According to the Sports Brain Guard website, the product was created by Dr. Russell Blaylock and developed by Newport Nutritionals, a company based in Irvine, California. There is no contact information listed for Blaylock either at his personal website (RussellBlaylockMD.com) or at the Sports Brain Guard site.
1 November 2011..........
In a finding that exposes just how aggressively, misleadingly, and perniciously ImPACT concussion management software is being marketed, Concussion Inc. has uncovered ImPACT and University of Pittsburgh Medical Center documents advising potential purchasers that not even baseline neurocognitive tests are needed in order to safely use their expensive, for-profit product.
Baseline testing is the holy grail of “concussion awareness.” The evidence of its fraudulence, as usual, is hiding in plain sight. Examples:
In talks at medical conferences, neuropsychologist Jamie Pardini of the UPMC Concussion Program discusses “How I Manage Concussions.” At Muchnick.net/pardini.pdf, you can download a PDF file, which appears to include slides shown to the audience, perhaps a PowerPoint presentation. Look at slide number 8, “Clinical Protocol: Neurocognitive Testing.” The first point on the timeline, pre-concussion, states, “Baseline Testing (Not necessary for decision making).”
The lead story of the December 2005 issue of the CIF News, the newsletter of the California Interscholastic Federation, was a promo for ImPACT under the headline, “ImPACT Technology Ensures Safe Return to Play After Concussion.” The article was written by the company’s director of sales and marketing. It states, “[I]n the event that baseline testing is not possible, ImPACT has a normative database of thousands of non-injured athletes, and such data can be used effectively for adequate comparison and deciding safe return to play. Thus, ImPACT may now be used effectively in a clinical setting when baseline data is not available for comparison.”
ImPACT Applications, Inc.’s own website tackles the question head-on (so to speak). Here’s the explanation from the FAQ page (ImPACTtest.com/faq): “Yes, the program can, and should, be used even without a baseline. In the report summary scores (composite scores), the norms are printed out and automatically tabulated. The raw score is accompanied by a percentile which indicates where they fall relative to healthy age and gender-matched controls. For example, if the composite score falls at the 5th percentile … that would indicate 95 out of 100 non-concussed individuals would perform better than the athlete that is being tested. By understanding their pre-injury status, this data can be extremely informative and helpful. For example, a typical A/B student should be around the 60th percentile or higher on all composite scores, those that are C students should typically fall around the 40th percentile or higher and those with learning disability or very poor students could fall as low as the 20th percentile or so and be considered within normal limits. We use the program all the time without baselines and the data is very helpful for clinical management.”
I don’t think UPMC and ImPACT would be able to find many, if any, experts who were not already on their payroll who would be willing to assert that a “normative database” could responsibly substitute for individual baseline tests. Young people’s brains are still growing and changing, and their responses to standardized tests fluctuate year to year, even month to month, with variances that make the UPMC and ImPACT claims here almost criminally unsupportable.
All this does not even to get to the general flaws of subjective neurocognitive tests, which have already been widely discussed: the reality that test-takers sandbag the baseline tests with deliberately dumb answers and boost their scores on repeat tests with the help of Ritalin.
30 November 2011..........
The National Institutes of Health yesterday fulfilled my Freedom of Information Act request and supplied five documents from the University of Pittsburgh Medical Center’s multimillion-dollar grant application and progress reports on concussion research for the period 2001–06.12
This is no mere underwriting of purchases of lab equipment or travel to scientific conferences. It is a major subsidy, including compensation breakdowns, for a monumental public health study. The grant shows tens of thousands of dollars of annual remuneration for Mark Lovell, Dr. Joseph Maroon, Micky Collins, and others.
As noted previously, the NIH conflict-of-interest disclosure by UPMC is not included with this document release. The federal rules put the control of the public release of that disclosure in the hands of the grant recipient itself.
One of the more intriguing loops left unclosed by this release is: What happened at the back end? Did UPMC ultimately report out conclusions from its fMRI study?
