Should sports injuries all be covered by the UK Health Services? The brain damaging season of international rugby is about to begin.

Several items in the news make me ask this question again. If we believe in deserts based rationing perhaps our politicians could give thought to dangerous sporting activities. The paraglider did not happen to get a head injury to add to his physical ones – thank goodness. It would be sensible for the state to insist on insurance as a co-payment …. Insurance companies should be responsible for the long term care after injury.

Nadeem Badsghah reports 4th Feb 2016: Paraglider survives flying into a cliff

The former army officer cracked seven ribs, two vertebrae and a shoulder blade and had his pelvis shattered in five places by the impact…. (all repaired by the English Health Service)

Tom m Whipple reports on a small study (no power) which indicates contact sports also have risks: Head injuries cause brain damage found in patients with Alzheimer’s. The brain damaging season of international rugby is about to begin.

Suffering a serious head injury can lead to changes in the brain that are associated with Alzheimer’s disease, research by scientists at Imperial College London has found.

Several studies have suggested that people who suffer a brain injury are at greater risk of dementia, but it was not clear why. In the latest research, published in Neurology, nine patients who had suffered a severe head injury had their brains scanned and compared with the scans of uninjured people.

In all cases the accidents that caused the injury, which included motorcycle crashes and assaults, had been bad enough to require hospital treatment but not brain surgery. The average time between the accident and the study was two or three years, long enough for the brain to stabilise.

“Historically, the damage from brain injury is thought to be static after four months,” said Dr Gregory Scott, from Imperial College. “Increasingly, there is evidence that suggests that is not true, that it is a risk factor for dementia. What though could be the mechanism from an injury that would cause something to get worse over time? That’s not obvious. The view that a brain injury lays the seeds of long-term problems is quite a new idea.”

In the patients who had suffered the injury, Dr Scott and his colleagues found increased build-ups of amyloid beta, a protein strongly linked to Alzheimer’s, even though none of the subjects had developed the disease. In particular, these deposits were found in a central region of the brain, where it builds up in Alzheimer’s patients.

“We are not saying these people have Alzheimer’s,” said Dr Scott. “What we found was evidence of an unusually high level amyloid plaques.” He believes that head injuries could lead to shearing forces that damage white matter, the connecting material in the brain. When damaged, white matter can produce a protein that is a precursor to amyloid plaques. This could point to a mechanism for the link between head injuries and dementia.

One limitation of the study, apart from its small size, was that it looked at people who had had severe injuries. Dr Scott suspects that minor concussions could cumulatively have similar effects.

“Should you play rugby? I’d certainly have reservations. There are probably similarities between one big head injury and lots of little head injuries.”

Dr Rosa Sancho, the knowledge manager at Alzheimer’s Research UK, said: “Evidence suggests that significant or repeated head injury could lead to an increased risk of dementia, but the biological processes underlying this link are not well understood,” she said.

“This small study suggests a mechanism by which damage to the brain could lead to an accumulation of the hallmark Alzheimer’s protein, amyloid, but the people in this study didn’t have any Alzheimer’s symptoms and we don’t know whether they will develop the disease in later life. More research involving larger groups of people will be needed to fully investigate the long-term effects of head trauma on the brain but it’s encouraging to see more research being done in this area.”

Sport’s timely post-mortem – A burden on the state – parents need to be aware of the risks they take for their children when they put them forward for contact sports.

Brain injuries from contact sports – should these be covered by the Health Service?

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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