A butterfly flapped its wings last June and nine months later sport is still dealing with the fallout. It happened when Dr Steve Haake, a professor of Sports Engineering at Sheffield Hallam University, was confronted with a case of self-plagiarism committed by a contributor in a set of conference proceedings he had edited in 2006. It got Haake thinking about a similar incident in his life from around the same time. In 2000, he wrote an article called Physics, Technology and the Olympics, for Physics World. In 2012, he was surprised to find much of that same article repeated, verbatim, in an editorial published in 2005 by the editor in chief of the British Journal of Sports Medicine, Dr Paul McCrory. After dealing with the one old case, Haake decided, at last, to do something about the other.
You may not have heard of McCrory – Haake didn’t know much about him either – but if you have played or watched a contact or collision sport in the last 20 years he has had a hand in your pastime. McCrory was a founder member, and the co-chair, of the Concussion in Sport Group. They produce a consensus statement which is supposed to sum up the existing research into concussion, and which shapes medical practice in the field across grassroots and professional sport. They are funded by World Rugby, the IOC and Fifa, among others. McCrory has been one of the most influential figures in the field for the last 20 years.
The BJSM eventually agreed with Haake that there was a “significant overlap” between the two pieces. McCrory explained that it had been an editing error, that a draft version of his article had been uploaded by mistake. And that is where the matter might have rested. But the story was picked up by an organisation called Retraction Watch, where it caught the attention of an academic named Nick Brown. Brown describes himself as “a self-appointed data police cadet”. He and friend James Heathers had previously exposed flaws in the work of the former Cornell professor Brian Wansink, among others.
Brown decided to start digging into McCrory’s back catalogue. He soon found more articles that contained similar “significant overlaps” with other publications. Within hours of these coming to light, McCrory had stepped down from CISG. One of CISG’s key roles is to evaluate new concussion research. It’s a job that requires the trust of the community of people doing the research, especially since CISG uses such strict eligibility criteria. That strictness is ostensibly why they have always adopted such a conservative position on the risks of chronic traumatic encephalopathy. It says there is not enough proof. According to the group’s most recent consensus statement, it’s still not possible to say that there is “a cause-and-effect relationship” between CTE and concussion. McCrory was the lead author.
The chain of events that followed Haake’s decision to deal with that one case of plagiarism from 2005 has left the governing bodies that relied on CISG in the years since having to explain why they invested so much stock in their work and decide whether they will continue to stand by it. The group’s credibility, which had already been called into question by campaign groups and politicians during the DCMS hearings into concussion in sport last year, is at an all-time low. Their latest conference, which has already been postponed twice, is due to be held in Amsterdam later this year.
This is a problem for World Rugby in particular, and not just because of their involvement in the legal test cases about how their sport handled concussion in the years they were being guided by CISG. Rugby union’s governing body currently operates a six-day return-to-play protocol, meaning it’s possible for a player to be concussed one Saturday, and, if symptom-free, they can be back playing by the following Saturday (although in practice players are often out for much longer). It used to have a mandatory three-week stand-down for concussed players, but this was changed to bring it in line with the recommendations made by CISG in their 2012 consensus paper, of which, again, McCrory was the lead author.
In the last year the AFL has increased its return-to-play period to 12 days and the Rugby Football League increased its return-to-play period to 11 days. World Rugby has come under pressure to increase its return-to-play too, but hasn’t – it says this is because of a belief that a blanket time-limit would mean that players start under-reporting symptoms (if they are right about that, it suggests they still have more work to do on their player-education programmes because the players still don’t understand exactly what’s at stake, although, given that last CISG Consensus statement questions the link between CTE and concussion, they are not alone in that).
What World Rugby has done instead is adopt what it describes as a more “individualised” approach to the issue, in which the time it takes to return-to-play is decided on a case-by-case basis. This shift, which is in line with the advice from their independent concussion working group, suggests it is already trying to put distance between itself and the policies laid out by CISG, which they relied on for so long.
This “individualised” approach is fine in theory, but in practice inevitably leads to inconsistencies in the way concussed players are managed. If it’s going to work, everyone involved, especially players, former players and their families, has to have complete faith in all the different processes the sport is using to diagnose concussions and manage the return to play.
Given these are the same systems that allowed Tomas Francis to play on after he showed evidence of concussion against England, and which have allowed Wales to say they are happy to pick him again to play tomorrow even though he had a previous concussion in November, that is not the case.
