Skip to main content
SpringerLink
Log in

Conflicts of Interest in Recommendations to Use Computerized Neuropsychological Tests to Manage Concussion in Professional Football Codes

Neuroethics volume 7, pages 63–74 (2014)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Daneshvar, D.H., C.J. Nowinski, A.C. McKee, and R.C. Cantu. 2011. The epidemiology of sport-related concussion. Clinics in Sports Medicine 30(1): 1–17.

    Article  Google Scholar 

  2. Makdissi, M., P. McCrory, A. Ugoni, D. Darby, and P. Brukner. 2009. A prospective study of postconcussive outcomes after return to play in Australian football. The American Journal of Sports Medicine 37(5): 877–83.

    Article  Google Scholar 

  3. Hinton-Bayre, A.D., G. Geffen, and P. Friis. 2004. Presentation and mechanisms of concussion in professional Rugby League football. Journal of Science and Medicine in Sport 7(3): 400–04.

    Article  Google Scholar 

  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.

  5. McKee, A.C., R.C. Cantu, C.J. Nowinski, E.T. Hedley-Whyte, B.E. Gavett, A.E. Budson, et al. 2009. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neurology 68(7): 709–35.

    Article  Google Scholar 

  6. Omalu, B.I., R.L. Hamilton, M. Kamboh, S. DeKosky, and J. Bailes. 2010. Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. Journal of Forensic Nursing 6(1): 40–46.

    Article  Google Scholar 

  7. Guskiewicz, K.M., S.W. Marshall, J. Bailes, M. McCrea, H.P. Harding, A. Matthews, et al. 2007. Recurrent concussion and risk of depression in retired professional football players. Medicine and Science in Sports and Exercise 39(6): 903–09.

    Article  Google Scholar 

  8. Kaye, A.H., and P. McCrory. 2012. Does football cause brain damage? Medical Journal of Australia 196(9): 547–49.

    Google Scholar 

  9. Valerio, J., and J. Illes. 2012. Ethical implications of neuroimaging in sports concussion. Journal of Head Trauma Rehabilitation 27(3): 216–21.

    Article  Google Scholar 

  10. Gilbert, F., and L.S.M. Johnson. 2011. The impact of American tackle football-related concussion in youth athletes. AJOB Neuroscience 2(4): 48–59.

    Article  Google Scholar 

  11. Dunn, W.R., M.S. George, L. Churchill, and K.P. Spindler. 2007. Ethics in sports medicine. American Journal of Sports Medicine 35(5): 840–44.

    Article  Google Scholar 

  12. Anderson, L.C., and D.F. Gerrard. 2005. Ethical issues concerning New Zealand sports doctors. Journal of Medical Ethics 31(2): 88–92.

    Article  Google Scholar 

  13. Goldberg, D. 2008. Concussions, professional sports, and conflicts of interest: Why the National Football League’s current policies are bad for its (players’) health. HEC Forum 20(4): 337–55.

    Article  Google Scholar 

  14. Davis, M. 1982. Conflict of interest. Business & Professional Ethics Journal 1(4): 17–27.

    Article  Google Scholar 

  15. Davis, M. 1993. Conflict of interest revisited. Business & Professional Ethics Journal 12(4): 21–41.

    Article  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.

  19. Thompson, D.F. 1993. Understanding financial conflicts of interest. New England Journal of Medicine 329(8): 573–76.

    Article  Google Scholar 

  20. Lexchin, J., L.A. Bero, B. Djulbegovic, and O. Clark. 2003. Pharmaceutical industry sponsorship and research outcome and quality: Systematic review. BMJ (Clinical Research Ed.) 326(7400): 1167–70.

    Article  Google Scholar 

  21. Choudhry, N., H. Stelfox, and A. Detsky. 2002. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA: The Journal of the American Medical Association 287(5): 612–17.

    Article  Google Scholar 

  22. Aubry, M., R. Cantu, J. Dvorak, T. Graf-Baumann, K. Johnston, J. Kelly, et al. 2002. Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. British Journal of Sports Medicine 36(1): 6–7.

    Article  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 

  24. McCrory, P., W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, et al. 2009. Consensus statement on concussion in sport: The 3rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine 43(Suppl 1): i76–i84.

