>> thank you, dr. molfese you are recognized for your five minutes. >> thank you chairman terry, ranking member schakowsky and members of the subcommittee for this opportunity. if we could have the slides. go to the next slide. yeah. so i think the earlier group talked about a number of -- if you can go ahead and put that on power point -- a number of sports where rate of concussion is particularly high. there are, of course, dr. gay will talk about some of that, in terms of weaknesses of women's necks relative to men's necks. that puts them perhaps more at risk for a concussion. concussion accounts for in the

united states roughly about 75% of traumatic brain injuries. it is a brain injury. there is damage to the brain. there's a discussion about whether it's permanent or temporary. in the military the rate is 77%. so it turns out that youth sports are a good model for also looking at concussion in terms of the military. in fact, most of the military concussions occur in situations most like they do with the rest of america. some certainly occur in theater, but the majority occur outside of theater, in accidents like youth are prone to experience. if we look at brain injuries overall, there are estimates -- these are all estimates, of course, and they vary across the literature. we're looking at somewhere probably in the neighborhood of 4 million traumatic brain injuries per year in the united states. a sobering part of that is our

birth rate in the united states is also roughly about 4 million. this does not count other ways that children are exposed to head injuries. perhaps a disciplining irate parent who slaps a child that creates rotational movement that can, in fact, produce a concussion. those, one would suspect, are largely unreported. recovery generally is fairly quick. usually anywhere within a few hours to a few days. some will persist two weeks even perhaps out to six weeks, but roughly about 20% seem to persist beyond that time. next slide, please. this is a slide on some data under review. it will give you a sense. these are data using brain electrical activity. so basically we have a net of 256 electrodes that fits on the head in about ten seconds or so. and we present a series, in this case, a series of numbers.

one number at a time. all the college athletes had to do was simply say whether the number they currently see matches or does not match a number that occurred two positions earlier. and on the left side those orbits, those circles you see, colored circles, on the left for match and nonmatch, those are images of the brain electrical activity on the scalp recorded from those electrodes between 200 and 400 milliseconds. so 0.2 to 0.4 of a second after the number appears. the schematic on the right shows you the head position. so it's a very rapid brain response. for those athletes who have no history of concussion we see very clear difference in the electrical activity for a match versus a mismatch. a lot of yellow and green in the top left orb and in the bottom we see red and various shades of

blue from the front of the head to the back of the head. on the right, though, these are individuals who have a concussion history of one to two years earlier. not current. yet at 200 to 400 milliseconds their brains cannot discriminate whether those two numbers are the same or different. they also might get these tasks correct, but it takes them roughly 200 milliseconds longer. that's 20 synapses. so the processing speed is slow. and after two years, one might suspect that's a permanent change. next slide. i think that -- yeah. so in terms of critical scientific gaps, some of these we do, dr. graham talked about. you know,how does concussion affect the brain in the short and long-term. we really don't have much information about that. what's the dose requirement. dr. graham talked about that. to produce concussion, postconcussion syndrome. cte. how can we reliably objectively detect when the brain is

injured, and when, importantly, it's fully recovered. we have no ways to do it. lots of individual differences from one person to the next. we think there are genetic factors involved but there could also a concussion history the person may not think they have. how many of us have bumped our head getting in and out of the car. we have a quick rotational movement and that could produce, perhaps, a head concussion. how does the brain recover from tbi and, finally, how we improve and recover, accelerate recovery. we really have no scientific basis for any interventions. thank you. >> thank you,. dr. johnston you are now recognized for five minutes. >> chairman terry, ranking member schakowsky and members of the committee, thank you for inviting me to testify before you today alongside this illustrious panel about our experience in alabama following -- >> could you pull the microphone a little closer? >> is that better?

-- our experience in alabama, following passage of concussion legislation as well as work we're currently doing at the university of alabama birmingham to improve sports safety. as in that state of nebraska, youth sports and youth football are an extremely important part of our culture and as a result we take the safety of our children very seriously, as well. as well known to the committee, the problem of concussion has gained prominence over the past decade thanks to important research and advocacy work done by scientists, physicians and public health professionals at many centers across the united states and through the work of public officials highlighting this research. of significant concern, recent studies identified potential long-term health consequences including depression, chronic traumatic encephalopathy and other neurologic diseases associated with repeated impacts. professional football gets media attention, it's important to keep in mind over 70% of all football players in the u.s. are under 14 years of age. any effort directed at improving safety in football and other impact sports will need to address these youth athletes. parallel to enacting alabama's

concussion law in 2011 as in many states the alabama state concussion task force, think first alabama initiated a statewide concussion and education and awareness program and it worked. in that first year we observed 500% increase in referral of youth athletes referred to the concussion clinton at children's of alabama, a trend that has held steady since that time with about 350 youth athletes seen every year. to optimize care of this rapidly increasing patient population, we develop a multidiscipline protocol. it's in my appendix one. following the concussion guidelines athletes were evaluated by physicians expertise in concussion, kept out of school until symptom-free, referred for testing when appropriate and supervised in a graduated return to play and a return to play program. a formal study in 2012 demonstrated establishing this program resulted in significantly better concussion care and decreased institutional resource utilization. even though these efforts,

resulted in improved recognition and treatment of concussion in alabama and in other states, we believe that much remains to be done in order to prevent sports-related brain injury in the first place. given the difficulty of delineating a specific concussion threshold as has been said previously, using existing helmet technology and other subjective ways of evaluating athletes, research has begun to widen from concussion to correlating accumulative impact exposure over time which chances advanced mri imaging techniques and neuro psychological changes. animal models have problems with cognitive impairment, spatial learning. as seen also in football players compared to single impact controls in those that have not had these injuries. though definitive conclusions for threshold impact frequency hit counts cannot be drawn from these early studies, it has being clear that subconcussive impacts, those that don't result in concussion play a role in cumulative brain injury over time and need to be studied. recent studies of youth players by researchers at wake forest

suggested a significant portion of young players head impact actually takes place during practices. the largest impacts happen to take place during those practices a lot of times doing outdated drills, like oklahoma drill or bull in the ring supervised by well meaning but untrained coaches. emulating top level collegiate programs which don't do these practices and these drills, teams like university of alabama, ivy league and others, the alabama high school athletic association recently published nonbinding guidelines to limit full contact hitting practices to twice per week. i believe this type of intervention is complementary to the stuff that usa football is talking about about techniques, not just the techniques of hitting but also the number of hitting practices per week as well as what drills are going to be done during practice. pop warner instituted similar guidelines but a small section. eliminate frequency of hitting at practice as well as type of drills would have a large effect on safety significantly decreasing the cumulative impact exposure for every youth

football player in america. also become clear football helmet standards defined by national operating committee for standards in athletic equipment must be updated to reflect our understanding of the epidemiologies of concussion. it is clear linear impact and acceleration play a role in concussive physiology and only linear impact is studied by the system which was from a skull fracture tolerance model developed in the 1960s. we believe having multiple other -- a more complete picture seen in the football field are necessary in order to come up with meaningful standards, in collaboration with university of alabama football program engineers at uab, and the developer of the safer barrier for nascar and irl have developed developed a robust video analysis system to analyze impacts and recreate them in a purpose built lab. in conclusion the passage of concussion awareness legislation, community education recent advances in our understanding of head impact exposure in youth athletes have

improved the overall safety of impact sports and we're recognizing concussions more frequently, however much work remains specifically in concussion education and drafting policies to limit head impact exposure for youth athletes in contact sports. as part of this multifaceted approach to a complex problem new helmet standards is crucial for development of safer helmets. mr. chairman, thank you for the opportunity to testify. >> thank you. dr. gay, you are recognized for five minutes. >> thank you, chairman terry. i'd like to thank the subcommittee for inviting me to testify today. i'm speaking to you as a football fan who happens to be a physicist. my main professional interest is the understanding of how protective equipment works and how it can be improved. today i wish to consider several aspects of football that are problematic as far as concussions go and how we might move forward to make the game safer. american football is an inherently violent sport. that's one of the reasons we love it. the forces encountered in football can be huge.

