The trivialisation of injury data must end: New Zealand Journal of Sports Medicine

Please see attached my recent critique of articulations of risk in rugby union organisations, appearing in the New Zealand Journal of Sports Medicine.

NZ Journal Sports Medicine

Joe Piggin

 

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An urgent call for clarity regarding England Rugby’s injury claims – update

A couple of weeks ago, Prof Alan Bairner and I wrote an analysis of England Rugby’s false and misleading injury rate claims. Here is the link:

http://idrottsforum.org/feature-piggin-bairner170523/

I can now report that England Rugby responded. Here is the initial response – with names redacted:

Dear Joe, 

Thank you very much for your email and for bringing this to attention.

The RFU takes player safety extremely seriously. I would like to take the opportunity to respond to your email and to you and Professor Bairner on your editorial (An urgent call for clarity regarding England Rugby’s injury claims). 

We acknowledge that an editing error was made in the wording used as part of our Rugby Safe booklet, which was published two years ago. It should have read: There is no evidence to show that rugby poses a specifically greater risk of catastrophic injury than other sports and other activities to align with the graphic used directly after it on page eight (screengrab attached). This was a mistake as part of the publishing process.

We want to ensure all our resources include accurate information, so will be undertaking the following:

  • Amending the 2015 Rugby Safe booklet to remove the inaccurate wording with immediate effect (the 2015 document has already been removed from our website)
  • Publishing an updated Rugby Safe booklet next season using the latest research and findings

The RFU has apologised to Colin Fuller for the error. It was not our intention to mislead. We will continue our ongoing commitment and work to ensure player welfare is central to all that we do.
Yours sincerely,

###### #####

RFU 

Just a pose juxtaposed

Rome blog photo

Corporate brands spend millions of dollars to offer us visions of fitness, physical activity and success (#wantitmore). At the same time, there are young people literally rolling around on the public footpath with their mates.

This is not a post critiquing either pose. Someone might be as offended by the sexualisation of the female model as by the footpath being usurped for motives other than pedestrianism. However, it did make me wonder about what we should spend our time wondering about. Static, decapitated displays shouting from commercial billboards? Or the anarchic, concrete activities of those who find and use space when and where they can?

#wantwhatmore?

Joe Piggin

And one more on Big Sugar’s impact on science …

I was at a conference in Brasil recently, where one study examined the use of carbohydrate during endurance exercise. Here were the findings which were presented to around 300 undergraduate and postgraduate sport students:
20160609_135446

And there was more:
20160609_135527
So the take home message was “consume a lot of carbohydrate”.

Then the speaker had to acknowledge the funders of the study. Here is the slide showing them:

20160609_135539.jpg

The two top organisations were not described as problematic in any way. Instead they were positively acknowledged for their financial contributions. If you look around their websites you will clearly see a “pro-sugar” attitude of these organisations.
https://www.suikerinfo.nl/ and http://www.sugarnutrition.org.uk/index.html (At the end of 2016, the “British Nutrition Foundation” ceased operating.)

On the day of the conference I took a screenshot of the info on their website. You can see just how much they advocate the use of sugar and refute sugar consumption as a cause of obesity. And even more incredibly, the source for their claim about sugar not causing obesity … is themselves! What a scam this is!

17821645_10155407100564050_276584919_n

You can also see that many of the companies providing money to the British Nutrition Foundation have a strong profit motive for increasing consumption of their high sugar products.
I wonder if the closure of the British Nutrition Foundation is connected with consumers moving away from high sugar products?
Joe Piggin

UK Sport’s explanation of medal success (and “super-elite athletes”)

Organised sport in the UK has been heavily criticized in recent months, and with good reason. The issues gaining most media attention include:

  • Shocking historical and recent sexual abuse in football
  • Accusations of bullying in British cycling and British swimming
  • Distrubing player management policies in elite rugby
  • Two children being killed after participating in boxing and kickboxing matches

I am sure most sport in the UK is organised well and respectful of participants. These events did remind me though of UK Sport’s explanation of how they try to win medals. At a talk last year a representative from UK Sport (the govt funder of high performance sport) put up these slides to show how they perceive medal attainment. It is somewhat discomforting to know that they have done research in “super-elite athletes” and discovered they had often “experienced childhood trauma”.

20151021_141346

If that is the recipe for winning gold medals, I think the fewer super-elite athletes there are, the better!

