Almost half of all Americans consider themselves a fan of professional football, according to a recent Associated Press poll. In a country with a population of over 319 million, 49 percent of people polled said they were NFL fans (Poll: 49 Percent Are Pro Football fans).
Spectators enjoy watching their favorite athletes utilize every bit of their ability to outwit and out muscle their opponents. The rewards of a career in the NFL can be enormous and the risk of serious injury is equally as great. Not unlike the ancient Romans watching gladiators fight to the death, football fans cheer loudest when a defender makes a bone-crunching hit on a quarterback or when a receiver defies gravity making an unbelievable catch during a mid-air collision with a safety. Until recently, fans of professional football might not have been aware of the potential harm that their favorite players were exposed to each week.
Injuries are common in football. Bone fractures, lacerations, contusions, sprained tendons, torn ligaments, and even “turf toe” are just some of the trauma football players endure. Given the natural physical intensity of the game it is not unusual for athletes to receive multiple hits to their heads. Some hits are easily shrugged off, while others require some down time to recuperate.
Unlike visible trauma, the severity of head injuries is not as easily detected and the long-term consequences were virtually unheard of until recently. It is now clear that a correlation between repeated concussions and Chronic Traumatic Encephalopathy, otherwise known as CTE, exists among professional football players and it appears the NFL purposefully chose to ignore it.
A long time ago...a pathologist made a discovery.
Pathologist Harrison Martland was the first to describe CTE in a 1928 Journal of American Medical Association article as dementia pugilistica or “punch drunk” syndrome. Doctor Martland noted that symptoms such as slowed movement, tremors, confusion, and speech problems were typical of the condition. As a result of his study of repetitive head injuries, he hypothesized, “Marked mental deterioration may set in necessitating commitment to an asylum” (Martland). Doctor Martland concluded, “The occurrence of the symptoms in almost 50 percent of the athletes who develop this condition in mild or severe form, if they keep at the game long enough, seems to be good evidence that some special brain injury due to their occupation exists” (Martland, 1103).
By 1966, the diagnosis Chronic Traumatic Encephalopathy began to appear in medical literature and has since become the preferred terminology for this condition. In his journal article, “Chronic Traumatic Encephalopathy: A Review," Michael Saulle, MD, states, “CTE is a progressive neurodegenerative disease that is a long-term consequence of repetitive closed head injury for which there is no treatment and no definitive pre-mortem diagnosis” (Saulle). CTE has been closely tied to athletes who participate in contact sports with a high incidence of traumatic brain injury (TBI) as in boxing and American football.
Dr. Omalu meets Mike Webster and makes the connection.
In September of 2002, a pathologist at the Allegheny County coroner’s office in Pittsburgh, Pennsylvania, named Bennet Omalu, was assigned to conduct an autopsy on the body of a hometown football hero. Webster had been the starting center for the Pittsburgh Steelers offensive line for 15 seasons, from 1974 to 1988. He was known as “Iron Mike” partly because he would refuse to leave the line up even after sustaining serious injuries. He once played six straight seasons without missing a single snap. Webster was a key component in the Steelers’ four Super Bowl wins in the 1970’s. He was selected for the Pro Bowl nine times and was inducted into the Pro Football Hall of Fame in 1997.
After his football career ended, Webster began experiencing severe dementia, paranoia, explosive behavior, and memory loss. Years earlier he had been diagnosed with brain damage as a result of the many blows to the head he had received as a player. Dr. Omalu was not just the coroner assigned to Webster, but a specialist in forensic neuropathology. Though his examination of Webster’s heart showed damage consistent with that of a heart attack, when he learned of Webster’s history of brain damage and mental illness, he wanted to study his brain (Sokolove).
To his surprise, Webster’s brain appeared relatively normal, but under microscopic examination he discovered large accumulations of tau proteins. Dr. Omalu explained that, “Tau was kind of like sludge, clogging up the works, and killing cells in regions responsible for mood, emotions, and executive functioning” (Laskas). Dr. Omalu spent years analyzing the data he uncovered and wrote a paper outlining his findings; it was published in the peer-reviewed journal Neurosurgery in 2005 (Sokolove).
The short video below explains the pathology of Tau protein and how it is affected by concussions.
The short video below explains the pathology of Tau protein and how it is affected by concussions.
