OT: Investigation into UNC concussion research

Disclosure: This is about a video series on The Athletic. However, I believe it is unlocked to non-subscribers.

I just watched this video series (Outside the Lines-Style) about the concussion research at UNC. As someone in a research field adjacent to this, I know Kevin Guskiewicz's name - he is at the top of the field. Basically, UNC had a high number of football players diagnosed with ADHD. It is suspected that this was done in order to get athletes to stay eligible by allowing them access to learning aids or ADHD medication to help them keep grades up.

Subsequently, UNC football players were the subjects of many studies done on concussions over a number of years by the UNC brain research center. The investigation looked over all of these papers and there is no mention of excluding players with ADHD diagnosis. In one specific masters thesis, they mentioned that there were players with ADHD in the study and that it is a limitation off the study. When the study was published in a journal (which is where people would actually read it), it was not mentioned.

If this is true, this is a big deal. This research is used by the NFL, NHL, NCAA, and every other concussion researcher in the US. (The reason it's a big deal is because people with ADHD perform worse in concussion tests as shown by previous research by other groups). I saw a couple papers in the video with some researchers at VTs helmet lab listed in the author block. If the results of these studies aren't accurate, there could be a whole lot more that we don't know about concussions than we even realize. I highly recommend watching the videos (I believe there's also an unlocked article) if you have some time.

Link to videos

Link to article

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Comments

There are two other main points that the article didn't necessarily bring up but that are important to consider in the grand scheme of it all (pun not intended, this was clearly a scheme),

  1. Adderall/Ritalin are known performance enhancing drugs (banned in NFL, NHL, MLB, NBA, NCAA) so the more athletes diagnosted with ADHD, the more athletes get exemption for taking PEDs
  2. The reason listing test cases with ADD/ADHD/LD is important is because of the effects the drugs have on recovery. Players taking Adderall/Ritalin will show via psychological testing that they have recovered much faster than their brain has actually recovered

As an aside to point number 1, there was a great video but I can't remember the source off the top of my head that discussed the use of inhalers and albuterol where if a rider could get diagnosed with asthma they could use albuterol. What's crazy is the percentage required in the blood streem to trigger a failed drug test was like 50 pumps of the catridge. Albuterol is used to free up airways so cyclists are big on this because it allows them to process oxygen at a higher rate all while staying under the legal limits. All I am saying is athletes will do anything to get a competitive advantage but it is a whole other thing when a University is facilitating it themselves. And in tandem with point 2, they are facilitating a practice that could prematurely clear players (possibly) and increase the risk for TBIs.

But don't worry, I am sure after 8 years of investigations, they will be found to have committed zero infractions....

This was mentioned in the videos. Not really surprising to me at all based on the fact that it's UNC

You know, that Albuterol thing is funny. When I worked in the clinic we obviously gave it to patients with breathing troubles. I ALWAYS wondered if taking before Albuterol before a PT test would actually help with getting a better run time. Lol

Yeah never-mind that they are giving their players legalized speed in order to keep them academically eligible. The lows of college football are pretty amazing. We need to win games, so lets make some speed addicts out of our players to keep them on the field!

What's
Important
Now

What's Important Now....

I have a feeling you get what I mean.

"BuT UnC iS StIlL a PuBlIc IvY" -Every Wahoo, probably.

Shocking a university that sanctions unsubstantial courses for both athletes and general students would be involved in tainted research efforts.

I watched all three of the videos and thought that the biggest scam was the erroneous diagnosis of ADHD. This was an obvious effort to allow for:

  • Extra academic benefits to help maintain eligibility;
  • Use of banned chemical therapeutics that were beneficial on the football field and for academics.

The erroneous diagnoses then invalidated research by:

  • Inclusion of athletes with true ADHD;
  • Inclusion of athletes on Ritalin and/or Adderall.

All this and they still sucked at football

I just sit on my couch and b*tch. - HokieChemE2016

All this and they still sucked at football

FIFY

I mean, you can connect the dots and basically come to a conclusion (not necessarily the actual truth) that the ADHD diagnosis was omitted from the concussion studies in order to mask the cheating using ADHD diagnosis to allow for PEDs for the football team.

