Degraded or obsolete. Im pleased to learn of your donation. It strikes me of an knowledge meant that wearing an old helmet when playing football is not advisable. It is a statement that would be very influential. Weve also heard that reconditioning those under 10 years old is important to ensure the proper phone density and that other degraded parts are replaced. Want to ask you the following questions. I guess that is why im sitting in the seats. We realize that many issues are subject to negotiations. Can they commit to supporting the habitant helmets on the field that are over 10 years old . In the youth space. I plead not enough familiarity with the issue. I know there are a couple of states that would be happy to work with you to pursue it. The first question is committed to prohibiting helmets on the field of over 10 years old. Can you commit to the supporting a policy positions that these present an unacceptable safety risk that is right most of the helmet industry . I see no reason why we would have a concern with that. It sounds appropriate. I recommend that the helmet should be discarded after 10 years. Can the nfl Committee Supporting a position that helmets be discarded after 10 years . We would certainly support helmet companies and how they advise people to use their products. We have heard stories of using players players using beat up helmet or adjusting them by removing some padding. Will the nfl commit to support a policy position that all players should wear helmets that are reconditioned properly . All of our players have choices in which helmet they use as long as they pass the standards. That is something that is a point of discussion with the players association. They passed the standards. They were reconditioned properly. They have the appropriate padding. The helmets are reconditioned regularly. Our management works to make sure their helmets are in good working order. Thank you. Thank you very much. [no mic] he discusses the interpol database system and which countries use it. As always we will take your calls and you can join the conversation at facebook and twitter. Washington journal live at 7 00 a. M. Eastern on cspan. Housetinue now with the Energy Committee on sports and brain injuries. In neuroscience and medical research. Physics when he arrives. So, panel ii, i will introduce you. He is the advertising practices at the federal trade commission. He is the Student Ambassador for the National Council on sports he. If i may editorialize, i think jan did a great job of juxtaposing a days of tbi and confessions concussions on each panel. This is from a more scientificbased panel. Thank you for taking your day away from school. I know how tough it is to be pulled out of school and come testified before Congress Just like a normal High School Students. Dr. Robert graham at the institutes of medicine. Dennis, center for brain biology and behavior at the aimed university of nebraska and think you. Then dr. James johnson, assistant professor at the department of neurosurgery at the university of alabama birmingham. Star of screen. Professor of atomic, manipulator binoculars and atomic physics. A phd division of chief neuropsychology, childrens medical hospital. And not quite up to the level of university of nebraska we have the harvard medical school. That is just humor. A professor of psychiatry and radiology at brigham and Womens Hospital harvard medical school. Thank you for being here for a very impressive and esteemed panel a scientists and experts. We will start. Your now recognize for your you are now recognized for your five minutes. The green light is on. Is it better . I am the assistant director for the division of advertising practices at the federal trade commissions bureau of protection. I am pleased at this opportunity to provide information about the actions we have taken over the last few years with respect to concussion protection claims. Claims that implicate Serious Health concerns, especially those potentially affect and children and young adults are always a high priority at the commission. The commission strives to protect consumers using a variety of means. Section five of the federal trade Commission Act prohibits unfair acts or practices. In interpreting section five, the commission has determined a practice is deceptive if it is likely to mislead a consumer acting reasonably and is likely to affect the consumers conduct, choice, or decision about a particular product at issue. The commission does not test products for safety. It does require an advertiser have a reasonable basis for all objective claims conveyed in an ad. The commission examines specific facts to determine the type of evidence that will be sufficient to support a claim. When claims involve health and safety, advertiser generally must have confident, reliable, Scientific Evidence substantiating the claim. As awareness of the dangers of concussion has grown, manufacturers have begun making concussion protection claims for an increasing array of products. These include football helmets and mouth guards, but also include other products. In august 2012, the commission announced a settlement with the makers of brain pad. The Commission Alleged it lacked a reasonable basis that they reduced concussions, particularly those caused by lower jaw impacts and falsely claimed Scientific Evidence proved the mouth guards did so. Final order prevents them from representing any equipment as assigned to protect the brain from injury will reduce the risk of concussion unless the claim is true and substantiated by reliable Scientific Evidence. The commission sent out warning letters to nearly 20 other manufacturers of Sports Equipment advising them of the settlement and warning them they might be making deceptive claims about their products. The ftc has monitored these websites and is working with them as necessary to modify their claims. In some cases, to ensure the necessary