Concussions

While the story is not a new one, for the NFL, it represents a high-profile and potentially embarrassing cinematic interpretation of a period in which the league sought to refute research suggesting football may contribute to brain disease.

From 2003 to 2009, for example, the NFL’s now disbanded Mild Traumatic Brain Injury Committee concluded in a series of scientific papers that “no NFL player” had experienced chronic brain damage from repeat concussions, and that “Professional football players do not sustain frequent repetitive blows to the brain on a regular basis.”

"There's no question that there's a problem in football. That people who play football are at risk for this disease," said Dr. Ann McKee, director of Boston University's CTE Center and coauthor of the new study. "And we urgently need to find answers for not just football players, but veterans and other individuals exposed to head trauma."

The JAMA study is the largest of its kind and all of those studied were required to have football as their primary exposure to head trauma. The criteria for submitting a brain was based on exposure to repetitive head trauma, regardless of whether that individual exhibited symptoms during their lifetime.

The study points out potential bias because relatives of these players may have submitted their brains due to clinical symptoms they noticed while they were living. It also acknowledges the lack of a comparison group that represents all individuals exposed to college-level or professional football. Without that, the study lacks an overall estimate on the risk of participation in football and its effects on the brain.

Out of 202 deceased former football players total -- a combination of high school, college and professional players -- CTE was neuropathologically diagnosed in 177, the study said. The disease was identified in 110 out of 111 former NFL players. It was also found in three of the 14 high school players and 48 of the 53 college players. The study included brains of individuals who have been publicly confirmed to have had the disease, including Ken Stabler, Kevin Turner, Bubba Smith and Dave Duerson.

"The medical and scientific communities will benefit from this publication and the NFL will continue to work with a wide range of experts to improve the health of current and former NFL athletes," the NFL told CNN in a statement, noting that "there are still many unanswered questions relating to the cause, incidence and prevalence of long-term effects of head trauma such as CTE."

With little more than a month remaining in a five-year agreement to pay for concussion research, the NFL still owes the National Institutes of Health $18 million—more than half of the $30 million that the league agreed to provide for the study back in 2012. Today, a group of Democratic members of the House Committee on Energy and Commerce released a letter to commissioner Roger Goodell, demanding to know the league’s plans for completing the payment.

Jim Plunkett spent 15 seasons as an NFL quarterback from 1971-86, with all those years of punishment taking a heavy toll on his body.

In an interview with Elliott Almond of the Bay Area News Group, Plunkett said his "life sucks" and it's "no fun being in this body right now. Everything hurts."

The 69-year-old Plunkett has had a litany of health issues both during and after his NFL career. He's undergone 18 surgical procedures to repair his back and to give him artificial knees and an artificial shoulder, according to Almond.

The recent news about the degenerative brain disease CTE having been found in deceased former NFL players has triggered new warnings from people predicting the decline of the football and the inevitable weakening of the league’s popularity and prosperity. While the latest study regarding the relationship between chronic traumatic encephalopathy and football is concerning, we have been here before with dramatic assessments about the future of the game—and we will find ourselves in this position again and again. All the while, the NFL’s popularity and prosperity has not withered; it has grown.

THE STUDY

Beyond the presence of CTE being found in 110 of 111 brains that belonged to former NFL players, an equally if not more troubling finding was the prevalence of the disease among those without NFL experience—those who had participated in lower levels of football. Of the 202 such brains tested, 87% were found to have CTE.

Dr. Ann McKee, the study’s lead researcher, noted that there was an inherent bias in the sample of donated brains. Many of the players who were posthumously examined suffered from mood disorders and dementia later in life, and their families were searching for answers. There are not many, if any, brains being examined of former players who went on to lead active and healthy lives. Thus, as any research scientist will tell you, it was a skewed sample.

Having said that, there is still compelling data. What I found most interesting was that linemen—offensive and defensive—represent a sizable majority of players found to have CTE in this latest study. We so often focus on the violent collisions suffered by wide receivers, running backs and quarterbacks in the open field. However, the study indicates more long-term damage in those playing in short-range areas, with repetitive impacts on every play. This finding, if backed up by a more longitudinal study, points to a recommendation to limit contact football as much as possible—specifically at early ages. And that extrapolated finding will not play well at 345 Park Avenue.

NOT GOOD NEWS FOR THE NFL

The NFL responded to the study with usual language about continuing to make football safer; it is not the first time—nor will it be the last—the league has had to confront the reality of CTE. Indeed, at a 2015 roundtable in Washington, Jeffrey Miller, the NFL’s point person on health and safety, responded “yes” when pressed on a potential link between playing football and CTE. Miller was sitting next to Dr. McKee, who at that point had discovered CTE in an overwhelming majority of brains examined. What else was he going to say?

OUR CONTRADICTION

Periodic hysteria will come and go with findings like this study, stoking the fire for those forecasting that football will devolve like boxing, which is viewed by many as a savage sport in decline. That may be a reaction that gets some attention but, well, good luck with that.

As interest in boxing has declined, similar yet more violent sports such as UFC have surged—sports that allow for more contact (lighter gloves with less padding) and more bodily damage than boxing. Violence is inextricably linked to many sports beyond football, in part giving rise to their popularity. Violence sells (just ask Hollywood), and that is why we are drawn to UFC takedowns, NHL fights, NASCAR wrecks, and MLB bean balls.

As to a potential diminution of the talent pool in football, I find it hard to believe there will be a discernible difference going forward. As a former agent and team executive, I have seen the thousands of players begging for NFL tryouts every year; there is no shortage of those trying to enter the league.

Ultimately, we are at this place in our society regarding the NFL and football in general: we bemoan the violence, but we are drawn to it. Like many, I have criticized the NFL about the era depicted in League of Denial and Concussion. And I have seen firsthand the ravages that football has bestowed upon some former player. Yet despite the distaste from those films and the empathy toward what football has sown for these players, I consume the sport regularly. And there are millions like me. There is no zero-sum game here; any reasonable person has to be aware of the contradiction.