Casson, the new cochair, baffled researchers and laypersons alike. Even more than Pellman, he would become associated with the NFL’s refusal to admit it had a problem—the league’s true disbeliever. A bald, combative man, Casson was emphatic: He didn’t believe the evidence. His denials were all the more confounding because of his experience with boxers. Casson’s 1982 study in the British Journal of Neurology, Neurosurgery, and Psychiatry was regarded as a breakthrough and had been particularly well timed, coming the same year that Duk Koo Kim, a South Korean lightweight, died of a brain hemorrhage after fighting Ray Mancini outside Caesars Palace. Casson and his colleagues performed CT scans on 10 boxers shortly after routine knockouts. Five showed signs of cerebral atrophy. Experience appeared to be a predictor: the more bouts, the more brain damage. Among the five boxers with 20 or more fights, four had cerebral atrophy. Of the five with fewer than 12 fights, only one had it. Rather than a single punch, Casson and his colleagues wrote that “a cumulative effect of multiple subconcussive head blows is the most likely culprit,” a fact that, when applied to football, had dramatic implications for the men in the Pit.
The year after his study came out, Sports Illustrated brought in Casson as a consultant to examine a CT scan of Muhammad Ali’s brain. The scan had been taken in July 1981, before Ali was cleared for his last fight, against Trevor Berbick. “They read this as normal?” said Casson, poring over the scan. “I wouldn’t have read this as normal.” At SI’s request, Casson also performed neurological exams on three other living fighters: the heavyweights Jerry Quarry and Randall (Tex) Cobb and a bantamweight named Mark Pacheco. Quarry and Pacheco had abnormal CT scans and signs of cavum septum pellucidum, a shearing of the ventricles. The exercise foreshadowed the debate about football 30 years later. Casson had become part of a long line of researchers to reveal the devastating effects of the sweet science on the brain. But on the question of whether boxing should be banned, Casson replied no. “A boxer ought to know what he’s getting into if he wants to go on and be a champion,” he said. “He should know what he may be sacrificing. A doctor has to tell the boxer if he thinks the fighter should stop, but in the end it’s not really a medical decision. Society has to decide what we’re going to do about boxing.”
Casson had studied boxers for decades and had come away with no doubts that the sport caused brain damage. But when it came to football, he wasn’t buying it. He later told Congress: “My position is that there is not enough valid, reliable or objective scientific evidence at present to determine whether or not repeat head impacts in professional football result in long term brain damage.” In a 2010 article for Neurology Today, Casson quoted Charles Darwin: “False facts are highly injurious to the progress of science for they often endure long.” He wrote that Guskiewicz’s dementia and depression studies at North Carolina suffered from “inherent methodological limitations,” especially a possible bias in how players self-reported their injuries. He wrote that the buildup of tau protein seen in the brains of “a few retired NFL players” was not “exclusive to head trauma.” NFL doctors had been treating concussed players “in a cautious and conservative manner for many years,” he asserted. Casson concluded: “The public has been led to believe that dementia and depression are a frequent and inevitable consequence of a career in professional football. This ‘false fact’ is belied by the presence of a large number of retired players who, despite experiencing multiple concussions, have gone on to have brilliant careers in broadcasting and other endeavors.”
Cantu, while tearing into the NFL one afternoon at a conference in Las Vegas, described Casson to the audience of 100 researchers as “a neurologist that had studied boxers and should have known better.” Guskiewicz came to believe that Casson was the single most destructive force for the NFL during the entire era of denial, worse even than Pellman. “Whoever picked Ira Casson should have been fired before he was fired,” said Guskiewicz. Casson, in fact, had been selected personally by Tagliabue, he told Congress and others.
Even people who liked and admired Ira Casson felt that he was his own worst enemy. “Ira is a good man; he just can’t keep out of his own way,” said Lovell. “So dogmatic. He became a lightning rod. Presentation matters. I think everybody has a reasonable point of view. But when you dogmatically say this is all just like a scam, everybody writes you off. And Ira got kind of written off as a nut. His presentation is such that if you’re looking for a villain, you know, he became it.”