What this theory doesn't take into account is the potential loss of upper millions to potentially billions in research grants for the university that would be jeopardized for low millions in athletic booster donations and athletic revenue due to better football results.

So, while the dots look tantalizing, I just don't see a major research university rolling the dice on a nationally recognized program by fudging the study results to cover up an attempt to win more football games. I do however think that clearly someone fudged data in order to get desired results in order to secure more grant funding / recognition. That stuff happens a lot on the academic side of things from time to time.

This whole thing seems ridiculous to me for a handful of reasons:

1) There is some very clear bias against the research program by the authors of the Athletic article. Several times they refer to the research team using the athletes as "lab rats". Asking players to put sensors in their helmets to measure head impact force while compensating them fairly according to IRB protocols is the opposite of such a statement.

2) Anyone who has written a technical thesis/dissertation and then went through the peer-review process of turning that into a journal paper knows there are tons of people editing the manuscript before it gets submitted. Furthermore, the suggestion that the research team was trying to hide it based on the removal of a spit-balled sentence in a Master's thesis is ludicrous. Of course the following wouldn't have made it into a peer-reviewed paper: "...a learning disorder which was prevalant in a significant number of our subjects (DO WE KNOW A NUMBER or % TO ADD HERE?)"

3) With respect to the conflict of interest forms, this one is a little trickier. Should he have disclosed that he was working on the NFL head/neck/spine committee? Yes. Does everyone in the field know that he was on that committee? Absolutely. Would disclosing that information at the end of a paper have changed peoples minds about what was in it? Absolutely not.

4) Finally, if you actually look at the number of UNC football athletes prescribed medication for ADHD (38%) it pretty much alligns with the number of athletes who are 2 standard deviations below the normal patient scores for complex attention (41.1%). I would guess that UNC is no different than most collegiate football teams: made up of players who on average score much worse on standardized tests than the average collegiate population at said school. The goal was to study the football athelete population, which they did.

1) I don't necessarily agree. While I'm sure they would prefer to find some dramatic evidence, I don't think the use of the phrase lab rats means anything. I find that people (even researchers) not in the human subjects research field use that phrase often. And while the helmet lab at VT primarily uses in-helmet sensors, I'm sure you know that UNCs research includes functional testing. Not that it really matter either way.

2) This is very true, I find it hard to believe that they wouldn't have asked each subject if they were taking any medications. I don't believe they were intentionally trying to hide something, but it seems like that would common practice in neurological research, no?

3) I agree with all of this.

4) I don't remember all the numbers, but the 61% of UNC athletes diagnosed with ADHD or a learning disability seems pretty impossible to me. I think they said the national average was something like 8%. I guess that speaks more about UNC athletics and not about the research, but it is sketchy.

Btw, I didn't mean to imply that anyone from the VT Helmet Lab would have anything to do with any sketchiness that may or may not have occurred. Just thought the collaboration would show the clout that Guskiewicz's research has in the field.

2) You find it hard to believe because any study that is worth anything will do a complete medical history and current medication list. In fact if results are going to the FDA or NIH, this is required (I think). I work in pharmaceutical clinical trials and if a subject is in a trial for IBS but takes advil because they have a headache, the research team wants to know about it asap. The medications may or may not have affected the outcome of the research, but the study team would 100% have known about all meds the subjects were taking.

I was part of a clinical trial, and they asked me to list my medications every visit.. aspirin, antibiotics, everything

Exactly. I do human subjects research, and even though our outcomes would be very unlikely to be affected, we always ask and record or it's part of the exclusion criteria.

