Apparently we cannot diagnose CTE in the living, but we can also definitively tell living people with multiple TBIs that they don’t have CTE (so don’t worry) even though last week’s consensus meeting pointed to a debate about single vs multiple exposures amongst pathologists.

Here’s a simple question: would there be any harm in saying to a concerned patient: “look if you’re seriously worried, and just to be REALLY clear I’m personally not given your history, then stop doing what you’re doing.”

Patient: “Doc I really like Cheetos but I’m concerned that I’m gaining weight and will become really fat.” Doctor: “Well maybe you should consider stoping eating Cheetos.”

Patient: “Doc I really like smoking but I’m worried about cancer and heart disease.” Doctor: “well I’d personally recommend that you consider methods that will help you stop smoking.”

Patient: “My favorite burrito place - I eat there everyday - leaves me with a bad case of heartburn. I’m worried about getting strictures.“ Doctor: “Have you considered eating more salads?”

Patient: “Sometimes when I drink, I make bad choices.” Doctor: “Have you considered just not drinking?”

Patient: “I’ve had four concussions; I’m worried about CTE.” Doctor: “Well if you’re worried have you considered other activities. Volunteering at homeless shelters, being an Eagle Scout, cross country, & theatre also impress college admissions committees & teach great lessons.”

Dichotomous thinking serves neither patient or clinician. It has happened that middle aged adults and their caregivers have asked “could this be from football” been told by docs “no” only to learn “Stage X CTE” at autopsy.

It would seem to be basic decency to learn from that fact and say to young people who are concerned about their own exposures “you know, if you are genuinely worried, you can stop.”