Field of Science

Zika virus poses a greater threat than we thought

The Zika virus outbreak in South America has caused thousands of cases of microcephaly, where an infant is born with an unusually small head and brain. The threat is so serious that the CDC has issued a level 2 alert for anyone attending the Olympic Games in Brazil this summer. The World Health Organization has also issued travel precautions.

Most of the attention has focused on microcephaly, understandably so, but Zika threatens more than just pregnant women. In recent months, the evidence has been building that Zika also causes Guillain-Barré Syndrome (GBS).

GBS is a rare but terrifying disease, in which your own immune system attacks your nerve cells, leading to rapid paralysis and, in some cases, death. With the best available modern care, the death rate is about 5%, but it's much greater when patients cannot get high-level care.

The first report of Zika as a cause of GBS appeared earlier this year in The Lancet, in a study of a 2013-14 Zika outbreak in French Polynesia (Tahiti). 42 patients were identified with Guillain-Barré syndrome (a startlingly high number for this otherwise rare disease), and 41 of them tested positive for Zika. None of those patients died, but the study provided convincing evidence that Zika was the cause of GBS.

This year, reports have emerged of a sharp increase in the number of cases of Guillain-Barré in South America, where the Zika outbreak is most severe. As the Washington Post reported back in February, the small town of Turbo, in Colombia, which normally sees at most one case per year, has already seen five cases, three of them fatal.

In response to this threat, a group of more than 200 doctors from around the world has signed an open letter to the WHO (read it here) that
"call[s] for the Rio 2016 Games to be postponed and/or moved to another location—but not cancelled—in the name of public health."
The letter points out that Rio is at the epicenter of the Zika epidemic, with 32,000 cases so far, and the holding the games there–with all the associated travel involved–may accelerate the spread of the dangerous Brazilian strain.

The newly emerging risk of Guillain-Barré syndrome makes it clear that Zika virus presents a threat to everyone. The Rio Olympics are likely to make it worse. Anyone planning to visit Rio for the Games should take all the precautions they can, but the best plan might be simply to stay home.

I took the SAT so you don't have to. It's a very poor test of math skills.

As I write this, tens of thousands of high school students are hunched over desks, filling in little circles with number 2 pencils, laboring to complete the SAT, a test that will have an outsized impact on where they go to college. In my state, the test starts at the teenager-unfriendly hour of 8:00am and last a grueling four hours or more.

One of my daughters is among those students. and as preparation she took the four practice tests provided by the College Board–the private company that owns the tests. (The tests are administered by the Educational Testing Service.) There are two main parts to the SAT, a math test and a verbal test, and as every student knows, the scores range from 200 to 800 on each part. For many decades, this test has been one of the main gatekeepers to college: the US News College rankings use it, and colleges advertise the average SATs of their freshman classes. Every student wants to know what SAT score they need to get into their preferred university. 1.7 million high school students will take the SAT this year, and many of them will take it twice.

I wanted to understand what the test was like, so I took the math test with my daughter–three times. On three successive weekends, we each took one of the practice tests, and then used the answers provided by the College Board to score ourselves and review what we got wrong.

Here's what I learned from taking the SAT math test: it's all about speed. The concepts are not difficult; you need to know algebra, geometry, a little bit of trigonometry, and a tiny bit of statistics. The main skill you need, though, is speed. It's a very poor test of how well you understand math. For the three tests, I was only able to finish everything on time once. Even so, I had to work very quickly and I didn't have time to go back and check my answers.

Question 27 from SAT test 2 from the College
Board. "D" is the correct answer.
The math test has two parts: one with 20 questions, for which you get 25 minutes, and another with 38 questions, for which you get 55 minutes and where you're allowed to use a calculator. The test is designed to trip you up if you work too quickly: many of the multiple-choice answers match the answer you would get if you made a careless error of a particular type.

Doing well on the SAT requires that you know the tricks of the test, and that you've memorized many formulas so that they come to mind instantly. And I mean instantly: if you have to think for 30 seconds to remember something, that's far too long.

