League of Denial

by Mark Fainaru-Wada

  As he watched Webster struggle, Bob Stage cringed. The Steelers’ pilot had enjoyed Webster’s company for years and considered him one of the most decent men he had ever known. The man he was now watching was being honored for his greatness on the football field, which was fitting, but it was no longer Mike Webster.

  “It made no sense,” Stage said. “It broke my heart.”

  Perhaps most notable in Webster’s speech was who he didn’t thank—and who didn’t attend. There was no mention of Steelers owner Dan Rooney or Joe Gordon or anyone else from the team’s front office except for the beloved and deceased Steelers patriarch, Art Rooney Sr. No one from the organization attended. Dan Rooney said he was in Dublin preparing for the team’s American Bowl preseason game the next day against the Bears. “I expected more,” Pam told the Post-Gazette. “It’s a shame. They could have sent someone or sent a telegram. It would have been the classy thing to do.”

  By this time, Webster’s festering enmity toward his former team was obvious to those closest to him, though its origins were never clear. Part of it was Webster’s belief that the Steelers had never offered him a coaching job at the end of his career, although Dan Rooney later said they had. Part of it certainly was his growing paranoia and, with that, his lasting belief that Rooney had somehow betrayed him. Why he came to hate Joe Gordon, no one really could say. Just a year earlier, Gordon and Rooney had rescued Webster from the Pittsburgh Greyhound station. But hate was what it was, and as Webster got sicker, that hate consumed him.

  There was, however, one moment of astonishing lucidity in Mike Webster’s Hall of Fame speech, a moment that seemed to capture the essence of the sport that had broken him. “You know, it’s painful to play football, obviously,” he told the crowd. “It’s not fun out there being in two-a-day drills in the heat of the summer and banging heads. It’s not a natural thing.”

  Seated behind Webster was the NFL commissioner, Paul Tagliabue. This remark, as truthful as any that Webster would utter that day, seemed to provoke in Tagliabue neither awareness nor reflection as he sat next to Bradshaw watching an NFL legend unravel. Instead, the commissioner and Bradshaw seemed to be laughing at something.

  4

  FUCK YOU, JERRY MAGUIRE

  In March 1996, about a year and a half after Merril Hoge announced his retirement, some of the nation’s leading experts in sports medicine gathered during a spring snowstorm at Allegheny General Hospital in Pittsburgh. By the standards of some medical conferences, it wasn’t a huge gathering: about 200 brain specialists, team doctors, and trainers, mostly from across the Northeast. The conference was billed as “the first cross-disciplinary attempt to confront the many difficult issues regarding evaluation and treatment of sports-related concussion.” Maroon, who cohosted, used his Steelers connections to put together an “experts roundtable” of doctors and retired players, including Hoge, New York Giants linebacker Harry Carson, Steelers quarterback Mike Tomczak, and Buffalo Bills safety Mark Kelso. The moderator was former Steelers great Lynn Swann, whom Maroon introduced as “a master chef, poet, and good friend.”

  What followed was an eye-opening dialogue about the realities facing the NFL when it came to brain injuries. The players told the audience of doctors that they had spent their entire careers essentially ignoring them, playing through pain and injury out of fear of letting down their teammates and losing their jobs. During one exchange, Swann asked Carson, a future Hall of Famer and one of the best linebackers of his generation, a leading question: Do players feel their “livelihood” is threatened when they come off the field?

  “Very much so,” said Carson. “Football players are very insecure people. Players are interchangeable parts. Someone played your position before you, and when you leave, someone else is going to be in your place. You are only there for a short time, so you want to make as much as you can in the time given you. You do not want to give anyone else a shot at your job. Football players understand that if they give someone the opportunity to do the job better, their days are numbered.”

