The British Journal of Sports Medicine says it is investigating a body of work published by its former editor-in-chief, neurologist Dr Paul McCrory, in light of “additional allegations of plagiarism” against the world-renowned concussion expert.
The peer-reviewed journal will also review the past four consensus statements published by the global Concussion in Sport Group (CISG), of which McCrory was the lead author, along with a sample of other papers on which he is the first or senior author.
McCrory resigned from his role as chair of the CISG in March after the British Journal of Sports Medicine retracted a 2005 editorial, published while he was editor-in-chief, citing an “unlawful and indefensible breach of copyright” of the work of Prof Steve Haake.
In the months since, he has been accused of copying material in other articles without attribution and reportedly apologised, telling website Retraction Watch that he had requested the papers in question be retracted and “the errors were not deliberate or intentional”.
He has also become the subject of investigations by the AFL, for whom he is a former longtime concussion adviser, and Australia’s medical regulator. McCrory has not responded to questions about the allegations from Guardian Australia.
In a statement on its website, the BJSM, which is published by the Britain-based BMJ Group, said it was prepared to take action should the additional allegations turn up further instances of plagiarism.
“BMJ recently retracted ‘The time lords – measurement and performance in sprinting’, authored by former BJSM editor-in-chief Dr Paul McCrory, due to what was established by BMJ’s Research Integrity team as unlawful and indefensible breach of copyright,” the statement read.
“We are aware of additional allegations of plagiarism against Dr McCrory that have since been brought forward. BMJ and BJSM take these allegations very seriously. The BMJ Research Integrity team is currently examining these allegations and will act accordingly when the investigation is complete.”
McCrory, who is also an honorary associate with the prestigious Florey Institute for medical research in Melbourne, was editor-in-chief of the BJSM from 2001 to 2008. He has published hundreds of articles in journals including that publication.
“The BMJ Research Integrity team is investigating all allegations as well as a sample of other papers in which he is the first or senior author,” the statement said.
“We understand that Dr McCrory has resigned from his leadership position in the Concussion in Sport Group (CISG) as well as his role as part of the Scientific Committee of the International Consensus Conference on Concussion in Sport.
“BJSM has published five iterations of the consensus statement from these consensus conferences (Vienna 2001, Prague 2004, Zurich 2008, Zurich 2012, Berlin 2016). Dr McCrory is first author on the latter four statements.
“These will also be reviewed by the BMJ Research Integrity team. Whether Dr McCrory’s actions affected the content of prior statements is the purview of the Scientific Committee appointed by CISG.”
The CISG is an international body of experts who have met every four years since 2001 to provide sporting codes around the world with blueprints on how to manage head injury, and is funded by the International Olympic Committee, Fifa and World Rugby among others.
The consensus statements it produces have been used to inform the concussion management policies of professional leagues including the NFL, World Rugby and the AFL, and is responsible for developing the standardised SCAT5 tool used by doctors to evaluate head injuries in athletes aged 13 and over.
McCrory is the lead author of four of the five consensus statements, which have been plagued by criticism for allegedly not being informed by strong evidence. The most recent of these statements, issued in 2016, does not acknowledge “a cause-and-effect relationship” between repeated concussion or sub-concussive impacts and the neurodegenerative disease chronic traumatic encephalopathy.
Last year a group of academics, researchers, clinicians and carers argued the CISG’s consensus statement process has consistently underplayed the risks.
McCrory has been a high-profile public spokesperson about concussion in sport globally. He has also on multiple occasions expressed doubts over the relationship between concussion and CTE, and his resignation has prompted questions about the quality of evidence behind some concussion policies.
Earlier in April the AFL announced that senior lawyer Bernard Quinn QC would lead an independent review into concussion advice and medical research provided to the league and its players by McCrory.
Following the plagiarism allegations, there has been a growing push for better concussion research. A study published in the Journal of Concussion by researchers in Canada analysed the most widely cited concussion consensus statements and guidelines, finding they were not informed by strong and well-designed clinical trials, known as randomised control trials.
The researchers included in their analysis those four CISG concussion in sport consensus statements authored by McCrory.
“There remain many unanswered questions about how concussion can best be prevented, diagnosed, managed, and treated,” the authors of the analysis wrote.
“A review of widely-cited concussion consensus statements demonstrates that best practice in concussion management is still largely informed by moderate-level evidence … calls for further high-quality evidence have been made in order to form definitive clinical guidelines.”
A separate study led by Monash University in Melbourne published in April found the brains of amateur Australian rules footballers are still recovering two weeks after receiving a concussion.
The study, published in the journal Sports Medicine Open, adds to growing concern that sports-related concussion guidelines that allow players to return to competition 11 days (NRL) or 12 days (AFL) after they have been concussed may be inadequate.
Associate Prof David Wright, from the university’s department of neuroscience, used magnetic resonance imaging (MRI) to measure structural changes, oxygen consumption and blood flow in the brains of concussed male and female amateur Australian rules players.
The 13 athletes in the study underwent the MRIs after being cleared to return to play following the mandatory 12-day recovery period. They were compared to a group of 16 control group Australian footballers who had not had a sports-related concussion for the previous three months or more.
Despite the recently concussed Australian footballers being cleared to play, the study found evidence that the athletes’ brains had not yet fully recovered.
“We found evidence of residual injury in the white matter of the brain as well as a trend for reduced blood flow in the brains of those who had had a recent concussion and been deemed fit to return to play,” Wright said.
White matter changes and repeated head injury have been linked to the development of mental illness and an increased risk of suicidal ideation. White matter degradation has also been seen in athletes with no other conditions, such as heart disease or diabetes, that might explain it, as in the case of the late AFLW player Jacinda Barclay.
A joint article written by neuropathologists and neuroscientists, published in the Medical Journal of Australia following McCrory’s resignation from the CISG, said: “McCrory’s downfall has cast doubt over international consensus guidelines for the management of head injury in sport, and focused a bright light onto conflicts of interest in sports medicine within elite/professional sports”.
A co-author of the article, La Trobe University neuroscientist Associate Prof Alan Pearce, said although the AFL had announced a review of McCrory’s concussion work and medical advice, attitudes around concussion still needed to change.
Pearce, who has previously spoken of his difficulties with the AFL when he tried to study the impact of concussion on former players, said it was now clear the resolution of symptoms was not enough to clear a concussed player to return to the field. More rigorous research was needed and should be funded to better understand what concussion recovery looks like, he said.
