League of Denial

by Mark Fainaru-Wada

  “Well, you have testified to that. But I just asked you a simple question. What’s the answer?”

  “The answer is, the medical experts would know better than I would with respect to that. But we are not treating that in any way in delaying anything that we do. We are reinforcing our commitment to make sure we make the safest possible deal for our—”

  Conyers again cut him off dismissively: “All right. Okay. I have heard it.”

  Goodell wasn’t Casson, but in his own equivocating way, the commissioner was just as resistant. Then, toward the end of the session, Linda Sanchez, a perky Los Angeles Democrat, ruined the NFL’s day. Sanchez had been a driving force behind the 2007 hearings. A former labor lawyer, she had been elected in 2002, joining Loretta Sanchez as the first sisters to serve together in Congress. Their father, a Mexican immigrant and former machinist, had Alzheimer’s disease. Sanchez said she regretted that Ira Casson hadn’t made it to the hearing “because there are a number of really great questions I would have loved to have asked him.” She still managed to make his presence felt by showing a clip of Dr. No’s rapid-fire denials to HBO.

  Sanchez asked Goodell to read aloud from the NFL pamphlet telling players that “current research” had not shown that repeated concussions lead to permanent problems, a statement that seemed to contradict a lot of current research.

  “Okay. Thank you,” Sanchez said politely when the commissioner was finished. Then she cheerfully tore into him:

  “I am a little concerned—and I hear the concern expressed by some of the witnesses on the panel today—that the NFL sort of has this kind of blanket denial or minimizing of the fact that there may be this link. And it sort of reminds me of the tobacco companies pre-1990s when they kept saying, ‘No, there is no link between smoking and damage to your health or ill effects.’ And they were forced to admit that that was incorrect through a spate of litigation in the 1990s. Don’t you think the league would be better off legally, and that our youth might be a little bit better off in terms of knowledge, if you guys just embraced that there is research that suggests this and admitted to it?”

  It was a nightmare scenario for the NFL: the comparison to Big Tobacco. Others had made it before. Nowinski drew the analogy in Head Games; on a shelf in his office at BU, he displayed a book, The Biologic Effects of Tobacco. Brent Boyd, the former Vikings offensive lineman, repeatedly made the case that the NFL was like the powerful tobacco companies “fighting against the link between smoking and cancer.” But now Linda Sanchez had introduced the analogy to the House Judiciary Committee.

  “Well, Congresswoman, I do believe that we have embraced the research, the medical study of this issue,” said Goodell.

  “You are talking about one study, and that is the NFL’s study,” said Sanchez. “You are not talking about the independent studies that have been conducted by other researchers.”

  It was the hearings’ most powerful moment, the one that would haunt the NFL for years. Part of what made Sanchez’s argument so powerful was that it rang true. There were, in fact, many similarities between Big Tobacco and Big Football. The NFL didn’t have 400 law firms on its payroll or a database of 180,000 research papers that had cost hundreds of millions of dollars to assemble. But much like the tobacco companies, the NFL had used its power and vast resources to try to discredit scientists it disagreed with and bury their work, cherry-picked data to make selective arguments about concussions, and elevated its own flawed research. Playing on “the margins of science” was how Anthony Colucci, a former top researcher at R.J. Reynolds, had described Big Tobacco’s strategy to the Wall Street Journal in 1993.

  The tobacco fight’s version of Omalu was Dr. Ernst Wynder, a public health researcher who was fresh out of medical school at Washington University in St. Louis when he published a landmark study in 1950 that identified smoking as a significant risk factor for lung cancer. As with Omalu’s inquiry, Wynder’s had started in the morgue: During an internship at New York University, he had watched the autopsy of a two-pack-a-day smoker who had died from lung cancer. Wynder followed up his first study by setting out to establish a direct link between smoking and cancer. He painted pure tobacco tar sucked out of Lucky Strike cigarettes onto the shaved backs of mice. Among the 62 mice still alive at the end of a year, 58 percent developed cancer.

