From Concussions to Carl Sagan: A Few Words with Sports Illustrated's David Epstein

It's possible that even the insular MMA crowd has heard the name 'David Epstein'. He was, after all, the first high profile journalist to cover MMA, having done so all the way back in 2007 for Sports Illustrated. But his emphasis has never been MMA, instead having distinguished himself as a writer of medical science in sports, with his work having found itself in publications like Discover, Scientific American, and The Guardian. In the sports world, however, he might be best known for helping break the story (alongside Selena Roberts) on Alex Rodriguez' steroid use, and the unique scientific insights offered behind Ben Roethlisburger's antisocial behavior.

On top of being one of the most informed minds on the issue of brain trauma in sports, he's also an incredibly cool individual, and was kind enough to talk to me on the phone for over an hour. Amusingly, it was a fanpost on BloodyElbow that allowed me to cross paths with Mr. Epstein, as we were both asked to contribute work at In Media Res over media representations of brain injuries in sports (big thanks to the theme week organizer, Shane Toepfer). Despite shining a bright light on the concussion problem with cutting edge research, his position on the topic remains fiercely nuanced, and uniquely level headed.

We talked at length about brain trauma, but not just brain trauma. I've divided this interview into 2 parts, the first of which concentrates on an introduction to David Epstein, the person, and the concussion problem. Stay tuned to HKL for the second part tomorrow, in which David talks about ImPACT, ADHD, and tells a great GSP story while giving his prediction for the Georges St. Pierre vs. Nick Diaz fight.

David: So one of the first things I'd like to ask, is why the interest in science and sports? What about that unique combination appeals to you?

David Epstein: Up through the college, it just kind of merged my interests basically. I studied geology, astronomy, and ended up going for my masters in geology, actually. I was also a national level competitor in the 800 meters, so I was a national level athlete and a science student and was always interested in the science behind my own training. With science in general I saw the potential to merge my interests. The one thing I really wanted to do with my career was to try to reach an audience with science content. To basically reach an audience like me who didn’t spend all their disposable income on Scientific American (laughing). And so sports journalism was a way to do that.

And then going on from that there was a traumatic event where one of my former training partners dropped dead after a race. And so I became curious to find out what happened to him. His family signed away his medical records to me, and so I went and started learning about sudden cardiac death in athletes, and more specifically, a disease called Hypertrophic Cardiomyopathy, and so I decided I need to write about this. And I felt like I wanted to do something so that my friend didn’t die in vain. That was my first long sports science article for Sports Illustrated.

David: I’m curious. Was there a particular figure of inspiration, or a scientific figure of inspiration for you? You mentioned geology, and I think I heard astronomy somewhere in there too. Someone like Carl Sagan, perhaps (?)…

David Epstein: Absolutely. When I got interested in science I was really interested in him (Sagan). We actually have a funny family story about Carl Sagan because he briefly dated my aunt when she was in college. On one particular day he was having a discussion with one of my relatives, talking passionately how we would put a man on the moon, and of course, this was back in the 50’s, and so my relative thought this guy was just some out of his mind, crazy person (laughing). But as I got older a guy by the name of Dr. Bernd Heinrich,  who was a biology professor at the University of Vermont, and an Ultra Marathon Champion, wrote a book about why we run, about the evolution of human endurance running, and kind of studied endurance in other animals for his Ph.D. With the research in mind, he then applied what he learned to his own training, which led to him winning the World Ultramarathon Championships. And it's just awesome.

David: Sounds like a book I'll have to add to my Amazon.com shopping cart. So obviously, one of the reasons, though not the only reason for asking you to agree to this was to talk a bit about the concussion problem. I want to start with David Zinczenko’s piece in the New York Times on MMA, who referenced a John Hopkins study that found only 28 percent of all MMA bouts are decided by a blow to the head. Part of Zinczenko’s argument that MMA, quote unquote, only looks dangerous, in addition to that primary statistic, was the presence of wrestling, and how fights are often decided by wrestling alone. Can you talk about why this argument is a little deceiving given what you've found on the unlikely incidence of concussions in other sports?

David Epstein: First, on the issue of MMA safety, having talked to a lot of doctors, the short answer is that nobody knows for sure. But there are obvious markers that distinguish its level of safety from boxing, for example, because a fighter isn't asked to stand back up after getting hurt, just to receive more punishment. I think there's a sound theoretical suggestion that these rules in MMA, stopping the fight once a fighter is down, for example, limits brain trauma. At the same time, when I talk to these doctors, they say that the blow to the head with the most force may well be the heel to the head. I don’t know if you remember seeing Gabriel Gonzaga and Mirko CroCop-

David: Oh yea, yea (laughing)...

David Epstein: (laughing) So a hit of that magnitude is probably never good (laughing).But going back to the incidence of concussions-

David: Well I understand you've found that incidence in some unlikely places, like equestrian sports, for example?

