Broken Brains with Bruce Parkman
Broken Brains with Bruce Parkman is presented by The Mac Parkman Foundation
The mission of this show and the foundation is To serve as a source of information, resources, and communications to the community of parents, coaches/Athletic trainers, medical staff, and athletes that are affected by sports-related concussions and to raise awareness of the long-term implications of concussive and sub-concussive trauma to our children.
Broken Brains will also explore how Concussive Trauma impacts our Service Members and Veterans.
Join us every week as Bruce interviews leaders and experts in various Medical fields, as well as survivors of Concussive trauma.
Broken Brains with Bruce Parkman
Protecting Young Athletes: Brain Health and Safety in Sports
In this episode of Broken Brains with Bruce Parkman, host Bruce Parkman and expert neurologist Dr. Daniel Kantor tackle the critical issue of repetitive brain trauma in youth sports. Together, they explore the dangers of concussions and sub-concussive hits on young athletes, emphasizing the ongoing development of the human brain and the lifelong impact of head injuries.
Dr. Kantor advocates for legislative changes, improved safety protocols, and the role of organizations like the NCAA in prioritizing athlete safety. The conversation dives into the importance of educating parents, coaches, and medical professionals about the risks of sub-concussive trauma and the urgent need for diagnostic tools and injury prevention measures.
This episode is a call to action for parents, educators, and policymakers to reimagine youth sports with brain health at the forefront. Listen now and be part of the movement to protect the next generation. Don’t forget to follow, share, like, and subscribe on Spotify, YouTube, and Apple Podcasts!
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Chapters
00:00 Introduction to Repetitive Brain Trauma
02:14 Understanding Concussions in Youth Sports
06:47 Legislation and Safety Measures for Athletes
10:05 The Impact of Subconcussive Hits
14:35 Challenges in Addressing Brain Injury Awareness
18:24 Proposed Changes to Youth Contact Sports
23:12 Minimizing Exposure in Youth Sports
24:30 The Role of NCAA in Youth Sports Safety
25:29 The Importance of Raw Talent and Injury Prevention
26:56 Legislation and State Agreements on Sports Safety
30:14 Education and Awareness on Subconcussive Trauma
34:34 Protocols for Diagnosing Brain Trauma
39:20 The Reality of Brain Injuries in Sports
42:28 A Call for Safer Sports Practices
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LinkedIn: Daniel Kantor, MD, FAAN
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Website: kantorneurology.com
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Produced by Security Halt Media
Hey folks, welcome back to another episode of Broken Brains with me, your host, bruce Parkman. Our show is focused on the issue of repetitive brain trauma, particularly covering the issues of repetitive head impacts from sports and repetitive blast exposure in our military veterans and what this exposure is doing to the brains of these kids, athletes and veterans, of what we can do as a society to improve the safety of sports and military service. We look at researchers, scientists, patients, advocates and brain experts across the issue and bring them here in the podcast so that you, the viewer, are as formed as possible of what is going on out there and what we can do, because this is the largest preventable cause of mental illness in this country and we are all in a position where we need to do better. On our show today is another awesome guest, dr Cantor.
Speaker 1:Dr Cantor is the President Emeritus of the Florida Society of Neurology and, after studying literary and computer science at Penn, he enrolled a charter class at Ben Gurion University and Columbia University and, after completing his neurology residency at Thomas Jefferson University, he chose to remain in the US and use his healthcare skills to help urban and rural populations, as a director of Comprehensive MS Center, university of Florida, in Jacksonville. Most recently he served as the director of the Division of Neurology and as the inaugural neurology residency program director at Florida Atlantic University. Go Owls, watch them in the NCAA championship there a couple of years ago. Dr Cantor, I mean, what an amazing resume to bring to the show today. We really appreciate it, and we know that you're heavily involved in the issue of course neurology. Now you are a neurologist, sir.
Speaker 2:Yes, I am, yes, I am, and I'm actually here in Florida. I chair the subcommittee on concussion for the sports medicine advisory committee of the Florida High School Athletic Association. So what I deal with every day is how do we prevent and how do we hopefully treat what are preventable head injuries in our children?
Speaker 1:That's an amazing well, I didn't know about that. That's an amazing perspective that you have on youth sports. Now we've talked to the Florida High School Association about the issue of repetitive head injuries and what we have to do, because if we could let's just dive into this if we could stop contact in practice in football or cross heading I mean heading in soccer, rugby we could eliminate massive amounts of the exposure that's in the end hurting these kids. I mean, how long have you been in this position, sir, and what is the progress that you're seeing on understanding the threat of repetitive ed impacts as a risk to our children and what can we do to do a better job of working to improve the levels of exposure?
