League of Denial

by Mark Fainaru-Wada

  Lovell was put in charge of setting up the NFL’s neuropsychological testing program, which he based on the model that he and Maroon had created for the Steelers. A few years later, after Lovell testified on behalf of Hoge—and, by extension, against the Chicago Bears and the league—Lovell thought he’d probably be ousted from the committee and would never work in the NFL again. But Pellman never brought it up, nor did anyone else. Instead, the league gave Lovell $12,000 in seed money to spread the gospel of neuropsychological testing. He traveled from city to city, team to team, armed with a letter of support from Tagliabue, who wrote: “We strongly recommend that all clubs in the NFL implement such a testing program so that neuropsychological data is available to club physicians, or other treating physicians, in the event of player concussions.”

  The NFL’s concussion committee was up and running. Pellman reported directly to Tagliabue. The commissioner was rarely seen at the committee’s meetings—Feuer recalled him sitting in on only a couple of sessions, during which he rarely spoke—but his representatives frequently attended. Those representatives included, from the very beginning, NFL attorneys. Two lawyers who supported the early work of the MTBI committee were Jeff Pash, the league’s general counsel, and Dorothy C. Mitchell, a young lawyer who served as counsel for policy and litigation. Mitchell’s responsibilities included providing legal oversight for the NFL’s medical and safety committees. Pellman and his colleagues later wrote that Mitchell “worked tirelessly to initiate the MTBI research.”

  Dorothy Mitchell’s contribution to the MTBI committee wasn’t totally clear, but at one point she used information related to the NFL’s concussion research to try to discredit an expert witness in Hoge’s lawsuit. That witness, John McShane, had been the team doctor for the Philadelphia Eagles and a clinical assistant professor at Thomas Jefferson University in Philadelphia. In 1996, McShane received a $134,000 grant from the NFL to study changes in the brain chemistry of concussed NFL players, a study that included other league-affiliated doctors, including Lovell. But before the study got off the ground, the Eagles sold their medical rights to another provider, and McShane was ousted as team doctor, leaving him without access to the players for his league-commissioned study.

  Instead of intervening to keep the study alive, the NFL—first Pellman and then Mitchell—sought to recover the grant money, some of which already had been spent on sophisticated software. The aborted study had long been forgotten until July 2000, when Mitchell FedExed material related to the dispute to the attorney defending John Munsell, the Bears doctor who had treated Hoge. Munsell’s attorney walked into court the next day and tried to use the NFL’s documents against McShane, a former league physician who was prepared to testify that Munsell and the Bears had negligently sent Hoge back on the field to his doom.

  McShane, sitting in the back of the courtroom as he watched the argument unfold, was baffled and angry. He felt he had tried to do research that would help the NFL with its concussion problem, only to be thwarted because the Eagles had changed medical providers. Now he was under attack by the league because he planned to testify on behalf of Hoge. “I couldn’t understand why anybody would be mad at me,” he said. “I had all good intentions; I wanted to do a study that would provide valuable information. Then this change happened that I had no control over, and they were impugning me. I was just stunned.”

  The judge ruled that the dispute had nothing to do with the case, and McShane was allowed to testify. But it was an early sign of how the NFL and its ostensibly independent concussion committee were willing to throw their weight around—and for which side. The league was prepared to send Elliot Pellman, in his authority as chairman of the MTBI committee, to testify that Munsell’s questionable treatment of Hoge was in fact sound. And the NFL lawyer who helped form that committee was willing to intervene in a concussion lawsuit against an NFL doctor. Before the MTBI committee had published a word of scientific research, it had staked out a position as a defender of the NFL.

  The McShane study was just one of a number of early NFL concussion projects. The MTBI committee produced an educational video about how to wear a helmet properly. It looked at special mouthpieces and Kevlar caps that purported to reduce concussions. There seemed to be no end to the parade of gadgetry that passed before the MTBI committee from entrepreneurs seeking the imprimatur of the NFL. Many of the projects were considered and discarded, but Pellman was especially passionate about one initiative: helmet design. For various reasons, including the threat of lawsuits and a regulatory process that effectively was run by the helmet companies, there had been little in the way of helmet innovation over the years. With appropriate testing and the right design, Pellman thought, the NFL could use its vast resources to create a concussion-resistant helmet.