  That study, published in five parts beginning in 1953, prompted tobacco executives to form an “objective” and “disinterested” research group staffed by the public relations firm Hill & Knowlton. The Council for Tobacco Research—known originally as the Tobacco Industry Research Committee—soon began to churn out reports denying the connection between smoking and lung cancer. The council encouraged researchers to examine other factors such as “viruses and diet and car exhaust, to take contrarian positions, to savage the other side in the letters column of scientific journals,” wrote Dan Zegart in Civil Warriors: The Legal Siege on the Tobacco Industry.

  “The entire tobacco research council was a front put up by Hill & Knowlton,” said Victor DeNoble, a former Philip Morris whistle-blower whose research proved nicotine is addictive, in an interview for this book. “They recruited scientists and paid them to make statements that just clearly were not true, couldn’t be based in fact. They were opinions. And that went on for years.”

  The tobacco industry’s researchers, foreshadowing the debate around football and brain damage, engaged in what Zegart called a “metaphysical quarrel over the definition of cause.” There had long been an expectation that smoking heightened the risk for a variety of diseases, just as some scientists thought that the kind of brain damage seen in boxers might show up in other sports. But tobacco researchers continued to toss out a host of other possible factors that might be to blame, making it difficult to establish a clear causal link.

  Of course, there were a lot of differences, too, between the retired debate over the hazards of smoking and the one that was heating up over football. Smoking, in the end, was a public scourge with no real utility to anyone who came in contact with it. Football promoted discipline, character, and mental and physical well-being and brought people together by the millions. It was an incredibly sophisticated, uniquely American sport, and entire books would be written about its appeal. Also, football, unlike cigarettes, wasn’t addictive (although some Texans might disagree). The tobacco industry’s manipulative fight against science went on for five decades and left zero doubt about the risks of smoking. The research into football, though ominous, was relatively new and far less conclusive about the ultimate risk and prevalence of neurodegenerative disease.

  That was the point, Nowinski told the committee when he testified later in the day: “So much of this crisis has mirrored Big Tobacco and the link between smoking and lung cancer. And I ask you, if you were able to create all the smoking laws and awareness we have today back in the 1950s when the first conclusive pathological research was done linking smoking to lung cancer, would you save those millions of people who smoked without understanding the risks?”

  To the question of whether football should be banned, McKee replied, “Football is an American sport. Everyone loves it. I certainly would never want to ban football.… We haven’t banned cigarette smoking. People smoke. People make that choice. But they need to make an informed decision. They need to understand the risks and it needs to be out there if they want to pay attention to what those risks are.

  “What I don’t understand is why we are expecting that exposure to repetitive head trauma will cause disease in 100 percent of the individuals that suffer this trauma,” she continued. “Do we expect 100 percent of cigarette smokers to develop lung cancer? Do we expect 100 percent of children who play with matches or even with chainsaws to get hurt? No. Even if the percentage of affected individuals is 20 percent, or 10 percent or 5 percent, there are still thousands of kids and adults out there right now playing football at all levels who will eventually come down with this devastating and debilitating disorder.”

&nb
sp; The comparison between the NFL and Big Tobacco had been planted in a public forum, and now the NFL was stained with it; it was as indelible as the tar that Ernst Wynder had smeared on his mice.

  “Those hearings did one thing,” said Bob Stern, one of the cofounders of the BU Group. “They said: ‘NFL equals Tobacco.’ ”

  Within three weeks of the hearing, Casson and Viano were out as cochairs of the MTBI committee. Goodell sent a memo to all teams stating that the two men had “graciously” resigned. The league announced several changes to its concussion policy, including a rule compelling teams to consult an independent neurologist after a player sustained any type of brain injury. Players with concussion symptoms were “no go” for practice or games and could not return to play the same day—a direct contradiction to the conclusion of one of the NFL’s most controversial papers. A much-touted study to determine the long-term effects of playing football—originally scheduled to be released in 2010 and then pushed back to 2011 or 2012—was suspended indefinitely. Casson had been overseeing that study.

