Numlock Sunday: Christie Aschwanden on Concussion Snake Oil

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By Walt Hickey

Welcome to the Numlock Sunday edition. Each week, I'll sit down with an author or a writer, behind one of the stories covered in a previous weekday edition for a casual conversation about what they wrote.

This week, I spoke to Christie Aschwanden who wrote Football’s Concussion Crisis is Awash in Pseudoscience for Wired. Here's what I wrote about it:

Players and parents are aware of the risks posed by concussions, and are seeking out treatments and preventative technology to eliminate the risk of concussions on the football field. The issue is that the only way to eliminate the risk of concussions on the football field is to walk off of that field and into the stands, and so lots of what’s being hawked to parents and athletes is junk science and branding. Helmets — which are excellent at their original job of reducing skull fractures — can’t eliminate the risk. While they dissipate the force of an impact, they don’t eliminate it. One device, the “Q-Collar,” applies pressure to the jugular and asserts that the higher blood pressure in the skull serves as bubble wrap for the brain. Researchers have tried and failed to replicate the company’s study that backs that up, and the correlation may be spurious to begin with: using the same methodology as the paper, one researcher demonstrated concussion risk is 30 percent lower in teams with animal mascots rather than non-animal ones. 

I spoke to Christie earlier this year about her great new book, Good to Go: What the Athlete in All of Us Can Learn from the Strange Science of Recovery.

Christie can be found at her website, on Twitter, and at Wired. Her book is wonderful and available wherever books are sold. You should also check out her podcast, Emerging Form.

This interview has been condensed and edited.

Walt Hickey: You wrote a story in Wired about how there's a whole spate of new tech that people claim can help prevent concussions. But realistically there's a lot more snake oil going on than actual medical advances. What's going on?

Christie Aschwanden: The first thing to know is just that awareness of football's concussion problem is probably at an all time high at this point. We've had a major Hollywood movie, there have been multiple investigative journalism reports about this, we have players now retiring early because of worries about concussions. It's also not just about concussions. It's also about CTE. The greater scare is that players may be at very high risk of this thing called CTE, which is not actually that well-understood at this point. But one thing that is very clear is that it does seem to be related to these repetitive hits to the head.

If we lived in a different world, you would say, "well, hitting your head hurts your head, and maybe we shouldn't do that." But that's not the culture that we live in. We live in a culture where millions of people tune in every Sunday to see a bunch of men bash each other's heads in. And so as long as our society wants to do that, we're sort of stuck with this.

That's the background. What we have right now is this culture of fear — a legitimate fear, it's pretty clear that bashing your head is not good — but the central question for football right now is "is there a way to keep the game? Can we keep letting these guys bash each other every week without causing longterm damage to their brains?" That's an open question. Really we're faced with this physics problem: if your body is decelerating, and your brain is too, because your brain is part of your body, if an abrupt change of motion or an abrupt stop or an abrupt start or a twisting seems to be very poor for concussions — and there really isn't a good way to mitigate that.

I'll just give you an example, this is something that we face while in a motor vehicle. Imagine that your brain is your body sitting in the car. If you're in the car and it comes to a very abrupt stop, and all of a sudden you're being thrown through the windshield. The way that we have mitigated that with cars is that we have seatbelts. There's no way to put that seatbelt around your brain.

That has not stopped companies from making claims like that, but that's the basic physics problem. It's just sort of a fundamental problem. So there's a lot of fear, particularly among parents and young people and athletes, thinking should we even be allowing our kids to play football? You also have college administrators, coaches of high school and even coaches of younger kids, responsible adults who are in charge of keeping kids safe, among them there's all this fear of litigation, frankly.

This has created this enormous market for products that promise to mitigate and reduce the risk of concussions. There are ways to reduce the risk of concussion. The number one way is to not hit your head. If you want, you can put a helmet or some sort of padding around the brain; if you are hit in the head it can absorb some of the shock, and extend that moment of momentum change to lessen the impact, but you're not going to be able to eliminate it.

You wrote about how originally helmets were just to stop skull fractures and now people expect miracles from them but helmets can't do everything and at a certain point, we're hitting a limit with the tech. People seem to want a technological solution to what fundamentally seems like a game play problem.

I think you just hit the nail on the head. Technology is not going to solve football's concussion crisis. There’s just a physical limit to how much a helmet can do. That is not to say that there haven't been advances.

What I learned while reporting this story is that in some ways, the way that helmet technology has been driven thus far has made helmets bigger and heavier and more onerous. The way it's looking now, twisting and rotational movements seem to be particularly important for concussions and might increase longterm CTE risk. So when you have a heavier helmet, you basically create more momentum. It may provide more protection from fracturing your skull, but it may actually make the situation worse, thinking about these rotational forces. Because now you have this bigger thing on your head that's creating more momentum and more force as you’re getting yanked around. Bigger, better helmets may in fact be more dangerous in that respect. The idea that a helmet is going to solve concussions? I just think it’s a nonstarter.

