{"id":26123,"date":"2022-09-13T13:31:09","date_gmt":"2022-09-13T13:31:09","guid":{"rendered":"https:\/\/test11.f5test.in.ua\/blog-press\/open-letter-the-available-evidence-demands-the-relationship-between-rhi-and-cte-should-only-be-described-as-causal\/"},"modified":"2022-09-13T13:31:09","modified_gmt":"2022-09-13T13:31:09","slug":"open-letter-the-available-evidence-demands-the-relationship-between-rhi-and-cte-should-only-be-described-as-causal","status":"publish","type":"blog-press","link":"https:\/\/concussionandcte.org\/en-ca\/news\/press-release\/open-letter-the-available-evidence-demands-the-relationship-between-rhi-and-cte-should-only-be-described-as-causal\/","title":{"rendered":"Open Letter: The available evidence demands the relationship between RHI and CTE should only be described as causal"},"content":{"rendered":"

To Whom it May Concern:<\/p>\n

As scientists, physicians, researchers, and public health experts, we believe the relationship between repetitive head impacts (RHI) and chronic traumatic encephalopathy (CTE) should no longer be referred to as an \u2018association\u2019. Rather, we believe that the available evidence demands the relationship between RHI and CTE should only be described as causal.<\/p>\n

We respectfully request your organization update all position papers and public-facing statements to reflect the current scientific understanding in an urgent effort to educate the public.<\/p>\n

As you consider this request, we ask that you review a recently published analysis of the evidence for RHI causality in CTE using the Bradford Hill criteria. The Hill criteria were created specifically to provide a methodology for reviewing epidemiologic research to determine when it is appropriate to move from labeling an observed relationship as an association to causation.<\/p>\n

The review, entitled Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and CTE<\/a>, was published Frontiers in Neurology on July 22. The evidence for causation has strengthened considerably in the last few years, specifically in strength of association, biological gradient, consistency, plausibility, and coherence.<\/p>\n

The authors conclude that the evidence in favor of RHI as a causal pathway leading to CTE is compelling enough to move from \u201cassociation\u201d to \u201ccausation.\u201d We agree with this conclusion, and we support creating policies to prevent CTE in the next generation of contact sport athletes and others exposed to repetitive head impacts.<\/p>\n

We recognize that RHI may someday be found to not be the only risk factor or precipitant to CTE, as many diseases have multiple causes. However, it is time to publicly acknowledge that RHI is a causative factor which can lead to CTE.<\/p>\n

In August, we petitioned the National Institute of Neurological Disorders and Stroke (NINDS) to review this evidence and update their statement on causation. On October 5, 2022, NINDS updated their official statement on CTE<\/a> to \u201cCTE is a delayed neurodegenerative disorder that was initially identified in postmortem brains and, research-to-date suggests, is caused in part by repeated traumatic brain injuries.\u201d<\/p>\n

To many, this is not new information. The idea that boxing causes progressive neurodegeneration has been widely accepted for nearly a century. In 2019, the U.S. Centers for Disease Control and Prevention (CDC) issued a fact sheet<\/a>, stating, \u201cThe research to-date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts.\u201d<\/p>\n

Besides NINDS and CDC, organizations that now utilize or publicly support causation language include the NFL in the United States, the National Health Service, Football Association, and Professional Footballer\u2019s Association in the United Kingdom, and the Australian Football League.<\/p>\n

We have created an online dashboard<\/a> listing organizations that recognize the role of RHI and rTBI in CTE causation, and we also list organizations that explicitly do not or have not made public statements. Please let us know if we do not have your organization listed appropriately.<\/p>\n

We look forward to your response and are available individually or as a group to respond to any questions you may have.<\/p>\n

Signed,<\/p>\n

Mike Alosco, PhD<\/strong>
\nAssociate Professor of Neurology
\nCo-director, Alzheimer\u2019s Disease Center Clinical Research Core
\nPrincipal Investigator, CTE Center
\nBoston University School of Medicine<\/p>\n

Breton Asken, PhD, ATC<\/strong>
\nAssistant Professor
\nDepartment of Clinical and Health Technology
\nUniversity of Florida
\nFixel Institute for Neurological Diseases<\/p>\n

Rhoda Au, PhD<\/strong>
\nProfessor of Anatomy & Neurobiology, Neurology and Epidemiology
\nBoston University Schools of Medicine and Public Health<\/p>\n

Kathleen Bachynski, PhD, MPH<\/strong>
\nAssistant Professor of Public Health
\nMuhlenberg College<\/p>\n

