group of people ordinarily would have it, say in their 60s or 70s, if you look at people who have had repeated head injuries - and this includes football players and boxers who even have more head trauma - you'll see much, much elevated rates.

CONAN: And quickly, people - helmets, don't the helmets protect you for this?

HAMILTON: Well, helmets protect you, in a way. They spread out the force of a collision, so you don't have skull fractures and those kinds of things. But, you know, think about your skull, and your brain as like a raw egg, okay? You've got a hard shell on the outside. You've got a soft, sort of liquidy gel on the inside. And you can take an egg and shake it and cause huge acceleration and deceleration forces without ever breaking the shell. And what the - you know, what a helmet does is keep you from breaking the shell, but it doesn't keep all that stuff inside, the sort of gel that is your brain, from having huge forces exerted and turning and twisting inside there.

CONAN: And again, as we mentioned, obviously, head and spinal injuries -neck injuries in particular - are the most serious, and we've all read the stories of the couple of players who've broken their necks in the game and been paralyzed and their difficult returns to any form of mobility at all.

HAMILTON: These are the things you don't recover from.

CONAN: Yeah. Then there are the injuries to joints: shoulders, knees, hips, fingers, wrists, ankles.

HAMILTON: There is a huge literature on problems of osteoarthritis especially, which is sort of a catch-all phrase for when your joints hurt and not caused by, you know, your immune system attacking your joints, but rather by repeated injuries to joints. And football players, along with a lot of other athletes, have these and, as I think you mentioned, it goes all the way from the top to the bottom of your body. It's everything from your shoulders, the hips, the knees, the ankles. These are all places where you have people who retire from professional football, and they report being in a lot of pain. When you do surveys, they report a lot more pain than other people.

CONAN: And it's interesting. The game is described not as a contact sport, but as a collision sport.

HAMILTON: I think anybody who's ever watched the game would have to agree with that description.

CONAN: Let's get some callers on the line: 800-989-8255. Email us: talk@npr.org. We want to hear from people in the game, as a player, as a coach, as a trainer, as a doctor. What do you experience in your life? What's your story?

Let's start with Mark, and Mark's with us from Chico in California.

MARK (Caller): Yeah, I played football for a major university, and I've had, as a result of that - this was a number of years ago. I have two artificial knees and two artificial shoulders. And I just wore the joints out from repeated dislocations and injuries to them, just completely wore those four joints out. So now I've got metal and plastic in both shoulders and both knees.

CONAN: And as good as those things are, they're not as good as the originals.

MARK: No, they're not. I wish that I could go back, and they're not as good as the original at all, and especially these shoulders. They're very delicate, and, you know, there's so much rotation and everything that you have to gain back. It's extremely limiting in what you can do. So it's a sport, they said, an experience that would last me a lifetime. Unfortunately, I wasn't aware of how they meant it.

CONAN: How long after you stopped playing did these problems become so bad you needed surgery?

MARK: Well, while I was playing in college, I had four or five knee operations, and just through the immediacy of getting me back out on the field, maybe, oh, four to six weeks after having knee surgery, you'd be back out playing. And you know, you would take the pain medication and the shots they would give you. But in my late 30s and early 40s, I recognized I was having problems. And now in my early 60s, 63, I've got those four joints completely replaced, and they're still painful. So it doesn't alleviate the limitation or the pain. It's just - it makes it able to get up and do things during the day.

CONAN: Jon Hamilton?

HAMILTON: Yeah, I'd be curious to know. You talk about going back so quickly. And did you find that that was sort of culture of the game, was that you get back in regardless of the injury, whether it's a head injury or a knee injury?

MARK: Yes, it was. It was - you'd be brought in, and you would be told that, you know, this amount of money was laid out for you for a scholarship, and your scholarship was guaranteed and that, you know, you have people that are counting on you and people that have financed you. And you know, you get money that's given to you off the record. And, you know, you have a sponsor. And, you know, there's a lot of pressure of feeling that you're letting people down, and, you know, you forego your own health and welfare. I did.

CONAN: And I have to ask: Was this long enough ago that the knee surgery you had was arthroscopic, where they just make a little hole, or was this the big cut?