What's more, the questions themselves can be lengthy, and students might waste precious minutes just trying to be sure they understand the wording. For example, one question shown here filled half a page: just reading it would take some students longer than they can afford for this speed-obsessed test. (If you want to see a full-sized image, get the tests here.)

Statistics is a relatively new topic area for the SAT, and if the practice test is any guide, they haven't yet figured out how to construct good stat questions.  Here is one of them:

A researcher conducted a survey to determine whether people in a certain large town prefer watching sports on television to attending the sporting event. The researcher asked 117 people who visited a local restaurant on a Saturday, and 7 people refused to respond. Which of the following factors makes it least likely that a reliable conclusion can be drawn about the sports-watching preferences of all people in the town?
A)  Sample size
B)  Population size
C)  The number of people who refused to respond
D)  Where the survey was given 
The official correct answer is D, because (says the College Board) the survey was not collected from a random sample. However, I could argue that A is at least as good an answer, because 117 people is a tiny sample from what is called a "large town," and because we don't know that the people who visit this restaurant are un-representative of the town. Whether you think the answer is A or D, this is a lousy question to put on a test where the answers should be unambiguous.

You might be wondering what my score was. I'm not going to reveal that, but I will say that I had a higher score when I took the SAT in 1975, as a 15-year-old high school student. I must have been faster then, but I'm pretty certain that I understand math better now, after 35 years of working in a mathematical field. I suspect that the current test puts a greater emphasis on speed than the 1975 version, but there's no way to check that without copies of the 1970s-era SAT exams.

Let me put this another way: there's not a single question on any of the practice math SAT exams that I would call difficult. Most of them are quite easy if you know a bit of algebra and geometry. But unless you are fast, answering all 58 questions in 80 minutes is darn near impossible. For example, consider this simple problem:

At a lunch stand, each hamburger has 50 more calories than each order of fries. If 2 hamburgers and 3 orders of fries have a total of 1700 calories, how many calories does a hamburger have? 
This question is not multiple choice; you have to write down a number, which means you have to work it through. Any student who knows basic algebra should be able to solve this, but can s/he do it in less than 75 seconds? And if takes 90 seconds, does that mean s/he should be rejected by Yale?

As a measure of true understanding, the SAT math test is terrible. We should not be using it to make enormously consequential decisions about where almost every high school senior in the country goes to college. On a positive note, a growing number of colleges have rebelled and no longer require the SAT. Two years ago, a large study showed that, at colleges in this group, there was no difference in college performance between students who submitted SAT scores and those who didn't.

Perhaps pressure from colleges that are making the SAT optional will force the College Board to create a math test that measures something that matters for college success. They could go a long way towards a better test by simply giving students twice as much time. If that made the test too long, they could simply ask fewer questions. Meanwhile, I hope that more colleges will make the SAT optional, and instead use high school grades and other, more meaningful measures of a student's knowledge.

(*This was written on June 4, 2016, the date of the second SAT test in the "new" format. Prior to March 2016, the test had three parts, each with a maximum score of 800.)

Allergy sufferers beware! These eyedrops are a scam.

Spring allergy season is upon us, and plants are bursting into leaf and bloom, spreading pollen everywhere. For some of us, this otherwise beautiful season is a time to stock up on antihistamines and tissues, and we try our best to stay indoors.

When pollen causes red, itchy eyes, we look for eyedrops to provide some relief. The American Academy of Allergy, Asthma, and Immunology and has a list of eyedrops here that includes products such as Zaditor®, Alaway®, and others. These eyedrops contain real medicine that can soothe itchy eyes and reduce your allergy symptoms.

So I was in the pharmacy section of my local grocery store, Giant, looking for eye relief, but they were sold out of Zaditor. Right next to the empty slot, though, I saw a row of other eyedrops from a company called Similisan®, and I took the picture shown here.
Homeopathic eye drops at Giant Foods in Baltimore.
Looks legitimate, right? Each box has a cross on it (apparently intended to resemble the logo of the Red Cross), and they are in the pharmacy section. I picked up the box labeled "Allergy Eye Relief" to take a closer look, though, and saw the word "homeopathic" near the bottom of the box.

