This week in Amsterdam, the sixth International Consensus Conference on Concussion in Sport is taking place. You may have never heard of the Concussion in Sport Group, but if you participate in rugby, football, ice hockey, or any number of other contact or crash sports, the decisions made there will affect you.
The purpose of the conference is to study the most recent research on concussions, brain injuries, and the short- and long-term effects of head impacts in sports, and then to issue a consensus statement on the most effective approaches to diagnose and treat these conditions.
Whether you play in the Premier League or a Sunday league, the consensus document dictates how you will be treated if you are struck in the head while playing. CISG is a small subset of the vast international community of physicians, scientists, and researchers in this field. The last agreement was signed by 36 individuals, but the group is backed by the IOC, Fifa, and World Rugby, among other sports organizations, giving it disproportionate authority and influence.
The last conference was convened in 2016, and the final consensus was issued the following year. They are scheduled to occur every four years, but this one was delayed twice because of the epidemic, therefore the present recommendations are six years old. It is unclear why the organizers believed it was preferable to wait two years to conduct an in-person world conference rather than an online or hybrid one, but in light of everything else that has transpired in the interim, this is currently the least of CISG’s concerns.
The chair, Dr. Paul McCrory, resigned in March after it was discovered that he had plagiarised a British Journal of Sports Medicine article he had written. After further investigation, the British Medical Journal retracted nine more of McCrory’s articles and added expressions of concern to another 74. McCrory claimed that the error was due to an editing error, but the journal retracted nine more of his articles and added expressions of concern to another 74 “The scientific record depends on confidence,” the BMJ stated, “and BMJ’s trust in McCrory’s work – specifically the articles he has published as a single author – has been broken.”
McCrory was a founding member of the CISG, an influential member of its committees, and the principal author of multiple versions of the consensus statement.
The BMJ determined that there was no plagiarism in the previous consensus statement, but noted that “the question of the amount of McCrory’s input to and impact on the five versions of the consensus statement is a subject for the CISG-appointed scientific committee.” This was an elegant way of saying “your turn.”
It is not simply that McCrory’s study has been invalidated that poses an issue. As an influential member of the CISG scientific committee, he was evaluating the veracity and quality of the research of everyone else. Consensus declarations have, for example, continually questioned the association between head impacts and CTE. The present one claims that “a cause-and-effect relationship has not yet been established between CTE and sports-related concussions or exposure to contact sports,” which has been regularly highlighted by the sports’ governing bodies in response to calls for reform.
One of the most important issues taken at the meeting will be whether the new consensus should recognize the clear and substantial evidence of a causal relationship between CTE and repetitive head injuries.
Trust in the consensus process was already poor, particularly among players afflicted with the injuries it seeks to alleviate. Concerns were raised over the lack of transparency regarding potential conflicts of interest, the methodology used to choose committee members, and the evaluation standards for research. In response to McCrory’s resignation, Fifa, the IOC, and World Rugby agreed to evaluate the consensus procedure.
Eight months later, Fifa asserts that “progress has been made about the worldwide concussion conference.” This includes a revamped governance model, confirmation that the CISG would remain autonomous, and modifications to the scientific committee’s leadership group.”
These “leadership group modifications” refer to the addition of Prof. Robert Cantu, medical director of the Cantu Concussion Centre, and Prof. Mike McNamee, an independent medical ethicist. There are a few additional details on what is new. One spokesman stated that efforts were being made to include “more critical voices in the meeting,” however Dr. Ann McKee, head of the CTE Center at Boston University, informed the Guardian that she would not be attending. Others who have paid the €500 charge will be present.
Drs. Judith Gates and Sally Tucker of the Repercussion Group are among them. Gates states, “I view the McCrory case as a pebble in the water.” “It has reverberated throughout an entire academic network, spreading everywhere his work has been cited, quoted, or utilized to direct new study efforts. The implications are enormous. This is why the conference this week is so crucial. As a community, we must speak up and declare, “This work is potentially polluting, and we do not yet know to what extent.” “How do we get it back to where it should be?”
The Repercussion Group has presented a white paper to the conference proposing methods for achieving the objective. It requires a transparent, upfront disclosure of any potential conflicts of interest by CISG members, as well as the participation of players, patients, and care providers in the process.
Gates states, “We feel the consensus process should be more cautious and player-centered.” “We are not pushing for change thoughtlessly, nor are we playing the blame game, but we are saying to the CISG, ‘You should have those voices at your table.'”
At the heart of the debate in Amsterdam is the question of whose consensus this is and whether it reflects the opinions of the CISG or the broader sports community that is influenced by it.