MARK: They opened the whole thing up. When I had the surgeries back in the early '70s and early '80s, it was - they opened up the whole knee. And even when they replaced my second knee just six months ago, they had to open up the whole thing from subsequent damage that was done to the joints in the back. So they had to open up the whole thing.

CONAN: So you have a couple of wonderful zippers there.

MARK: Yes, I do.

CONAN: All right. Mark, thanks very much, and good luck to you.

MARK: Yeah, thank you.

CONAN: Bye-bye. Let's see if we can go next to Matea(ph) - I hope I'm pronouncing that correctly - in Sacramento.

MATEA (Caller): Yes, from Sacramento.

CONAN: Go ahead, please.

MATEA: I volunteer full-time at the Hyperbaric Clinic of Sacramento, and recently, we've been getting a lot of, you know, we got a Kings player in and we actually got a WEC fighter. A lot of what he's doing is he's trying to use hyperbaric medicine to recover - to basically, you know, push the oxygen past the scar tissue, which wouldn't be able to be done on Earth's plane right now. But what he does is he goes into a chamber that pushes the oxygen past damaged tissue, and basically it's a timing thing because he wants to, you know, repair his injury twice as fast. But also he's focusing on the scar tissue in the middle that needs, you know, oxygen desperately so that the scar tissue doesn't form around that and to prevent, you know, to prevent what they call being punch drunk, to prevent that.

CONAN: So a hyperbaric chamber, briefly, is higher pressure and more dense amounts of oxygen so that it can presumably promote healing?

MATEA: Yeah, promote healing in the brain and promote healing in tissue. Like, for instance, it was Uriah(ph). His hand was broken, and he basically wanted to revive the hand and recover the hand faster than, you know, he could normally do. So basically, he just went into the chamber and recovered his hand.


HAMILTON: I have also heard something about hyperbaric chambers in use for recovery, but just to be clear, I think most of this is we're talking about short-term recovery. This is not going to help people who have had repeated head injuries and are now in their 40s, 50s and 60s.

MATEA: Well, actually, the studies, the first studies were done on boxers, and it's actually to prevent head injuries for later. For - it's basically to get to the scar tissue that normally, the tissue that wouldn't get any oxygen or any treatment, and…

CONAN: Well, I have to say, Matea, we're not - those studies may exist. I haven't seen them, and I don't think Jon has seen them. So…

MATEA: There's a new one done by the MIND Institute recently.

CONAN: All right, well, we'll take a look at it. Thank you very much for the phone call.

MATEA: Thank you so much.

CONAN: We appreciate it. We're talking today about the game of football and asking: How dangerous is it? NPR science correspondent Jon Hamilton is with us. Up next, Christopher Nowinski joins us, a former college defensive lineman who suffered serious head injuries.

So players, coaches, trainers, what effects do you see? Give us a call: 800-989-8255. Email us: talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. On Monday, the Big 10 Conference suspended Ohio State safety Kurt Coleman for one game after a head-to-head collision against Illinois. College football is trying to crack down on the brain-rattling, helmet-to-helmet hits with worries about concussions and, of course, other injuries. The head is hardly the only concern.

We're talking about the game of football. How dangerous is it? If you've been in the game as a player, coach, trainer or as a doctor, what effect do you see, and how does the culture of the game play into this? Our phone number: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

And Jon Hamilton, science correspondent, is with us here in Studio 3A. And joining us now is Christopher Nowinski. He started at defensive tackle for Harvard and suffered a series of concussions. He wrote the book "Head Games: Football's Concussion Crisis." He's now co-director at the Center for the Study of Traumatic…

(Soundbite of laughter)

CONAN: Well, Christopher, can you pronounce that for me?

Mr. CHRISTOPHER NOWINSKI (Co-Director, Center for the Study of Traumatic Encephalopathy; Author): Encephalopathy.

CONAN: Thank you, easy for you to say - at Boston University School of Medicine, and joins us today from our member station in Boston, WBUR. Nice to have you with us with us today.

(Soundbite of laughter)

Mr. NOWINSKI: Thanks for having me today.

CONAN: So when was the first time you were injured?

Mr. NOWINSKI: Well, geez, overall?

(Soundbite of laughter)

CONAN: Well, at least your head.