Speaker 2:In early 2010, so about 2013,. Florida was one of the states that now we have all 50 states, but one of the states that said wait a second, we have to do something to stop concussions, and one way to do that is not to get rid of sports, because, as you say in your book, as you say really eloquently, we can't do that. We're America, we're into sports. Sports is great for many other things, but we got to do it responsibly. So we said, well, let's bring down the threshold to take someone out of play and then, when we take them out of play, let's make the threshold higher to put them back into play, and that was the basic idea.
Speaker 2:Now, historically, what happened in Florida was the legislation first went up by a Florida House member who's actually a physician, dr Renwart, and he tried making it that only MDs and DOs so medical doctors and osteopathic doctors, would be the ones to put patients back into play.
Speaker 2:So the kids would be taken out by the coach or by anybody, by the trainer, by the coach, by a parent, but then they could only go in by a medical doctor or osteopathic doctor.
Speaker 2:The last day of legislative session in Florida one of the House members or senators he was a chiropractor and he added on chiropractic doctors to chiropractic physicians to be the one. So they killed the bill that year. But I think what the Florida High School Athletic Association did really smartly is they saw the writing on the wall and so they set up a sports medicine advisory committee, and in that sports medicine advisory committee I became the chair of the subcommittee on concussion, and so a year later they passed legislation in Florida and now there's legislation in every state. But the legislation basically says that they have to set up a committee and then that committee has to make rules and propagate rules, and so the committee has deferred a lot of those rules, obviously to the subcommittee on concussion. You know, one of the issues I've noticed in Florida is it's a large, large state. People forget that we're very long but we're also very wide. We're actually in two time zones.
Speaker 1:It takes forever to drive across the state.
Speaker 2:When you get all the way to Pensacola, you're in a different time zone. You're in central time zone, and so you need to be able to have the same rules in a big city area Like I live in southern Florida, between Fort Lauderdale and Boca, a place called Parkland, which unfortunately made the news in 2018. And you have to have the same rules here as you do in the panhandle of Florida.
Speaker 2:Where there may not be an MD or DO or a chiropractor for hundreds of miles, and you certainly won't be a neurologist for many hundreds of miles, and so we have to make the same rules in all those places, and the basic idea is to try to make it very easy for someone to come out of play and harder for them to get back into play.
Speaker 2:Now, with that said, what does harder mean? It means there's, as you've talked about before, there's the graded or graduated return to play, and so these international ideas of return to play are basically that at every step you don't have symptoms for 24 hours and you go on to the next step. The problem with that is you actually can go pretty fast. You can go from having a concussion, can go pretty fast. You can go from being, you know, having a concussion, but having no symptoms then for 24 hours. Then you go into light exercise, you know light, light movement no, no, uh, no, no symptoms. Then you go into the next one and you have no symptoms and eventually you're back at contact sports, and the next week weekend you might actually be back in a game.
Speaker 2:You're sure that is maybe OK for NFL players, maybe it's not OK for elementary school students and it's probably not OK for many of the high school students, especially in the younger side of it I mean the human brain as you talk about. Really well, if anyone out there hasn't looked at your book and read it, it's a very easy read, it's a very important read and I think it's a book that I think gives tribute both to your son's life but also to the science of what's going on. And when I read it, what actually made me most amazed was I was like but this stuff is obvious. And then I was like maybe it's not obvious to everyone, like I'm gonna run this, what I do for a living, like it's obvious to me, but maybe it's not obvious to everyone. And made me really open, even someone who's who stands out there as an advocate, realizing that there's still so many gaps in kind of where we are. And so what happens is, you know, as the body gets bigger, you know things start to develop better. You start to become better at running and you become better at talking, become better at everything.
Speaker 2:But your brain, even though you don't see it, it's still taking times to form, and your human brain is not fully myelinated, especially in what we call the frontal cortex, the area that makes the important decision-making. We call it the executive functioning of the brain. That doesn't happen until, like you're, in your early 20s. Even after the time that we allow people to drink alcohol and to vote and to serve in the military, that is still developing. So I'm not saying we should take away all these things and change what we decide a human being is and what an adult is, but we should realize that there's a reason why teenagers are more impulsive. There's a reason why with age comes wisdom. As you go, not only do you get new experiences, your actual brain is still forming. You're still getting that myelin, it's still getting that white matter covering, that fatty white matter covering in the front of the brain and also in other parts of the brain. And so when you damage that, when it's still forming, that's not good. You can imagine when you have a bone that's still growing and you damage it, it's not going to grow as well, and the same might be true for the human brain. Now it is true that we have amazing resilience as human beings and we have this idea of neuroplasticity and things can make amazing kind of changes. You can have people with only half their brain and they're still able to function. But that's not what we want. We don't want to be in that position.
