"Who Killed Davey Moore?"

In November 2013, PBS released a documentary titled “League of Denial”, which chronicled the supposedly secret phenomenon of chronic traumatic encephalopathy in the NFL. Neurological findings were present in several retired football players, and current superstars, including Brett Favre, disclosed that they had been struggling with such sequelae of recurrent head injury as memory loss and depression. Some report entire years they can’t remember.

Part of the national conversation spawned was a review of the inherent conflict of interest in providing medical care to professional athletes. There is great ethical incentive to protect the safety of any human body, but particularly one so talented and well trained. There is great financial incentive to allow that same human body to return to the game, even if it means fudging the details slightly. There is great personal incentive when faced with an athlete, any athlete, whose greatest joy comes from motion and contact and competition and you stand in the position to take that joy away. None of us are immune to these pressures, whether the athlete is a 300 pound defensive lineman on national television, or the 120 pound martial artist who insists that she’s taken blows to the head much worse than that one so can’t she get back into the tournament, doc? How many of us know an athlete, or a fan for that matter, who place greater value on the player’s ability to “take a shot”, than they do to the ability to “get out of the way”?

In this issue of OFP, we feature an article that hopes to take some of the subjectivity out of the process of medical clearance in the head-injured, exploring several different metrics for evaluation before return to the game, reviewing post-injury treatment and monitoring, and discussing some of the legislation and other standardization measures which are applied to student athletes in most states. This academic review is accompanied by a patient handout specifically for athletes and people who work with them. There are no perfect tools, but systems make our delivery more standard and keep us all out of trouble. They also provide us backup when trying to sell our patients on unpopular but necessary decisions.

In 1963, Bob Dylan penned a song describing the untimely death of Davey Moore, a boxer who died in the ring after several signs of severe head injury were under treated, in part due to the conflicts of interest on the part of the manager, the referee, and even the screaming crowd who continued to cheer as Mr. Moore wobbled on his feet. 40 years later, all of us continue to share clinical and moral responsibility for the athlete with traumatic brain injury. We at OFP hope you find this issue useful in creating clinical pathways for keeping them safe.