NFL's concussions expert also sells equipment to league
Updated: August 10, 2007, 5:29 PM ETBy Peter Keating | ESPN The Magazine
The National Football League's director of neuropsychological testing is also the chairman of a company that sells testing software to NFL teams, a dual role which raises questions about conflicts of interest.Mark Lovell, director of the Sports Concussion Program at the University of Pittsburgh Medical Center, oversees neuropsychological testing programs for the NFL. In that capacity, he has helped teams use neurocognitive tests -- which essentially grade subjects on their memory and reaction time -- to help team doctors make decisions about when injured athletes can return to play. This season, baseline neuropsychological tests will be mandatory for all NFL players for the first time. In the late 1990s, Lovell and Joseph Maroon, clinical professor of neurological surgery at the University of Pittsburgh and team neurosurgeon for the Pittsburgh Steelers, developed their own computer-based battery of tests, calling it the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) system. Together with Michael Collins, assistant director of the Sports Concussion Program at Pittsburgh, they launched a company called ImPACT Applications to make their product commercially available. Today, Lovell is chairman and software developer at ImPACT Applications, Collins is chief clinical officer and Maroon is chief medical officer.
At the same time, Lovell and Maroon are members of the NFL's Committee on Mild Traumatic Brain Injury (MTBI), which conducts research projects designed to help the league better understand and manage concussions. Lovell is also a consultant to the Steelers, and oversees neuropsychological testing programs for the Indianapolis Racing League (IRL) and CHAMP Car Racing. From 1997 to 2007, he co-directed the National Hockey League's neuropsychology program. Lovell's overlapping roles and financial interest in ImPACT have drawn criticism from several doctors and athletic trainers working in the field of sports concussions. Their ire has intensified as Lovell sometimes has not identified himself as one of ImPACT's developers in his scientific research. On at least seven occasions since 2003, Lovell has authored or co-authored studies on neuropsychological testing, including papers directly evaluating ImPACT, without disclosing his roles in creating and marketing ImPACT, according to an ESPN.com review of recent medical literature. In one case, an examination of Lovell's connections prompted an academic journal to rewrite its disclosure guidelines for authors. "It is a major conflict of interest, scientifically irresponsible," says Christopher Randolph, professor of neurology at Loyola University Medical Center in Chicago and former team neuropsychologist for the Chicago Bears. "We are trying to get to what the real risks are of sports-related concussion, and you have to wonder why they are promoting testing. Do they have an agenda to sell more ImPACTs? And if you're writing a paper and you have anything to do with a company involved, it's imperative that you disclose it." Earlier this year, NFL commissioner Roger Goodell ordered all teams to implement baseline neuropsychological tests. ImPACT, which is one of a handful of computerized neuropsychological systems available (CogSport, the Concussion Resolution Index, and the Automated Neuropsychological Assessment Metrics are among the others) has since become the league's de facto standard testing system. Thirty of the NFL's 32 teams now use ImPACT, according to the company's Web site. "I can see why the league would want one standardized test," says a leading neurosurgeon, who asked to remain anonymous because his patients include former NFL players. "I can't for the life of me understand why they would want that standard to be a test that is owned by two members of the [MTBI] committee." Lovell declined to reply by e-mail or telephone to questions sent to him by ESPN.com. He also declined a request to be interviewed by "Outside the Lines." "These are very important issues that are too complicated to address in an edited 10-second sound-bite," says Susan Manko, spokesperson for the University of Pittsburgh Medical Center. In a statement to ESPN.com, NFL spokesman Greg Aiello said: "The commissioner is not expecting the committee to specifically recommend a single neuropsych[ological] testing protocol. Most of the clubs have already decided to use the ImPACT test on their own, or were already using it. There are many members of the committee who have had no role in developing ImPACT and no financial interest in it. And ImPACT has been the subject of a good deal of independent study." Scientists are currently debating how useful ImPACT and other computerized systems are in diagnosing concussions. Citing multiple studies, Lovell and his colleagues have stated that "ImPACT has been shown to be an effective tool for concussion management." They have asserted repeatedly that ImPACT measures real effects, not just the ability of subjects to improve on tests with practice, and that it can discern even mild concussions.
Mel Evans/AP PhotoImPACT is used by trainer Erin Cearfoss last August at Northern Burlington County Regional High School in New Jersey.
|On Sunday, "Outside the Lines" will examine the journeys of two men who have become unlikely partners in the common belief that brain damage from repeated concussions in football can lead to depression, dementia and suicide. One is a former pro athlete whose career was ended by concussions; the other is a doctor who worked on the autopsies of two former NFL players. In addition, "Outside the Lines" takes a close look at Mark Lovell's ImPACT test and its use by the NFL, and explores whether it is good science to have a member of the league's concussions committee analyzing data and helping set policy using a product in which he has a financial interest. Guests include Garrett Webster, the son of late former NFL center Mike Webster; and ESPN The Magazine's Peter Keating. "Outside the Lines" is hosted by Bob Ley. Tune in Sunday at 9:30 a.m, ET, on ESPN.|
In the March 2006 edition of Brain Injury, for example, Lovell and three co-authors described ImPACT as a "brief computer-administered neuropsychological test battery" without detailing its origins. The acknowledgments to that study contained the equivalent of an advertisement for the software: "Additional information on ImPACT is available at www.impacttest.com
AP Photo/Mark LennihanNFL commissioner Roger Goodell has mandated baseline neuropsychological testing for all players for the first time this season.
Peter Keating is a senior writer at ESPN The Magazine, where he covers investigative and statistical subjects. He started writing "The Biz," a column looking at sports business from the fan's point of view, in 1999. He also coordinates the Magazine's annual "Ultimate Standings" project, which ranks all pro franchises according to how much they give back to fans. His work on concussions in football has earned awards from the Deadline Club, the New York Press Club and the Center for the Study of Sport in Society.