Orthopedics & Sports Medicine

August 15, 2018

NFL settlements raise new questions on head trauma and Parkinson’s and ALS

The National Football League, which long has resisted the growing reality that game-related head blows can cause major harms to its players, may be providing yet new and unintended warnings about the sustained damages of concussions.

The Los Angeles Times reported that pro football’s pay-outs, as part of its billion-dollar head-injuries settlement with NFL players and their union, have been surprisingly high in cases where retirees have claimed damages due to Parkinson’s and ALS.

Parkinson’s, the newspaper noted, is a “progressive movement disorder that produces tremors, impaired movement, and slurred speech.” It is “marked by the buildup of proteins called Lewy bodies in brain cells.” ALS, also known as amyotrophic lateral sclerosis or Lou Gehrig’s disease, is a condition affecting “nerve cells in the brain and spinal cord and ultimately results in a fatal inability to initiate and control muscle movement.”

August 6, 2018

As Big Pharma rivals battled to hype opioids, watchdogs dozed. They slumber still.

by Patrick A. Malone

When Big Pharma pursues rapacious profits and regulators snooze, patients suffer terrible consequences, as new revelations about the opioid crisis show.

Kaiser Health News Service , via the Washington Post, and The New York Times both have done excellent investigative digging into drug makers’ role in fueling the prescription painkiller mess that authorities estimate claims 116 lives a day due to overdoses.

Fred Schulte, writing for the independent, nonpartisan Kaiser service, reported that rival makers — seeing how much money Purdue Pharma was making with its powerful and addictive OxyContin drug and that it was encountering law enforcement and regulatory challenges — stepped in with “similarly dangerous painkillers, such as fentanyl, morphine and methadone.”

July 27, 2018

Wrestler scandal fuels rising concern on how schools, teams protect kids

by Patrick A. Malone

Soon, many young people will be back to school and signing up for sports teams. Many will have to undergo physical exams before they can play. And it’s a tragic reality that grown-ups may need to think a lot how to protect young people from sexual predators who also are doctors.

That’s because Ohio State University, sadly, has joined the University of Southern California, Michigan State-USA Gymnastics, and Penn State University in the notoriety of dealing with a sexual abuse scandal involving adults and students. In the case of the Buckeyes, it’s Big Ten male wrestlers.

OSU said it had hired an outside law firm to investigate the allegations against Richard Strauss, who had blue-chip credentials and served as the team doctor to university wrestlers roughly from 1979 to 1997. The doctor killed himself in 2005. Lawyers interviewed more than 200 one-time OSU students, with 100 of them accusing Strauss of sexual misconduct, “including former athletes from 14 different sports teams.”

July 6, 2018

NHL sells its players short by failing to acknowledge harms of head blows

by Patrick A. Malone

The 2018 Stanley Cup may rest for a bit as the pride and joy of enthusiasts in the nation’s capital and of its title-winning team. But as fans of the pro and amateur game look to the future, they may have reason to be downcast about hockey’s most important component: its players.

Author Ken Dryden (photo above, left) has important things to say about them, because he was a goaltender for the Montreal Canadiens and has been enshrined in the Hockey Hall of Fame. The onetime Canadian parliamentarian has pointed out that owners and bosses in the National Hockey League, as illustrated by videotapes of their sworn testimony in a long-running court case, are locking arms and taking a counter-factual position on the damages that players may suffer due to blows to the head they receive in games.

In “infuriating” fashion, NHL Commissioner Gary Bettman (photo above, right), Boston Bruins owner and chairman of the league’s Board of Governors Jeremy Jacobs, other team owners, senior league executives and doctors are playing ostriches, Dryden wrote in a recent Op-Ed in the Washington Post. They’re sticking their head in the sand, insisting that hockey has no issue at all with “chronic traumatic encephalopathy, or CTE. That’s a degenerative brain disease that has been found in athletes including professional hockey and football players, as well as soldiers and others who have suffered repeated brain injuries. Symptoms of CTE include cognitive impairment, depression, emotional instability and suicidal thoughts.”

