Jonathan P. Baird

Another football season is drawing to a close and I think there has been less mention of CTE – chronic traumatic encephalopathy – this season. CTE is the neurodegenerative condition affecting football players who have suffered from too many head hits.

In 2021, there were two stories which illustrate the continuing nature of the CTE tragedy. Vincent Jackson and Philip Adams, both former NFL players, killed themselves. Both were in their thirties, Jackson was 38 and Adams was 32. After their deaths, both received diagnoses of stage 2 CTE, a supposedly milder form of the disorder.

Jackson died alone in a hotel room. It appeared he drank himself to death. The coroner found alcoholic cardiomyopathy, a heart disease caused by alcohol abuse. As for Adams, he murdered six people before he shot himself. Their stories are a stark reminder of the dark side of football that receives insufficient scrutiny.

Jackson was a three-time Pro Bowler and he had six years where he gained over 1,000 yards as a wide receiver. He had a twelve year career, earning the nickname “Invincible”. He was a supremely talented athlete and widely considered a great guy, an NFL role model.

Along with his wife Lindsey, Jackson planned to co-write children’s book. He was the devoted father of four kids. He also went into business and had a thriving portfolio of investments. His wife said,

“His whole plan in the NFL was to set himself up to not have these struggles.”

She reported that around the time his career ended in 2016, Vincent started forgetting conversations. He started showing symptoms of depression. His attention span had diminished. By 2018, she said Vincent was becoming paranoid and he started shutting the blinds when he was at home. He described his brain as becoming “fuzzy”. He turned to alcohol as he felt it cleared his thinking.

Jackson was aware of CTE. In 2015, he saw the movie Concussion about the doctor who first diagnosed the condition among NFL players. He refused to allow any of his children to play tackle football until they reached high school. Jackson minimized any concerns of brain injury as he never received a concussion diagnosis. He tried to hide both his declining cognitive health and his alcoholism.

Dr. Ann McKee, an expert on CTE, based at Boston University School of Medicine, studied Jackson’’s brain after his death and diagnosed CTE. She said the brain had “mild frontal lobe atrophy” and a “split in the internal membrane” with multiple lesions in the frontal cortex.

The New York Times reports that according to the CTE Center at Boston University 20% of players found to have CTE never had a diagnosed concussion. The CTE Center does not see concussions as a reliable indicator of CTE. They would argue that a more direct association are the thousands of smaller subconcussive hits Jackson sustained during his football career.

Jackson’s alcohol use was a destructive coping mechanism for his cognitive decline. He drank to feel better but he could not stop.

Philip Adams did not have Vincent Jackson’s superstar career. He was a defensive back who played for six different teams during his NFL career from 2010-2015. His career was closer to the NFL norm for players who were in the journeyman category. He played in 78 games.

Before he murdered six people, Adams’ family said he had complained of excruciating pain, memory loss and difficulty sleeping. Adams’ sister told USA Today that her brother’s “mental health degraded fast and terribly bad”.

Dr. McKee also studied Adams’ brain after his death. She found severe frontal lobe damage, similar to the brain damage of Aaron Hernandez. Adams’ behavior had shifted dramatically near the end of his life. His temper had escalated and he had neglected personal hygiene. Dr. McKee did not think Adams simply snapped. She said his behavioral and cognitive issues “appeared to be a cumulative progressive impairment”.

The Adams family released a statement that said, in part,

“After going through medical records from his football career, we do know that he was desperately seeking help from the NFL but was denied all claims due to his inability to remember things and to handle seemingly simple tasks, such as traveling hours away to see doctors and going through extensive evaluations.”

Adams died of a self-inflicted gunshot wound to the head. It is not clear why he murdered six people before he shot himself. The investigating sheriff found multiple guns, ammunition and writings which he deemed “incoherent” at Adams’ residence.

A few observations are in order. The deeper problem that has been increasingly identified in football is the cumulative effect of repetitive head hits – not just concussions. Both the examples of Jackson and Adams speak to that.

In the realm of risk reduction, pro football could do much more to protect the players’ health. The NFL could shorten the season and get rid of Thursday and Monday night games. It could build in more bye weeks. It is no secret that many players hate not having enough time to recover from games. All the scheduling is about maximizing profit at the players’ expense.

Playing less does not rule out brain injury but it might lessen harm.

Then there is improving football helmet technology. There is a genuine dispute about whether helmet design can be improved. Dr. David Camarillo of Stanford, a nationally respected bioengineer, believes he could design a helmet that could reduce concussions by 75%. On the other hands, opposing experts point out that more sophisticated helmets do not do much about the accumulation of subconcussive hits. They argue that safety should mean no head hits.

Science could help these issues if CTE could be diagnosed while players are living. Now CTE can only be diagnosed through an autopsy. However, in December, scientists at Boston University produced a study that shows MRIs may soon be able to detect CTE while people are alive. That would be a huge breakthrough for early detection.

Finally there are more radical reform idea like moving from tackle football to flag football. Maybe football needs to be reimagined in a less lethal design.

The profit system is a meat grinder. Even with the NFL concussion settlement, the NFL still tries to minimize responsibility. More attention must be paid to the well-being of players after football. Too often, permanently impaired ex-players are left on their own to fend. Ex-players should not be treated like cars with an expired warranty.