  Then came the headline that the NFL never wanted to see: “Is Tackle Football Too Dangerous for Kids to Play?”

  It ran atop a New York Times blog item written by Katherine Schulten, editor of The Learning Network. The piece referred to a guest column that had appeared in the Times a few days earlier in which a father, Adam Buckley Cohen, recounted his 10-year-old son Will’s anxiety about playing football for his Pee Wee team. Cohen began the column with this quote from Will: “Dad, I’m scared. I only have one brain, and I don’t want to hurt it playing football.” Will had read about Troy Aikman’s inability to remember his winning performance in the 1993 NFL Championship Game and was aware that Steve Young had retired because of concussions.

  On the morning of December 20, Schwarz read a wire report that the NFL planned to donate $1 million to the Boston University Center for the Study of Traumatic Encephalopathy and would encourage current and former players to donate their brains to the institute. Schwarz was surprised, in part because Nowinski, his best source, typically notified him about all breaking stories related to BU. When he got Nowinski on the phone, Schwarz was told, “I don’t know anything. I don’t know what the fuck is going on.”

  Nowinski was aware that Goodell had reached out to Cantu about supporting BU’s research by urging players to donate their brains after death. The commissioner had mentioned the discussion during the hearings. But the BU Group had heard nothing about money. Nowinski became concerned that the donation would be perceived as an attempt by the NFL to buy BU’s support. The BU brain trust—Cantu, McKee, Nowinski, and Stern—spoke by phone. Cantu told Schwarz that BU wouldn’t take any money from the league without assurances of its independence.

  Nowinski didn’t think the timing of the NFL’s announcement was coincidental. BU and the Players Association were preparing to announce the next day that the union would be recommending that players pledge their brains to BU. Nowinski figured the league, still reeling from the hearings, had gotten wind of the plan and wanted to share in the attention for supporting CTE research.

  Schwarz reached out to Aiello for comment on the NFL’s overtures to BU. He asked the NFL spokesman the standard questions: What went into the decision? Who was involved? He then posed the more vexing question: Why would the NFL give $1 million to a group whose findings it had fought for years?

  Aiello said matter-of-factly: “It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems.”

  Wait, what? Had the NFL’s chief spokesman just acknowledged the link that Goodell had scrupulously avoided weeks earlier in front of Congress? The link that Casson, Pellman, and Viano had fought for years? How did Aiello’s comment square with the pamphlet advising NFL players: “Research is currently underway to determine if there are any long-term effects of concussion in NFL athletes”?

  “Greg, that’s the first time you’ve ever said that or anyone with the league has ever said that,” Schwarz said evenly, concerned that Aiello might back off.

  “We all share the same interest,” said Aiello, sounding miffed and slightly impatient. “That’s as much as I’m going to say.”

  The next day, stripped across the top of the New York Times sports section, was the following headline:

  N.F.L. ACKNOWLEDGES LONG-TERM CONCUSSION EFFECTS

  Virginia Grimsley, the wife of John Grimsley, McKee’s first CTE case, sent a bottle of champagne to BU. The group had brought about change.

  “It was the turning point,” said Nowinski. “I mean, the only way to say it is, you changed their mind. In a sense, it was a victory.”

  Aiello’s statement, though, marked not only the first but also the last time anyone from the NFL has publicly acknowledged the connection between football and brain damage.

  15

  “PLEASE, SEE THAT MY BRAIN IS GIVEN TO THE NFL’S BRAIN BANK”

  The magnitude of the wreckage soon became apparent. It wasn’t just Casson and Viano. The entire Mild Traumatic Brain Injury Committee had been blown up by Goodell. It had been 16 years since Tagliabue had created the NFL’s research arm in response to a concussion crisis the ex-commissioner had never quite believed in. Under the leadership of Pellman and, later, Casson and Viano, the committee had published 16 scientific papers and assorted other studies. It had conducted biomechanical reconstructions of concussions on crash-test dummies, completed a six-year epidemiological survey involving hundreds of players, performed thousands of neuropsychological tests, engineered a new helmet, and even re-created NFL-strength concussions in rats. All of that was now discarded as worthless. It was as if a factory had been shuttered. Mitch Berger, a prominent San Francisco neurosurgeon who was among the researchers the league brought in to begin anew, said he and his colleagues “essentially started from zero.” Even the much-ridiculed name—the Mild Traumatic Brain Injury Committee—was scrapped. The research entity that replaced it was christened the NFL Head, Neck and Spine Committee.

