Endorsing members (presented in alphabetical order) by Stephen T. Casper,* Paul Chazot,* Amanda Ellison,* Judith Gates,* Irene R. Gottlieb,* Conor Gormally,* Malayka Gormally,* Karen Hind,* Patria Hume,* Doug King,* Elizabeth Sandel,* Alice Theadom,* Sally Tucker.*
*Indicates authors. 

For immediate release

White Paper: Run It Straight: A Call to Action Against a Perfect Brain Injury Delivery System

The Repercussion Group submits this White Paper to warn the public, policymakers, sports organizations, and social media platforms about the rise of the “Run It Straight” social media challenge and related for-profit competitive events. These businesses basing for-profit “sporting” events off of a dangerous social media challenge epitomizes the transformation of violence into entertainment, augmented by social media.

The Repercussion Group is a stakeholder group of academics, researchers, clinicians, caregivers, and advocates from around the world seeking to raise awareness and drive policy change related to the immediate and long-term effects of repeated head impacts in sports. Many of us are caregivers to people with impact-related neurodegenerative diseases. Others live with the consequences of concussions that continue to affect daily life. All of us know individuals who are suffering from dementia and other conditions that have been linked to brain injuries.

“Run It Straight,” involves two participants running at each other at full speed and colliding, with the winner decided by who hits the hardest and stays upright. These events are recorded, shared, and amplified on social media platforms, including YouTube, Facebook, and TikTok, where they reach broad audiences, often including younger viewers. The popularity of this challenge has inspired for-profit competitive events, including Run It Straight Official, and the RUNIT Championship League. These activities, like so-called “Dwarf Tossing” before them, turn real human risk and harm into a spectacle. They represent what Medical Historian Stephen Casper calls “perfect brain injury delivery systems”—efficient packages of harm that transform the risk of severe brain injury into viral entertainment.

The biomechanical forces involved in these collisions are equivalent to being in a car crash without a seatbelt. These forces have the potential to cause death or lifelong disabilities that can affect every aspect of a person’s life. Yet the RUNIT Champions League and the “Run It Straight” social media challenge on which RUNIT is based are framed as merely a challenge, a game, or a sport, with no mention of the catastrophic potential for head and neck injuries, acute brain damage, or long-term neurological diseases.

It’s critical to emphasize that, although participants may choose to engage in such activities, their choice is neither fully free nor fully informed. Social, financial, and peer pressures can drive individuals to participate in these risky contests without a proper understanding of the level of risk they are taking on. Are social media companies incentivized to build algorithms to generate excitement and normalize the practice for the world’s youth, turning injuries into clicks and views? Absolutely. Are organizations like the RUNIT Championship League further incentivized to maximize the violence of their ‘sport’ to drive engagement and differentiate themselves in an oversaturated market? Yes. This is an example of how social media’s role as both an incredibly profitable global industry and a cultural superhighway incentivizes social trends that turn fantasy into reality with foreseeable and terrible consequences. The real cost of these events and trends is borne by those who get hurt, their families, the health care systems––and not by the audiences who cheer them on or the businesses who profit by ignoring the harm their products create.

It is our ethical duty to raise awareness about the dangers of “Run It Straight,” the RUNIT Championship League, and similar activities. We urge sports organizations, policymakers, and social media platforms to acknowledge the seriousness of these risks and take action.

Recommendations

  • Clearly warn the public as to the fragility of the human brain to concussive or subconcussive blows. Quite simply, the human body is not designed to withstand blows to the head. 

  • Clearly warn the public, athletes, and parents about the dangers of “Run It Straight,” the RUNIT Championship League, and similar activities, emphasizing the risk of brain injury, death, disability, and long-term neurodegenerative diseases.

  • Develop and enforce bans on “Run It Straight” events and the RUNIT Championship League in organized sport and on social media platforms, including demonetizing videos that promote such activities.

  • Educate social media companies about the health risks of these videos and their responsibility to moderate content that endangers human life.

