Dylan Cleaver on sport
Sport analysis and comment from Dylan Cleaver

Rugby research caught in the breakdown

By Dylan Cleaver

Last year, representatives from World Rugby, New Zealand Rugby and the Auckland University of Technology delivered the results of a three-year study into the health of retired rugby players. Behind the united front, there were divisions.
This year the Herald published an unscientific series about the possible links between rugby and dementia experienced by a number of All Black and Taranaki rugby legends. Photo / Brett Phibbs
This year the Herald published an unscientific series about the possible links between rugby and dementia experienced by a number of All Black and Taranaki rugby legends. Photo / Brett Phibbs

Here's an awkward truth: in the days leading to the release of findings into a study commissioned by World Rugby, the lead researcher, AUT's Patria Hume, considered not attending the press conference.

Here's another: over the same period, AUT and World and New Zealand Rugby struggled to agree what could and couldn't be said at the presentation.

Later, during research for a follow-up story on the study, Hume would tell the Herald that "World Rugby and NZ Rugby did not give approval for the full report and all the results to be released", a statement that set off alarm bells.

READ MORE: THE LONGEST GOODBYE: Rugby and the dementia dilemma

It was not the first time Hume had expressed frustration at the processes behind the study.

On the morning of the 2015 press conference, Hume put the finishing touches to a statement she would not read out. She prophesied this in an email to professorial colleague Max Abbott, writing: "It will be interesting to see if Ken [Quarrie, NZ Rugby scientist] and Martin [Raftery, World Rugby head of medical] agree to me saying it when we meet at 10am."

What she never said was this (the bold type is ours):

"Proportionately more rugby players had worse brain health scores ... To better address the implications for player neurocognitive health we believe players should be aware of the potential increased long-term risk of cognitive impairment from concussion so they can make informed choices about engagement in sport and return to play following injury."

Those details are contained in a tranche of documents obtained by the Weekend Herald under the Official Information Act.

While some material, including the full Rugby Health Study report, was withheld due to "commercial sensitivity", several emails point to the difficulty Hume appears to have had in presenting results to her satisfaction.

The research was sponsored by World Rugby. Effectively they own it.

Professor Patria Hume of Auckland University of Techniology. Photo / Supplied
Professor Patria Hume of Auckland University of Techniology. Photo / Supplied

At the press conference, media were given a fact sheet about the project. Sources spoken to on the condition of anonymity by the Weekend Herald claim the fact sheet reflected a sanitised version of the findings.

New Zealand Rugby and World Rugby strongly oppose such allegations. NZ Rugby refuted any "suggestions the findings were 'sanitised' in any way" or that information had been omitted.

"During any research project of this nature it is entirely normal scientific practice for robust debates to occur about research methodology, analytical processing of data and presentation of results ... As is also normal, there was some debate about how to best communicate the findings prior to the study's publication."

The emails raise one pertinent question: can sporting bodies ever be truly independent arbiters of research into the safety of sports they are compelled to protect?

Debate about the effects of concussion on the long-term health of athletes won't go away.

There were signs of chronic traumatic encephalothapy (CTE) in the brain of deceased NFL legend Mike Webster. An amateur rugby player in Ireland was identified as having suffered CTE as a result of concussions. In the United States, former All Black Geoff Old has been diagnosed with CTE symptoms and told the Herald he was "scared" about his future.

This year the Herald published an unscientific series about the possible links between rugby and dementia experienced by a number of All Black and Taranaki rugby legends.

In short, there are strong suggestions that head knocks suffered as part of legal play in various sports can cause severe problems in later life.

New Zealand Rugby was firm this week that it takes such concerns seriously. In its response to Herald questions about the delivery of the AUT-researched report, it revealed it was undertaking comprehensive research into the possible links using official Government data.

World Rugby was equally forthright, citing player welfare as its top priority and confirming "the need to research a possible link between multiple head impacts in sport and dementia".

Ken Quarrie says he met Hume on the morning of the press conference but did not see any statement she had prepared.

He says he was not aware of Martin Raftery directing Hume as to what she could or couldn't say.

According to the documents released under the OIA, Hume knew she was up against it in terms of delivering what many at AUT saw as the study's most important message.

On July 25, three days before the presentation, she wrote to Max Abbott, a pro vice-chancellor at AUT, discussing the fact retired rugby players were still binge-drinking more than the general population.

"It is one of the few findings WR/NZR would agree could go in the fact sheet," she wrote.

"Do you mean we are not allowed to discuss the cognitive impairment findings?" Abbott replied.

An earlier exchange with another colleague, Alice Theadom, pointed to increased frustrations with rugby authorities around the neurological aspects of the study.

"I think our reference to this should be sufficient given the norms are published unless you can think of anything else we can do?" Theadom wrote in relation to a point they were unable to get on to the fact sheet that would be released to the public.

