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Since early in the pandemic, professional sports leagues have been sponsoring and participating in COVID-19 studies, offering large populations and needed funding to help researchers learn more about a disease threatening both public health and the leagues' operations.

As new studies launch with the National Basketball Association (NBA) returning to action soon, experts are simultaneously applauding the leagues' involvement while questioning their motives and citing glaring limitations.

Potential conflicts raised by funding from professional leagues has raised alarm bells for some.

"There are always concerns about conflicts of interest, no question there," said Lee Igel, PhD, a medical ethicist with the New York University Tisch Institute for Global Sport. "What are the objectives? ... This is one moment where those things certainly matter more than they ever did before."

Igel's chief question: Are the leagues principally motivated by improving public health -- or by returning athletes to play?

"You can't have the best of both worlds," he said.

Antibody & Spit Tests

During the spring, the NBA and Major League Baseball (MLB) partnered with researchers on separate studies of COVID antibody tests.

The MLB study in just 0.7% of a national population featuring mostly staff and not players (10,000 total employees from 27 of its 30 teams), said lead researcher Jay Bhattacharya, MD, of Stanford Health Policy in Palo Alto, California.

MLB funded most of the study, along with and , he said. Bhattacharya was not paid by any of the funders, he said.

MLB listened to his advice on protecting participants and double-checking data. He showed MLB the manuscript, and "they let me say whatever I want," he added. "I really do believe they did this for public health reasons."

Results from the are not yet available. The NBA has shared protocol information with its teams, ensured samples were mailed to researchers and made staff available to the researchers, said project leader Priya Sampathkumar, MD, of the Mayo Clinic in Rochester, Minnesota. The NBA paid for the tests, and Mayo is funding data collection and analysis activities.

As NBA personnel have been arriving at the league's "bubble" in Orlando this month to resume the season -- players, coaches, and others are to have as little contact as possible with the outside world -- Yale University researchers have launched an NBA-funded study of , they confirmed via email. According to reports, they hope their spit test will prove to be at least as sensitive as the swab tests now universally deployed -- allowing for easier testing access and use.

The NBA is lining up logistics and providing a framework including a scarce resource: an asymptomatic cohort, said Anne Wyllie, PhD, of the Yale research team. The league is paying for the testing samples to be distributed, collected and sent to Yale.

"It's been a massive collaborative effort," Wyllie said. "It's dire. There need to be more testing options out there."

The Yale researchers had planned to simultaneously conduct an epidemiologic examination of the NBA population; but Harlan Krumholz, MD, of Yale, told 麻豆传媒 via email that that has been unofficially frozen due to complexities associated with the league's return. Restarting a season after four months off has even without getting involved in science.

In an effort to pick up infections quickly, all NBA personnel in Orlando are also being asked to wear rings provided by , a Finnish wearables company, that sense heart rate, respiratory rate, and temperature to develop a composite COVID risk score.

University of Michigan researchers will evaluate the players' data, . Researchers are reportedly studying Oura rings' effectiveness in other contexts. NBA players are being encouraged to opt into a study arm at the .

The NBA also donated $100,000 to co-fund another Mayo Clinic study of convalescent blood plasma transfusion, according to in June in Mayo Clinic Proceedings. Lead author Michael Joyner, MD, said NBA funding helped researchers get the study going: "We are very appreciative."

Benefits of Leagues' Involvement

The researchers and other experts praised the leagues for their assistance. "I think these studies have a lot of ability to contribute to public health," said Zach Binney, PhD, an epidemiologist at Emory University in Atlanta. "This deserves to be counted in [the leagues'] favor."

With the government offering limited funding, researchers have to look elsewhere, said Sarah Fields, PhD, a sports studies scholar with University of Colorado at Denver.

Joyner's team, for example, initially had not secured enough government funding for their study, he said. So they reached out to several contacts for help and the NBA was one of about a dozen entities to oblige. While he appreciates its $100,000, he noted that United Health Group provided $5 million.

Wealthy sports leagues' involvement is "kind of convenient," said Fields.

"The biggest challenge of big-scale research is getting subjects," she noted. "We are using a convenient population with a funder who will pay. I totally understand why [the researchers are] doing that."

