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Dr. Ann McKee: Are sports damaging our kids brains? · Broken Brains with Bruce Parkman

• 0:12
  Speaker 1: Hey folks, welcome back to another episode of Broken Brains with Bruce Parkman and where we take a look at the issue of repeated head impacts and repeated blast exposure and how it's affecting our children, our veterans and our athletes and contributing to what we think is the largest preventable cause of mental illness in this country, and how we're going to make change and build the advocacy and awareness for all the people out there that have not only been impacted by these issues, but the people yet to come, our kids and future service members.
• 0:45
  Speaker 1: And we reach out to the community around the globe and find the most amazing people researchers, scientists and doctors, and victims and NFL players.
• 0:53
  Speaker 1: And today we have an unbelievable, prestigious guest, dr Ann McKee herself, who is basically I just call her Miss CTE.
• 1:02
  Speaker 1: I mean, this lady is incredible.
• 1:04
  Speaker 1: If you don't know her, she's a neurologist and neuropathologist and she works for the CT Center at the VA, boston Veteran Affairs.
• 1:12
  Speaker 1: She's done an amazing job getting the military support.
• 1:16
  Speaker 1: She runs basically the largest brain bank in the world in support of CTE and she's known for her work in studying not only CTE but the issues of repetitive brain impacts.
• 1:26
  Speaker 1: And, dr Anne McKee, I didn't know this, but in 2018, time named you one of the most 100, most influential persons in the globe.
• 1:34
  Speaker 1: That is amazing, and this lady is a gladiator.
• 1:38
  Speaker 1: She's been taking on the NHL, the NFL, all in the name of trying to get the awareness out that we all need to know in order to make change in this society, and she is absolutely in the front of this battle and has been for a long time.
• 1:55
  Speaker 1: Dr McKee, thank you so much for coming on the show today.
• 1:59
  Speaker 2: Oh, I'm happy to do it.
• 2:02
  Speaker 1: So let's sound like how did you start?
• 2:04
  Speaker 1: I mean, what got you into this?
• 2:05
  Speaker 1: I mean, you are, you know, the expert in the world, right?
• 2:08
  Speaker 1: We see you all the time.
• 2:10
  Speaker 1: I post everything you ever put out, and so you know, how did you like?
• 2:14
  Speaker 1: How did Ann McKee get going into picking up these brains and saying, well, I want to know what this problem is all about?
• 2:23
  Speaker 2: Yeah, I mean it's a series of lucky coincidences or maybe, you know, preparation meets opportunity.
• 2:32
  Speaker 2: But you know, I grew up in Appleton, wisconsin.
• 2:36
  Speaker 2: I think that's important feature of my life because it was the town where the visiting team stays when they play the Green Bay Packers.
• 2:45
  Speaker 2: So as a young kid I was a thorough, you know, packers the football team.
• 2:51
  Speaker 2: It was huge.
• 2:52
  Speaker 2: In my town Everyone was a football fan.
• 2:55
  Speaker 2: My dad was a huge football player.
• 2:57
  Speaker 2: He played for Grinnell College and my brothers played football and I was playing football from the age of two on.
• 3:05
  Speaker 2: I, you know, we just did it in the summers, but I'm sure I would have played football if I'd been born a different gender.
• 3:15
  Speaker 2: Anyway, I grew up loving football and I love football players.
• 3:22
  Speaker 2: I idolize them, I'll be honest.
• 3:25
  Speaker 2: And then, back in 2003, I had been studying Alzheimer's disease for quite some time, really very interested as a neuropathologist in Alzheimer's disease and also these tau-based disorders that are more unusual, like things like PSP and corticobasal degeneration.
• 3:44
  Speaker 2: That's what I thought was going to be my life's work.
• 3:47
  Speaker 2: And then just I happened to examine the brain of an individual who was diagnosed with Alzheimer's disease.
• 3:56
  Speaker 2: That came through our brain bank for Alzheimer's and he had been a world champion boxer.
• 4:02
  Speaker 2: His name was Paul Pender.
• 4:03
  Speaker 2: People in the New England area remember him.
• 4:06
  Speaker 2: He twice fought Sugar Ray Robinson for the title and won.
• 4:11
  Speaker 2: And you know, in his late 50s he started experiencing some behavioral changes.
• 4:17
  Speaker 2: He started getting irritable, getting abusive with his wife and family and notably he had memory problems.
• 4:26
  Speaker 2: And so when he came in to be evaluated, actually at the Alzheimer's Center that I now direct my colleagues you know they thought this can't be anything related to his boxing, because it's been.
• 4:40
  Speaker 2: He retired at the age of 32.
• 4:41
  Speaker 2: This is decades later, 30, almost 30, 30 years later, so this can't be boxing related.
• 4:48
  Speaker 2: And they diagnosed him with Alzheimer's disease.
• 4:51
  Speaker 2: And then, at post, when I looked at his brain, it was, first of all, it was the most florid case I'd ever seen of tau.
• 5:00
  Speaker 2: There was tau everywhere in the brain and it was doing all these strange things.
• 5:05
  Speaker 2: It was circling around blood vessels, it was really patchy and it was involving parts of the brain that are never involved in Alzheimer's disease.
