Hacker News Reader

Comment by whafro | Hacker News Reader

Perhaps this is an important step, but my understanding is that a large share of early-onset dementia is suspected to be caused by head injuries more minor than diagnosable concussions.

If we find that conclusively to be the case, this kind of test could in fact be more dangerous than no test at all, as athletes (both adults and children) are cleared to continue play after getting "dinged" but not testing positive with a field-side assay such as the one discussed here.

I've always believed that while adults may be able to make their own decisions about risk, children certainly don't have the capacity to choose between looking cool/tough in the moment, having significant cognitive/memory issues in your 30s like my old friend did [0], or worse.

Athletes and parents should continue to be concerned.

[0]: https://www.inquirer.com/philly/sports/20160805_Sielski__Bry...

View on HN

But we already have a culture of ignoring head injuries in sports.

Rugby, and American Football are only just coming to terms with how dangerous repeated concussions can be. I can't speak for American Football, but for rugby at least, they're trying to take concussion seriously.

I say trying, because there's still a large impetus in rugby culture to minimise/deny concussion, even more so since the rules changed to try to prevent repeated concussions - if you have a concussion, you can't play for at least 20 days since symptoms abated (in my country), which can make a real difference in a team's performance in a given season if you're their star fly-half[1]/winger[2] (for Americans, kinda like the quarterback in that those positions often define the plays made).

Where I can see this being valuable is in detecting concussions that are either a) subtle enough in symptom to slip past the referee's / team doctor's notice, so picking them up via easy testing can prevent further damage (as a concussion on top of concussion is the worst case scenario) and b) pick up concussions that people are trying to deny because it may harm or hinder the team if they're benched.

I can see easy testing for this bringing benefits to both groups a) and b) even if the b's might not be super happy about it.

[1]: Highlights of Dan Carter, probably the second best fly-half in rugby history: https://www.youtube.com/watch?v=D3UsOzJuq5M [2]: Highlights of Jonah Lomu (RIP), arguably the best winger in rugby history, and an absolute machine: https://www.youtube.com/watch?v=OsXTa7UCGlk

I don't disagree in general. What I'm saying is that if what's dangerous is a head injury with a [purely fictional/illustrative] severity of 5 on a scale of 1-10, but this test detects only a diagnosable concussion at 8+, it would be a double-edged sword:

- Individuals with severe injuries (8+) would be detected and could not deny it. You'd rid sports of the trainer who asks how many fingers he's holding up, and the answer is always "two." This is a good thing.

- Individuals with significant injuries (5+) would not be detected and would continue playing, causing perhaps worse outcomes. These injuries are more common, and sports would build up to accept and embrace them, since evidence may take decades to gather that reducing diagnosable concussions is not enough.

The latter case could affect thousands/millions more people, and may in fact be the real metric we should be targeting, rather than the as-currently-defined diagnosable concussion.

Sure, I agree, you definitely want to detect the more subtle cases.

Thing is, I doubt a saliva test would ever replace the "Well, he just asked the entire opposing team to marry him and told us he can see the future"[1] detection of concussion, or all the other known symptoms of concussions that referees at the club levels, and team doctors at the professional levels are trained to notice.

So yeah, if this can detect concussions not detectable via current methods, it's a definite win. But I also agree that if it were to replace the existing techniques, it'd be a net loss.

But I believe that, ultimately, the administrators of these sports realise a bunch of brain damaged former players is bad for the sport, so they will use it in a manner that complements, not replaces, existing diagnostic techniques.

[1]: Pretty much how my last concussion went down (thanks rugby league), except it was my teacher and half of my class I asked to marry me before they sent to me the sick bay. The delusions of predicting the future were very much real.

> Rugby, and American Football are only just coming to terms with how dangerous repeated concussions can be

Add football (soccer) to that list: https://www.bbc.com/sport/football/55335979 https://www.theguardian.com/football/2021/mar/04/england-fif...

The changing of the guard in the players' union should be instrumental in getting better protection, after years of stonewalling in the name of protecting salaries.

Reply on news.ycombinator.com