disclosures are clear and prominent. Commission staff continues to survey the marketplace for concussion reduction claims and alert advertisers who are making potentially problematic claims of our concerns and of the need for appropriate substantiation for such claims. Commission staff also investigated concussion reduction claims made by three major manufacturers of football helmets. The staff determined to close investigations without taking formal action, by which time all three companies had discontinued the potentially deceptive claims or agreed to do so. Those cases are discussed in greater detail in the written testimony. The commission plans to continue monitoring the market for products making these claims to ensure advertisers do not mislead consumers about the capabilities or science. At the same time, we are mindful of the need to tread carefully to avoid inadvertently chilling research or impeding the development of new technologies and products that truly provide concussion protection. The commission appreciates the committees interest in this important area as well as the opportunity to discuss our effort to ensure the information provided to consumers, in particular to the parents of Young Athletes, is truthful and not misleading. Thank you. Ian, you are recognized for your five minutes. Thank you for the opportunity to share my story. I am here as a Student Ambassador for the National Council on youth sports safety. Im also a senior at Bethesda Chevy Chase High School in bethesda, maryland. I was a sophomore playing in a high school offseason lacrosse game when i sustained a serious head injury we later discovered was my third concussion. Until then, i did not appreciate what a great life i was living. I got good grades in challenging classes, played high school lacrosse, was working on my Second Degree black belt in martial arts, had a job i loved, performed in my schools jazz ensemble, and had an active social life. It was over in a split second. My concussion left me with only 5 of normal augmented activity. I was almost immobilized. I spent 2. 5 years recovering and wondered if i would ever get that life back. It has been a long, slow process. At first, all i wanted to do was sleep. Noise and even moving my eyes caused headaches and nausea. I was enrolled in the program where i received ongoing evaluation and treatment for symptoms. After missing school for two weeks, i tried to go back but was not able to function. The frustration of trying to focus on lectures and the constant sensory bombardment made a Normal School day impossible. However, i eventually enrolled in a home teaching program. With the help of my tutors and family, i was able to complete my course work at my own pace. I finally returned to school in december but was still far from recovering. I have spent the 2. 5 years since my concussion slowly regaining organizational skills, the ability to learn and retain information, and most important, my personality. During this time, my friends and family learned to recognize the signs i needed to shut down from any kind of mental or physical activity for a day or two. These relapses were tough and discouraging. They meant i had to drop a class and miss a band trip to chicago, among other things. The worst was when i could not go to my first concert, the red hot chili peppers. The friend i gave my ticket to owes me. The spring after my injury, i was cleared to return to sports but made the hard decision i would not play lacrosse or other intensive sports again. I know a lot of people recover and return to play, but the possibility of another concussion means i could lose everything again and not come back the next time. I now look at my recovery as something that has made me stronger. But i know i am one of the lucky ones who had resources and medical attention i needed and a School System aware of concussion issues and provided an unusually high level of support. It is not over yet. My recovery continues. My outlook is positive, and i am excited about the future as i prepare for college. Im thinking about becoming a High School Math or science teacher. I have a hard question. What can be done to create a safer sports environment to ensure when injuries do occur the support for full recovery is available . We cannot just do away with youth sports. I played baseball, soccer, and lacrosse. Being on those teams gave me a healthy outlet. It taught me important lessons. Sports are one of the best parts of growing up in becoming a strong adult. They teach us if we work hard, we will become skilled and proud of our accomplishments. They teach us how to be part of a team, have pride and success, and learned the lessons of defeat. They teach us sometimes we have to quit thinking of ourselves and think of the good of the team. For these and many other reasons, i hope steps can be taken so future Young Athletes have these opportunities. There are two important things i think would make a big difference. The first is to change the cultures of hitting hard to take out an opponent rather than playing to win through skill and brushing off injuries to get back into the game. While better equipment may decrease injuries, it is coaches, parents, and players who have to back away from the need to win at all costs were fear the losing status of the team is out for injury, to be willing to recover fully before returning to play. It will take a while, but if youth and professional sports are to survive, these attitudes must be embraced. When injuries do occur, we must have a way for qualified personnel to quickly assess injuries on the field, how players get immediate attention, and support recovery through schools and medical institutions. These are the things that were done for me and are the reason i have been able to return to normal. As a Student Ambassador, the message i hope to give Young Athletes is this. You think you are invulnerable and take risks and brush off injuries because you think you will recover quickly from anything that happens. You wont. Dont be a hero, especially when it comes to your head. It is the only brain you will have. Your personality is who you are. It is not worth a couple of seasons of glory to lose the opportunity of a lifetime. Thank you. Very good. Dr. Graham, youre recognized for five minutes. My name is bob graham. I served as the chair of the institute of medicine sports related concussions and youth study. You have my testimony before you and copies of the study. I will take these minutes to give you a summary. The institute of medicine is part of the National Academy of sciences, chartered by congress to provide advice to congress and the executive on various scientific issues. We were specifically impaneled to look at the evidence about the causes and consequences of concussion in youth and military, the state of concussion diagnosis and management, the role of protective equipment, and sports regulation. We had 17 members on our committee. We worked in 2013. Dr. Molfese was a member of the committee. We came with six recommendations. The first was the cdc needed to establish a better mechanism for National Surveillance to comprehensively capture the incidence of concussions. You heard a number of figures in one sport or another. We know where they are measured. We do not know the incidences in sports where they are not measured or more closely watched. We need that baseline to know the degree to which we have a problem, and as we take corrective measures, the success rate we are having in making an impact on decreasing the incidences of concussion. We need better surveillance and epidemiology. The two, a couple of recommendations related to research. We need the nih and dod to look more specifically at what metrics and markers are for concussions. How do you assess the severity of a concussion . How do you find diagnostically whether an individual has had a concussion . Now it is based on observation and selfreport. Are there physiologic markers that could be used to give us better documentation concussion has occurred . Perhaps without the individual knowing it or without it being observed. Secondly, we need the nih and dod to look at the short and longterm consequences of concussions. We have heard testimony of individuals who have had one or more concussions, longterm consequences. Some sense of the epidemiology and what treatment and interventions may be, and what rehabilitation may be. The fourth recommendation was to the ncaa and National Federation of State High School associations to look at ageappropriate techniques and playing standards. Your first panel talked a bit about that, mostly at the professional level. But can you change the manner in which the sport is practiced and the rules of engagement in the sport that may decrease the risk of concussion . There was one example from the hockey area where they changed the level where they allow body checking and felt they saw a decrease in concussion. We think that same examination should take place at the college and elementary and High School Level to see whether they can have the same impact. The fifth recommendation had to do with a better study of the role for protective equipment. Your first panel talked a lot about that. The committee had a number of questions about that. Our Committee Found there was very little evidence helmets protect against concussions. There is a lot of data. I think other panelists will be talking about that. You may come away with an equivalence degree in physics this morning. It is a complicated issue. There are a number of suggestions. We did not recommend you dont use helmets. They do protect against bone injury and soft tissue injury. But the suggestion the helmet itself may decrease the incidence of concussion, the evidence does not appear to be there to us. We think the nih and dod have a role in looking more specifically at what we may be able to do related to the biomechanical determinants. Our final recommendation had to do with the topic that has come up frequently. That is changing the culture and the way concussions are viewed. This is a significant injury. Athletes need to be encouraged to report, to take themselves out of the game. Coaches and parents need to be encouraged to say for your own protection, you need to be removed and give yourself a chance for recovery. Thank you. Dr. Molfese, youre dr. Molfese, youre recognized for your five minutes. Thank you for this opportunity. If we could have the slides. Go to the next slide. Yeah. The earlier group talked about a number of if you can go ahead and put that on powerpoint. A number of sports where the rate of concussion is particularly high. There are differences in rates for men and women. Dr. Gay will talk about that in terms of weaknesses of womens necks relative to men and how that puts them at more risk for concussion. The next slide. Concussion accounts for roughly 75 of traumatic brain injuries in the United States. It is a brain injury. There is damage to the brain. There is discussion about whether it is permanent or temporary. In the military, the rate is 77 . Youth sports are a good model for looking at concussion in the military. Most military concussions occur in situations like they do with the rest of americans. Some certainly occur in theater. But the majority occur outside of theater in accidents. Next slide. If we look at brain injuries overall, these are all estimates and they vary across literature. We are looking in the neighborhood of 4 million traumatic brain injuries per year in the United States. Part of that is our birth rate in the United States is roughly about 4 million. This does not count other ways children are exposed to head injuries. Perhaps an irate parent who slaps a child creates Rotation Movement that can produce a concussion. One would suspect those are largely unreported. Recovery generally