Drake Calls for Independent Investigation of UNC Concussion Research Allegations

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Drake Calls for Independent Investigation of UNC Concussion Research Allegations

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PRESS RELEASE – NOVEMBER 7, 2019

For immediate release
For more information:
Dr. B. David Ridpath, Ed.D.
President
The Drake Group
www.TheDrakeGroup.org
740-677-2642


The Drake Group Calls Upon the U.S. Department of Defense Office of the Inspector General to Initiate an Independent Investigation into Allegations of Concussion Related Wrong Doing

 

NEW HAVEN, CT – B. David Ridpath, Ed.D., president of The Drake Group, stated, “Over the past five months, a number of serious allegations related to University of North Carolina – Chapel Hill (UNC) concussion research, the diagnosis of learning disabilities (LD) and attention deficit and hyperactivity disorders (ADHD) among UNC athletes, the possible failure to advise UNC athletes with secondary LD/ADHD of heightened concussion risk and other concerning ethical issues have been raised. While we do not opine on the validity of these allegations, the number, specificity and seriousness of the allegations are alarming. In addition, we express strong concerns regarding the possibility of a truly independent investigation. Thus, we recommend that the U.S. Department of Defense (DoD) Office of Inspector General lead an international panel of expert bio-ethicists and neuroscientists in an independent investigation to determine the veracity of UNC concussion-related research deficits alleged by Ted Tatos and Donald Comrie.”

Introduction
On June 6, 2019, Ted Tatos, a University of Utah adjunct professor and economist, and Donald Comrie, the chief executive officer of NeuroLabs, published the research article: “Cognitive Disorders Among Incoming College Football Athletes: Legal and Medical Implications of Undisclosed Inclusion in Concussion Research” in the Journal of Scientific Practice and Integrity (JoSPI).[i] This study called into question the validity and utility of research conducted under the direction of Kevin M. Guskiewicz, Ph.D., ATC, a world-renowned researcher, who is currently the UNC Interim Chancellor and the Co-Director of the UNC Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center. Guskiewicz is among the most respected researchers and experts in the realm of sport-related concussion. He has received 23 research grants, published over 90 journal articles and six textbook chapters and awarded honors by the American College of Sports Medicine (2003), the National Academy of Kinesiology in 2006, and the National Athletic Trainers’ Association (2008) as well as receiving a prestigious MacArthur Fellowship. He has served on the NCAA’s Concussion Committee, the NFLPA’s Mackey-White Health and Safety Committee, and the NFL’s Head, Neck, and Spine Committee.[ii] He serves as a member of the operating committee of the NCAA-Department of Defense Grand Alliance CARE Consortium. Research generated by the Gfeller Center, considered by most to be one of the top concussion research centers in the U.S., is used to establish protocols dictating removal and return to play decisions related to concussion.

It is with great respect for Dr. Guskiewicz’s and the Gfeller Center’s outstanding contributions to our understanding of sport-related concussions that we ask for an independent examination of Tatos’ and Comrie’s allegations. It is the responsibility of every faculty member to welcome transparency and peer review of research theory, data, methodology and findings and to appropriately respond to criticism that may detect flaws in such. Tatos, Comrie and Guskiewicz should welcome an independent review. We note that since the original Tatos/Comrie publication, Guskeiwicz produced a formal response “100%” denying the allegations[iii] and both Tatos[iv] and Comrie[v] in turn responded with a strong reiteration of concerns. In addition, the allegations generated a documentary series[vi] and various statements supporting both sides. The Drake Group believes that only an independent and truly unbiased investigation will do justice to the questions raised.

We also note that this call for an independent investigation is on point with the mission of The Drake Group which is to defend the integrity of higher education institutions and protect college athletes from academic fraud or other practices that may endanger their physical and psychological health from the corrupting influence of highly commercialized college sports. Drake has a proud history of supporting whistleblower faculty willing to expose truth in the face of the overwhelming power of prestigious institutions of higher education and high-ranking leaders within such institutions intent on protecting the institutions and their own brands and reputations at all costs, even failing to act in the best interest of their students. We add our voices to this call for an independent investigation recognizing this power differential while making no presumption as to the outcome of such an examination.