Robert Cantu, MD, explains, “Multiple concussions trigger progressive degeneration of the brain tissue and cause a build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last concussion. Brain degeneration is associated with memory loss, confusion, impaired judgment, paranoia, impulse control problems, aggression, depression, and progressive dementia” (Cantu).
Science collides with a corporate super power.
Doctor Omalu expected the NFL would appreciate his work and use the evidence of concussion related brain injury to fix the issue. Instead he was ridiculed and harassed by a series of scientists who were employed by the NFL. They accused him of having flawed data, of misunderstanding his results, and even petitioned Neurosurgery to retract his paper (Sokolove). The NFL viewed his discoveries as a threat to their existence. If the problem were truly as serious as Dr. Omalu claimed, parents might not allow their sons to play football in high school. Where would colleges find quality players? How would the NFL sustain itself without that continuous crop of fresh young men to replace the older, worn out ones? The multi-billion dollar corporation attacked Dr. Omalu with an arsenal of doctors and lawyers. The NFL had declared war on Dr. Omalu and unfortunately the death toll would continue to rise.
The tragic deaths continue...
By the time his paper was published, Dr. Omalu had already received another brain from a retired NFL player to study and several more arrived in the years to follow. Pittsburgh Steelers offensive lineman Terry Long committed suicide in 2005. In the 13 years after his retirement, Long had suffered from progressively worsening mental illness that eventually led him to kill himself by drinking anti-freeze; he was 45 years old. Another retired Steelers offensive lineman, 36-year-old Justin Strzelczyk, drove his car head-on into a tanker truck filled with explosive chemicals during a police chase. Strzelczyk suffered from dementia and experienced episodes of paranoid schizophrenia. Dr. Omalu’s examination of Strzelczyk and Long revealed their brain’s also contained high levels of tau (Laskas).
The following short videos are from an ESPN documentary about the final days of Justin Strzelczyk and his violent death. They provide insight into his mental state at the time of his death, as a result of CTE.
The following short videos are from an ESPN documentary about the final days of Justin Strzelczyk and his violent death. They provide insight into his mental state at the time of his death, as a result of CTE.
Two decades of denial.
Eleven years before the discovery of toxic tau protein, the NFL began a campaign intended to minimalize public perception of CTE. In 1994, the NFL created the acronym MTBI, which stood for Minor Traumatic Brain Injury (Ezell). They deliberately preempted the seriousness of traumatic brain injury by placing emphasis on the word ‘minor’. NFL commissioner at the time, Paul Tagliabue, appointed the New York Jets team doctor and rheumatologist Dr. Elliot Pellman as the chairman of the MTBI committee (Ezell). A Rheumatologist is an internist that specializes in musculoskeletal pain disorders such as arthritis and osteoporosis. Dr. Pellman was asked by Newsday magazine what the MTBI committee was doing to address the issue of concussions. He replied, “We discuss it on the list of things every time we have a league meeting. We think the issue of knees, of drugs and steroids and drinking is a far greater problem, according to the number of incidents” (Ezell). Dr. Pellman also told Sports Illustrated magazine, “concussions are part of the profession, an occupational risk” (Ezell). These opinions indicate either a fundamental lack of understanding for the gravity of traumatic brain injuries, an obstinance influenced by the power of a multi-billion dollar corporation, or both. The fact that CTE can only be diagnosed post mortem is the sole argument that can be made in defense the NFL. Except, that once they were presented with detailed scientific research they chose to initiate a scheme of denial and attempt to discredit the source.
Reading the signals...
Observe the body language employed by NFL Commissioners Tagliabue and Goodell in the photos below. Taken several years apart, the images show the commissioners speaking at press conferences about concussions. Both are leaning slightly to the right which can indicate an attempt to appear non-threatening and thoughtful. Their raised hands with palms up are used to imply innocence. Commissioner Tagliabue has a facial expression of concern, while Commissioner Goodell's expression appears somewhat surprised. How does their body language influence you?
New commissioner, Same story.
In 2007, Roger Goodell, the newly appointed commissioner of the NFL, organized a meeting of doctors and trainers from all 32 teams to address the issue of concussions. Surprisingly Dr. Omalu was not invited to the conference. Neurosurgeon Julian Bailes was asked to speak and he presented Dr. Omalu’s research on his behalf (Laskas). Dr. Bailes recalled the less than warm reception he received:
"They didn't say, ‘Thanks, Doc, that's great.’ They got mad at me. We got into it. And I'm thinking, this is a new disease in America's most popular sport, and how are its leaders responding? Alienate the scientist who found it. Refuse to accept the science coming from him." (Laskas)
The back and forth exchange of clear scientific data versus a mentality dedicated to impugn the messenger continued into the next decade, even as retired players continued to die young and tragically.
