Conflicts of Interest in Recommendations to Use Computerized Neuropsychological Tests to Manage Concussion in Professional Football Codes
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Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways.
KeywordsConcussion Sport Conflict of interest Chronic traumatic encephalopathy Neuropsychological test ImPACT CogState NFL AFL NRL
Thanks to Mal Parker, Eric Racine, Julia Hocking, and Adrian Carter for their comments on an earlier version of this work. This work was supported by an NHMRC Postdoctoral Fellowship.
- 4.McKee, A., T.D. Stein, C. Nowinski, R.A. Stern, D.H. Daneshvar, V.E. Alvarez, et al. 2012. The spectrum of disease in chronic traumatic encephalopathy. Brain. doi: 10.1093/brain/aws307.
- 8.Kaye, A.H., and P. McCrory. 2012. Does football cause brain damage? Medical Journal of Australia 196(9): 547–49.Google Scholar
- 16.Davis, M., and A. Stark (eds.). 2001. Conflict of interest in the professions. New York: Oxford.Google Scholar
- 17.Brody, H. 2011. Clarifying conflict of interest. American Journal of Bioethics 11(1): 23–28.Google Scholar
- 18.Institute of Medicine. 2009. Conflict of interest in medical research, education and practice. The National Academies Press. Washington D.C.Google Scholar
- 23.McCrory, P., K. Johnston, W. Meeuwisse, M. Aubry, R. Cantu, J. Dvorak, et al. 2005. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine 39(4): 196–204.Google Scholar
- 26.ImPACT. 2012. Available from: http://www.impacttest.com/
- 27.CogState. 2012. Available from: http://www.cogstate.com/
- 28.Axon Sports. 2012. Available from: http://www.axonsports.com/.
- 29.Concussion Vital Signs. 2012. Available from: http://concussionvitalsigns.com/
- 30.Headminder. 2012. Available from: http://www.headminder.com/site/cri/home.html
- 31.CogState. 2011. Investor Presentation. Available from: http://library.cogstate.com/public/asxrels/Investor_Presentation.pdf
- 38.Buchan, H.A., K.C. Currie, E.J. Lourey, and G.R. Duggan. 2010. Australian clinical practice guidelines—a national study. Medical Journal of Australia 192(9): 490–94.Google Scholar
- 45.Broglio, S.P., M.S. Ferrara, S.N. Macciocchi, T.A. Baumgartner, and R. Elliott. 2007. Test-retest reliability of computerized concussion assessment programs. J Athl Train. 42(4): 509–14.Google Scholar
- 46.Randolph, C., M. McCrea, W.B. Barr, and S.N. Macciocchi. 2005. Is neuropsychological testing useful in the management of sport-related concussion? Journal of Athletic Training 40(3): 139–52.Google Scholar
- 50.CogState. 2011. CogState launches Axon Sports concussion product. Available from: http://library.cogstate.com/public/asxrels/Axon_Launch_Aug_2010.pdf
- 51.CogState. 2011. CogState Acquires 100 % Holding of Axon Sports. Available from: http://library.cogstate.com/public/asxrels/Cogstate_Acquires_100pc_Holding_Axon_Sports.pdf
- 52.Axon. 2010. Dr. Paul McCrory, Neurologist & Sports Physician, Joins Axon Sports. Available from: http://ebookbrowse.com/gdoc.php?id=94945627&url=e237300217da2534b43c4f0b4edb603c
- 54.Moriarity JM, Pietrzak RH, Kutcher JS, Clausen MH, McAward K, Darby DG. 2012. Unrecognised ringside concussive injury in amateur boxers. British Journal of Sports Medicine 46(14): 1011–5.Google Scholar
- 55.AFL. 2011. Responsible approach to concussion in the AFL. Available from: http://www.aflcommunityclub.com.au/fileadmin/user_upload/Coach_AFL/Injury_Management/ResponsibleApproachConcussionintheAFL.pdf
- 56.AFL. 2011. The Management of Concussion in Australian Football. http://www.aflcommunityclub.com.au/fileadmin/user_upload/Manage_Your_Club/3._Club_Management_Program/9._Football_Operations/Trainers/Injury_Management/Management_of_Concussion/Concussion_Man_v7.pdf
- 57.CogState. 2011. NRL Mandates Use of CogState Sport For Concussion Management. Available from: http://library.cogstate.com/public/asxrels/2011_04_01_NRL_CogState_Mandate.pdf
- 58.NRL. 2012. NRL Mailbox: Concussion. Avaiable from: http://www.nrl.com/nrl-mailbox-concussions/tabid/10874/newsid/67441/default.aspx
- 59.CogState. 2011. Toyota Announces Sponsorship of Axon Sports Roll-Out in Australia. Avaiable from: http://library.cogstate.com/public/asxrels/Toyota_Sponsers_Axon.pdf
- 60.Prichard G. 2012. League and American football not concussion cousins, says medic. http://www.smh.com.au/rugby-league/league-news/league-and-american-football-not-concussion-cousins-says-medic-20120516-1yrbp.html: Sydney Morning Herald.
- 61.Lane S. 2012. US concussion study may not apply to AFL: doctor: Sydney Morning Herald. http://www.smh.com.au/afl/afl-news/footballs-medical-fraternity-split-on-stricter-concussion-guidelines-20110322-1c57y.html