That April, as the NFL ocean liner was making its groaning pivot, Casson sat down for an interview with Bernard Goldberg, the writer and Emmy-winning TV correspondent. Goldberg, the author of works such as Bias and 100 People Who Are Screwing Up America (And Al Franken is #37), was also a correspondent on HBO’s Real Sports. Goldberg was trying to sort out the growing controversy around football and brain damage. He interviewed Casson, the new cochair of the MTBI committee, to get the NFL’s views.
“Is there any evidence, as far as you’re concerned, that links multiple head injuries among football players with depression?” Goldberg began.
Casson cocked his head slightly.
“No,” he replied emphatically.
“With dementia?” asked Goldberg.
“No.”
“With early onset of Alzheimer’s?”
“No.”
The interview was taking place nearly two years after Omalu’s report on Webster and months after the studies on Long and Waters had been published. By then, the NFL had established the 88 Plan in John Mackey’s honor. The drumbeat of accounts of mentally disabled players like Ted Johnson kept growing louder.
“Is there any evidence as of today that links multiple head injuries with any long-term problem?” Goldberg asked finally.
“In NFL players?” said Casson. “No.”
Goldberg said he walked away thinking: “Well, he’s pretty sure of himself.”
The NFL had replaced Elliot Pellman with a man who from that point forward became known to critics as Dr. No.
The rumors began to circulate that spring of 2007, when so much change seemed to be in the air. The NFL was planning a Concussion Summit, it was said, and even the Dissenters might be invited. “And then sure enough the invitation came by e-mail,” Guskiewicz said. “I think we all sort of thought, ‘Okay, maybe this is a good sign.’ I’ll be honest with you. I was a little nervous. You didn’t know what to expect.”
The NFL had undergone one other major change. Paul Tagliabue had retired after nearly 17 years as commissioner. He was replaced by his right-hand man, Roger Goodell, the league’s chief operating officer.
It was hard to ignore how Tagliabue, as he walked out the door, had dumped a mushrooming health crisis in Goodell’s lap. “Commissioner Goodell inherited a nightmare, truly inherited a nightmare,” said Bob Stern, a Boston University neuropsychologist who soon would become involved in the crisis. “He inherited a cover-up.” Tagliabue, of course, had long shared the MTBI committee’s skepticism about the magnitude of the concussion problem. There was no indication that his views had changed. But if anyone was equipped to grasp the huge potential ramifications for the NFL—and the need to change course fast—it was Roger Goodell. After taking office at age 47, Goodell adopted an expression for what he believed was one of his main responsibilities as commissioner: “Protect the shield,” he called it, safeguarding the integrity of the game. By then, Goodell had spent more than half his life in the league. He had dreamed of being NFL commissioner since his teens. Goodell’s idol was his late father, Charles, a Republican senator from New York who lost his party’s support and then his seat after sponsoring a bill to end the Vietnam War. When Goodell graduated from Washington & Jefferson College in 1981, he wrote to his dad: “If there is one thing I want to accomplish in my life besides becoming commissioner of the NFL, it is to make you proud of me.” Goodell started his quest to become NFL commissioner from the bottom. He personally wrote letters to Tagliabue’s predecessor, Pete Rozelle, and all 28 t
eams, asking for an opportunity to serve. He landed an internship in the NFL’s secretarial pool, where he clipped newspaper articles and fetched coffee for the league’s PR department. Goodell was now the most powerful man in American sports.
When Goodell took over the previous September, the concussion issue was not at the top of his agenda. At the time, the primary concern was how to divide the league’s expanding riches, which would soon approach $10 billion a year, and the possibility of an impending work stoppage. The focus had changed quickly with the publicity surrounding players such as Waters and Johnson and the obvious disconnect between their personal stories and the attitude of the league’s doctors, articulated most forcefully by Ira Casson.