Speaker 2:And you bring up another really good point, which is when we think about baseball especially, we think about you know how many pitch counts you have. We don't want to damage the person's shoulder, we don't damage the person's elbow, we don't have that for the head, and we don't have that for the head for several reasons. One of those reasons is we don't actually know. So we don't know how many hits is too much. So when you're throwing a baseball and you throw it over and over, eventually what you're going to do is you're going to tear your ligaments and tendons, and it's not going to be good for you. But with the brain you get.
Speaker 2:Even these hits that don't cause a concussion. No one notices that. Even the person themselves doesn't notice, or their family, but they're what we call subconcussive hits, so almost at the point of concussion, but a little bit less. And if you think it's hard to diagnose concussions or to notice a concussion, it's definitely hard to notice a subconcussive hit. We could, though, as a society, say well, a subconcussive hit is a certain amount of force at a certain angle. Okay, how do you measure that? Well, that, we definitely have the technology. We have inserts inside helmets, we have the engineering that makes it possible. It's a little more expensive, obviously, than your regular helmet, but we have the possibility of knowing and counting how many of those hits people can have.
Speaker 2:And what we could do is we could choose an arbitrary number. We could be wrong, we could say you're allowed to have this many per season and this many per lifetime of play, and we may find out in the future that we're wrong, that maybe the number is less or maybe the number is more. But at least we've come to some sort of agreement. And I think that's what's so important in society is to come to some sort of consensus, because you can't have some players and some teams saying, oh, we're going to do this and other ones saying we're going to do that, and then the kid in the middle feels like, well, this seems arbitrary. And they're right, it's a little bit arbitrary.
Speaker 2:That kind of happened during COVID, right? You saw one governmental agency say one thing, one governmental agency say another thing. Things seemed arbitrary because we didn't have the science yet, and so until you have the full science, you have to come to some sort of agreement. You can't say well, we don't know, so we can't protect our kids. That seems silly. We know it's bad, we don't know how bad, so let's choose something in between. Like, a kid who gets hit 100 times a day is probably not good, right? I think everyone would agree. So a kid who gets hit a hundred times a day is probably not good, right? I think everyone would agree. So a kid who gets 30 times a day is that bad, probably. So we should come to some sort of agreement on what's not good for our children and I think, doctor, I mean, do you?
Speaker 1:I'm just writing questions down left and right? You are this. I mean, if anybody could listen to the last 12 and a half minutes of what Dr Cantor just said, he has just outlined everything that we need to fix. And it's not about, oh, sports are bad. I'm in my 60s, I still play rugby, all right. It's about we know that some cussive hits aren't good, and so, dr Cantor, why are we here in 2025? So, dr Cantor, why are we here in 2025? We know that these hits are not the overtime produce. You know they produce horrible results for athletes.
Speaker 1:We focused on athletes, since you know this was, you know, identified in 2009 as CTE, and you know we go down the whole path there, but we have never looked at children. And you know we go down the whole path there, but we have never looked at children. And so and it also we focused on concussions, so much that we have yet in the last four years. I remember when I challenged Dr McKee on why she did not look at my son's brain from a damage perspective, vice, a CT perspective, and she went back and we'll talk about the study here in a little bit she said, oh my God, we found everything that we had in the book structural damage, demyelination, blood brain barrier, all kinds of stuff, right, and so you know, why are we so, you know, delayed in considering this as an issue, especially when it comes to our kids? And what do you think some of the first steps should be? I mean, you're on the committee, you're in a position to affect this, you know.
Speaker 2:Yeah. So you know, one reason I think that we don't have a full understanding of it and we don't come to an agreement is probably because we're a little bit uncomfortable. We ourselves play sports or we have family members who played sports. We think sports is a good idea. We want our children to have those benefits. You know, when I was a neurology residency program director, I would be interviewing people who are they're already doctors, so they're MDs or DOs and they want to become specialists in neurology. And I'll tell you two things made them higher up on the list. It wasn't like how many papers you wrote and it wasn't like how much interest you had. I assumed everybody was smart and everybody was interested. If you played organized sports and if you were in the military, that told me that you were good at teamwork and you were good at leadership. So there are definitely things that are amazing about sports and so we don't want to take them away. When you start thinking about NFL and then you start thinking about, like, other professional sports leagues and then college sports leagues which are becoming kind of more similar to professional there's so much money involved in it, yes, sir Then you get down to high school and high school, even though it may not seem like there's money involved in it. Yes, sir, then you get down to high school in high school, even though it may not seem like there's money involved in it. There there is.
