Steve Thompson’s film should make rugby sit up and listen. But will it?

Risk is mostly a subjective judgment. For anyone scared of heights, even standing near a cliff-edge railing can feel daring. For others there is nothing to beat the surge of adrenaline that precedes a freefall parachute jump. Both are entirely legitimate human reactions. And, ultimately, who is to say that one is more rational than the other?

Until recently it has been worth recognising this whenever rugby’s future is being discussed. Then you switch on the television and watch Head On: Rugby, Dementia and Me, featuring Steve Thompson. A 2003 World Cup winner, still only 44, struggling to recall his daughter’s name and sifting through a boxful of mementoes from games which are a complete blank. For those of us who have known, liked and respected Thommo over many years it was heartbreaking.

Recent days have also yielded plenty of other grim updates, from Willie Stewart’s study of an increased risk of motor neurone disease among former Scotland internationals to the depressing neurological update recently supplied by the former England and St Helens rugby league prop James Graham. On Sunday at least three players were either knocked out or forced off prematurely after heavy blows to the head at Wasps. On Friday night I also watched Bristol’s Ellis Genge, among others, smashing into rucks at Ashton Gate and found myself wondering if the sport has ever exposed players to as many brutal collisions as it currently does.

So what next? According to James Drake it is no longer even a question. The rugby-loving philanthropist and founder of the not-for-profit Drake Foundation – which has put £2.2m towards funding detailed evidence-based scientific research into sport-related brain injuries – is adamant something fundamental has to change. Last year one of the studies backed by the Drake Foundation found 23% of a group of 44 current elite rugby players had abnormalities in their brain structure. Drake was sure it would trigger instant, far-reaching change. Instead he fears the penny is not dropping nearly fast enough.

Hence his appearance in Thompson’s film. And his desire to spell out, once again, some of the starker home truths raised by last year’s study. “We’ve looked at it from a number of different angles and come to the same conclusion: that elite rugby union is not safe,” he says bluntly. “It’s the old Sherlock Holmes technique: when you eliminate the impossible, whatever remains is the truth. It is impossible that we can carry on as we do now, with the same number of impacts.

“The average age of the players sampled was 25. They had unexpected abnormalities – and some shrinkage – to their white matter. You don’t yet know if that’s going to progress to clinical symptoms. But if you ask a cardiologist whether any structural change is acceptable in the heart they’d say ‘No way.’”

Both World Rugby and the Rugby Football Union insist much continues to be done to mitigate the risks to elite players, including the encouragement of lower tackle heights and certain law amendments. In a statement to the Guardian, in the wake of the Thompson programme, the RFU also praised its former hooker for speaking out. “We were deeply saddened to hear the brave personal account from Steve Thompson and his family. We applaud players for telling their stories, it is an incredibly brave thing to do.”

But a significant gap continues to exist between the official concussion-driven stats and the as-yet unknown consequences in later life of the cumulative intensity of impacts in the elite game. Drake, and other groups such as Progressive Rugby, are not involved in the ongoing legal case being pursued by almost 200 ex-union players but do have longer-term concerns for the well-being of a generation of ex-pros. “Concussion is a fairly convenient way of dismissing the problem,” suggests Drake. ‘You can say ‘a player seems to have recovered from a concussion’ without knowing what is going on in his head now or, potentially, in the future.”

“But you can’t draw a line in terms of the cumulative intensity of impacts. And therein lies the problem. Based on all the evidence I’ve looked at there has to be a significant reduction in the cumulative intensity of impacts. Significant. Not papering over the cracks. It’s got to be a major change, you’re not talking about window dressing.”

If it was up to him, three alterations would be immediate. “To me it was ludicrous for World Rugby merely to recommend reducing contact in training to 15 minutes. Of course you have to make things like that mandatory. Secondly you have to look at having eight substitutes. Big strong men coming on to the pitch and playing against players who are already tired is not a good thing. I think substitutions should be for injury or genuine fatigue. And you’ve got to do more within the game itself to reduce the cumulative intensity of impacts. All those three things are common sense, based on the evidence.

“I’m a risk averse person. I’d never have stood up and said to Steve that elite rugby was not safe unless I was certain in my own mind that was the case. I don’t want to point fingers and name names but I’m a little upset that more has not been done. People have known about the problem for a long time and not enough has been done to reduce those impacts. The problem has been left on the shelf. There’s got to be some soul searching.”

Drake was initially motivated by the sight of a concussed Hugo Lloris, playing for Tottenham, staying on the field with a concussion in 2013. At first he wondered whether his mission might be akin to inviting a big tobacco company to do more lung cancer research. Now after the Thompson film – “Maybe it was some sort of watershed” – he hopes more people will listen. The Drake Foundation, he adds, is branching out from sport and looking to extend their head injury focus to abusive domestic situations and the prison population. Just let that sink in. Rugby players are increasingly sharing a similar ball park to battered partners and violent inmates. Risky business or not, that is a perception no self-respecting sport can afford to ignore.