In recent years, I have been involved in various efforts to advocate for accurate representations of injury risks. In rugby specifically, challenging erroneous and misleading claims about injury risk is important, so teachers, parents and players can be given accurate and pertinent information about risk. I and my co-authors have applied our analytical skills to the background processes of risk reporting – that messy and complex interplay of research, policy and practice that eventually manifests as risk information. Speaking of which …

In 2016, I was amongst a group of 73 sport scholars, academics, doctors, and public health professionals who signed an open letter arguing that it was necessary to remove the collision elements of the school game so that children play touch and non-contact rugby.

At face value, the open letter focused on a very small part of school sport. We were only arguing for …

• one rule change …
• to one sport …
• at schools …
• in one country.

The letter attracted a lot of media attention. And rugby governing bodies devoted a significant amount of resources, time and energy which resisted the proposal. These were press releases, media interviews, and resources seemed to be devoted to journal article writing. Now 6 years has passed since the open letter, it is a useful moment to reflect on some of the claims that were made at the time, particularly as brain health/risk has become very prominent in recent years (which I think makes the open letter particularly prescient).

So a few of us have published an article (behind a paywall at the moment) analyzing some of the responses to our open letter. These responses in academic journals are worth examining for how the proposal was framed by others, and the problems that come with such framing. Feel free to read these articles for context if you have access.

In 2016, Tucker et al. published Article 1 “Injury risk and a tackle ban in youth Rugby Union: reviewing the evidence and searching for targeted, effective interventions. A critical review.”

Then in 2017, Quarrie et al. published Article 2 ‘Facts and values: on the acceptability of risks in children’s sport using the example of rugby — a narrative review’.

In our own article, we argue there are a number of omissions, distortions, and misleading remarks which frame the ideas in our original open letter quite differently. These issues include:

Both articles omitted a long list of proposed reasons/motives for making a rule change, including issues around a duty to inform, a duty of care, issues of compulsory participation, and time loss from school.

Both articles omitted any reference to the proposed solution of children playing touch and non-contact rugby. By only mentioning half the solution, they did a disservice to the open letter.

Article 1 seemed to mis-attribute “cited” “terms”, to make a point about the “acceptability” of rugby participation.

Can all childhood injuries even be prevented?

Article 2 suggested that the open letter signatories believed that “all childhood injuries, regardless of origin, are inherently undesirable and should be prevented.” To be clear, I have never met anyone who has ever proposed that “all childhood injuries should be prevented”. As an approach to daily life and risk management, this idea seems nonsensical. So I found it strange, by virtue of signing a letter about school rugby injuries that I was being implicated with this idea. And it propagated an unbecoming trope – that a group of academics were out of touch with reality to the extent that they wanted to “wrap kids in cotton wool” and would never tolerate any injury. The article even included a quote from a former NZ rugby captain:

“If you look too closely at the game it’s silly really when you bash the hell out of each other. But it’s fun and if you took the risk out of everything you wouldn’t do anything in your life.” Richie McCaw, former All Blacks captain, 2017, (bold added).

Aside from the possible confirmation bias that comes from quoting a successful rugby player in a medical journal, five years on, this quote can be read more critically. With the brain injury crisis that has enveloped collision sports around the world, the inclusion of McCaw’s quote might lead readers to ask questions like – is it really all or nothing? Is “bashing the hell out of eachother” tolerable for me? Is it tolerable for school children? Especially when the long term effects of rugby injuries for former players are beginning to be understood in more detail now.

McCaw’s quote can also be read in contrast with another former national team player from England. Steve Thompson recently said:

“Would I let my kids play rugby at the moment? No, I wouldn’t. Touch rugby, yes. …. Do I think it’s safe for kids to do tackle rugby? No, I don’t…”.