Mr. NOWINSKI: My head, you know, I remember having a couple concussions playing at Harvard. They were never diagnosed. So, for example, we were - an inter-squad game, I was a blocker in the wedge, but we had a short kick. I catch the kick-off, I run full speed ahead. I was never allowed to touch the ball, so I didn't know how to run. I put my head down, went head to head with a big hitter we had and didn't remember falling down, didn't remember really going to the sideline. I did remember that the sky was orange, which was a first, because it was blue, I think, before the hit.

CONAN: Probably was.

Mr. NOWINSKI: Probably was, yeah. And - but it was the kind of thing that I just, you know, took a knee for a few plays and was back in playing. And, you know, it was never diagnosed, and it was no big deal.

CONAN: Was that, oh, he just got his bell rung?

Mr. NOWINSKI: No one even noticed. I didn't say anything. You know, I got up slowly from the hit, but, you know, it's not the kind of thing that, you know, there's no one out there policing you when you get up a few steps slower. And no one's asking any questions when you go to the sideline in most cases. So it was never really - it was really not recognized. I didn't realize I had - that was a concussion until, you know, four or five years later, when I was a pro wrestler with WWE, and I kept blacking out and getting other, more severe concussions and then put the puzzle together.


HAMILTON: Yeah, Chris, did anybody at that time even tell you how to recognize a concussion?

Mr. NOWINSKI: No. I mean, you know, the Harvard staff is great, but we did not have, like, a preseason speech about if you get hit in the head and you experience these symptoms, you need to say something.

HAMILTON: I mean, there's no shortage of doctors in that area who could have provided that information.

Mr. NOWINSKI: Yeah, no, I mean, it's funny. I mean, it's just something that's done across the country, whether high school, college, and it's something we really push for with our work now. Because you do the studies, and they find that kids do not know what a concussion is, and therefore, they can't report it when they get those symptoms.

CONAN: And the culture of the game that we've been talking about earlier, your team needs you, you've got to get back in there - that discourages kids from reporting, sometimes, to the trainer or to the coach: I think I have a problem.

Mr. NOWINSKI: I think you're right. I mean, that culture of the game, I'm feeling it right now. I feel like I shouldn't be bad-mouthing football. I'm picturing my old teammates out there going oh, he's just soft. But, you know, I've played through - I remember playing a game with a broken hand that I broke in the first quarter, and I told my - this is high school. I told my coaches, like in the third quarter when I realized I couldn't use it anymore, I said I think my hand's broken. But I was the captain of the team, and they said okay, keep playing.

And so you apply that mentality from regular injuries to your head, and that's - you know, I think that's one of the major reasons why kids are also playing through their concussions. They think that it's just like a sprained ankle rather than it can cause you sudden death if you get more hits to the head.

CONAN: Let's get some more callers on the line. And we'll go next to Tom, and Tom's with us from Iowa City.

TOM (Caller): Hi, Neal. Thanks for taking my call.

CONAN: Sure.

TOM: Kind of a different tact, I guess. I played high school football and junior high football, so a total of, I guess, six years, and never really received any sort of major injury - you know, pulled muscles and that sort of thing. But I played soccer for many years, and I broke my leg in a soccer game. I got multiple concussions in soccer games. I blew my knee out skiing. I separated my shoulder riding a mountain bike down a hill.

So it seems like all the other sports were the ones that were to my detriment, and in football, I was safer. Just interesting. I just want to see what your folks have to say about that.

CONAN: Jon Hamilton?

HAMILTON: Yeah, I'd be curious to know what position you played on the football field.

TOM: I was a defensive end, for the most part. You know, I was tackling and blocking a lot, so I was getting there.

CONAN: I wonder, for Christopher Nowinski, defensive ends, as far as I understand, except when you're in the wedge, like you are in a kick-off play, in the line, there's a lot of grappling, a lot of knee injuries, maybe some shoulders, not so many head injuries.

Mr. NOWINSKI: That's not exactly true. You know, at our brain bank at the Center for the Study of Traumatic Encephalopathy at BU, most of the cases we have are linemen, because we forget - we see these big hits that a guy like Tim Tebow got at Florida or a wide receiver gets in the open field, but we forget that linemen coming off the ball get hit in the head actually three or four more times per game, about 40 or 50 times a game, with an average of about 30 Gs. That's from some studies done at Oklahoma and some other places. So you do get repetitive, low-level - and I use "low-level" in quotes - but low-level hits to your head constantly.

