If you haven't read part 1 of my interview with David Epstein, I hope you do so. The second half is a little less informal, with a lot of talk dedicated to MMA, and Martin McDonagh (a playwright), but up front, a lot of discussion was devoted to the ImpACT test: the go-to entry level test for measuring basic cognitive skills, and one the NFL uses for its players in the draft, what can be changed about it, and along the way he gets to talk about a unique angle in the discussion on ADHD.
Unfortunately I couldn't transcribe everything, but he was never at a loss with something interesting to say. Among the things skipped, Tim Sylvia as a participant for a pain study he was involved in, and David Epstein has a book on the way on genetics (in the immortal words of Bart Scott: "can't wait!"). Many thanks to David for doing this, as he was beyond courteous in allowing me to bother him at such length.
David: So given what we know of frontal lobe function, specifically the prefrontal cortex, does ImPACT feature ways to measure goal dependent decision making, which is specific to the frontal cortex, as it is in the Wisconsin Card Sorting Test, which is used for patients with mental illness?
David Epstein: I’ve actually taken the ImPACT test. I don’t think it has something exactly like the Wisconsin Card Sorting Test, which focuses on how flexible you can be mentally when things are changing around. The ImPACT test is much more kind of straight forward, emphasizing memory ability to answer questions quickly, to recognize patterns, and you’re made to do other tasks while remembering what you saw before, much more strictly memory and focus oriented. I can't remember if the Wisconsin Card Sorting Test is quite like that, but correct if I'm wrong
David: Well, I think the ImPACT test has something similar, but for example, in the Wisconsin Card Sorting Test, you’re actually told whether or not, when you arrange cards to match symbols, and they can be grouped by color, or shape, they’re told if they’re right or wrong if I'm not mistaken-
David Epstein: No, that’s right. They give you cards with symbols, which you have to match, and the patient is told if they're right or wrong. And so the question is about how quickly they learn the rules, and then rules change without them knowing it. And it gauges how quickly they can adjust. ImPACT doesn't have anything quite like that.
David: So how do you think the ImPACT test can be changed?
David Epstein: I think the ImPACT test is good for what it does, which is to establish a baseline, and to quickly, measure these results via computer, which many can take at once. The problem has to do with certain kinds of brain impairment. If you’re impaired in the language center of the brain, the impact test may or may not show it. It’s good, but it’s hard to tell. If we can get fMRI and give people what’s called an n-BACK test, that's different. So you had the players in the Purdue study take what's called an n-back test where "n" is just a variable.
For example, if it’s a 1-back test, they flash letters in front of you, and you just have to click what you saw 1 letter ago if the selected letter repeats itself. If it’s a 2-back test, you have to click whenever you see the letter that you saw 2 letters ago. So with this, you can really tell with high definition when someone is having impairment. Maybe to have ImPACT with a time component, to see if people are as quick as they were before would be useful, although I think having a human presence like a neurologist would be great, to keep an eye on them. The ImPACT test is good, and broad, but there’s potential for improvement as well.
David: Something I found striking, or rather, interesting about your demeanor on this issue is your lack of doomsday thinking. We’ve actually had a writer in the MMA community stop watching, and writing about the sport because of what he learned about Chronic Traumatic Encephalopathy, and the Owen Thomas case. And your response to Steve Granelli’s piece at In Media Res on Chris Benoit, and when steroids were blamed in place of CTE, seems atypical of others, including Ben McGrath of the New Yorker, who appear to think professional contact sports are nearing extinction. So more broadly, why is the sports sky not falling?
David Epstein: Ok so Owen Thomas. We had a story online about him, and the doctors said they don’t believe CTE contributed to his suicide, nor do I think anyone is making that case. His brother, and Sports Illustrated ran a story on this, said he had been a troubled kid as early as 14. I don’t think in that particular case, anyone is blaming CTE. The fact that CTE was found in someone was so young, is certainly scary, but when we’re finding CTE, in just about every brain only some of them are having behavioral problems. And given what doctors are hypothesizing, that the numbers are potentially very high with almost everyone who plays having the prospect of showing signs of CTE at some point...yet many of these guys are not suffering from early dementia.
There’s a component, where we have to look at this, and say look, there are people who are going through the same things on the field that aren't suffering the deleterious effects, so there are other things going on. There is a lot of individual variation. How many NFL players don’t end up taking their own lives? I think we have to be careful about taking these tragic, horrendous, and hopefully preventable cases, and extrapolating them to everyone because that’s not what’s happening to everyone. I’m just cautious about extrapolating too far when there are clearly a lot of people in the same environment not having the same health outcome. But what do you think?
David: I agree. It seems to me people are more informed by the parts, rather than the sum, given that we really know very little about CTE in the grand scheme of things. And there's a tendency to be reductionist, and say, 'oh well here's the gene for this or that, voila, there's your explanation for psychopathic behavior', and there just seems to be so many factors at play here that can't be relegated to simply one.
