Saturday, April 16, 2016


By Ronald T. Fox

Back in November of 2014 I posted the first of a series of essays on head injuries in football. In that first post (Head Injuries in Football: The NFL Fumbles), I criticized the NFL for what appeared to be a disingenuous campaign to discount scientific evidence that blows to the head in football could have lasting neurological damage and for its character attacks on scientists who presented the damning evidence. I suggested that league-sponsored research on the question of brain injuries was designed to play down the risks of head hits rather than find out what was really going on. A recent investigation by the New York Times sheds new light on the questionable science employed by NFL in researching the head injury problem.  The Times found that NFL researchers omitted numerous documented concussions from its data bank over the five-year period of its investigation, and—even more troubling—it may have borrowed its deceitful script from the tobacco industry: delay, deflect and distract. The key question in all this remains: did the NFL connive to cover up the risks to player’s health or did its committee of doctors and executives simply err on the side of caution?
Normal Brain and Brain with Advanced CTE
Scientific evidence about the presence of Chronic Traumatic Encephalopathy (CTE) in the brains of deceased former players with histories of blows to the head was first discovered in 2002 when forensic pathologists Dr. Bennet Omahu autopsied the brain of Mike Webster, the former Pittsburgh Steeler. Subsequent research by Dr. Ann McKee, director of Boston University’s Center for the Study of Traumatic Encephalopathy, who made wives and families of former players, as well as politicians on Capitol Hill, aware of the CTE problem, turned up the heat on the NFL to respond, which it did beginning in 2003 by publishing the results of its own research in a succession of papers in the peer-reviewed journal Neurosurgery. Research was conducted under the auspices of the league’s Mild Traumatic Brain Injury (MTBI) Committee, which was formed in 1994 after a cascade of frightening player concussions.

Dr. Bennet Omalu
Drawing on what it said was a “full accounting” of all concussions diagnosed by team physicians from 1996 to 2001, the league concluded there was no scientific evidence that brain injuries caused long-term harm to players. Despite some troubling questions about the validity of its research, raised by a number of neuroscientists and some peer reviewers, the NFL continued to tout its suspect science. For the last 13 years it has stood by its research, although it was ultimately forced to acknowledge that concussions may have long-term effects.
Steve Young Concussion
Steve Young Takes Another Hit
The New York Times investigation found the MTBI research to be alarmingly shoddy. Drawing on confidential data, The Times found that more than 100 diagnosed concussions were omitted from its studies, including head injuries to such notable stars as Troy Aikman and Steve Young. Concussion injuries omitted from the MTBI data base made the incidence of concussions appear less frequent than they actually were. Was this downplaying a result of human error, excessive caution, differences in how key terms were operationalized, or did the NFL purposely endeavor to deceive the public?
Contrary to the league’s claim that “all teams participated” and that “all players were therefore part of this study,” The Times found that most teams failed to report all of their players’ concussions, discrepancies it discovered when it examined concussions that appeared in post-game, public injury reports, meaning diagnoses reported to the league by team medical staffs. The omission of so many concussions should not surprise since the league did not push hard for a full accounting. Teams were only “strongly encouraged” and “not mandated” to participate, and, according to a league spokesman, some teams “did not take the additional steps of supplying the initial and/or follow-up forms.” Some teams did not report concussions for several of the years under review. The Dallas Cowboys, for example, did not report any concussions.—no concussions over the five-year period! If you believe this, I’ll sell you my beach-front property in Arizona.
Why would teams not report all concussions to the MTBI Committee when they were part of the public record? And, why didn’t the MTBI notice the discrepancies and push back?
Typical explanations were that concussion symptoms can be so brief that no one notices and that doctors might have used different criteria to make concussion diagnoses. Also, it has been contended that players occasionally hide their symptoms of concussions from team doctors because they want to continue playing or don’t want to be labeled pussies. Such explanations are hard to swallow. My suspicion is that the MTBI committee did not press for a full accounting because it preferred numbers that would make concussions appear less prevalent. For their part, individual teams may have been reluctant to offer a full account for fear of questions being raised about why certain players returned to the field more quickly than they should have. Neither the league nor its members wanted to offer bad news; on the contrary, they had a common interest in downplaying the concussion problem.
Conflicts of interest were inherent in the process. Most of the MTBI Committee members were associated with an NFL team in some capacity-- as a neurosurgeon, physician, or, in some cases, an athletic trainer. This meant, in effect, that they made decisions about player care and then studied whether those decisions were proper. Even though MTBI researchers stated unambiguously that their financial or business relationships had not compromised their work, there is good reason to think otherwise.
As The Times reminded readers, the NFL’s actions were reminiscent of how the tobacco industry manipulated scientific evidence to cover up the health risks of smoking. Was this purely coincidental or are we talking collusion?