CONAN: Tom, was that your experience?

TOM: You know, I don't - yeah, there's definitely a lot of hitting going on. I think, you know, there's obviously a lot more padding and helmet and that sort of thing when you play football versus going downhill skiing or playing soccer.

So yeah, there's definitely a lot of hitting, but I don't - maybe I did, but I don't remember any concussions or any major injuries while I was playing football. They seemed to happen when I was doing other stuff, other silly stuff as a kid.

CONAN: Well, yeah, other silly stuff as a kid. I guess maybe football can be dangerous. Being a kid can be dangerous, sometimes, too.

TOM: Absolutely.

CONAN: Tom, thanks very much for the call, and good luck from recovering from all those injuries.

Here's an email we have from Jim: I went to a scrimmage once as a resident physician. A player got clobbered. When I tried to evaluate him, his coach shoved me aside, and I never worked as a team physician again. It's too dangerous.

And I wonder, Chris Nowinski. What's your experience with team physicians?

Mr. NOWINSKI: Well, my experience has always been great. I mean, I have to say, you know, in high school and both at Harvard, they really care about you. But, you know, the stories I hear from a lot of NFL players that are involved in our studies are pretty horrendous in terms of, you know, coaches trying to push them back into games and not giving them, you know, time to be evaluated or the full knowledge of their injury so they can go back in there.

I mean, there is that undercurrent of coaches doing the wrong thing. And most of them do the right thing, but some really don't care about your health and more care about wins and losses and their salary.

CONAN: Do you think it helps when there's a, you know, a renowned case like we saw with Tim Tebow, and anybody who follows football saw that hit on TV. And now we're watching his coach and the doctors evaluate him and see if he's getting ready to go. His team, I think, has a by-week this week. They're not playing. So they're seeing if he can be ready to play a big game against LSU next weekend.

Mr. NOWINSKI: Yeah, it's great for raising awareness, and actually, you know, it's funny this happened the way it did. Three years ago, Chris Leak, who was their quarterback back then, had a concussion in a game. I wrote an article about it for SI.com because Chris Leak got blasted in the middle of a game, ended up - was clearly dazed, went - you know, started playing terribly, started having to call time outs for no reason because he couldn't remember the plays, yet they never took him out. Or they took him out and they evaluated him and they gave him Tylenol on the sidelines for the headache he had, and they let him keep playing. This was only three years ago.

And he came out of the game and told the media I was dinged up out there, which means he had a concussion. And then Urban Meyer freaked out and said no, no, he didn't have a concussion. You know, he's fine. It wasn't our fault. We did everything right. And I think he's learned his lesson, and now he's saying mostly the right things. He's not saying everything right, but it's a big change from three years ago.


HAMILTON: I think a lot of people are watching the Tim Tebow case because they're looking to see whether he is going to be put back in for that next big game. And a lot of the, you know, neurosurgeons of people who treat these injuries think that two weeks is not a lot of time to recover from a head injury like this and that, in fact, if you're knocked out, it might be wise to be out for a number of months.

CONAN: Let's get Mara(ph) on the line. Mara's calling from Boulder in California.

MARA (Caller): Hi. I'm just calling to say that I was a former sports journalist, and I grew up around football, my brother being a pre-collegiate player who was pretty highly ranked, spent many days in the hospital. And my father, who was on practice teams, has now had his ankles replaced, knees and all that. And so I'm actually encouraging my boys to do other sports, a little safer sports like fencing.

CONAN: You wouldn't think playing with swords would be safer, but of course, their tips are rounded. And how are they responding, Mara?

MARA: You know, they're fine with it. We've talked about my brother compound-fracturing his arm. One of our good family friends is a trainer for an NFL team. They get to hear the stories of what really goes on, and they're pretty fine with it.

They are being told ahead of time, though, that, you know, these former NFL players are having autopsies done. Their brains are literally shredded, and they definitely don't want to be going that direction. So simply talking to them, and they're still pretty young at this point, is helping to discourage them from going into that sport.

But it's tough for me because I grew up in a world where if you didn't play football or if you weren't great at sports, you really didn't have a whole lot going for you.