  This was an attractive but not especially new idea and one that was not nearly as simple as it sounded. From the bloody early beginnings of football, the impulse to create more and better protection had been seen as an antidote to the sport’s inherent brutality. Often the solutions were nonsensical or made the violence worse. In 1889, players for Princeton started wearing their hair long in the belief that it would protect them from head injuries, launching a nationwide trend. Around the turn of the century, some players wore “head harnesses”—leather straps that fit snugly around the skull. Others wore hard leather nose protectors that hung from a strap that wrapped around the forehead. None of these devices worked, and some encouraged more head thumping. In 1905, when 18 players died—many from head trauma—several university presidents called for the abolition of football. President Teddy Roosevelt famously stepped in to save the sport, convening an emergency summit at the White House. “Football is on trial,” he told representatives of the country’s elite college football programs. The summit led to dramatic changes in the way the game was played: The forward pass was legalized, and the yardage needed for a first down went from 5 yards to 10, increasing the emphasis on speed. Football as we know it was saved. But the crisis, in what some would call a setback, also produced the NCAA.

  As football evolved through the twentieth century, so did the methods for protecting the head. The head harness morphed into a full leather helmet; by the 1930s, teams were decorating them with colorful logos. But the deficiencies of leather helmets were obvious: They became flimsy and tore, reeked of sweat and mildew, and in the end did not provide much protection. Then, in 1939, Riddell, a Chicago company founded by a high school football coach, patented a helmet with a hard plastic shell. Mass production was delayed by World War II and a propensity of the early plastic helmets to shatter. The designer, Gerry Morgan, later Riddell’s first chairman, observed that the human head is “the damnedest thing to fit. It comes in all shapes and sizes—egg heads, square heads, flat heads, and lopsided heads. The head isn’t round, it’s elongated, especially larger heads.” The NFL made helmets mandatory in 1943, and by the mid-1950s, the plastic helmet—ABS thermoplastic, a high-strength polymer—was widely used.

  But each technological advance came with a corollary: more destruction. One man’s protection was another man’s weapon. The face mask is but one example. The need for it was made abundantly clear by players like Hardy Brown, an undersized 49ers linebacker who liked to plunge his shoulder into the face of unsuspecting ball carriers—“the Humper,” Brown called his signature tackle—shattering jaws and breaking noses. Brown later bragged that he knocked out 75 to 80 players during his ten-year career. George Halas once stopped a game to check Brown’s shoulder pads for steel plates. But no sooner had Riddell started bolting face masks onto its helmets than players figured out they could be used to wrestle men to the ground like steers. One was Dick “Night Train” Lane, a Hall of Fame cornerback for the Los Angeles Rams, Chicago Cardinals, and Detroit Lions whose brutal tackling style became known as the Night Train Necktie. By 1956, the NFL had instituted a penalty for an entirely new term that had entered the English language: face masking.

  With the advent of the p
lastic helmet, football significantly cut down on catastrophic head injuries such as skull fractures and hemorrhages, but the flip side was that the human head was suddenly turned into a projectile. That dynamic in the NFL—a step forward for safety, followed by ingenious forms of new mayhem, followed by more rules—continued well into the 1980s and 1990s and was very much alive when Elliot Pellman began his new helmet project in 1995. Shortly after the MTBI committee was formed, Bob Cantu, a neurosurgeon and concussion researcher in Boston, ran into Pellman at a conference sponsored by the American Orthopaedic Society for Sports Medicine. Cantu had never met Pellman, who was still largely unknown among researchers, but he was struck immediately by Pellman’s confidence that the NFL had a handle on the problem.