• 5:12
  Speaker 2: And, probably most importantly, it didn't have any beta amyloid.
• 5:16
  Speaker 2: And so I knew immediately without beta amyloid it cannot be Alzheimer's disease.
• 5:22
  Speaker 2: And then, you know, I was like, oh my God.
• 5:25
  Speaker 2: You know, I think this is a chronic traumatic encephalopathy was the first case I'd ever seen, and it was.
• 5:31
  Speaker 2: It was extraordinary and I was, fat, immediately fascinated by it and I wanted to see more brains that had that same type of involvement, and so I looked for more boxing brains.
• 5:44
  Speaker 2: And then it was actually five years later that I happened, just by happenstance, to be introduced to Chris Nowinski and he was looking for someone who would look at the brains of football players and, knowing what I'd seen in the boxer and thinking, you know, I love football, I love watching football, I wonder if the same thing is happening.
• 6:08
  Speaker 2: And so, yeah, he was the one that brought in the next two cases.
• 6:14
  Speaker 2: That was Tom McHale, and I can't remember his name right now.
• 6:21
  Speaker 2: That's embarrassing, but you know these were John Grimsley and these were hugely important cases for me.
• 6:29
  Speaker 2: They were 45-year-old gentlemen.
• 6:31
  Speaker 2: They'd both played in the NFL as linebackers for nine years and they both started getting into trouble around their 40s.
• 6:39
  Speaker 2: It was just subtle changes, behavior changes, like not able to multitask, some inattention, memory issues, and then, in the case of Tom McHale, he started getting addicted to painkillers which was very unlike him and his business failed.
• 6:58
  Speaker 2: And in the case of John Grimsley.
• 7:00
  Speaker 2: He just wasn't remembering things.
• 7:03
  Speaker 2: His wife told him I mean, his wife even mentioned in the morning that their son was getting married and by the afternoon of that same day he'd completely forgotten.
• 7:13
  Speaker 2: So the wives, lisa McHale and John Grimsley's wife, were alarmed and they both came from families with some medical background.
• 7:23
  Speaker 2: So when Chris Nowinski reached out to them to see if they'd be willing to donate their brain for science, for us to examine it, you know they both agreed and that started the ball rolling.
• 7:38
  Speaker 2: And you know, since then we've had over 1,525 brain donors.
• 7:44
  Speaker 2: We have over 700 American football players.
• 7:47
  Speaker 2: We have ice hockey, rugby, soccer.
• 7:50
  Speaker 2: We have mostly men, about 96% men but we're getting more and more women.
• 7:55
  Speaker 2: As women started playing sports, they're experiencing some of these difficulties too.
• 8:02
  Speaker 2: We do get military veterans.
• 8:04
  Speaker 2: We have about 325 military veterans and of course some of those are women.
• 8:11
  Speaker 2: And we're really trying to broaden our demographics.
• 8:14
  Speaker 2: We have mostly white people, but we're getting ever-increasing numbers of people of all races and ethnic groups.
• 8:26
  Speaker 2: So you know it's been a whirlwind.
• 8:30
  Speaker 2: It started for me really that, you know, 16 years ago and it has just been a crescendo of wonder.
• 8:43
  Speaker 2: You know this has been.
• 8:44
  Speaker 2: It's as though I opened Pandora's box, I had no idea what I was going to get into and it's just been a wild wild ride.
• 8:53
  Speaker 2: Let me just say and I know I'm being too long winded but it's you know, I, we saw the problem.
• 9:03
  Speaker 2: I saw the problem in John Grimsley no-transcript younger when they died, and I immediately knew this was an enormous problem.
• 9:37
  Speaker 2: And I showed the case to my brother, who is a family medicine guy, and we both had been interested in the effects of playing sports.
• 9:49
  Speaker 2: And just between the two of us kind of talking shop and saying, you know, there's something going on, there's just a lot, you know, anecdotally, there's just a lot of people experiencing problems later in life.
• 10:05
  Speaker 2: And I showed it to him and he was like, oh, you know, oh, my God, the NFL has to know about that.
• 10:10
  Speaker 2: It was our reaction.
• 10:11
  Speaker 2: We're going to go to the NFL.
• 10:12
  Speaker 2: They need to know that this is happening to their players.
• 10:16
  Speaker 2: And, of course, you know, eventually I was invited to present my work to the NFL in 2009.
• 10:24
  Speaker 2: And the reception, as I'm sure you're aware, was not quite what I was hoping for.
• 10:29
  Speaker 2: It was very dismissive.
• 10:30
  Speaker 2: They thought I was just an incompetent doctor, basically's box 16 years ago.
• 10:36
  Speaker 1: Okay, right, and yet the I mean the, the amount of awareness that's out there and parents and teachers and coaches is still pretty much like it was 16 years ago.
• 10:56
  Speaker 1: I mean, we have not had well, right.
• 11:00
  Speaker 1: It's, it's still.
• 11:00
  Speaker 1: We still haven't had the.
• 11:02
  Speaker 1: Now, when I talk to people, I know when you talk to people, but we're catching, you know the people in our networks, right, and you're speaking on this all the time and you know.
