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Authors: Steve Almond

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Over the past few years, a growing body of medical research has confirmed that football can cause traumatic injury to the brain, not as a rare and unintended consequence, but as a routine byproduct of how the game is played. The central concern among doctors is no longer catastrophic injuries—concussions that result from big collisions—but the incremental (and therefore largely invisible) damage done by numerous sub-concussive hits.

A study commissioned by the NFL Players Association determined that recently retired pros (ages thirty to forty-nine) are nineteen times more likely to suffer from brain-trauma-related illness than—what's the right word here?—noncombatants. Given that aging stars don't want to be seen as disabled, they tend to downplay or even hide their infirmities. The numbers are likely higher.

Players may die younger, too. “Whereas white males live to 78 years and African-American males live to approximately 70 years, it appears that professional football players in both the United States and Canada have life expectancies in the mid to late 50s,” according to Dr. Lee Nadler, a neurologist
at Harvard. A 2011 study conducted by the Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina put life expectancy for players at fifty-five.

NFL officials have sought to rebut these claims by trumpeting a 2012 study conducted by the National Institute for Occupational Safety and Health. It tallied death rates among more than 3,400 former players and concluded that they enjoy greater longevity.

But this approach, as any actuary would tell you, is inherently flawed, because the average age of death among men in the general population factors in those who die as children or young adults, as well as the poor, sickly, and undernourished. Oh, and smokers. The proper control for NFL players would be a cohort of super-fit, affluent, college-educated men. The study also tracked subjects who turned pro between 1959 and 1988, an era when players were much smaller. Until a sound longitudinal study is conducted, no one can say for sure how playing football effects mortality.

What has become increasingly obvious is that numerous NFL players incur brain damage. Doctors have autopsied the brains of dozens of former pros such as Junior Seau, Mike Webster, and Dave Duerson, and confirmed that they suffered from a form of dementia called Chronic Traumatic Encephalopathy (CTE). Like Seau, Duerson, an All-Pro safety, shot himself in the chest. Before taking his life, he sent his family a text message requesting that his brain be used for research.

A new crop of retired stars is just beginning to report
symptoms. Brett Favre, among the most heralded quarterbacks of the past two decades, shocked fans when he confessed to memory lapses last year. “I don't remember my daughter playing soccer one summer,” Favre said. “So that's a little bit scary to me. For the first time in forty-four years, that put a little fear in me.”

Terry Bradshaw was so concerned about his faculties that he sought diagnostic help five years ago. “I couldn't focus and remember things, and I was dealing with depression,” the sixty-five-year-old Hall of Famer recounted. “I got tested to see what condition my brain is in. And it's not in real good shape.”

Running back Tony Dorsett received the same news last year. At fifty-nine, he had been living with bouts of depression and memory loss. In a tearful television interview, he admitted he gets lost driving his daughters to their sports games. “It's painful, man, for my daughters to say they're scared of me … I've thought about crazy stuff, sort of like, ‘Why do I need to continue going through this?' I'm too smart of a person, I like to think, to take my life, but it's crossed my mind.”

Once again, nobody can say for sure what the prevalence rate of CTE is in active NFL players. The diagnostic tools don't exist yet. Doctors have yet to determine how factors such as drug use or genetic disposition might contribute to the brain damage they're seeing. And the sample group is admittedly skewed—former players whose families have submitted their brains for examination. But the numbers are stark. As of March, neuropathologists at the NFL's designated
brain bank had examined fifty-five former football players. All but one showed signs of CTE. Already, the disease has been identified in the brains of deceased college players and even one high schooler.

The first wave of media coverage, two decades ago, focused narrowly on the impact of concussions. As doctors gathered more data, and shifted focus to the risks posed by the smaller collisions that occur every single play, the story evolved from a practical question—how to minimize big hits?—to an existential crisis.

It's useful to recall here the manner in which the public outcry over violence reshaped football a century ago. Back then, the President of the United States felt duty-bound to help speed reforms. The game was killing and maiming college and high school players. It was a moral problem.

The moment football became a business, violence was no longer just a moral problem. It was a money problem.

This, of course, is the big dance of capitalism: how to keep morality from gumming up the gears of profit, how to convince people to make bad decisions without seeing them as bad. We have whole industries devoted to this voodoo, the dark arts of advertising, marketing, public relations, lobbying. Every day, an army of clever men and women are devising new ways to get us to enjoy tobacco and animal flesh and petroleum and corn syrup without suffering the harsh aftertaste of guilt, without dwelling on the ethical costs of
these pleasures. Oftentimes, you will hear some academic type marvel at the American capacity for self-delusion. Here's our secret: we're soaking in it.

I mention all this not just to get my socialist jollies, but to emphasize the larger system within which modern football operates. From the perspective of its governing body, the NFL, the game is a multi-billion-dollar product. And those of us who love it are not innocent
fans
rooting for our teams to prevail. We're
consumers.
Our money and attention are what subsidize the game.

This is true of all pro sports. But it's especially true of football. Consider this factoid. In 1948, nearly nine-tenths of the revenue earned by the NFL's best team, the Philadelphia Eagles, came from ticket sales. The share from radio and TV rights was 3 percent. Hardcore fans kept the league afloat, the ones who braved stadiums so cold that players sat bundled in hay to keep warm on the sidelines.

This season, the NFL will receive $5 billion in TV rights alone, nearly half its total revenue, and three times more than Major League Baseball earns. This money is generated by the tens of millions of casual fans engaged in what we might call “passive consumption” (i.e., watching a game on your couch while inhaling Cheetos).