Speaker 2:I remember, one kid I saw, and it wasn't for concussion, but it was at. It was in jacksonville, at the university of florida in jacksonville, and the kid would. He was a teenager and every time he wrestled he blacked out. So I'm a. So I said maybe you should stop wrestling. His mom looked at me and said this is the way he's going to college and I never saw them again. That was his ticket to college, was his scholarship, so there was money tied into it. Whether you want to say it was money or education, it was money tied into his education, and so there's definitely that tied into sports.
Speaker 2:People who play sports are competitive by nature. That's partially why they're so good at sports, and so to take someone out when they're not feeling like they should be out doesn't feel right to them. They feel very resistant, and unless we as a society that's why I say it has to be a unified front If we have some adults saying one thing, some adults saying another thing. Then the kids are going to be like, well, I'm going to go with the one who says the thing I believe in. Instead, we have to just come down hard. We have to say these are the rules. We might change these rules, we'll ree. Yeah, you have no symptoms. Yeah, you look great. Yeah, you might be the exception, but we have to have some sort of rule so we don't end up with situations like what happened to your son.
Speaker 1:And let's talk about some of those rules that we're proposing as parents, as doctors. The first of all is there should be no head contacting until 14. I don't care what the sport is, until the prefrontal cortex starts developing, and that's the age. Right there and you've already outlined how important this part of the brain is I mean, everybody needs to start at the same playing field, right? I mean, like you said before, so if it's flag football, no head soccer, no touch rugby, no check hockey, we are not only establishing a baseline for this beginning of exposure, but we have also eliminated exposure during some of the most critical developmental parts of a child's life. Would you have any problem with that position of saying look until high school, okay, contact, know, contact sports should be avoided by you know, children. Is that a?
Speaker 2:rational question. I actually think that makes a lot of sense. I understand where people would have resistance to this. People might say well, you know, that's not how we did it before. I got to tell you when I was a kid we didn't ride bicycles. When we rode bicycles, we didn't wear helmets. When we went skiing, we didn't wear helmets. When we went skiing, we didn't wear helmets.
Speaker 2:That was like crazy idea and now we know what we know now and so do we really want to be smashing our kids heads into each other or into other objects? It's probably not a good idea. Now, one of the things you bring up is obviously organized sports. You have to remember, kids are playing sports in other ways. Kids are playing sports after school, during school, at recess, kids might still be playing tackle football or tackle other sports or heading the ball. I remember my nephew, who's now just turned 13. He was disappointed when he was told that if he wants to play in the soccer league, he's not allowed to dive and he's not allowed to head the ball, and he's like well, what's the point of playing? Like to him, that's what he thought soccer was going to be about.
Speaker 2:As a father now with a nine-year-old daughter who's not afraid of the ball, so they put her as goalie in soccer, and I watched those like heads come towards her, towards her, and you know, I watched the other uh feet come towards her head when she's running towards the ball. I'm scared of the ball. She might not be uh. When I see her playing flag football though, yeah, sometimes there's accidental hits. You can't get around, you can't get accidental hits.
Speaker 2:I gotta tell you, kids fall off bicycles. Unfortunately there's accidental hits. You can't get around. You can't get around. Accidental hits, I got to tell you. Kids fall off bicycles. Unfortunately, there's an epidemic of domestic violence in this country. People get hit all the time. People fall. People are climbing and fall. People hit their head in so many different ways Motor vehicle accidents. We can't stop everything, but we can't stop rooting for our kids to be hitting their heads, like we don't have to be there as the parents rooting them on no, and so I think that is a very reasonable idea. And if you watch how the nfl does it now, now they say well, we don't want contact all the time. These are really valuable players, rarely be headed contact all the time. These are really valuable players. They ought to be headed ahead all the time. And so let's just do it on game day. Let's try to do less when it's not game day.
