Friday, November 14, 2014

HEAD INJURIES IN FOOTBALL: THE NFL FUMBLES


nfl concussions


NOTE:  This is the first of a three-part essay on head injuries in football.  This post will trace the sordid history of the NFL’s denial of the connection between concussions and later life neurological impairment.  For this history, I draw heavily on the book League of Denial: Inside the NFL’s Concussion Crisis by investigative journalists Mark Fainaru-Wada and his brother Steve.  The book earned them a prestigious 2014 George Polk Award for investigative journalism.  The brothers also made a documentary film called League of Denial, which aired on PBS.  I hope BLS followers watched the program, but if you didn’t you can stream it on pbs.org.  Part II will focus on changes the NFL made in response to growing pressure to take action to mitigate head injuries.  The possible connection between brain injuries and domestic violence will be taken up in Part III.

I recently watched a PBS Frontline program on the NFL’s concussion crisis called League of Denial, written by Mark Fainaru-Wada and Steve Fainaru.  The program traced the decade-long effort by the NFL to discredit scientific research that pointed to a likely connection between repeated head collisions in football and permanent brain damage.  Watching the documentary made me so mad I almost threw my remote at the TV screen.  Part of my reaction was outrage at the NFL’s despicable behavior and part was personal.  One of the former players who suffered neurological damage was Ralph Wenzel, a fraternity brother and friend of mine from San Diego State in the early 1960's.  Wenzel died at age 59 after suffering from Alzheimer’s.

The NFL’s history of denials, evasions, lies and duplicity in the face of mounting scientific evidence of the dangers of repeated football collisions amounts to nothing less than criminal negligence.  I say this because evidence seems to point to the fact that the NFL knew about the long-term dangers of concussions long before it acknowledged the problem and it didn’t inform the players.  Worse yet, it published its own “scientific” papers claiming there was no evidence of a connection between concussions and brain damage.

The NFL’s negligence exposes how much the league prioritizes private profit over the health and safety of players who have gone to war on the football fields. This shouldn’t be a big surprise; protecting the bottom line is instinctive for profit-seeking corporations.  If faced with possible financial damages arising from a practice or product, the natural impulse is to challenge the evidence supporting the damage claim. To do this they often hire their own scientific “experts” to undermine the honest science in the public mind.  Friendly scientists are always available—for a price.  If you have sufficient financial resources, it’s pretty easy to raise enough doubt to scuttle or weaken a potential lawsuit.

Witness what the tobacco industry was able to accomplish in the 1950s and 1960s. Deploying their own in-house “scientists” they were able to obfuscate the cancer-causing nature of smoking for nearly two decades.  Sowing a little doubt, a Brown and Williamson memo declared decades ago, “is the best means of competing with the ‘body of fact’ that exists in the mind of the general public.” Fostering doubt is now standard practice throughout corporate America.  It is currently being effectively deployed by oil, gas and coal interests to raise doubt about the validity of climate science.

The NFL began to hear about a possible link between head collisions and long-term brain damage in the early 1990s.  After Troy Aikman’s much-publicized concussion in 1994, Commissioner Paul Tagliabue created a Mild Traumatic Brain Injury (MTBI) committee to “study” the problem.  A serious investigation, however, was not on the money-conscious NFL’s mind, evidenced by its appointment of Dr. Elliot Pellman, a New York rheumatologist with no previous experience in brain science, as its chair.  Tagliabue left little doubt how the NFL viewed the problem when he told Sports Illustrated that “concussions are part of the profession, an occupational risk.”  He later dismissed reports of long-term brain damage as “one of those ‘pack-journalism’ things.”

Paul tagliabue


In 1995 super-agent Leigh Steinberg went public with his concerns about concussion injuries received by two of his biggest clients, Aikman and Steve Young.  He convened a seminar on the effects of concussions attended by players who listened to a panel of medical experts.  Player curiosity increased when the American Academy of Neurology publicized results of research indicating that concussions could have serious neurological consequences, including problems with memory and concentration, confusion, speech and hearing difficulties, and severe headaches.

Curiosity and speculation became more focused when forensic pathologist and Allegheny Court Medical Examiner, Dr. Bennet Omalu, autopsied the body of former Pittsburgh Steeler lineman Mike Webster, who died at age 50 in 2002.  Webster’s physical and mental health had steadily declined since his retirement from football.  He often appeared confused, couldn’t remember familiar things, and had frequent headaches and bouts of rage. His family said they didn’t recognize the person he had become.  Webster eventually divorces, slipped into dementia, and was living in his pickup truck when he died.

Dr. Omalu found that 17-years of football and post-retirement abuse had taken a very heavy toll on Webster’s body, as one might expect, but his brain at first glance appeared relatively normal.  Taking a closer look with a microscope, he found evidence of severe damage.  Omalu said it looked like a brain of “people with Alzheimer’s or someone who had suffered a severe head wound.”