• 11:12
  Speaker 1: So why can't this knowledge right when I met you, and so everybody knows my son, mac, is at Dr McKee's Brain Bank and, unfortunately, that's how we met the first time when she looked at my son's brain.
• 11:25
  Speaker 1: You know we have this alarming and you know, unbelievable knowledge that can save lives, save kids.
• 11:35
  Speaker 1: We just got to do things differently.
• 11:38
  Speaker 1: Why is it that this has not gotten out there?
• 11:41
  Speaker 1: I mean, it's just, and I was appalled.
• 11:44
  Speaker 1: That's why I ended up writing a book, because I think people need to know this.
• 11:48
  Speaker 1: And, of course, you know this book's not a bestseller either.
• 11:50
  Speaker 1: Ain't nobody signing up to read about you know?
• 11:53
  Speaker 1: Hey, you know this sport that I love might be hurting my kid, but when people read it they go oh my God, and that all came from me meeting you that day on this TV screen.
• 12:02
  Speaker 1: So you know, 16 years, here we are.
• 12:05
  Speaker 1: You know you're, you've got this amazing brain bank, you're doing all this amazing research and yet you know contact sports.
• 12:13
  Speaker 1: You know, kids, parents, nothing's moving.
• 12:16
  Speaker 1: How do you know what, what?
• 12:17
  Speaker 1: What do we got to do?
• 12:19
  Speaker 2: Yeah, no, it's an enormous frustration.
• 12:22
  Speaker 2: You know that.
• 12:24
  Speaker 2: You know you're just beating your head against the wall with this, literally, with this information, and it's really falling on deaf ears.
• 12:31
  Speaker 2: There's been an improvement?
• 12:34
  Speaker 2: You know there's no.
• 12:35
  Speaker 2: There's more public awareness that this can happen.
• 12:39
  Speaker 2: It's not a complete novelty anymore.
• 12:42
  Speaker 2: I think people are aware of it, um, and and clearly you know, some parents are more aware than others and some communities are more aware than others.
• 12:51
  Speaker 2: Um, but I think what we're facing is football's a part of our culture.
• 12:57
  Speaker 2: It's you could call it a religion.
• 12:59
  Speaker 2: It's absolutely intrinsic to our national identity.
• 13:18
  Speaker 2: It's absolutely intrinsic to our national identity.
• 13:23
  Speaker 2: It's that's part of their own personal identity and culture and it makes them an American, it makes them patriotic, it's, it's football is much greater than just a sport, just a form of entertainment.
• 13:39
  Speaker 2: It's actually a national identity.
• 13:42
  Speaker 2: So I think that's part of the problem with the public.
• 13:46
  Speaker 2: And then, of course, we're up against billion dollar companies like the NFL and the NHL, and unless we can make awareness about CTE affect them financially, I don't think they'll ever really embrace any change, because any significant change, because you know the bottom line is they're looking to increase their profits and, if anything, they're extending the number of games and, you know, and in many ways making football even greater risk.
• 14:20
  Speaker 2: They have done I will say they've done a lot to manage concussion, which is one type of head injury, one head impact injury, and it's an important one, but it's not the primary problem.
• 14:34
  Speaker 2: It's all the hits to the head, it's the hits that don't cause symptoms, what we call non-concussive hits.
• 14:40
  Speaker 2: Those occur, you know, hundreds to thousands of times a season and those are the ones that, over time, really damage the brain and that we really haven't been able to make a lot of traction with.
• 14:55
  Speaker 2: We need to take hits out of the game, right, but head impacts are really intrinsic to the sport of football.
• 15:02
  Speaker 2: So we'll have to really change some important rules if we want to keep the players safer.
• 15:09
  Speaker 2: Some of the easiest ways to do it would be raise the age that kids start playing tackle football.
• 15:16
  Speaker 2: Yes, you could shorten the season, you know.
• 15:22
  Speaker 2: You could shorten the number of minutes a game.
• 15:24
  Speaker 2: You could make rules, rules that maybe fewer people on the field, just less collisions.
• 15:30
  Speaker 2: There are a lot of things you could.
• 15:32
  Speaker 2: You could do if there were incentive to do it, but I think, I think, uh, the culture is just so strong about this, the that it's really difficult to make any impact.
• 15:46
  Speaker 1: It's a religion.
• 15:47
  Speaker 1: I think that's how Dr Bucknell the Australian you're equivalent down there Right.
• 15:53
  Speaker 1: And his TED Talk said ah, it's a religion, you know.
• 15:59
  Speaker 1: I think that you know.
• 15:59
  Speaker 1: The thought that everybody's like folks like you and I, they're out there trying to ban football, is absolutely wrong.
• 16:06
  Speaker 1: As a matter of fact, when I met with my son, my son's school, I said look, you know, we're trying to make it safer.
• 16:12
  Speaker 1: In fact, if they would listen to you and adopt some of your recommendations, we can have our cake and eat it too.
• 16:20
  Speaker 1: And I think this is all about exposure.
• 16:22
  Speaker 1: If we literally you know what are your thoughts on, you know, you say you know, you know, if we, if we had kids that didn't start till, you know, we're never going to get this out of high school.