consider a big hit between a running back and linebacker at full speed. we can show using newton's law that the force each player exerts on the other exceeds three quarters of a ton. this is why football is called a contact sport. two players who collide at full speed helmet to helmet are experiencing the same force to their heads that one of them would feel if he had a 16-pound bowling ball dropped on his helmet from a height of eight feet. medical knowledge of concussions is in its infancy. but we know one thing for sure, forces to the head and neck cause concussions. we've just heard how big these forces can be. here is another problem. they are getting bigger. since 1920 the average weight of pro linemen has increased 60% to just over 300 pounds. at the same time these players have gotten about 10% faster. combining the factors of speed and mass to calculate kinetic energy, the energy available to

cause injury, we find the amount of energy dumped into the pit at the line of scrimmage on any given play has almost doubled since 1920. an exact opposition to this trend is the fact that players are shedding their protective gear. fine knee pads that used to be centimeters thick now bear a remarkable resemblance to tea cup doilies. collars popular with linemen of my generation have gone the way of a flying wedge. modern football helmets are technological marvels but players choose them not for their collision cushioning ability but for how cool they look. another problem is the poor state of our medical knowledge. while i'm not competent to explain these issues i think it's safe to say that a room full of head trauma physicians will not agree on the details of what concussions are or what causes them. this means that the diagnosis and treatment of concussions has a long way to go. as our understanding of these issues improve we may find that injury rates due to the increasing energy of the game

and the wholesale shedding of equipment have increased faster than we thought. finally, football is big business especially at the college and professional levels. when monetary forces manifest themselves as they do, for example, bounty programs and illegal doping, to improve performance, the game becomes more dangerous. what are the solutions? we need better equipment. but this can get tricky. for example, it's apparent that adding more energy absorbing foam to the outside of a helmet will lower the force delivered to a player's skull. this has been tried in the past. the problem is the added padding increases the helmet diameter as well as its coefficient of friction, meaning that the opposing player can expert a lot more torque on your head. nonetheless several companies today are proposing the same basic padding idea for youth football, for whose players the risk of collisions to the head is almost certainly greater. the use of the star system for rating helmets and the hit

system for monitoring collisions to a player's head represent important first steps toward improving football safety. for a variety of reasons that disregard players' safety, they are largely ignored. our understanding of the physiological and epidemiological issues related to concussions must be improved. there is now an understanding in the nfl and at the college level that significant research in the area is needed. several of the members of this panel, including my colleague from nebraska dr. molfese, are leading cutting-edge efforts in this area. finally incremental rule changes and more stringent enforcement of existing rules are needed. in my opinion, some of the new rules regarding targeting, peel back blocking and definition of a defenseless opponent are making players more hesitant on the field. these rules may actually increase the rick of injury. rule changes should be studied and possibly reversed.

it is my belief that a return to a level of padding worn in 1970s would make the game significantly safer. more thorough doping rules should be developed and actually enforced. the nfl season should be reduced to 14 games, and the college season returned to 11. finally more stringent requirements regarding when a player with a concussion can return to the game need to be implemented. these are my thoughts for your consideration. thank you for your attention and your valuable time. >> thank you for your valuable time. and dr. gioia, i appreciate you being here. you are recognized for five minutes. >> thank you, chairman terry, ranking member schakowsky and members of the subcommittee. i appreciate the opportunity to speak on behalf of the safety of our children in this country. i'm a pediatric neuropsychologist at children's national health in washington, d.c. and director of the score

concussion program. i'm a clinician, researcher and a public health educator. today i'd like to take my time to focus my comments on the importance of public health education for youth concussion using my expertise as a clinician and researcher. i've worked for the last decade with the cdc on their heads-up concussion program materials. we all know, and i think ian said it just perfectly, that sports and recreation provide important developmental opportunities to enrich the lives of our youth. they teach life lessons. we have to balance those incredible benefits of sports participation with careful attention to safety issues, and science must drive our action-oriented approach. concussions are serious injuries to the brain that threaten the development of our youth. in an attempt to protect our youth, we now have laws in all 50 states and the district of columbia, all with the good intent of protecting student athletes through rules for educating coaches and parents and removing suspected

concussions and not allowing them to return until properly cleared. all states including -- include the high school at this level, but only 15 out of those 51 include youth sports. so less than one-third are looking at the majority of athletes. in preparing for this testimony, i was posed with an important question and challenge within youth sports. with concussion awareness now at an all-time high, our youth sports teams and organizations and parents more aware but still not sure what to do about it? and the simple answer to that question, with my experience, is yes. many coaches and parents are not equipped to know what to do with a suspected concussion. mechanisms to teach active recognition and response to every coach and parent are inconsistent and limited in scope. the health and safety of youth athletes is largely in the hands of coaches and parents at the youth level. they need medically guided

training in early identification of concussion and protection. coaches and parents must receive training in action-oriented concussion recognition and response. awareness isn't enough. they have to be prepared properly. we know that, as you've heard, repeated concussions present the greatest challenge to our youth. our greatest challenge is really the universal, consistent and effective implementation of these 51 laws so that we can prepare those coaches and parents to know what to do and have the tools with which to do it. at children's national health system over the past ten years our score program has delivered hundreds upon hundreds of action-oriented parent and coach concussion education and training programs using the heads-up materials from the cdc. we've learned much about community needs and how to deliver the message. so we deliver scenario based training where we present to coaches and parents an actual situation and what they must do to recognize and respond.

this is all very, very important as we put these responsible adults in place. you've heard about some important other kinds of activities and good examples of head safe action, head smart action, such as usa football's heads-up tackling program where coaches are educated in concussion recognition response but also taught techniques that we believe can improve taking the head out of the game. but we have to go further in all youth sports. we do not have a coordinated universal strategy at this point for action-oriented solution driven methods to recognize and respond to these injuries. we have the tools, we have many of the programs, but we do not, at this point, have the delivery mechanism to do that. so we have to build also on active partnerships between youth sports organizations and medical care systems. concussions are complicated. they are not simple. we're not asking parents and

coaches to be clinicians and go out and diagnose. we have willing teammates, as you've heard through usa football, u.s. lacrosse, usa hockey, usa rugby and other organizations. but we need to build those partnerships. we need the help of the professional sports leagues, as you're hearing from the nhl and the nfl and the sports manufacturing world to team with us. we also need a quarterback ultimately to make this happen. we have to leverage the efforts of other organizations like the national council on youth sport safety, youth sport safety alliance, the sarah jane brain foundation's plan, all of this is important for us to do. we need, obviously, funding to do that to move forward. can we move from awareness to action? yes, we can. concussions are serious injuries that threaten our youth, but we do not need to be scared away from that. we do not need to avoid developmentally appropriate participation in sports activities. what we need to do is focus on how to teach recognition and

response and our country needs a good, universal mechanism to implement community focused youth concussion solutions. we believe that can help children ultimately as they enjoy the benefits of sports. our score model applies here. it says play hard, play safe, but play smart. thank you. >> very good. dr. shenton you are now recognized for your five minutes. >> thank you. i want to thank chairman terry, ranking member schakowsky, members of the subcommittee. i'm honored to be here today. my focus is going to be on radiological evidence of both concussion and subconcussive blows to the head. if i can have the next slide. what is known is that mild traumatic brain injury is common in sports injury. when we're talking about a single mild tbi, about 80% get

better, between 15% and 30% go on to have persistent concussive symptoms, as have been described today. what's most concerning, though, are what's been called chronic traumatic encephalopathy and other neurodegenerative disorders. that's the second one where it's repetitive mild traumatic brain injury that we're really concerned with. the clearest evidence comes from postmortem studies. if i can have the next slide here is a postmortem slide that shows protein in the brain, those are the brown areas that show up. this is a case of a retired professional football player who had symptoms and presumed to have chronic traumatic encephalopathy which was confirmed at postmortem. next slide, please. here are four individuals, a, b, c, d. what's interesting, this is work by goldstein, it shows that blast injury and repetitive brain trauma look the same at postmortem.

so we have a military person at 45 with one close range blast injury. a 34-year-old with two blast injuries, an amateur football player at the age of 18 with repetitive concussions, and then a 21-year-old, with subconcussive blows to the head only. next slide, please. what is known? we've gone over the first two. third is mild tbi is difficult to diagnose. that's been a really serious problem. because if you use conventional ct and conventional mri you are not likely to find differences or abnormalities in the brain. many people have said there's no problem then. the problem is the correct advanced tools have not been used until more recently. now with advanced neuroimaging we're able to both diagnose and move towards prognosis and hopefully intervention. advanced neuroimaging techniques such as diffusion imaging which

we've been using in our laboratory show radiological evidence of brain alterations in living individuals with mild tbi. so we can detect this early and perhaps then look at underlying mechanisms and characterize what's going on in order to come up with preventive measures. next slide please. this is a study from our group looking at hockey players from university hockey players in canada. and the bottom line is over on the right. the first is at preseason and the second is at postseason. the red dots are three individuals who had concussion during play, from preseason to postseason. and the increase is in increase in extra cellular water in the brain, which is not a good sign. next slide, please. we also looked at gray matter, looking at cortical thinning, in the brain. and that's the cortex where neurons are in the brain, and this is a study in former professional football players who were symptomatic when we looked at them.

what we found is there's cortical thinning compared to age matched normal controls. what's most concerning, however, is that blue line that shows that the cortical thinning accelerates with age, whereas the red line, our control group where it's almost completely flat. and this suggests that cortical thinning may indicate abnormal aging and a risk for dementia that we can see right now in living individuals. next slide, please. now, this is a study that we did in germany with elite soccer players. we selected them specifically for not having a history of concussion and not having any symptoms whatsoever. what we found was compared to swimmers, professional swimmers, there was a huge difference between the two groups with the controls on the left and the soccer players on the right. almost a complete separation between the two groups with an increase in what's called radial

diffusivity, which is a measure of damage to the myelin in the brain. next slide, please. what we don't know. why do concussive and subconcussive trauma result in some and not others. another question we don't know is why do some develop neurodegenerative disease and others do not. what are the predisposing factors. is exposure genetics involved. not every football player, not every soccer player, not every hockey player who plays and gets hit to the head ends up with these neurodegenerative diseases which is what i think people are most concerned with. next slide. so what we need is diagnosis to detect brain injury early. we have imaging tools now that are sensitive, widely available, and can be applied in vivo. prognosis to follow recovery and degenerative processes. we need to follow recovery and degenerative processes to predict who will have a poor outcome and who will have a good outcome.