Kevin Bieniek, PhD<\/strong>
\nDirector, Glenn Biggs Institute for Alzheimer\u2019s & Neurodegenerative Diseases Brain Bank
\nNeuropathology Core Leader, South Texas Alzheimer\u2019s Disease Research Center
\nAssistant Professor, Department of Pathology & Laboratory Medicine
\nUniversity of Texas Health Science Center at San Antonio<\/p>\n

Charles Bernick, MD, MPH<\/strong>
\nClinical Professor of Neurology
\nUniversity of Washington<\/p>\n

Yelena Bogdanova, PhD, PhD<\/strong>
\nAssistant Professor of Psychiatry
\nBoston University School of Medicine<\/p>\n

Michael Buckland, MBBS, PhD, FRCPA, FFSc (RCPA)<\/strong>
\nClinical Associate Professor of Pathology, School of Medical Sciences, University of Sydney
\nHead of the Department of Neuropathology at Royal Prince Alfred Hospital
\nFounding & Executive Director, Australian Sports Brain Bank<\/p>\n

Samantha Bureau, PhD<\/strong>
\nDirector of Programs
\nConcussion Legacy Foundation<\/p>\n

Robert Cantu, MD, MA, FACS, FAANS, FICS, FACSM<\/strong>
\nClinical Professor of Neurology
\nBoston University School of Medicine<\/p>\n

Stephen T. Casper, PhD<\/strong>
\nProfessor, Humanities and Social Sciences
\nClarkson University<\/p>\n

David X. Cifu, MD<\/strong>
\nAssociate Dean of Innovation and System Integration and Eminent Scholar
\nHerman J. Flax, MD Professor and Chair, Department of Physical Medicine and Rehabilitation
\nSenior Consultant, Sheltering Arms Institute
\nVirginia Commonwealth University School of Medicine
\nSenior TBI Specialist, U.S. Department of Veterans Affairs
\nPrincipal Investigator, Long-term Impact of Military-relevant Brain Injury Consortium Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC)<\/p>\n

John F. Crary, MD, PhD<\/strong>
\nProfessor
\nDirector, Neuropathology Brain Bank & Research Core
\nDirector, Physician Scientist Track in Experimental Pathology
\nDepartment of Pathology
\nNash Family Department of Neuroscience
\nDepartment of Artificial Intelligence & Human Health
\nFriedman Brain Institute
\nRonald M. Loeb Center for Alzheimer\u2019s Disease
\nIcahn School of Medicine at Mount Sinai<\/p>\n

Jeffrey L. Cummings, MD, ScD<\/strong>
\nJoy Chambers-Grundy Professor of Brain Science
\nDirector, Chambers-Grundy Center for Transformative Neuroscience
\nDepartment of Brain Health, School of Integrated Health Sciences
\nUniversity of Nevada Las Vegas (UNLV)<\/p>\n

Maurice Curtis, PhD<\/strong>
\nProfessor of Neuroscience
\nHead of Department, Anatomy and Medical Imaging
\nCo-Director of the Neurological Foundation Human Brain Bank
\nThe University of Auckland<\/p>\n

Daniel Daneshvar, MD, PhD<\/strong>
\nAssistant Professor
\nAssistant Chair for Research, Department of PM&R
\nHarvard Medical School<\/p>\n

Steven T. DeKosky, MD, FACP, FANA, FAAN<\/strong>
\nDeputy Director, McKnight Brain Institute
\nAerts-Cosper Professor of Alzheimer\u2019s Research
\nProfessor of Neurology and Neuroscience
\nAssociate Director, 1Florida ADRC
\nUniversity of Florida<\/p>\n

Marc Diamond, MD<\/strong>
\nDirector, Center for Alzheimer’s and Neurodegenerative Diseases
\nProfessor of Neurology and Neuroscience
\nPeter O\u2019Donnell Jr. Brain Institute
\nUniversity of Texas, Southwestern Medical Center<\/p>\n

Ramon R. Diaz-Arrastia, MD, PhD<\/strong>
\nDirector of Traumatic Brain Injury Clinical Research Center
\nAssociate Director for Clinical Research, Center for Neurodegeneration and Repair
\nJohn McCrea Dickson M.D. Presidential Professor
\nUniversity of Pennsylvania Perelman School of Medicine<\/p>\n

Dennis W. Dickson, MD<\/strong>
\nRobert E. Jacoby Professor of Alzheimer’s Research
\nNeuropathology and Microscopy Laboratory
\nMayo Clinic<\/p>\n

