In the wake of the Florian Fritz head injury scandal, we ask whether independent doctors should be brought into domestic rugby.
The Fritz incident represents the latest in a string of concerning cases in the professional game where apparently concussed players have undergone the IRB's Pitchside Suspected Concussion Assessment (PSCA) and returned to play in clear contravention of the head injury protocols.
While the visceral nature of the Toulouse centre's injury and physical state added to the public outcry, it was the footage of head coach Guy Novès appearing to incite the player and medical staff to return him to the game that sparked the greatest shock and so generated the most heated debate.
It is common for us to hear of professional and amateur coaches pressuring their doctors under similar circumstances, but last Friday's Top 14 playoff marked the first time such duress had been captured on camera so vividly.
Since the drama unfolded, the discussion has centred on the introduction of Independent Match Day Doctors - discretely employed with no vested interest in the outcome of the game - to rule on or oversee concussion evaluation pitchside, with French player's association Provale demanding they be brought in to the Top 14 and Pro D2.
The IRB have introduced these physicians at Test level, but say they have no jurisdiction over domestic, union-run competitions.
Rugby's governing body, who announced on Monday an enhancement of the PSCA protocol, also states their stats show it is team physicians, who "know their patients", that remove players more often than their independent counterparts.
An assortment of head injury experts are not so sure, adding their voices to the many condemning the flouting of the concussion protocols in the case of Fritz, and highlighting the "impossible position" faced by team medics.
Last week, leading Melbourne-based neuroscientist Dr Alan Pearce said he felt team medics were placed in a "pressure cooker" environment when assessing players.
Now, Birmingham University researchers Dr Michael Grey, a reader in Motor Neuroscience, and Mr Tony Belli, a neurosurgeon, argue introducing independent doctors across professional rugby would cut down on the number of dangerous decisions and benefit player welfare.
"I would like to highlight that there is a good argument that team physicians are probably in a better position to make the return to play decision based on their history with players," said Grey.
"That said, they are placed in an impossible position by team management.
"In my opinion there needs to be oversight by an independent physician, but the independent physician should not replace the team physician.
"The recent case again demonstrates that some in professional rugby are not following the international guidelines to which they have signed up. Clearly, the governing bodies are not doing a good enough job to police themselves."
Belli added: "I cannot see how Fritz was possibly allowed to return to the match after a clear concussion. There should have been no assessment to make there: the concussion was obvious to everybody and he should have been removed from the game completely.
"Unfortunately the highlights the misuse of the current assessment tools: these should only be used if there is suspicion of concussion; instead, they are being used, even when the concussion is obvious, to determine whether somebody is fit to play on.
"This is not what the guidance says at all.
"Removing players for 'assessment' is not the issue here - and it's no surprise that team doctors assess their own players more often than independent doctors.
"The question is removing players from the game. I think that this should be done by an independent doctor with powers to overrule the team doctor, if the team doctor makes the wrong decision."