David Epstein: Yea, that kind of shocked me, and that came out when I was interviewing and reading the work of a guy named Jeffrey Barth who specializes in head trauma at the University of Virgina. He some years ago with some colleagues tried to look across a number of sports and their concussions rates. And the most unlikely place was in equestrian sports, which we usually think of as a very genteel sport, but what they found is that there was something like 90% of people surveyed who had suffered a concussion. The major ways the people would be concussed was falling off a horse, or taking a branch to the head while riding on a trail

...but one I never would have thought at all, was when people were grooming the horses, if the horse would shift its weight, being so heavy, they would slam people up against the wall of the stable, and apparently that was a rather regular way to suffer a concussion if you spent significant time with horses over the years. But the point, and one Barth emphasized, is that you don’t even need to get hit in the head to suffer a concussion. People get rear ended and get a concussion just from their head jerking really quickly. Because the brain is encased in fluid, it hits the side of the skull at the slightest, but sudden acceleration. The stable wall probably isn’t as hard a hit as Ray Lewis taking out a wide receiving coming down the middle but if the person taking the blow isn’t ready, if the neck isn’t tense, then even a seemingly small hit can be really bad, and we see that in baseball and hockey. Where Justin Morneau takes a knee the head on an innocuous collision in the infield, and is out for 8 months. Or Sydney Crosby, who takes a blind side hit and is out for, like, a year. When these hits come when you’re not ready, they can be especially dangerous.

David: Did you ever come across any unique data with regard to wrestling?

David Epstein: I actually had trouble finding good data. There’s more data for soccer. But asking around, the only study of any worth I know of was a North Carolina study, which found that wrestling sits as low as cheerleading on the concussion scale. When the concussions do occur, 86% of the time they occurred when people were trying to prevent a takedown. Wrestling does have a high injury rate, but they come from torn ligaments, broken bones, and eye injuries. But the more we learn, the more we know that subconcussive hits are the real culprit. 

David: So can you talk a bit about that? How people’s perception on this issue is skewered, and how concussions alone are not the measurement of trauma, and to that end if you can talk about some of the interesting Purdue research, and what was done with accelerometers.

David Epstein: So this group at Purdue, what they wanted to do, is to find out...so basically we kind of know the story when it comes to football players who have been playing for a long time. When they die, we autopsy their brain, and everytime that’s done we see those tau proteins which are a sign of CTE. So the Purdue researchers, in knowing how this story ends, wanted to see how this story begins.

They said let’s see if we can find brain impairment in real time and so their idea was to insert accelerometers in the player’s helmet, and log every hit that the players took over the course of a season and find out what amount of g-force causes a concussion and then to measure how mentally impaired the player was by the concussion. So if the player got concussed the idea was to take them into the lab, have them take tests on memory, and focus (with imPACT), and eventually test their short term memory while being put under an fMRI. 

What surprised the group at first, yea they're seeing these big hits, 80 g’s, 100 g’s, and so forth, but after the first couple of weeks, the players didn’t have any concussions. Despite this, several of their kids were showing impairment on the tests, and irregularities on the MRI. So at first they’re thinking something is wrong with their equipment, until pretty soon they realized most impaired kids were consistently the ones taking the highest number of mid level hits, especially mid level hits on top of their head. The best predictor of impairment on these tests on memory and focus was not who suffered a concussion, but who suffered the greatest number of middling hits, the kind of hits linemen put on each other every play. The fortunate thing is they went back to their baseline scores on the imPACT tests, but the bad news is that they’re impaired in the absence of a concussion; impaired in a way that’s difficult to identify. You see their brain is working differently in the MRI, and now the real question is when does that become irreversible, and at what point?

The study emphasized that it might not be these concussive blows. In fact, concussions just might be a proxy for the number of hits someone has taken and it's perhaps just the accumulation of small hits, speaking to the idea that that you can either break something with one gignantic hit, or a number of small hits. And I think we’re gonna see attention towards limiting the number of subconcussive hits. Even just looking at NFL players, who are the players ending up with CTE and dementia? They’re not just the safeties, who are putting big hits on guys in the open field. They’re linemen.

David: What I also found interesting is that these studies, along with others, seemed to pinpoint where this trauma is taking place, namely in the prefrontal cortex, which houses what we think of when we think of general cognitive function. Can you talk a bit about what happens when this area of the frontal lobe is damaged?

David Epstein: So the prefrontal cortex is kind of, in laymen’s speak, the part of the brain that is uniquely human. In the period that modern humans arose, the prefrontal cortex grew at a disproportionate rate compared to the rest of the brain, and is much much bigger in humans than in other species. And that is reflected in how it's specialized: for example, specialized for social decision making, moral judgment, and the ability to emphasize, for example.

So we see that when people who have a damaged prefrontal cortex, usually soldiers, they show signs of not being able to navigate social situations well anymore, or they'll say inappropriate things publically, without expressing any realization that they’re being improper. So a lot of times family members of soldiers say that 'well there's nothing physically wrong, but there's something wrong regardless', and it's reflected in personality. Normal people understand where to take a derogatory comment, which is to keep it in their head instead of saying it out loud.

So when that damage is done, we're altering these behaviors that are important to modern human society. Doctors who work with people who have been injured in battle require behavioral therapy, and we see the same thing with some of these athletes. People like Mike Webster, and some boxers who have basically ceased to function socially, and thus can't even hold down a regular job, or simply can't lead normal lives. In losing those functions, these guys are reacting with an acute despondency because they are losing functions that are hallmarks of the prefrontal cortex, which itself is a hallmark for uniquely human behavior.