Speaker 1:You just brought up one of the most important aspects of what we're trying to do with. So we're writing informed consent in Florida right now for parents to be aware of these risks in order to promote safer sports. Now, for parents to be aware of these risks in order to promote safer sports. And I mean what we're saying is like, look, if we just took the contact out of practice, the NFL does not practice during the season. They do no contact drills during the season. Some of the I know the Ivy League colleges don't as well, some other ones do. And in the end, if you're an education facility or you're an educational organization, you should be probably focused more on academics anyways than you know sports. But from even most college level all the way down to your Pop Warner guy, we practice every. We have contact in every practice and in high school it's like every day of the week, like every day of the week. If we could eliminate just the exposure and practice, we could almost solve and this became endemic, and not just the public school systems but the Pop Warner systems and all the other crazy. We're nuts about sports in this country, but if we made the lack of contact as a practice a priority. We could almost resolve the CTE crisis, because that's where it all comes from. It's the aggregate amount of exposure, as you very well know, and we're getting a lot of positive reception because people are starting to understand that this is my child. And that woman who said this is my kid's ticket to college, and all that, this is your child's brain. They only have one and you're going to be, and all that, this is your child's brain. They only have one and you're going to be taking care of your child, if you know, when you allow them to play. You know so much sport, so what would you? I mean we, we feel that this would be positively received and maybe it's just one day a week. We'd have to, you know, look at something that would be acceptable, you know, but it's, it's, it's letting.
Speaker 1:I guess, once people understand, oh my god, the brain is that the helmets don't protect the brain. I mean, the brain is still getting. That's my child's brain. It's still getting damaged, it's still good. What are we going to do? And we're and, and these younger generations are not as sports crazy as our generation is or the ones that we brought up. I mean my, my, my children, kids aren't even really watching these contacts. Of course they're watching other things right their screens, but you know. But do you think there is a compromise that we could reach, where you know any any where where where contact is allowed, and say it is high school and up, that we could work to minimize the exposure? Because that is the true danger, that is the, when you dial the risk in in the aggregate. I mean, how many days do you spend in an actual game day, vice? How many days have you spent practicing for that game day, and where is most of the exposure coming from? It's practice.
Speaker 2:Yeah, I think the way to do it actually is. So I used to be the vice chair of the american academy of neurology's uh sports neurology section and my chair at the time was the chief medical officer of the ncaa, and so what I think he has to look at. I think what the ncaa and the neurologist there need to look at is they need to say these kids playing in high school, and I got to tell you it's before high school. Also, I'm really worried about those elementary kids. They're doing it in a pathway towards college.
Speaker 2:Yeah, very, very, very few become elite athletes, but even like just into the pathway to college. We got to say, as NCAA, we got to host these people and I think we have to host, I think they have to host from all 50 states because we all have rules, different rules, and we have to all come to agreement. We have to say that's it In our state, it's not happening. And then they say it's in our state, it's not happening. And I got to tell you you have some of the big sports states say that, so you have Florida and Texas and then from a population point of view, the big four from population so are New York and California, if those four big states say anything.
Speaker 1:I think you can start to see the rest of the country. Follow along New York, york and in california I testified on the ban, which was the wrong way to go, but they're already there, you know I live in florida, you know tampa and so I think to your point.
Speaker 1:I mean we get, and when you, when I talk to college coaches, they go. We would love and even high school coaches through a lesser extent, they would love to see these young men or children come to them without years of bad skills and without all the injuries that they had from playing when they were too young. And I think that you know, I know that from the high school perspective, you know that's the first time you have position coaches. You got an athletic trainer. Usually you got a little bit more support and they're like look, we would love to get these kids.
Speaker 1:Because here's the point, and I have had yet to find anybody disagree with me If you're going to go to college or the NCAA or to the NFL, you have what's called talent.
Speaker 1:You have a raw, native talent that nothing is going to stop you, with with some good coaching, of going where you're going to need to be. And I get so upset with I'm having an issue with a NFL player that's in a certain political position in Florida who is actively against any legislation that addresses this issue in contact sports because he feels that this is a way to get in the college if you're from a challenged demographic of this nation. And I tell him, and I tell everybody, your child has a better chance of becoming a neurologist, a lawyer or an accountant than they do of being in the NFL. So why are you not focusing on this? And if they're going to get to college on their raw talent, then we should be preventing as much exposure and practice as possible so that their brain is still intact when they get to college, so they can get that career that they're going to live off of for the rest of their life.
Speaker 2:Absolutely.
Speaker 1:I just thought, you know it's crazy absolutely.
