Posts Tagged ‘football and brain injury’

Exposing All The Harm: Football Players and Head Damage – posted 1/1/2015 and published in the Concord Monitor on 1/9/2015

January 1, 2015 6 comments

This article appeared in the Concord Monitor on January 9, 2015 under the title “The Offseason”.

I think there is plenty of room to disagree about the most compelling football or football-related story of 2014. Locally some might pick the New England Patriots’ surprising run which may lead to a Super Bowl appearance. As I recall, part of the fan base was ready to unload the quarterback and the coach early in the season.

Then there was the Washington Redskins’ name controversy which threatened to reach critical mass. In November, thousands of Native Americans in Minnesota protested the racist name saying, “We don’t want to be your mascot.”

I also would mention the Ray Rice and Adrian Peterson stories. They unintentionally shed light on some typically hidden realities.

The saddest story was the suicide of Ohio State football player, Kosta Karageorge.The police found Karageorge’s body, along with a handgun, in a dumpster. They ruled Karageorge died of a self-inflicted gunshot wound.

Karageorge’s mother told police her son had sustained several concussions and he suffered from “confusion spells”. Shortly before he died Karageorge sent his mother the following text message: “I am sorry if I am an embarrassment but these concussions have my head all fucked up.”

The concussion/brain injury story must remain at the top of the football story list. The NFL itself announced this fall that it expects a third of retired players to develop long-term cognitive problems. That could be Alzheimer’s, Parkinson’s, Lou Gehrig’s Disease, or dementia.

Just to spell it out a bit more, the NFL’s own actuarials show that players who live to age 50-59 develop Alzheimer’s and dementia at a rate 14 to 23 times higher than the general population of the same age group. For the age group 60-64, the rate is 35 times higher.

NFL players can expect to die 20 years earlier than the average American male. Research from Harvard initiated by the NFL Players’ Association concluded that the average life expectancy for NFL players is in the mid to late 50’s.

The health consequences of football is a still unravelling mystery although pieces of the puzzle have become clear. The American people need the whole picture, unvarnished. It is a matter of public health. The issues touch players and their families from Pop Warner to high school to college to the pros.

The ongoing federal court lawsuit filed by thousands of retired players against the NFL is a treasure trove of revealing information. Many of the affidavits and declarations filed in this case show the terrible physical and psychological harm experienced by former players. The suffering and tragedies recounted are overwhelming.

Robert Stern Ph.D., a foremost expert and very experienced clinical neuropsychologist with a specialty in the evaluation and diagnosis of neurodegenerative diseases, has studied the mid-to-late life changes in the cognitive, mood, and behavior of former pro football players. In his lawsuit Declaration, Dr. Stern writes that the head impacts do not simply reduce to cognitive impairment like dementia. He stated:

“…it is my scientific opinion that many former NFL players have significant changes in mood and behavior (e.g. depression, hopelessness, impulsivity, explosiveness, rage, aggression), resulting, in part, from their repetitive head impacts in the NFL, that have, in turn, led to significant financial, personal, and medical changes, including but not limited to: the inability to maintain employment, homelessness, social isolation, domestic abuse, divorce, substance abuse, excessive gambling, poor financial decision-making and death from accidental drug overdose or suicide.”

While there are many very sad stories to choose from, I will mention two. Kevin Turner played in the NFL for 8 years as a fullback with the Patriots and the Eagles. He is now 45. In 2010, he received the diagnosis of ALS or Lou Gehrig’s Disease. This was 11 years after he stopped playing football. Turner is a named plaintiff in the players’ lawsuit against the NFL.

Turner now gets oxygen through a port in his neck and he obtains nutrition through a tube to his stomach. He spends most days in bed. He has gone from his playing weight of 250 pounds down to 150. His mind remains sound but he has lost control of everything above his waist. After a bout with severe dehydration and pneumonia, which led to respiratory failure, he went on a ventilator.

