Upside the Head
Galetta, like many neurologists, believes that especially for younger players, the main problem isn’t hits in games. “More concussive hits take place during practice,” he says. “We have to be careful about how often we have full-contact drills, and properly educate athletes about their technique. And we need to eliminate some of the gladiator-like drills still being used. They teach you perseverance, how to try to overcome fatigue, but they are largely destructive.” While he clearly believes the King-Devick test will make all youth sports safer, I ask him how he would feel about his two athletic sons—one now a third baseman for Haverford College, the other a pitcher and outfielder in high school—playing football. He pauses for a moment. “I was disappointed that neither of my boys played football,” he says, carefully, “but I’m now quite thankful they are baseball players.”
AFTER MY TALK with Galetta, I call Robert Cantu at BU to ask what he thinks about King-Devick. “It will be of some value and some use,” he says, “and properly used as a tool in the tool bag, I would support it … but their findings are very preliminary.” And then, out of nowhere, he takes a swipe at Galetta and Balcer: “They don’t have any background in concussion research,” he says. “They don’t have a good feel for what concussions are all about. They talk about finding nearly 100 percent of concussions. … We’ll see what the data shows. … I doubt it will be able to predict more than 75 or 80 percent of the time. That’s good enough to rule somebody out, but not good enough to rule somebody in. And we don’t want simplistic tests to let people go back in.”
Cantu then raises an extremely technical issue about brain function and eye movements, and expresses concern about a conceptual shortcoming of the King-Devick test. He says he finds the idea that it can catch all concussions to be “specious” because of “cerebellum and balance issues.” Saccadic eye movements, he says, don’t involve the cerebellum, so the test wouldn’t pick up balance and coordination problems.
I e-mail Galetta and Balcer to ask what they think of this. They immediately arrange a conference call with me, during which Galetta tries to be diplomatic. “The problem is that all of us don’t know all aspects of the brain and its functions,” he says, carefully but forcefully, “and there will be gaps in our knowledge. Some of us have expertise in neuro-ophthalmology, others may be better in operating, and it’s only through collaboration that we can improve understanding.”
But what about the cerebellum and saccadic eye movements?
“As for what [Cantu] said, I would think that is not a correct statement. In my 25 years as a neuro-ophthalmologist, it has been proven that the cerebellum is of paramount importance for saccadic accuracy.” He and Balcer go on citing studies and details. But they also try to frame the discussion as one born of the infancy of concussion science, the shortage of experts and rigorous studies, the overreliance on “expert opinion.”
During an e-mail exchange with test inventor Steve Devick, I mention what Cantu said about his test. And I’m quickly reminded just how incestuous this world is, and precisely why Galetta and Balcer insist on doing their research pro bono, without any financial links to the test.
Devick calls Chris Nowinski, the retired wrestler, because it turns out they’re making a movie together. (They liked each other so much after meeting at the Eagles game last fall that Devick optioned Nowinski’s book, and hired Hoop Dreams director Steve James.) Apparently, Nowinski then calls Cantu—his partner.
I e-mail Cantu around lunchtime on a hot, barbecue Saturday in July—and two hours later, he e-mails back, saying he stands by his point. “I would not expect the King-Devick test to pick up all concussions as the visual pathways and eye movements do not involve ALL areas of the cortex. Furthermore … ” At the end of his otherwise friendly, albeit technical, e-mail, he writes, “sounds like you may be being used to push a product”—the King-Devick test.
After several more rounds of e-mails, I give up and let everyone agree to disagree. Time will tell, I say.
“Yes, time will tell,” Steve Galetta writes back, “and that is the part of research I love. Sometimes you have it right, sometimes you don’t. It is important to stay humble and to know your limitations.”
But because even science is a contact sport, he can’t resist getting in one more hit.
“You can,” he writes, “only go so far with expert opinion.”