Tatos’ and Comrie’s Allegations
Tatos and Comrie examined 2004 through 2012 documents publicly released by UNC as a result of an independent investigation conducted by Kenneth Wainstein and the law firm Cadwalader, Wickersham & Taft into academic fraud at the institution. These documents included neuropsychological test results, diagnosis rates of learning disabilities and attention deficit disorders (LD/ADHD), and stimulant medication prescriptions among incoming athletes over this period.[vii] Such documents were the focus of Tatos and Comrie’s paper, which analyzed neuropsychological test scores from these athletes and compared them to normal, ADHD, and brain injury normative scores from the literature. In addition, documents related to athlete exit interviews and emails indicating concerns about the health and welfare of athletes were examined. Findings from this analysis led the authors to report the following alleged deficits in Guskiewicz/Gfeller Center research and question the validity of other research done under the auspices of the NCAA-DoD Grand Alliance CARE Consortium (CARE Consortium)[viii]:

  1. Failure to disclose the presence of LD/ADHD subjects in research papers despite the fact that LD/ADHD have been known to be confounding factors in concussion research since 1999. Undisclosed inclusion of LD/ADHD athletes in concussion studies can pollute the research, particularly when citations of such studies propagate throughout the literature or such studies are included in meta-analyses.
  2. Failure to reveal abnormally high LD/ADHD rates as high as 60% among some incoming UNC football athlete cohorts. Overall, approximately 39% of the 182 primarily revenue-sport athletes tested during the 2004-2012 period, were diagnosed LD/ADHD. The expected rate in the general population is 2.4% within the normal population and the NCAA estimates 5 to 8.7% in the college athlete population.[ix]
  3. Failure to disclose use of stimulant medication by these research subjects (stimulant medication masks concussion symptoms and is a co-morbidity/modifying factor in concussion research).
  4. The failure to disclose the presence of LD/ADHD athlete subjects and their stimulant medication status raises serious questions on critical concussion research relied upon by other medical and scientific researchers. Because concussion results from college athlete samples are used to create normative baselines that are applied to other populations, including the US military, whether such reliance placed non-LD/ADHD college athletes and military personnel at health and safety risk due to resulting normative baselines that are too low was raised as an issue. If true, using such baselines would result in premature return to physical activity and greater risk for subsequent injury or misleading indications that cognitive recovery has occurred when it has not.
  5. Evidence that at least some UNC athletes with LD/ADHD and using stimulant medication were not advised of the risks associated with their sports participation (higher risk for heat stroke, dehydration, cardiac arrhythmias and mild traumatic brain injury) which raised questions related to proper consent to participate in research (i.e., Belmont Report ethical principles and guidelines for the protection of human subjects of research).
  6. Some UNC football athletes (data did not include identifying information) exhibited neuropsychological test scores at matriculation that were consistent with traumatic brain injury patients. This finding raised questions of whether these subjects had adult onset ADHD (possibly related to sport-related brain trauma as opposed to developmental ADHD) and were therefore at higher risk for concussion and brain injury if they continued to participate in collision or other sports with high concussion rates.
  7. A clear pattern emerged from a comparison of unpublished work of UNC graduate students whose studies were subsequently published in peer reviewed journals co-authored with UNC researchers. The unpublished work clearly documented the participation of LD/ADHD subjects and medication status while such data was inexplicably omitted in the corresponding published versions. Other articles not originating from graduate theses and relying on UNC football athlete subjects did not disclose the prevalence of LD/ADHD and medication as confounding factors.
  8. Failure to disclose that the diagnosis and medication prescription rates present in the UNC athlete population did not comport either to general population figures or to any other readily identifiable group to which such results may be usefully extrapolated.
  9. No factual research was provided to support the NCAA-DoD Grand Alliance CARE Consortium justifications offered for extrapolating concussion research results from college athletes to the military, namely similarities in athleticism, risk-taking and the pursuit of physical excellence. Further, abstract characteristics such as pushing or striving for excellence are not relevant characteristics for comparing sample and target populations with regard to concussion research.
  10. Research was identified that utilized self-reported LD/ADHD subject histories without revealing such methodology as a limitation of the studies (self-reported medical history data has been demonstrated to be susceptible to underreporting).

The veracity of each of these allegations should be determined because each alleged deficit has serious ethical and practical implications that extend far beyond application to college athletes and members of the military.

