The hits keep coming

IRELAND’S best rugby player, Brian O’Driscoll, could barely stand after taking a hit from a French rival during last year’s Six Nations tournament. Medics helped the dazed centre off the pitch, but minutes later he was back on, his head wrapped in bandages. Team-mates called him a warrior. His dad, Frank, called the decision to let him return “nonsense”. Brian had suffered a concussion, an injury caused to the brain when it moves abnormally in the skull as the result of an external force—such as being walloped by a hulking Frenchman.

In the short term, concussions can cause dizziness, nausea and memory problems. Doctors recommend at least a week’s rest after sustaining one. In the long term, multiple concussions may lead to far more serious problems, like early-onset dementia. Mr O’Driscoll senior worries about his son’s future health. Those who run and profit from rugby, and other sports that see hefty men’s heads shaken by collision or contact with fast-moving balls, should be worried, too. Brain injuries threaten these games’ very existence.

American football provides a cautionary tale. When players began complaining about their heads in the 1990s, the National Football League (NFL), which runs the sport, played down the problem. When the brains of several American footballers who died early showed signs of chronic traumatic encephalopathy (CTE), a degenerative disease also known as “boxer’s dementia”, the league dismissed the findings and touted its own reassuring research. But last year the NFL agreed to pay $765m to settle a class-action lawsuit brought by ailing former players who accused it of deception. In January a judge rejected the settlement, saying it might not be enough to cover the players’ health-care costs.

Wealthy American-football clubs can handle the financial strain. But similar lawsuits would bankrupt professional rugby. Though the sport is played in less litigious countries, rapacious lawyers are not just an American phenomenon. Potential clients abound. The Rugby Football Union, which runs the sport in England, reported 6.7 concussions per 1,000 hours played last season. Some doctors and players believe the real rate is much higher and exceeds that of American football. Players “see stars” in nearly every match, says Rory Lamont, a former Scottish international.

Doctors have accused the sport of trivialising the issue. The body that oversees the game recommends that professional players suspected of concussion come off to be checked out by a doctor. Players must answer a series of questions, including “Where are we?” and “Which half is it?”, and pass a balance test to be allowed to return. Failure means the team must use a substitute, or play on a man down. Some have passed just minutes after being knocked senseless. Rugby leagues say they are conducting their own research on concussions—much as the NFL did.

Even subconcussive blows can cause brain damage if an athlete sustains enough of them. In a study of amateur football (soccer) players, Michael Lipton of the Albert Einstein College of Medicine in New York found that those who frequently headed the ball had brain abnormalities similar to those found in patients with concussions. Perhaps this should have come as less of a shock. Jeff Astle, a former English footballer known for heading the ball (which was heavier in his day), died of degenerative brain disease in 2002, aged 59. The cause of death was recorded as “industrial injury”—the industry being football.

Collisions between players are a more obvious cause of concussions in football. Many professional leagues now issue red cards (automatic ejections) for high elbows. But, as in rugby, concussed players find their way back onto the pitch. Hugo Lloris, a goalkeeper for Tottenham in the English Premier League, returned shortly after being knocked out during a game last November. He was allowed back on, his manager said, because he “seemed assertive and determined to continue”.

Those who see shades of the NFL’s alleged deception point to the Zurich guidelines, a set of recommendations for dealing with concussions on which many rugby and football leagues rely. These have been criticised for downplaying the long-term consequences of brain injuries. Though the science is young, the evidence so far all points in one direction. The brains of several former boxers, hockey players and American-football players have shown signs of CTE. The NFL itself has reported higher rates of dementia among former players than the general public. Ongoing studies hope to clarify the causal links.

Fans may be happy to cheer the brutality, like Romans watching gladiators. Boxing and other fighting sports, after all, still draw crowds. And the pressure to make American football safer has already led to rule tweaks: some of the riskiest types of collisions now attract stiffer penalties. But that is more than has been done in other ball sports, and anyway, may not be enough. A recent poll found that four in ten Americans would steer their children away from American football because of worries about concussion. If that share grows further, advertisers could take fright—and the supply of future players could dry up.