• 16:31
  Speaker 1: I personally believe and I've said this over and over again that contacts for should be an adult occupation.
• 16:37
  Speaker 1: When you're 18, you can join the army, you can jump out of planes, you know, but you're informed, right, and this is a biggest.
• 16:43
  Speaker 1: One of the biggest problems we have right now is informed consent.
• 16:46
  Speaker 1: If you're going to do something, you're going to jump out of a plane, you're informed that, hey, if your parachute doesn't open, you're going to have a big problem.
• 16:54
  Speaker 2: Yes, and you're old enough to make that decision Old enough?
• 16:56
  Speaker 1: to make that decision and so.
• 16:58
  Speaker 1: But you know, looking at you know, are we going to get you know kids this out of high school right now?
• 17:04
  Speaker 1: No, but if we can start with informed consent, but I think even with the NFL and college and high school, if we just took contact out of practice, Absolutely.
• 17:14
  Speaker 1: Maybe 30 minutes a week and that's an easy solution and that eliminates 70 to 80 percent of the exposure that these people could have.
• 17:22
  Speaker 1: And that is so.
• 17:23
  Speaker 1: Yeah, to 80% of the exposure that these people could have.
• 17:27
  Speaker 1: And that is so I talked to.
• 17:27
  Speaker 1: We have high schools winning championships in Florida that have no contact practice.
• 17:30
  Speaker 1: Guess what?
• 17:31
  Speaker 1: Six NFL coaches, all with you know we'll talk about TES or CTE and Vivo in a bit, but none of them.
• 17:37
  Speaker 1: They will not allow their kids to practice.
• 17:39
  Speaker 1: If we would just eliminate contact in practice, we can have our football, we can have our rugby, we can have our lacrosse and we can have generations that play the sport and then their brains don't end up with you at that location.
• 17:55
  Speaker 2: You know, in an ideal world, it would also be nice to actually track how many hits these kids are experiencing.
• 18:01
  Speaker 2: How many hits these kids are experiencing.
• 18:03
  Speaker 2: So you know, obviously different players have different styles of play and some styles of play are much more risky than others, and there's an individual component to this.
• 18:13
  Speaker 2: You know how much they lead with their head or use their head in their tackling technique.
• 18:19
  Speaker 2: But you know, so we could sort of of, if we could just sort of monitor it somehow and try to keep track of what each kid is experiencing.
• 18:30
  Speaker 1: Um, you know, I think that would make a tremendous difference as well no doubt do you know right now that you know they got all these.
• 18:36
  Speaker 1: You know the nfl and and and they uh, their Riddell's got this sensor system that goes inside a helmet you know.
• 18:44
  Speaker 1: But the the issue is they won't say at what uh level of G force they're kicking off a hit.
• 18:50
  Speaker 1: They say it's an acceptable industry standard and I was like, yeah, it was, I'm.
• 18:54
  Speaker 1: The NFL says they'll.
• 18:55
  Speaker 1: You know, a concussion is rated at 95 G's and we all know that.
• 19:00
  Speaker 1: You know, 25 G's is about like what running your car into a bridge at 30 miles an hour or something like that, but I think there is a point that could be made to.
• 19:09
  Speaker 1: To track that, to track those devices have you?
• 19:13
  Speaker 1: Have you looked at those devices before?
• 19:15
  Speaker 1: Because that I mean the impact tests.
• 19:17
  Speaker 1: These baseline tests can all be fudged by an athlete that just wants to pass.
• 19:22
  Speaker 2: No, and they're not precise enough to pick up the, the.
• 19:25
  Speaker 2: You know, they're just not, uh, they're not precise enough to pick up the problem.
• 19:30
  Speaker 2: Yeah, accelerometers, uh, they've gotten much better uh, and you know, one of the initial problems with them was they were better at the linear hits, the uh, the acceleration deceleration, and not as good as at the rotation.
• 19:44
  Speaker 1: But everything is improved.
• 19:46
  Speaker 1: Can you explain the difference for our audience between a linear and a rotational hit for parents?
• 19:51
  Speaker 2: Sure.
• 19:52
  Speaker 2: So what's happening is these hits are happening inside the helmet.
• 19:56
  Speaker 2: That's why the helmet, which was designed to stop skull fractures and deaths on the field, which was designed to stop skull fractures and death on the field, things like brain hemorrhages that's what the helmet is for.
• 20:09
  Speaker 2: But the helmet doesn't protect against these acceleration-deceleration forces.
• 20:16
  Speaker 2: When you're running quite quickly and you're stopped, your brain is actually propelled forward and then backward in the brain.
• 20:23
  Speaker 2: Your brain is actually propelled forward and then backward in the brain and it's that linear acceleration-deceleration that stretches the brain inside the skull and actually can damage the tissue because of these tissue-shearing forces.
• 20:37
  Speaker 2: And then the rotational injury is more of a lateral hit where your head spins and the brain, because it's tethered at the back by the brainstem and the spinal cord, it actually twists.
• 20:50
  Speaker 2: It twists in response to these more lateral hits and it can cause damage to the brainstem.