  • Recognize that “Run It Straight” and the RUNIT Championship League are not a sport but a perfect brain injury delivery system that exploits participants for entertainment.

  • Develop educational resources for schools and communities that emphasize safer sports, healthy exercise and recreational activities, and explain the risks of uncontrolled high-impact collisions.

  • Encourage policymakers to pass urgent legislation banning the organization, promotion, and monetization of “Run It Straight”-style events, including the RUNIT Championship League.

  • Call on researchers to study the pathological, neurological, social, and economic repercussions of these types of activities and to share the findings within the public domain.

Conclusion
“Run It Straight” and businesses like the RUNIT Championship League are the latest in a long line of spectacles that commodify violence and human suffering. Clinicians, scientists, policymakers, and platform managers have an ethical obligation to protect vulnerable individuals from these perfect brain injury delivery systems and improve our cultural understanding of the human brain’s vulnerability to collisions. 

OpenAi was used in the preparation of this document. The argument, content, and framework represents the equal contribution of the authors. The prompt description is listed below in references.  

Ai Prompt and References

Drafting Prompt Summary for White Paper on “Run It Straight”

This first draft of the White Paper on “Run It Straight” was generated with the assistance of OpenAI’s ChatGPT, guided by a detailed prompt that emphasized the following:

  • Modeling Structure and Tone: The draft closely followed the structure and tone of  previous Repercussion Group white papers. This approach was chosen to maintain consistency with the group’s voice and ensure clarity and impact.

  • Original Wording: Every sentence was newly written and paraphrased, avoiding any direct copying from prior white papers or other published documents.

  • Content Relevance: The prompt included instructions to focus on the specific issue of “Run It Straight,” adapting the general principles from the group’s earlier work on concussion.

  • No Direct Quotes from Other Sources: No language from outside sources was included verbatim, and all references to previous group ideas were rephrased or summarized to maintain originality.

  • Emphasis on Plagiarism Avoidance: The prompt directed the AI to avoid using any direct language from the earlier white paper or any published articles to prevent copyright infringement and plagiarism.

  • Ethical Standards: The draft was written with attention to ethical writing practices, transparency, and a commitment to the Repercussion Group’s values of honesty and integrity.

The result was a first draft that was consistent with the Repercussion Group’s prior work while being entirely original in its wording and specific in its focus on “Run It Straight.”


Endorsing members

Presented in alphabetical order: by Stephen T. Casper,* Paul Chazot,* Amanda Ellison,* Judith Gates,* Irene R. Gottlieb,* Conor Gormally,* Malayka Gormally,* Karen Hind,* Patria Hume,* Elizabeth Sandel,* Alice Theadom,* Sally Tucker*  

*Indicates authors. All authors contributed equally.

Consensus on Concussion in Sport 2022

Members of the Repercussion Group have submitted this White Paper to the 6th International Consensus Conference on Concussion in Sport.

For several years the Repercussion Group has brought together researchers, clinicians, caregivers, and advocates from across the world in dialogue to discuss the immediate and long-term effects of repeated head impacts in sport at all levels. Among us are individuals caring for someone with impact-related neurodegenerative disease. Others have unresolved post-concussion symptoms years after a concussion or concussions. Many of us know individuals who are suffering from dementia after playing contact and collision sports, including some affected before age 50. Several of our members live with the repercussions of these injuries as we await the consensus authors to catch up after over two decades with the lived consequences of repetitive head impacts.

The Repercussion Group expresses concern that patient, caregiver, researcher, and provider knowledge like ours remains excluded from a consensus process that has yielded five previous consensus positions on the definition, diagnosis, management, and treatment of concussive injuries. We submit that the consensus process since its inception in 2001 has historically downplayed the detrimental effects of repetitive head impacts in sports. Further, although the consensus panel authors previously acknowledge that there are individual differences in recoveries, the focus has been on return-to-sport and return-to-school – without due consideration of retirement from sport. There has been essentially no substantive discussion of the management of multiple concussions, persistent postconcussive symptoms, and exposure to overall head impact, including criteria to aid clinicians and patients regarding decisions about retirement from sport. The increased neuropathological load of multiple concussions and repetitive subconcussive impacts that can lead to both chronic symptoms in the short-term and neurodegenerative diseases in the longer term have not received adequate attention during the consensus process. 

