It was a clear sign of just how entrenched the NFL was. Changing the culture was a game not of yards, but of inches. Every once in a while, the NFL would indeed capitulate with a concussion concession, like adopting a rule that banned certain types of deliberate helmet-to-helmet hits. But when it came to the long-term ramifications of repeat concussions, the NFL’s position remained immovable: no admission of any problem, pending the findings in a few years of its own ongoing research study of 120 retirees.
While the NFL’s internal research continued to limp through its fifteenth year, another independent study pushed the issue toward a tipping point. For that study, which had been commissioned by the NFL itself, University of Michigan researchers asked 1,063 retired players if they had ever been diagnosed with “dementia, Alzheimer’s disease, or other memory-related disease.” The phone survey found that ex-players over forty-nine years old were five times more likely to receive such a diagnosis than men of the same age in the general population. More alarming, retirees aged thirty to forty-nine were nineteen times likelier to be diagnosed with a memory-related disease than men of the same age in the general population. Two days after The New York Times broke the story on its front page, the House Judiciary Committee announced that it would hold congressional hearings to look into the impact of head injuries on football players and on society in general.
On October 28, 2009, before a standing-room-only crowd in the Rayburn House Office Building on Capitol Hill, the NFL absorbed a barrage of hits during a hearing that left Roger Goodell sputtering like a battered quarterback. Defending the league’s policies in the face of heated criticism from a steady stream of lawmakers, doctors, safety advocates, and ex-players, the NFL commissioner repeatedly refused to acknowledge a direct link between football and brain injury, between football and cognitive impairment, between football and dementia. This time, however, he was facing foes more formidable than the critics the NFL had been stiff-arming for years. Two California congresswomen, in particular, took turns expressing exasperation with his evasiveness under the tough questioning about the long-term impact of concussions.
At one point, Representative Linda Sánchez asked Goodell to read aloud from the NFL’s educational pamphlet informing its players that concussions hadn’t been proven to cause permanent problems, and then rebuked him. “The NFL has this blanket denial or minimizing of the fact that there may be this link,” she said. “And it reminds me of the tobacco companies, pre-nineties, when they kept saying, ‘Oh, there’s no link between smoking and damage to your health.’ ”
At another point, Representative Maxine Waters, whose husband had played linebacker for six NFL seasons, became so irritated that she interrupted Goodell to deliver a finger-jabbing accusation. “I think you’re an eight-billion-dollar organization that has not taken seriously your responsibility to the players,” she scolded. “I know you do everything you possibly can to hold on to those profits, but I think the responsibility of this Congress is to take a look at the antitrust exemption you have and take it away.”
The threat to revoke an antitrust exemption worth billions to the league in TV revenue wasn’t just about doing right by the two thousand active NFL players and the sixteen thousand retirees. It was also about the millions of amateur players on every level from the colleges to the high schools to the peewee leagues. Panelist after panelist testified about the impact of the concussion culture trickling down to the kids emulating their NFL heroes. That’s why it was so important for McKee to present evidence of CTE not only in seven middle-aged NFL retirees, but also in the eighteen-year-old high school player and four former collegians who had never played pro football. And that’s why the most moving testimony was delivered not by any doctor or player or executive, but by a burly, bearded father who spoke for all the parents and for all the kids.
Dick Benson told the story of his son Will, a seventeen-year-old quarterback who had collapsed during a high school game two weeks after suffering a concussion and died from second-impact syndrome. He chronicled how he’d spent the next five years lobbying Texas state legislators to pass a high school safety bill in his son’s memory. Periodically dabbing a tissue to his face as photos flashed on screens showing Will from baby swing to football field, Dick Benson concluded his testimony with a plea to the NFL and to Congress. “My one request is,” he said, pausing several times to fight back tears, “don’t . . . let it . . . happen . . . again.” He composed himself just long enough to add, “Please.”