CONAN: Christopher Nowinski, I wonder, I don't know whether you have children, but if you have a son, would you encourage him to play football?

Mr. NOWINSKI: You know, I don't have children right now. So I'm very happy I don't have to make that decision anytime soon. You know, really - we are really pushing to reform the game so that it is safe to play again. I mean, we have to remember that the game has involved incredibly over 100 years. And at various times, it's been a lot more dangerous. They nearly banned it in 1905 because so many people were dying. And I think it's another time to reform it. I mean, if it was the game today, if I had to choose today, I would say - I'm going to push him towards basketball.

CONAN: Mara, thanks very much, and good luck.

MARA: Thank you.

CONAN: Bye-bye. Here's an email from Terry(ph). It's very cultural. If there weren't crashes, no one would watch NASCAR. Even as a former high school ATC, there was a pressure to overlook symptoms and get the athlete back into the game, whether it was football or not. But all sports have risks.

And Jon Hamilton, as we heard from our friend the soccer player-skier who had a fine time in football and injuries in others sports, there is risk, whatever you do.

HAMILTON: Indeed. I mean, there's a huge sports literature - medical literature on sports about injuries in various sports. And, certainly, when you look at knee injuries, soccer is way up there. And there are lots of risks in other things. If you ever go to an orthopedic surgeon, I mean, you'll hear him and talk about ballet dancers. You'll hear about some major orthopedic problems.

CONAN: But Christopher Nowinski, making the game safer, how do you do that?

Mr. NOWINSKI: Well, you - it's a multi-strategy issue. I mean, we really push for education. So the concussions that do happen actually do get diagnosed and managed properly so that you have actual less brain damage, hopefully.

CONAN: And we've heard about people establishing a baseline so that they can then do another test later to see if there's been damage.

Mr. NOWINSKI: Absolutely. And you mentioned the penalty, the one-game suspension for helmet-to-helmet hits. That's a big deal. And that needs to be even more enforced, because those helmet-to-helmet hits are very dangerous. Then when you move away from the head and you're talking about the rest of the body, I mean, what we're doing to ourselves by getting, you know, guys over 300 pounds when they're 16, 17 years old and that way for a long time. I mean, I remember when I was in college and I got up to about 290 and had to go to on high blood pressure medication for the rest of my college career. And it was very strange to be young and healthy and on that. And so, you know, cardiovascularly, there's an issue there, as well. So, you know, that - we might have to have smaller people somehow. Weight limits? Who knows?

CONAN: Here's an email we have from John in Overland, Texas. Being a former high school and college football player, I can attribute many of my physical health problems from the game. Multiple concussions, broken bones and both knees completely reconstructed have set me up with problems now and a very pain-filled future. Too much emphasis is put on sports, this game in particular, but not enough information is given to participants about the possible damage that it could be done to their bodies and minds. Oh, yeah. Did I mention I'm only 27 years old?

We're asking how dangerous is football? Our guests: Jon Hamilton, NPR science correspondent, and Christopher Nowinski, author of "Head Games: Football's Concussion Crisis" and co-director at the Center for the Study of Traumatic Encephalopathy - I'm going to get that right someday - at Boston University's School of Medicine.

You're listening to TALK OF THE NATION from NPR News.

And let's go next to Evan, Evan calling from St. Louis.

EVAN (Caller): Yes, hello. Specifically, I grew up in St. Louis playing soccer, so this is not specifically a, you know, a football question. But as a coach - now I coach in St. Louis and I coach elementary-age soccer players. And it's not uncommon to have a collision on the field. If it does involve somebody bumping heads, as a coach, what can I do to assess the situation? Is it just a bump, or is it - how do I know if we're talking about potentially a concussion? What's the proper thing for a coach to do…

CONAN: Christopher?

EVAN: …taking care of his players from the sideline?

CONAN: Christopher Nowinski?

Mr. NOWINSKI: That's a great question. It would help if you trained your kids in a pre-season to understand what the symptoms of a concussion are so they can tell you. Because if you're - you know, with our coaches education that we do at the Sports Legacy Institute, we're really training coaches not to diagnose concussions but to be able to recognize them and get them to a medical professional. So the idea is if you suspect there's a concussion, if they're acting any differently, if they're - if they complain of headaches or dizziness or confusion or they seem unsteady or they have that dazed look in their eye, you get them off the field.

