Thursday, October 17, 2013

League of Denial: The NFL's Concussion Crisis

by Bill Holmes 

On last Tuesday night (10/8) PBS aired a Frontline documentary titled League of Denial: The NFL's Concussion Crisis. As you can guess this is about the link between football, brain trauma and the long term effects.

I'm not going to detail all the players in this documentary. If you are interested the program is on the PBS website.

This documentary was originally a joint project between Frontline/PBS and ESPN. In the last few weeks ESPN withdrew their support and had their logo and credits removed from the final product. Suspicion is that the NFL pressured ESPN into dropping out. Of course ESPN denies that and says the reason they pulled out after about 12 or 13 months of the project is because they realized they had no editorial control of the documentary. The Worldwide Leader in Sports is a multi-billion dollar company with legions of lawyers and broadcast professionals, yet it took them 12 months to realize they had no editorial control. The fact that ESPN has a very lucrative business relationship with the NFL had no possible bearing on that decision. If you believe that, please call me about some swamp land I have for sale. The NFL and ESPN must think we are all stupid. ESPN has mentioned the documentary and showed short clips but that is probably because they took so much heat about dropping out. Ironically ESPN investigative reporters were the primary reporters on this story and participated in the program.

This was a typical Frontline documentary. It had the required somber and serious narrator, Will Lyman, and dramatic music. The good guys were 99% good and the bad guys were 99% bad. A few medical professionals, ex-players and family members were the good guys and gals. The NFL in general was the bad guy with a few specific people especially bad. There was the normal disclaimer that the NFL and certain individuals did not respond to requests for interviews or statements for the show.  

The main theme was what did the NFL know, when did they know it and was there a deliberate cover-up. It was far from a fair and balanced presentation but there is plenty of food for thought particularly if you have young family members who are playing, will be playing or have played football.

Here is what I took away from the presentation. In the past we were pretty ignorant about football injuries particularly head and brain injuries. Once questions and evidence about long term effects of brain trauma came to light the NFL stalled, fought and denied the findings and certainly took no responsibility for any injuries. Although more study is needed it is pretty clear that playing football is not particularly good for the human brain. Money, as always, clouds peoples interpretations of the facts.

Some of the advocates for change have come to conclusions that are not yet proven or fully supported by the current body of evidence. There is plenty of smoke but the cause or causes and size of the fire is not fully known.

The NFL has and is acting like a big bully multi-billion dollar enterprise. Much of their response to the problem is at best questionable and at worst criminal.

Mike Webster
The potential for long term brain damage began to come to light to non-NFL people in the mid 1990's. We don't know when the NFL first had suspicions or evidence. The first NFL player disability claim for mental impairment was made in 1997 by Mike Webster, a 17 year NFL Hall of Fame center mostly with the Pittsburgh Steelers. His claim was approved by the NFL in 1999. Buried in the claim approval is a statement that Webster suffered brain damage from playing NFL football. That seems to indicate the NFL knew of potential problems no later than 1999 and possibly much earlier.  

Mike Webster died in 2002 at age 50. His last few years were fraught with physical and mental problems. After the death Bennet I. Omalu, M.D., a Neuropathologist, did an autopsy of Webster's brain and found that he suffered from chronic traumatic encephalopathy (CTE). The extent of the disease was much more than would be expected in a 50 year old. Omalu published his findings and ultimately became a target of the NFL. They tried to discredit him and have the publication retract his paper.

The NFL formed the Mild Traumatic Brain Injury Committee to "study" the issue. Like the title? It doesn't even acknowledge that there could be anything but mild trauma. This was a committee primarily made up of NFL team physicians and others employed or sympathetic to the NFL. The original committee chairman was a team doctor but not a neurologist. Dr. Omalu was not invited to join. This "unbiased" committee published several studies all of which denied a relationship between head trauma and concussions suffered in football games with long term brain damage or CTE. They even concluded that it was OK for players to reenter a game after suffering a concussion. Besides publishing their own findings, they carried out a campaign to discredit any study that didn't agree with theirs. Nobody but the NFL understood the problem or knew how to do research. 

Eventually Boston University (BU) became involved and did independant analysis of several brains from dead NFL players. Of the 46 brains they studied 45 had CTE. Probably just an amazing coincidence. BU and other researchers have since found CTE in dead high school and college players. The NFL continued to deny any football cause and effect.

Eventually Congress held some hearings. This got the NFL's attention and in 2009 they finally admitted that maybe football had something to do with this problem. They even funded research at Boston University, the same lab they had disparaged previously. This is clearly a PR move meant to assuage concerns by the public and Congress.  

The documentary depicted Paul Tagliabue and Roger Goodell, the past and current NFL commissioners respectively as the major villains. There was also plenty of disdain for Dr. Elliot Pellman, longtime chair of the NFL's Mild Traumatic Brain Injury Committee and a personal physician of Tagliabue.  Dr. Ira Casson, aka Dr. No, the NFL expert on head trauma was also singled out. He's a pretty easy guy to dislike. Tagliabue and Goodell were both lawyers and answer questions like lawyers. They are nearly impossible to pin down on this issue. 