When the daylong hearing was finally over, the NFL and Goodell had been beaten into submission. In the end, the chastened commissioner insisted, “We are changing the culture of our game for the better.” While the words sounded the right note, no one seemed convinced that they would translate into action anytime soon given the NFL’s long history of recalcitrance.
The fallout from the hearing, however, would be stunning in its speed and its breadth. Almost overnight, the NFL did a complete reversal: the most public voice opposing concussion reform was now suddenly supporting it.
Just a month after the hearing, Goodell announced a series of changes that signaled a stricter policy designed to “protect the health and safety of our players, and set the best possible example for players at all levels and in all sports.” The NFL would now require that outside neurologists and neurosurgeons independently clear concussed players, taking return-to-play decisions out of the sole control of team physicians who were vulnerable to conflict-of-interest pressures from their employers. What’s more, the NFL would now require players with any significant sign of concussion to be removed from a game or practice and be barred from returning the same day. The ruling meant that concussed players, who as recently as 2007 could still return to games even if they had been knocked unconscious, would now be automatically sidelined for the day if they experienced such signs of concussion as confusion, disorientation, amnesia, and memory loss, whether or not those symptoms quickly subsided; players could still return to the field the same day they experienced headache and dizziness, but only if those symptoms did not persist. In a league that had long maintained it was safe for players to return to action as soon as their symptoms cleared, such a major policy shift would take time to permeate the play-through-pain mindset.
The week Goodell announced the stricter concussion policies, the increased focus was as conspicuous on the field as the absence that Sunday of Ben Roethlisberger and Kurt Warner, the two starting quarterbacks in the 2009 Super Bowl. Each had suffered a concussion the previous Sunday and then had been cleared to return after passing neurological exams and neuropsychological tests, but their teams decided to err on the side of caution. Even though Roethlisberger lobbied Steelers coach Mike Tomlin to play despite the headaches that returned at a midweek practice, the team neurosurgeon, Dr. Joseph Maroon, recommended that he sit out the next game. In the locker room after the Steelers lost in overtime, wide receiver Hines Ward questioned Roethlisberger’s toughness and said the team was split 50–50 on whether their star quarterback should have played despite the concussion. “We needed him out there, we wanted him out there,” said Ward, noting that he had lied to doctors many times in the past and played despite concussions. “This is the biggest game of the year. Me being a competitor, I just wish we would’ve had all our weapons out there. It’s frustrating.” By challenging his team’s enlightened handling of Roethlisberger’s fourth diagnosed concussion, Ward underscored what an uphill battle it would be to change attitudes so ingrained in the culture.
Goodell’s reforms weren’t limited to policy changes. He also accepted the resignations of Casson, the chief critic of the evidence linking football to cognitive decline, and Dr. David Viano as co-chairmen of the NFL’s concussion committee. Casson and Viano had joined Pellman in authoring the controversial 2005 study that concluded “it might be safe” for high schools and colleges to adopt the NFL’s practice of allowing concussed players to return to play the same day they were injured. In the wake of Casson’s re
signation, the NFL suspended the study he was conducting into the impact of concussions on retired players. As Linda Sánchez had quipped on the eve of the congressional hearings in ridiculing that study, “Hey, why don’t we let tobacco companies determine whether smoking is bad for your health or not?”
To avoid any perceived conflict of interest, the NFL decided to fund outside research. The league even teamed up with its biggest nemesis: Chris Nowinski and his Center for the Study of Traumatic Encephalopathy. For so long, Nowinski, McKee, and their colleagues had been accused of trying to kill the American institution known as football. When Nowinski began his crusade four years earlier, Gene Upshaw, the hard-nosed Hall of Fame lineman then running the NFL Players Association, had dismissed him as a greedy author just trying to sell books. When McKee showed her CTE slides to her big brother Charles, a family physician in Wisconsin who had been an All-American quarterback at Lawrence University, he had warned her, “You’re going to ruin football.” For their part, McKee and Nowinski were rabid football fans who saw themselves not as a game wreckers, but as game changers. They considered it vindication that the NFL was now donating $1 million toward their center’s ongoing research into CTE, no strings attached.