20151021_141627

Of course, one might argue that this is an opportunity to turn negative experiences into positive ones, but it is still very problematic. As is encouraging people to focus on the “mundane”. No wonder many athletes retire from their sport with few transferable skills, other than “dedication”.

We need to develop a kinder approach to athlete management, by moving away from “No compromise” policies, and towards an approach that values both short term and long term well-being of participants.

Joe Piggin

New Zealand Cricket – promoting sport and junk food to children

In 2004, the World Health Organisation noted that “Most national regulations recognize children as a special group in need of special consideration and stipulate that advertising should not be harmful or exploitative of their credulity.”

It was unfortunate then, to watch the half time break in an international match between New Zealand and South Africa at Eden Park in Auckland where more than 100 children were adorned in McDonald’s branded t shirts and played on the field.

Eden Park McD

The 3o minutes of play was framed by the stadium commentator as a wonderful opportunity for the children, and McDonald’s were promoted as contributing positively to the development of the sport for young people. Some parents were clearly happy with their children on show at Eden Park, taking photos of their children from their seats. I however, remain deeply concerned about the financial connection between a company that promotes ultra-processed food and physical activity for children.

 

Milo drink, rugby and activity monitors

Hello from New Zealand,

With Autumn approaching in the global South, winter sport clubs are beginning to promote preseason training for adults and juniors alike. I saw an ad in the New Zealand Herald encouraging young people to sign up to Auckland Junior Rugby. If they do sign up, they can (possibly) win an “activity tracker”. The marketing of Milo is subtle in the ad. The ball is adorned with a Milo logo, and the prize is the “Milo Champions Activity Tracker”.

picture1

We know that too much added sugar is a problem for children, and their teeth. And we know that marketers can mislead consumers about the health status of highly-processed foods.

I am concerned (but not surprised) that the marketers of such products continue to heavily promote such products to young people. The reason this practice continues is well explained by Yoni Freedhoff: “If your company’s product is a vice, marketing it by way of wholly unrelated, but exciting, fun, or emotional sponsorships/ties is essential.” Similarly, Candice Choi noted that a corporate “investor day” promoted ideas about connecting with customers at an emotional level.” Here is what this means for companies selling high-sugar products:
hersheys

Of course, sports is one such place for excitement and emotion. Here’s an example of the sort of promotion Milo has used in recent years to promote their product in schools.
https://www.youtube.com/watch?v=LA7xi5HwhIM

And sadly, this is rampant in New Zealand Football as well. McDonald’s First Kicks, McDonald’s Fun Football, and McDonald’s Mini Football are the official names of the schemes.

To what extent do sports clubs have a duty of care to their members? How can we decrease the amount of ultra-processed food consumed by young people? We need to resist these sponsorship arrangements.

Joe Piggin

PS: There are also ongoing debates to be had about the safety in high impact collision sports, and the normalisation of tracking devices, but I shall save that for another day.

Rugby, rules and rhetoric

As I once said “We are all discourse analysts. Whether we are reading, debating or writing policy we are attempting to understand the political dynamics at play in its construction and predict the ramifications of its implementation.”

Here I look back on the previous year and examine how the rugby world faced two major public furores; first an open letter calling for the removal of rugby in schools, and second, a major reworking of the rules of rugby. The benefit of hindsight helps us a lot here. I take this press release and consider it in the context of what subsequently occurred.

So, the day after an (admittedly provocative) open letter calling for a ban on tackle rugby in school sport was released (March 1), World Rugby released this statement (March 2). The fact World Rugby’s response came out very quickly after the letter is noteworthy. This was over 1,000 words crafted to reassure the public, via the media and twitter, that there was no problem to be concerned about. Below I respond to some extracts from the press release:

WR: “As a global governing body, our responsibility is to minimise the risk in our sport and we continue to be committed to making rugby as safe and enjoyable as possible for all ages through education and promotion of correct preparation and playing techniques, prevention strategies and minimising and managing the risks associated with one of the world’s fastest-growing team sports.”

JP: “Minimising risk” and “as safe as possible” are relative terms. They are purposefully vague, since it would be unthinkable for “one of the world’s fastest growing team sports” to remove tackling.

WR:“We are leading the agenda in sport …”

JP: We should be wary of any organisation that wants to grow its sport around the world AND lead the agenda of child safety, especially in schools. School safety should be the responsibility of schools.