Speaker 2:I just uh, you know it's. It's crazy, yeah, there's, and there's two ways of doing it. One is, as you say, with legislation, and so you have legislation in all the states, or even federal legislation, although I think there's a state issue, uh, the other way to do it is to go you know, every state now has its source of committees and to just promulgate these rules in every single state. But every state has to agree, because if you have, you know, texas not doing it and Oklahoma doing it, well, the people in Oklahoma aren't going to feel like it's very fair because their kids might not get into those big schools, and so you really have to have us all sit down together. And who can have us all sit down together? I don't know that. It should be the professional, you know, like the NFLs of the world. There's too much history, frankly.
Speaker 1:I think the NCAA should step up to the plate, and I think they would be and they rely on the high schools and the high schools rely on these children to give them, you know, good teams. I think you know, when you start talking about the value of our children's future, everybody agrees and I don't know why this is so hard. We all agree that, oh my god, my children. I don't want anything to impact my child. I mean, listen to what you just said about your daughter. You know, just playing. You know, when it comes to our children, we do everything for you know, when it comes to our children, we do everything for our children. Yet when it comes to sports, for some reason their future, their mental health, is not a variable because we've been groomed. I mean, I just watched an NFL show the other day. I don't watch a lot of them anymore, but they had a Nickelodeon. You know there's SpongeBob and Patrick on NFL actively promoting. I mean we are being groomed as a society that these sports are safe. And then you talk to most of the doctors that we deal with that are not neurologists. There was a study in the New England Journal where I think 40 or 60 percent of them would recommend football to parents because they're not educated on the impact of subconcussive trauma. So I think to your point, not only could the NCAA play a. Now I'm going to take a look at this because we're getting ready to form a council and I'd like to invite you to consider a position on the council on repetitive brain trauma, position on the council on repetitive brain trauma and the, but it's also, you know, the, the, the, the.
Speaker 1:It's not, it's not just the NCAA coming in and saying hey, we've got to, we got to do this, it's also getting the medical and nursing and psychological community on board with this whole issue of subcussive traumas that they're better aware what, what can we do from? You know you're a neurologist or you're a brain specialist. How do we educate? Like our you know our entire medical and psychological community are not educated in the issue of subcussive trauma. It's not trained in any athletic training curriculum that I have pulled down in. It's not addressed in any nursing or medical curriculum. As you know, an issue for the general population to understand. Our psychological communities are absolutely uneducated in the fact that when teenagers show up to them, that they could ask a couple of questions to see if that psychological issue may be attributed to an excessive amount of subconcussive exposure.
Speaker 2:Which also aren't by sports, right, which are also by domestic violence, once again. So that's what they really should be asking about is. Shouldn't you be asking about, like, what you know in your family situation was bad and scarred you for life? They should be asking, like, what actual physical trauma did you have to the head, even if it wasn't knocking down, even if it wasn't knocking hard enough for people concussion? I think most people, especially people who watch your podcast, know that. You know, being knocked out has nothing to do with a concussion, right, so you don't have to be knocked out to have a concussion.
Speaker 2:People used to think that, right, and they used to think, oh, it's the people who are completely or completely lost consciousness, right, and they used to think, oh, it's the people who are completely lost consciousness. Now we know, no, it's that person who has that angular hit at the right velocity, at the right speed, you know, at the right force that's going to give it to them. Subconcussive hits are even harder to tell, and so this idea that there's lots of repetitive trauma that can happen. You know, I think we can educate our professional communities in a couple of ways. One is at the medical school level, but that I've got to tell you is a far way, because it takes a long time. When you go through medical school, you still have another three to eight or 16 years until you become a full-fledged attending. It's a long time.
Speaker 2:There are things like continuing medical education. Frankly, there are many ways of being in continuing medical education and doctors already have a lot of different requirements, Although, I've got to tell you, a lot of states have mandated the CME requirements, mandated continuing medical education. So when we renew our Florida license, for example for medicine, we have to do you know they alternate what the requirements are, but we have to do like a safety module including, you know, in addition to a large number of other continuing medical education where you can choose what you want. But we have to do.
Speaker 2:You know HIV ones, the DA now has ones about pain, the DA now has ones about pain. The question is whether states could maybe, and state medical boards should maybe say well, there should be one about subconcussive hits, about repetitive hits, repetitive hits to the brain, to our children, and that's important enough. A subject at this time Doesn't mean 20 years is going to be the requirement. This isn't something that has to be forever, but maybe it makes sense for the next few years, for the next few cycles, to make that a requirement so that everybody gets up to speed.