"I do not think there is anything else we can do," replied Hume. "They [World and New Zealand Rugby] just do not want us to say there is any issue at all."

Dr Ken Quarrie is the Senior Scientist for New Zealand Rugby. Photo / Supplied
Dr Ken Quarrie is the Senior Scientist for New Zealand Rugby. Photo / Supplied

It was a far cry from March 2014, when report co-author Dr Steve Marshall, a New Zealander working as a director in the Injury Prevention Research Center at the University of North Carolina, wrote to Hume, Raftery, Quarrie and NZ Rugby medical director Ian Murphy to say: "Congrats to the AUT team on this excellent report. They have really done excellent work here."

In another email he wrote: "The study is going to be a major contribution to the science of rugby health."

That was the feeling at AUT, too. One source said there was general excitement that the highly regarded Hume had led a study that would be a real "game-changer" for the sport.

It would be another 16 months after Marshall's email before any aspect of the study was revealed, to the frustration of many.

In September 2014, Raftery fired off an email to Hume after an article in the UK Mail on Sunday criticised World Rugby's failure to deliver concussion research.

"This is embarrassing for Brett [Gosper, World Rugby chief executive] and [World Rugby] yet the responsibility for this failure rests not with him or [World Rugby] but with AUT ... [I] would appreciate if the reports can be completed as promised or an explanation provided why these reports are delayed."

In an email to Hume on October 9, 2014, Quarrie outlined unease at rugby headquarters about the presentation of some of the findings.

"What I have noticed, and what I think Martin [Raftery] is particularly sensitive to, is emotive language creeping into academic works. 'An alarming rate', etc, where such language reflects the preconceptions or biases of the author(s), rather than as evidence-derived fact."

Quarrie goes on to list the weaknesses and biases of the study, before concluding: "It is not a case of 'watering down' the findings - we need to report the findings in light of the strength of the evidence we have available to us."

In these emails, Quarrie references concerns that many in the science and academic community have about commissioned research: that sporting bodies, particularly those administering contact sports, can muddy the waters when researching the long-term health effects of their codes.

At one point he sent Hume a link to a story titled "Science, harassment and the limits to transparency". In the subject line he wrote: "Interesting article on research disclosure and pressure from corporations."

In a full response to detailed questions from the Herald, Quarrie said: "I fully support NSOs [national sporting organisations] carrying out research to examine the health effects of their sport. I have dedicated my professional life to this cause. I have grappled with the inherent conflict that is associated with such research but not doing it is not an option. I personally do not believe an NSO can claim to be a 'truly independent arbiter' of such research and in my time with the NZRU, we never sought to do so."

Professor Giselle Byrnes, head of Massey University's research, academics and enterprise department, said studies commissioned and paid for by an interested party are bound by codes of ethics that vary from institution to institution.

Byrnes, talking without knowledge of the rugby study, said having a co-author of the report involved with the interested parties, in this case Quarrie and Raftery, complicates the "ethics rubric".

Or, as an AUT source said: "It's the age-old question of how you fund research. If rugby doesn't pay for it, who does?"

Reports about the July 28 press conference to release the fact sheet were muted.

It was covered for the Herald by Steve Deane, now a freelance journalist. He said the whole affair was "awkward".

His story, filed that day, highlighted the underwhelming presentation.

"After three years of recruiting, quizzing and testing retired sportspeople," Deane wrote, "a World Rugby-funded study conducted by AUT produced few solid findings."

Raftery himself seemed to downplay the work's significance.

"This has been a difficult study," he said. "It has been difficult to recruit, difficult to analyse and difficult to interpret. Maybe the outcomes haven't been as conclusive as we'd like them to be, but that's life."

Those involved in preparation for the day may not have been surprised by the awkwardness.

According to the OIA documents, by March 2015, the AUT's frustrations with World and NZ Rugby were manifold. Staff joked that when a series of emails did not get through from NZ Rugby it was because there was excellent "quality control" on the server.

On July 16, less than two weeks before the presentation, Mike Jaspers, an NZ Rugby communications employee, wrote an email to AUT which said:

"Given this is a World Rugby study ultimately, they should take the lead in directing the public comments ... I note also your alteration to bullet point two around 'no definitive link' [between concussions and dementia] - clearly the chances of links between long-term health outcomes will be the focus of media attention so this statement needs some care."

Mike Jaspers. Photo / Getty Images
Mike Jaspers. Photo / Getty Images

Jaspers said his week that "the key issue of interest from a media perspective was going to be the existence or otherwise of a link between playing rugby and long-term health issues and I was encouraging the authors of the media statement to be clear in the way they expressed their conclusions in this area".

The OIA documents suggest the day of the media release was fraught for AUT.

Hume wrote to AUT communications staffer Susannah Dalton at 9.47am, with the subject line: "at least the changes on the attached [meaning the press release] need to be made".

