An AFL-commissioned independent review of the sports concussion work undertaken by neurologist Dr Paul McCrory has found multiple failings in a program involving past players, but no link to the plagiarism that saw many of his published papers being retracted.

One of the main findings of the review panel, chaired by senior lawyer Bernard Quinn KC and including neurologist Professor Michael O’Sullivan of the University of Queensland, was that the $662,000 funding provided by the AFL  for Dr McCrory’s work at the Florey Institute resulted in no published research.

The review (link here) found that the on a Past Player Project was “under-funded and under-resourced and suffered from a lack of governance, stewardship and coordination in how it was rolled-out and implemented, and how it simultaneously accommodated clinical and research objectives.”

It also found that past AFL players who underwent imaging investigations for concussion were left in the dark about the results and whether the tests related to clinical treatment or were only for research purposes.

It noted that the research program was terminated by the Florey Institute in 2019 due to lack of outside funding sources, but the panel said the Florey Institute should still ensure the project can be completed if that is possible and that participants are informed of the outcomes.

“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 and there was also an ethical principle that participants should be given the option of being informed of the general outcome and results of a study,” it said.

Problematic relationship

The panel found that Dr McCrory had only an informal ‘advisory’ role with  the AFL and the relationship became ‘problematic’ due to lack of clear reporting lines and protracted periods of no or delayed responses to correspondence.

While there was no evidence of conduct that constituted impropriety, the panel did take issue with the advice Dr McCrory provided to the AFL on concussion management.

It noted that in early 2021, he disagreed with the AFL’s proposed return to play protocols which he said “did not reflect the current and evolving science”.

However the 57 academic articles he provided to back his concerns were found by the panel to be “not inconsistent” with the proposed return to play protocol.

The Panel said the instances of plagiarism it identified in Dr McCrory’s research and academic works were “an embarrassing blemish” on his professional/academic reputation, but did not affect or taint the work he had undertaken for the AFL on concussion guidelines, “in large part because they do not involve the falsification or fabrication of relevant research.”

According to the AFL, its links with Dr McCrory ended in early 2021 with his resignation from the AFL’s scientific committee. He had worked mostly on an unpaid basis, although he was remunerated for his provision of neurology services provided to present and past AFL players referred to him.

The report authors said they understood Dr McCrory had made an undertaking to the Medical Board of Australia not to perform certain neurodiagnostic procedures, nerve conduction studies and/or electromyography.  He was not required to disclose the undertaking to the AFL and the Panel said there was no evidence that suggested he had acted inconsistently with the undertaking.

Apology

AFL General Counsel Andrew Dillon thanked the independent Panel for their work and said the AFL accepted the criticism relating to a number of inadequacies in AFL concussion research between 2014 and 2019.

Significant improvements have been made in the resources devoted to this area within the AFL and lines of accountability since that time, he said.

“The Panel has recommended that the AFL take steps to improve the clinical care aspects for past players and we will act on that recommendation as soon as possible and will consider and respond to all other recommendations in the Report,” said Mr Dillon.

“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. We will continue to invest, engage, resource and do better on this type of research and the facilitation of care going forward,” he added.

The AFL said it was now investing up to $1m a year on concussion research projects and $2.5m a year on a large-scale, 10-year longitudinal research project.

Mr Dillon also noted that in 2021 the AFL appointed Adjunct Assoc. Professor Catherine Willmott as Head of Concussion Innovation and Research and Rachel Elliott as Head of Concussion and Healthcare Governance, and more recently Dr Jonathan Reyes, a clinical and research neuropsychologist, in the role of AFL Concussion Research Lead.

“Our current 11-step, minimum 12-day return to play protocol continues to be an important tool in the best practice of ensuring a safe return for players who suffer a concussion.  The AFL will shortly undertake its annual review of the elite and community football concussion guidelines with the benefit of the research learnings that will be presented at the Concussion in Sport Group’s conference in Amsterdam in late October,” he said.

Dr McCrory is still listed as a laboratory head at the Florey Institute of Neuroscience and Mental Health. A spokesperson for the Institute told the Guardian that it had been concerned by the allegations of plagiarism and other issues raised with respect to Dr McCrory.

“Our assessment of these matters is ongoing and remains confidential,” they said.