And the latest guidelines - which were just updated in Zurich in 2008 -is they don't return back to the same game. And then you shouldn't be sending them back until they are signed off by a medical professional, whether it's a doctor or an athletic trainer.

CONAN: So, err on the other side of the caution, in another words.

Mr. NOWINSKI: Always err on the other side of the caution. And make you're educated on what the signs and symptoms are so you can recognize them.

CONAN: Evan…

EVAN: I can take you one step further, then. I mean, at that point, should I be saying, okay. You know, Steve, he was, you know, bumped on the - just to make an example - and then I take him to parents and I'd say, it looks to me like - I'm guessing, but potentially this could be something more than just a bump. You need to take him to the hospital or something. Is that - I mean, I want to follow through. I just don't want to - I want to be more proactive than just deciding that he doesn't play in the next game. Do you know what I mean? I…

Mr. NOWINSKI: Right. That's a great question.

EVAN: …want proper (unintelligible). So what should happen?

Mr. NOWINSKI: So, if you - if it's an emergency situation, so there are certain standards - and you can get them on the CDC's Heads Up Web site, which I recommend everyone going to who's involved in sports, and distributing their materials. But there's a list of things to look for, to send them to emergency room, whether it's being knocked unconscious, whether it's vomiting, whether it's symptoms getting worse overtime. There's many. And that's the emergency room situation. You should definitely be involved in that personally. If it's not…

EVAN: So that's what we're talking about, some pretty specific symptoms. It's - this isn't something that's really elusive to diagnose.

Mr. NOWINSKI: You know, it would depend on - I mean - I have to -remember that I'm not a doctor, so I'm just passing along the information that I - am shared by my doctors. But regarding the standard return-to-play, if it's not an emergency room situation, you really do have to be dependent on the parents to go to the doctor, and then you have to hope that the doctor's well-trained. One of the big problems with this issue is that not every doctor is up to speed on the latest guidelines because they've change so much recently.


Mr. NOWINSKI: So there's - no. I'll stop.

HAMILTON: Just one thing I would add to that is that one of the things that's tough about concussions is that you cannot just do a CT scan or an MRI scan and see it the way you can with bleeding in the brain or some other conditions. So you need somebody who is trained to look for the symptoms of it, and that's how it's diagnosed, not by some magical test.

CONAN: Evan, thanks very much for the call.

EVAN: Thank you.

CONAN: All right. Bye-bye and good luck. And we have this email from Danielle in Moses Lake, Washington. Don't forget the fatalities: Spokane Valley Christian High School just lost a player last weekend, Andrew Swank, 17. He was hit hard on the field and died later in the hospital. A terrible tragedy.

And, well, Christopher Nowinski, she's right. We can't forget that there are people who die in these situations from time to time.

Mr. NOWINSKI: No. I mean, it's a terrible tragedy to have. You know, it seems like a few kids every year just from head injuries are dying, playing high school football. And many of other die from heart ailments and other issues, overheating now. And so we do have to remember them. I actually spoke with some of the staff at that school in Spokane. And, you know, there - you know, the place is just - it's terrible. It's sad. Everybody's worried, could I have done something differently?

CONAN: Mm-hmm.

Mr. NOWINSKI: And, you know, in some cases, unfortunately, you can't. I mean, actually, there's a kid in my high school. My coach's son died from second impact syndrome. He - Kurt Thyreen. He was - he got a concussion on a Friday night game. Nobody knew. Actually, his teammates knew. So he was in the band, blowing the trumpet. He couldn't blow the trumpet in band class all week, but no one told the doctors, so they let him play the next week. And he died on the field.

CONAN: Chris Nowinski is the author of "Head Games: Football's Concussion Crisis," co-director at the Center for the Study of Traumatic Encephalopathy - I think I got it right…

Mr. NOWINSKI: You got it.

CONAN: …at Boston University - see, I can learn - at the School of Medicine. He joined us from member station WBUR in Boston. Thanks very much for your time today.

Mr. NOWINSKI: Thank you.

CONAN: And Jon Hamilton, we'll let you get back to the science desk. Appreciate your time.


CONAN: Coming up: Juliette Lewis.


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