Freethought San Marcos: A column
by LAMAR W. HANKINS
Two recent documentaries about head injuries in football (“League of Denial: The NFL’s Concussion Crisis” by PBS’s Frontline and “The United States of Football” by Sean Pamphilon), have been difficult to get out of my own head. As I have watched portions of a few football games since considering the information provided by these documentaries, the specter of life-long neurological damage and, often, early death has hovered over the screen like the ghost of Christmas future. But unlike Ebeneezer Scrooge, football is unable to change its nature – it is a violent sport, which is its allure to many people.
Most football announcers I’ve heard during the current season have spent considerable time discussing the new rules against spearing an opponent with one’s helmet or using it to hit the helmet of an opponent. Helmets are being made safer, but they cannot protect the brain from severe blows to the head. The new rules are intended to reduce the incidence of serious injury, but they cannot prevent such injury. The rules may have some benefit, however. If someone gets a concussion, they are removed from the game and evaluated by physicians before being allowed to continue to play. But the most troubling aspects of the game are the longer-term consequences of brain trauma.
Frontline reported on twenty years of evaluation and research into the brains of former NFL players, college players, and even a high school player who died and whose brain was donated for study. For most of the last twenty years, the NFL and college football programs have denied serious problems. Not so any longer. In 2002, Dr. Bennet Omalu, a pathologist, identified Chronic Traumatic Encephalopathy (CTE) in the brain of former Pittsburgh Steeler and Kansas City Chiefs center Mike Webster, who had committed suicide because of the severe mental health problems he was having. CTE is a degenerative brain disease that has been found in almost four dozen deceased football players, most of whom played in the NFL.
In 1994, under pressure from players and others, the NFL established a committee on Mild Traumatic Brain Injury, which downplayed the harmful effects of concussions by questioning the scientific conclusiveness of the research. They were correct that there was no conclusive evidence linking football injuries with CTE, but there was cause for alarm nearly 20 years ago. Their resistance reminds me of the tobacco companies’ denial of a causal relationship between smoking and lung disease. Some members of Congress looking into the NFL’s response to brain trauma noticed this parallel as well.
Although the NFL was slow to take concussions and their damage seriously, in 1995, an agent for Troy Aikman and Steve Young, both active star quarterbacks at the time, held a seminar on the effects of concussions. A panel of experts described the symptoms of concussions, causing San Diego Charger Gary Plummer to tell a newspaper reporter, “By their standards, I must’ve had 200 concussions.”
Two years later, the American Academy of Neurology issued a report indicating that repetitive concussions can cause brain damage. The Academy recommended that players be removed from play if they lose consciousness or exhibit concussion symptoms during the next 15 minutes following a head injury. The report warned, “Repeated concussions can cause cumulative brain injury in an individual over months or years.”
The NFL Retirement Board ruled in 1999 that Mike Webster’s head injuries left him “totally and permanently disabled as “the result of head injuries he suffered as a football player,” but the ruling was kept secret until uncovered by reporters. Nevertheless, the NFL continued to deny that there was a problem with head injuries.
In 2000, two researchers, Dr. Barry Jordan and Dr. Julian Bailes, at an annual meeting of the American Academy of Neurology, presented startling results of a survey they had done with 1,090 former pro football players. The study was paid for by the NFL Players Association and summarized by Science Daily:
“According to the surveys completed by the players, 60 percent had suffered at least one concussion during their amateur or professional careers, and 26 percent reported three or more concussions. . . . When compared to players who did not report any concussions, the group with one or more concussions reported significantly more neurological symptoms. These included problems with memory and concentration, confusion, speech or hearing difficulties, numbness or tingling in extremities, and headaches.”
The two researchers called for more definitive studies. The next year, quarterback Troy Aikmen retired after numerous concussions. Steve Young never played football again after he was knocked out for 30 seconds during a game in 1999.
In 2003, a sports medicine researcher at the University of North Carolina, Dr. Kevin Guskiewicz, published a paper about the dangers of repeated concussions:
“Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history . . . and previous concussions may be associated with slower recovery of neurological function.”
The Centers for Disease Control (CDC) reported to Congress on traumatic brain injury (TBI) in 2003. The CDC explains that a concussion is a type of TBI that causes “the brain to bounce around or twist within the skull. . . . This sudden movement of the brain can cause stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain.”
The CDC reports that a concussion can result in one or more of these symptoms: one pupil is larger than another; the person is hazy, cloudy, foggy, drowsy, or cannot be awakened; there is a headache that gets worse; there is weakness, numbness, decreased coordination, repeated vomiting or nausea, slurred speech, convulsions or seizures, no recognition of people or places, increasing confusion, restlessness, or agitation, unusual behavior, and/or loss of consciousness, even briefly; the person is dazed or stunned, or forgets an instruction; the person is unsure of the game, score, or opponent, moves clumsily, and may answer questions slowly; the mood, behavior, or personality of the person changes; he is unable to concentrate or recall events before or after the incident, and may experience dizziness or balance problems, double or blurred vision, and/or sensitivity to light or noise.