He earned about $8 million during his playing career but he had to file bankruptcy in 2009. He has 3 kids and he is still fighting hard for his family.

Dale Meinhart was a former Pro Bowler who played middle linebacker for the St. Louis Cardinals from 1958 to 1968. He was known as a ferocious tackler. At age 48, he started experiencing symptoms of chronic traumatic encephalopathy. He could no longer fulfill job duties. He became nonverbal, aggressive, and he suffered memory lapses. He refused to see a doctor. He was angry and he spent days in a chair at home or driving aimlessly.

When Dale finally visited a family physician, he was prescribed tranquillizers. In 1986, his family initiated court proceedings to have him committed in order to seek adequate medical care. Doctors diagnosed Alzheimer’s Disease.

Meinhart had 2 children, ages 10 and 15, at the time. The family was surviving on his wife’s $20,000 a year teacher’s salary. Meinhart’s wife contacted the NFL and explained Dale’s situation. She asked if any other retired NFL players were experiencing similar dementia and personality issues. The NFL staff gave her a firm “No” for an answer.

Also, the NFL advised Mrs. Meinhart that Dale could not receive disability benefits because she could not prove his dementia was caused by playing football. One can only wonder how many former players’ families made similar calls and received the same response.

After Meinhart spent time at an Oklahoma State Mental Hospital, the family found a nursing home with a locked Alzheimer’s wing. Meinhart spent the next 17 years there until he died in 2004. There was no good place to put a cognitively impaired 6’2″ 250 pound physically active male who was unable to care for himself and who would unwittingly walk off if not restrained.

Stories like Turner and Meinhart are all too common but awareness about the number of players affected and the scope of the harm is dim. The NFL has tried for a generation to obscure, mislead and deny the truth about concussions and brain injury. Contrary to appearances and the league’s public relations efforts, the NFL is still fighting as hard as possible in the lawsuit to deny the scope of relief to many players who have been devastated by their injuries or who have died.

I do think we need to ask: is this acceptable? Should we as a society accept the harm as an unfortunate but inescapable part of the game? I will offer a tentative answer. No.

When a person is 20, it is a rare person who will dwell on how they expect to function at age 50 or 60. As you age, the question takes on more substance.

I do want to say I love football as much as anyone. I remember going to my first Philadelphia Eagles’ game when I was 6 years old. My dad and I had Eagles’ season’s tickets at Franklin Field for a number of years and we saw the Eagles beat the Packers for the NFL Championship in 1960. I played 105 pound and 120 pound football as well as playing in countless pickup touch football games. I have been a lifelong fan.

However, I still think the whole truth should come out. We are far from that happening. There are no shortage of good questions still outstanding about the effects of hits to the head.

More on Football and Brain Injury – posted 12/23/2013

December 24, 2013 10 comments

Another football season is winding down and I have to say it has been remarkably entertaining. With so much parity in the NFL, it is impossible to know which team will win out in the end.

There have been so many good story lines. Can the Pats win it all without Gronk? Can Peyton Manning come back with the Broncos and lead them to the Super Bowl? As a Philadelphia Eagles fan, I am excited about the team’s future with Coach Chip Kelly as well as the emergence of quarterback Nick Foles.

At the same time, remaining in the background, are the gnawing, unanswered questions about football and brain injuries. Except for the occasional stories about the increasing number of players whose lives have been destroyed, the football/brain injuries story has receded.

Possibly the settlement of the federal court lawsuit between the players and the NFL at the start of the football season had something to do with this. The deal was generally applauded although a cynic might say the NFL was essentially making a large payoff to make the lawsuit go away.

It remains to be seen how well the NFL has provided for the long-term health needs of its players. When I wrote about this for the Concord Monitor in September, I struck a skeptical tone. I had pointed to the NFL’s long history of denying the link between concussions suffered playing football and long-term brain damage. I compared the NFL’s denial around brain injury to the tobacco companies’ denial of the link between smoking and lung cancer.