By the end of the 2009 season, the NFL, the same league that used to promote head-rattling hits in commercials, was airing a public service announcement to warn kids, parents, and youth coaches about the dangers of concussions. The thirty-second message, created in conjunction with the CDC at the behest of Congress, featured the NFL logo and an announcer’s authoritative voiceover: “Concussions and other head injuries must be taken seriously. If you’re a player, protect yourself and your teammates. If you think you’re hurt, don’t hide it. Report it, and take time to recover. If you’re a coach or parent, know concussion symptoms and warning signs, and never let athletes return to action before a health professional says it’s OK. Help take head injuries out of play.”
To ensure that its own players got the message, the NFL produced a poster warning them about the dangers of concussions and admitting that multiple head injuries could indeed lead to permanent brain damage as well as depression and dementia. In the wake of the NFL’s stubborn denial of such long-term consequences, this signaled a reversal of position that was as astounding as it was overdue. By the opening kickoff of the 2010 season, the poster—headlined CONCUSSION in big block letters—hung in every locker room throughout the league. Subtitled “A Must Read for NFL Players,” it was the football equivalent of the Surgeon General’s Warning on every pack of cigarettes that smoking can kill you: “[Traumatic brain injury] may lead to problems with memory and communication, personality changes, as well as depression and the early onset of dementia. Concussions and conditions resulting from repeated brain injury can change your life and your family’s life forever.” That warning was also handed to every player, replacing the brochure that since 2007 had insisted there was no evidence of any long-term effects.
Stripped across the bottom of the NFL poster, a string of photos showed boys and girls playing soccer, hockey, baseball, and lacrosse, as well as football. The accompanying text offered a reminder in bold letters to the players that they were role models for kids across America: “Other athletes are watching . . .”
• • •
The posters had been up for barely a month when Roger Goodell journeyed to Seattle on a mission to spread his newfound gospel beyond the NFL’s locker rooms. “We know, in the NFL, that we set a standard in sports,” he declared at a conference on concussions in youth sports. “When we change our approach, others take notice. And they will follow.” Leading by example, however, was no longer enough for the newly converted commissioner. He was unveiling a new poster, patterned on the NFL’s, designed to hang in school locker rooms across the nation—“so that every girl who plays soccer, basketball, or field hockey and every boy who wrestles or plays football or competes in lacrosse [will] be aware of the symptoms of concussions.”
Goodell was just getting started. He introduced the former middle school football player whose debilitating brain injury had inspired Washington’s landmark state concussion law. With Zackery Lystedt by his side, Goodell vowed to lobby aggressively for similar safety laws in other states. “This must become the standard for how youth concussions are treated,” Goodell said. “I have made it a league priority to keep this going until all fifty states have passed Zackery’s law or found a way do something that is just as significant.”
Goodell had already sent a letter to the governors of the forty-four states without concussion laws, urging them to push for similar legislation to protect young athletes from head injuries. From the moment it was enacted in May 2009, the Zackery Lystedt Law had become the template for every state formulating legislation on concussion safety: it required that any youth athlete suspected of sustaining a concussion be immediately removed from play and then prohibited from returning without written clearance from a licensed healthcare provider trained in concussion management. Because provisions varied widely in the six states that had already adopted concussion laws, federal bills were introduced in both the Senate and House of Representatives to try to bring some uniformity to concussion policies. The crisis was escalating too fast, however, for Goodell to wait for legislative initiatives to take their course.