• 20:58
  Speaker 2: And that's why sometimes you see people like Tula Taglialova, you know, have some brainstem reflexes when he went down, because certain hits can actually cause damage to the brainstem.
• 21:12
  Speaker 2: It's not as common with linear hits, it's more common with rotational hits.
• 21:16
  Speaker 2: But those are the forces that we need to mitigate, we need to lessen.
• 21:23
  Speaker 2: They cause stretching of the brain, twisting of the brain, and when that happens inside the skull, inside the helmet, the tissue is actually stressed and nerve cells can be torn, and they're especially vulnerable at the crevices of the brain and around blood vessels.
• 21:44
  Speaker 2: So that's the nature of the injury.
• 21:46
  Speaker 2: It isn't so much the hit on the head.
• 21:56
  Speaker 1: It's the forces inside the helmet, inside the skull.
• 21:58
  Speaker 1: The two issues that are very important for parents to know about is that you know that you create this, you know they talk about the cytocline cascades and the neuroinflammation, and then if the child continues to play, then you know.
• 22:17
  Speaker 1: Then what are we looking at as parents when you have a child that's maybe taking some hits, maybe he's had one concussion or one big blow that he doesn't know is a concussion you keep, but he keeps playing?
• 22:28
  Speaker 1: What's going on inside the brain that these parents need to understand?
• 22:33
  Speaker 2: so every time they've, you know, have a child or or anyone has one of these hits to the head, depending on the magnitude of the hit and probably, and the number of hits, right.
• 22:45
  Speaker 2: So it's not just the individual hits but it's the number of hits over time that's causing brain injury.
• 22:52
  Speaker 2: And the brain injury that we know happens, like you mentioned, there's damage to the blood vessels.
• 22:59
  Speaker 2: The small blood vessels inside the deep parts of the brain actually get twisted and torn and they get leaky.
• 23:06
  Speaker 2: So things that we keep out of our brain.
• 23:09
  Speaker 2: We have a very, very closed system in the brain.
• 23:11
  Speaker 2: We keep out things from the blood that might cause the brain to be inflamed and it's called the blood brain barrier and it's a very, very tightly controlled system.
• 23:22
  Speaker 2: But once you injure the blood vessels in the brain, that blood-brain barrier breaks down, it starts letting things into the brain that ordinarily we'd keep out and those cytokines like you mentioned, pro-inflammatory molecules, get in there and it really sets up a lot of inflammation in the brain.
• 23:41
  Speaker 2: So that's probably the first two things that happen with these hits is the change in the blood vessels, the injury to the small blood vessel, and then this immediate leakage and inflammation, and then what happens very commonly too is the long projections of the nerve cells, the axons, the things that actually connect one neuron to another.
• 24:07
  Speaker 2: Because they're having these acceleration-deceleration forces, they're also stretched and they can become injured.
• 24:17
  Speaker 2: So you get damage to those long fibers, and those long fibers are mostly found in the white matter.
• 24:23
  Speaker 2: So there's white matter damage.
• 24:25
  Speaker 2: I would say that the white matter damage is also a very early feature of these injuries.
• 24:31
  Speaker 2: And then later, after many hits or maybe big hits, but after some time not right away, and only in some people tau starts to build up.
• 24:43
  Speaker 2: And that tau, you know, it starts focally, it starts in just small spots in the brain.
• 24:49
  Speaker 2: But then with aging and we're talking aging, even 20 year olds, a 20 year old compared to a 25 year old that aging, with aging, these changes actually get worse and the tau appears to get more and more deposited.
• 25:09
  Speaker 2: You start to see more and more tau, and even though these individuals give up their sport, they stop playing, there's a vicious cycle happening in the brain with inflammation and tau, and then the tau, more inflammation, and so there's this vicious cycle that occurs after time that will keep getting worse the older the individual lives, and so the idea is let's pay attention to these early injuries, let's find out when we're having these blood-brain barrier problems.
• 25:47
  Speaker 2: There are ways to detect it.
• 25:49
  Speaker 2: Let's look for this inflammation, let's look for these white matter changes, the axonal change.
• 25:54
  Speaker 2: If we can detect those and modify those, dampen those down, you know, rest the brain, do other things that.
• 26:06
  Speaker 2: Rest those, you know, reduce those changes.
• 26:10
  Speaker 2: Then we wouldn't have anybody on this trajectory towards further damage and further damage.
• 26:17
  Speaker 2: And that's what we really want to prevent that late life consequence.
• 26:23
  Speaker 2: And then I just want to say, like your son, he was in the beginnings of this.
• 26:28
  Speaker 2: Right, he wasn't at the tau stage, he was in the beginnings of it.
• 26:32
  Speaker 2: Even that can be very disabling.
• 26:34
  Speaker 2: He had symptoms.
• 26:35
  Speaker 2: He was, you know, having some difficulties.
• 26:38
  Speaker 2: You can talk about those better than I.
• 26:40
  Speaker 2: But you know, even before the tau starts, before you get into this vicious cycle, there's damage to the brain that we could interrupt if we paid attention.
• 26:55
  Speaker 2: A lot of these athletes problems.
