Q&A With NCAA Chief Medical Officer Dr. Brian Hainline
In January of 2013, the NCAA hired Dr. Brian Hainline to become the organization’s first chief medical officer. According to the NCAA, Dr. Hainline will “create a new Center for Excellent to function as a national resource to provide safety, health and medical expertise and research for physicians and athletic trainers.’’
Dr. Hainline, who earned his bachelor’s degree at Notre Dame and earned a medical degree at the University of Chicago’s Pritzker School of Medicine, will also oversee all student-athlete health and safety initiatives. Dr. Hainline was the chief medical officer of the United States Tennis Association. On October 23, Hainline attended the Big Sky Conference meetings, where he spoke to university presidents about the concussion crisis, as well as other issues facing student-athletes today that will be researched by the NCAA.
“While Dr. Hainline’s message to the Big Sky presidents included the latest information on the concussion issue, he was much more interested in discussing the broad view of student-athletes’ health,’’ said Big Sky Conference Commissioner Doug Fullerton. “The holistic view of the student-athletes’ health in the 21
st century was of particular interest to our presidents and they are committed to making the Big Sky Conference a leader in these efforts going forward.’’
Dr. Hainline agreed to a “Q&A” session with Jon Kasper of the Big Sky Conference prior to speaking to the league presidents:
Q: What kind of message are you trying to get across to University presidents?
A: One message is that the NCAA has changed by creating this position, a chief medical officer and the sports science institute. Now the message of health and safety is much more visible. Even bureaucratically it’s no longer in the bureaucratic middle. This is a senior-level position. So, it really is a philosophical statement by the NCAA that the message has to be delivered in a different manner and with more importance.
Q: The big national debate right now centers on the concussion issues related to football. How have we gotten to this point?
A: Concussions aren’t new, what’s new is the media is now paying attention to it. Twenty years ago it was almost impossible to get anyone to listen to a talk about concussions. It was, primarily at that time, concussions that were related to boxing. Even then it didn’t generate much interest, because the intent of boxing is to create a concussion. It was early in the early 2000s when the media attention focused, and then it really came to a pinnacle in 2009 with the Congressional hearings and the NFL. The NFL made a dramatic shift in their culture, or at least how they advertise their culture that they were now taking head injuries and concussions very seriously. Since then it’s been almost media frenzy. In part the frenzy continues because there are so many unanswered questions.
Q: What are the next steps in concussion research?
A: I think there are several next steps. One is the definition of concussion and the manner in which it is diagnosed has to change dramatically. Right now there are over 40 working definitions of concussion. Not one is satisfactory. There is a whole separate project going on with the Department of Defense to come up with a multi-stage definition of concussion. That’s one problem. The other problem is that right now we have not one objective biomarker for diagnosing concussions. A biomarker, for example, is if you go to the emergency room for chest pain and you think you might be having heart attack, they are going to draw a blood sample, which will give an objective biomarker of hard enzyme. They’ll do an electrocardiogram, which is an objective biomarker of the electrical activity of the heart. Even from those two tests you can diagnose a heart attack with a high probability. With concussion the imaging study is a CAT scan, which doesn’t tell you anything except that there is not a bleed. The MRI protocols have not been refined enough to really tell us what is going on with regard to concussions. We don’t have any blood biomarkers yet, and we have no electrical biomarkers yet. The diagnosis is primarily based on subjective symptoms, and that is where Alzheimer’s disease was in 1990. That’s another problem. With regard to CTE in particular, I think that’s an alarm that everyone needs to hear. But what we don’t know is what the numerator is? We have identified about 85 cases with a denominator of multiple millions of people who have played football. But there is something. There really seems to be a correlation, but what we don’t know is if repetitive head trauma enough, or do you need something else? That something else could be genetic. It could be another disease of inflammation going on. That something else could be a psychiatric disease. That something else could be drug an alcohol abuse, or it could be some combination of all of that. So that is another very active area of research. All of these things are coalescing. We’re hopeful in the next two or three years we’ll have more objective legs to stand on than we do right now.
Q: What can schools and conferences do right now to help the situation?
A: I think the first is to look at how they are educating the students, the coaches and the medical personnel. Sometimes the education is a one-sheet handout and the students sign it. There needs to be robustness to the educational efforts. That is actually a project we’re undertaking and hoping to roll out next year, an educational paradigm that can be used by anyone who wants it. That is one very important thing. The second is that the diagnosis and management has to be done in a conflict-of-interest free environment. That means the athletic trainer, the team physician; they can make a call on what is in the best of the student-athlete that is not at all influenced by the coach.
Q: There seems to be a lot more attention being paid now not only to the high-impact collision, but the repetitive low-impact collisions. What kind of research is being conducted on that front?
A: That’s what we call sub-concussion impact. That also may be important. We don’t know the importance yet, but we know it’s important enough that the NCAA in conjunction with the Collegiate Athletic Training Society and other groups, we have a summit in January in which we’re going to evaluate all of the science for sub-concussive impacts and we’re going to first recommend football-specific practice guidelines that will be a model for all of the other sport-specific guidelines. The other part of what needs to happen for practice - and I think we’re still a couple of years off - is to have validated sensors. Right now sensors are marketed much more aggressively than science really should allow. Once we have more validation for sensors and we understand the meaning of repetitive sub-concussive impacts, that’s going to shift the practice guidelines in the future.
Q: Is it too early to put limitations on how much contact there is in practice?
A: Our conference in January is to look at all the science, the data, and the consensus statements we have to date and we’ll come up with answers in the springtime.
Q: It’s important to note that this isn’t just about football, correct?
A: We need to look at every sport and we need to separate males from females. Females respond differently to concussions or to the biomechanical forces that lead to concussions than males do.
Q: What other aspects of the concussion are being overlooked?
A: The other part is how concussions might have an impact on academic performance. What’s appropriate academic rest and what are the relationships between the athletic department and the rest of the school? Just as you need physical rest, you need cognitive rest. That’s underappreciated by faculty sometimes.
Q: So, if a student-athlete suffers a concussion on Saturday, they aren’t likely to perform well on a test the following Tuesday?
A: They are not. Not only are they not in condition to perform well, but by trying to force the performance you are delaying the recovery of the concussion.
Q: Other than head trauma, what other types of medical issues will you and the NCAA focus on?
A: I think the biggest thing is student-athlete mental health. We have a task force coming that is going to address that at multiple levels ranging from depression and anxiety to how student-athletes identify themselves to violence, suicide, and sexual abuse. We’ll be presenting research that has never yet been unveiled in public. We’re going to use that as the basis for developing further research studies as well. Another serious issue is doping and drug abuse - doping from a performance enhancing drug point of view, but just as important, and perhaps even more so, is alcohol and recreational drug abuse. Recreational drug abuse is not just marijuana; it is prescription narcotics and prescription stimulants. I think another issue is really looking at the student-athlete in society. There is such an intense push to specialize in sport at a young age. Some of it is all geared so you can get a college scholarship. If you aren’t developing the human being properly you end up entering college as damaged goods.