That’s why he had resolved months earlier to seek help from the dean of concussion specialists, Dr. Robert Cantu. No one could provide the commissioner a broader perspective on the problem than the Massachusetts neurosurgeon, whose pioneering work ranged from authoring the first concussion guidelines in 1986 to teaming with McKee at the vanguard of today’s CTE breakthroughs. So when Goodell was in Boston for the NFL’s 2009 fall owners meeting a couple of weeks before the congressional hearings that would spur its stunning reversal on the concussion issue, he asked Cantu to swing by his hotel for a private one-on-one discussion. For ninety minutes, Goodell sounded out Cantu on ways to move the league forward on the concussion problem. Cantu urged him to strengthen the league’s return-to-play guidelines and player education efforts—two initiatives that could immediately benefit the pros and that would invariably trickle down to college, high school, and youth athletes. What Cantu couldn’t stress enough was the responsibility of the NFL to attack the problem from the grassroots up and the importance of better concussion education on the youth and high school levels. He suggested that the NFL already had the ideal vehicle to accomplish this: its partnership with USA Football, the national governing body on the youth and amateur levels. Two months after the meeting, USA Football integrated concussion awareness into its flagship program that trains and certifies thousands of youth league coaches throughout the nation.
The urgency of dealing with the concussion crisis was growing with each succeeding diagnosis of CTE in younger players. In the summer of 2010, two cases in particular made it painfully clear that CTE was not just a phenomenon striking retired pros in middle age and later—it was developing in the younger brains of players who were still active. The football world was shaken when Dr. Bennet Omalu uncovered the first case of CTE in an active NFL player: Chris Henry, a notoriously troubled wide receiver who was just twenty-six when he fell or jumped to his death from the back of a speeding pickup truck during a frenzied domestic dispute. Then came the even more shocking news that Dr. Ann McKee had uncovered the first case of CTE in an active college football player: Owen Thomas, a junior lineman at the University of Pennsylvania who was just twenty-one when he committed suicide with no previous history of depression. More to the point, he also had no previous history of concussion. Because he’d never been diagnosed with one, McKee suspected that the CTE was caused by concussions Thomas had never reported, the “subconcussive” hits linemen absorb on every down, or a combination of both factors. Unlike the eighteen-year-old brain in which she’d found only incipient traces of disease, this twenty-one-year-old brain was by far the youngest to merit a firm diagnosis of CTE—mild, but definite.
Wh
en McKee showed her colleagues the Thomas slides, they were shaken—especially Cantu. Peering at the now-familiar brown splotches, Cantu shook his head and resolved to ratchet up his longtime crusade for concussion safety. “We can, and we must, develop brain trauma guidelines similar to the ‘pitch count’ regulations now used in Little League baseball,” he declared. “We count the pitches of every baseball player to ensure a small number do not develop shoulder and elbow problems—and yet we don’t count how often children get hit in the head playing football, even though it can lead to early dementia or possibly depression and suicide years later. We have pitch counts for pitchers from Little League to the Major Leagues who want to limit the number of pitches they throw and protect their arms; we’re probably going to have to go to hit counts to the head in our football players to protect the brain.”
The inspiration for Cantu’s “hit count” proposal came from research conducted by his colleague Kevin Guskiewicz. As director of the University of North Carolina research center poignantly named after a local teen who died from a traumatic brain injury suffered in his very first high school football game, Guskiewicz had been studying the effects of head impacts to analyze just how much punishment players’ brains sustain on a daily basis. Since 2004 he had monitored the impact of every hit at every UNC football game and practice with a new technology known as HITS, shorthand for Head Impact Telemetry System. Small sensors placed inside the players’ helmets measured the force and location of each hit, then transmitted the data in real time to a laptop computer on the sideline.
What Guskiewicz saw on his computer screen would shock him: players were routinely absorbing multiple impacts in practice exceeding what most scientists theorized was the concussion-causing threshold of seventy to seventy-five times the force of gravity. Players were averaging a thousand to twelve hundred head hits per season, with some linemen estimated to log up to eighteen hundred of them. Perhaps most troubling, fully 20 percent of hits were located at the top of the helmet, meaning that far too many players were leading with their heads as a battering ram or lowering their heads dangerously just before impact. A 2010 study of three NCAA football teams raised the alarm: each team averaged three thousand hard hits to the head during one full season of practices—three hundred of which fell in the concussion-causing range of 80 to 119 g’s and two hundred of which exceeded 120 g’s.
The Concussion Crisis Page 32
