'I hope and pray that rugby will get through this dark moment'

James Drake is feeling conflicted. He loves his rugby. Has done so ever since he was enchanted as a young boy playing at schools level in Cardiff. And yet, he has grave fears for its future. Concerns that resulted in him setting up the Drake Foundation and ploughing over £2.2million into concussion research these past few years.

The generous spend by his not-for-profit organisation isn’t confined to investigating head injuries in rugby. There have been intriguing projects on the brain effects of heading a football and even head impacts suffered in domestic violence, more of which will emerge later this year when those latest reports are published.

It was rugby, though, which originally tickled the curiosities of the Drake Foundation, a Premiership club swinging its doors open in 2015 with a warm embrace, and the use of blood samples became the kernel behind the 2021 publication of the Drake Rugby Biomarker Study which found that 23 per cent of current elite players had structural abnormalities to their brain white matter or blood vessels.

Separate to that, another Drake concussion study found that elite players from the amateur era aged 75 and over who had suffered three or more concussions had a poorer cognitive function score than those with fewer or no concussions.

It’s all food for thought in an unsettled climate where rugby is jeopardised by lawsuits issued on behalf of players whose brain health is alleged to have been damaged by concussions when playing the sport.

The Drake Foundation has nothing to do with upcoming courtroom concussion battles. Legalities aren’t its thing, but the organisation's founder was deeply touched when earlier this year he met with Steve Thompson, the 2003 England World Cup winner who can no longer remember anything about that wonderful match in Sydney and whose brain health trauma has been well documented.

“I am influenced by the fact that Steve is an incredibly lovely man, an incredibly disarming, unassuming human being,” said Drake to RugbyPass over a 30-minute Zoom call from his Foundation’s HQ on brain health and concussion.

“I’m an amateur portrait painter and I sent him a painting on his birthday. He sent the most beautiful note to me about how he loved it and so on and I found myself moved by that. You couldn’t but be moved by that. At a human level, I was completely disarmed and moved by Steve. He is one of the finest people I have met for a very long time, without any shadow of a doubt.”

Traumatic rugby stories such as Thompson’s weren’t in the public domain when Drake had his interest originally piqued by concussion in sport. But what he has realised in the years since setting up the foundation is that there are now plenty of red flags that he believes rugby’s ruling bodies must notice and react to. “There were a number of main reasons for starting it [the foundation],” he explained.

“My father was coming to the end of his life. I had been a great rugby fan, I’d really been happiest on the rugby pitch as a schoolboy in Cardiff and my father also loved rugby, so I wanted to do something in the name. When Barry O’Driscoll left World Rugby, I picked that up. He is someone of high integrity and must have left for good reasons.

“I’d a science background so I understand the concepts and in 2013, I wanted to do something philanthropic and wanted to set something up and the most important thing I have achieved since then is to connect contact sport, mainly football and rugby, with neuroscience research.

“There were some disturbing incidents on the football pitch at the time, Hugo Lloris, the Tottenham goalkeeper, staying on the pitch with a concussion. There was rugby's George North with a number of concussions, incidents that from a common sense standpoint were stupid and I wanted to go out and get some evidence.

“There is no point saying something, you have to get evidence. I wanted to fund studies and I also wanted to start a conversation around this whole area, and the conversation now takes the form of an annual meeting that we convene with the FA and the RFU, which is now called the Drake Sports Head Impact Research Symposium.

“I went to a Premiership club in 2015 and to my amazement not only did the CEO and the owner say, yes we will get involved but all the players said yes and that was fantastic. I had two ideas for studies - one was a biomarker study, compounds in the blood that tells us something over time about brain health.

“The other was neuroimaging, to be able to show there were changes to the white matter of the brain that everyone could understand. We built it up to six or seven teams, including a women’s team and some rugby league teams.

“Seven years ago I couldn’t have said to you rugby is unsafe. It was my instinct that safety was going in the wrong direction but I could go no further than that. Now I can say, hand on heart, elite rugby is not safe in my opinion. That does not mean it applies to the grassroots but the problem is these things spill over.

“We did a survey that showed that two-thirds of parents of youths players are concerned about long-term effects and two-thirds of amateurs are concerned about long-term effects so it does affect the game right through, unfortunately. Could more have been done? Yes. In the last two years, it is true to say that World Rugby and the RFU have tried hard to address these issues but I don't think they have still gone far enough.”

World Rugby chairman Bill Beaumont is another ex-rugby player that Drake has painted. “Bill is a lovely man, I painted him three or four years ago. I have a lot of respect for him. I have made it clear to him what I feel about these things [brain health]. I have never flinched from it and I have my viewpoints. I respect Bill, we all know he is a good man but I have made my points very clear and I don’t believe elite rugby is safe at this time.”

If he had free rein to implement change to improve the concussion situation, what would Drake do to assuage his fears about rugby’s safety? “The past is a different country but if we can return to the game pre-95 hypothetically, people like me would not be jumping up and down with concern.

“When you get to your 70s you are going to get some cognitive effects but when you get to your 40s and your brain health changes, that really does flag up. It’s only several hundred (ex-players) but nevertheless, combined with the data we have shown, it does raise a red flag to me.

“I'm not an expert on the laws but there are three things that one can say with reasonable confidence: one is reducing the number of impacts in training. To be fair to World Rugby they have recommended a reduction to 15 minutes a week. I would say to them, make it mandatory.

“Secondly, it would be common sense that instead of bringing on eight fresh players at 60 minutes, do that only when there is injury or genuine fatigue. And thirdly, they have to find some way of reducing the accumulative intensity of impacts in the elite game. It’s going to carry on and we do need common sense to address it.

“Rugby is something that has been there from my childhood, been there all my life. It’s the wonderful crowds, the good humour, the feel-good factor. It’s hard to put it into words, the game is a joy to watch from many angles but it’s that wonderful feel-good factor of being together with a lot of people and feeling the same way.

“I love the game. It’s very hard to put it into words but I do enjoy it so I hope and pray that rugby will get through this dark moment. Without any question, it is a dark moment and we just have to get through it and make some changes. They will be needed and I'm sure it will come through to the other side.”

One thing that the Drake Foundation believes would be of benefit would be if broadcast media were more willing to embrace concussion research even though the language brain health findings can be difficult to translate to the regular rugby fan.

“This subject is now talked about a lot more but I am not aware of any commentator in the last year mentioning our study and I am not aware that any of the rugby discussion group programmes have mentioned our study which is sad in a sense.

“I would have thought they could have mentioned it in passing but here we are, they haven’t and yet it [the research] is out there. It’s only one study, of course, but it would be nice to air some of these things in a responsible way in the media.

“It would be so easy to get the study taken out of context. I am at great pains to say to you it is a small study and there weren’t any clinical symptoms. We don’t if there will be later down the line, I’d be very careful to say that.

"But they [broadcasters] are probably a little bit afraid because they can’t put it in the right context. I understand that. There are regular newspaper articles but I would just like to see a little more televised discussion. That said, we have come a long way.

“Funding research and creating conversations have brought together collaborators who might previously not have met across sport and science and over the last seven, eight years the conversion in this area has massively increased and it is now at government level.”