Speaker 1:That makes absolute sense. Sir, there's no doubt that on the education and awareness, we have to do a lot. They've gone through you know being and we see this in the military population all the time soldiers that are mentally ill, and yet we're just starting to come around to the fact that that mental illness was not caused by just participating in combat. But combat has been about all that exposure. And are you familiar with the traumatic encephalopathy syndrome protocols that Bob Stern created back I think it was like 2015,. 2017? Yes, well, we're working hard to get those. They were approved by NINDS in 2019, but not validated for actual exposure.
Speaker 1:And here we are talking about four simple questions that even a parent could answer that could indicate that we might have a biological or physiological issue in addition to the cognitive, psychological or behavioral problem. Is there a possibility? We're pushing hard to see if we could get those validated, but we don't know what the process might be. And are, you know, actively looking for, you know, a partner to engage with on that? Do you see those you know coming around? Because right now, when we talk to doctors and nurses, they're like well, I have no diagnostic criteria. You know, I have no, you know tools or whatever you know. And once we start recognizing this is going to be a problem, there's going to have to be some kind of you know. Once we start recognizing this is going to be a problem, there's going to have to be some kind of you know protocol established to you know, support the diagnosis. What do you think could happen there? What are you seeing in the field?
Speaker 2:Well. So I think what has to happen is, you know, when you think about how it happens from a research point of view, you have a gold standard and then you have a new measure that you try to measure it against. The problem with a lot of things that have to do with the brain in general, not just about brain injury, is there aren't that many gold standards, right? The brain is a mystery. It's inside a hard box or a skull and we think with it, and it's hard. When you think with something, it's hard to use that same tool to try to understand what your problem is Like. So, for example, when a kid gets hit with a concussion or a subconcussive hits many of them, then what's going to happen is they might just not be just as sharp, not like tremendously slow.
Speaker 2:We're not talking about these like extremes of people taking their own lives and people say, oh, my kid's not going to do that. That's not going to happen to me. It doesn't have to be that their grades can go from being like in the even if they're great students can go from 97s to 92s because of a head injury, and that may not seem like a big deal to everybody, but I got to tell you over time that means that that person's had injury and it's better for someone not to have brain injury than to have brain injury, and so I think we could talk about it offline. But I think there are ways that we could, you know, have like a consensus protocol test, you know, test for questions, see whether they can work in helping to diagnose some people and hoping maybe to make some diagnostic decisions, but also some strategic decisions in terms of what a kid should do next.
Speaker 1:And you bring up, you know, two good points in that. One is that in my case, my son, I never noticed, even after all, that brain trauma because he didn't do something like you would talk about. There was no remarkable event. He never got arrested, he never was in trouble. He was always that kind, caring, generous human being. But you know, his grades did go down a little bit and we like, all right, because he was, he was going to join the army, he didn't want to go to college, like all right, man, you don't need those A's, no more. Ok, but it was his apathy that.
Speaker 1:But it wasn't like I don't want to do anything, it was like I just don't want to. I want to be in my dark room, I want to play with my video games. You know, it wasn't anything that we could put our finger on. And that's what we want parents to understand is that if your child is being impacted by these sports and you know, and if you've got your child in contact sports every month of the year and we'll talk about this a second you are not, you are failing your child because the brain cannot take that much abuse and continue to function and a lot of this functionality that you're going to come across is not noticeable, as Dr Cantor just said, and so we really got to get to that. But the other point, doc, about, oh, we don't have a gold standard Well, that's not good enough anymore, because we know this is a risk to our kids and we have to do something. And that's what we're saying on the veteran side, it's like all right, you know, we just can't prescribe drugs and give therapy anymore. We've got the guys still 22 of them still killing themselves every day. We have to do something different. And here, when we have a part of the brain or the part of the body that is so hard to assess and diagnose because it's not a broken bone body that is so hard to assess and diagnose because it's not a broken bone, when you fix this bone, this is the brain, right, and unfortunately, have I now become so cognitive or aware of how valuable it is? We have to do something better than we are, because we're still seeing suicides, we're still seeing mental illness and we know that this is a threat this whole time, from you know, say, 2015,.
Speaker 1:Even when my son passed away, there was only two papers I could find on subcussive trauma. Now look up subcussive trauma, repetitive head impacts. Look at all the research, all the understanding, yet we're doing this the same way, we're not changing and our kids are continuing to be impacted. So just a couple points there that I think we need to work better on and we can talk offline about those protocols. But from your perspective, every time I talk to a neurologist, say, your kids play contact sports, they're the first ones to go like are you crazy? And then you talk to people that are not neurologists, that are very, very successful doctors, are like, well, yeah, I mean, you know the, the, you know it's just the level of awareness is just it needs to be.