Uh oh. It turns out that these products are little more than very, very expensive bottles of sterile water. For $9.99 you get 10 ml of water that contains several extracts–in vanishingly small amounts–for which there is no evidence whatsoever that they have any effect on allergies. Similisan's allergy relief bottle contains:

  • Honeybee
  • Eyebright (a plant)
  • Sabadilla lily (another plant)

Yes, that's right: they grind up honeybees and put them in the eyedrops. The (wacky) idea is that because bee stings cause allergic reactions, a tiny bit of ground-up bee in solution will prevent those reactions. This flawed principle is the basis for all of homeopathy, which has stuck around for 200 years despite the complete absence of evidence that it works.

As I've written before, homeopathic drugs get a free pass on regulation, thanks to Congress. Homeopaths will tell you that their drugs are regulated by the FDA (they often make this claim in the comments on my articles - just watch), but they're not. All the FDA can do is check to see if the products contain the ingredients listed on the label. Unlike real drugs, though, the FDA does not and cannot require that these "drugs" have any effect whatsoever.

I don't think I need to say more about ground-up bees, but what about those other two ingredients? Eyebright is a plant that has "little or no evidence of efficacy" for eye infections. Its use dates back to the ancient Greeks, and has an interesting history:
"Eyebright was used as early as Theophrastus and Dioscorides, who prescribed infusions for topical application in the treatment of eye infections. This in large part was due to the similarity of the “bloodshot” petals to irritated eyes."
That's right: the flower petals look like irritated eyes, and this was enough to get the early Greeks to try them out as a treatment. Needless to say, the physical appearance of a plant has nothing to do with its efficacy as a medicine. (But try telling that to a homeopath.)

Sabadilla, the third ingredient, is a plant extract used as an insecticide, with an active ingredient called veratrine. As Laura Pottorff from Colorado State University explains, "its dust can be highly irritating to the eyes." Therein lies the homeopath's motivation for using sabadilla in eyedrops: homeopaths believe that a substance that irritates the eyes will somehow soothe the eyes if it is sufficiently diluted.

Similisan claims that their 3 homeopathic eyedrops will relieve itching, burning, watering, and redness in your eyes. The box just says it's "manufactured according to homeopathic principles," but doesn't explain that it hasn't been shown to be effective. You have to go to their website to discover that
"The uses of our products are in compliance with official Homeopathic Compendia. They were not the subject of approved applications reviewed by the Food and Drug Administration prior to marketing." 
In other words, they've never presented any evidence that these things actually work.

One can only hope that the sabadilla in Similisan's eye drops is sufficiently diluted; if not, you're putting insecticide in your eyes. The package says that all three ingredients are at 6X dilution, which in homeopathic jargon means 1 part in 1 million. The problem is that homeopathic substances have no real standards, so we don't know how much of the active ingredients were in the original mixture before dilution.

I was curious to see if Whole Foods Market sold the same stuff, and not surprisingly they do, in their special section devoted to homeopathy. (I've written about WFM and their love affair with homeopathy before.) The only difference is that Similisan costs more at Whole Foods, $11.99 to $14.99 depending on which flavor you buy (check out the photo below).

Homeopathic eye drops at Whole Foods Market. How much
money do you want to waste on a tiny water bottle?
Homeopathic eye drops are nothing more than really, really expensive water. At $10 for 10 ml, that works out to $1000 per liter. Similisan proudly states that it's sold at a wide variety of U.S. retailers and pharmacies, including CVS, Kroger, Publix, RiteAid, Safeway, Target, Walgreens, Walmart, and Wegmans. Seems like they're doing quite a good business selling their $1000/liter water.

Consumers beware: the eyedrops you're looking at, even in the Pharmacy section of the store, might be expensive, ineffective make-believe medicine. Make sure to read the package closely; the fake medicine is sometimes right next to the real stuff, and the packaging is designed to fool you.