  “I still remember Elliot waltzing into those meetings, saying, ‘We’ve got this committee, and the National Football League; we’re gonna solve the concussion problem,’ ” said Cantu. Pellman described how the NFL intended to accomplish this: “He said, ‘We’re going to build the best helmet imaginable,’ ” Cantu recalled. “They were going to eliminate this traumatic brain injury problem with a superhelmet. And it didn’t matter how much it cost because the National Football League could afford anything.”

  The creation of a concussion-resistant superhelmet immediately struck Cantu as an idea both appealing and remarkably naive. The appeal was obvious: If the solution to reducing football-related concussions was tied to better equipment, the league could throw money at the problem. There would be no real need to examine how the game was played or the long-term effects on the players. But Cantu felt the solution was simplistic because he did not believe better helmets could prevent concussions, which, of course, were injuries that occurred inside the skull. In fact, Cantu thought a new and supposedly improved helmet could make the problem worse as players became emboldened by the illusion of better protection, starting the cycle of mayhem all over again.

  Cantu wasn’t the only one with doubts. Lovell understood the vagaries of concussion better than any member of the MTBI committee. Over the next several years at his clinic at the University of Pittsburgh, he and his colleague Micky Collins would see dozens of patients a week. Lovell and Collins had been cranking out their own research, and if anything, it continued to reveal how diverse and unpredictable concussions were. They defied easy solutions; Collins called it a “cryptic” injury. Some people recovered quickly; others needed to stay in a dark room for weeks as their brains healed. Some people seemed able to withstand huge amounts of trauma. With others, a slight jostling of the head might trigger an injury. And as Guskiewicz would show, the severity of concussions often grew with each injury.

  In the MTBI committee, Lovell said he argued that helmets were fine for protecting the outside of the head. He said he thought research creating more and better protection was an interesting and certainly worthy endeavor. But the goal of engineering a superhelmet to reduce concussions was not a realistic solution, he said.

  “I think that was a fantasy,” said Lovell. “I’ve always said it’s a fantasy. I never thought that was a realistic thing to do.”

  In many ways, Lovell thought the idea was understandable, the logical creation of an exuberant rheumatologist who had been put in charge of a brain committee, and of engineers and other MTBI members who didn’t spend their lives studying the myriad symptoms of traumatic brain injury.

  “It’s the fantasy of people who don’t spend 50 hours a week seeing patients who are all different,” said Lovell.

  But Pellman’s enthusiasm was undiminished. At the end of 1999, he told the Philadelphia Daily News: “Within the next six months to a year, incredible stuff is going to come out. We think we’re really going to be able to push the envelope. The helmet manufacturers no longer will have any excuses. We’re going to understand the nature of this injury better. We think this is not only going to revolutionize head gear for football players, but across the board. And we definitely think it can have an impact on decreasing the number of concussions.”

  How does one set out to create a superhelmet? The MTBI committee’s idea was to take all NFL concussions between 1996 and 2001 and try to re-create the brain-scrambling hits on anthropomorphic crash-test dummies. (Photos showed the dummies wearing Riddell helmets with odd logos, like the players in Any Given Sunday.) The committee examined videotape of each recorded NFL concussion; in 182 cases, there was a clear view of where the point of impact had occurred. From those 182 concussions, the committee gleaned enough information in just a couple of dozen cases to calculate the speed at impact. An Ottawa engineering firm was hired to re-create those hits in the lab, using a weighted pendulum with a curved plastic hammer to simulate a helmet-to-helmet hit. The goal was to establish the amount of force that caused each injury, identify how and where the injuries occurred, and then design a helmet that better protected players against those types of hits.