• 27:02
  Speaker 2: They start complaining about not being able to control their thoughts, maybe inattention, trouble with their memory, depression apathy all sorts of yeah, apathy, and it's hard to tease out, you know, because these are young kids and they're having adolescence is hard enough, Right.
• 27:24
  Speaker 2: Yeah, I mean it's hard to figure out, it's hard to see, but we really need to pay more attention when kids are complaining.
• 27:31
  Speaker 1: It is.
• 27:32
  Speaker 1: And then kids like my son, who don't complain and their only you know issue was apathy.
• 27:36
  Speaker 1: But there, you know, he, you know Mac, was damaged enough by the age of 17, where he had been schizophrenic for two years, depressed for the number, didn't know what to tell anybody, and ends up running off a cliff.
• 27:48
  Speaker 1: I know that's hard for some people to hear, but that's why we're talking to you and hopefully that we can educate these folks.
• 27:57
  Speaker 1: But it's important for parents to understand.
• 27:59
  Speaker 1: Like you just said, you can stop your child from playing, but if they've been playing since they were six and now they're, you know, all the way through high school, all right that's.
• 28:07
  Speaker 1: You know.
• 28:15
  Speaker 1: That's 12 years of exposure to a developing brain, not just a brain.
• 28:17
  Speaker 1: This is a brain that is still growing, you know, in every way, in preparation for adulthood, and is still not ready by 18.
• 28:26
  Speaker 2: Right, right, and the other point.
• 28:29
  Speaker 2: I think maybe the point was lost because I had such a long-winded answer.
• 28:35
  Speaker 1: It was awesome.
• 28:36
  Speaker 2: But the point we want to make and the point I think is especially relevant to you and Mac this is happening to kids, right?
• 28:45
  Speaker 2: This is not just something in the pros, this is not just something if you play elite level.
• 28:50
  Speaker 2: Contact sports found changes in uh, of cte, the tau protein, and 63 of 152 uh.
• 29:07
  Speaker 2: Contact sport athletes uh, that had come into our bank, um, and they'd come in before the age of 30.
• 29:15
  Speaker 2: These are kids who have not even reached the age of 30 and we're finding about 40 of them them contact sport athletes have CTE, and this is after amateur levels of sports.
• 29:28
  Speaker 2: This isn't playing in the NFL, and this is the thing we really need to stress with coaches and parents that we need to change how we're playing these games so this doesn't happen to your kid.
• 29:42
  Speaker 2: We want to keep these kids safe.
• 29:44
  Speaker 2: They've got a whole long life in front of them and we can't do things that are damaging their brains and preventing them from realizing their full potential.
• 29:55
  Speaker 1: And not only did you find CTE in 40% of those brains.
• 29:59
  Speaker 1: I think it was in a study that you found structural damage and psychological disorders in 100% of them, and 80% of them died by suicide or drug overdose.
• 30:09
  Speaker 1: I mean, this is a massive issue that's impacting children to your point, and they're not even making it to the NFL.
• 30:16
  Speaker 1: They're not even making it to college, some of these kids, and they're still having these issues.
• 30:24
  Speaker 2: Yeah, exactly, they're playing amateur level sports.
• 30:27
  Speaker 2: 71% of those with CTE played amateur level sports.
• 30:33
  Speaker 2: There was one woman too.
• 30:34
  Speaker 2: We had one collegiate soccer player in that group.
• 30:36
  Speaker 2: But this is what we have to prevent away, because it's we don't want to hear it.
• 30:45
  Speaker 2: It's not going to go away because we don't.
• 30:48
  Speaker 2: You know, this is just not we want to.
• 30:51
  Speaker 2: You know, continue doing these sports the same way.
• 30:53
  Speaker 2: This is only going to go away if we address this problem and really try to lower the number of hits experienced in these young people in these sports.
• 31:05
  Speaker 2: We absolutely have to do it in order to make these sports safe and, yes, we have to keep.
• 31:11
  Speaker 2: Sports are wonderful for kids.
• 31:13
  Speaker 2: They're psychologically very important for their development, but physically very important.
• 31:19
  Speaker 2: We want to keep our kids playing sports.
• 31:20
  Speaker 2: Physical fitness is hugely important, but they can't be risking their brain to play these sports.
• 31:28
  Speaker 1: No, ma'am.
• 31:28
  Speaker 1: And I think that another point for parents too is I know we've talked a lot about football here, but what are the other sports that are impacted?
• 31:36
  Speaker 1: I'm seeing, you know, research on gymnastics, just from the way they twist and twirl and I mean, what are these other sports that you know parents need to be concerned?
• 31:46
  Speaker 2: I don't know anything about gymnastics, I have to say, um, but uh, you know ice hockey.
• 31:53
  Speaker 2: Uh, we've seen it with ice hockey.
• 31:55
  Speaker 2: We see this and there's a dose relationship between the number of hits and risk for getting these brain injuries.
• 32:01
  Speaker 2: Uh, we've seen in ice hockey.
• 32:03
  Speaker 2: We're certainly seeing it now in rugby and there's a huge interest uh in australia and the uk about rugby because that's such a popular sport in those areas and you know, there's this is there's been a huge surge of uh awareness.
• 32:21
  Speaker 2: Uh, really, uh, because of the players.
