NZ Herald 13th May 2012

It sounds like the plot for a thriller. Only this isn’t fiction.

It’s currently taking place in two separate spheres at once, in real life. And it’s something I feel passionate about.

The first industry involves sport. NFL, Ice Hockey, Rugby Union, Rugby League (in the UK and Australia) and Australian Rules. No prizes for guessing where the last one is played. The one thing these games all have in common is physical contact, and lots of it. Crowds love a bit of biff, thump and robust exchanges. But at what cost?

For years now, high profile players have been the focus of media attention for all the wrong reasons. Not a season goes by without more scandalous headlines about players involved in sexual assault, domestic violence, alcohol and drug abuse, off-field violence and betting controversies. Boys will be boys, we’re told and it’s mostly harmless fun. Harmless of course, except for the victims, families and consequences for players themselves.

With a life expectancy of 50 yrs for NFL players, it’s easy to assume that retirement, high food intake and reduced exercise are the causes. But a number of premature deaths and suicides in former NFL players and even a player who stopped after high school, shocked the medical community.  Each was found to have the unusual finding of CTE (chronic traumatic encephalopathy).

What is CTE? It’s permanent and ongoing damage to the brain that was previously only ever seen in boxers after a career of blows to the brain. MRI and other medical investigations aren’t able to pick it up. Sadly, it’s only diagnosable post mortem.

CTE predominantly affects the front parts of the brain, or frontal and temporal lobes, which are responsible for decision-making, impulse control, mood, memory, amongst other things. Damage to these areas can result in depression, increased aggression, sexual inappropriateness, impaired judgement, addictive behaviours like gambling, drug and alcohol abuse. Does any of this sound familiar when you think about the football and ice hockey scandals?

It did to me three years ago, when I began writing Death Mask. Please don’t think for a moment that I’m taking credit for the surge in information or subsequent outcry about CTE, or the decision by many former players to sue the NFL, but the headlines kept on coming and a fictional novel on the topic attracted more than the crime readers.

The chief executive officer of a professional team contacted me after reading the novel, and asked me to help educate players and team management about the dangers of CTE. He felt that the book had really captured the culture and mentality of team behaviour. It was a huge compliment, and vindicated a ‘slight’ obsession for research, but the lines between fiction and reality had begun to blur.

As Death Mask was released in Australia, we coincidentally had a number of severe concussions during games and there was ample footage of players stumbling around the field before collapsing.

It’s unusual for a fiction author to make it to the sports pages and sports segments of TV news shows. My sports fanatic father was so proud! (Above, Kathryn is interviewed with NFL player Colin Scotts.

Some commentators argued that I was just trying to bubble wrap children and that concussions were just a part of robust gladiatorial competition. As a doctor, and parent, I am in no way against sport, but any sport that causes brain damage and premature death deserves some review. It is, afterall, sport. Thankfully, public awareness has increased the pressure on sports doctors and administrators to take action and reassess the risks.

Now, medical science is discovering that CTE doesn’t actually require severe concussions. It may be caused by recurrent, minor blows to the head and is especially damaging to developing brains. Helmets don’t necessarily protect the head and are heavy enough to cause some major damage.

At the beginning of the blog, I mentioned two spheres involving multibillion dollar industries and strange autopsy findings.

The second industry is, not surprisingly, war. Tragically, there has been an epidemic of suicides and social problems experienced by veterans of Iraq and Afghanistan. A newly published medical article reports that over a dozen veterans have been found to have CTE at autopsy. A 27 yr old diagnosed with post-traumatic stress disorder was the first recorded victim.

In no other wars have troops been exposed to, and survived, so many explosions.

Current thinking is that the number of blasts from bombs or grenades have a catastrophic impact on these young brains, and may be responsible for the high rate of suicides in veterans. A helmet might protect from the head from shrapnel, but can’t do anything about the brain rattling around inside the skull.

If CTE is occurring in people this young, the worst is yet to come. Degeneration continues to occur with age.

