December 5, 2016
Are the risks associated with playing football on a high-school team so great that educational leaders should withdraw their backing of the sport? Four physicians weigh in on the issue in an article published online Dec. 5 in the journal Pediatrics.
Lewis Margolis, MD, associate professor of maternal and child health at the UNC Gillings School of Global Public Health, formulates a dissenting argument in the article, claiming that traumatic injuries, including concussions, pose too great a danger to the developing brain, and that no sport is worth the risk of diminished health for young football players. Other discussants acknowledge the risks but believe that appropriate education and care can keep young players safer.
“Concerns about the risks of traumatic brain injury from football continue to grow,” Margolis said. “Given that football accounts for the largest share of sports-related concussions, school boards should act in the best interests of these boys and young men by ending support for high school football. While we wait for clinical and basic research to answer key questions about the short- and long-term consequences of these brain injuries, school boards should show leadership by ending exposure to this, the riskiest of high-school sports.”
Margolis’ co-discussants in the “Ethics Rounds” article are Gregory S. Canty, MD, medical director of the Center for Sports Medicine and assistant professor of pediatric orthopaedic surgery at the University of Missouri at Kansas City School of Medicine; Mark Halstead, MD, associate professor of orthopaedic surgery and of pediatrics, director of the sports concussion program and medical director of the Young Athlete Center at Washington University in St. Louis; and John D. Lantos, MD, professor of pediatrics and director of pediatric bioethics at the University of Missouri at Kansas City School of Medicine.
Lantos provides the frame for the discussion, inviting the three other physicians to “review the evidence about sports risks and discuss what is known and not known about the science and ethics of high school football.” Their comments are presented as advice to a hypothetical pediatrician who is called upon to provide an argument for or against high school football to a local school board.
“High school football, as currently played,” Margolis writes, “violates the four biomedical ethical principles of nonmaleficence [‘First, do no harm’], beneficence [Do benefits outweigh risks?], respect for autonomy [Are parents and players consenting to accept risks with all available information?] and justice [The percentage of African-American players far exceeds the percentage of African-Americans in the population at large, and therefore puts this group at particular risk].”
Margolis notes that football is deeply imbedded in U.S. culture.
“However,” he says, “our society has researched other harms, such as tobacco use, alcohol-related driving, and obesity-related unhealthy diets and exercise, and successfully changed social norms. Pediatricians should advocate for the discontinuation of high school football programs until, and more importantly, unless we can be assured that it does not have long-term detrimental consequences.”