Let's Drop High School Football

To the Editor—The true silence in traumatic brain injury is the failure of health professionals and school officials to insist on a halt to youth football as it is currently played. The special section on traumatic brain injury in the recent issue of the NCMJ makes scant mention of football, even though it poses the greatest risk for sports-related head trauma; more importantly, football is the major contributor to sports-related head trauma, because of its wide participation [1]. Using data from 100 high schools in the High School Reporting Information Online system, Rosenthal and colleagues reported a rate of 9.4 concussions per 10,000 athletic exposures for boys' football, 65% higher than the next most risky sport, boys' wrestling [2]. Due to the participation of over 1 million players in high school football [3], this sport accounts for well over 60% of concussions in boys. Ten years ago, football was estimated to account for more than 55,000 concussions per year [4]. With the changes in reporting, that figure is regarded as an underestimate.

Given the association between football and concussions and between concussions and long-term brain damage, more research is clearly needed [5]. However, research on the prevention of concussions should proceed only in carefully controlled clinical trials, guided by the ethical principles that pertain to any medical or public health study. Until the risks are clarified in rigorous trials, permitting boys to play tackle football violates the principal of primum non nocere—“first, do no harm.” Absent clear and thorough informed consent, where the risks and potential benefits are described, high school football breaches the principal of autonomy, because parents and their sons do not have the information they need and deserve to make an informed decision.

Parents who discourage their sons from playing football demonstrate thoughtful consideration of 2 facts: first, football is the major cause of sports-related concussion in boys; and, second, there are “currently no proven interventions to prevent concussions” [6]. Health professionals and school officials should applaud these parents and follow their lead in the prevention of football-related concussions.

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