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Soccer linked to ALS (Lou Gehrig's disease)


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From the New York Times:


An A.L.S. Puzzle on the Soccer Field


Published: March 1, 2005

Why soccer would be a risk for amyotrophic lateral sclerosis is a mystery.

But a new study has found that Italian professional soccer players get the disease at a rate nearly six times as great as the general population.

The study, led by Dr. Adriano Chiò, a professor in the department of neuroscience at the University of Turin, was inspired by the work of an Italian prosecutor, Raffaele Guariniello, who was investigating soccer players' use of illegal drugs.

As part of his inquiry, he ordered a report on the causes of death among 24,000 men who played professional or semiprofessional soccer in Italy from 1960 to 1996.

His finding - that Italian players died of A.L.S. at a rate almost 12 times as great as normal - puzzled researchers, who decided to undertake a much more rigorous study.

A.L.S., often called Lou Gehrig's disease, is an incurable and invariably fatal degenerative disease of the nervous system.

Although there have been many suggestions about the possible risks for the illness, including participation in sports, no clear-cut evidence has been found for any risk factors except age and sex. (A.L.S. tends to strike around age 60, and a vast majority of patients are men.)

The new study, however, found not only an increased risk among these Italian athletes, but also that the risk was dose-related: the longer an athlete played, the greater his risk of contracting A.L.S.

Moreover, the researchers found, the mean age at which the athletes developed the disease was 51, 10 years younger than the general population. The report appears in the March issue of the journal Brain.

Dr. Chiò said he was surprised by the results.

"I can tell you that when I was asked to perform this study, I thought it would be a waste of time," he said. "I didn't believe I would find any significant result. Now I know I was wrong."

He said the study's methodology was sound.

"We are very confident that these results are real and are not due to a statistical effect," Dr. Chiò said.

But he cautioned that the meaning of the findings was not clear, that A.L.S. is a very rare disease and that the study's results in no way suggested that anyone should stop playing soccer.

"I think this is a very good study," said Dr. Ruth Ottman, a professor of epidemiology at Columbia University. "The methodology seems quite rigorous, and the dose-response relationship supports the validity of the results."

The study's subjects included all native Italian male professional soccer players who were on a team roster from 1970 to 2002 and who had played in at least one official match. The total came to more than 7,000 men.

Eighteen cases of amyotrophic lateral sclerosis were identified. The researchers interviewed all living players who had A.L.S., as well as the doctors and relatives of players who had died from the disease, and compiled detailed medical and personal histories of the patients' activities and health before, during and after their time as active athletes.

The researchers also gathered family histories, paying particular attention to neuromuscular disorders. One form of A.L.S. is inherited, but no affected player had the disease in his family.

Dr. Chiò and his colleagues suggest several explanations, none of them with certainty. Perhaps, they say, A.L.S. is related to heavy physical exercise, and therefore not related particularly to soccer.

Or maybe trauma, particularly the head trauma involved in heading the ball or repeated traumas involving the legs, is a factor. Illegal or legal therapeutic drugs may also be involved, and it is possible that environmental toxins like fertilizers or herbicides used on soccer fields play a role.

The authors concede, however, that each of these hypotheses has weaknesses, and the puzzle endures.

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