knowing that, we might be able to intercede with treatment, to halt possible cascade of neurodegenerative changes. and finally, just in summary -- next slide -- sports concussion leads to alterations of the brain's white and gray matter. advanced neuroimaging is sensitive to detect brain alterations following concussion and subconcussive brain trauma. and the impact over time is important. we need longitudinal studies to identify different stages of recovery and being able to pick out ahead of time what is going to lead to a poor outcome so we can intercede. and finally, some measures of safety such as rules for returning to play are needed following observable evidence of brain trauma. thank you. >> thank you. very impressive testimony from everyone. i was even impressed that you all stuck to the five minutes pretty close. now, i'm going back to dr.

molfese. i think your testimony and dr. shenton's kind of juxtapose each other here very nicely. so part of what your research is doing is finding that baseline of the new athletes that enter university of nebraska. is this allowing you to detect the injuries earlier that there may have been some pre-existing subconcussion? how are you identifying that, what is it telling you, and what are you then -- what is the university doing to implement some level of protections? >> one of the major changes we've seen, and i think this is occurring across the field now, is the effort to get preconcussion data. so basically more schools are moving to assess student athletes prior to the start of the season. then that certainly is what

we're doing. and thenshould a player be injured, and they are identified through trainers or the medical team. one of the weaknesses here is that the players do not always self-identify. so we've run across that a number of times in our testing. we'll pick up something on our test the trainers and medical team didn't know about simply because the player didn't disclose. then we also tried to test somebody else who plays a similar position but has not been injured and they act sort of as a game control over the course of a season. generally what we're finding is both effects that occur across the season in just our normal players who have no history of concussion being identified, their brain's speed of processing does change over the four to five months of training

in the season. but then with the players who are -- who do experience a concussion, we see in terms of brain electrical activity again the slowdown of about 200 milliseconds. that's four times faster than the slowdown you see in multiple sclerosis for an example for a contrast. clearly the brain has changed the way it's processing. we're just now moving to start intervention programs with the players who we identify. there's some data out there with early alzheimer's that suggests working memory-type tasks may -- even a week of intervention shows a four to five-week gain, continual gain in improvements. so we're trying to see if we can see some of that occurring. >> thank you. dr. gay, in regard to concussions, many times it's not a direct blow but contrecoup, it's being hit so that the head is going back and forth and the brain is sloshing around.

you mentioned going back to 1970s type of equipment. tom osborne likes to talk about the neck roll that -- describe to me what you mean by 1970s equipment and how it may actually reduce concussions. >> thank you, mr. chairman. yeah, the neck roll, what i call a horse collar, is really a piece of equipment that's disappeared from the game. it does an important thing. it essentially immobilizes the head. so if concussions are concurred by the rattling of the brain back and forth, especially from a blow to the side, the horse collar will substantially damp that down. to my knowledge, there are no epidemiological studies of that being effective, but i can't -- my personal opinion, even though i'm ignorant -- largely ignorant of medical science, is that if you immobilize the head that's

going to solve a lot of problems, especially with these rotational hits. yeah. >> dr. graham, does that make sense? >> i think whether or not the horse collar would have that effect, i don't know. of course, our committee was based purely on science and reviewing the literature. but i think the principle is you want to find ways to minimize the linear and rotational forces that come into effect with a blow to the head. whether you can do that by equipment, whether you can do that by change in play, that's what you have to do to decrease the evidence -- the incidence of concussion. >> thank you. i only have 11 seconds left so i'll yield back and recognize the ranking member, miss schakowsky.

in addition to the science, so much talk has been about culture. and it seems to me that that is very important. so a change in the culture means not only managing head injuries when they occur, but also encouraging safer play to reduce the risk of head injuries. mr. heaton, you spoke about the need to change the -- i'm quoting from your testimony -- win at all cost attitude among players and coaches. what would you tell teens to help them change that attitude both within themselves and teammates and perhaps more challenging in coaches? >> thank you. well, frankly, i would actually encourage the coaches to stress this as much as possible as well as the parents. the coaches and the parents are there to help us learn how to play these sports correctly. if they can emphasize not having to worry about winning to the

point where you get hurt, it will trickle down to the players. the players become coaches. it's this never ending cycle of teaching and making sure that the players know that winning is not the most important thing. you know, it feels great to win. i'd much rather lose than have another concussion. >> clearly you were aware because of the severe consequences of the brain injury. do you think youth athletes understand what those symptoms are? >> yes. i think it's getting better, indeed, especially at my school. we emphasize making sure that you know the symptoms of concussions. i feel like it's spreading as well. >> let me ask dr. gioia that. >> certainly at this point the

education programs are also being directed towards the athletes. quite honestly, about five years ago, maybe six years ago, there was a study that showed that was the number one reason why athletes weren't coming out of the game. they didn't know how to tie together the symptomatology. it wasn't simply that they didn't want to lose playing time but they didn't know what they were dealing with themselves. we also believe that athletes and teammates need to watch out for each other. the concussed athlete may not have the wherewithal to know they aren't right yet their teammate next to them oftentimes does. so there's a responsibility within that team to take care of each other and that's an important focus. >> that goes to culture as well. >> absolutely. >> dr. shenton, please explain a little how advanced neuroimaging works and describe the type of changes in the brain your lab is able to detect that traditional imaging can't, and also some of the types of neuroimaging used by your lab have been a significant part of the research on diseases like alzheimer's and

schizophrenia. why are the same imaging techniques appropriate for research on these diseases and research on sports-related -- >> i have a slide which is just to the end of my slides that just explains in one slide diffusion imaging which i think would help out here. >> the one slide i really didn't understand, was it was comparing swimmers with -- >> with soccer players. but i was going to go through and show you why diffuse injury is important. because the injury that happens in the impact to the brain is generally a stretching of the cables in the brain, which are really the white matter. for example, the corpus colosum is the largest white matter track in the brain. and you get shearing. this doesn't show up on tradition ct or mri.

in fact, the first mild tbi conference i went to, no one showed a brain. i looked to my colleague and said why would no one show a brain? and he said because everyone knows that you can't see anything on the brain. i said, but nobody is using the right tools here. this is just a very simple principles of diffusion imaging. if you look on the left, this is ink that goes on a kleenex. it goes in all directions. that's called isotropic diffusion. if you look on the right, it says an isotropic diffusion. so you're dropping ink on newspaper. newspaper has fibers so it restricts the water. this is the same principle that's used quantitatively to look at the brain. so if you're in csf it's very round, and it's isotropic and everything goes in the same direction. if you're looking at white matter you're restricted in two directions. so you can measure how -- what the integrity of white matter fiber bundles in the brain. that's what you need to look at in mild tbi.

if you have someone come in with a moderate or severe brain injury, you don't need this kind of technology. they are just going to be put into neurosurgery and do an operation. it's these very subtle brain injuries that aren't recognized using conventional imaging where you can recognize it if you use something like diffusion imaging. we have shown over and over again now that you can see -- and it's not just our group. starting in 2003 people started using diffusion imaging because it's the most sensitive imaging tool that exists today to look at diffuse external injury, which is the major injury in mild tbi. what needs to be done now is to look at acute injury and see what predicts outcome. like do acute injury at 72 hours, at 3 months, at 6 months, can we then predict knowing that what happens at 72 hours if you

have -- we have one in our lab trying to separate water that's outside the brain versus outside cells versus in cells. if you can predict from 72 hours, then you can go back and say, okay, maybe we want to put in anti-inflammatory medications if this is a neuroinflammatory response. we don't know enough right now. the only way to know is to do these longitudinal studies and follow over time using very sophisticated imaging technology, in my opinion. once you know, you can diagnose. once you diagnose -- >> this could be very promising not only for our athletes, but our returning veterans and applied eventually to schizophrenia or alzheimer's. >> i'm primarily schizophrenia research. that's what i've done for 30 years before i became a tbi researcher in 2008. we have a measure called free water based on imaging, this

kind of imaging, that shows early on at the very first episode of schizophrenia you see fluid around all of the brain that's free water. it's like the isotropic. but in just the frontal lobe you see it more restricted to tissue, inside tissue. this was a brand new technique developed by a fullbright scholar in our lab from israel. >> i'm going to have to say thank you. it's very promising. thank you. >> yes, thank you. gentleman from new jersey is recognized. thank you, mr. chairman. dr. johnston, you stated that many sports-related concussions still go undiagnosed, and i'd like to know why in your opinion that is the case, and how can we improve that? our state laws and also the

involvement of coaches, and players and ptas, areas where we need to have improvement. >> thank you for the question. i think i would echo what has been said by others on the panel. it's on. sorry. i would echo what's been said by others on the panel that i think a lot has to do with recognition. obviously people are very good at recognizing when someone gets knocked out on the field. but, of course, that's a small percentage of all concussions. and i think that as our understanding of all the various symptoms that can go with concussion have arisen, it becomes incumbent upon us to improve the quality of the education that we give to our coaches, players, trainers, officials, about the symptoms of concussion. i think that that's the main reason. my sense is in general the culture, at least speaking for the state of alabama, that all of the coaches that i've come into contact are believers. they're not purposefully hiding,

you know, kids and putting them back in knowing they have concussions. but i think that sometimes it's hard to recognize, especially when young athletes don't tell you how they're feeling. and other issues which i guess, brought up the importance of teammates being involved with diagnosing these players so they can be pulled and appropriately evaluated. >> how close in your opinion are we to a better design for helmets? >> i think that we are at the very beginning. i think we have been using a standard not changed for 40 years that was designed for skull fractures that has served its purpose. i think many investigators around are working to improve the quality of the standards to include linear and rotational acceleration as well as other important aspects of impacts. just like the automotive industry did 30 years ago with once you start ranking cars with safety ratings, the market can be relied upon for manufacturers to improve their helmet designs to improve their sales. that's the stage we're at. i think standards are an important part of the equation. >> thank you.