These people have served their countries and may end up paying for the rest of their lives, and with shortened and debilitated lives. More importantly, there is NO treatment. We all owe it to troops to prevent CTE and protect those who have already returned from active service. The potential health problem for the US, UK and Australia, amongst other nations, is enormous.

Now, if a journalist dares ask me if I want to bubble-wrap troops and stop all wars, I can unequivocally say yes.

http://www.murderati.com/blog/2012/5/8/kathryn-fox-comes-to-murderati.html#comments

They are sold to us as floating pleasure domes – luxury hotels on the sea – where every day is perfect and the party never stops.

But scratch the surface of the cruise ship industry and the truth isn’t so dazzling.

Behind the pina coladas and the smiles lies a murky world of sexual assault, drugs and violence, even murder.

Incredibly, one passenger goes missing overboard every two weeks.

Now, you’d think the big cruise companies would be desperate to get their industry shipshape.

You couldn’t be more wrong.

For full 60 minutes story and transcript click here

She quickly uncovers a sordid pattern of assaults, unchecked drug use and mysterious disappearances. With crew too afraid to talk, she is drawn into the underbelly of the cruise line, its dangerous secrets and the murky waters of international jurisdiction.

Shadowed by a head of security with questionable loyalties, Anya can trust no one. Her family’s life depends on what she does next.

One thing is certain. The killer is still on board.

But on her wedding day, Ms. Kande, her head modestly covered in a plain white shawl, vowed to protect her own daughters from the same ancient custom. Days later, her village declared it would abandon female genital cutting for good.

Across the continent, an estimated 92 million girls and women have undergone it. But like more than 5,000 other Senegalese villages, Sare Harouna has joined a growing movement to end the practice.

Read the full article here

Visit www.tostan.org

The Sunday Times UK 17 April 2011 Review

Concussion…Shaun Valentine in the hands of the trainers after being knocked out playing for the Cowboys against the Bulldogs in 2001. Picture: Rohan Kelly Source: The Daily Telegraph
SOMEWHERE between the dizziness and dry retching, Shaun Valentine will try to get himself ready for work.Not the landscaping business he runs now, but rather one he hasn’t held since high school.

“Whenever the dizzy spells come on, it’s like I go back in time,” Valentine reveals without a hint of drama. “I get really groggy, confused.

“I think I’m still working at one of the jobs I had after leaving school.

“Eventually I do snap out if it and get my bearings.

“Yeah … eventually.”

If you cannot remember the four years, 36 games and seven major concussions that made Valentine’s NRL career, don’t feel bad neither does he.

This is life for the retired leaguie, still only 35, who labours to pay the mortgage, loves his two children and starts every day looking for the same set of car keys he has “religiously” placed on the lounge room bar every night before.

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It’s been this way for a while now, Valentine admits. Misplacing items, forgetting messages. The gifted athlete who once counted memory among his greatest assets now recalling games only via DVD.

Which isn’t to say he wants to make a big deal of his condition. Exactly the opposite. He starts almost every answer this particular day with, “Mate, it’s nothing too bad … ”

“But without trying to whip up a frenzy, this is a concern,” leading Sydney neurologist Mark Davies warns. “It could be that Shaun’s issues are caused by Type II diabetes, by thyroid disease or a calcium disorder. But it could also be that he’s suffering from repeated hits to the head.”

Does anyone still need convincing that the dark spectre of concussion has finally exploded in the NRL?

That this cloudy conundrum is no longer the domain of only American footballers like the late Mike Webster, the former Pittsburgh Steeler and owner of four Super Bowl rings, no less who a few years back was found urinating into his oven and pouring super glue on to rotted teeth.

A tortured soul so desperate for sleep, he’d use a Taser gun to render himself unconscious.

No, this is about the Kangaroo retiree, not even through his 50s, who now sits in a nursing home crippled by dementia. Or the cult Winfield Cup figure confiding in mates about the onset of Alzheimer’s. The Daily Telegraph has agreed not to release their names.