David Epstein: Absolutely. That’s what it is. Anecdotes of players are very powerful, but there’s a dramatic dose of players who live fine lives. If we want to understand this issue, we have to look at them too.
David: Jumping away from the issue of brain trauma, I'd like to ask you this: what is the most interesting story no one is talking about?
David Epstein: (laughing) Wow...that's a rather broad question. But ok. One thing that has interested me lately is: wide ranging potential impacts of Attention Deficit Hyperactivity Disorder (ADHD) medication. This is relevant to sports for a number of reasons. We have a massive number of young people medicated for ADHD, and it affects the dopamine system in the brain. If you think about the kids that get medicaited, we’re talking about kids who are running around, and generally unable to kind of focus on one thing at a time for extended periods. Ok, so there is a growing number of doctors and scientists who are of the opinion that that is a good thing. In fact...that this is exactly what you want in a society that has such a dramatic obesity epidemic. (Doctors) Of the opinion that this is somehow adaptive to the environment, which allows us to pay attention to different things quickly, to move around, and expend a lot of energy.
However, change in the dopamine system is maladaptive when the kid is supposed to sit still for 10 hours a day, and so our biology may not be syncing with our environment. Talking recently with some scientists, there is the opinion that this is possibly contributing to the obesity epidemic because you might be medicating out this basic drive just to move, and be active. Additionally, you start to look at evidence about heat regulation. In using these medications which are basically amphetamine like drugs, there’s some really convincing evidence that you’re more predisposed to dangerous core temperatures when you’re on those medications.
There was a case of a kid in Kentucky last year who died in the high school football practice and his coach was actually tried for murder for not providing him enough water and driving him too hard. The evidence is clear, though, that water barely, if at all, can control core temperature. So that’s not the issue. We don’t know how much it contributed, but the kid in this case was medicated for ADHD. And it’s clear in trials in highly trained cyclists, something about this medication takes away your brain’s inhibition from letting your body get too hot. Normally if you’re at 41 degrees Celsius core temperature, your brain forces you to slow down your exercising, and that's it. You can't keep going.
But with those medications, even when athletes didn’t know they were getting placebo, they can bring their core temperature up above levels they never would have gone to, where their brain would have shut them down otherwise. And that’s why amphetamines work so well for endurance athletes, because it allows you to exercise harder. It seems to be the case that it takes away the central nervous system inhibition. And so this may be predisposing people to heat stroke kind of conditions. And so I’ve been interested in that because there’s a potentially wide public health application.
David: As this is an MMA website, I have to ask you an MMA question. I don’t know if you’re secretly a hardcore fan and can talk about Hatsu Hioki’s stateside potential (laughing), or if you’re only slightly more knowledgable than a neophyte, but I demand that you make a prediction on the Georges St. Pierre vs. Nick Diaz fight.
David Epstein: I’m definitely a fan. I wouldn’t call myself a hardcore fan compared to some of the people that are hardcore but I’m definitely a fan. In fact, some of my first stories I wrote for SI were MMA related, because I felt like they should be covered more, and we didn’t have anyone doing it, so my first 4 or 5 cover stories were MMA. So, GSP/Diaz…first, I have to tell you this story….
I was trying to get my girlfriend to watch the sport, and so I was kind of telling her who the guys were, and how this is a technical thing they’re doing, and how they’re not just rolling around randomly, and all this. So, she was on the subway in New York one day, and just wanting to impress me, spotted a couple of guys and decided they were mixed martial artists, probably just so she could tell me she talked to some mixed martial artists on a train.
And so she starts talking to these guys asking them ‘hey you guys are fighters aren’t you?’, just on the subway. She’s very courageous. So this guy in a very thick French accent, keeps telling her, 'no, we're not fighters, we’re ping pong players, we're Ping Pong champs'. She’s a journalist too, so she’s grilling them the whole time, and the guy just insists that he’s in that good a shape because ping pong is that much more of an athletic sport than people assume (laughing). She leaves after that, comes and tells me, saying ‘I'm pretty sure I saw some fightes but they kept telling me they were ping pong players’, and she starts to describe the guy, and I’m like ‘wait, was he bald with a thick French accent?', and she's like 'yea that's the guy!', and I'm like, 'oh man you just rain into GSP on a subway' (laughing). He must be a fairly humble guy, to stick with the ping pong routine the whole time.
So on to my prediction, I gotta go with GSP. I think it should be a great fight. Both these guys have good stamina but I tend to feel like his wrestling will make the difference, but more than anything I want to see them have a good fight, because he’s had a couple of, I guess, lackluster fights, and I tend to think Nick Diaz is not gonna allow that to happen.