David W. Dodick, MD<\/strong>
\nProfessor Emeritus\/Founder\/Director of Sport Neurology & Concussion Program, Mayo Clinic Arizona
\nChair, International Concussion Society
\nChair, American Brain Foundation
\nChief Science Officer, Atria Institute
\nChair, Atria Academy of Science and Medicine
\nAffiliate Professor, University of Copenhagen
\nAdjunct Professor, Norwegian University of Science and Technology<\/p>\n

Margaret Esiri, DM, FRCPath<\/strong>
\nEmeritus Professor of Neuropathology, Oxford University<\/p>\n

Sir Richard Faull, MBCHB, DSc, KNZM, FRSNZ<\/strong>
\nUniversity Distinguished Professor
\nDirector, Centre for Brain Research
\nFounder and Director, Neurological Foundation Human Brain Bank
\nThe University of Auckland<\/p>\n

Adam M. Finkel, ScD, CIH<\/strong>
\nClinical Professor of Environmental Health Sciences
\nUniversity of Michigan School of Public Health
\nDirector of Health Standards, US Occupational Safety and Health Administration, 1995-2000<\/p>\n

Sam Gandy, MD, PhD<\/strong>
\nMount Sinai Endowed Chair in Alzheimer\u2019s Disease Research
\nProfessor of Neurology and of Psychiatry
\nDirector, Mount Sinai Center for Wellness and Cognitive Health
\nIcahn School of Medicine at Mount Sinai<\/p>\n

Lee E. Goldstein, M.D., Ph.D.<\/strong>
\nAssociate Professor of Psychiatry Radiology, Neurology, Pathology & Laboratory Medicine, Biomedical Engineering, Boston University School of Medicine & College of Engineering
\nCo-Leader, Biomarker Core, Boston University Alzheimer Disease and CTE Center<\/p>\n

Michael J. Grey, PhD<\/strong>
\nReader in Rehabilitation Neuroscience, University of East Anglia<\/p>\n

Lea T. Grinberg, MD, PhD<\/strong>
\nJohn Douglas French Alzheimer\u2019s Foundation Endowed Professor
\nProfessor in Residence – Departments of Neurology and Pathology
\nCo-leader, Memory and Aging Center, Neurodegenerative Disease Brain Bank
\nGlobal Brain Health Institute, Faculty and Member of the Executive Committee
\nInstitute of Computational Health Sciences, Faculty, UCSF<\/p>\n

Elisa Hill-Yardin, PhD<\/strong>
\nAssociate Professor
\nSchool of Health and Biomedical Sciences
\nRoyal Melbourne Institute of Technology<\/p>\n

Sidney R. Hinds II, MD, FAAN<\/strong>
\nCOL (retired), United States Army
\nAssistant Professor, Neurology\/Radiology
\nUniformed Services University
\nCo-PI & Lead, External Collaborations,
\nLong-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC)<\/p>\n

Kenneth S. Kosik, MD<\/strong>
\nHariman Distinguished Professor of Neuroscience
\nCo-Director, Neuroscience Research Institute
\nSanta Barbara, CA<\/p>\n

Chester Mathis, PhD<\/strong>
\nDistinguished Professor of Radiology
\nUniversity of Pittsburgh
\nUPMC Endowed Chair of PET Research<\/p>\n

Ann McKee, MD<\/strong>
\nWilliam Fairfield Warren Distinguished Professor of Neurology and Pathology
\nBoston University School Medicine
\nDirector, BU CTE Center
\nChief, Neuropathology VA Boston<\/p>\n

Jesse Mez, MD<\/strong>
\nAssociate Professor of Neurology
\nCo-director, Alzheimer\u2019s Disease Center Clinical Research Core
\nBoston University School of Medicine<\/p>\n

Michael D. McClean, ScD<\/strong>
\nAssociate Dean for Research and Faculty Advancement
\nProfessor of Environmental Health
\nBoston University School of Public Health<\/p>\n

Bruce Miller, MD<\/strong>
\nA.W. and Mary Margaret Clausen Distinguished Professor in Neurology
\nDirector, Memory and Aging Center
\nCo-Director, Global Brain Health Institute
\nUniversity of California, San Francisco (UCSF)<\/p>\n

Helen Murray, PhD<\/strong>
\nResearch Fellow, Centre for Brain Research
\nDepartment of Anatomy and Medical Imaging
\nThe University of Auckland<\/p>\n

Christopher Nowinski, PhD<\/strong>
\nCEO, Concussion Legacy Foundation
\nExecutive Committee, Boston University Alzheimer\u2019s Disease Research Center<\/p>\n

Alan Pearce, PhD<\/strong>
\nResearch Manager, Australian Sports Brain Bank (Victoria)
\nAdjunct Associate Professor
\nSchool of Allied Heath, Human Services & Sport
\nLa Trobe University<\/p>\n

Gil Rabinovici, MD<\/strong>
\nEdward Fein & Pearl Landrith Distinguished Professor
\nDirector, UCSF Alzheimer\u2019s Disease Research Center
\nDepartments of Neurology, Radiology and Biomedical Imaging
\nUniversity of California, San Francisco (UCSF)<\/p>\n

Philip Schatz, Ph.D.<\/strong>
\nProfessor of Psychology
\nSaint Joseph’s University<\/p>\n

Julie Stamm, PhD, ATC<\/strong>
\nClinical Assistant Professor
\nDepartment of Kinesiology, University of Wisconsin-Madison<\/p>\n

Judith A. Steen, PhD<\/strong>
\nDirector of the Neuroproteomics Laboratory | Associate Professor
\nBoston Children\u2019s Hospital | Harvard Medical School<\/p>\n

Thor D. Stein, MD, PhD<\/strong>
\nAssociate Professor of Pathology & Laboratory Medicine
\nCo-Leader of the Neuropathology Core
\nBoston University Alzheimer Disease and CTE Center
\nBoston University School of Medicine<\/p>\n

Robert Stern, PhD<\/strong>
\nProfessor of Neurology, Neurosurgery, and Anatomy & Neurobiology
\nDirector of Clinical Research, BU CTE Center
\nSenior Investigator, BU Alzheimer\u2019s Disease Research Center
\nBoston University School of Medicine<\/p>\n

Michael J. Stuart, MD<\/strong>
\nProfessor, Department of Orthopedics and Sports Medicine
\nMayo Clinic<\/p>\n

Catherine Suter, PhD<\/strong>
\nChief Scientist, Australia Sports Brain Bank
\nDepartment of Neuropathology at Royal Prince Alfred Hospital
\nSchool of Medical Sciences, University of Sydney<\/p>\n

Carmela Tartaglia, MD, FRCPC<\/strong>
\nMarion and Gerald Soloway Chair in Brain Injury and Concussion Research
\nAssociate Professor, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto
\nCo-director Memory Clinic – Toronto Western Hospital
\nDirector Memory Clinical Trials Unit<\/p>\n

Charles H. Tator, OC, MD, PhD, FRCSC, FACS<\/strong>
\nProfessor of Neurosurgery, University of Toronto
\nFounder, ThinkFirst Canada and Parachute Canada
\nDirector, Canadian Concussion Centre<\/p>\n

Neil Vasdev, PhD ACSF, FRSC (UK), FSNMMI<\/strong>
\nCanada Research Chair in Radiochemistry and Nuclear Medicine
\nAzrieli Endowed Chair in Brain and Behaviour
\nProfessor, Department of Psychiatry, University of Toronto
\nAssociate Professor of Radiology, Harvard Medical School
\nDirector, Azrieli Centre for Neuro-Radiochemistry, Centre for Addiction & Mental Health (CAMH)
\nDirector & Chief Radiochemist, CAMH Brain Health Imaging Centre<\/p>\n

Jennifer Weuve, MPH, ScD<\/strong>
\nAssociate Professor, Department of Epidemiology
\nBoston University School of Public Health<\/p>\n

Adam White, PhD<\/strong>
\nSenior Lecturer in Sport & Coaching Sciences
\nDepartment of Sport, Health Sciences and Social Work
\nOxford Brookes University<\/p>\n

Kristine Yaffe, MD<\/strong>
\nProfessor of Psychiatry, Neurology and Epidemiology, Psychiatry
\nUniversity of California San Francisco School of Medicine
\nWeill Institute for Neurosciences
\nRoy and Marie Scola Endowed Chair
\nVice Chair of Research in Psychiatry<\/p>\n","protected":false},"featured_media":0,"template":"","format":"standard","blog_press_categories":[42],"class_list":["post-26123","blog-press","type-blog-press","status-publish","format-standard","hentry","blog_press_categories-press-release"],"acf":[],"yoast_head":"\nOpen Letter: The available evidence demands the relationship between RHI and CTE should only be described as causal - Concussion Legacy Foundation<\/title>\n<meta name=\"description\" content=\"To Whom it May Concern: As scientists, physicians, researchers, and public health experts, we believe the relationship between repetitive head impacts\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/concussionandcte.org\/en-ca\/news\/press-release\/open-letter-the-available-evidence-demands-the-relationship-between-rhi-and-cte-should-only-be-described-as-causal\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Open Letter: The available evidence demands the relationship between RHI and CTE should only be described as causal - 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