"They didn't say, ‘Thanks, Doc, that's great.’ They got mad at me. We got into it. And I'm thinking, this is a new disease in America's most popular sport, and how are its leaders responding? Alienate the scientist who found it. Refuse to accept the science coming from him." (Laskas)
The back and forth exchange of clear scientific data versus a mentality dedicated to impugn the messenger continued into the next decade, even as retired players continued to die young and tragically.
David (aka Jason Luckasevic) and Goliath (aka the NFL)
Attorney Jason Luckasevic began his career in 2000 at a law firm in Pittsburgh. At the same time, his older brother, Todd, was in his medical residency at the Allegheny County medical examiner’s office, working under Dr. Omalu. Over the next few years, Jason Luckasevic worked with Dr. Omalu on several cases and a professional relationship as well as a friendship developed. Luckasevic grew concerned watching his friend being attacked in the media, “It looked to me like Bennet had raised his hand and said there’s a problem we need to be aware of, and he got savaged for it” (Laskas). In 2006, Luckasevic began meeting with retired NFL players, many of whom exhibited various signs of progressive brain disorder. As he gradually earned the trust of a few retired players, more started calling him.
In 2011, Luckasevic, on behalf of approximately 4,500 ex-NFL players, filed a class-action lawsuit against the league for damages related to on-field concussions. The retirees contend the league failed to warn them adequately about the dangers of brain damage. In return, the NFL vehemently denied the allegations and expanded its attack on Dr. Omalu’s research (Laskas).
In 2011, Luckasevic, on behalf of approximately 4,500 ex-NFL players, filed a class-action lawsuit against the league for damages related to on-field concussions. The retirees contend the league failed to warn them adequately about the dangers of brain damage. In return, the NFL vehemently denied the allegations and expanded its attack on Dr. Omalu’s research (Laskas).
The NFL goes from "Defense" to "defendant."
By 2009, the NFL was coming under intense scrutiny by the media, player organizations, and the scientific community. More doctors, conducting more research, and public concern for player safety resulted in a series of Congressional Committee hearings. Rep. Linda Sanchez (D-Calif.) told Commissioner Goodell, “the league’s response to the problem reminds her of the tobacco industry’s handling of the link between smoking and health problems in the 1990s” (Ezell).
At a press conference in December, NFL Spokesman Greg Aiello told reporters, “it’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems” (Ezell). This is the first admission by the NFL that a correlation exists between concussions and long-term brain disorders.
At a press conference in December, NFL Spokesman Greg Aiello told reporters, “it’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems” (Ezell). This is the first admission by the NFL that a correlation exists between concussions and long-term brain disorders.
The gallery below contains some recent satirical images by nationally recognized political cartoonists. They draw attention to the NFL's handling of the concussion issue. Satire can play an important roll in sharing information, especially when free speech or dissent are prohibited by those in power.
Click on any image to enlarge.
Click on any image to enlarge.
Seeing the blitz coming the NFL finally decides to punt.
In an unprecedented turn of events, the NFL reversed its position on concussion related brain injuries in 2010. Immediately NFL spin-doctors began working feverishly to undo decades of denial and obstruction. The league donated $30 million to the National Institutes of Health for brain trauma research. The NFL also instituted new rules designed to minimize concussions from high-risk plays such as punt returns, hits on defenseless receivers, and direct hits to the head. Helmet to helmet hits were banned from the game and now includes a 15 yard penalty, a $50,000 fine, and potential suspension (Ezell). Then, in 2013, the NFL players association donated $100 million to Harvard Medical School for research into the health problems that affect current and former football players (Ezell).
Lawyers huddle to discuss a settlement.
In another surprise move, three years of ongoing court proceedings debating the lawsuit brought on by retired NFL players may be coming to a close. The NFL is expected to agree to a settlement offer mediated by United States District Court Judge Anita Brody. The settlement provides an uncapped amount of money for the treatment of CTE and damages, which the court expects could exceed $1 billion (Belson). It also includes $75 million for testing retirees, $10 million for concussion education, and establishes procedures for determining a player’s eligibility (Belson). The league is also not required to admit it withheld information about the dangers of head injuries from the players. Depending on a player’s age and degree of disability, a retired player could receive between $100,000 and $5 million (Belson).
