Jonathan P. Baird

Players have reported to NFL training camps, exhibition games are underway, and we are already back to football. Along with the players reporting, we also get new updates on the grim toll of brain injuries. The two are now inextricably linked.

The big news for this season is the major new study of football’s effects on the brain. A team of researchers led by neuropathologist Anne McKee examined the brains of former NFL players and found that almost all – 110 out of 111- showed signs of chronic traumatic encephalopathy or CTE.

As Daniel Engber, a writer for Slate has pointed out, that statistic can be misleading. The brains in Dr. McKee’s study were not randomly selected. They were donated by family members who suspected that researchers might find evidence of damage.

Still, even if the numbers are not as spectacularly high as show up in the new study, it is hard not to see them as significant.

CTE has cognitive symptoms like memory loss, violent mood swings and attention deficit; behavioral symptoms like depression and suicidality; and inflated rates of Alzheimer’s and dementia.

In a recent series, the Associated Press put a human face on many previously undisclosed CTE stories. The AP reporters talked to family members of many former players who were diagnosed with CTE after they died. One story I would mention is Ollie Matson’s. Matson was an Olympic medal winning sprinter in the 1952 Helsinki games, a College and Pro Football Hall of Fame player, and a very great running back for the Cardinals, Rams and Eagles. He played pro ball from 1952 to1966.

Matson’s story is remarkable. He played college football for the University of San Francisco. In 1951, Matson’s team went undefeated but they were not allowed to play in any bowl game because Matson and another teammate were black. In that era, the Orange, Sugar, and Gator Bowl committees would not invite any teams that had black players. Matson was the prototype big back before that was common. He was a great receiver, punt and kickoff returner, and open field runner. When Matson retired from the pros, he was second only to Jim Brown in all-purpose yards.

In the AP story, Matson’s son said his father barely spoke in the last four years of his life. He only said “hi” and “bye”. He could not tell a $10 bill from a $100. The dementia symptoms worsened in the years before he died. Matson needed a wheelchair and a nurse for the final five years of his life. The family did not know what to make of his symptoms. Matson’s son now says he now feels robbed of his father’s last years. No one knew about CTE then.

Unfortunately, science still does not have a way to test the prevalence of CTE among living players. That would tremendously improve the science but we do now know for a certainty that there is a neurodegenerative brain disease that is found in individuals who have been exposed to repeated head traumas. The disease is pathologically marked by an increase in abnormal tau protein in the brain. We now know that some significant percentage of players are adversely affected.

With that knowledge, we need to look at how the NFL has responded to the increased awareness of CTE. While the League has taken some steps, especially a concussion protocol, what they have done is grossly inadequate.

Not nearly enough has been done to protect the players. The concussion protocol is a good idea but in practice it has been less than effective. Too often players who are clearly wobbly on their feet end up staying in games.

I think Sally Jenkins, a sports writer for the Washington Post, has most clearly explained the complex reasons this happens. Jenkins explains that the NFL’s compensation structure forces players to play hurt or get cut.

Most NFL players are not superstars with eye-popping contracts. Many are relative unknowns fighting to have a career. The average NFL career across all positions is about two and a half years. Players need playing time to have a chance to succeed. Concussions can get in the way of the opportunity to play. That is a strong disincentive against reporting any injury.

Jenkins argues that the NFL shifts responsibility for head injuries onto the players and away from management. If a player commits a vicious helmet-to-helmet hit, he will get a heavy fine and even a suspension. Think Kam Chancellor of the Seahawks who got a $23,152 fine for spearing. When the medical and coaching staff ignore the concussion protocol, the NFL typically looks the other way.

Jenkins uses the example of Case Keenum, a backup quarterback for the Rams. In a very close 2015 game, with one minute left, the Ravens sacked Keenum and his head bounced violently off the turf. Keenum immediately clutched his head. He could not get up for a while after the play and was down on all fours.

The protocol required Keenum to be removed from the game and to be examined by an independent concussion expert. That did not happen. A Rams trainer briefly talked to a wobbly Keenum. The Rams coach, Jeff Fisher, said Keenum “felt he was okay” and he also said “it was a critical point in the game”. Keenum never was pulled from the game. After the game, doctors diagnosed Keenum with a concussion. The NFL had a conference call about what happened but decided to do nothing. No coach or medical staff got fined or punished for leaving Keenum in the game.

This type of scenario, which is not uncommon, is an occupational health and safety issue which requires further regulation. The League will fine players for spearing and for roughing the passer but it has not fined coaches, trainers, and team doctors for flagrant violations of the concussion protocol. Nor has it penalized owners for countenancing health and safety violations.

Maybe if management took a serious financial hit, more attention would be paid to the correct implementation of the concussion protocol. Now it seems like only the players get fined.

Jenkins calls it “blame-shifting”. The League skates through its own liability by placing all consequences on the players.

There is a need for harder-edged rules that mandate a protocol where players are automatically pulled off the field and examined by an independent concussion expert. The doctors who make the call about a player returning to the game must not be connected to any team or the NFL power structure. The desire to win at all costs is corrupting.

In the realm of occupational health and safety, I think of NFL players as equivalent to coal miners. People may say players or miners assume the risk of their jobs but both occupations are inherently dangerous. Where the players face CTE and orthopedic injury, the miners face black lung, not to mention the danger of mine accidents and cave-ins.

Since the late 19th century, the federal government has regulated coal mining. As fatalities in mines increased (between 1900-1910, coal mining fatalities exceeded 2,000 annually) federal coal mine health and safety law became more comprehensive and stringent. Not surprisingly, with the tougher laws, mining fatalities dramatically dropped.

Football owners have the same kind of control over their business that mine owners have had over the their industry. A big difference is that the NFL owners patrol themselves without much interference. Indifference to player health and safety is a by-product of this brand of laissez-faire capitalism.

I would suggest that NFL owners are modern-day equivalents to 19th century robber barons. According to Forbes Magazine, the NFL’s ten richest owners are worth a combined $61 billion. I probably do not need to say that is an astounding figure. With those kind of resources, it is wrong to assume that far more could not be done to make the game safer. Safer equipment, more protective rules, consequences for coaches, trainers and owners, and better medical research into harms to players could change the game in a very positive way.

I remain doubtful the League will adequately police itself. After all, a few years ago the League denied the very existence of CTE. Now it pushes sole responsibility on the players. Over the history of the NFL, you have to wonder how many thousands of former players suffered from CTE who we will never know about. That is a legacy of suffering that goes far beyond the concussion lawsuit.

No one can deny football is exciting and supremely athletic. But, the human cost remains needlessly high. It does not have to be that way.