I think the parallel is instructive. The matter of football and brain injury is at a very early stage of awareness. Concussion science is young. Careful students of the NFL will note the league has refrained from making any admissions about the health risks of football. The lawsuit settlement has given it some breathing room.

The NFL’s earlier position of absolute denial is no longer tenable because of all the player disclosures of death and disability. The NFL’s public stance has now morphed into more subtle forms of denial. I would describe the NFL’s new posture as “debating the science”.

This is a well-worn strategy frequently employed by a variety of industries. When accused of bad actions which expose the public to a significant public health risk, the industry seeks to generate doubt about the probability and magnitude of the risk.

The goal is to create a controversy and a debate about the science. If the science is inconclusive, there is no need for immediate action. An epidemiologist, David Michaels, has written about the manufacture of doubt. He has described doubt as the best means of competing with the body of fact that exists in the mind of the general public.

In the world of occupational health and safety, examples immediately come to mind. I think of miners and silicosis, construction workers and asbestos, workers exposed to lead and hazardous chemicals, among others. Owners in these industries denied hazards as long as they could until government regulation forced minimum standards to protect workers.

In a different context, I also see a parallel to climate change. Even though there is overwhelming scientific proof of climate change and consensus among the great majority of scientists, deniers, with economic and political motives, use doubt as justification for inaction.

I do not believe the public yet appreciates how bad the NFL’s actions have been. The players’ lawsuit accused the NFL of intentional misconduct, concealment, and fraud in misrepresenting the long-term effects of concussions. The NFL failed to properly treat concussed players and actively worked to conceal the causal link between football and brain injury. In effect, the owners’ profits were placed ahead of everything.

It is a mistake to gloss over the history. Going back almost 20 years when the NFL set up its Mild Traumatic Brain Injury Committee, it placed a rheumatologist in charge. The rheumatologist, who had no background in brain science, had been then-Commissioner Paul Tagliabue’s personal physician.

In the eyes of that Committee, the NFL did not have much of a concussion problem. The NFL’s PR department argued that when concussions occurred, 92% of players returned to the field in less than 7 days. Rather than pointing to a health concern, the NFL saw the players’ quick return as evidence the problem was minimal. Until very recently, the NFL’s position was that concussions were minor events that went away quickly with few long-term effects. The examples of Mike Webster, Andre Waters, Dave Duerson and Junior Seau, rather than anything the NFL did, have demolished the NFL’s former position.

Let me raise some of the questions which I see as ongoing and unresolved. Are efforts to alter rules and improve playing equipment sufficient? Do teams need independent trainers and physicians? Are team doctors compromised by a conflict of interest since their loyalty is to who pays them? Isn’t it true they are not medical advocates for the players but their role has been to get the player back on the field as soon as possible?

What about the health needs of players who were not part of the lawsuit, including those who played 10, 20, 30 or 40 years ago? What consideration, if any, do these players get? Or how about those retired players who are on the borderline. They may have some symptoms like memory loss, severe headaches, and insomnia but no clear diagnosis. A difficulty in assessing chronic traumatic encephalopathy, the football-related brain injury, is that it is a post-mortem diagnosis. I am not aware of any test that can determine if it exists in a living player.

Outside the NFL, one large question is: should children play football? At what age is it safe? When is it safe for a child to return to a game after experiencing a concussion? How many concussion events are too many? This is a game played by millions of children and adolescents. We know developing brains are at a higher risk of concussion incidence.

One generalization I would make: in the NFL, players with concussions get cleared to return to play too soon. Bennet Omalu, a brain pathologist who has been a key researcher of football-related brain injuries, has written that recovery from a single concussion episode might require three months – not days.

Maybe in the future, players will have to wear the following statement on their uniform: “Playing football carries increased risk of brain injury that may have long-term effects and helmets do not prevent that”. Or maybe they will have to sign a waiver to that effect. As with cigarettes, we might get to that place.

These issues are not going away and neither is football. It is safe to say there are more questions than answers.