The official stance of the NFL is that the issue is under study and there are no conclusions yet. They have been studying this since 1997 but still don't have any answers. They have backed away from any admission that long term brain damage is caused by football. Despite accepting no responsibility or admitting any guilt, the NFL recently negotiated a settlement of a lawsuit by former players to the tune of $765 million. That's an awful lot of not guilty. The NFL is an $8 to $10 billion per year enterprise.

The NFL is using the practice of publicly funding studies but privately suppressing any meaningful results. Kind of like our government, kick the problem down the road, pretend to be working on it but really continue doing business as usual. Does this remind you of the tobacco industry of a few years ago? They denied that cigarette smoking caused health problems while pretending that current research was inconclusive but they were diligently working on it. Delay and distract.

I'm not giving those on the other side of this battle a free ride. While some of the research findings are compelling there are many more questions. Some of the doctors, scientists and researchers have become advocates. I'm not saying their research is biased but some of the conclusions may be. The almost 100% of CTE in the autopsied brains is startling but it is a rather small number. Are there other factors besides football contact involved? Were these 50 or so brains predisposed to CTE or other brain injuries? Did performance enhancing (PED) or recreational drugs and alcohol contribute? Why do some football players who suffered multiple concussions live normal post football lives with no signs of dementia? Is the problem genetic? These and other questions were ignored or glossed over in the documentary.

As with most issues this one is not black or white. Neither side is 100% right or wrong. My opinion is that the NFL knew more and knew sooner than they admit. They continue to skirt the real issue while publicly telling us all how concerned they are about player safety. What they are concerned about is making money. If making the game really safer meant more money the NFL would become the NFFL, the National Flag Football League, for the 2014 season. On the other side, we need some new researchers to become involved. People who are truly objective scientists and institutions that are not funded by parties with vested interests. The researchers need more brains to autopsy to see if the findings from the first 50 hold true when there is a much larger sample. So far most of the studied brains were from former NFL players who exhibited signs of mental damage and/or died prematurely. There also needs to be extensive research into other possible contributing factors. Current medical opinions are largely shaped by the results of brain autopsies. Once causes are known we may be able to come up with effective prevention. Until then we should err on the side of caution, particularly when it comes to youth football. Changes in tackling techniques, more informed and aware coaches, rule changes, better and quicker medical assistance and any other improvements that the research indicates will help. 

Conspicuously missing from the documentary were the players union (NFLPA) and the equipment manufacturers. Folks that make helmets must have data on head trauma. The NFLPA needs to be as concerned about player safety as they are about the salaries and union dues. They need to encourage current and former players to participate and cooperate with safety studies. They need to tell players that they must be honest about injuries they suffer whether it's a concussion, a knee, ribs or any other part of the body. They should work on the standard contract structure so it's easier for the players to be honest and can let injuries fully heal before returning to action. They need to have a say in who are the team doctors or maybe pay their own doctors to be on the sidelines.

This won't be easy. Football is a tough sport with a long history of rewarding the those who ignore injuries. The fans love the big hit as much or maybe more than the scoring plays. Those who are coaching now were brought up in a football environment that told players to run it off if their ankle was hurting or they twisted a knee. Back in the days you shook it off when you had your bell rung (head trauma or concussion). 

I grew up in Florida and have lived in Texas for almost 30 years. Both places take their football seriously. Kids start playing organized flag football at 4 or 5 years old. They are playing tackle with full pads by third grade. It's a way of life. There's practice most days after school then Saturday games. The teams have cheerleaders so the girls can participate. High school teams play in beautiful stadiums that look like college facilities. Big video screens, artificial turf, thousands of seats some with luxury boxes and suites. The playoffs go on forever and the championship games are played at places like Cowboys Stadium. 

I'm a fan and I don't have the answers. Can we make football relatively safe? Will we find that a high percentage of participants will suffer brain damage? What if we find only 1% are predisposed to CTE, is the risk reward worth it? What if that number is 2%, 5%, 10%, 25%, 50%? What's the cutoff where the risk exceeds the rewards? Most pro players and even college players realize that they may need a knee or shoulder replacement in their 40's or 50's and are willing to live with that possibility. Will they feel the same about potential brain damage? My kids played football but they are grown now. When they were playing we were worried about a damaged knee or broken arm. Worse case was a neck or spinal injury. We weren't worried about dementia in 40 years. One of the grandkids is currently playing football and now we know more. What are parents suppose to do? Almost every activity comes with some risk. We need to learn those risks and then along with the child make informed decisions. Maybe Junior should start working on his jump shot, corner kick or how to hit (or throw) a curve ball.

Will safe football be exciting football that fans want to see. That is the dilemma the NFL and colleges face.

I'm conflicted but at least for now I'll be watching the games this Saturday and Sunday.

The documentary was flawed but it is food for thought. I'd rate it an A for subject matter and a B for execution. It's tough to get the true facts when money, power and politics are involved. What is your take?


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