CTE on the Accountable Care Agenda? Junior Seau it’s latest victim?

By Gregg A. Masters, MPH

On a day when another athlete dies from self inflicted wounds, and the acronym ‘CTE‘ (chronic traumatic encephalopathy) finds its way into the popular press, while perhaps opening a line of inquiry as to health consequences of repetitive brain injury, we may find the ante in and around the ‘accountable care’ conversation has just been raised a notch.

According to the Center for Traumatic Encephalopathy at Boston University School of Medicine:

“Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.  These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement.  The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.”

I learned of this tragedy via Twitter just past noon Pacific time via the headline: ‘NFL legend Junior Seau found dead at his California home‘.

In the public reaction department, The North County Times reported:

‘According to Former NFL player and 1968 Oceanside High graduate Willie Buchanon, who played with the Packers and Chargers from 1972-82, said he was stunned.’

My first reaction was why, Buchanan said. We lost an Oceanside Pirate, a San Diego Charger. He was on top of the world. To take his life like this, we don’t know what led him to this. Everyone in Oceanside looks up to Junior. He’s Oceanside.

Yet the LA Times begins to connect certain dots via:

Seau is the eighth member of the 1994 Chargers, who lost to the San Francisco 49ers in the Super Bowl, to die at a young age. Linebacker Lew Bush died of an apparent heart attack last December. Running back Rodney Culver died in a 1996 plane crash; linebacker Dave Griffs died in a 1995 car crash; linebacker Doug Miller was struck by lightning in 1998; center Curtis Whitley died of an overdose in 2008; defensive end Chris Mims died of an enlarged heart in 2008; and defensive tackle Shawn Lee died of cardiac arrest in 2010.

While on Twitter and Facebook the questions were fast and furious, including the inevitable speculation:

Addiction: Cunning, Baffling and Powerful. Hope you’ve finally found peace Mr. Seau. I will always remember you sitting in Jitters ukulele and telling me that I sang pretty at karaoke. RIP.

Followed by:

Wait, did he have an addiction problem?

So another one has fallen ‘before his time’ or was it his time and no-one noticed (or worse cared)?

Epidemiologists speak of the incidence and prevalence of disease (morbidity) in a given population to establish benchmarks of normative distribution, and to provide guidance as to specific nature, timing, and location of intervention.

Yet today we speak of the “triple aim’ and the related concepts of population health management vs. our traditional episodically focused sick care system. As we move to embrace expanded notions of community wellness and prevention, we’d better get clear as to the extent of morbidity that may exist in certain ‘demographic groups’ to recognize and effectively address the underlying pathology – including the associated social or economic determinants of dis-ease. Absent this nervous system, we’ll be blindsided by what may appear patently obvious – yet only in retrospect.

So welcome to another chapter in the accountable care conversation. Let the discussion of ‘CTE’, domestic violence, or as some may have suggested alcoholism, drug abuse or underlying depression begin in earnest given our lofty intentions to proactively manage identifiable health risks, including those sometimes ‘invisible’ yet tragic morbidities.