dr. gay, in your testimony, you've discussed the fact that there is a numerical rating system for a helmet's impact. i think it's designed at virginia tech, the star system. you called it the best tool we have for analyzing the merits of various helmet systems. can you briefly explain how the numerical scoring system works? >> yes. thank you mr. vice chairman. basically it involves a test where you drop the helmet from a given height, a varying height, to the side, to the front, to the back. it tries to simulate the kinds of impacts that a football player would actually experience, and numerical scores are given to the maximum acceleration that the knocks the head inside the helmet feels for these given drops based on a, in my opinion, fairly crude initial model of what causes

concussions. there's no effect taking into account rotation. there's no effect of temperature. and, in my opinion, the reproduceability is not as good as one would like, having tried to do examples of these kinds of tests in groups that i've been involved with. so i think it's a good first start. it's the best we have right now, i think it needs to be paid attention to. but there's a lot of room, a lot of room for improvement. >> thank you. and finally, ian, how old are you and what grade are you in? >> i'm 18 and i'm a senior. >> does that mean you'll be going off to college in the autumn? >> yes. >> do you know where you will be attending college. >> i'm going to elan university in north carolina. >> in north carolina. my congratulations to you and my condolences to your parents on the cost of higher education in this country. it's a great school. i have a god daughter who is a freshman there.

that means she's a little older than you but i'll be happy to introduce you to her. and let me say, i am very proud of your testimony and i could not have done what you have just done when i was 17 or 18, and certainly i think the nation has benefitted by your outstanding testimony. >> thank you. >> thank you. >> gentleman from mississippi you are recognized for five minutes. >> thank you, mr. chairman and thank each of you for being here and sharing your expertise on what is a topic we're really just, i think, only really learning about as it's been in the news for several years, but it is, i think, coming to the forefront in your work and your information and your testimony on the record here today. i think will be beneficial to us.

as a parent of a 24-year-old young man with fragilec syndrome, i particularly appreciate the work that you do at the children's hospital, you dr. gioia, you, dr. johnston. but this is -- in preparation for this, i had some discussion with some parents some back home, and the interesting discussion is, i had several friends who have daughters playing youth soccer and a number have reported an increase in the number of concussions suffered by young ladies playing youth soccer. we seem in the news to always associate it with nfl and helmet to helmet contact and concussions and things we see on the field. but it appears in everything we do in life. every sporting event there's that danger and that risk. that's why i think what you're

doing with the think first alabama doctor johnston is the preventive part of it. is how do we educate our players and coaches, parents. and perhaps, if using a teammate approach, it may be the safest thing may be to have the backup position player be the one to report for the first teamer when they need to come out. that might get them off the field. but thank each of you for your work. dr. johnson, educate just a little bit on what is a sub con cussive impact. what does that mean and how important is that when addressing concussion diagnoses? and should subconcussive impacts affect rules of game of play and if so, how? >> i think the definition would be all those other -- the 99.9% of impacts that happen that don't result in a concussion. as has been pointed out, that the rub with concussion is the diagnosis part. if you look at the historical

studies, rates of concussion in different sports, it's variable. and a lot has to do with who is diagnosing it. males versus females. whether or not men are more or less likely to report symptoms. i think the subconcussive impact is all those other impacts that we have found more and more information with the important imaging that's been done in boston and other places that even the subconcussive impacts have results in terms of anatomic structural changes in the brain over time. i think the subconcussive impact needs to be addressed in terms of lessening the overall cumulative impact that the player has. football is the obvious thing in terms of player practices and how many practices a week children should be able to do. hitting and whatnot. but i think that has applications for all sports. >> thank you. dr. molfese, if i could ask you the question, just for -- clarification first, if i could

ask, the 77% of military. >> yes. >> that figure, is that how many of tbi cases have suffered concussions or is that 77% of all military? i wasn't quite sure. >> that's traumatic brain >> that figure, is that how many of tbi cases have suffered concussions or is that 77% of all military? can you tell us more about the sideline imaging work that you're doing? is this practical? is this something we can expect to see rolled out to sidelines across america to diagnose for athletes and on to battlefields to diagnose our warriors? >> i think it's possible. we published a paper just this last year in 2013 where we took one of our eg systems and recorded on the sideline of a field. the biggest challenge for us in making a practical is to get the processing time down. at this point takes us an hour. if we can get it down to five minutes, then i think we can sell it to the coaches.

they're the ones that are going to determine. and i guess at this point, given all the other issues -- the common tests are the impact, which are some neuropsych assessment tools, sort of questions to the player, and they have to reflect and they may be a little foggy because of the concussion. but these tests don't have any predictability or reliability after two days post injury. that's our big problem. doesn't predict recovery time, doesn't predict the severity of the injury and so on. so these biomarkers that we're all talking about are really the critical things that we're hoping are going to be much more reliable. and more predictive. >> thank you. >> thank you. generally this would end. but we all have so many questions. we're actually going to do a second round and plus the bells aren't going to go off for at least another seven minutes.

and jan does have a conflict and she has given us approval that she's going to leave but she trusts us to ask legitimate questions of you. >> but let me just really thank this panel, the previous panel as well, but the intensity of the scientific research and then its application to the playing field and actually so many other fields, i really want to thank you for telling us what's going on. and i also did want to thank ian heaton for coming here today. i think it's important to have people like brianna and ian to tell their stories and give us a face to the importance of this. i want to thank the ftc, too, for making sure that false claims aren't made. but this is so important, so appreciated. and then we'll have to figure out where it leads us.

but it certainly has informed us. thank you. >> i would agree with every word of that. so this is a question to you, dr. molfese and dr. shenton and it dovetails into what the gentleman from mississippi was talking about, as well. are the symptoms of a concussion or tbi uniform enough so that it's possible for early detection or developing a checklist for a coach or a parent to be used, you know, by nonmedical? we'll start with you. >> no. >> well, that was easy. >> the symptoms overlap with depression and ptsd and that's been a real problem. in fact, there was a paper published in the "new england journal of medicine" that said when you remove the effects of depression, and you remove the effects of ptsd, mild tbi doesn't exist. and that's a real disservice.

it used to be people would claim that when people came in complaining that they still had symptoms from hitting their heads, since there was no evidence from conventional mri or conventional ct, they said, go see a psychiatrist. so it was really not appropriate at all because there's at least a small minority of people who have mild concussion who go on to have symptoms, and they can go on for months, for years and then they can clear up. that's separate even from cte. what you need is radiological evidence for diagnosis the same way you would want to know values of a blood test for cholesterol or a broken leg. i think we're moving in that direction. that's what we need as the hard evidence because the symptoms are too nonspecific. >> dr. molfese?

>> there are published studies looking at the number of symptoms and a wide variety of symptoms people report. there's no data that indicates whether somebody reports lots of symptoms versus a few symptoms, that that has any relation to how long they're going to recover, how serious the injury is, how great the impairment is, unfortunately. >> can we get to a point where a seventh grade coach -- the seventh grader takes a big hit, that there's a checklist, per se, that the coach can use to determine if that kid should go back into the game? >> i think in general there certainly are guidelines out by the cdc and others that list concussion symptoms. and so i think the general bias at this point is if the individual reports any of these symptoms, that they should be pulled. because we do know that there is data to indicate that if you do have a concussion and then you start playing again before the symptoms resolve, the likelihood of even death is much greater. not to mention further

significant concussion that's going to take longer to recover. >> all right. so this one is for dr. johnston and dr. gioia. one of the debates occurring in the state of nebraska right now is you have a child or a high school student that suffers a concussion during a game. so it's been diagnosed. what do you do next? right now the thought is you keep them home or her home, dark, no electronics. that's kind of the norm. there's a discussion whether that's appropriate or not. or to what length. or to what length. what do you know? what would you recommend? >> well, i will tell you about how we handle things in alabama and i think a lot is based on

the cdc guidelines which is once an athlete is diagnosed they're removed from the field of play and then they are evaluated. we use the scat, a sideline based assessment and use it afterwards as well. it has a mini inventory of neurological exam and function. when children have symptoms that persist, obviously they don't return to any sort of play or escalation of activity fl their symptoms have completely resolved. those children who have symptoms lasting beyond the two weeks are then referred to neuropsychologists like dr. gioia and our traumatic brain programs. >> you recommend dr. gioia? >> yes. it comes to what's the best treatment for this injury. and let me just say the field is moving on this one. and the recommendations that we make, and i have written several recent papers on this, is that in that acute stage of symptoms, probably the first few days, maybe for some, little bit longer if there's more severe number of symptoms, is that they really reduce their activity, cognitive and physical. but what you want to be doing is

increase the activity over time. we don't black box kids until they're asymptomatic. that has a lot of likely negative effects on kids obviously being removed. what we do is initially shut them down, restrict them, and gradually start to bring them back to school and physical activity. but that has to be individualized based, again, on the severity of the symptom presentation. that's where we are right now. we need a whole lot of research to help validate that. >> thank you. mr. lance? >> i have no questions. >> the gentleman from missouri gets to ask another question. mississippi. i thought you were billy long. >> that hurt. that hurt. thank you, mr. chairman. and a couple of questions that i would have. one would be if we're looking at

this -- doctor, if i may ask a question? >> yes, sir. >> in your testimony you state that football players at the elite levels are shedding equipment to increase speed and mobility. >> yes. >> but the decision of which helmet to wear is their own and that player often chooses a helmet's looks, shape, feel, over its collision cushioning ability or safety features. do some physicians require different levels of cushioning? and, if so, would you recommend a special helmet for specific positions that would meet all safety standards? >> that's a great question. currently there are no position specific helmets being made. i think the helmet manufacturers try to do the best they can for everybody. i would say that -- not to belabor the point but i think

for linemen where you typically get no severe hits but a lot of subconcussive blows, that horse collar is crucial. i wouldn't recommend that a wideout wear a horse collar. that would really affect the quality of the play. it's an interesting point because certainly some players might tend -- this is why i'm an advocate for the hits system. it will give us much more detailed information about what positions get hit where. one could envision if we have a large database then improving helmet design to react to the information that we got from that kind of information. >> dr. graham, if i could ask you, how much money has been spent on sports concussion research? and where is most of the funding coming for for that research? >> unfortunately that was not an issue that our committee looked at nor would we have the resources to pull it out.