28 February 2012..........
Neurosurgery has published a new paper claiming that healing time from a concussion now can be predicted with more precision. Remember that Neurosurgery is a virtual house organ of the NFL and historical repository of canned, cooked, and unethically produced articles on traumatic brain injury. UPMC today put out a press release:
The study, one of the first to examine concussion prognoses, showed that specific neurocognitive “cut-off” scores derived from ImPACT™ (Immediate Post-concussion Assessment and Cognitive Testing) improved clinicians’ ability to predict which sports-related concussions could take longer — as much as five times longer — to rehabilitate than others. They found, in as many as 85 percent of the cases, the scores could warn athletes, parents, coaches, schools, teams, and health professionals when a concussion is likely to take on average a month to heal.
Micky Collins, the UPMC program director who co-owns the for-profit ImPACT Applications, calls the study “a game-changer” because it augurs “a way of determining within two days of injury who’s going to take a month or longer to recover.”
Meanwhile, in the neglected common-sense wing of youth concussion research, another journal, Brain Injury, has published a paper by Université de Montréal neuropsychologist Dave Ellemberg buttressing the intuitively obvious case that teenagers are far more vulnerable than adults in this area. Furthermore, Ellemberg says, a first sports-related concussion “will result in six months to a year of neurophysiological side effects for adolescents, adults, and children alike.”
29 February 2012..........
Pittsburgh is the national capital of Concussion Inc. — and proud of it!
“Health care is booming business in Western Pennsylvania,” says the Pittsburgh Tribune-Review:
The industry’s impact in the region last year was $15.8 billion, and health care employed more than 112,000 workers, according to a report published by the Hospital and Healthsystem Association of Pennsylvania. The number represented 10.5 percent of the total workforce in Allegheny, Westmoreland, Washington, Beaver, Butler, Fayette, Armstrong, and Green counties.
Health care continues to dominate the local landscape as UPMC and West Penn Allegheny Health System, the two largest providers, fight for patients and insurance customers in the region.
Highmark Inc., the region’s largest insurer, has proposed acquiring West Penn Allegheny for $475 million. Because of that merger, UPMC intends to terminate agreements between its doctors and Highmark.13
UPMC owns 19 hospitals and had 2011 operating revenue of $9 billion — up from $8 billion in 2010. “The system employed 54,000 people in Western Pennsylvania, including more than 5,000 physicians. Its hospitals admitted and observed more than 234,000 patients. CEO Jeffrey A. Romoff earned $4 million in 2009, according to public tax disclosures.”
The part about the UPMC turf war with West Penn Allegheny Health caught my eye. In 1999, Dr. Maroon made regional business news when he and his celebrity-studded practice at Allegheny General Hospital — West Penn Allegheny Health’s flagship — jumped to UPMC.
As it happens, last October I was contacted by Dr. Jack Wilberger, the neurosurgery chair at Allegheny General and a vice president of West Penn Allegheny Health. “Our Concussion Center is becomi
ng more robust as more and more realize the issues you describe,” Wilberger told me. I have since noticed that Wilberger occasionally lands a dissenting quote in the Pittsburgh press coverage of UPMC’s management of hockey star Sidney Crosby’s long recovery from a series of concussions.
None of this should be taken as an endorsement of Jack Wilberger; I don’t know Jack Wilberger from Jack. But “health care is booming business in Western Pennsylvania.” That much I know.
6 March 2012..........
The UPMC media relations department never responds to my inquiries, and that hurts my feelings. Peer-reviewed studies show that I get between 30.07 and 43.24 percent madder than baseline every time UPMC flacks ignore me.
However, the indefatigable Dustin Fink of the Concussion Blog yesterday did receive an unsolicited email from Chuck Finder, who joined the UPMC staff recently after years as a sportswriter for the Pittsburgh Post-Gazette.
Last week Fink wrote an unflattering analysis of UPMC’s hype of its new “concussion recovery predictor” model.14 Whereupon Finder contacted Fink. Below, as a public service, I reproduce Finder’s entire message, including the memo from UPMC’s Brian Lau responding to Fink’s questions.