And shouldn’t we be asking how Phil Gould knows six leaguies who’ve committed suicide?

“I’m horrified that our footy codes aren’t taking this issue seriously enough,” says Dr Kathryn Fox, a Sydney medical practitioner whose past three years have been spent researching the effects of head injury on footballers.

“Up to one in five people who suffer concussion will have cognitive or personality changes.

“That’s irrefutable – and here in the NRL we’re treating our young men like human crash test dummies.

“Involving them in collisions the equivalent of hitting your windscreen while driving at 60km/h.

“They’re doing it hundreds of times a year, too.

“I know young men who’ve had seizures on the field, who’ve dropped from A-grade to C-grade students … and still we’re asking if this is a problem?”

Certainly in America the question marks have gone.

They were erased eight years ago when Dr Bennet Omalu, completing Webster’s autopsy, discovered a previously unknown brain disease which he labelled Chronic Traumatic Encephalopathy, or CTE.

Causing degeneration of brain tissue and the accumulation of tau protein, symptoms of CTE include depression, aggression, violence and extremely advanced Alzheimer’s.

Or, in the case of Pittsburgh lineman Justin Strzelczyk, driving your pick-up headlong into a tanker of corrosive acid – a crash that killed him at the age of 36.

Autopsies revealed he had suffered from brain damage, most likely caused from years of impact playing football.

Indeed, there’s a school of thought suggesting the NRL’s increased player behaviour problems are in direct response to a CTE build-up in bigger, faster, heavier athletes whacking each other at 13gs (the risk of death arising with constant application of 16gs on the human body).

So what’s being done?

Right now, Sydney neurosurgeon Dr Richard Parkinson – the man who saved the career of Rabbitoh Ben Ross – is halfway through a two-year study into the impact of head and spinal injuries in the code.

But that’s all we know.

Dr Parkinson is currently working in the US.

Elsewhere, NRL chief medical officer Ron Muratore is overhauling NRL concussion rules while monitoring studies from the US. He stresses, however, that while NFL linebackers will use their head as “a weapon” 30 or 40 times a game, NRL clubs “boast an average of four to seven concussions a year”.

Yet what about when the statistic becomes staggering Knights forward Richie Fa’aoso?

Should we be worried about him when you consider the college footballer, only 18, who died with a brain containing more tau than you’d find in a 50-year-old?

“People need to understand league players are open to the same concussions – the same multiple concussions – as NFL players,” Australian Medical Association professor David Mountain warns. “Yes, there are differences in the way they tackle.

“But to see a guy whacked in State of Origin; to see him staggering, reeling about and then later return to the fray … it cannot be right.”

Professor David Ames of Alzheimer’s Australia agrees, adding: “We know head injuries are no good … it’s why we invented seatbelts.”

It’s also why Dr Davies is now urging NRL-specific studies be undertaken. Why the RLPA is closely following proceedings and Aussie boxing legend Johnny Lewis suggests concussed players rest the same 28 days as fighters.

“But I guess the NRL is big business,” Lewis shrugs. “And no one can miss a minute.”

Just ask Valentine.

The forgotten footballer who, playing against the Auckland Warriors back in 2000, was cleared by a Cowboys club doctor to return to the field after being kayoed by giant Ali Lauitiiti. Who, within minutes, was iced again by fellow Warriors enforcer Joe Vagana.

“Which is when I had the seizure,” says Valentine, eventually cut by the Cowboys on medical grounds.

“Out cold five minutes. After that I was concussed against Wests Tigers, against Canterbury and … ahhh … no, sorry, can’t remember the rest.”

Valentine admits he could be the first Australian to join the revolutionary research into CTE.

“Because the scariest thing, it’s not the seizures,” he shrugs. “It’s the questions. Like afterwards, when you finally sit down in the quiet and think to yourself, ‘What the bloody hell is going on upstairs’?”

@nickwalshaw

walshawn@dailytelegraph.com.au