Dalton wrote to Jaspers, saying: "I note this [press release] has changed somewhat since the last version we reviewed. As per the need for an agreed approach to Comms, we request that the attached amends be made."

In notes to her own staff, Dalton would ask if they were aware the changes were being made. They were not.

Jaspers replied at 10.45am: "This is something you need to take up directly with Dom [Rumbles, communications manager at World Rugby] and Martin [Raftery]. NZ Rugby and World Rugby have agreed this release - and disagreed with AUT's views around your views on any links being established."

This prompted AUT's head of communications, Alison Sykora, to alert the university's head of legal, Andrea Vujnovich, that "there still seems to be some differences in points of view between the rugby organisations and our researchers. Just alerting you as these may come to the fore during today's media conference".

At 11.39am, a little more than an hour before the study partners were due on stage together, Vujnovich warned that it may be a breach of contract for the AUT to say that it did not agree with certain statements (which were withheld from the Weekend Herald when the OIA documents were released).

Quarrie said this week he was unaware this had happened until after the event, but "World Rugby are the lead agency for this research and so retained ultimate editorial authority".

Byrnes, again without knowledge of this study or AUT ethics considerations, said it would be "extraordinary" for a commissioning organisation not to accept the opinion of the academic researcher.

She was aware of only such case in her academic career, in Australia.

The emails raise one pertinent question: can sporting bodies ever be truly independent arbiters of research into the safety of sports they are compelled to protect?

Despite discussing the possibility of not going to their own presentation, AUT appeared, according to their contractual obligations. Hume did a number of interviews that day, one of which later caught the eye of Rumbles who alerted Raftery and he challenged Hume: "Does this article and title accurately reflect your opinion of outcomes from the study?"

Essentially, World Rugby's problem was that Hume said she could not rule out a definitive link between concussion and long-term cognitive health.

"I was trying to make clear that we can not say there is no definitive link, like we can not say there is a link," wrote Hume.

As this exchange was occurring, Abbott put out his own release. It had been delayed by a day amid a debate over whether the terms of AUT's contract with World Rugby allowed him to do so. Abbott was known to be unhappy with the fact sheet.

"I am not a member of the research team and, as an academic, have freedom, if not an obligation, to comment on research that is in the public domain," he wrote to fellow staff.

The release, which was not widely picked up, was pointed. You did not have to read hard between the lines to work out his concerns.

"The full extent of the study results and their relevance will not be known until the report is in the public domain," he wrote. "While the media statement indicated worse neuropsychological results and greater variability in elite rugby players, it did not state what proportion scored within the range indicative of clinically significant brain dysfunction."

To simplify: Abbott thought this was a significant omission.

Martin Raftery (Left). Photo / Getty Images
Martin Raftery (Left). Photo / Getty Images

The postscripts to the AUT study and to the Herald's series, "The Longest Goodbye - Rugby and the Dementia Dilemma", have not been without friction.

It has been difficult to get straight answers from NZ Rugby or AUT about what prevented the study being released in full to the public before now, more than four years after the study started.

Both said this week it was because the remaining papers are due to be published in online journal Sports Medicine, of which Hume is on the editorial board. All parties said it was important the full results were peer reviewed before they were released.

Before the release of the fact sheet, Jaspers said he was "all for" the full study being released unless it risked confusing messages.

There was no mention of exclusivity to certain journals, though he said this week that was a result of his "misunderstanding of the academic process".

When the Herald previously asked AUT why the study hadn't been released in full, it said we would have to ask World Rugby.

What is clear from the emails is that NZ Rugby was unhappy with an email Hume wrote to the Herald saying that "World Rugby and NZ Rugby did not give approval for the full report and all the results to be released".

Hume would later backtrack on that in a subsequent email to her communications staff.

"Hopefully this keeps WR and NZR on side (acknowledging implications for the current Rugby Codes Research Group and potential MOA with NZR for AUT to be a preferred provider of research), while also not breaching the original project contract.

"Our best bet it seems is to keep trying to get the papers approved for submission asap."

Two of those four papers are about to be published, say AUT, while two others have been submitted for publication.

The Herald forwarded specific questions to AUT and Hume. AUT released a statement and Sykora said "Patria is on sabbatical and overseas at the moment so I believe she is unlikely to respond".

The AUT statement said: "The findings released through Fact Sheets in 2015 provide the preliminary outcomes of the research prior to them being validated through peer review ...

"While there was robust debate about the content of these fact sheets, the information they provide was agreed upon by AUT researchers and rugby organisations."

All the organisations make the point that the limitations of the research meant there were never going to be any "definitive" findings.

"AUT would welcome the opportunity to work with NZ Rugby and World Rugby on further research into this area, which clearly needs to be better understood."

And that's one thing, at least, that everyone involved appears to agree on.

- NZ Herald

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