This will be the last post I do on this thread because I don't really feel like getting into a back and forth argument. I also did human research, and am co-author on several football head injury papers, though none with Kevin. Football athletes are a whole different bag than musculoskeletal research volunteers or other human research projects. I am not saying that college football is the same as the NFL, but there are a lot of stories out there that around this time, that football players were given and prescribed medication without them actually knowing what was given to them. Even within the videos on the Athletic there is an email from the head athletic trainer expressing concern that student health and the team physician don't even know what the kids are taking. I disagree with the notion that the research team would be expected to be able to figure it out themselves if the players couldn't/wouldn't tell them without violating HIPAA. Importantly, they were trying to study the football population at the NCAA level, and I suspect this is pretty common all over the place. If you think that this is common, then they hit their goals and the findings likely translate to other collegiate football populations.

Now you could argue that the medical team was in the wrong in prescribing these medications. However, with respect to the number of players diagnosed and prescribed medication, even in the "whistleblowers" paper they show that a large percentage of the UNC football population scored poorly in the baseline neurocognitive tests. Keep in mind 38% were prescribed meds when you look at the table. You can argue that the test was no-good for use as a diagnostic tool, but it seems like the numbers line up at least.

Anyways, have fun and just know football is a different animal.

Definitely not arguing your expertise as you certainly know more about this field than I do. You make some good points - appreciate the responses.

No problem man. And by the way, it makes sense why the whole thing seemed blown out of proportion now that I've looked a little further.

Ted Tados, the researcher who is behind the whole Athletic article, has some pretty strong bias against UNC as a whole that he failed to disclose *wink *wink. According to the New York Times in 2016:

A Twitter user named Ted Tatos โ€” his Twitter handle is @BlueDevilicious, and yes, he went to Duke โ€” began poring though the emails, tweeting out the most egregious ones on practically a daily basis. He has recently been focusing on the improbably high number of diagnoses of learning disabilities among North Carolina athletes โ€” allowing them to receive special accommodations.

2016 Article

What you say makes sense.

But I find this paragraph, if true, disturbing:

While the total number of UNC football players receiving ADHD medication is unclear, a 2009-2010 end-of-year report showed that 16 of 23 freshman football players (70 percent) were prescribed medication.

Mary Willingham was a learning specialist inside the athletic department between 2003 and 2010, working with the neuropsychologists responsible for LD or ADHD testing at UNC. She says there was pressure from coaches to keep players academically eligible to compete, and that diagnosing football players with a learning disability or ADHD was helpful in those efforts.

It just doesn't look good.

Woof...the irony

Everybody knows you don't use your name for things like that if you have a bias...find someone else to release the information. Silly Ted.

All this is way outside my field of expertise.

But fuck UNC.

I watched the 10 min vid to understand better... its sickening IMHO. 16 of 23 in one freshman class diagnosed with ADHD and prescribed meds that are considered PED's by NCAA. Head Athletic trainer red flagged the diagnosis and prescriptions not documented by the team physician or student health physicians. Immediate ? is, who are these physicians writing scripts that the players were seeing after requesting to be tested for ADHD and how is UNC athletic tied to them (or them to UNC)?

'Its easy to grin, when your ship comes in, and you've got the stock market beat,
but the man worthwhile, is the man who can smile, when his shorts are too tight in the seat'

Pretty sure anyone can go to a doctor and be diagnosed with adhd if you answer questions correctly. I remember kids doing that in school to get a leg up on testing / get accomodations.

Danny is always open
23 can't read

But he stumbled upon documents detailing abnormally high percentage rates of UNC athletes with LD/ADHD from 2004 to 2012, a stretch when UNC was trying to revamp its football program. The percentages were consistently three to four times greater than the national average.

In one email from 2007, for example, neuropsychiatrist Thomas Gualtieri, hired by the school as an outside contractor, revealed that among a group that included incoming football players from the previous two years and women's basketball players from the previous year, 61 percent "had either ADD or a learning disability (or both), and the large majority were previously undiagnosed."

A paper co-authored by the NCAA's chief medical officer, Brian Hainline, and published this year says "the prevalence of ADHD in student-athletes and elite athletes may be 7 percent โ€“ 8 percent."

None of this is really OK.

At what point does UNC clean up their act? Seems as if some outside pressure will be needed, as UNC seems incapable of policing themselves.