As a document that shapes how healthcare providers across the globe act, the consensus document has unfortunately promoted a ‘wait and see’ approach to the risks of long-term symptoms and neurodegenerative diseases, even as authorities describe mounting evidence that the relationship is causal under the Bradford Hill Criteria.(1) Consensus makers have an ethical duty of care to mitigate further preventable harm to others and to provide the most up-to-date guidelines based on available evidence. 

“Our understanding of the prevention, detection, management and potential longer-term effects of concussions in sport have evolved rapidly over the last 20 years.”

~Schneider KJ, Patricios J, Echemendia RJ, et al Concussion in sport: the consensus process continues British Journal of Sports Medicine Published Online First: 06 May 2022.


This, in short, is why we are called the Repercussion Group. We are interested in the repercussion of years of failures to warn, to act, to be forthright, to accept that sometimes scientists and clinicians must make decisions and provide advice with imperfect evidence that points towards inconvenient truths. It is our duty to ensure that decision-making around acceptable risks to athletes rises to meet the ethical standards expected of the medical profession. These decisions, including those made in the consensus process, must be informed by an understanding of their gravity with regard to the health of millions of individuals who play sport at all levels; to remember the overarching principle: above all, do no harm. 

We recognize that this is not merely a clinical issue for clinicians to debate; science, social science, and medical humanities (with respect to experiential factors) all have a place. We recognize that only through a holistic understanding of the repercussions and the steps that can be taken to ameliorate them (both at the source of injury and ensuing treatment) will we effect meaningful change. We recognize that conflicts of interest can be a significant ethical concern.

Recommendations

Attendees, delegates, and authors at the 2022 Concussion in Sport Conference should:

  • Provide guidelines that are patient-first not sport-first and translate the statement into multiple languages so the international community has access to the guidelines.

  • Provide rigorous trans-disciplinary evaluation of all the evidence with open debate on the contentious issues and clear documentation of the consensus development process.

  • Include patients and caregivers in the consensus development process.

  • Declare all conflicts of interest from the outset and explain how they will be managed.

  • Clearly articulate the management of multiple concussions and persistent postconcussive symptoms with respect to developing criteria to aid clinicians and athletes regarding decisions about retirement from sport.

  • Clearly articulate to all stakeholders available evidence for any relationship for a causal link between repetitive head impacts and remote neurodegenerative disease which is thus a repercussion.

  • Clearly warn that failure to mitigate repetitive head impact exposures could have repercussions.

  • Clearly articulate guidance to sports organizations about safeguards for mitigating repetitive head impact exposure in practice and games.

  • Identify and respond constructively to the suggestions offered in: Casper ST, Bachynski KE, Buckland ME, Comrie D, Gandy S, Gates J, Goldberg DS, Henne K, Hind K, Morrison D, Ortega F, Pearce AJ, Philpott-Jones S, Sandel E, Tatos T, Tucker S, Finkel AM. “Toward Complete, Candid, and Unbiased International Consensus Statements on Concussion.” in Sport. J Law Med Ethics. 2021;49 (3):372-377.

  • Identify and respond constructively to the analysis of the evidence by Nowinski, Christopher J., Samantha C. Bureau, Michael E. Buckland, Maurice Curtis, Dan Daneshvar, Richard LM Faull, Lea T. Grinberg et al. "Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy." Frontiers in Neurology: (2022), 1489.

(1) Nowinski, Christopher J., Samantha C. Bureau, Michael E. Buckland, Maurice Curtis, Dan Daneshvar, Richard LM Faull, Lea T. Grinberg et al. "Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy." Frontiers in Neurology: 1489.