clearly you can identify some research being done in the federal sector that applies to this. but the private research that may be done by the sports leagues, by the manufacturers of equipment themselves, i don't know any good way to quantify that for you. >> i appreciate everybody being here. it's a very important issue. we love our children going through sports. we love to watch it. and we don't want anybody being hurt that shouldn't be hurt. so hopefully this increased focus will lead to better research, better safety equipment, detection and of course, prevention. so thank you so much. thank you, mr. chairman. i yield back. >> thank you. the gentleman from mississippi. and i just want to thank -- this was a truly all-star panel of medical experts and physics. and much appreciated. ian, thank you.

and so that does conclude our hearing for today. now, for our witnesses, we, whether we showed up or not, have the right to send you a question. it's called a written question. we have about 14 days to write those and submit them to you and i would appreciate a couple of weeks. you don't have to do it right away. but at least if you can get them back to us, if there are any, within about 14 days. i just again want to thank you for coming out and providing some very, very valuable testimony for us. and we are adjourned. this weekend on the c-span

networks, tonight at 9:00 pm eastern, memorial service for president reagan's press secretary, james brady. on saturday night at 9:00 pm eastern, former secretary of state colin powell talks about world affairs and sunday evening at 8:00 on q & a, author robert timber talks about how, in vietnam, a land mine explosion went off and almost killed him. and ralph nader talks about the issues that plague america. saturday at 10:00, surgeon and author gawanda. and naomi klein on capitalism and its impact on climate change. tonight at 8:00 on c-span 3, curator and director toni highly

explains the museum preserving the agency's history. king george's war of the 1740s, how it helped the colonists gain valuable fighting experience for their own revolution. sunday night on the presidency at 8:00 pm, president ford's testimony on the ni dpchlt on pardon. find our television schedule at c-span.org and let us know what you think about the programs were your watching. e-mail us at commen comments @c-span.org. join the c-span conversation, like us on facebook. follow us on twitter. jay rockefeller is retiring after 30 years in the u.s. senate. he is a democrat but republican appears to have the edge over secretary of state natalie tenant. they debated earlier this week.

>> would you vote again today to repeal aca, which would mean 160,000 west virginiaans would lose their insurance? >> i would vote for repeal and replace. i voted for that 50 times. the aca has some very good things about it. first of all, making sure people don't get cut off their insurance a for pre-existing condition. absolutely for that. was for that before the president decided to take it into in a larger and much more detrimental direction. i believe keeping our students on until they're 26, i think that's a good thing. so there are good things. so we need to keep what's good, replace it with what will work. get rid of a business mandate. make sure our businesses are not having a 30% increase in their premiums, which we're seeing. 7,000 west virginians have lost their health care plan, because -- remember the president, who

i'll remind you my opponent supported and supports his policies and his health care policies, said if you like your health care plan, you can keep it period. well, that didn't work out so well. so it was sold as a bill of goods basically. we're hearing people who are losing their physicians, whose deductibles have gone into the thousands of dollars. it's unaffordable. were things wrong? yes, with the health care system, i wish we'd worked together. i wish we'd worked in a bipartisan way to find a way to keep folks who are on insurance now, the 140,000 medicaid, we want to keep them insured because that's important to us not just to them, but it's important to us as a state. >> secretary tenet, your response? >> well, there she goes again. i wish -- she says one thing and votes another way. she says she's for all of these things in the aca, but yet she has voted to repeal it. i won't vote to repeal it. because i know what it's like to go without health care. my daughter delaney had open heart surgery when she was a

week old. many folks across west virginia prayed for her, and those prayers were answered because that surgery saved her life. she's a healthy, happy 12-year-old right now. but when my husband and i started our small business, we wanted to buy insurance. so he called and i can remember the day i came home and he said i talked to the insurance companies trying to get insurance for us and the business and the family. and he said they would cover me and you, but they wouldn't cover delaney because of her pre-existing condition. i was devastated because i thought, what parent takes something that their child can't have? so i will never go back to the

days when insurance companies can deny insurance for someone with a pre-existing condition. congresswoman capito, to sit here and say she's for that, too, she's voted to take that away.

in terms of time in prison for certain crimes and for certain jobs. you know, i don't think you should be required to check the box as a felon, which only increases recidivism. and i think if people have paid their debt to society, society needs to welcome them back into society and make it easier for them to come back into society if, again, for certain crimes and for certain positions. >> same thing. >> i appreciate you asking that question. because my whole campaign -- my opponent's whole campaign has been pretty much based on this bogus charge, the 97% charge. i mean, independent political analysts have called it both misleading and not reflective of

my record. the national journal, which does a review of all of the votes, not just a subsection, ranks me right in the sensible center. and your questionnaire, where have i stood up against my party? let me go through my list. i support drilling off the coast of virginia. as long as we get a share of the royalties, but i support that. i support the keystone pipeline. i've been protested against because of that support. i stood up repeatedly against the president on the foreign policy choices, both around as we've talked about with isil, but also in terms of being stronger against putin in russia. calling early in march for these kind of stronger opposition to his activities in ukraine and around europe. and it's that reason that virginians know my record. it's that reason why, again, in this campaign i'm so proud to have the support of more republican, former republican legislators than when i ran the first time. if his claim had merit, i don't think that would be the case. what it is, though, is the kind of political sound bite attack charge that comes from somebody who spent their career as a

partisan operative. more campaign debates over the weekend on our companion network c-span. tonight live in eau claire, wisconsin, scott walker debates mary burke. it's the first of two debates in the wisconsin governor's race. it starts at 8:00 p.m. eastern. saturday at 8:00 eastern, a debate in the race to replace five-term iowa senator tom harkin. democratic congressman bruce braly debates state senator jodi ernst live on c-span. sunday, rick snyder faces mark shawer. that's live at 6:00 p.m. eastern on sunday. with live coverage of the u.s. house on c-span and the senate on c-span2, here on c-span3 we complement that coverage by showing you the most relevant congressional hearings and public affairs events. then on weekends, c-span3 is the

home to "american history" with programs that tell our nation's story, including six unique series, the civil war's 150th anniversary, visiting battlefields and key events. american artifacts, touring museums and historic sites to discover what artifacts reveal about america's past. america," featuring government and educational films from the 1930s through the 1970s. c-span3, created by the cable tv industry and funded by your local tv or satellite provider.r tonight on c-span3, american history tv examines spying in the u.s. ru)u$ then a look at spying during the civil war.q

after that, german espionage against the u.s. during world war ii and later a conversation about the soviet and u.s. spiesd c-span's 2015 student cam this nationwide competition jf for middle and high school students will award 150 prizes totally $100,000. t)uuráq+en minute n the topic "the ñ2 @r(t&háhp &% three branches and you."okñ of view, and must be submitted by january 20th, 2015. go to studentcam.org for more information. grab a camera and get started rr today.xds7sation the senate commerce committee over the summer held i the committee examined athletic scholarships, campus sexual assaults and the issue of l assa be paid.ults

among the witnesses the head of the ncaa, college athletic the nd this hearing will come to k order, and i want to thank all of you very much for coming t( here. you're a bit squeezed in there.f ouse, so bejfjf comfo#!%áp'd be glad.e1 college sports has an absolutely e t9=i 9ieuju)urjr))qó culture of our country. not only do college sports inspire incredible fan p!'kjujrg across the country, but they c provide a very important way fo( qi] written, do athletics as an avocation and get an education.f we're going to talk about that r today.xd an

athletics has prcded an avenued to college which otherwise wouldn't have existed, and it's important to understand that. college athletes and athletics college athletes and athletics amateurism.rooted i and the history of that is veryx qáur'g and important going c back to the founding in 1906 and all the rest of it, going back, actually, to the greeks' concept of amateurism.okcng in 19 playing college sports is +8jza supposed to be an avocation.to students play college sports for the love of the game, not for jf notion of college sports is jfl being undermined by the power t and the influence of money.xdjfa i remember a meeting i had in my office with the three top e thr executives of espn, and it was one of those meetings in which n one of they meetings in which n just went around in circles, t( each talking about what a great