Of course, the letter writers never wanted to take the risk out of everything. It is intriguing that such a trope would be advanced in an article having ostensibly been through a peer review process. A reading of the 1-page text of the open letter would have shown that touch and non-contact rugby was being proposed as an alternative – a sport that of course has injury risks. Unfortunately, the trope of extreme risk-averseness is presented in the form of a rhetorical question for the signatories:

“… what level of injury to children resulting from participation in rugby would be seen by her [Pollock]and the signatories of the open letter as ‘acceptable’, or even ‘tolerable’. If the answer is ‘none’, there is no debate to have. It follows that if no injuries to children are acceptable, contact rugby for children should be banned, with similar logic presumably resulting in bans for other activities that carry risks of injury and/or death to children such as football, gymnastics, cycling/mountain biking, fairground rides, swimming, climbing trees, hiking, rock climbing, snow sports, sailing, fishing, equestrian and being transported to and from school by car or motorcycle.”

And so significant attention in an academic article is devoted to a rhetorical question about all sorts of common activities such as football, hiking and going to school, with the possibility left hanging in the article that these are activities which the signatories would be against. The effect of all this is the signatories are painted as extreme risk avoiders.

What would the equivalent be at the other end of the risk spectrum? I imagine it would be similar to a school rugby promoter being accused of believing that “any” sort of high-risk behaviour should be compulsory for school children. So compulsory unaided rock climbing, compulsory jousting, compulsory bare-knuckle boxing, or whatever other high-risk activity they want to administer. Of course, these suggestions are fanciful, and I would not offer these in an academic discussion as plausible equivalents to the various risks of rugby.

Relatedly, we contest the veracity of the claim that there is a “‘dominant paradigm’ among those working in childhood injury prevention that ‘all childhood injuries, irrespective of origin, are unacceptable’.” Instead we suggest the references supposedly used to support that argument say the opposite – that “injuries can be ‘prevented or controlled’ (italics added) through either primary, secondary, or tertiary prevention – ‘preventing new injuries, reducing the severity of injuries, or decreasing the frequency and severity of disability after an injury’”. Again, the accusations levied in the direction of the open letter signatories do not seem to hold water.

On sociology

Article 2 claimed ‘The values of the signatories of the open letter, most of whom are scholars of sociology, rather than injury prevention or public health, are relevant to what level of risk they believe is acceptable in rugby’. We did a count ourselves on this, and even being generous towards ‘sociology’ in cases of multi-disciplinarity, only 34 out of 73 were predominantly ‘scholars of sociology’. Does 34 out of 73 count as most? No, we don’t think so.

We wonder how this claim was created. It also buys into the trope of positioning the signatories as particularly unknowledgeable about the topic (despite the signatories ironically being accused of deploying the dominant paradigm of injury prevention moments earlier). This frames the letter writers as inexpert in the subject, which would certainly be a tactic deployed by those with an interest in defending the status quo of rugby tackling in schools. In various media, attacking the legitimacy of the signatories seemed to be a popular technique when the letter was first published.

And speaking of sociology, despite not accounting for ‘most’ of the signatories, scholars of sociology focus on a range of closely-related themes – risk, danger, education, policy, power, and control across a wide range of settings and cultures. Sociologists often need to be interdisciplinary, often traverse a wide range of social problems, including different types of risks, and often view social practices holistically. Since the open letter intersected with health, education, safe-guarding, physical education and physical activity, it would seem that sociologists are well placed to contribute. In any case, the 73 signatories of the letter, whatever their background or professional discipline, would have a wide variety of beliefs about all sorts of risks. For example, sociology can be a risky thing to do itself!

Other motives? Or omitted motives?

Article 2 uses an example of one signatory, who once remarked (in a different setting, in a different context), of his apparent contempt for ‘men’s team sports’. This remark was used as the basis to claim that ‘If reasons other than those concerning player welfare were a motive for the authors of the open letter calling for a ban on contact in schools’ rugby, then stating those reasons in the letter would have helped clarify the debate’. But when the article in question had already omitted discussion of many ‘motives’ which were explicitly emphasised in the open letter (including issues of compulsion, consent, and the duty to protect children), this doesn’t quite seem like fair play. This echoes a trope of the letter writers as have ulterior motives. Sure, critical analysis of motives is a good thing, but the clearly stated motives (in paragraphs 3, 4, 6 and 7 from the open letter) are entirely ignored in favour of an insinuation of “other reasons” being motives. Advocacy is certainly made more difficult when the original issues raised are not considered at all in responses, and further, when the issues raised are conflated with other matters entirely.