Many skeptics view this settlement as a sweetheart deal for the league considering the NFL’s $9 billion annual revenue. New York Times reporter Michael Sokolove put this in perspective by stating, “That’s nothing for an entity as rich as the NFL. Goodell, the league’s commissioner, made $44 million last year - or nearly nine times the maximum payment for the most severely brain-damaged NFL retiree” (Sokolove). While several players are expected to opt out of the proposed settlement, it could be ratified by early 2015 (Belson).
Since the onset of professional football, research has shown that repetitive head injuries can lead to chronic brain disorders. As early as 1928, the symptoms of slowed movement, speech problems, confusion, and mental deterioration were recognized outcomes. Over decades, more and more research was conducted to examine the pathology of closed head injuries, or concussions. Despite efforts to minimalize the condition, Chronic Traumatic Encephalopathy has become the prominently accepted result of concussions in medical science. Thus it was evidenced that multiple concussions do perpetuate CTE and NFL players in particular suffer the symptoms of this progressive neurodegenerative disease. As the 100th anniversary of the NFL approaches, only after many players have tragically died as a result of CTE, and a sizeable lawsuit by over 4,500 retired players, is the NFL finally acknowledging the research…that the correlation between concussions and CTE is real.
Since the onset of professional football, research has shown that repetitive head injuries can lead to chronic brain disorders. As early as 1928, the symptoms of slowed movement, speech problems, confusion, and mental deterioration were recognized outcomes. Over decades, more and more research was conducted to examine the pathology of closed head injuries, or concussions. Despite efforts to minimalize the condition, Chronic Traumatic Encephalopathy has become the prominently accepted result of concussions in medical science. Thus it was evidenced that multiple concussions do perpetuate CTE and NFL players in particular suffer the symptoms of this progressive neurodegenerative disease. As the 100th anniversary of the NFL approaches, only after many players have tragically died as a result of CTE, and a sizeable lawsuit by over 4,500 retired players, is the NFL finally acknowledging the research…that the correlation between concussions and CTE is real.
Why should NFL fans care?
Holding competitive games in large capacity venues has been around for centuries. Traumatic injuries and even death have always been a part of competition. People used to travel great distances on foot for an opportunity to witness an event. Now we only need to turn on a television, a tablet, or a mobile phone to watch our favorite sports. Multiple 24/7 sports media outlets broadcast events via satellite, cable, and the web. Changes in public opinion and morality eventually led to the end of gladiators fighting to the death for entertainment. Is that what is happening here or are we doing the reverse? Have our morals deteriorated to the point where spectators are demanding athletes sacrifice their lives for the sake of a game?
Even though the NFL is preparing to settle the concussion lawsuit with an astronomical amount of money the potential for players to develop serious brain disorders still exists. Fans, parents, and players from peewee to pro need to educate themselves about the dangers of concussions. Hopefully all of the attention and large amounts of money being directed at concussion education, prevention, and treatment will have a positive affect on the sport.
The gallery below is a collection of photos from various NFL games over the past few seasons. They are a split second, frozen in time, during violent head to head collisions. These images help illustrate the destructive force and potential mechanism of injury players endure on a weekly basis.
Click on any image to enlarge.
Even though the NFL is preparing to settle the concussion lawsuit with an astronomical amount of money the potential for players to develop serious brain disorders still exists. Fans, parents, and players from peewee to pro need to educate themselves about the dangers of concussions. Hopefully all of the attention and large amounts of money being directed at concussion education, prevention, and treatment will have a positive affect on the sport.
The gallery below is a collection of photos from various NFL games over the past few seasons. They are a split second, frozen in time, during violent head to head collisions. These images help illustrate the destructive force and potential mechanism of injury players endure on a weekly basis.
Click on any image to enlarge.
References/Works Cited
Associated Press. "Poll: 49 Percent Are Pro Football fans." ESPN. ESPN Internet Ventures, 25 Jan. 2014. Web. 11 Nov. 2014.
Belson, Ken. "Brain Trauma to Affect One in Three Players, N.F.L. Agrees." The New York Times. The New York Times, 12 Sept. 2014. Web. 02 Nov. 2014.
---. "N.F.L. Makes Open-Ended Commitment to Retirees in Concussion Suit." The New York Times. The New York Times, 25 June 2014. Web. 11 Nov. 2014.