WR: “Never have players, medics and management been so aware of the risks of injury …”

JP: Until later that year, as it would turn out, when World Rugby would “aim to change culture in the sport to ensure that the head is a no-go area”.

WR: “Results from the World Rugby Sportswise Survey (2015) revealed …”

JP: The SportsWise survey was eventually retracted.

WR: “84 per cent of parents believing sufficient measures are taken by schools and sports clubs to protect children against injury during sports and activity.”

JP: Given that World Rugby has made significant changes to the conception of “the head”, it seems 84% of parents were wrong. Perhaps they had not been informed properly.

WR: “It is true that there is an element of risk in everything that we do in life …”

JP: This statement elides the real and measurable risk from playing collision sports.

WR: “Compared with other sports and activities, rugby has a relatively low injury severity rate despite being known for its physicality.” [note – the term “severity” was added after it was pointed out to World Rugby that there earlier claim was erroneous and misleading.]

JP: Well this is sort of true and sort of false. It’s true when looking at the Australian sport injury data, but false when considering other research on injury risk. A variety of research published in the BJSM notes a high rate of severe injuries.

WR: “However, the call for a ban on tackle rugby is not based on evidence nor does it add to our understanding of the important issues surrounding player welfare.”

JP: Given that World Rugby had to retract their evidence about risk in rugby and change their press release, I would encourage a more humble view about what “evidence-based” means. Secondly, I suspect that the letter contributed in part at least to the reformulation of rugby’s treatment of the head, so I suspect that it did add to player welfare.

WR: “This is a vocal minority that doesn’t reflect the views of millions of people who embrace the wonderful game …”

JP: Rates of concussion are increasing, and I suspect World Rugby had to act in order to preserve either a decrease in popularity of young people playing rugby, or the threat of litigation.

WR: “As the American Academy of Paediatrics (AAP) stated within a 2015 policy statement, although removing tackling would reduce the risk of injuries to players, it would fundamentally change the sport.”

JP: Hmmm, now World Rugby say that there is evidence that that removing tackling would decrease the risk, albeit evidence from another policy statement.

WR: “… this uninformed call for a ban.”

JP: It depends what you mean by “uninformed”. I suspect the other signatories of the letter just wanted children to be safer at school, and not made to forcibly take part in high impact collision sports.

WR: “As parents we believe that the safeguards are in place and will continue to improve and that the character and benefits of the game far outweigh the relatively low risk of injury.”

JP: Sadly World Rugby did not completely change their press release to remove all the erroneous material. Perhaps I will send them an email.

 

World Rugby’s erroneous sport injury statistics

Yes, all sport has an element of risk, but if there is one thing that is non-negotiable, it is the provision of accurate injury statistics to the public. Unfortunately, this document called the World Rugby Sportswise Survey has been in the public domain for nearly a year. Even with a cursory viewing of the “Australia” graph, something seems incorrect:
world-rugby-sportswise-survey

(Note: As of 16 September 2016, World Rugby has claimed to retract this but a simple web search reveals it is still available various places online). To be clear, the data in the Australia graph above is incorrect. The statement that “compared with other sports and activities, rugby has a relatively low injury rate …” is also incorrect. For more see http://bjsm.bmj.com/content/early/2016/09/15/bjsports-2016-096406.extract

When it becomes known that erroneous data are publicised about risk in sport, the publishers should clearly retract them and display the correct data. The original, more valid Australian government data is below: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549097
injury-stats
You can see that the “participation based” data shows rugby is the 4th most injurious sport, per 100,000 participants.

Very problematic claims about injuries manifest elsewhere. For example, the publishers of “Rugby Safe” in England should make some corrections to their document as well. See the very problematic quote below: http://www.englandrugby.com/rugbysafe/

rugby-safe-quote

There is actually a lot of evidence. For example, here is a screenshot of an academic article by CW Fuller which totally contradicts CW Fuller:

risk

It is therefore inappropriate for this comment to appear in a document discussing safety.

Let’s hope the public can be provided with accurate statistics by organisations with significant marketing power, so parents and children are better informed about risk in various sports. It is no longer enough to dismiss safety concerns by saying that “everything has risk”. When children are made to play particular sports at school, they and their parents should have a good understanding of the risk involved.

This problem of falsely representing injury risk has occurred recently in another collision sport – the NFL:  http://www.nytimes.com/2016/07/28/sports/football/nfl-concussions-youth-program-heads-up-football.html?_r=0

Joe Piggin