After years of allowing players to return to the field after concussions, the US National Football League announced recently that it would impose strict rules on concussion management. The new rules require players with significant signs of concussion to leave a game or practice for the whole day. The New York Times says that former professional football players are said to be suffering from dementia and other memory-related diseases at several times the rate in the national population. However, players will often hide their symptoms because they want to continue playing. Concussion is quite easy to hide, because there may be few externally recognisable symptoms. The league formerly allowed players to return after symptoms had subsided. However, the reappearance of symptoms hours or days later shows that players often do not have time to properly heal from the initial blow.

Medical experts have called for a change of culture. Young players are particularly at risk of injury as governing bodies at high school and college levels do not have concussion management rules. The NFL’s acceptance of responsibility for player’s health and safety could change players’ mentality in high school and college competitions.

Bioethicists have waded into the debate and have compared the situation of serious athletes to desperate patients participating in a clinical trial. Both will agree to almost anything to get what they want. Furthermore, there is ample scope for conflict of interest. Gay Culverhouse, a former president of the Tampa Bay Buccaneers, told a Congressional committe in October: “ the team doctor is hired by the coach and paid by the front office. This team doctor is not an advocate for the players. That doctor’s role is to get those players back on the field…If a player chooses independent medical counsel he is considered not a ‘team player.’ He becomes a pariah.”

John Papas, a football coach at Buckingham Browne & Nichols School in Cambridge, Mass., said that announcers’ and NFL players’ statements on the issue will not go unnoticed by high school and college players. “High-school-age players look up to the NFL players — they all want to be tough guys,” Papas said last week. “The message the NFL is sending now is the right message: If you think you suffered a concussion, there’s no way you’re going to get better without resting.” ~ New York Times Dec 2, Dec ; Bioethics Forum, Nov 5