  Perhaps the most startling admission came from Tony Yates, the Steelers’ team doctor, who said he was essentially powerless to bench a highly motivated player. He cited as an example Greg Lloyd, a Steelers linebacker who once said, “I know I haven’t played a good game unless my hand has been stepped on or if somebody somewhere isn’t bleeding.” Yates told his fellow doctors, each of whom had taken the Hippocratic oath (“Do no harm”), that the ultimate authority for getting Greg Lloyd off the field was not him, the doctor, but the head coach. “Many times it is just physically impossible,” Yates said. “Only a head coach can pull a player off. When we finally reach the head coach and impress upon him the seriousness of an injury, the players come off.”

  Sitting in the audience, mesmerized, was a Michigan State graduate student named Michael (Micky) Collins. He had made the five-hour drive down from East Lansing with his faculty adviser, mostly out of curiosity. Collins felt like he was at a personal crossroads. A former pitcher and outfielder at the University of Southern Maine, he was in his second year studying for a master’s degree in clinical psychology. But Collins had no idea what he wanted to do with his life. He missed sports and had thought about coaching or perhaps a career as an athletic trainer. He had traveled to Pittsburgh at the suggestion of his adviser, who thought the combination of sports and brain research might stir Collins’s interest.

  Collins was attentive to what the players had to say, but for him the real stars were the doctors and the scientists. He watched as Joe Maroon and Mark Lovell presented their latest findings on concussions. “These are the coolest guys in the world,” Collins thought. During the drive back to East Lansing, he told his adviser: “This is what I want to do with my life.”

  At this point in the looming concussion crisis, Merril Hoge was no longer a professional football player; he was a case study and a cautionary tale. During the conference, Lovell had presented slides showing how Hoge’s brain function had fallen off a cliff after the hit in Chicago. Lovell’s concussion test already was becoming known in neuropsych circles as the Pittsburgh Steelers Test Battery, although the Steelers didn’t own it and the test was not yet the marketing juggernaut it would come to be. Collins was fascinated. After watching Lovell’s presentation, he approached him and asked if he could use the Steelers Battery as the basis for his own research into football-related concussions. Lovell readily agreed. Thus began the steep upward trajectory that within five years would turn Collins into one of the leading concussion experts in the country and a member of a partnership with Maroon and Lovell that would shape the NFL concussion saga in huge and controversial ways.

  Collins was nothing if not enterprising. He first used the Steelers Battery on the Michigan State football team, having secured permission through a trainer. Collins baselined a Spartan a day for months, all the while thinking to himself, No way this is gonna work. Then one day a lineman named Chris Smith came off the field with a concussion. Collins tested him the next day. “He looked normal, he talked normal, he acted normal, and he went right back to play,” said Collins. There was one problem: The test indicated that Smith was a walking zombie; he shouldn’t have been playing at all. “I was thinking to myself, ‘Wow. This really works,’ ” said Collins. At that point, he was in no position to influence whether Chris Smith played or sat out, but he was emboldened. He secured a small grant to study other colleges. He traveled to the universities of Utah and Pitt and then got an internship to study the University of Florida football team.

  When he was done, Collins wrote up his findings. He submitted the paper not to some minor publication for young researchers but to the Journal of the American Medical Association, or JAMA, the most widely circulated medical journal in the world. “ ‘What the hell, it’s a sexy topic, isn’t it?’ ” he thought. Collins titled his sexy paper “Relationship between Concussion and Neuropsychological Performance in College Football Players.” He cold-called a JAMA editor, who agreed to ta
ke a look. The fact that the paper was accepted, he later acknowledged, was a tribute less to its quality (“It’s probably the worst paper I’ve ever published”) than to the sudden appetite for a subject that researchers had ignored for years but that now seemed critically important, an issue whose time had come, like the dangers of nicotine or cholesterol. The paper’s major findings, published in 1999, were that neuropsychological testing was an effective tool to assess concussions in athletes and that those with a history of multiple concussions or learning disabilities were far more likely to fail those tests.