In May, 2009, the NFL still was denying any connection between concussion and “permanent problems.” That same year, Dr. Ann McKee and a team of scientists from the recently formed Center for the Study of Traumatic Encephalopathy reported they had found several new cases of CTE – including in a 45-year old former NFL player and in the brain of an 18-year old high school football player who died ten days after a fourth concussion.
Four months later, the New York Times reported that an NFL study had found that former NFL players were 19 times more likely than the general population to have dementia, Alzheimer’s, or other memory-related diseases. In December, 2009, the NFL acknowledged for the first time that “it’s quite obvious from the medical research that’s been done that concussions can lead to long-term effects.”
As a result of its new concession, the league strengthened its “return-to-play” guidelines after a player shows signs of a concussion. The next month, the NFL donated $1 million to Dr. McKee’s research in football player brain injury and designated Dr. McKee’s center at Boston University (BU) as the “preferred brain bank of the NFL” to enable it to continue to research brain damage of deceased NFL football players.
The next September, Dr. McKee and her group of researchers at BU reported the first case of confirmed CTE in a college football player who had never been diagnosed with a concussion. That same month, the NFL donated $30 million for research into brain trauma to the National Institutes of Health.
Frontline reported that, in spite of rule changes directed at the problem of concussions, concussions increased 14% during the 2012 football season from the previous year. In November, 2012, Dr. McKee reported that CTE was found in 33 of the 34 brains of deceased football players she had examined up to that time. She acknowledged that the sample of brains she researched may be skewed because most of the donations were from deceased football players who had brain symptoms indicating some kind of brain problem.
In January of this year, the NFL Players Association announced a $100 million fund to Harvard Medical School to study health problems of current and former football players who show signs of heart problems, skeletal and joint injuries, and brain trauma. The NFL also announced a new requirement that an independent neurologist be required on the sidelines of every NFL game. The NFL also had specialists in the head, neck, and spine develop concussion assessment protocols, a symptom checklist, and related assessments for use by all NFL teams.
This past August, the NFL settled a brain trauma lawsuit with 18,000 retired players for $765 million, an amount that may be insufficient to adequately compensate players who qualify for benefits under the settlement. Frontline reported that CTE has been found now by researchers in 45 of 46 brains of deceased football players that have been studied.
These two documentaries have raised questions about brain injury among football players at all levels of play. When I listened to the Frontline broadcast, I immediately began thinking about the effects of football on children playing in the least regulated football games – the Pop Warner, PeeWee, and youth football leagues, that I see practicing around town after school many days.
While Dr. McKee had warned in the Frontline broadcast that any child under the age of 14 should not be playing tackle football, the Pamphilon documentary focuses on these 5 to 14 year olds, looking at the dangers they may face. Dr. McKee appears, also, in this documentary and explains that “because a young athlete’s brain is still developing, the effects of a concussion, or even many smaller hits over a season, can be far more detrimental, compared to the head injury in an older player.”
Many of these youth leagues have safety rules that limit the improper use of the helmet in games and practice, and reduce the amount of contact time allowed during practices. But when NFL players and others related to the sport speak out against the youth leagues, they are often subjected to ridicule, shame, or criticism for their candor. One of them is former NFL player Kyle Turley, who made these remarks to The Atlantic writer Allen Barra about youth football:
“It should be outlawed and banned. There can be serious disruption when those kids who are still developing are hurt. You can die from other sports, but those kind of injuries are freak occurrences. Besides, do we really know what the bad effects of young boys playing tackle football really are? Many doctors I’ve talked to have said that the real problem is cumulative, that you can’t really know how bad it is until you measure the effects of these kind of hits 10 or 20 years later. In football, we are letting our kids risk their health because of a game. It’s an awesome game, but we don’t need to give our kids to it.”
With those thoughts in mind, and considering the current medical knowledge we now have about brain injury, I wondered how a parent allowing a child to play youth football would be viewed from the standpoint of the Texas laws prohibiting child neglect. Neglect includes “placing a child in . . . a situation that a reasonable person would realize requires judgment or actions beyond the child’s level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child.”
Is it neglectful to allow a child to play tackle football if a reasonable person would conclude that such a young child does not have the “maturity, physical condition, or mental abilities” to judge that there is a substantial risk of immediate harm to the child in that activity? Only a jury or judge can decide what is reasonable under the circumstances, but a finding of unreasonableness in allowing a child to play tackle football would not surprise me given what we know now about TBI and concussions in football at all levels.
Further, under the Texas Family Code a parent has the duty to care for, control, and protect the child. Is that duty fulfilled when a parent allows a child under the age of 14 to play tackle football, considering the apparent danger of such an activity? Once again, a jury or judge will have to answer that question, if it is ever presented in a trial forum.
Although I don’t know the answers to these questions, they would give me pause if I still had a child in the age bracket between 5 and 14. At the very least, the questions deserve a thorough, informed, and serious discussion.
© Lamar W. Hankins, Freethought San Marcos
LAMAR W. HANKINS is a former San Marcos city attorney.