Washington Post's Science section descends into pseudoscience

The Washington Post has some bad news about migraines.
Every Tuesday, the Washington Post has a special section devoted to Health and Science. It’s usually my favorite section, with features such as “medical mysteries” and highlights of the latest news from the world of science.

Not this week. Instead, the front page of the section featured a lengthy article that was a long anecdote by a woman who firmly believes that acupuncture cured her migraines. The title gave me a feeling of dread: “Acupuncture needles stung, but they cured my migraines” (the online version linked here has a different title). As I feared, there wasn't a whit of science in it.

Let’s get one thing out of the way first: acupuncture is rank pseudoscience. It’s based on a primitive, pre-scientific notion of a “vital force” (for which no evidence exists), usually called qi, that runs through the body along meridians (no evidence for these either). Plunging needles into the meridians is supposed to manipulate this vital force and cure all sorts of things, ranging from pain to infections to cancer. All of this is nonsense. If you want to know more, I recommend Acupuncture Watch; or see Ben Kavoussi’s article explaining how postmodernism, with its notion that all truth is relative, has allowed acupuncture and other mystical, archaic beliefs to gain traction in medical practice; or check out Jann Bellamy’s discussion of acupuncture as “legalized quackery”.

I’ve written about the nonsense that is called acupuncture before (in 2013, and in 2012, and in 2010), so I won’t rehash that here. But it’s really disheartening to see a great (or once-great?) newspaper devote a large chunk of its weekly science section to pseudoscience.

Back to this week’s nonsense article. In this lengthy piece, author Margarita Gokun Silver describes how she began to experience debilitating migraines after the age of 40, which grew worse over time. She tried pain relievers, which worked at first but then stopped working. One expensive pill worked for the migrations but gave her severe nausea. Eventually, she writes, “exhausted by these side effects, I turned again to the Internet.”

Great. Now, there’s nothing wrong with looking for solutions in the Internet–we all do it. But this is an article in the Washington Post Science section! Nowhere does the author describe anything resembling actual science. Instead, she describes how she discovered a “breakthrough” in her yoga class, when another yoga student suggested acupuncture. She decided to give it a try.

(You might be wondering, who is Margarita Gokun Silver? She describes herself as a writer, novelist, and painter–not a scientist or a doctor.)

After several acupuncture sessions, the author tells us, her migraines seemed less frequent, and eventually she decided she was cured. She still gets migraines, but when they get bad she uses acupuncture again. This, she tells us, is her cure.

The entire story is a classic example of how we can fool ourselves into thinking that whatever we tried last is what worked. Migraines come and go, and this woman’s story is not unusual. She had a long series of bad migraines that eventually subsided, and she still gets them. When they were at their worst, she tried everything she could find, and when the episodes became less frequent, she gave full credit to acupuncture. She might just as well have tried chocolate milk, and then written an article claiming “chocolate milk cured my migraines!”

I don’t blame the author (well, not much) for wrongly believing that correlation equals causation. But we have scientific methods that are really, really good at figuring out if a treatment works. Scientists have already looked at this particularly claim, and the bottom line is that acupuncture doesn’t cure migraines. If you don’t believe me, then read the article about treating migraines by Dr. Steven Novella, a Yale neurologist who specializes in headaches, and look at his summary of how not to treat migraines, which points out that
“acupuncture proponents have been able to change the rules of clinical research so that essentially negative or worthless studies of acupuncture are presented as positive.”
Last week's Washington Post Science section was a major fail. I can't imagine why they gave a lengthy forum to a non-scientist to write about pseudoscience. If they wanted to feature a story about migraines, there's plenty of good science out there, even if there's no magical cure. What's next, Washington Post? Will you invite Jenny McCarthy to write about vaccines and autism, or Gwyneth Paltrow to discuss detox treatments? I sure hope not.

Why are we growing corn to fuel our cars? Three reasons why ethanol is a bad idea.

Most of us are driving around right now in cars powered by a combination of gasoline and ethanol. Ethanol is a fuel alternative produced from corn (mostly), and it has been touted for years as cleaner, carbon-neutral alternative to gas.