  The initial NFL research elicited some fascinating details about the action taking place on the field. The sheer magnitude of the violence was astonishing. The concussed athletes were being hit by fully armored players moving at speeds between 17 and 25 miles per hour (Usain Bolt reaches a top speed of nearly 28 miles per hour). For 15 milliseconds, their heads were struck with 70 g to 126 g forces. A longer duration, of course, would kill anyone, but the momentum transferred in such collisions is still the equivalent of being hit in the head by a 10-pound cannonball traveling at 30 miles per hour. The numbers alone raised ominous questions about the repetitive nature of football, which, as Vince Lombardi famously noted, “is not a contact sport, it’s a collision sport.” Everyone experiences elevated g forces from time to time—on roller coasters, stopping short in traffic, even sneezing—but the effects are worse when the elevated g forces are repeated over and over at extremely high levels. Like 25,000 car crashes, as Webster explained it.

  By the end of 2001, the MTBI committee had amassed a trove of information about concussions in the NFL. The laboratory experiments alone encompassed not only the videotaped pounding of the crash-test dummies but a film library of hundreds of concussions, not to mention the mathematical calculations on velocity, acceleration, and points of impact. The NFL Mild Brain Injury Surveillance Study had produced an enormous amount of data on the symptoms of concussion, including memory loss, loss of consciousness, concussion rates by position, games missed, and on and on. Lovell’s neuropsychological testing program had been up and running for six years: All but three teams—the Vikings, Panthers, and Cowboys—were using some form of the test battery Lovell and Maroon had developed for the Steelers. From the original Group of 27 in 1993, the program had expanded to include thousands of neuropsychological tests on hundreds of NFL players. Pellman’s MTBI committee had access to those data, too.

  The MTBI committee was now ready to publish its research. But where? There are hundreds, if not thousands, of scientific and medical journals dealing with issues involving the brain, sports, or both, ranging from the Journal of the American Medical Association to the Clinical Journal of Sport Medicine. But only one had an NFL consultant as its editor in chief. Michael L. J. Apuzzo was a professor of neurosurgery at the University of Southern California. In 1992, he was appointed editor in chief of Neurosurgery, the official journal of the Congress of Neurological Surgeons. Apuzzo was a stereotactic neurosurgeon—a highly specialized field that involves the use of three-dimensional mapping to place probes deep inside the brain—and something of a Renaissance man. He had patrolled the Arctic Ocean on a nuclear submarine for NATO; produced a 2,540-page textbook titled Brain Surgery: Complication Avoidance and Management; helped design new instruments for microsurgery; and been honored by the queen of Spain. Bob Cantu, who knew Apuzzo well, used words such as worldly, scholarly, erudite, and visionary to describe him. “And he’s also a very prideful person,” said Cantu. “He doesn’t lack for understanding of his accomplishments, which are significant. And yes, he likes a bit of the stage.… But don’t most people?” Apuzzo’s USC biography
spanned nine pages when printed out and described him as “one of the world’s best known and respected neurosurgeons.”

  Some people around the NFL also considered Apuzzo something of a jock sniffer. Among his many endeavors, Apuzzo, a tall, slender man with receding dark hair and plastic-framed glasses, worked the sidelines as a consultant to the New York Giants. Bill Barr, the former neuropsychologist for the Jets, called Apuzzo “a sports guy wannabe. He works in LA, but he shows up at all the Giants games, which is not a convenient thing. That tells me he wants to be in the game so badly that he’ll travel all the way across the country for these games. He’s a neurosurgeon, but you’d see him on the sideline. Brandon Jacobs goes down with a knee injury and Apuzzo will be down there looking at the knee in his raincoat and golf cap.” Apuzzo clearly was thrilled by his association with the NFL. After working the 2001 Super Bowl between the Giants and Ravens, he told an interviewer: “When I was in the military I worked in a nuclear-powered submarine where we’d be submerged for three months doing very dangerous things. We were dependent on each other for life and death, and it was an extremely moving bonding experience. Until this game I’d never experienced anything else like it. Everyone was very aware of what it meant to be a part of this game, to be a part of the team that came so far.” Cantu said Apuzzo “really enjoyed the association” with the NFL in general and Tagliabue in particular. Apuzzo frequently worked into his conversations with Cantu that he’d just had lunch with the NFL commissioner in New York, a bit of name-dropping that didn’t initially strike Cantu as important but soon would.