The risk for chronic traumatic encephalopathy (CTE) in the National Football League (NFL) workforce qualifies as a “significant risk of material impairment of health” that would allow the US Occupational Safety and Health Administration (OSHA) to intervene to reduce exposure to repeated head trauma, according to research findings presented at the American Public Health Association 2018 Annual Meeting and Expo, held November 10-14 in San Diego, California.

In determining how OSHA might help regulate head trauma in the NFL, public health researchers found that both healthcare and legal professionals have been “manufacturing doubt” regarding the severity of CTE in professional football. This doubt stems mainly from the results of a study in which 110 of 111 deceased former NFL players were discovered to have had a pattern of brain lesions characteristic of CTE.

Some physicians have asserted that the association between repeated head trauma and CTE may be “artefactual rather than causal” and that the high incidence rate is biased because of “self-selection of players who had cognitive or emotional symptoms.” Furthermore, these healthcare professionals claim that even if repeated head trauma causes CTE, the lesions may be “inconsequential as a clinical matter.” In addition, some physicians assert that there were CTE cases in which the person had no history of head trauma. The researchers rejected this claim, stating that nearly every disease has multiple causes.

Continue Reading

Conversely, public health scientists do not view the evidence with the same skepticism. The study researchers “make the case quantitatively that even accounting for the non-representative nature of the 110 cases” the risk for CTE in the NFL workforce qualifies as a “significant risk of material impairment of health.” In addition, the researchers stated that CTE can be used as a “real-time” example of how analyzing case reports, epidemiologic and toxicologic evidence, and in vitro data via a public health approach “excels at its purpose.”

Related Articles

“We suggest that physicians and lawyers should have a better appreciation for how regulatory science can shed light on public health problems and increase social welfare while we await definitive answers regarding specific causation,” the researchers concluded.

Click here for more news from the American Public Health Association 2018 Annual Meeting and Expo.


Finkel A, Bieniek K. A quantitative risk assessment for chronic traumatic encephalopathy (CTE) among NFL workers: how public health science evaluates evidence. Presented at: American Public Health Association APHA 2018 Annual Meeting and Expo; November 10-14, 2018; San Diego, CA. Abstract 5043.