  The Dissenters had won. The world had been turned upside down. As the NFL began to spread money around, it recruited its biggest critics to help solve a problem it once had treated as fiction and now acknowledged as deadly real. One of those critics was BU. To assuage the group’s concerns about maintaining its independence, the NFL drafted a two-page letter, signed by Jeff Pash, the league’s general counsel, recognizing “the importance of preserving the Center as an independent and credible voice.” The letter designated BU the NFL’s “preferred” brain bank and pledged to encourage players to “donate their brains to the Center.” Cantu, one of the original Dissenters, who had described the previous committee as stooges for the commissioner, was named a “senior advisor” to the new panel.

  Not everyone was thrilled with the new arrangement. Bernie Parrish, the retired Browns defensive back, who had pledged his brain to BU, warned that the NFL was trying to buy off the researchers. He wanted no part of it. A year earlier, even before the NFL made its donation, Parrish had confronted Nowinski about this very possibility.

  “Look, you can’t do that,” he told him. “Once you accept money from them, they own your ass.”

  “We would never take money from them,” Nowinski responded, according to Parrish.

  Now BU was doing exactly that. Parrish wasn’t happy.

  “I want my brain back!” he declared during a follow-up hearing before the House Judiciary Committee. Not long after, he rescinded his pledge to BU.

  Guskiewicz, who had savaged the NFL in a commencement speech and later compared Tagliabue’s slapdash creation of the MTBI committee to an airport security breach, was brought on as a full-fledged member of the new panel, overseeing rules and equipment. From his days taping ankles for the Steelers, Guskiewicz had come far. His groundbreaking work would garner a $500,000 “genius grant” from the MacArthur Foundation for “major advances in the diagnosis, treatment, and prevention of sports-related concussions.” Guskiewicz had to think lo
ng and hard before accepting the NFL’s invitation. The league had approached him once before, an overture he had perceived as “damage control” to show that the NFL was doing something “without canning Casson and Viano and admitting we were fools.” Guskiewicz had said no that time, but now Casson and Viano were gone and everything was different, he believed. It was a total reversal. Guskiewicz signed on as an unpaid member of the committee, although he recognized that one of the first questions people would ask was “Did the NFL buy Kevin Guskiewicz?”

  For years, the old committee boasted just one neurosurgeon, Hank Feuer of the Colts. It had been just another sign of the NFL’s lack of seriousness about concussions—the virtual absence of the doctors most intimately familiar with the brain. Now the NFL was appointing brain surgeons to head the new committee. The cochairs were Richard Ellenbogen and Hunt Batjer, respected neurosurgeons with no previous ties to the NFL. Ellenbogen was chief of neurosurgery at Seattle’s Harborview Medical Center, one of the country’s busiest brain trauma facilities. His specialty was children. Ellenbogen had helped pass the Zackery Lystedt Law, which set strict return-to-play guidelines in Washington State, mandating the removal of any young athlete suspected of having a concussion. The law was named after a middle schooler in Maple Valley, Washington, who had returned to play after a concussion and developed a brain hemorrhage that almost cost him his life. Ellenbogen’s team had performed several surgeries on the boy.

  Goodell had recruited Ellenbogen personally. The brain surgeon was on his way to the emergency room one morning when his cell phone rang. The caller identified himself as the NFL commissioner. Ellenbogen thought it was one of his colleagues or an old friend having some fun with him, so he proffered Goodell an obscenity. Goodell assured him that he was in fact the NFL commissioner and was looking for a doctor to chair his new concussion committee. “I felt like such a dope,” Ellenbogen recalled. He met with Goodell and agreed to take the job.