Former rugby players whose dementia symptoms have only recently been linked to concussion will be the first of many cases to come forward, says a renowned Australian journalist and sports commentator.
Peter FitzSimons says he's now concerned for his own brain health, given the knock-out blows he'd suffered while playing for the Wallabies and various club sides over a 20-year football career.
The columnist, author and historian spoke to the Weekend Herald ahead of his appearance on a panel about the lasting impacts of concussion in Dunedin next month, which comes as New Zealand Rugby and Statistics NZ launch a new inquiry into possible increased risks of dementia.
Five years ago, he began investigating chronic traumatic encephalopathy (CTE), which causes early onset dementia, and its connection to elite contact sport in Australia and overseas.
It culminated in an expose featuring interviews with AFL legend Greg Williams and rugby league great Shaun Valentine, both now facing long-term brain impairment, along with top brain experts.
Even with the increased exposure there has been around the topic since, he remained worried that complacency around concussion was still all too common in professional sports culture.
He recalled his fury at the Wallabies' controversial decision to let flanker George Smith return to the field after he was concussed minutes into a match against the British and Irish Lions in 2013.
"He was knocked completely motherless, he was off the field for about five minutes, and he was back on there," he said.
"I went ballistic in the paper, and what they said was, well, he passed the test. And I said ... any test that [could] get George Smith back on the field shouldn't be there."
The incident prompted the International Rugby Board to refine its Pitch Side Concussion Assessment (PSCA), which Smith had passed.
Yet Mr FitzSimons was still hearing of similar cases today.
Interviewing former NFL player John Hilton for his Sunday Night investigation reminded him of his own recklessness.
"It was like tuning into a radio station with a range of 60 miles when you are 100 miles away ... he was coming in and out of lucidity," he said.
"And I look back on the naivety that we had as footballers, which was thinking that it's only boxers who got punch-drunk, and the point has been made to me by various neurologists; the brain doesn't know what hits it. It doesn't know if it's a fist in a glove or not."
He considered the notorious 1990 test against France in which he was knocked out twice but continued to play on.
"I played the game of my life when I came to, because I was so angry at the French second rower who had hit me and I just went berserk for the rest of the match.
"Had I taken another hit that day, Christ knows what would have happened.
"The point is, that neither the Australian rugby union, nor the Wallabies management, nor I, had any clue about second impact syndrome. I just shook it off and I was very lucky."
Decades later, he was startled to be told by a leading US neurologist there was a real chance the countless hard knocks veteran players such as himself had sustained could have lasting consequences.
"Basically, your brain is a bowl of jello, floating around in a bucket of bones. It's not meant to rattle around.
"And it worries me. Whenever I lose my train of thought, it worries me."
He expected the risk would be even higher among rugby league players.
"Those one-on-one tackles, when one man runs flat out at me, and I run flat out at him, and I stop him ... I don't know how many times that happened, but not often.
"Whereas the rugby league guys, they are doing that 30 times a game, and the impact of one of those tackles is like a car running into a wall at 30km an hour -- it's not enough to kill you, but it rattles people."
Mr FitzSimons has been keeping an eye on developments here in New Zealand, where a three-year World Rugby-funded study conducted by Auckland University of Technology published last year failed to identify definitive or causal links between rugby and long-term cognitive health issues, but encouraged participants to consider potential negative health impacts.
Following an unscientific series of articles about the possible links between rugby and dementia experienced by a number of All Black and Taranaki rugby legends, published by the Herald this year, he expected there would be many more cases to come.
Still, he believes New Zealand is further ahead at tackling the issue than his own country.
"It's a bit better now, but we've got a long way to go."
• Peter FitzSimons will speak about concussion in sport alongside Professor Damian Bailey and Professor John Sullivan at Dunedin's St David Lecture Theatre Complex on July 13, as part of the NZ International Science Festival. For more information and tickets, visit www.scifest.org.nz
Peter FitzSimons on concussion
"We see these guys get knocked motherless, and we see them stagger from the field, and it's obvious to everybody that they are concussed ... but they do the test and they come back on." - on his concerns with sideline concussion assessments in elite sport
"It seems to me that you are doing better than we are doing." - on Australia and New Zealand's efforts to address the issue
"I look at the naivety of people like me, rugby players, and we got knocked out." - on concussion in his own playing days