In Nos. 1 and 5, Lau asserts that symptoms such as fatigue and headache can exist without concussions and are sometimes confused with them. Of course, the same point makes the “sensitivity” percentage claims for the ImPACT system — to the hundredths of a percent! — meaningless. We have no way of knowing if concussion symptoms are abating or if mere “concussion-like symptoms” are abating. Two can play this circular logic game.
In No. 4, UPMC explains that its recovery-predictor study has no “traditional control group.” English translation: There is no control group.
Dustin,
First, please allow me to introduce myself. My name is Chuck Finder, and in my previous life as a sports writer I penned more than a few concussion stories/series in my 25 years at the Pittsburgh Post-Gazette. I joined UPMC in mid-January to help represent their Sports Medicine and Concussion Program work.
Folks here noticed your Feb. 29 blog questions prompted by their Cut-Off Study news release, and Brian Lau — one of the co-investigators — typed up answers for you.
Use them however you choose: They can be for your edification solely or, if you wish, you have UPMC’s approval to post them as they are …
Chuck Finder
UPMC Media Relations
*****
[BRIAN LAU MEMO]
Why would you neurocognitive test anyone with symptoms, while still recovering? The symptoms after a concussion — fatigue, headache, etc. — are non-specific findings that may or may not represent a concussion. Moreover, some athletes have some of these same symptoms at baseline. Neurocognitive testing has traditionally been used to determine the presence or absence of a concussion. This study adds to other preliminary evidence that neurocognitive testing while an athlete has symptoms during recovery may also assist in predicting length of recovery. A previous study showed that symptoms used alone had a 40.81% sensitivity in predicting protracted recovery. When neurocognitive testing was used with symptoms, the sensitivity in predicting protracted recovery increased to 65.22%.
Are the numbers based upon the ImPACT “norms” or a baseline calculation? There are no numbers in this study requiring the use of norms or baseline calculations. We used the numbers from the first ImPACT tests and determined cutoffs off that.
Is this experiment repeatable with other measures? This is the first study to attempt to set cutoffs for prognosticating return to play early after injury. As recommended in the discussion section, we hope that this study encourages other groups to conduct similar studies to evaluate the value of cutoff scores.
Where are the control groups? It should be noted that this was an observational study that followed athletes, whom underwent a structured recovery program. It was not designed to compare two different diagnostic modalities or treatment intervention. Therefore, the traditional control group vs. study group that compares traditional practice with a novel diagnostic tool or treatment is not represented in this study. However, recovery from a sports concussion usually takes less than 14 days. In this study, the athletes were divided into protracted and short-recovery based on this time frame. As such, the short-recovery group may be considered the control group because it represents the natural recovery time following a sports concussion.
Is the accuracy of ImPACT that sensitive (is there even one accurate enough to make this assessment)? ImPACT testing has been shown previously to have a high degree of sensitivity (81.9%) and specificity (89.4%) in diagnosing concussions (Shatz et al., Arch Clin Neuropsychol, 2006). The sensitivity and specificity in prognosticating the recovery time following a concussion has only recently been studied. A recent study showed that when ImPACT testing and symptoms were evaluated together, there was a sensitivity and specificity of 65.22 and 80.36%, respectively. The effectiveness of ImPACT testing as a prognosticating tool should be further validated and we hope that this study will encourage others to do so.
What did each individual do for management of the concussion in the two days? All athletes were followed by certified athletic trainers who made the initial on-field diagnosis of a concussion. These certified athletic trainers were also trained in the graded extertional activity protocol used in this study which requires athletes to be symptom free at rest and to be cleared by clinical concussion specialists. Therefore, in the time frame prior to initial neurocognitive testing (mean: two days), athletes were kept out of practice and game situations.
25 September 2012..........
The Pittsburgh Post-Gazette is in the middle of examining how “UPMC has come to dominate Pittsburgh’s landscape, much like the steel industry did.”
Part 1 of the series includes the following account of a questionable land deal between UPMC and my favorite physician-piñata, Dr. Joseph Maroon, in 1999, the year Maroon was recruited away from Allegheny General Hospital:
Dr. Maroon also was a prolific real estate investor and had bought about three dozen parcels on the North Side.