• 32:25
  Speaker 2: The players are speaking out.
• 32:26
  Speaker 2: You know, international rugby players are getting into trouble in their 40s and 50s and so there's a lawsuit now about rugby and you know.
• 32:38
  Speaker 1: Soccer as well.
• 32:39
  Speaker 2: So it's not soccer, right?
• 32:42
  Speaker 2: And then, even in that study that I was talking about previously, we even had amateur wrestlers with CTE that's.
• 32:50
  Speaker 2: That's like high school wrestling.
• 32:53
  Speaker 2: So there's, you really just have to avoid getting your head hit, and and how you do it is is less important that it's the hits to the head that are the problem.
• 33:04
  Speaker 1: Absolutely.
• 33:05
  Speaker 1: There's so much, you know that, that you know we have to learn and and and and and push out to to parents because it's I mean it's everywhere, everywhere you look.
• 33:16
  Speaker 1: I mean we were just contacted by a family whose son took his, his life and he liked to practice heading the soccer ball.
• 33:25
  Speaker 1: Now, what parent out there feels that, ah, he's just heading the soccer ball is going to change his brain in a way that's going to affect his future and that's what we're trying to get along.
• 33:37
  Speaker 1: I mean all my NFL buddies.
• 33:38
  Speaker 1: I'm starting to meet NFL players and they're all a mess.
• 33:41
  Speaker 1: I mean, they're wonderful men.
• 33:43
  Speaker 1: You know, we have a beer.
• 33:45
  Speaker 1: We'll tell stories.
• 33:46
  Speaker 1: They're just like soldiers, you know, and we have a beer.
• 33:48
  Speaker 1: We'll tell stories.
• 33:49
  Speaker 1: They're just like soldiers and it's just every one of them.
• 33:52
  Speaker 1: They just heavily recommend parents, at least don't start until high school.
• 33:57
  Speaker 1: And then, just because of what you're saying, the importance of the brain you only have one brain.
• 34:06
  Speaker 1: It's going to determine everything that you're going to become and move that on.
• 34:13
  Speaker 2: And also so a couple more points I think are worth mentioning.
• 34:16
  Speaker 2: It's not everybody that's getting into trouble, right.
• 34:19
  Speaker 2: It's not 100%, it's not everybody, but it's enough people, it's enough of these athletes to really be concerned, right, it's like you're playing Russian roulette with your kid's brain and they're at risk.
• 34:33
  Speaker 2: And then the next thing I definitely want to mention is they need to be seen, and it's not always easy finding a doctor that actually understands what these injuries are.
• 34:45
  Speaker 2: And you might be gaslit by the medical profession because they're hopelessly ignorant about this situation.
• 34:54
  Speaker 2: So you really have to find someone that's knowledgeable about these conditions and I just want to emphasize that there's treatment to help these symptoms right, we know like if Mac had come in and seen somebody who was aware of these issues, I think he could have gotten a lot of comfort and help in terms of reducing his apathy, because there are things that can be done that make the individual feel better and, we hope, also promote brain recovery.
• 35:30
  Speaker 2: But they have to be seen and they might have to go to several different people because not every physician or nurse practitioner or medical professional knows about these injuries.
• 35:43
  Speaker 1: And I think that's an important point, dr McKee, is that you know for the parents to understand is that the first indication that your child might be suffering from the types of issues associated with repeated head injuries is going to be some form of mental illness, whether it's impulsivity, rage and you need to be alert.
• 36:03
  Speaker 1: We only knew that after the fact that Mac was experiencing extreme amounts of apathy.
• 36:10
  Speaker 1: But for a 17-year-old getting ready to join the army, wanting his room dark, spending less time away from his parents, but without fighting or drug use or violence or yelling at his mom, he was the same Mac all the way till he left us and it's amazing how these kids, when they love their parents, will just hide things until they want.
• 36:33
  Speaker 1: So some of the less more you know apparent forms of mental illness might be.
• 36:38
  Speaker 1: That might be something that the parents need to work at.
• 36:41
  Speaker 1: So, so what's, what's what's next, dr McKee?
• 36:45
  Speaker 1: What are you working on that can get us to the next step of awareness and, like you said, the medical professionals for those parents?
• 36:53
  Speaker 1: They just did a survey I think it was in the New England Journal of Medicine, and 65%, or some crazy number of doctors would actually recommend playing football to a dad who asked him if his son should or should not participate.
• 37:07
  Speaker 1: That is the level of ignorance that we have in our medical associations.
• 37:12
  Speaker 1: We know that our HI is not trained to athletic trainers, psychologists, doctors, nurses.
• 37:18
  Speaker 1: There is an enormous gap that we need to overcome, but it's going to take research and science.
• 37:23
  Speaker 1: So what are you working on right now that could get us to the next level, doctor?
• 37:27
  Speaker 2: What are you working on right now that could get us to the next level.
• 37:29
  Speaker 2: Doctor.
• 37:29
  Speaker 2: Well, you know that what we need is to be able to identify this disease in living people and in youth athletes.
• 37:43
  Speaker 2: We need to identify when they're getting into trouble with brain injury, when they're starting to develop the vascular changes, the inflammatory changes and the white matter changes, because those two, as you know, can be quite disabling.