Top Tobacco Executives Tell Congress Smoking Is Not Addictive
Although The Times found no direct evidence that the NFL took its denial strategy from Big Tobacco, records show a rather cozy relationship between the two businesses. Preston R. Tisch, part owner of both the NY Giants and the Lorillard Tobacco Company, and a board member of both the Tobacco Institute and the Council for Tobacco Research, entities that were central to the industry’s campaign to hide the risks of cigarettes, was a member of the MTBI committee. The Times said that Tisch asked Lorillard’s general counsel, Arthur J. Stevens, to recommend legal cases to NFL commissioner Paul Tagliabue that might help the league confront biased judges and damaging evidence about head injuries.
Records show that the league and the tobacco industry shared lobbyists and consultants, and sometimes intersected in the legal arena. Dorothy C. Mitchell, one of five lawyers at Covington and Burling, was assigned by the NFL to provide legal oversight for the concussion committee. Mitchell’s experience included defending the Tobacco Institute, the industry trade group, against smoker lawsuits, allegedly including during the time she worked for the MTBI Committee. Her work for the MTBI was highly praised by the NFL. Commissioner Tagliabue had been a partner at the same firm before becoming NFL commissioner.
The Times noted the NFL twice hired a research firm (which it didn’t name) that had done work on behalf of the Tobacco Institute to study player injuries. It also pointed to other instances where the league sought lobbying advice from representatives of the Tobacco Institute. All this doesn’t prove collusion, but it sure looks very suspicious.
So while the evidence uncovered by The NYT clearly demonstrates that the MTBI Committee’s research was more deeply flawed than its critics originally thought, it doesn’t definitively prove that the shoddy research was deliberate, aimed at upholding the league’s public image and protecting its bottom line. It does, however, strongly point to the possibility, if not the likelihood. After all, isn’t this what big businesses, like tobacco, energy, and consumer goods, do when their economic interests are threatened by revelations that their products might be harmful to human health and safety? Haven’t we seen enough of this over the years? Why would one expect the NFL to be any different?
Dr. Ann McKee
The NFL’s manipulation of brain science and its decades- long campaign of denial does not just reflect its concern about possible costly lawsuits, it extends further to the future of the game of football. If it is definitively proven that head collisions cause lasting and irreversible neurological damage, and that damage starts in one’s formative years playing the game, then we’re talking about an existential threat to the game. Already several players are retiring out of fear of brain damage. Players at the amateur level also have reason for concern. A recent preliminary study of subconcussive blows in amateur football by Boston University researchers, published on March 31 in the Journal of Neurotrauma, found that the more hits to the head a young football player experiences, the greater the risk that he will be depressed, have difficulty making decisions or develop other forms of cognitive impairment as an adult. If young people turn away from the sport, professional football will be in serious trouble.
The NFL predictably challenged the NYT story, saying that it did not “present a shred of evidence to support its thesis that the NFL intentionally concealed concussion research data. It denied, among other things, that it took legal advice from or shared lobbyists with the Tobacco Institute and hired Dorothy Mitchell because of her experience with tobacco litigation, claims, by the way, not made in The Times article. It asserted that its studies “never purported” to include all concussions, a claim contradicted by other studies and peer review statements. Claiming it had been defamed, it demanded a retraction. The New York Times refused to retract the story.
As regular Phronesis readers must know by now, I tend to see evil intentions behind suspect corporate behavior.  Acknowledging my bias, I still believe the evidence is solid enough to reasonably conclude that the NFL knew exactly what it was doing in attempting to play down the risks of head injuries. Stay tuned for more revelations. They are certain to come.

Should Parents Let Their Children Play Football?


  1. Thanks for your well thought out article. I heard a report on NPR that youth participation in football is down by almost 20%. My son has said that he will not let his boys play football.
    On the other hand football is so ingrained in the American culture that people will actually watch the NFL combine and a NFL pre-season game will draw more viewers than a MLB playoff game!

  2. Great piece on some of the truths behind the $11 Billion dollar NFL industry. Goodell, drawing his $44,000,000/yr salary will do anything to protect the Shield.

    I played on the 81 SF 49ers Super Bowl team, developed hydrocephalus from concussions early in the season at age 22, and survived 3 emergency VP Shunt brain surgeries in 8 months. I fought creditors for years and was forced to sue the 49ers for Work Comp carrier, The Travelers, just to get my last two brain surgeries paid for.

    I won my case in 84, refused their $35,000 offer to settle and kept my medical open and used Vocational Rehabilitation to return to school to complete my Biology degree in 86.

    I survived 5 additional emergency brain surgeries and several gran mal seizures during a 10 month period while enrolled in Organic, Bio Chem and Physics courses. I finally graduated with a BS in Biological Conservation, 8 brain surgeries, gran mal seizures and major short term memory issues in 1990 at age 32 and began my career as a Wildlife Biologist.

    In 93 I survived my 9th brain surgery, yet went on to teach high school Biology, Chemistry, Environmental Studies and Algebra for several years and launch an Environmental Consultanting firm. In 2012 The Travelers wanted me to settle both my knee and brain suit. (I had also had a knee surgery during the 81 season, and two more in 84 repairing their shoddy work, including an experimental GoreTex ACL transplant.)

    In 2012 The Travelers offered me $73,000 to close both my cases. I refused, and they haven't paid a bill since. They are currently into me for over $70,000 despite the fact I was rated 100% disabled by Social Security in 2012 and forced to go out on disability. I was forced to take them back to court after they refused a Drs prescription stating I needed a minimum 30 day inhouse Neurocognitive treatment at the Center for Neuro Skills in Bakersfield, CA. We won our hearing in 2013, they appealed, we won, they took me to a 3 judge appellate panel, we won and they took me to the CA court of Appeals which we just won. All just to with hold my earned benefits. I was admitted to the Center for Neuroskills 8 days ago and have finally been receiving 7 hrs of treatment a day.

    George Visger
    Biologist/Traumatic Brain Injury Consultant
    The Visger Group


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