Independent Investigation
The Drake Group expresses significant concern regarding the possibility of ensuring an independent and unbiased investigation of the Tatos and Comrie allegations. We believe that any of the following factors may have the power to bias an investigation or the selection of investigators:

  • The work product of many sport-related concussion researchers in the USA may have relied on the UNC research being examined and may be questioned, thereby representing a conflict that would preclude service as an investigator.
  • Tatos and Comrie detailed several individual researchers’ denials regarding the need to exclude, disaggregate, or reveal the presence of LD/ADHD subjects while presenting examples of these same individuals maintaining otherwise. The results of the investigation may have reputation implications.
  • Many of the top concussion researchers in the USA have been working together under the auspices of over $64 million in Department of Defense and NCAA grants (the NCAA-DoD Grand Alliance CARE Consortium) which includes over 30 institutions of higher education, including UNC. Much may be at stake regarding the continued credibility of this work.
  • Fear of retaliation is always present when dealing with allegations of wrong doing involving respected individuals or powerful institutions. Investigators may fear repercussions such as not being considered for research grants or work not being accepted for publication in prestigious journals, both being perilous outcomes in the higher education “publish or perish” environment.
  • The importance and power of football in American higher education has been well documented. The possibility that investigation results might ring a loud warning bell about the health dangers to college football athletes may tempt investigators to suppress such results.

All of these factors lead The Drake Group to strongly recommend that the DoD Office of Inspector General, a nationally respected ethics oversight agency, lead the investigation. We also recommend that this office consider appointing an international panel of bio-ethicists, epidemiologists, statisticians and neuroscientists that include ALS or other brain disorder experts and public health scientists, in addition to those who have worked in the area of sport-related concussion, in order to counter the domestic polluting possibilities of this fact situation.

Need to Address Additional Issues
In addition to the central question of inclusion of LD/ADHD subjects in concussion-related research and the other Tatos/Comrie allegations detailed above, The Drake Group believes the following additional issues should be addressed, if not within the context of the recommended independent investigation, by higher education institutions and organizations concerned with the following additional integrity concerns:

  1. Should standard concussion research policies, including the standard operating guidelines for research produced as part of the CARE Consortium, be revised to require (a) the exclusion of LD/ADHD and subjects on stimulant medication from or separate reporting in such research studies, (2) prohibition of self-reported medical histories, (3) reporting of researchers’ prior employment or relationships with funders and (4) double blind methodology when possible?
  2. Has the NCAA issued specific best practice mandates to member institutions related to the need to reassess college athlete baseline neurological assessments which occur prior to the identification of LD/ADHD and to include assessments while athletes are taking and not taking stimulant medications, recognizing that many athletes do not take such medications year-round?
  3. Are LD/ADHD college athletes being properly assessed with regard to whether their LD/ADHD disorder is directly related to brain trauma vs. developmental LD/ADHD (especially acknowledging research that indicates that racial/ethnic minority children are less likely to be diagnosed)? Are college athletes with possible brain trauma related LD/ADHD being explicitly and adequately advised by independent medical authorities of the increased risks related to continued participation in collision sports or sports in which there is an elevated risk for concussion or repeated hits to the head?
  4. Recognizing the facts that (a) Division I college athletes are disproportionately represented among students admitted with waivers of normal academic requirements and may therefore be under prepared compared to classroom peers, ( b) there is considerable pressure among Division I athletic programs to keep athletes eligible in order to produce winning teams or justify inordinately high coaching salaries and an LD/ADHD diagnosis permits a waiver of full-time student status and other significant academic accommodations[x], (c) the stimulant medication commonly prescribed for LD/ADHD individuals is a banned athletic performance enhancing drug routinely waived by the NCAA for LD/ADHD athletes, and (d) athletic department academic support staff, coaches and college athletes are fully aware that LD/ADHD college athletes have access to such medication which is perceived to have both fatigue-reducing and performance enhancing benefits, the NCAA and its member institutions should adopt policies that better validate LD/ADHD diagnoses among college athletes thereby minimizing the possibility of cheating. For example, multiple diagnosticians may be utilized and appointments arranged by the institutional office handling learning disability accommodations with every effort made to anonymize the student’s identity as an athlete.
  5. Are all research centers involved in the CARE Consortium or associated with institutions of higher education required to have a memorandum of understanding with funders regarding commitment to research independence and integrity? Is such an ethics agreement publicly available and does it detail the spirit of the following: (1) All research flows from the mission, vision, and values of the institution/Consortium; (2) research activities are determined by a commitment to empirical, honest, and accurate pursuit of objective knowledge; and (3) financial supporters have no influence over any aspect of research design, methodology, execution, analysis, or conclusions?
  6. Did any of the entities that developed and marketed concussion baseline testing and return-to-play tools (e.g. IMPACT, SWAY) rely upon UNC or other research which included LD/ADHD athletes in their samples? Were these instruments fully validated or should they been revalidated if investigation findings validate LD/ADHD allegations?