Competing and confounding interests

Speaking of declaring ‘other reasons and motives’, the logical extension of such a suggestion would become quickly unmanageable and probably uncomfortable for the declarers. For example, employees of World Rugby or England Rugby (for example) would need to disclose their specific financial interests at every instance of advocacy as well as all the other benefits they have received through their connection with the sport, as this would surely ‘motivate’ their involvement. I look forward to any author beginning such transparent declaration to ‘clarify the debate’.

Cheekily, and taking declarations to their logical extreme, I wonder if “confounding interests” would be useful to disclose too. For example, I signed the open letter and:

I played collision sports for 7 years.

My support of both the All Blacks and Buffalo Bills for has spanned two millennia.

I own a rugby ball.

Do these factors make the proposal more palatable now that I’ve declared my interests? Or should I not have declared any of this? It certainly grates against a narrative that a signatory supposedly doesn’t like rugby.

Distortions of school decision making  

Article 1 claimed that “effective (risk management) interventions must, by definition, be realistic and obtain the support of the major stakeholders within the specific target population”. However, this framing doesn’t work in the UK school setting. If an activity involving an external stakeholder is deemed to be too injurious, then it would not matter whether a ‘major stakeholder’ supports its removal. That’s a decision for the school and education leaders.

Article 1 also frames tackling in school rugby as essential, by claiming that “the danger then, of removing the tackle from compulsory rugby in schools as has been proposed, is that it would deny the need and opportunity to many young players to begin learning a skill set …“. Is there any evidence that shows tackling needs to be learnt by school children? This claim seems more ideological than evidenced based. It is entangled with corporate interests, rather than a pedagogical justification. An imperative to learn to tackle would cement rugby as an essential part of schooling, and would be useful for the corporations who would be detrimentally affected by the removal of tackling from schools.

This point is worthy of a bit more exploration. Which activities for children should we endorse as children “needing” to learn at school? Swimming? Cycling? Self defense? Throwing? Catching? Where does tackling feature in a hierarchy of essential skills to learn?

Incredibly, article 1 concludes by claiming that the proposal “may also lead to unintended consequences such as an increase in the risk of injury later in participation”. I would have thought that any new adult player later in life would be looked after by rugby clubs they join to ensure they are well prepared before being placed in tackle situations. Isn’t progression an important part of skill development, after all?

Corporate interests in rugby research

What I found interesting is that both articles included declarations of ‘competing interests’ from various authors connected to various rugby governing bodies. Many of the claims and distortions mentioned above seem to favour the interests of rugby organisations. We found no distortions and claims in either article that worked against the interests of rugby organisations. Did we not look hard enough? Was this our bias at work? It would be interesting to see if anyone can find any such distortions.

There was one quote, in article 1, which read – “This proposal does, however, deserve substantial scrutiny for the possibility that it may be an effective (albeit extreme) means to improve player welfare…” (bold added). Despite this quote, not only was the potential effectiveness not investigated, the proposed solution of touch and non-contact rugby was not even mentioned. Oh well, so much for the “substantial scrutiny”.

Was the proposal to remove tackling ever really “extreme”?

A recent survey in the UK found more than half of respondents favoured ‘a ban on tackling at Under-14 (65%), Under-16 (58%) and Under-18 (55%) level.’ So even if removing tackling for children (at schools) used to be an ‘extreme’ idea, it’s not anymore.

How influential were corporate interests in all this? Well, there is certainly an entanglement of corporate rugby interests and defense of the status quo. Whether this framing (as we discuss in the article) was accidental or unconscious is a matter for the writers. We assume that no one would try to purposefully mislead readers. I think we should assume that people in professional positions are making genuine attempts to make the world a better place. But equally, there’s a reason why competing interests sections exist. Whether through unconscious drift, or by accident, or both, I think a range of pressures, assumptions, and ways-of-being can affect the messages that are produced, no matter how much science, objectivity, and integrity is espoused. And so, while unaffiliated advocates can be easy targets for claims of bias and skewed opinions, I suspect it can work both ways.

There is nothing sacred about school sport policies. Sports are added to schools, and removed, for all sorts of reasons. For rugby governing bodies, I suspect the removal of tackling from schools would be unbearable (even as a short term, localised, comparative intervention).

Joe Piggin