  “Quite honestly, and not to sit here and blow, but this paper was seminal,” said Collins. He seemed dismissive of the earlier work of researchers such as Jeff Barth, who had reached similar conclusions but had published his research as a chapter in a book called Mild Head Injury. Years later, that book was still available on Amazon, delivered to your doorstep within days, but Collins would say: “The other article published on this stuff was published in some obscure journal, and there was very little. You had to dig deep to find it.” Collins’s own article, in contrast, was big-time: “This was JAMA!”

  Collins had short blond hair, an angular head that squared off at its crown, and the wiry physique of a distance runner. He was tightly wound and argumentative and sometimes came off as being about as charitable with his peers as he was with Barth. Collins had particular contempt for neurologists, for example, believing that most of them failed to grasp the intricacies of his particular specialty: “There are some incredible neurologists, but ninety percent of them have no clue how to manage a concussion, ninety-five percent of them,” he said. When explaining his work and the science of concussions, he had a habit of punctuating his sentences with a quick check to make sure his listeners were able to keep up: “You following me? Does that make sense?” He was the opposite of his mentor, Lovell, who projected a kind of sleepy calm. But when Lovell went to work at the new sports medicine center that had been established at the University of Pittsburgh Medical Center, joining Maroon at UPMC, he brought Collins with him.

  Collins worshiped Lovell. “Mark Lovell is probably the smartest human being I’ve ever met in my life,” he said. “He has vision. He’s a tinkerer. He’s the mad scientist in the room. Smoke comes out from under the door. I’m the guy that sees all the patients and runs around.”

  After decades of neglect, concussions were taking off as a research subject that merited serious attention. As Collins had correctly pointed out, examining the brains encased in football helmets adorned with the team logos to which millions of Americans had sworn allegiance was suddenly a sexy topic. There was money to be had and, equally important, prestige. There were headlines and careers to be made. The researchers who got in early—Jeff Barth, Joe Maroon, Mark Lovell, and a few others—soon begat other researchers, and they too began to make discoveries, many of which would prove highly problematic for one of the nation’s leading concussion factories: the National Football League.

  Julian Bailes was a rising star when Maroon recruited him out of Northwestern University in Chicago to join him on the neurosurgical staff at Allegheny General Hospital in 1988. The two men could hardly have been more different in background and temperament. Maroon had grown up in Bridgeport, Ohio, a striver in the blue-collar image of his hustling father. Bailes was the son of a Louisiana Supreme Court justice. He had spent much of his early life in New Orleans and other parts of Louisiana and exuded the easy charm of a southern patrician, a stout handsome man with a slight drawl and thick dark hair that he swept back from his forehead.

  Bailes had been ambivalent about beginning his career in sleepy Pittsburgh. But Maroon possessed one particularly attractive chit: In addition to performing brain surgery, Bailes could join him working the sidelines with the Pittsburgh Steelers, learning from the man who had watched over the brains of Terry Bradshaw and Jack Lambert. Bailes had been an all-state linebacker in high school and had gone on to play at Northwestern State University, a small Division I school in Natchitoches, Louisiana. He still lived and died for football. “I said, ‘Shit, that sounds like as good a reason as any to move to Pittsburgh,’ ” Bailes recalled. “I’m in.” He quickly adapted to his surroundings. “You know, there was no greater feeling than being a single neurosurgeon in Pittsburgh and going to the Porsche dealership and writing a check for $120,000 and driving this Porsche out and not even caring,” he said. “I went through about five of them.”

  In the mid-1990s, around the same time Maroon and Lovell were developing the Steelers Battery, Bailes was introduced to Frank Woschitz, a longtime official with the NFL Players Association. Woschitz had just conducted a health survey on retired players that he hoped would persuade the union and the league to give the players lifetime health insurance. It was a huge problem: Players often left the game so battered that they were unable to qualify for health insurance. But the league refused to provide it.