But the league's ascendance has had unintended consequences. Stars now qualify as national celebrities, and their physical deterioration is front-page news. Television coverage renders each game as both epic and personal. Back in the seventies, the camera angles were limited and the images
often grainy. The players remained obscure under their bulky exoskeletons, more like superheroes than human beings. Today, we see the game in high-def. Slow motion replays show us the unnatural angle of a broken ankle, and a quarterback's contorted face at the precise moment he is concussed. We hear the impact thanks to tiny microphones affixed to player's uniforms. It's gotten harder and harder for even casual fans to deny the cruelty of the game.

The standard rationalization hauled out at this point is that the NFL will clean up the game. As fans, we want to believe that league officials will choose the righteous path over the profitable one. This is nonsense and always has been.

From the beginning, the NFL has sought to obscure the most disturbing aspects of the game. This is why Bertie Bell, the first great commissioner of the NFL, wrote a stipulation into the contracts the league signed with TV networks prohibiting them from showing injuries or fights. “In the matter of television and radio we are doing a job for the public,” he explained, “a job of showing them the best football in the world.” In a more candid moment, Bell explained the appeal of the sport this way: “You knock my brains out this Sunday and I knock your brains out the next time we meet.”

So football's guardians have always tried to walk this absurd line, between selling violence and disavowing it. The best way to gauge how league officials will respond to safety concerns is to consider what they have done thus far.

The first commissioner to issue a public statement on concussions was Paul Tagliabue, who succeeded Pete Rozelle in 1989. His statement: “On concussions, I think this is one of those pack journalism issues, frankly. The problem is a journalist issue.” He cited steroids, drinking, and other injuries as more pressing matters.

Having served as the league's lead counsel before becoming commissioner, Tagliabue eventually adopted the same activist strategy employed by the tobacco industry. He sought to shape public debate by flooding the market with junk science. The NFL created a “research body” called the Mild Traumatic Brain Injury Committee. (If you believe, as I do, that language is essentially an instrument of truth, we might pause here a moment to linger upon the spooky propagandistic frisson produced by the juxtaposition of those two words:
mild, traumatic.
)

Tagliabue chose a man named Elliot Pellman to chair the committee. Pellman was a rheumatologist with no experience in brain research. He worked for the New York Jets and was Tagliabue's personal physician.

Members of the committee published sixteen papers in a medical journal called
Neurosurgery,
whose editor-in-chief was a consultant to the New York Giants. These papers invariably reached the same conclusion: NFL players were, if not impervious to brain injury, unlikely to suffer long-term effects. The authors, many of whom had worked in and around football for years, seemed at times almost touchingly naive about the fundamental nature of the game. (“Professional
football players do not sustain frequent repetitive blows to the brain on a regular basis.”) A number of these papers found a home in
Neurosurgery
only after being rejected by other editors and peer reviewers. Some were later repudiated by their own authors. Still, the committee provided crucial cover for Tagliabue. Every time some pesky reporter brought up concussions, he could point to the MBTI and its reams of exculpatory data.

The problem was that the number of former players showing signs of cognitive damage kept growing. They also began committing suicide in rather flamboyant ways. Steelers lineman Terry Long drank anti-freeze. His teammate Justin Strzelczyk led police on a high-speed chase before crashing into a tank truck at 90 mph. Long was forty-five, Strzelczyk thirty-six.

By the mid-2000s, a group of neurologists unaffiliated with the NFL had begun examining deceased players and finding incontrovertible evidence of brain damage that explained the disturbing symptoms of dementia reported by family members. In 2007, new commissioner Roger Goodell listened to a number of these doctors present their findings at a conference he convened on brain injuries.

His public response subtly undermined the link between football and brain damage. “I'm not a doctor, but you have to look at their entire medical history,” he said. “To look at something that is isolated without looking at their entire medical history I think is irresponsible.” The league also released a carefully worded pamphlet whose ostensible purpose was to
inform players of the risks associated with concussions: “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly … Research is currently underway to determine if there are any long-term effects of concussions in NFL athletes.”

The league had entered its official Obfuscation Phase.

It didn't last long. Two years later, an NFL spokesman told a reporter this: “It's quite obvious from the medical research that's been done that concussions can lead to long-term problems.” By this time, larger media outlets—
The New York Times
and
PBS
in particular—had begun piecing together the NFL's systematic cover-up. Players had begun to speak out and to consider legal remedy.

In 2011, a former Atlanta Falcons safety named Ray Easterling sued the NFL, an action eventually joined by more than 4,500 other former players. The suit accuses the NFL not only of negligence but fraud, a “concerted effort of deception and denial” that includes “industry-funded and falsified research.”

In 2013, the NFL agreed to pay a settlement of $765 million, along with an estimated $200 million in legal fees. The presiding judge deemed this sum insufficient to cover the anticipated medical costs of the 20,000 players who eventually may qualify for payment.

Anybody with even a rudimentary sense of how corporations regard liability will understand why the NFL is so eager
to make a deal. First, a settlement would guarantee that league officials never have to answer questions under oath regarding what they knew, and when, about the link between football and brain damage. Second, they would avoid the discovery phase, which would make public the grisly medical histories of former players. Presumably, some of these players and their family members would testify. It would be a public relations disaster.

And that's what matters, in the end, to NFL officials, and what makes their conduct so transparent. Roger Goodell and the men who work for him are not stupid. They've looked at the mountain of medical data and come to the same reluctant conclusion that Big Coal and Big Meat did decades ago. The business they run is unsafe for their workers.

The moral decision in this situation isn't very complicated: you stop playing the game until you learn more. You explain the dangers to your players (and the public) and you apologize for gambling with their health.

BOOK: Against Football
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