The problem is that ethanol’s benefits have been greatly exaggerated, leading to Congressional regulations that required ever-increasing amounts of ethanol in our gasoline supply. The government requirement goes back to 2005, when gas prices were much higher and the U.S. was in the midst of the Iraq war. Ethanol was supposed to be a clean way to reduce our dependence on foreign oil. The growing mandate for ethanol has instead created an enormous, artificial demand that has had unintended consequences, many of them bad.

Some background: Congress requires automakers to meet fuel economy (“CAFE”) standards for all their cars and light trucks. To encourage ever-greater use of ethanol, Congress modified the CAFE standards in 2005. As a result of that law, this year the EPA will require refiners to use 18.1 billion gallons of ethanol to fuel our cars.

Politicians still love ethanol. In the 2016 presidential campaign, several candidates came out in support of continuing the corn-based fuel program, hoping this position would win them votes in the Iowa caucuses. Iowa is a big corn state.

Unfortunately for the rest of us, mandating the use of ethanol is a terrible policy. Here are three reasons why.

1. Ethanol lowers your gas mileage–a lot. Ethanol only has about 2/3 the energy content of gasoline, meaning it simply cannot provide the same amount of power per gallon (or liter) as gas. E85 fuel, which uses 85% ethanol and 15% gasoline, is widely available, and some gas stations now offer no alternative. Consumer Reports put E85 to the test, and found that highway mileage decreased by 29% and city mileage by 22%. Car and Driver ran their own tests and found a 30% drop in mileage on E85. According to the Union of Concerned Scientists, nearly all gas sold in the US today has 10% ethanol–much less than in E85, but still providing lower fuel efficiency than straight gasoline.

Making things worse, ethanol attracts water and is more corrosive to some metals and rubber than gasoline. So it's bad for your car.

2. Using ethanol doesn’t reduce carbon emissions. The main argument for using ethanol is that because the carbon contained within it was recently put in the ground, burning ethanol (and releasing that carbon) is carbon neutral. Compared to extracting oil, which has lain in the ground for millions of years, growing corn and extracting ethanol puts far less carbon back in the atmosphere.

This argument makes sense, but only in a very narrow context. In an article published in Science in 2008, Timothy Searchinger and colleagues pointed out that previous analyses
“failed to count the carbon emissions that occur as farmers worldwide respond to higher prices and convert forest and grassland to new cropland to replace the grain (or cropland) diverted to biofuels.” 
When the scientists accounted for these land-use changes, they found that using corn to produce ethanol will double greenhouse emissions over a 30-year period. Switchgrass is only slightly better, increasing emissions by 50%. As the Union of Concern Scientists explains that “sustainable production is possible” only if we stop making ethanol from corn.

Admittedly this is a complex topic, but it seems that ethanol-from-corn simply doesn't reduce carbon emissions. Thus the entire justification for using ethanol to fuel our cars is unsound.

3. Increasing fuel efficiency means we’ll never be able to meet Congress’s mandated levels of ethanol usage, not unless we sacrifice even more gas mileage. Automakers have made great progress in producing more fuel-efficient cars, and the growing electric car market (Tesla!) mean that we’re using less and less fuel each year. This is terrific for reducing carbon emissions, but it means that Congress’s original mandate to use more ethanol becomes far harder to satisfy.

What happened was that back in 2005, Congress told us how to solve a problem (carbon emissions from our cars), instead of just encouraging us to solve it using innovative new ideas. Corn producers and their government representatives—governors, Senators, Representatives—all got behind the ethanol “solution” because they saw increased profits in it. Now we are stuck with a non-solution that, as the NY Times recently put it, is “a boon for Iowa and a boondoggle to the rest of the country.” It’s long past time to end the ethanol mandate.

Long term antibiotic use for Lyme disease doesn't work, according to new study

Fifteen years. That's how long scientists have been trying to prove a negative: that "chronic Lyme disease" does not exist, and that long-term antibiotic usage does not help with symptoms that include joint pain and fatigue. This past week, a study in the New England Journal of Medicine showed that long-term antibiotic usage–the favorite treatment prescribed by doctors who call themselves "Lyme literate"–is a failure. Will it convince any of those doctors to change their practice? I doubt it.

Lyme disease is a serious illness, caused by bacteria that are transmitted through tick bites. Although the disease has been infecting humans for centuries, it got its name relatively recently, in 1975, when two Yale doctors, Stephen Malawista and Allen Steere, investigated a cluster of illnesses near the town of Lyme, Connecticut. The symptoms included joint pain that resembles arthritis, so much so that Malawista initially called it "Lyme arthritis." A few years later, biologist Willy Burgdorfer discovered the true cause, and the bacterium Borrelia burgdorferi was named after him. As deer have spread through the suburbs of modern society, ticks traveling with them have spread Lyme disease far and wide; the NIH reported over 36,000 cases in the U.S. in 2013. (Note that the CDC estimates the true number of cases may be closer to 300,000, ten times the number actually reported to health authorities.) Lyme is also common in Europe.

Luckily for most of us, a brief course of antibiotics usually cures people completely of Lyme disease. For some people, though, symptoms including fatigue and joint pain can linger for up to six months. The cause of these longer-term symptoms remains a mystery, and is an active area of current research. One possible explanation from the CDC is that
"the lingering symptoms are the result of residual damage to tissues and the immune system that occurred during the infection."
Unfortunately, the lack of a scientific explanation has opened the door to wildly speculative treatments, based on little or no evidence, by doctors who think they know the answer. These doctors, some of whom have adopted the label "Lyme literate," insist that their patients suffer from what they call Chronic Lyme Disease. Among other things, they've formed an association called ILADS that claims that:
"Most cases of chronic Lyme disease require an extended course of antibiotic therapy to achieve symptomatic relief" and "many patients with chronic Lyme disease require prolonged treatment until the patient is symptom-free."
Not only do these treatments cost far more than the 2-week course of treatment recommended by the Infectious Disease Society of America, but they also have the potential to cause harm: it's just not good for you to be on antibiotics for months or years. Indeed, one of the first studies (in 2001, by Mark Klempner and colleagues) to look at the efficacy of long-term antibiotic use explained its motivation as follows:
"Case reports and uncontrolled trials describe success with prolonged antibiotic therapy, often with a recurrence of the symptoms after the discontinuation of therapy. In view of the substantial morbidity and even death associated with prolonged parenteral antibiotic treatment of Lyme disease, it is important to determine the efficacy of such therapy."
"Substantial morbitity and even death": clearly, long-term antibiotic treatment is not something to be prescribed lightly. The 2001 study found no benefit from long-term versus short-term antibiotic usage for the treatment of Lyme disease.

Despite the science, some doctors persist in prescribing–against the advice of professional societies–long-term courses of antibiotics. Because the practice continues, a European group conducted a new study of long-term antibiotic use in patients who claim to have persistent symptoms from Lyme disease. Anneleen Berende and colleagues reported the results of this well-designed double-blind, placebo-controlled study in the New England Journal of Medicine just last week. Their findings matched those of the 2001 study: long term antibiotic use has no benefits for patients.

The study had three arms: a placebo group and two different treatment groups, who were given two different antibiotics. Everyone got a two-week treatment with real antibiotics, followed by 12 more weeks of either antibiotics or placebo. The pills were created just for this study to look identical, so that neither the doctors nor the patients knew who was getting the placebo.

In an editorial accompanying the article, my Hopkins colleagues Michael Melia and Paul Auwaerter explain that the take-home message is that
"Patients with subjective, vexing symptoms attributed to Lyme disease should not anticipate that even longer courses of antibiotics will produce relief, a finding that is in concert with results from previous trials."
I doubt that "Lyme literate" doctors will accept the latest results and stop prescribing long-term antibiotic use; their websites indicate that they already know that they are right. I hope, though, that patients will start to question doctors who put them on long-term, possibly harmful antibiotic regimens that don't provide any benefit.

(For more information, see this excellent video by Dr. Auwaerter about Lyme disease and its treatment.)

This could be the end of youth football

The end of a lawsuit this month might also signal the end of youth football. The plaintiff in the suit, Debra Pyke, claimed that her son suffered brain damage from repeated head injuries in his youth football league, which caused chronic traumatic encephelopathy, or CTE. Just a couple of weeks ago, the youth football league Pop Warner settled the $5 million case, reportedly for under $2 million.

Debra Pyke’s son, Joseph Chernach, committed suicide in 2012 at the age of 25. He had played youth football for four years, from the ages of 11 to 14, and her lawsuit claims that he suffered from CTE as a result. CTE has been in the news a great deal of late, after it was discovered by Dr. Bennet Omalu to be the cause of early dementia in an alarming number of NFL football players. (Actor Will Smith plays Omalu in the recently released movie, Concussion.)

Pyke’s lawsuit holds nothing back in its claims about the damage of football. She argues that tackle football is a "war game,” and provides copious examples to back it up, including these:
“Football is not a contact sport. It’s a *collision* sport. Dancing is a good example of a contact sport.” (from former Michigan State coach Duffy Daugherty)
“Pro football is like nuclear warfare. There are no winners, only survivors.” (from Frank Gifford, former NFL player and long-time football broadcaster)
The lawsuit includes multiple arguments about why children are more vulnerable to head injuries. Their brains are still developing, and have less myelin to protect their brain cells from damage. Until the age of 14, children's are disproportionately large, and their necks are weaker than adults’ necks, making them prone to greater rotational forces when hit in the head.

Just looking at pictures of young boys wearing football helmets makes many of these points obvious. The idea that young boys are intentionally crashing into one another, often involving their heads, should give any parent cause for concern. Slate writer John Culhane described this as a “bobblehead effect” in which “their brains crash back and forth in their skulls.”

When Pyke’s lawsuit was filed last year, Culhane called it “The Lawsuit That Could Threaten Kids’ Football.” Despite the title of his article, he concluded that
“even in the unlikely event that she [Pyke] wins her case, youth football isn’t going anywhere. But a finding that Pop Warner is carrying on an abnormally dangerous activity would surely drive up the cost of insurance, and therefore make the sport more expensive for participants. It might also make more parents question whether they want to risk their children’s safety.” 
The “unlikely event” didn’t happen, but only because the league settled the suit.

Pop Warner football has a dedicated safety section on its website. It includes pages devoted to their concussion policy, and articles that argue that “rewards outweigh risks” and that “the relationship between developing CTE and playing football remains unclear. The link between the number of concussions a person sustains and the risk of developing CTE is also uncertain.”

Using words such as “unclear” and “uncertain” seems to me to be a classic example of sow confusion rather than admitting the obvious: youth football can be dangerous. Consider the “pee wee” league game in 2012 where five boys got concussions in a single game. The coaches were suspended afterwards, but the damage had already been done. At the time, the NY Times pointed out that “Pop Warner has done more than perhaps any other organization to try to protect young players from head injuries,” but the fact is that football is a violent contact sport.

(Pop Warner did not respond to my request for comment.)

As the New York Post reported when the settlement was announced, Pop Warner had $2 million in liability coverage for players in Wisconsin at the time of the lawsuit, in 2012. They now carry $1 million per player and allow individual chapters to add another $1 million.

Think about that for a second. Why would you want your son to play in a youth sports league where the league feels the need to carry a $2 million insurance policy on every player?

Parents: you and your kids have other options besides football. Youth sports are a great way for kids to exercise, have fun, make new friends, and learn the value of teamwork. Your kids can choose soccer, tennis, baseball, or basketball, all of which have large networks of youth leagues. Many regions of the country have other sports as well. There’s no reason to suit up a child with a helmet on his still-growing head and send him out on a field to be knocked around and possibly concussed.

Joseph Chernach suffered a tragedy, and his family’s suffering will never go away. We’re now learning that even powerfully built grown men suffer permanent injuries on the football field. There’s no reason to expose children or teenagers to similar risks.