DOCTOR JAMES ROBSON has welcomed the publication of a medical article which indicates that former international rugby players face a significantly increased risk of neurodegenerative diseases compared to the general population – but Scottish Rugby’s Chief Medical Officer has warned that the small sample size and scope of the study means that the alarming headline figures need further investigation.
The study, which was led by the University of Glasgow and published on Tuesday night, compared health outcomes among 412 male former Scottish international players against 1,236 matched individuals from the general population.
The research showed that the increased risk for the former international rugby players ranged from around a doubling of risk of a dementia diagnosis to an over 10-fold increased risk for motor neurone disease diagnosis.
“On the face of it, it is concerning,” acknowledged Robson. “But that concern has to be taken with the view that it is a relatively small study of a small population. So, there are various things that may lead into that and what we need is outside expertise to come in and take that information about increased risk and tell us what the next questions are.”
Robson also welcomed the news that MND Scotland plan to convene an expert group, in light of the study’s results, to provide advice to Scottish Rugby on how screening could be developed and built into health checks for current and former players.
“The offer of being able to speak to some of these eminent people which will inform what we do as a union and as a sport is really welcome,” he said. “I will work with anybody, and it would be particularly good if we could get an international expert panel because this may not just be pertinent to Scotland.
“We need to find out if this is a cluster of some sort, a statistical anomaly, but you’ve to take it on face value because that way everybody treats it with the utmost seriousness.
“We know that the cause of motor neurone disease is multifactorial. It is a complex mixture of environmental factors, but the study wasn’t set up to actually show cause and effect. It is largely a study to show health outcomes, and what they are doing is interrogating health records and death certificates of ex-players, so at some point somebody must have had the diagnosis, or been prescribed a drug, or attended a clinic, which has led to a label. But it does require more urgent research into that.
“There are so many unknowns and that’s part of the reason why nobody knows what the cause is and hence nobody has managed, apart from in a very small number, to devise drugs to help treat this hideous condition,” he added.
“What it does is stimulate more discussion, and it gives us a chance to reach out to other people, or other people reach out to us in the research sphere. I have been overwhelmed by the number people who have offered help on the back of this, in terms of Motor Neurone Disease Scotland, Brain Health Scotland, all of these bodies are willing to help us make our game safer.”
Doctor Jane Haley, Director of Research at MND Scotland, shared Doctor Robson’s cautious approach to interpreting the findings of the report.
“While the initial results do seem concerning, the study is based on a small sample size which means that, because MND is a relatively uncommon condition, larger studies will be needed to determine whether this result can be confirmed more widely,” she said.
“A connection between elite level sports and MND has been proposed before, but this is the first time an increased risk has been indicated for rugby players.”
Meanwhile, Professor Willie Stewart, lead author of the paper, expressed his frustration at rugby’s slow response to the risks associated with brain injuries when he spoke to the press on Tuesday.
“Rugby has talked a lot about head injury management [but] I think those conversations have gone on a while and progress is pretty slow,” he said. “I think this should be a stimulus for them to pick up their heels and start making pretty dramatic changes as quickly as possible to try to reduce risk.
In response, Robson highlighted some of the work which has gone into researching this issue and reducing risk.
“We’ve been doing work for years. We don’t stand still. For example, we launched the brain health clinic in April, so that our men and women ex-internationals can have their brain health examined using the best knowledge we have at the moment, and a plan to mitigate risk going forward can be formulated,” he explained
“In March, World Rugby announced five massive pieces of research looking at injury rates, concussion rates and preventative strategies. That kind of press doesn’t get the traction that this kind of headline gets, and yet it is all integrated and it is all about what are we doing to make this game safer.
“We’ve had the evolution at elite level of pitch-side care, namely HIA [Head Injury Assessment], and we’ve all evolved pitch-side care courses that the general public can tap into.
“Over the years, training sessions have got much shorter. There was an immense piece of work out by World Rugby three and a bit years ago, before the last World Cup, about contact work and how to monitor it, and how to modify it.”
“We’re now at the stage of: how do we measure these things? And with that in mind we’ve got a great partnership with Hit IQ, the major manufacturer of mouthguard technology [which provides real-time and comprehensive head impact data] and we also use video analysis to delineate what we’re doing in the training week.
“But remember, in order to put people safely on the park on a Saturday there is a certain amount of conditioning you need to do,” he added. “Largely, that can be done in pre-season, and once you get into the season you can adjust the amount of contact you are doing in the training week.
“So, we’re always looking for angles to improve and some of it is technology and some of it just old fashioned and saying: ‘I think we’ve done enough’.
“Medicine is a mixture of science and art. For example, a player can pass the head injury assessment and the clinician can say: ‘I’m not putting you back on because I think that you have been concussed’.
“Sometimes that’s what happens in our camp. Sometimes I will sidle up to Gregor Townsend or [defence coach] Steve Tandy and say: ‘I think we’ve done enough today’.”