  Bailes had agreed to look at the data for Woschitz—hundreds of questionnaires stacked in cardboard boxes—expecting that it would focus on mundane issues such as arthritis, back injuries, and heart disease. But when Bailes took a closer look, he was stunned. “Yes, they had hyperlipidemia [high cholesterol] and joint pain and cardiac disease, as expected,” he said. “But they were also having all kinds of cognitive problems. It was way out of line for what you would expect.”

  Bailes shared this curious piece of information with a New York neurologist named Barry Jordan. In neuroscience circles, Jordan was already something of a legend. While attending Harvard Medical School in the late 1960s, Jordan, one of the few African Americans in his class, had decided to make up his own concentration: sports neurology. “All my classmates laughed at me,” he said. By the time he connected with Bailes, Jordan was one of the preeminent experts in sports medicine in the country and the chief medical officer of the New York State Athletic Commission.

  Jordan agreed that the survey findings were off the charts. He wasn’t entirely surprised. Jordan had done a lot of research into boxing, in which the issue of chronic brain damage had been known since the 1920s, and had been expecting to see it show up in other contact sports. As early as 1999, he wrote that chronic brain damage “has been described primarily in boxers, but it may be anticipated in other sports such as American football, ice hockey and perhaps soccer.”

  Now, if Frank Woschitz’s survey was correct, retired football players were showing dramatically elevated signs of incipient dementia in huge numbers. Bailes and Jordan followed up with a survey of their own. To avoid tipping off the players that they were specifically looking at brain damage, Bailes and Jordan asked questions about a broad spectrum of injuries. Again, the numbers were dramatic.

  In May 2000, Bailes and Jordan presented their findings at the American Academy of Neurology’s annual meeting in San Diego. Out of 1,090 former players, 60 percent reported that they had sustained at least one concussion during their careers; more than a quarter reported more than three. The players with concussions, most in their fifties and sixties at that point, were reporting significant neurological problems: memory loss, confusion, speech or hearing problems, and headaches.

  The news, preliminary as it was, was in many ways worse than what researchers such as Barth, Lovell, and Collins were uncovering. Those studies had shown that concussions had to be taken seriously, with symptoms that often lingered for days or weeks or even longer. But it was assumed that with time those symptoms eventually went away. After the release of his first paper in JAMA, Collins told the Detroit News: “If you give the brain time to heal, there’s no reason to see long-term deficits.”

  But Bailes and Jordan were suggesting that that wasn’t necessarily the case. They were saying something quite ominous: that the head-banging endemic to the NFL might have far-reaching—even permanent—consequences.

  Bailes vowed to study the issue further. He believed “a trove of information” was contained in Frank Woschitz’s cardboard boxes, a researcher’s gold mine. L
ater, those early results would remind Bailes of another health crisis he had witnessed. “It’s like when HIV started coming out; I was here in Chicago, and we didn’t know what it was,” he said. “There were these young men, 22, 23 years old, showing up with Kaposi’s sarcoma and other weird things that you shouldn’t get when you’re 23. It was the HIV suppressing their immune system.”

  Looking back, Bailes believed that he and Barry Jordan had stumbled onto “the first whiff” of another new disease.

  The early scientific breakthroughs of the 1990s involved almost exclusively men who toiled in white lab coats beneath the fluorescent lighting of hospitals and universities. But there was a connection between the growing interest in concussion research and the carnage unfolding in stadiums across the country. In many ways, the research was being fueled by the dawning awareness of football fans, who began to notice that the big hits they so relished seemed to produce a sobering by-product: the vacant stares of their heroes lying motionless on the field.

  In the tenth week of the 1992 season, the New York Jets traveled to Denver to play the Broncos. The Jets’ premier receiver at the time was Al Toon, an elegant contortionist whose jazzy surname perfectly fit his improvisational style. Toon stood 6-4 and once made the Olympic trials in the triple jump. He frequently hurled himself into space to make impossible catches, climbing above defenders who lacked his speed and balletic grace. Toon often paid for it: The Steelers’ Lloyd once knocked him out cold, then slapped the turf with his palm next to Toon’s splayed body as if he were counting him out.