Brick, Michael. "Tau Could Be the Key to Monitoring Brain Damage From Concussions." Newsweek. Newsweek Magazine, 29 May 2014. Web. 05 Nov. 2014.
Cantu, Robert, MD. "What Is CTE?" Chronic Traumatic Encephalopathy (CTE). Sports Legacy Institute, n.d. Web. 05 Nov. 2014.
Ezell, Lauren. "Timeline: The NFL’s Concussion Crisis." PBS. PBS, 8 Oct. 2013. Web. 22 Nov. 2014.
Fenno, Nathan. "Hall of Famer Mike Webster's Estate, Others Sue NFL over Concussions." Los Angeles Times. Los Angeles Times, 21 Mar. 2014. Web. 05 Nov. 2014.
Laskas, Jeanne M. "Game Brain: Football Players and Concussions." GQ. Condé Nast, Oct. 2009. Web. 14 Nov. 2014.
Martland, Harrison S., MD. "Punch Drunk." Journal of the American Medical Association 91.15 (1928): 1103-1107.JAMA Network. Web. 5 Nov. 2014.
Mckee, A. C. "The Spectrum of Disease in Chronic Traumatic Encephalopathy." Brain 136.1 (2013): 43-64. Web. 2 Nov. 2014.
Saulle, Michael, and Brian D. Greenwald. "Chronic Traumatic Encephalopathy: A Review." National Center for Biotechnology Information. U.S. National Library of Medicine, 10 Apr. 2012. Web. 05 Nov. 2014.
Strobel, Gabrielle. "Meet the New Progressive Tauopathy: CTE in Athletes, Soldiers" ALZFORUM. Biomedical Research Forum, LLC, 21 Nov. 2012. Web. 12 Nov. 2014.
Sokolove, Michael. "How One Lawyer’s Crusade Could Change Football Forever." The New York Times. The New York Times, 08 Nov. 2014. Web. 11 Nov. 2014.
Associated Press. "Poll: 49 Percent Are Pro Football fans." ESPN. ESPN Internet Ventures, 25 Jan. 2014. Web. 11 Nov. 2014.
Belson, Ken. "Brain Trauma to Affect One in Three Players, N.F.L. Agrees." The New York Times. The New York Times, 12 Sept. 2014. Web. 02 Nov. 2014.
---. "N.F.L. Makes Open-Ended Commitment to Retirees in Concussion Suit." The New York Times. The New York Times, 25 June 2014. Web. 11 Nov. 2014.
Brick, Michael. "Tau Could Be the Key to Monitoring Brain Damage From Concussions." Newsweek. Newsweek Magazine, 29 May 2014. Web. 05 Nov. 2014.
Cantu, Robert, MD. "What Is CTE?" Chronic Traumatic Encephalopathy (CTE). Sports Legacy Institute, n.d. Web. 05 Nov. 2014.
Ezell, Lauren. "Timeline: The NFL’s Concussion Crisis." PBS. PBS, 8 Oct. 2013. Web. 22 Nov. 2014.
Fenno, Nathan. "Hall of Famer Mike Webster's Estate, Others Sue NFL over Concussions." Los Angeles Times. Los Angeles Times, 21 Mar. 2014. Web. 05 Nov. 2014.
Laskas, Jeanne M. "Game Brain: Football Players and Concussions." GQ. Condé Nast, Oct. 2009. Web. 14 Nov. 2014.
Martland, Harrison S., MD. "Punch Drunk." Journal of the American Medical Association 91.15 (1928): 1103-1107.JAMA Network. Web. 5 Nov. 2014.
Mckee, A. C. "The Spectrum of Disease in Chronic Traumatic Encephalopathy." Brain 136.1 (2013): 43-64. Web. 2 Nov. 2014.
Saulle, Michael, and Brian D. Greenwald. "Chronic Traumatic Encephalopathy: A Review." National Center for Biotechnology Information. U.S. National Library of Medicine, 10 Apr. 2012. Web. 05 Nov. 2014.
Strobel, Gabrielle. "Meet the New Progressive Tauopathy: CTE in Athletes, Soldiers" ALZFORUM. Biomedical Research Forum, LLC, 21 Nov. 2012. Web. 12 Nov. 2014.
Sokolove, Michael. "How One Lawyer’s Crusade Could Change Football Forever." The New York Times. The New York Times, 08 Nov. 2014. Web. 11 Nov. 2014.