Multimillion-dollar study led by Dr Paul McCrory led to ‘confusion’ among player participants over tests and procedures, review says
A massive AFL study which promised to make “groundbreaking” findings about concussion resulted in no published research and “confusion” about what happened to tests performed on players, a review into the work of the league’s former concussion adviser, Dr Paul McCrory, has found.
On Tuesday, the AFL apologised to players involved in the study and admitted they were “let down”.
In March, a Guardian Australia investigation first revealed that findings from the multimillion-dollar study launched in 2014 never saw the light of day, despite the involvement of the world-renowned Florey Institute of Neuroscience and Mental Health and the AFL Players’ Association.
The study, which promised to examine the long-term effects of concussion on players’ brains, was driven by McCrory, the world-renowned neurologist and concussion expert who was chair of the international Concussion In Sport Group. In March, allegations emerged that McCrory plagiarised the work of other researchers, and he stood down from the CISG.
By October, nine of McCrory’s articles were retracted from prestigious medical journal the British Journal of Sports Medicine and 74 more had “notices of concern”. The journal’s editors said in a statement at the time that their trust in McCrory’s work had been “broken”.
Following the plagiarism allegations and after the AFL was unable to answer dozens of questions from Guardian Australia about what became of the AFL’s concussion research, including data from tests conducted on former players, the AFL announced that a comprehensive and independent review of McCrory’s work for the league would be undertaken. The league had been unable to detail to Guardian Australia the evidence McCrory used to recommend concussion policies. McCrory has not responded to repeated requests from Guardian Australia for comment.
The review, published on Tuesday, found the research project was “under-funded and under-resourced and suffered from a lack of governance, stewardship and coordination”.
“These problems manifested in there being no published research from the study which explained the results of the research imaging undertaken … and confusion on the part of the past player participants as to what tests or procedures related to clinical treatment as opposed to being purely for research purposes,” the review said.
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The review found research participants were “entitled to expect that projects would be pursued through to completion, so that their voluntary contributions of time and effort were not wasted”.
It also said “the Florey Institute should ensure this project can be completed if that is possible and that participants are informed of the outcome, as appropriate”.
A spokesperson for the Florey said in a statement: “We have been concerned by the allegations of plagiarism and other issues raised with respect to Dr Paul McCrory. Our assessment of these matters is ongoing and remains confidential.
“We will carefully review the 260-page [AFL] report in full before providing any response to its findings.”
The review panel made numerous recommendations to improve thethe AFL’s new concussion management and research governance structure. In a statement, the AFL said it would immediately commence a process of consideration and response to all recommendations.
The AFL’s general counsel, Andrew Dillon, welcomed the report and apologised to players who gave up their time to participate in concussion research.
“The AFL apologises to the past players who gave up their time in the hope of better understanding their own conditions and to assist with the research for the benefit of current and future players and were let down by the manner in which some of the research and clinical programs were at times conducted,” Dillon said.
“The welfare of our past, current and future players is of paramount importance to the AFL and we continue to take the necessary steps to improve safety at all levels of the game and to expand our research in this area.”
Between 2014 and 2022, the AFL paid the Florey Institute a total of $661,484.70 in research funding. The research collaboration agreement was terminated in 2019 by the Florey Institute with no reasons given.
In a memorandum of understanding between the AFL and Florey Institute, where McCrory had a laboratory, the AFL agreed to “assist in sourcing funds and related support for the Research” and “use reasonable endeavours to facilitate access to the players”. The institute agreed to “undertake the Research in a diligent and timely manner” and “provide quarterly reports on the progress of the Research to the AFL” or as requested.
McCrory was involved in early discussions about a formal partnership between the AFL and Florey, and encouraged it, the review found. The review panel heard that AFL personnel requested more funding for concussion research from senior AFL management but that it was not provided.
The review found that in early 2021, McCrory disagreed with the working draft of the proposed AFL and AFLW concussion guidelines and in particular the proposed return to play protocol, which he said “did not reflect the current and evolving science”.
In the course of the review, the Panel sought an explanation from McCrory as to the “current and evolving science” that he was referring to in early 2021. In response, McCrory referred the panel to 57 academic articles.
The panel found that the early 2021 proposed return to play protocol “was not inconsistent with the literature Associate Professor McCrory directed us to”.
Following McCrory’s resignation from the AFL’s scientific committee, the AFL and AFLW Concussion Guidelines adopted a minimum 12-day post-concussion rest and rehabilitation period after concussion.
The review found McCrory was neither an employee nor contractor to the AFL, but an “advisor” on an informal and mostly unpaid basis, though he was remunerated for providing neurology services to present and past players.
The panel found “aspects of the relationship were problematic, in particularly the absence of clear reporting lines and protracted periods of no or delayed responses to correspondence” by McCrory.
The panel also said the informal arrangement“created the potential for impropriety and detracted from the levels of accountability and transparency that could be expected of an entity of the AFL’s size and public profile”.
The independent review panel was chaired by the senior lawyer Bernard Quinn KC. The review panel interviewed 19 witnesses including the former players John Platten, Allen Stoneham and Daniel Venables. The panel requested an interview with McCrory, but he declined.
Current and former AFL chief medical officers Michael Makdissi and Peter Harcourt were also interviewed as part of the review. A copy of the findings has been provided to the Victorian state coroner, who is conducting an investigation of the death of former Richmond footballer, Shane Tuck.
Tuck took his own life in 2020 aged 38, and was later found to have had a severe case of chronic traumatic encephalopathy, a neurodegenerative disease associated with repeated head trauma and history of concussion.
Guardian Australia previously revealed that in May 2018 McCrory voluntarily provided an enforceable undertaking to the Medical Board of Australia and the Australian Health Practitioner Regulation Agency that he would not perform neurodiagnostic procedures, nerve conduction studies, or electromyography until approved to do so by the Board. That undertaking remains in effect.
The AFL was unaware of the undertaking until informed about it by Guardian Australia. The review panel found that, given the limited scope of the undertaking, McCrory was not required to disclose the undertaking to the AFL.
The panel also found the identified instances of plagiarism “[did] not affect or taint the work that Associate Professor McCrory had undertaken for the AFL, in particular the AFL’s guidelines on concussion, in large part because they do not involve the falsification or fabrication of relevant research”.