Also Appearing in This Week’s JAMA


Study Examines Brain White Matter Changes in Soccer Players

“Soccer is the most popular sport in the world, with more than 250 million active players. It is the only sport in which the unprotected head is a primary point of contact when heading the ball. In other contact sports, the deleterious [harmful] long-term effects of repetitive traumatic brain injury (TBI), such as impaired white matter integrity, are well recognized. However, whether frequent subconcussive blows to the head lead to TBI remains controversial, although evidence suggests impaired neuropsychological function in soccer players,” writes Inga K. Koerte, M.D., of Harvard Medical School, Boston, and colleagues. The researchers evaluated soccer players who had not experienced a concussion using high-resolution diffusion tensor imaging (DTI), which is highly sensitive for detecting alterations in the integrity of white matter.

As reported in a Research Letter, the study included 12 male soccer players from 2 training groups of an elite-level soccer club in Germany. A comparison group of 11 swimmers, who participate in a sport with low exposure to repetitive brain trauma, were recruited from competitive clubs. The researchers found differences in white matter integrity of the soccer players compared with the swimmers. “Although only participants without previous symptomatic concussion were included, advanced DTI revealed widespread increase in radial diffusivity [a certain pattern seen on magnetic resonance imaging suggesting alterations in white matter architecture] in soccer players, consistent with findings observed in patients with mild TBI, and suggesting possible demyelination [nerve disorder],” they write. “The etiology of the findings, however, is not clear. One explanation maybe the effect of frequent subconcussive brain trauma, although differences in head injury rates, sudden accelerations, or even lifestyle could contribute.” The authors add that future studies are needed to confirm the results and elucidate the cause and effects of white matter alterations in soccer players.

(JAMA. 2012;308[18]:1859-1861. Available pre-embargo to the media at

Media Advisory: To contact Inga K. Koerte, M.D., call Lori Schroth at 617-534-1604 or email


Viewpoints in This Week’s JAMA

Prevention of Fatal Opioid Overdose

Leo Beletsky, J.D., M.P.H., of the Northeastern University School of Law and Bouve College of Health Sciences, Boston, and colleagues suggest various steps to support a more comprehensive approach to reducing opioid overdose deaths in the U.S., which account for at least 16,000 deaths annually. “To date, federal government response has focused primarily on monitoring and securing the drug supply.”

“Federal agencies are uniquely situated to address national public health crises through increasing awareness, funding, and coordinated action. Community-based organizations, state and local health departments, and professional societies have taken the lead in developing, implementing, and publicizing overdose education and naloxone distribution as a component in a comprehensive response to this veritable epidemic. The federal government should actively support research and programmatic action on overdose education and naloxone access.”

(JAMA. 2012;308[18]:1863-1864. Available pre-embargo to the media at


Rethinking Opioid Prescribing to Protect Patient Safety and Public Health

G. Caleb Alexander, M.D., M.S., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues write that “prescription drugs, including amphetamines, opioids, and benzodiazepines, provide therapeutic value to millions of Americans. At the same time, there are increasing concerns about the skyrocketing rates of prescription abuse and overdose deaths.” The annual number of fatal drug overdoses in the United States now surpasses the annual number of motor vehicle deaths, and overdose deaths attributable to prescription opioids exceed those attributable to cocaine and heroin combined.

“Advocates of greater recognition and treatment of chronic pain have argued for a ‘principle of balance,’ stressing the need to balance the judicious availability of opioids with the need to prevent their misuse and abuse. Although prescribing practices vary widely, there is little evidence to suggest that physicians have curtailed their practice of prescribing opioids in response to exponential increases in addiction and overdose deaths. Broader clinical and public health research should examine the comparative effectiveness of different approaches to pain treatment concurrent with assessments that examine the effects and cost-effectiveness of opioid prescribing practices on community health and safety.”

(JAMA. 2012;308[18]:1865-1866. Available pre-embargo to the media at

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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