Brain-Injured Footballers, Voluntary Choice and Social Goods. A Reply to Corlett

In this essay, we respond to Angelo Corlett’s criticism of our paper ‘Ethics, Brain Injuries, and Sports: Prohibition, Reform, and Prudence’. To do so, first, we revisit certain assumptions and arguments Corlett makes concerning intercollegiate football and brain injuries in his 2014 paper ‘Should intercollegiate football be eliminated?’. Second, we identify and criticize two key elements in his response regarding (a) ‘luck egalitarianism’, and (b) ‘public goods’. We conclude by reaffirming our critical reading of Corlett’s original 2014 paper and by identifying further elements (i) luck and the nature of individual responsibility; and (ii) the nature of sports as public rather than merely private goods, that he would have to address for his latter 2018 position to hold true

Some comments on a paper by Macleod on Lagrangian interpolation

AbstractSeveral implementations of Lagrange interpolation are compared for stability against rounding error, using tables at equal intervals (unlike Macleod). It is found that the divided difference method is just as accurate as the modified Neville method. The former, being faster, should be used in all cases

Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport

The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27–30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews

Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies

Objective Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes.Design Systematic review.Data sources Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022.Eligibility criteria Studies measuring future risk (cohort studies) or approximating that risk (case-control studies).Results Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias.Conclusion Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27–30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete’s perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research

When should an athlete retire or discontinue participating in contact or collision sports following sport-related concussion? A systematic review

Objective To systematically review the scientific literature regarding factors to consider when providing advice or guidance to athletes about retirement from contact or collision sport following sport-related concussion (SRC), and to define contraindications to children/adolescent athletes entering or continuing with contact or collision sports after SRC.Data sources Medline, Embase, SPORTSDiscus, APA PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched systematically.Study eligibility criteria Studies were included if they were (1) original research, (2) reported on SRC as the primary source of injury, (3) evaluated the history, clinical assessment and/or investigation of findings that may preclude participation in sport and (4) evaluated mood disturbance and/or neurocognitive deficits, evidence of structural brain injury or risk factors for increased risk of subsequent SRC or prolonged recovery.Results Of 4355 articles identified, 93 met the inclusion criteria. None of the included articles directly examined retirement and/or discontinuation from contact or collision sport. Included studies examined factors associated with increased risk of recurrent SRC or prolonged recovery following SRC. In general, these were low-quality cohort studies with heterogeneous results and moderate risk of bias. Higher number and/or severity of symptoms at presentation, sleep disturbance and symptom reproduction with Vestibular Ocular Motor Screen testing were associated with prolonged recovery and history of previous concussion was associated with a risk of further SRC.Conclusion No evidence was identified to support the inclusion of any patient-specific, injury-specific or other factors (eg, imaging findings) as absolute indications for retirement or discontinued participation in contact or collision sport following SRC

Sports Betting, Horse Racing and Nanobiosensors – An Ethical Evaluation

Horse racing has begun to enter an economic decline in many countries, notably represented by a decline in revenues in betting volumes. A number of reasons may be attributed to this: the success of other sports; new online betting practices; and concerns over animal welfare. In response to this, horse racing institutions have begun to modify its practices, employing technologies such as GPS sensors and Wi-Fi active racetracks, with the aim of engaging a new generation of spectators, including betting spectators, to the sport. We consider a new biotechnological potential for the sport to develop through the use of nano/biosensors in horse racing. The biological data collected by these sensors in real time could be used to offer a number of potential benefits to the sport, such as new forms of bets, support for animal welfare and increased levels of immersive spectator experience. Despite these potential benefits, the use of nano/biosensors can also expose the sport to a number of disbenefits such as increased opportunities for corruption, technological determinism, and issues concerning unethical use of the data collected. We present a critical ethical evaluation of this potential development and argue that stakeholder consensus is required before the technology is implemented, and that an appropriate regulatory framework is established to support its (potential) implementation

Sport Integrity: Ethics, Policy and Practice: An Introduction

There can be little doubt that integrity in the playing and management of sport is becoming one of the critical issues in global sport and its governance. This special issue aims to contribute to the scholarship that is emerging in this important field for policy makers and managers in sport. The articles reveal the breadth of topics that are located within the scope of the term ‘integrity’, ranging from sport governance, athletes’ rights, match-fixing and sports’ organisational management practices. The approaches taken to the study of these critical issues by the authors is necessarily multidisciplinary, incorporating ethical theory, empirical studies and historical analysis that encourage an holistic understanding of the problems under investigation

Autonomy, eating disorders and elite gymnastics: ethical and conceptual issues

Participation in elite sport, and in particular those sports with special demands in terms of weight and shape, is associated with a higher risk for eating disorders such as anorexia nervosa [Sundgot-Borgen, J., & Torstveit, M. K. (2010). Aspects of disordered eating continuum in elite high intensity sports. Scandinavian Journal of Medicine and Science in Sports, 20, 112–121]. We report upon research exploring eating attitudes and behaviours within elite gymnastics. The study comprised 42 semi-structured interviews with gymnasts and support staff—34 gymnasts and 9 staff/support staff. The majority of those interviewed were acrobatic gymnasts (22; 16 males and 6 females) with 7 rhythmic gymnasts (all female) and 5 tumblers (all female). The mean age of those gymnasts interviewed was 17.4. A difficulty in precisely delineating extreme eating patterns (disordered eating) from having an eating disorder was noted. Within an elite sports context behaviours thought to be pathological in a more general setting might be fairly commonplace and even functional to the athlete's performance. The extent to which the athlete consents to these patterns of behaviour is problematic given their age and development. We argue that conceptualising consent as ‘authority to be cared for by a trustworthy coach’, more felicitously applies to the child/adolescent elite sporting context, helping us understand not only the focus of the elite gymnast, but also their relationship with the coach and the coaches' responsibilities

Ethics, Brain Injuries, and Sports: Prohibition, Reform, and Prudence

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on (a) the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative brain disease known as chronic traumatic encephalopathy (CTE); and (b) John Stuart Mill’s rejection of consensual domination (ie voluntary enslavement). We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that (i) certain autonomy-based arguments undermine paternalist arguments for reform; (ii) the nature of the goods people pursue in their lives might justify their foregoing (degrees of) future autonomy; (iii) Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; (iv) the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded