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PFA welcomes the National Institute of Health’s position on causation of CTE

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The PFA has welcomed the National Institutes of Health’s (NIH) decision to rewrite its official guidance on chronic traumatic encephalopathy (CTE), calling it a “crucial step forward”.

The NIH, which is the primary agency of the United States government responsible for public health and the world’s largest biomedical research agency, has now formally acknowledged that a causal link exists between repeated blows to the head and the neurodegenerative disease CTE.

Dawn Astle, Project Lead in Brain Health at the PFA, welcomed NIH’s updated statement: “This is a landmark decision and a key moment which recognises the causation of CTE.

“Historically, being told there is no causal link between heading and CTE has greatly distressed my family and countless others. While we didn’t need to be persuaded on causation, we welcome the scientific community’s support and the NIH’s new position.”

The NIH updated its official statement on causation after the Concussion Legacy Foundation (CLF) sent a letter, co-signed by 41 leading scientists, doctors and epidemiologists, to the National Institute of Neurological Disorders and Stroke (NINDS).

The letter cited a recent review of CTE research led by CLF’s Dr Chris Nowinski and co-authored by the PFA’s new Head of Brain Health, Dr Adam White.

The NIH now joins the US Centers for Disease Control and Prevention (CDC) in recognising that repeated traumatic brain injuries cause CTE. The CDC defines repeated traumatic brain injuries as “concussions, and repeated hits to the head, called ‘subconcussive head impacts’”.

Outside of ongoing discussions with football’s governing bodies, the PFA has also been working closely with the Industrial Injuries Advisory Council (IIAC). Following an initial application by the PFA in 2003 to recognise dementia as an industrial disease, the Council concluded that the scientific evidence at that time was insufficient to establish a causal link between dementia and heading footballs.

However, NIH’s new position adds to a growing weight of evidence accumulated over the past two decades. This includes the PFA-funded FIELD Study, which found that former professional footballers had three and a half times the death rate from neurodegenerative conditions than the general population.

Astle states: “We are in dialogue with the IIAC and will do everything we can to ensure that relevant evidence is considered, and continue to make the case for dementia and CTE in football to be classified as an industrial disease.

“This new guidance represents a huge shift by one of the world’s most renowned medical organisations and is a crucial step forward.

“We need better protection for current players and urgent resources to care for former players and their families who need help now.”

Contact the PFA

The Brain Health Department at the PFA will continue to offer support, guidance, and advocacy around neurodegeneration and repetitive head impacts.

If you are caring for a former player with dementia, you are not alone. The PFA and our dedicated Family Advisors are here to offer support. Please contact us at

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