Tony Ward: 'Time for rugby to wake up and ask not if damage is being done to players, but how bad that damage will be'
When it comes to chronic traumatic encephalopathy, while Aaron Hernandez has become a sorry poster boy for the neurodegenerative disease, he shouldn't be the baseline.
Indeed if you've had the chance to listen to the Boston Globe's brilliant podcast 'Gladiator' that delves into the life of the former New England Patriot, you'll know there's much more to his demise than head trauma alone.
From sexual to drug abuse, he's a reminder that while we look at the what and the when, too often we forget about the why and the how behind it.
However, Hernandez should still be a warning in that sphere despite all the questions, and a lack of all answers.
Anyone who has seen the photo of his head scan lined up with that of a normal brain his age will call it out as terrifying.
It's so bad that you don't have to be an expert to see that repeated brain damage created massive black spots, brought about by the broken-down protein Tau, a result of repetitive pounding to the head.
A couple of years back Boston University CTE Center director Dr Ann McKee spelled out the issue. She admitted she could not draw a straight line between Hernandez's brain trauma and the violent behaviour that landed him in prison where he committed suicide.
But she did say: "In our collective experience, individuals with CTE - and CTE of this severity - have difficulty with inhibition of impulses and aggressions, emotional volatility and rage behaviours". She added of Hernandez: "In every place we looked, it was classic CTE."
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The NFL is coming to terms with the issue, even if the wake-up call may be unsatisfactory as lawsuits are causing it to care.
But it's better than nothing as something had to be done, even if it wasn't in time for Jovan Belcher, who killed his girlfriend before going to the Kansas City Chiefs training facility and shooting himself, and Junior Seau, who put a bullet in his chest after suffering the same chronic brain damage after a hall-of-fame career mostly with the San Diego Chargers.
Overall, founder of the Concussion Legacy Foundation Chris Nowinski, who has had access to the brains of 91 deceased NFL players diagnosed 87 with CTE. As well as that, the NFL itself now expects 6,000 of its near-20,000 retired players to suffer from Alzheimer's or moderate dementia.
Which brings us back to this side of the Atlantic, and our own similar form of fun.
Rugby has taken some steps around the issue. One pro spoken to said that "player management is strong now, medical teams have a lot more autonomy than before. I honestly don't think World Rugby can make any more changes. It's just something that's going to happen, a professional hazard".
However, to hear the reaction to Johnny Sexton's latest head injury - this is a player who in 2014 alone suffered four concussions (three more than Hernandez ever had documented in the NFL) - suggests we've a way to go.
Simon Zebo noted: "Johnny plays on the line and some teams when they're playing against him, it's probably on the edge as well. That's just the way it is. It's Test footy, and it's good to watch".
Meanwhile, Joe Schmidt, who will decide on how much more his star player has to endure, said: "Johnny failed a HIA (head injury assessment). He just banged his head in the build-up to our second try, he just fell pretty heavily. He seems to be doing quite well now, though, so we're hopeful he'll be okay for the next game.
"He copped a stamp at one point; I don't even think it was a Scottish foot, I think it was one of our guys who tripped over him. He got two knocks so they were cumulative, and he has a swollen ankle, but that's just swelling."
Just? It's three years since Sexton had to take a full three months out during his time at Racing, where he admitted: "I was a bit lethargic, I had mild headaches."
Three more years' worth of heavy tackles, and here we are. Still carrying on down this road.
On Tuesday evening, a letter released with 60 signatures arrived under the headline, 'Experts call for caution on reporting long-term effects of head injuries in sports'.
In it, there was admittance that at this stage there is only preliminary agreement on how to recognise CTE, but no agreement on how to assess severity. One of the names underneath was Willie Stewart, a consultant neuropathologist at Glasgow's Southern General Hospital and an expert on head trauma, who has closely studied CTE. He reaffirmed this.
"The truth is we know very little about it, certainly not enough to be able to estimate with any certainty how many people might be affected or what the various symptoms might be."
However, asked about rugby, he says: "I think it still has a way to go, but it has made some progress. Ultimately, they appear conflicted between a spectacle of heavyweight athletes bludgeoning each other into submission, and the toll that model has on the players in respect of injury, brain or otherwise. Rugby will be taking this seriously when it makes meaningful changes to the game to work against the arms race and heavyweight rugby to make serious reductions in injury, even at the cost of a few punters sickened by the 'game gone soft'."
He's one of the people that has long warned of the term concussion due to the softening of language and shielding of reality, as instead what we are dealing with is brain damage at a cellular level. Worse, it won't come up on a live brain scan, rather it's an issue that can only be studied posthumously. In essence it's then the likes of Stewart sees in a microscope that fine fibres that act as cables have become stretched with head trauma. This sees messages passed more slowly and less accurately, be this a signal to your legs or the notion of memory. If injuries are cumulative, such is the poor ability of the brain to heal, it's not just permanent but degenerative.
It ought to leave rugby players wondering not if damage is being done, but how bad that damage will be and how that damage will manifest itself. Is that worth any more risk? Others have risked it. Andy Hazell said he'd "see stars" in training and that "I'd be standing at the back of the lineout thinking this is like I'm actually dreaming".
Wales' Jonathan Thomas quit after developing epilepsy, while former Cardiff wing Rory Watts-Jones went for tests after both his family and girlfriend noticed behavioural changes believed to have been brought about by repeated head trauma.
Again we don't know for sure the cause, but look at what we're playing with. Last year a study found retired rugby league players aged 40 to 65 had significantly worse reaction times and overall cognitive performance than others their age.
Sports fans and most stakeholders are selfish and that's fine. It's entertainment with players used mostly as pawns. From transfers to selection to missed tackles, it brings about a reaction. But this ought to fall beyond winning and losing as to know it's not good doesn't take a high degree of expertise. You don't go out and crash your car a few times a day. You wouldn't run into a wall for 80 minutes each morning. But this is what's happening.
Larger and larger men running into each other at higher speeds might be good viewing, but the end result isn't going to be good for anyone. Long gone are the days when a whippet like Philippe Bernat-Salles would get near this elite level.
Research shows that 30 years ago the average New Zealand player weight was 92 kilogrammes; today that's increased by over 15pc to 106 kilos.
Hayden Smith, who played in Aaron Hernandez's position for the New York Jets in between stints in rugby with Saracens, even drew a stark comparison.
He said collisions in the two sports feel similar, and that's ignoring that an NFL player will play 16 regular-season games at most, and concussion instances are higher in rugby. Take Sexton and Hernandez again as, while an uncomfortable comparison, it's important. Hernandez played just 38 pro games, 40 college games for Florida, and 28 high school matches - a total of 106.
That's exactly the same as Sexton has played in green alone, between Ireland schools, U-21, 'A' and senior, thus discounting his club, academy, secondary school and the Lions.
Thankfully, it's not a guarantee of anything, but for sure it's not a guarantee of nothing. No one is doubting his courage - you could see that in how he delayed his pass for Jacob Stockdale's try to the last millisecond to give the wing the best chance. But in the process he gave himself the least chance of minimising damage.
There's a fine line between bravery and what comes next and, while we love him for it now, how many will care when his career is over and he's left to deal with the potential effects of it?