busine they had control and power thats no other broadcast system would uju$rilled theyokñi were with it and how they were o yñrlp there is a growing perceptionp that college athletics, particularly division i footbal and basketball, are not s7çó what they really are is highly profitable commercial c ir they believe that. r athletics say the goal of!vhese xd young people with a college education but to produce a winning program that reaps financial rewards for the jf

athletic departments and their á schools.ng it is not, :o,ever, about th#@et students.ha they're part of what generates d the money. it's about capturing the billions of dollars of y television and marketing revenues that college sports dos generate and will generate even more. colleges and universities say that these revenues benefit college athletes and their coul student bodies ó4$sp)ge. but i think we have to consider whether the lure of such riches could corrupt the basic missiond of athletic programs.w3 winning teams get higher payoutq than losing teams, which creates a strong incentive to win, an +i incentive which land grant xd public universities and others are more than happy to follow. a#s!ïe)itjy much of the money is often m of funneled right back into those s sports programs in the form of multi million-dollar coaching ti salaries and state-of-the-eá facilities, many of them paid é for by the taxpayers to fát(w3r

perpetuate the cycle of winningc i think somewhere in my reading here, about $48 million of all the $900 million that nca gets f from, you know, their xd adness and broadc portion goes specifically to f academics.xd-qgyxd but even that's hard to figure. because nobody has the figures.1 they work for them, they make the decisions, he carries out ussi the subject ofon i discussion iw does he carry out what they want?é,éo cf1 o what powers do you have, mr. emmett, for actually carrying out what you think is a good r idea? you've been president of three n major universities at differentp places, and i would think that your passion for education wouli need to show itself.myán(ó[en

athletics, to me, are meant to  serve schools and their public duty to educate students, not the other way around. that's the way it's always put should be. dr. mark emmert is here to dr. present the perspective of the belong to the ncaa. i thank you for agreeing toenm testifk @r(t&háhp &hc% you some declined to come here, but you did, and i'm grateful for so. some did, but youq didn't. i t%jieve you were put at the w3 helm because you have incredibld reputation. that you're tremendously compensated. that's not what troubles me.kysf i think i'm just very skeptical that the ncaa can never live up tohmhe lofty mission that you x1 constantly talk about and which is written and printed in consta speeches and statements and xd responses to penn state this or something else that.r you know, the mission -- nothin(

comes before education -- is always there but the actions don't appear to be.ñi i don't see how the ncaa will jf ever be capable of truly makingh a safe, good education e aking experience for students their number one priority. 'm ber one priority. wrong, that i am wrong, and that i'm particularly wrong about the future.lp but i'll be a tough sellnp i think we believe that the ncad has largely been left to its own to determine what forms are w3e1 appropriate and how to accomplish its mission.t( as we continue to learn more çór about what goes on at some major universities and colleges, we xd want to know if tpá9j5yqlp seriously considering how çó college athletes are faring fá under this system.hletes a not just living as they do, bute injured as they often become, xd wracked by poverty.w3

if thk/h"on't do well, maybe wr their stipends are cut off, and is there a mandated four-year fá scholarship. all these things are put at fá play. how are young men who strap on their helmets on a t?çotball customers, how are they doing?eh how are our young men who lace up their shoes and play ht up their shoes and play which consumes the nation and ie deliberately spread out over a deliberately spread out over a long period of time so that no kid 10 years or older can ever c r(ájáátuju)h!ecause there's always basketball on.o a are colleges and universities living up to their end of the bargain and providing them withá a good education?xd are these young athletes entitled to any of the billionsk of dollars that are reaped from their athletic services?

and when young men and women are putting their bodies at risk, dd school, whether women'sxdxd lac( or men's soccer, do they have add equate hea,(ojejup'ce? i don't know. i don't know.w3and i ne and i never go into a res÷a(ran1 or barber shop or anything qw3 without asking,t(i] sometimes t their discomfort,xd do you have health insurance?r because i knowis the answer is going to be no.o work i care about health care, and i'm unhappy when people who work in places where they don't makeh a lot of money don't have healtd insurance.lp d(leagues sufficiently minimize the risk of concussions? and what happens to a student r run dry? all heard the deeply troubling comments of chavez napier, the

talented university of connecticut guard, the most basketball tournament in the midst of a tournament that tou generated hundreds of dollars in revenue for the oknc and itsokok members. mr. napiert( talked about how sometimes he didn't have enough çuz eat duringhcollege. how did college sportsok benefi mr. t(napier on the night he ha to go to bedxd hungry? you can look at that two ways.ol there he is, trying to pick outn a sensational example of a famous athlete and turn it into a large problem.not tryi i'm not tryinyrû"ár)hthink think it is a problem, and the f whole sense of giving students a er confidence that if they don't whatever and they don't make the team or they're let off in thein third year, are they dropped? de happens? i don't know. the title of today's hearing is "promoting the well-being and acadeqú! success of college athletes."s7

iq want to have ance1 objectives open-minded and frank discussion on this subject, and i'm going to try my best to. the ncaa has the same ''jl as i do. dr. ñrfáemmeret is going to tels promote sports as a means of e. achieving academic excellence.lp today i want to explore whether( the ncaa is fulfilling its plor mission.xdt( of fraudulentokjf academics, we still hear too many tragic stories of college athletes that have absolutely nothing to show for the services theyt( provide mr @r(t&háhp &hc%theyt( provide mi ofx3oç dollars. this subject is often discussed, but i'm here to tell you 4rjt should control the congress next time, and nobody is quite sure of that -- john thune has one w3

idea, bill nelson has another w idert,- and you. yeah, okay. and that i think we want to co+3r'ue this.lp oversight committee.of this we have jurisdiction over sports, all sports, all sports.o and we have the ability to vexdd subpoena, we have the ability wk investigations unit. we're very into this subject. to i personally am, i think our members are.t(95br so this is a part of a process s here. so i'm going to have some tough questions for our panel as the ncaa and its members schools, are they simply a legal cartel? have college spor4)á become aok multimillion dollar enterprise, which is no different than the corporate witnesses who have appeared before this committee,

or is the ncaac truly different does the5a00-year-old and do best interest of college athletes? the large questions and importantxd to be answer ed.ñr i turn now to my very distinguished ranking member, ct senator john thune, from the dit state of south dakota.in >> thank you, mr. chairman, for holding the hearing today, and i want to thank our panelists for the opportunity to examine the athletics.ñihe and, like you, i look forward t hearing from our witnesses, ñiw3 e national collegiate athletic st3 association is how the members of its institutions are is fulfilling the commitments made to our collegiate student etbalp athletes.é@ege and i'm an avid sports fan. i know all the members of this committee are as well.ñi as a former basketball player in high school and college and a proud father of a daughter who g

competed at the division ihthao participation in organized sports not only requires physical and mental strength but also teaches teamwork and other skills that serve you throughouc life. however, the college student ok athlete is and should be a e thi student first.ac colleges and universities must remember and prioritize their academic obligation to student athletes.orts h as the popularity of college as sports has grown, particularly a the popularity of college football and men's and women's basketball, so, too, has the itátt)páe athletic programs.xd urrent environment, the stakes have been raised both fod the student athlete who wants tç succeed and for ÷h university that has a financial interest in winning games. increasing revenues for some xdo schools andlp conferences have e broadcast rights for football and basketball games have become more common.for some games and the broadcast rights have become more to see their teams win and may d be inspired to contribute to trt jpsáy as we will hear today, the )jr

whose stated mission is so okko integrate collegiate athletes into higher education so the education of the student-athlete education of the student-athlete hor,çóinto h r, university and the commerciapk n considerations that often accompany college athletics, particularly in high-profile sports. sports. feel th many feel the commitment to the÷ student athlete is falling short. oint of contention involves athletic scholarships and whether the practice of t(c (áhju$ur multi-year scholarships unfairlr )-sm"ááuu"ent athlete at risk of losing their scholarships asp a result of poor performance orh injury. may benefit student athletes, they may disadvantage smaller x schools that can't match certain institutions. clearly, collegiate athletics in a isot without controversy. we will hear from ncaa's mh1)ñjf vocal critics today. while i'm sure today's hearing while i'm sure today's hearing important issues, i hope we will not lose sight of the positive impact that amateur ath lletics

has made on the lives of countless student athletes.okñi we must remember that college xr athletics is not just about ñi football and basketball. the director of athletics at the university of south dakota xd recently shared thexd results o exit introduce he conducts lete annually to evaluate the school'ses. athletic program fr the vantage point of the athletes themselves. he underscored two stories thatú stood out from this past year of interviews with athletes. he reitermd how a sophomore diver at usd recovered from oper qua championships, a feat that wouli not have been possible without the work of a dedicated trainina staff, academic support, coach,r o1et(sr&y. he also noted the moving story ( of a sophomoreçó swimmer who leaned onxd lpfriends, family al teammates to help her through xd the tragic loss of her father who passed away early in the fác season. with this support, hannah was est times in all of her swimming events at lp the summit league championships.