It's just as much like a torque issue as it is an impact issue?

Exactly. They have done a lot of good and they do protect against fractures and contusions and things like that. But when it comes to the brain and it comes to concussions and CTE, there's an emerging consensus that one of the things that's really important for CTE is perpetual or repeated sub-concussive hits. You don't even need a concussion to potentially increase your risk of CTE. That's important to know too, it's not just a matter of getting rid of concussions. You have this problem: if you keep hitting your head, eventually you're going to have some consequences for that, you know? Is anyone that surprised?

In the piece we see your bete noir shows up yet again, Tom Brady. He has been tossing his name in the mix when it comes to some specious new tech?

He got a little slap from the FTC. He was endorsing this product, a supplement that was making all kinds of foolish claims about being able to protect against concussions, that just didn't pan out. They were asked to stop making those claims, and the product was taken off the market.

There are a lot of supplements making strong claims. The FTC is sort of on this, and so they've tried to go after companies that are making false claims. Because of that, now you have companies that are being very careful about their claims, kind of in the way that a lot of nutritional supplements do, where it's like, "we can't say this prevents heart attacks, we'll say it promotes heart health" and things like that.

This didn't make it into the story, but there's a supplement now that has a financial relationship with Pop Warner. The kids' football league has a sponsorship with the supplement called Brain Armor. Even just the names are very deceptive in terms of what they're implying. It would be great if you could take a pill that would prevent you from getting a concussion, I get it, but that's not how it works.

You wrote about a popular device, the Q-Collar, that says it aims to increase blood pressure to your head by depressing the jugular. It's really popular, and also probably junk.

It's so fascinating. I think in a lot of ways, this typifies what's going on here, which is that you have this claim that sounds very scientific and it's really enticing. It's a collar that basically goes around your jugular and pinches it off a little bit, you're basically decreasing the blood flow out of your brain and your head, which if you think about it, seems like it could be kind of dangerous. I haven’t seen a lot of evidence saying that it could be dangerous, and the company says that it’s safe. But you know, the idea is that you're going to increase the blood volume in the brain and that's going to help?

Their whole concept comes from the idea that woodpeckers are jamming their heads all the time. That's sort of what they do. They hit their head on trees and that's how they get their food. The idea is if woodpeckers can do this, how can we harness whatever it is that woodpeckers are doing to protect football players' brains? The idea that this company came up with is that it's because woodpeckers have this weird tongue that wraps around the skull and protects it and increases the volume of the skull.

It turns out that these claims that they're making are not actually a accurate representation of what woodpeckers do. In fact they have some really interesting physiological adaptations to be able to bang their head on trees! But this idea that it's increasing pressure in the brain is not borne out by the evidence. That's not what woodpecker physiologists will tell you is happening.

If you go back to the analogy I was using earlier, where you have the person in the car, it's almost "we're going to make the person in there bigger so there's less room for them to be thrown around." It's an interesting idea, but there's just no real evidence that that's actually what's happening. They made a claim that teams at some higher altitudes have lower concussion rates, and it turns out that wasn't really the case. One researcher that I talked to actually tried to replicate that study and couldn't.

The other thing that's interesting here is that Vernon Davis, an NFL player, who wears the Q Collar, has had two concussions while wearing it. You can see him wearing it on television. I actually asked the company about this and the guy said that the first wasn't a concussion, it was a neck injury. Meanwhile he was out on concussion protocol. I didn't dig too deep into that.

But you know if it is really effective, it hasn't worked for these two guys.

Is there any last thing that you wanted to get in and if not working folks find your work?

The thing that was the most fun to discover while working on the story is that there is a town in Canada called Moose Jaw and the high school there has now mandated that their high school players wear this Q-Collar, the woodpecker thing. It also appears, I was not able to confirm this, but it looks as though one of the coaches may have some sort of relationship to the company or something.

So I would just say that if you are a parent, be careful and ask a lot of questions. If someone's telling you something works, ask to see the evidence.

You can find my work at my website. Please go read my book! That will tell you all sorts of stuff about these kinds of things. I'm writing for the Washington Post a lot now, I'll be appearing there quite a bit, and I've got some other stories in the works for Wired.

Look for me there and listen to my podcast Emerging Form, new season is coming out in November.

Oh yeah how's the podcast going?

It has been great. It's been fantastic. We've have so much fun with that. We've been getting tons of great feedback and we've been doing some live events now with it that have been really great and we've gotten just fantastic response. We took a break in between seasons and the break ended up having to be a little bit longer, because we learned a lot this past season and we want to make it even bigger and better at this time.

The Podcaster's Dilemma.

Yeah, exactly. We have a Substack. We'll be starting to roll out more content on that at the end of the month.

If you have anything you’d like to see in this Sunday special, shoot me an email. Comment below! Thanks for reading, and thanks so much for supporting Numlock.

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