May 27, 2018

Let’s bust this myth now: Don’t expect insurers to help cut medical bills

by Patrick A. Malone

Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy.

Marshall Allen, a reporter for the Pulitzer Prize-winning investigative site ProPublica, has just penned a strong myth-busting piece, cross-posted on the National Public Radio site, about health insurers, writing:

The United States spends more per person on health care than any other country does. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

May 23, 2018

Overrun by sports performance chatter? Can questions on MBI bust the bunk?

by Patrick A. Malone

If you can get your favorite sports fans peeled away from the latest broadcast pro event ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─ a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

February 11, 2018

Winter Games and Super Bowl offer health takeaways, too

by Patrick A. Malone

The Winter Olympic Games and the Super Bowl can offer fans not just exciting sports spectacles but also important health insights and information— everything from the risks of viruses and the value of hand washing to the dangers of head blows and why Americans may be slowly changing their minds about how they feel about violent recreations.

Let’s start with what can happen when you put more than 2,000 elite athletes from 92 nations in a village setting in Pyeongchang, South Korea. It’s no surprise that contagious illnesses can break out, and in this case the noxious norovirus. More than 100 cases of the highly infectious viral illness at the Olympic site have been confirmed already, and 1,200 people — many of them security guards for the Games — have been quarantined with disease symptoms. (The South Korean military has sent in forces to assist with security, in place of the quarantined guards).

Norovirus, aka the winter vomiting disease, is a gastrointestinal bug with other symptoms including diarrhea, nausea, and stomach pain, according to the according to the CDC. Its symptoms typically start 12 to 48 hours after patients come in contact with the virus. Symptoms might also include headache and body aches. Fever is uncommon. The sickness is highly contagious, spreading when viral particles get aerosolized over large areas. Hygiene becomes key in outbreaks, as public health experts have emphasized and global cruise lines have discovered.

February 2, 2018

Gymnastics scandal offers a tragic reminder of challenges in protecting kids

by Patrick A. Malone

His basic credentials would come under fire, but they were sufficient for the “doctor” to insinuate himself into major institutions, and, worse, into the lives of hundreds of girls and young women on whom he inflicted a tragic toll. His combination of enthusiasm — he was a rah-rah kind of guy— extreme controlling conduct, and horrific “treatments” never seemed to set off the red flags they should have.

Instead, Larry Nassar — an osteopath who served as an athletics and team caregiver for USA Gymnastics and Michigan State University — got away for years with abusing adolescent females put under his sway. He purportedly provided medical services to them, many in exclusive and demanding athletic camps where young participants were cut off from their friends, family, coaches, and personal physicians. He “treated” aspiring Olympians, at all hours of the night and day, alone and without any other adults around, in their bedrooms, on their beds — not in medical offices or athletic training facilities.

He enthusiastically told his patients, many of whom excelled at their sport because of their willingness to please adults and to be coached, that he could deal with their pains and injuries with what he termed pelvic manipulations in which he digitally penetrated them in their private parts. Without medical cause or justification, he conducted repeated and invasive “exams” of girls and young women’s genitals.

January 26, 2018

Repeated, lesser head hits, and not just concussions, linked to brain harms

by Patrick A. Malone

As the science keeps getting deeper, the news keeps getting worse about the harms that can be inflicted by repeated blows to the head in sports — and in life.

The path-breaking medical scientists at Boston University and elsewhere, who have helped to establish how concussions, notably in football, may lead to the onset of the neurodegenerative disease chronic traumatic encephalopathy or CTE, have told the Washington Post that their latest study may show that, “It’s really the hit that counts.”

January 12, 2018

Safety and injury prevention should be part of our new year exercise plans

by Patrick A. Malone

Millions of Americans may be hitting the gym as part of their new year resolve to get fitter. They also need to exercise caution and common sense to avoid injuries that could leave them in worse shape.

As the Washington Post reported, the 2018 health club crush will result in “hundreds of thousands of [exercisers] stumbling on treadmills, falling off exercise balls, getting snapped in the face by resistance bands, dropping weights on their toes and wrenching their backs by lifting too much weight.”

Further, the newspaper added: