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TROUBLING TREND

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A behavioral neuroscientist who's the CEO of the Concussion Legacy Foundation—and also a former college football player and WWE wrestler—reflects on SI's report last month that 21-year-old Washington State quarterback Tyler Hilinski had CTE when he took his own life last January.

THIS IS the third active college football player that we know had CTE. We've seen CTE in football players who played just a few seasons. We don't know where the floor is. But it's safe to assume that one season of football could give you CTE. The risk is not zero after one season. It just goes up each additional year you play.

We've seen it in kids as young as 17. We recently had a case of a young man who had post-concussion syndrome in eighth grade. He played five years of football, seven years of ice hockey, baseball. He never really played a sport after eighth grade—but he never recovered from his post-concussion syndrome. He died by suicide at the age of 20. He had Stage 1 CTE as well.

There are two discussions after stories like this. One is about whether CTE is caused by playing football. The evidence supports that CTE is caused by repetitive head impacts, but many don't want to believe it. People see the game under threat, and a lot are more focused on protecting the game than protecting those who play the game. It wasn't long ago that the NFL was in complete denial and just said CTE doesn't exist.

But there's a fair debate over whether CTE plays a role in the decisions that Tyler and others make that lead to suicide. We can't answer that. But it's absolutely something we should discuss because there's a known and incredibly strong relationship between concussions and increased risk of suicide. Most studies suggest a three to four times greater risk just from one concussion.

What can we learn from this? That this is something we can prevent if it is in fact caused by football. We could have kids start playing tackle football later, which could lower the risk of CTE dramatically. I don't know if you could have convinced me to stop playing when I was young. It's hard to walk away. The short-term costs of giving up football, which are known, are high: lose your friends, lose your identity, lose your path. The long-term costs are unknown because we can't predict the risk of developing CTE. Even if we could, let's face it, a high school athlete may not have the capacity to understand the risk. We're struggling to have doctors interpret this evidence in an appropriate manner.

I do think the moment we have an accurate diagnostic test for CTE in living brains will be a moment of reckoning for the game. People seem to be comfortable with at least one out of 10 NFL players having this disease, which is what we've seen over the last 10 years. (Overall, an estimated 10% of former NFL players, including 99% of those whose brains have been examined posthumously, have had it.) But no one will be comfortable with more kids getting it. If you put a high school team through the test and you find out some kids have this disease already, people may not let their children play anymore.

Nearly one out of five Americans still smoke, even though they know there's a good chance that decision will accelerate their deaths. So there always will be people who ignore the science and say it's worth it and it's my choice. But I also get the sense that once we can diagnose this and get an idea of the scope, there's going to be a scramble. There's a decent chance that no one who doesn't need the money will want to be on that field. And that would shut down all but the professional leagues.

We're starting to build interesting webs of teammates who had CTE. You start to realize that often lightning strikes twice or three or four times in one starting lineup. We're getting a brain almost every other day. We're going to get 200 this year. There will be more stories to tell, more families like the Hilinskis.