as the usd athletic director put and ixd quote, these two are ju ants7ç example of what college athletics should mean. if you strip away the money, the charter flights, you're left with studentxd athletes who oftn have to overcome personal, social, economic, athletic adversity all just to compete.r but they frequently do with d makes us all proud end quote.ñi determination na makes us all director of the university of south dakota.ñra5 recognizing the challenges exist, it'sw3ñi myxdçó hope tha ncaa, its member çóinstitutionso the studenstt athletes themselvk solutions to promote the education, health, and seek tox preserve amateurism in here congress can provide a forum but the w3r solutions are most likely to (7oe from those most directly involved in the education and development of student athletes. for holding this hearing.nbmosk

st question 55:átááqáyxdjf thank you.ucation ár).lplp we're going to hear the ok testimony, and then both senato mccaskill and senator booker, ñ mcca both of whom are sterling and wonderful people, are going to i get very, very angry at me because i'm going to charge into the regular ordu"and i'm going g to allow senator coates to ask the first question, which violates all the rules of the committee. >> well, i'm mad. >> that will make you a better questioner. coate >> as the most junior member on the committee, the rules will cr now allow me to be mad at you, comm t it's itterman, for7o worth, i was under the t(

impression also we were one of k the first to arrive and be ablei to ask questions in order. i arrived at 2:10 so i could be first.rc,np, i didn't want to put you in a nw bad spot or breach the rules either. >> you never do.to arriv you're wonderful. you will ask the first questionq after the two of us. and thank you for being here, ce and don't be nervous.'t wan okay.t(t bad i mean it.q+5 >> all right.lpxd >> it's a wonderful opportunitye to say what's in your heart and on your mind.tions >> yes, sir. first, i want to thank you and the committee for inviting me here today to share some of my>q experience and knowledge on thi1 very important subject, very (ó i've had many conversations wit3 fellow student athletes on this issue about the current role of student athletes today in this 4y/pathletics.it's a viate ery we often walk away from those ie conversations with mo"@çóoklet issue about the current role of s a first those questions and providing co some context and some clarity to this discussion so that we can

see our student athletes receivc maximum edification in all see u aspects of their person, be it f student, an athlete, a leader, ó and a man and a woman.ko that's very impsmant to me. the genesis of my story.e1ñi my parents are from the islands of the bahamas, my brothers are as well.5a i was born here in the states i went to high school in princeton, new jersey.ok after high school days if princeton, i would go over to y the university and i saw the big this guy who became my hero. his name was bill bradley. he was just a rockstar, in my opinion.portant the epitome of what a student fs athlete ought to be, college te basketball, american,c best player inftñlpcollege, princeto nba hall of famer, u.s. senator andxdc a rhodes scholarnd that's the first time i heard those twoxd words rhodes schola used in thefára same sentence. princeton, i had 83 scholarship offers to go anywhere and play

football. i was rated the number one prospect in the country by espn. i decided to go to florida state.xdnd i saw when i got to tallahassee on go campus, the first thing i did was go to theq office offá natió fellowships and told them that i wanted to be a rhodes scholar like my hero, bill bradley. if he did it, i wanted to do thatñiçó as well. three years later i was çó fortunate enough to earn that st scholarship.ollege. then i went to meet my teachersh and tell them i want you to mers increase my educational capitaló so i can be an outstanding at's those roads in the same sentence. future.s7mber one lastly, i went to my athletic et coaches and football coaches ane of national fellowships and tell my body and get me ready for a e career as a national football i] player. and, fortunately, i was able to be drafted by thñ(jf titans and play for the steelers as well. y story the steelers as well. is pristine and ideal, and may , be used as the poster childw3 f what you want a collegiate

athlete to have experienced. i will say my story is quite rare and unique. some people call it an anomaly.t outside of senator cory booker, to win at( rhodes scholarship was a guy namedfá p hayden.r he played at usc and los angeles rams as a quarterback. there are very few fáxtó student athletes who i have come in contact with who have had thn same infrastructure that i 2ñeo theok family support and theç r foresights, not come from a broken school or ñgkxfamily, abo engage in their college experience and maximize their team.lpqjd>ñçsoçr many more of my teammates, çónow it the college environment, they é struggled mightily, struggled ok economically, because with the some people call or not, the main breadwinners send some scholarship money homd

to take care of their immediated and extended family. they struggled academically as 3ju academic machinery and be spit k out at the end of that machine left torn, warn, and asking questions.lp really no directional guidance on where they should go. no purpose, no idea of their ta trajectory and sometimes it didn't behoove their interests,e the degree they earned.çó struggled ec said, chairman rockefeller,xd ws ar te pouring energy and exposu and highlighting on tvñiçó the ú!pbut i believe we are still 8ñ falling a bit short of edifying anvkmproving and augmenting theñ person the man, the woman and qo the philanthropist and the no dr leader. i believe if we do that, we can1 see these athletes at major cst. schools be prodshed light as yo said importantly, be productive pour leaders and citizens that go on

to be industries of men and stl women and really have an ízp÷ok indelible impact as they go on to their future. thank you for having me here.pe i'm looking forward to having ,o this discussion.t( >> thank you, very, very much and now devonn ramsay.if we do see these athletes at >> good afternoon.maw3antly, b >> devin, right?xdo on esqs!ers of the committee.very it is an honor and a pleasure to have this opportunity to be in your presence and share my story and thoughts on the current state of college athletics.xdmbu let me first thank you and your e my 1988, in red bank, new s?)sey. o my mother has ak5ge athletics. let me first thank you and your staff for the invitation. a blue ribbon school that covered kindergarten through eighth grade. i excelled in the classroom and participated in athletics.fáe1 by the time it was time for me to leave, i had the opportunity to go to the lawrenceville to school, right down the road in princetonvd  against myron.ñi

i decided this would be the best academic and athletic environment for me.ñi8th academic and athletic career gradui"u'g in 2007 and decided to sign my letter of intent to go+b-="át university of north carolinavw chapel hill.t( what drew me to that school was u as a top academic institution nd also thec new hire of then new coach, head coach butch davis. it showed that the university had an all-around commitment toh excellence. éz-pof north carolina has been filled with adversity.fá excellence. now my career been through three head coaches and been asked if i wanted to . shirt. however, despite all this, i managed to be named an offensiv starter four out of the six xd i pxt(howe 22p xdnfl analyst named the tope but most importantly, i got my

deg&ee in public policy, concentration in business.ok after graduating, i moved back o to redt bank, where i would lic pur[uv my hopes of making an nfl team. however, i didn't make the team at tampa bay.ce1çóte now in the summer of 2010, two ó of my teammates have violated ncaa rules and attended a partyb thrown by sports agents.qe1 the university of north carolina then launched their ownñr investigation into the matter thrown by counts of academic fraud. after the final practice ofigat conferencecoun rooms and was brd in for questioning by universitt officials. before the questioning began i 3 was told that this conversation would be recorded an"m55ád i if i needed a lawyer.ñrat i thought i had been called in l there to see if they could finda any more leads for the investigation.f then they asked -- they began t% ask me about my definition of t( academic fraud, academic ñiask

dishonesty and 0sjgiarism.rask f a two-year-old e-mail ñi correspondence between myself and a tutor. that' in the said e-mail i asked the university's tutor for help with grammar and y6crall quality in n the paper and she replied by l i adding four to five sentences ty a two and a half page paper.xdx. they asked me if this is the fáe exact same paper i turned in.lp( however, i couldn't remember, 4e was held out of competition, to they sent me to the university's honor court.ñiin the and the attorney general of t&m, honor court said there was no mo case here, that there wasn't ivi enough ñievidence. they had no final version of th1 paper. it wasn't submitted the electronically and, i don't know, most people don't keep as i was being held out by unc, an official from the compliance to plead guilty after being helr out for so many games that the

in fact, allow me to play.xd=+ito at this time, i believed that n the çóunc's compliance was very well versedt( in ncaa policy.fá however, it was a shocking blow when the ncaa then ruled me guilty of academic fraud, which stripped away my remaininge1 elledgeability and tarnishs a sy ruled me of after coming to the realization that unc was more concerned wite penalties and losses of çót( ility. of its own, my mother and i set out to find lawyers that would h at heart. t(r'st the ncaawoy norlp itsçó membership. fortunately for me, state heart. supreme court judge reached outd to my mother inpafter reading e an article that she had been @-d(withoutcq=ñ legal tenacity, would have no one top,ñi turn . as we went through thwppeals (&% process, which was possible with the endorsement2od the university of north carolina, the leadership at un]@&nce agai wanted me to take a plea for a i

reduced sentence.ñi onc however, judge orr, my mother a and i need%o&uz have my name unsullied. by going back and looking at thn to h lack of evidence, the ncaa overturned its rul$@g and d. reinstated my eligibility.e1xd unfortunately, the first game of the next season i tore three ligaments in my knee.e1 after receiving a sixth year ofy eligibility i was not able to unfortunately, the first game of until my final game, which i ok probably participated in two ecg plays.fáfáñi now one of the things that was -- looking back at my career fi could have e1s.at my career fi ings a few of my friends from tha lawrenceville went on to play a the ivy league.e1fát( ráh'ot as demanding as, you know, xdxdjfjf high-level division i football.á they were allowed to go in, you know, pursue other things during

and upon graduation, some of myg friends got great job offers. an internship gives you s direction, teaches you valuablef life lessons and prepares you ñe at a competitive football school, completing an internshil in order to bet( eligible to receive your stipend in the summer, one must be enrolled ina a certain number oqi%q i've seen several teammates try to manage and they ended up quitting because they were cc exhausted. only one was able to count çót( toward his credit hours and he d classes. at the university of north carolina, football players were one of the only teams allowed tp participate in camps to hone fá skills for coaching and create another source of income.clas in fact, during a panel discussion about the documentary sport, head coach of the georgii