Omalu identified the brain disease causing the behavioral change as Chronic Traumatic Encephalopathy, or CTE, a progressive neurological disease that leaves evidence in the brain.  CTE chokes off brain cells, causing, among other things, memory loss, agitation, anger, irritability, instability, and sleeplessness. It can lead to dementia, Alzheimer’s, Parkinson’s, and even Lou Gehrig Disease. He reasoned CTE could only have been caused by blows to the head.  Although CTE had been found in former boxers, this was the first evidence of brain disease in football players.  Omalu published his findings in the journal Neurosurgery. His discovery started a chain of events that would shake the NFL to its very foundation.

With visions of floodgates opening for class-action lawsuits from former players and their families dancing in its head, the NFL swung into action with a two-pronged strategy:  attack science and scientists that contended head collisions caused permanent brain damage, which it hoped would discourage further research, and create its own body of contrary scientific evidence to send a message that concussions and repeated head collisions are not a problem in the NFL. 

The NFL launched a vicious personal attack on Dr. Omalu claiming he had “misrepresented the facts” and drew “preposterous” conclusions. It demanded that Neurosurgery retract the article (which it refused to do). In October 2003, the MTBI committee published the first of 16 papers in Neurosurgery denying a connection between head injuries and later life problems.  The paper was published despite objection from Dr. Robert Cantu, editor of the journal’s sports medicine section, who questioned its science, but he was overruled by editor-in-chief, Dr. Michael Upuso, who also served as a consultant to the NY Giants football team.

Early MTBI papers stated that players could quickly return to play—even in the same game—and not have to worry that the injury would worsen or be chronically cumulative.  In November 2004, it had the audacity to suggest that because of a “winnowing process” NFL players are actually less susceptible to post-concussion syndrome brain injuries than the general population.

The next several years witnessed a running battle between new evidence of CTE in former player brains and repeated MTBI contrary claims.  Dr. Omalu published a second paper in Neurosurgery in November of 2006 after finding disease in the brain of other former players, including Steeler Terry Long, who had committed suicide.  Omalu reported that both Long and Webster had Major Depression Disorder after retirement despite not having a history of recorded concussions.  This suggested that an accumulation of sub-concussive hits could also be dangerous.

Commissioner Tagliabue retired in 2006 and was replaced by Roger Goodell, a good man to carry on the denial fight since he had previously served as chief operating officer for the MTBI when it sent those controversial papers to Neurosurgery.  The new commissioner proved as good at obfuscation as his predecessor, telling Americans that the alleged scientific evidence of brain disease and concern over head injuries was overblown.  He denied there was any connection to head trauma, dementia, or Alzheimer’s.  Goodell assured the public the league’s own six-year study proved things were “well under control.”

Although questions remained about the extent and prevalence of CTE, and definitive proof that its cause was repeated head collisions, an increasing number of case studies were confirming the presence of brain disease in deceased players who displayed Major Depression Disorder after their careers were over.  Most of the research was being undertaken at Boston University’s Center for the Study of Traumatic Encephalopathy, headed by Dr. Ann McKee.  McKee received an increasing supply of brains from wives and families of deceased players who, like Webster, had displayed neurological and behavioral changes after retiring from football.

Like Dr. Omalu, Dr. McKee’s research was attacked by the NFL. It repeated its doubts that head injuries were the cause of such changes, arguing that they could just as likely be a result of steroids, substance abuse, alcohol, or countless other things.  McKee, however, proved a much more persistent and formidable adversary.  At the 2009 Super Bowl, for example, McKee exploited the mega-media opportunity to hold a press conference where she announced several more cases of CTE.  At that time 45 of 46 brains the center analyzed showed evidence of the disease.

Despite its denials, the NFL was not unaware of the brain injury problem.  It funded an internal study in 2009 that concluded that former players were 19 times more likely to get dementia, Alzheimer’s and other neurological diseases than the general public.  This finding contradicted its frequently expressed contention that the problem was overblown.

To the NFL’s great displeasure, the report was leaked to New York Times reporter Alan Schwartz, who wrote an article highlighting its major findings.  When Schwartz contacted Goodell for a comment, the commissioner denied his own report. Despite repeated denials, the NFL knew it had a problem.
Still trying to get an NFL admission that head collisions might cause permanent brain damage, Schwartz contacted league spokesman Greg Aiello for a comment on the report.  During their conversation Aiello admitted it was clear there was a connection.  Here was the NFL’s designated spokesman contradicting his own commissioner.  Aiello’s admission was the first time anyone associated with the league had made such an admission.  The New York Times published the admission the next day.  Publicity forced the NFL to finally publicly admit the prevalence of post-careers brain disorders.

With this admission, more CTE findings, and heavy pressure on the NFL to do something, the league was forced to end its denial strategy and move to damage limitation,  It’s response will be addressed in Part II.






















2 comments:

  1. This is excellent, best you've done so far. Bravo Ron!

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  2. Thanks for sending me this paper. It is sickening how the NFL continues to be more concerned with their bottom line rather than the health of their players. I have no idea what the ultimate answer is, but I am hoping that you address what you feel can be done to protect present and future football players.

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