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A new consensus? A change of air as the concussion conference begins | Concussion in sports


What you may not know is that the sixth International Consensus Conference on Concussion in Sports is taking place this week in Amsterdam. You may never even have heard of the Concussion in Sport Group that organizes it, but if you play rugby, football, hockey or any other contact sport or sport, the decisions made there will affect you.

The work of the conference is to analyze the latest research on concussions, traumatic brain injuries and the short- and long-term effects of head impacts in sports, and then develop a consensus statement on the best ways to diagnose and treat them.

It doesn’t matter if you’re playing in the Premier League or the Sunday League, the consensus document sets out the treatment you’ll receive if you’re head-butted during the game. The CISG is one small group among a large international community of doctors, scientists and researchers working in this field. The latest consensus was signed by 36 people, but the group is backed by the IOC, FIFA and World Rugby, among other sporting bodies, meaning it has enormous powers and influence.

Their last conference was held in 2016, and the latest consensus was published the following year. They are supposed to take place every four years, but this one has been postponed twice due to the pandemic, meaning the current guidelines are six years old. It is not clear why the organizers thought it would be better to wait two years to hold an in-person world conference rather than an online or hybrid conference, but given everything else that has happened since then, this is the least of the questions facing the CISG at this point. .

Chairman Dr Paul McCrory resigned in March after it was discovered he had plagiarized an article he wrote for the British Journal of Sports Medicine. McCrory said it was an editing error, but after further investigation, the British Medical Journal retracted nine more of his articles, and 74 more added expressions of concern. “Scientific reporting is based on trust,” the BMJ said, “and the BMJ’s trust in McCrory’s work — particularly the articles he published as sole author — has been violated.”

McCrory was a founding member of the CISG, an influential member of its committees, and the lead author of several iterations of the consensus statement.

The BMJ reviewed the latest consensus statement and, although they concluded that there was no plagiarism, they noted that “the question of the extent of McCrory’s contribution to and influence on the five versions of the consensus statement is a matter for the scientific committee appointed by the CISG.” Which was an eloquent way of saying “to you”.

The problem isn’t just that McCrory’s own research has been discredited. As an influential member of the CISG scientific committee, he assessed the credibility and quality of the research of all others. Consensus statements, for example, have consistently questioned the association between head impacts and the neurodegenerative disease CTE. The current one states that “a causal relationship has not yet been demonstrated between CTE and sports-related concussions or contact sports,” a line that sports governing bodies have repeatedly quoted in defending themselves against calls for reform.

A decision on whether the new consensus should recognize clear and significant evidence of a causal link between CTE and repeated head impacts will be one of the key decisions made at the conference.

Confidence in the consensus process was already low, especially among players suffering from the injuries it was trying to address. There were concerns about a lack of transparency about potential conflicts of interest selection methods used to determine who sits on committees and criteria used to evaluate research. FIFA, the IOC and World Rugby have all committed to McCrory’s resignation revision of the consensus process.

Eight months on, FIFA says “positive steps have been taken in relation to the international concussion conference. This includes a revised governance model, confirmation of the CISG’s independence and changes to the Scientific Committee’s leadership team.”

These “changes in leadership” refer to the inclusion of Professor Robert Cantu, Medical Director of the Cantu Concussion Center, and independent medical ethicist Professor Mike McNamee. Other than that, there aren’t many details about what’s new. One spokesperson said efforts were being made to include “more critical voices” in the room, although the critical voice they mentioned, Dr. Ann McKee, director of Boston University’s CTE Center, told the Guardian she had chosen not to attend. Others will be there after paying 500 euros.

These include Dr. Judith Gates and Dr. Sally Tucker of the Repercussion Group. “I see the McCrory case as a stone in the pond,” Gates says. “This has sent ripples through the entire research network, spreading wherever his work has been referenced, cited or used to guide new research projects. The consequences are huge. That’s why this week’s conference is so important. As a community, we need to stand up and say, “This work is potentially contaminated, and we don’t yet know the extent of the contamination.” So how do we get it back to where we need to be?”

The Repercussion Group presented a white paper at the conference that suggests ways to do this. It requires clear, up-front disclosure of all potential conflicts of interest from CISC members and the inclusion of players, patients and healthcare professionals in the process.

“We think the consensus process needs to be more proactive and more player-centric,” says Gates. “We’re not mindlessly calling for change, we’re not playing the blame game, but we’re saying to the CISG: ‘These voices should be at your table.’

Essentially, the question in Amsterdam is whose consensus it is and whether it reflects the views of the CISG or the wider sports community that is influenced by it.


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