The Concussion Summit was designed to get the new commissioner up to speed. There had been nothing like it in the history of the NFL. The league would gather all medical personnel—doctors, trainers, neurological consultants—in one room and debate the science of concussions. All the original Dissenters—Guskiewicz, Cantu, Barr, and Bailes—were invited to make presentations. Apuzzo was the keynote speaker. The attendees were greeted with a large packet of material emblazoned with the NFL’s red, white, and blue logo. It included all the MTBI committee’s Neurosurgery papers on a compact disc, a laminated sheet of “Concussion Information for NFL Players and Family”—Point 1: What is a concussion?—six pages of references to peer-reviewed studies on ImPACT, and even the Guskiewicz and Bailes depression study that the league had shredded.
Omalu—the man who had started it all—was conspicuously left off the invitation list. No one could say why. Bailes was asked to present Omalu’s research.
“Why did they ask you? Why didn’t they ask me?” Omalu said to Bailes when he first heard about the summit. Here was his opportunity to try to persuade the NFL that he was right, that he wasn’t evil.
“I don’t know, Bennet,” Bailes said.
“He felt like he was being ostracized,” said Bailes, who agreed. “It was pretty shocking that Bennet wasn’t called. If it was real scientific discourse, they would want to have him there and they would want to pick his brain. You’d want to have the source there. Why would you want somebody else? Get him there, put him on the spotlight, like the witness stand, scientifically. Why wouldn’t you want to do that? It’s the truth.”
The daylong meeting took place in a 218-seat amphitheater at Chicago’s Westin O’Hare. The audience was composed mostly of white men in coats and ties. Goodell made the opening remarks at 9:15 A.M., emphasizing the NFL’s commitment to the concussion issue and thanking the MTBI committee for its work. Apuzzo spoke next. Barr, who by then had developed perhaps the least charitable view of the proceedings, described the presence of the Neurosurgery editor–New York Giants consultant as “very strange. To me, it was like whatever pact they signed with the devil about having him publish their findings, he probably said, ‘You guys owe me. I want to talk at the conference.’ It’s kind of embarrassing to have your grandfather get up there when you don’t want him to, but that’s what it was. He basically said, ‘I do this for the Giants and I’ll be happy to help any team that needs help with it.’ He really conveyed to me he was really just interested in being part of the game in a pathetic way.”
Apuzzo gave way to a series of 10- to 40-minute discussions on the topics of the day. Casson and Viano summarized the NFL’s research. Cantu spoke about guidelines for returning to play. Guskiewicz gave a presentation on the risks of returning to the same game. They were all touchy subjects, the source of much of the hostility between the Dissenters and the league, but the atmosphere was civil, even collegial. It could have been any dry medical conference.
Then Bill Barr took the stage. His topic was ostensibly the “Role of Neuropsychological Testing in Return to Play Decisions.” But really he had shown up to firebomb the NFL’s research. As Goodell looked on, Barr repeated his allegations that Pellman and Lovell had left out thousands of baseline tests in NFL Paper Number 6, the paper that supposedly had shown that players recover quickly from concussions.
“I said that the data collection is all biased,” Barr said. “And I showed slides of that. Basically I pointed out that we had been obtaining baselines on players for 10 years, and when you look at the study it only included a small amount of data. My calculations were that their published studies only included 15 percent of the available data. Let’s put it this way: There were nearly 5,000 baseline studies that had been obtained in that 10-year period. And only 655 were published in the study.”
Barr hadn’t come right out and said it, but essentially he was accusing the NFL’s researchers of fraud. The implication was that Pellman and Lovell had purposely excluded data that didn’t support their findings. Those NFL researchers were in the room. Pellman, after his demotion from committee chairman, had been left off the program but was still on the committee and was seated in the audience. Lovell was still director of the NFL Neuropsychology Program and in fact had also been asked to make a presentation to the group.