    Article  Google Scholar 

  25. Alla, S., S.J. Sullivan, P. McCrory, and L. Hale. 2011. Spreading the word on sports concussion: Citation analysis of summary and agreement, position and consensus statements on sports concussion. British Journal of Sports Medicine 45(2): 132–35.

    Article  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

  32. Grindel, S.H., M.R. Lovell, and M.W. Collins. 2001. The assessment of sport-related concussion: The evidence behind neuropsychological testing and management. Clinical Journal of Sport Medicine 11(3): 134–43.

    Article  Google Scholar 

  33. Collie, A., and P. Maruff. 2003. Computerised neuropsychological testing. British Journal of Sports Medicine 37(1): 2.

    Article  Google Scholar 

  34. Cantu, R.C. 2006. An overview of concussion consensus statements since 2000. Neurosurgical Focus 21(4): 1–6.

    Article  Google Scholar 

  35. Lovell, M.R., M.W. Collins, G.L. Iverson, M. Field, J.C. Maroon, R. Cantu, et al. 2003. Recovery from mild concussion in high school athletes. Journal of Neurosurgery 98(2): 296–301.

    Article  Google Scholar 

  36. Collins, M.W., S.H. Grindel, M.R. Lovell, D.E. Dede, D.J. Moser, B.R. Phalin, et al. 1999. Relationship between concussion and neuropsychological performance in college football players. Jama-Journal of the American Medical Association 282(10): 964–70.

    Article  Google Scholar 

  37. Kung, J., R.R. Miller, and P.A. Mackowiak. 2012. Failure of clinical practice guidelines to meet institute of medicine standards: Two more decades of little, if any, progress. Archives of Internal Medicine 172(21): 1628–33.

    Article  Google Scholar 

  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 

  39. Williams, M.J., D.A.S. Kevat, and B. Loff. 2011. Conflict of interest guidelines for clinical guidelines. Medical Journal of Australia 195(8): 442–45.

    Article  Google Scholar 

  40. Jureidini, J.N., C.J. Doecke, P.R. Mansfield, M.M. Haby, D.B. Menkes, and A.L. Tonkin. 2004. Efficacy and safety of antidepressants for children and adolescents. BMJ (Clinical Research Ed.) 328(7444): 879–83.

    Article  Google Scholar 

  41. Collie, A., D. Darby, and P. Maruff. 2001. Computerised cognitive assessment of athletes with sports related head injury. British Journal of Sports Medicine 35(5): 297–302.

    Article  Google Scholar 

  42. Collie, A., P. Maruff, M. McStephen, and D.G. Darby. 2003. Psychometric issues associated with computerised neuropsychological assessment of concussed athletes. British Journal of Sports Medicine 37(6): 556–59.

    Article  Google Scholar 

  43. Lovell, M.R. 2002. The relevance of neuropsychologic testing for sports-related head injuries. Current Sports Medicine Reports 1(1): 7–11.

    Article  Google Scholar 

  44. Lovell, M.R., and M.W. Collins. 1998. Neuropsychological assessment of the college football player. Journal of Head Trauma Rehabilitation 13(2): 9–26.

    Article  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 

  47. Randolph, C. 2011. Baseline neuropsychological testing in managing sport-related concussion: Does it modify risk? Current Sports Medicine Reports 10(1): 21–26.

    Article  Google Scholar 

  48. Gilbert, F., and B.J. Partridge. 2012. The need to tackle concussion in Australian football codes. Medical Journal of Australia 196(9): 561–63.

    Article  Google Scholar 

  49. Muratore, R. 2012. The need to tackle concussion in Australian football codes. Medical Journal of Australia 197(3): 146–46.

    Article  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

  53. McCrory, P. 2011. Future advances and areas of future focus in the treatment of sport-related concussion. Clinics in Sports Medicine 30(1): 201–208.

    Article  Google Scholar 

  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

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, 4029, Australia

    Bradley Partridge & Wayne Hall

Authors
  1. Bradley Partridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wayne Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradley Partridge.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Partridge, B., Hall, W. Conflicts of Interest in Recommendations to Use Computerized Neuropsychological Tests to Manage Concussion in Professional Football Codes. Neuroethics 7, 63–74 (2014). https://doi.org/10.1007/s12152-013-9182-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12152-013-9182-z

Keywords

search

Navigation