Speaker 2:But that's a good. That's a really good point, cause I do something that people are surprised about. So for many years I was a ringside physician in the state of Florida, so both with boxing and MMA and a lot of people were surprised. They said, wait, but you're a neurologist. I said, yeah, I'm not promoting them, but these sports are going to happen. And when you have two consenting adults and you can say, well, maybe there was a systemic reason why that. Whatever the point is, they're adults and they're making a decision to play a sport where the goal is traumatic brain injury right, that's the goal of blood and yet I think it's safer. I think it's a good idea for people like neurologists to be there. I also thought it was a good idea. If I want to really understand brain injury, I should see it happen in real time and it's going to happen, whether I'm there or not.
Speaker 2:So I might as well volunteer and be a doctor at the ringside. And so also my daughter and I look at her and I see her playing flag football. And you know those girls they run, but some of those are a little bit rough and sometimes it ends up being a tackle almost and I'm like, wait, should I not? Should I put her in a bubble? I'm like yeah, but then she's not. Should I put her in a bubble? I'm like yeah, but then she's not exercising, then she's not having those teammate experiences.
Speaker 2:I can't protect her from everything in the world. Yeah, it would be better if she was like a bubble somewhere and she wouldn't be exposed to anything, but then something bad would happen, you know. So, no matter what we're going to have risks, our point in life as parents is not to get rid of all risks for our children. We can't do that. We can't get rid of every time they're going to have their heart broken or every time they're going to have a bad grade or every time there's going to be some bully. But we can help soften the blow, we can help make it a little bit more reasonable. So you know, I'm not putting her into a contact sport, but I'm wanting to play a sport that's adjacent to a contact sport, absolutely.
Speaker 2:So to me it gets many of the benefits and almost all of the benefits, and in fact I think that's why the Olympics, that's why I think they're moving to having fly football, because it's really exciting to watch. I mean, it's almost the same excitement I know we like to see when two people hit each other. On the other hand, when they hit each other and they get hurt, like what happened with Tua, everyone was like, oh my God, look at what happened. I'm like we pay money to watch it, so why are we so surprised that it happened? Like these things are going to happen if we keep promoting it, but if we slowly move away. I think you're right about generational. I think this idea I think that's what the NFL is looking at also is that throughout the years, what happens is people are less and less into these contact sports and that means that the next generation might be okay with something else. They might be okay with, you know, on the computer sports or flight football or other kinds of sports.
Speaker 1:Yeah, we talk to parents all the time. Unfortunately, doc, I've got to get off and get ready for another podcast. But look, this has been amazing. I mean you have this is.
Speaker 1:I cannot thank you enough for the time. Your perspective on this is spot on. We just want sports to be safer. This is a risk to our children. It can be prevented, it can be mitigated and we can still play sports and they can still go on and be NFL players and guess what? At the end of their NFL career, they can enjoy their money instead of all of my NFL buddies who are disasters right now and self-admittedly, they're just like. You know it's hard, and so we want to change that. We want to change it all. I know it's hard, and so we want to change that. We want to change it all.
Speaker 1:I cannot thank you enough for your time, doc. This has been an amazing show. Love to have you come on again. I'll definitely be reaching out to you on some of the amazing. I didn't know half the stuff you did on the consultation side and that's so important out there. We'd love to work with you more and more. You know can't thank you enough and if it, if just well, any word for our viewers, especially our parents, that you know you might just think would be a parting gift to them as you sign off.
Speaker 2:Well, I think you brought up a really good point about the NFL players. The ones we see on TV are the sportscasters afterwards and we're like, look, they had a great career, they made a lot of money and now they're doing a lot of good work on TV and making more money. They made a lot of money and now they're doing a lot of good work on TV and making more money. What people don't see are all those retired NFL players that aren't on TV, all those ones that I saw as part of that NFL concussion settlement, that have these terrible concussions and terrible lives right now because of all the injuries that they had, and so I think there's a lot more happening. I think, as parents, it's our job to kind of peel back the onion and look at what really are we exposing our children to.
Speaker 1:Absolutely, dr Cantor. Thank you so much for coming on the show. I hope you have a very blessed 2025. God bless you and continue on your journeys to help our kids be safer, our athletes be safer, and we'll see you again on the show, sir.
Speaker 2:Thank you very much I appreciate it.