• 37:54
  Speaker 2: So we need to.
• 37:56
  Speaker 2: You know we are studying now the brains as they come in post-mortem at autopsy and we're doing things like you know, scanning them to see if we can see these changes during life, because we can apply that same scan to living people.
• 38:13
  Speaker 2: And we're looking for blood biomarkers, can we test for various neuronal molecules in the brain, inflammatory molecules that might give us a test for when brain injury is happening.
• 38:28
  Speaker 2: And if we can and there's people doing these studies all over the world that's the holy grail being able to identify these injuries with either blood-based biomarkers or different imaging, like brain, while the person's still alive, while we can give them hope and treatments that will lessen their difficulties.
• 38:54
  Speaker 2: And that's what we're doing.
• 38:56
  Speaker 2: So I'm doing it with people that come to autopsy looking for ways to see these injuries that I could apply to living people, and my colleagues are doing longitudinal studies of living athletes where they're looking for all sorts of changes in these living athletes.
• 39:15
  Speaker 2: There's something called Bank CTE that my group does at BU CTE Center and if you Google that Bank CTE, that's a study of living people where they would donate blood and the blood you know all the details of the blood will then come into us and be analyzed, because we're hoping to establish these a way to diagnose these brain injuries before we get to the point where we're talking about brain donation.
• 39:47
  Speaker 1: And so, dr McKee, if people do feel that you know, I know that I'm on the Veterans Advisory Board with Chris Nowitzki and the Cushion Legacy Foundation.
• 39:56
  Speaker 1: We really want to help expand Project Enlist for the military veterans.
• 40:00
  Speaker 1: Absolutely.
• 40:02
  Speaker 1: So, how do people find you, your research, get on the newsletter?
• 40:06
  Speaker 1: I mean, Dr McKee puts out an amazing newsletter every month.
• 40:09
  Speaker 1: Where do they go to find more information?
• 40:13
  Speaker 2: So it's all under the BUCTE center and I think it's just BUCTE.
• 40:18
  Speaker 2: I forgot exactly, but that's close enough.
• 40:26
  Speaker 1: We'll get it.
• 40:27
  Speaker 1: Google, dr Anne McKee.
• 40:28
  Speaker 1: She's all over the place.
• 40:29
  Speaker 1: Dr McKee, this has been amazing.
• 40:32
  Speaker 1: I'd love to have you come back on in the future and talk about military veterans and how you know RBE is affecting them, because that's a whole nother population that we're writing legislation for, but we do have amazing things.
• 40:45
  Speaker 2: Very important population.
• 40:45
  Speaker 2: We'll get on that soon.
• 40:46
  Speaker 2: We do have amazing things.
• 40:47
  Speaker 2: Yes, absolutely Very important population.
• 40:49
  Speaker 1: We'll get on that soon.
• 40:49
  Speaker 1: We do have our new app coming out.
• 40:52
  Speaker 1: It's called Head Safe.
• 40:54
  Speaker 1: It'll be out here on the Google Store and Apple Store.
• 40:57
  Speaker 1: We definitely want to get you to review that app.
• 41:00
  Speaker 1: We're going to be adding some of BU's resources to it for parents to understand about concussions, but it also educates them on repeated head impacts, recommended age for play, you know, return to play procedures all kinds of great stuff that we're trying to do to get the word out.
• 41:15
  Speaker 1: You've been amazing and before we go, I just want to thank you from the bottom of my heart, because if it wasn't for you that looked at my son's brain and given me the hope that we have right now, I might not be talking to you.
• 41:29
  Speaker 1: It was a very, very dark place.
• 41:31
  Speaker 1: So, because of you and we want to thank our sponsors, the Mack Parkman Foundation, for allowing us to have this podcast and to bring you on I wish you a wonderful vacation.
• 41:43
  Speaker 1: Enjoy your time, dr McKee, and thank you so much for coming on the show.
• 41:48
  Speaker 2: Well, thanks, bruce, I'm happy to do it, and I also want to thank you for being such a warrior in this space.
• 41:54
  Speaker 2: I mean, you have really been an advocate and you have bottomless energy, and we need people like you because you are really making a difference.
• 42:06
  Speaker 1: So thank you, no problem.
• 42:07
  Speaker 1: And I forgot to add that Dr McKee was the winner of the first annual Mac Award for RHI-related research at our conference earlier this year.
• 42:16
  Speaker 1: We're going to be moving that.
• 42:18
  Speaker 2: That's right.
• 42:18
  Speaker 2: That's right.
• 42:19
  Speaker 2: Thank you for that.
• 42:20
  Speaker 2: I love my little trophy.
• 42:23
  Speaker 1: Well, we're going to be moving it to DC next year, so we'll keep you informed.
• 42:29
  Speaker 2: And, of course, we would love you to be a part of it.
• 42:31
  Speaker 1: Okay, great, all right, dr McKee, you have a great day.
• 42:32
  Speaker 1: Keep up the good work, all right.
• 42:33
  Speaker 1: Thank you, ma'am.
• 42:33
  Speaker 1: God bless, take care.
• 42:35
  Speaker 2: Bye you.