Closing Comment
TDG president B. David Ridpath concluded, “Each of the above allegations and questions should independently cause concern. That all of the Tatos/Comrie allegations were raised about practices at the same higher education institution is doubly concerning. The stakes are enormously high if any of these allegations are verified: college athlete health related to concussion detection and return to play decision protocols, ethical and NCAA rules compliance issues related to the use of LD/ADHD diagnoses and important higher education integrity questions related to the validity of research and the possible misuse of government grants. We cannot ignore the pressures created by highly commercialized athletic programs which have created fertile ground for college athlete academic exploitation and, in the case of these allegations, may be endangering the health of college athletes as a byproduct of seeking competitive advantage. Similarly, we cannot ignore the pressures on higher education faculty to “publish or perish” and demonstrate their ability to acquire significant research grants. We hope that the intersection of these two enormous pressures has not resulted in wrong doing.”

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[i] Ted Tatos and Don Comrie. (2019) Cognitive Deficits and LD/ADHS Among College Football Athletes and Undisclosed Inclusion in Concussion Research. Journal of Scientific Practice and Integrity. DOI: 10.35122/jospi.2019 873611. Retrieve at: https://jospi.scholasticahq.com/article/8883-cognitive-disorders-among-incoming-college-football-athletes-legal-and-medical-implications-of-undisclosed-inclusion-in-concussion-research
[ii] See: https://exss.unc.edu/faculty-staff/kevin-guskiewicz/
[iii] See: Kevin Guskiewicz. Point of View: The Athletic Story, October 2019, Statement from UNC-Chapel Hill Interim Chancellor Kevin Guskiewicz. Retrieve at: https://tbicenter.unc.edu/assets/img/posts/19.pdf
[iv] See Ted Tatos. Tatos Response to UNC TBI Center Criticism. Retrieve at: https://www.academia.edu/40654165/Tatos_Response_to_UNC_TBI_Center_Criticism?email_work_card=interaction_paper
[v] See: Don Comrie. A Response to Statement by Interim University of North Carolina Chancellor Kevin Guskiewicz’s opinion of The Athletics’ article, Failure to Disclose: The mysterious absence of critical data from UNC’s renowned concussion research published October 8, 2019. Retrieve at: https://www.researchgate.net/publication/336650160_A_Response_to_Statement_by_Interim_University_of_North_Carolina_Chancellor_Kevin_Guskiewicz’s_opinion_of_The_Athletics’_article_Failure_to_Disclose_The_mysterious_absence_of_critical_data_from_UNC’s_r
[vi] See: The Athletic three-part video series at: https://www.youtube.com/watch?v=UWM6ES5ykL4&list=PLJFxqDQGJPM3fOD-XK_WEs-9iS5ZDv-JS
[vii] These documents were released in response to public records requests from two newspapers related to the independent investigation of 18 years of academic fraud for which UNC was placed on probations by its accreditation agency.
[viii] See http://www.careconsortium.net/ for a full description of the NCAA-DoD Grand Alliance CARE (Concussion Assessment, Research and Education) Consortium.
[ix] Tatos and Comrie also noted limited other LD/ADHD college athlete studies reporting higher than NCAA rates: Louisiana State University football(40%), Florida State University football and basketball (35% and 75%) and Pennsylvania State University athletes (20%).
[x] 14.4.3.9 Waiver-Student-Athletes With Education-Impacting Disabilities. The Division I Progress Toward-Degree Waivers Committee (see Bylaw 21.7.5.2) may waive the general progress-toward-degree requirements for a student-athlete when objective evidence demonstrates that the institution has defined full-time enrollment for that student-athlete to be less than 12 hours to accommodate for the student’s education-impacting disability. (Adopted: 10/31/02 effective 8/1/03, Revised: 8/7/08)