At the same time UPMC announced that Dr. Maroon was coming to work for the hospital, the surgeon sold UPMC a group of his properties for $5.2 million — real estate which cost him a fraction of that to acquire.
UPMC still owns all but two of the parcels it bought from Dr. Maroon in the deal. But 13 years after UPMC completed the transaction, the property is valued about $1 million less than the purchase price.
In 1999, both UPMC and Dr. Maroon denied there was any tie between his move to UPMC and the purchase of the property.
Dr. Maroon did not return calls seeking comment for this story.15
Give that Post-Gazette reporter, Sean D. Hamill, an ImPACT baseline test at once!
19 October 2012..........
The feds have indicted Dr. Joe Maroon’s former UPMC and Pittsburgh Steelers colleague, Dr. Richard Rydze, for human growth hormone trafficking.
Rydze made six-figure purchases of HGH by credit card from internet gray-market drug dealer Signature Pharmacy. He was busted by ESPN’s Mike Fish.16
..........
1 sports.espn.go.com/espn/otl/news/story?id=4724912.
2 The interview is viewable at youtube.com/watch?v=g8jqCZ4yUrs.
3 See www.thepostgame.com/features/201101/tpg-exclusive-nfl-orders-raiders-head-coach-hue-jackson-end-ties-company-linked-bann.
4 See Maroon’s piece of the hype at www.sportsbrainguard.com/sbg.aspx.
5 www.nytimes.com/2011/01/23/sports/football/23helmet.html?ref=sports.
6 blog.4wallspublishing.com/2011/04/23/critics-evidence-debunk-concussion-testing-in-football.aspx.
7 Video was originaly available at nflhealthandsafety.com/2011/01/20/performing-a-neurological-exam/.
8 Video was originaly available at nflhealthandsafety.co
m/2011/07/13/dr-ellenbogen-on-concussions/.
9 www.theintelligencer.net/page/content.detail/id/557704/-Sunday-Sit-Down—TODAY-S-GUEST–Dr–Joseph-Maroon.html?nav=510#.Tj_rrgQagV0.twitter.
10 “Concussions Take a Terrible Toll on America’s Young Athletes,” by Steve Jansen and Gus Garcia-Roberts, www.laweekly.com/2011-08-18/news/concussions-take-a-terrible-toll-on-america-s-young-athletes/.
11 www.mlive.com/sports/jackson/index.ssf/2011/10/orthopaedic_rehab_specialists.html.
12 The documents are available at muchnick.net/upmcgrantyr1.pdf, muchnick.net/upmcgrantyr2.pdf, muchnick.net/upmcgrantyr3.pdf, muchnick.net/upmcgrantyr4.pdf, muchnick.net/upmcgrantyr5.pdf.
13 www.pittsburghlive.com/x/pittsburghtrib/business/s_779870.html.
14 See theconcussionblog.com/2012/02/29/upmc-and-recovery-predictor/.
15 www.post-gazette.com/promohomepage/2012/10/02/PG-Special-Report-UPMC-Forging-a-Giant-Footprint-1/stories/201210020227.
16 sports.espn.go.com/espn/otl/news/story?id=3831956.
CHRIS NOWINSKI AND ALAN SCHWARZ
8 March 2011..........
Having lambasted Dr. Joe Maroon for his sundry commercial associations, I cannot fail to explore a controversy last week sparked by articles in the Boston business press reporting that Dr. Robert Cantu had some kind of advisory status with the innovative Xenith helmet company. Cantu, of Boston University, the physician who diagnosed Chris Nowinski’s concussions prior to the launch of his Sports Legacy Institute, is one of the leading lights in chronic traumatic encephalopathy research. Fasten your chinstraps for a complicated tale of hype in the world of venture capital.
I am not alleging here the kind of blatant corruption suggested by the deep-seated symbiosis of Maroon with the Pittsburgh Steelers, the NFL, WWE, UPMC, ImPACT, the unregulated supplements Vindure and Sports Brain Guard, and the Riddell Revolution helmet. That particular custodian of the Hippocratic oath has turned himself into a walking infomercial.
Concussion Inc. Page 11