Lovell already felt sick—literally. At four that morning, he had woken up vomiting, the result of a seafood allergy that had flared up after he’d gorged himself on crab legs and shrimp at a banquet the night before. “I was vomiting for like five hours,” he said. “Then I had to give two presentations in front of two hundred people in this highly charged [atmosphere]. You literally had people sitting on one side of the room and the other.” Lovell thought he might not make it. “I was deathly ill,” he said. “I didn’t think I’d be able to present, and I knew how that would look.” Steelers doctor Tony Yates, who was also Lovell’s physician, bailed him out by giving him Zofran, a medication used to treat nausea after chemotherapy.
Lovell recovered enough to present but now found himself under attack in front of the new NFL commissioner. Cantu watched from the audience, cringing. He’d had his own scientific disagreements with Lovell, of course, but he felt Barr’s attack was inappropriate. “I really felt badly for Mark because I didn’t feel that was the setting to be exposed to all this,” Cantu said. Lovell tried to rebut the allegations. He told the audience that he had used all available data at the time of the study and that it was unclear why he might not have received all of the information.
The next scheduled speaker was Joe Waeckerle, a Kansas City Chiefs doctor and member of the NFL committee. Waeckerle was scheduled to present a 10-minute “Editor’s View of the MTBI Research,” but according to Cantu, Waeckerle instead announced to the audience: “Well, we now have these ethics issues to assess.”
The NFL’s Concussion Summit had suddenly turned into an informal ethics inquiry, with Lovell as defendant.
At one point, according to Lovell, Barr was asked about the missing data: Did the NFL have them or not?
“Yes,” Barr replied, according to Lovell.
Barr said he did provide data to Lovell, but only up to 2000, four years before the paper was published. After that, he said, he was never asked for the information. As a result, the league had only part of his data. He said Lovell and Pellman never set up an organized system to collect all the data that were being compiled by the individual teams. But when the NFL wrote up the study, it implied that the data were comprehensive.
The NFL debated the ethical questions surrounding NFL Paper Number 6 before deciding that Lovell hadn’t done anything wrong. “It came down in favor of Mark,” said Cantu, who was still uncomfortable with what had just unfolded. “The net effect was he got exonerated in the open forum. But there was enough said before that it just was awkward, to say the least.” Barr agreed that the consensus was that Lovell “didn’t do anything intentional to not put data in there, but I don’t think anybody concluded he did a great job on that research.”
As the session broke up, Barr left the stage and made a beeline for the bathroom. “I had to take a wicked pee,” he said. As he walked out of the amphitheater, Micky Collins, Lovell’s protégé and partner in ImPACT, followed him outside, fuming.
Co
llins chased down Barr before he could make it to the men’s room.
“What are you doing!” Collins screamed, according to Barr. “You’re ruining everything! You’re an idiot! Everybody hates you!”
“He got his nose right up in my face, like managers in baseball when they get in the face of the umpire and they want everybody to know they’re arguing,” Barr said. “I’d never had anything like that before—where somebody is just right in my face.”
“Calm down, man,” Barr said he told Collins. “Micky, I feel like you’re going to hit me or something.”
Barr looked down the hallway. Television cameras were hovering nearby. Collins began to calm down, he said.
“You don’t understand what we’re trying to do,” Collins told him. “We’re trying to do good.”
“Micky, I don’t believe in the science you’re doing,” said Barr.
Collins suggested that he come to Pittsburgh to see how ImPACT really worked.
“Micky, you’re talking to me like you’re trying to convert me in a religion,” Barr said.
“You know what? It is kind of a religion,” said Collins, according to Barr.
Collins acknowledged that he had confronted Barr but said he never raised his voice. He said he was upset about Barr’s shabby treatment of Lovell.
“Bill, Mark Lovell is the most ethical human being I’ve ever met,” Collins said he told Barr. “For you to attack him is wrong. You look like a buffoon.”
He said he never compared ImPACT to a religion. “I would never use that language. That makes it sound like a cult; it’s creepy.” He said he merely told Barr that people gravitated to ImPACT “because it works.”
League of Denial Page 26