mason meq!ñ basketball team paue his team had to doeorge an internship before they graduate, a mandatory one. i think this is a great practice.in 5át(háruly wa)7 to develop student athletes and is prepare them for success on thei field, then they should mandatef that all athletes complete an sw internship.an athle the reason it needs to be mandated is because of the ñiçó existing culture that demonizesl any activity that won't directly help a program. players that go home for a semester -- and i have friends  that have done this -- are "n labeled as selfish and lazy ande almost a cancer to the team. but, in fact, he's just going fá home. he's still working out. he's just trying to improve his own value to the likelihood tha i've come to realize that t( hi athletics. and the ncaa as an institution no oe longe'cprotects the student athlete.i've com they're more concerned with e e signage and profit margins. as i was called to the initial p

meeting with investigators, i wasn't aware i needed to defendp myself against my university an the ncaa.re that and as a student, i lacked the defend myself against an reso 80-year-old institution. my family lacked the resources e to hire a lawyer, and if i refused to be interviewed i would have been held out until o testified. lacke in the ncaa, college football players have a very small windo of opportunity prove our worth q#ors players have a very small there needs to exist2al entity to the advocates for the student ume u athlete. i was extremely fortunate that e judge orr reached out to my ñr family to help. however, it terrifies me how qïe students would have had their eligibility unjustly taken and their reputationok damaged. the student athlete has a short thos renewable resource. en young men and women.txdokçócble there needs to be an that, the s

able to take protect that student athlete and haslp no ties to thefác financi being of the universities or tha ncaan. ties to the intimidate athletes and schools isnbngerous and unfair.a, to quote a famous roman poet, xa "who will watch the watchman?" thank you for the opportunity t is unfair. to quota poet, >> thank you very much, mr. ramsey.w3 appreciate it a lot. mr. taylor branch is from baltimore.t( he's an author andlp historian m has written what i call one of s the five best anxd books ever wn five best rights movement and the books and he's also an expert on this s. extensively. we welcome you, sir.velopmen >> thank you. thank you, senator rockefeller d and senator thune. thank you, members of the ps5çfn committee, guests, sports fans,x educators. you. lp the subject for your hearing today, college sports and the x.

well-being of college athletes, 'a=55qm2ujtjuár!le discussioncó. amateurism, balance, and equityd governance.eñijf the 4ppronouncement as the bedrock f principle of college athletics. the ncaa bylaws define and lpfáó mandate amateur conduct as follows --onouncem student athletes should be amateurs in an intercollegiate sport and their participation w should be motivated primarily y education and by the physical, mental, and social benefits to ó be derived.okñ student participation in ñroklyb intercollegiate athletics is anq avocation, and student athletes should be protected from çów3çó exploitation by professional and commercial enterprises, closed a pro that's ncaa bylaw 2.9.tectó[w3(

the word "amateur" reflects conflicted attitudes about dao o money, youth, and jpf purposes ( ivi its broad ambivalence has openea its &ity in public ce has openea habits, allowing the united ok states to become the world's0l only nation to develop flexibi pu jju'iversities involved, which were founded ton uphold intellectual rigor, ñi routinelyc ignoret( or excuse t contradiction s contradictionst(t( multi-billion dollar industry built on their undergraduate students. confusion and mythology begin o bumbling dabbler or rookie,

merriam webster gives a scheming tone -- the people who r)vaq!qñd company are a bunch of amateurs. this ambiguity gains a bunc reenforcement in our uniquely where fans are encouraged to cheer and boo without #qr'king s objectively.ok the ideal of ancient greek amateurism has always been w3 e cheer and of olympus actually competed fo. huge prizes.urism aristotle researched well-rewarded champions back slg through the records ofztq? lympic festivals.ds ofztq? aq+idence of high stakes victor and loss. ancient amateurism is a myth claims david young. purists who refuse to mix moneyd with sport did not exist in the. ancient world, concludes one çó author.ó[ and victor's monuments "'jst of success in the cash competitions as openly as they boast of victory in the sacred contests.i golf legend bobby jones is t( enshrined in modernxd history a.

the idealt( model amateur and go gentleman, whoçójf declined eve >w3 he earned. his reputation fits the true lid definition of amateur, which is% derived from the latin meaning s lover, specifying one who xd definition of amateur, which is derived from the latin amatur or lover rather than the hope of financial game. some non-college sports still allow athletes to declare and renounce amateur status. significantly, students, themselves, call themselves amateurs when they t invented intercollegiate sports after the civil war.rcol, until 1905, students retained general control in everything from scheduling and equipment to ticket sales.nd euited they included alumni with zero funds from the college. neither the faculties nor other

critics assisted in building the structure of college athletics declared walter camp, yale class of 1880 who became the father of college football in his spare time. the ncaa created in 1906 slowly transformed the amateur tra tige inherited from amateur athletesy total faculty control and the weak ncaa organization could not hire its first full time staff member until 1951. after that, however, burgeoning revenue allowed ncaa officials to enforce amateur rule as an objective requirement rather than a subjective choes. this is problematic. even if internal standards were allowed and somehow could be al measured, ncaa rules contradict the key requirement that college

sports must be a calling which t comes from vocari, to call and vox, voice, by denying athletes an essential voice. ncaa rules govern the players by fiat, excludeing them from membership and consent. balance. checks and balances are required for sound governance and the ncaa structure is unbalanced in at least four respects. first, ncaa csuffers an inheren conflict of interest because the ncaa lost its revenue from nt football and is almost wholly sg dependent on a contract for them march madness basketball tournament.second , second, the ncaa creates false impression of common practice between a very few schools that aggressively commercialize college athletics.

and the vast majority of schools with small crowds and small revenue. obscure differences between the academic mission on campus. in the classroom, colleges transfer in academics.ti there, athletes deliver highly valued expertise to the colleges. this distinction is basic and fundamental to your yo committee-stated purpose of promoting education fall integrity.urpo college athletes are or should be students in the classroom and competitive players in the athletic department.in they face multiple roles in rt careers like many merps. but their conflicting demands

cannot be balanced unless they're squarely recognized. universities implicitly concur by off-loading some of their academic sporesponsibility to t ncaa. fourth, the ncaa and its member schools strip rights from athletes unique le as a class.oe no college tries to ban work from students. no legislature could or would write laws of one targeted grou and producers in a legitimate enterprise. on the contrary, universities sponsor extensive work study det programs and students everywhere exercise freedom to market skills everywhere from pizza delivery to the entrepreneurial

launch of facebook, unless they're athletes. for college athletes alone, the, ncaa brands such industry unethical. equity. a basicbo freedoms above the convenience of observers.spor applied to college sports, this principle would mean that no e f freedom should be abridged ta because of academic status.tu i am neither a lawyer or professional economist, i find c ample evidence that experts ncas object to collusion in the ncaa's regulatory structure. in microeconomics, professors make a featured example of an economic cartel which reads any competitive profit. the courts have agreed in two landmark cases. co ncaa versus board of grievancesc

in oklahoma, the u.s. supreme court struck down the exclusive control of broadcast as a right over night, they won selling every broadcast they should bear.ugh we eat what we killed, bragged one official at the university of texas. assistant coaches won a $54 million award and cracked the $, million barrier since then with salaries skyrocketing in non-revenue sports. un by 2010, the university of florida paid its volleyball coach $365,000. thus, the supervisors of sports

have won economic freedom and they enjoy enormous large else. the players.regardin to reduce bargaining power, the ncaa reduces compensation.ssert they steadfastly assert that thd whole system is devoted to the t educational welfare and benefit of the college athletes.athlet football will never again be be placed ahead of educating, nurturing and protecting young people.ecting in caa president mark emeret, sitting near me, vowed when he announced ncaa sanctions for the recent scandal at penn state. such professions must be reconciled with due process and representation to the presumption of innocence. t inn

these rules can turn words on their head like alice in wonderland. the ncaa's bedrock pledge to avoid commercial exploitation of college athletes aims to safegu safeguard them from getting paid too much or at all rather than a toon little in the ordinary usae of the word exploit.ag to use selfishly for one's ends. i would suck jest one hopeful precedent from the work of your commerce committee. this is not the first time that the governance of amateur sports together with the education of college athletes has presented a vested interest. 50 years ago, an early bonanza intensified between the ncaa ana the amateur athletic union, aaud which controlled access to the olympic gamings. aau leaders accused an unpray un

trottic ncaa of sabotaging u.s. chances to win medals.erefor they claim they were already paid and not amateurs at all e e since the ncaa approved scholarships in 1956. the squabbling, exhausted mcarthur who recommended blue ribbon commissions that brought promoe sales, eventually, to this committee.ho your predecessor shaped what became the olympic and amateur sports act of 1978. one key provision of that law secured for active athletes, a 20% share of the voting seats on each of the u.s. olympic

committees. athletes tipped the balance on governing committees in the united states and around the globe.d marathon races and then tennis tournaments recognizena a right for prize money and keep their olympic eligibility. by 1986 when the international committee expunged amateur from its bylaws, indeed, most people scarcely don't notice the change. some of you helped reck news success in the revised ted t stevens olympic and amateur pic sports act of 1998.is this example suggests a good place to start.