Said Bhattacharya of his MLB study: "We wanted to understand how far along the epidemic is [nationally]. This was the only way to do it."

"We participated because the researchers at Stanford asked us to, and we promised them that we would deliver a nationwide sample and turn around the tests quickly among our employees," an MLB spokesperson wrote in an email.

Binney commended the MLB study for yielding a key finding: With the prevalence of antibodies so low, it squelched the popular notion that millions of Americans had already been infected as of its May public release. Because players and staff were scattered across the country when they were tested, results were geographically scalable. "That was an enormous public service," Binney said.

As designed, the saliva study will allow researchers to track antibodies and viral loads longitudinally via testing the same people regularly, Binney said.

Joyner does not see any potential hangups with the leagues' involvement, noting most large academic centers have conflict of interest statements built in, and IRBs and other bodies to monitor studies.

"There is an altruistic component," Fields said. "These studies will potentially benefit these leagues as well, but these are multi-billion-dollar organizations and it is nice to see they are doing something that could benefit all of us."

Funders' Influence

Whenever an interest group funds research, questions inevitably arise about whether it will try to steer the results in its favor.

There is precedent for pro sports leagues manipulating scientific studies and programs. The National Football League (NFL) has a long history of intervening in research and public health regarding concussions and long-term neurodegeneration.

The NFL to the league and covered up findings regarding concussion science dating at least from the 1990s until recently, according to .

But COVID is more prevalent and affects more groups of people than concussions in football, or any sport.

None of the researchers and experts interviewed for this story suspected league foul play with the COVID studies. Too much is at stake and the studies are too visible, they said.

But, experts noted, the leagues do have much to gain if the studies yield certain results. Data showing the saliva tests' efficacy, for example, would boost the NBA's image and help ensure the league not only can finish its current season in Orlando, but also play its entire 2020-2021 season as planned.

Igel worries how positive results would be perceived by a youth sports audience eager to return to play without social distancing, "without looking at the circumstances or the environment that the research is happening in."

Pro sports is a much more controlled environment, Igel said. "We are talking about athletes whose organizations invest millions of dollars in them, up against parents, administrators, and people in the community who want that for their kids one day," he said.

Where Are the Women?

One limitation in the studies that seems certain is their lower female participation. The NBA antibody, Oura ring and saliva studies include staff, but the WNBA, the pro basketball league for women, is not participating in at least two of the studies. (The WNBA is playing elsewhere, in Bradenton, Florida. It is unclear if it is participating in the Oura study.) These studies are likely to involve mainly men, experts said. The exception: The MLB study featured a population 40% female.

Not only is there the sex limitation, the saliva study is even more focused: and the , ranging from 19 to mid-30s.

The lack of women "won't take away from" the studies' findings, Igel said. "But we know the virus attacks and affects men and women differently."

Said Binney: "That is going to be a major limitation of any of these studies."

Despite these potential drawbacks, researchers and experts are giving the leagues the benefit of the doubt. As COVID continues to move around the U.S., they say public health needs all the assistance it can get, and now. Why not wealthy organizations with large populations?

"I would rather have the money than not accept it and worry about conflicts of interest," Binney said. "I don't see that as being a big risk."

Studying concussions in football threatened the NFL's viability because independent results revealed the sport's danger. But the current studies do not proffer "anything that risks undermining their sports fundamentally," he added. "It's probably more of a PR move on their part than any desire to produce their own science; maybe there's a little bit of community spirit too."

Said Fields: "They're not going to say basketball is protective against COVID."

"There are people who care. You tend to forget that with sports," Igel said. "It's so much about the money, but there is a high level of consciousness; it matters, it's not just about rushing back."

"Sure there's always some concern that you'll get the result you want if you pay for [studies]," Igel added. But the long-term consequences of manipulating a COVID study right now "would be disastrous. That's got to be factored in."

"It's a contribution to the existing body of knowledge," he said. "What most people are looking for understandably now is a silver bullet. ... But it's a study, its an indicator, it's a way forward. It's not the final answer and we have got to be conscious of that."

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