Friday, January 19, 2007
See no evil? The NFL won't face concussion facts
By Peter Keating ESPN The Magazine
Sad but true: You didn't have to actually read the comments by the NFL or the doctors on its concussions committee to know how they were going to respond to the Andre Waters case.
In a New York Times story on Thursday, forensic pathologist Dr. Bennet Omalu of the University of Pittsburgh says that former NFLer Waters had the brain of an 85-year-old man with signs of Alzheimer's disease before he killed himself on Nov. 20, and that multiple concussions caused or severely worsened Waters' brain damage.
And as usual, you could count on the league and the scientists conducting research for its committee on mild traumatic brain injury (MTBI) to channel South Park's Officer Barbrady, who likes to say, "OK, people, move along - there's nothing to see here." For years, the NFL has maintained there is no scientific evidence connecting concussions to lasting injuries or brain damage while also asserting that its committee is about to look into the matter.
In November 2003, Dr. Elliot Pellman, medical adviser to the NFL and chairman of its MTBI committee, appeared on HBO's "Inside the NFL" to discuss a report by the Center for the Study of Retired Athletes that linked multiple concussions and depression among former pro players with histories of concussions. "When I look at that study, I don't believe it," Pellman said flatly. Later, however, he announced the committee would begin to study the long-term effects of concussions.
Do Dr. Elliott Pellman and other NFL medical experts have their heads buried in the sand about concussions?
Two years later, the same Dr. Omalu now involved in the Waters case concluded that former NFL player Terry Long had died from chronic traumatic encephalopathy, a swelling of the lining of the brain, caused partly by "repeated mild traumatic injury while playing football." Pellman called that conclusion "speculative and unscientific." But he said the committee was planning its own look at the long-term impact of head injuries. "It will begin within the year and involve 160 active and retired NFL players, other athletes and those not involved in contact sports," the Pittsburgh Post-Gazette reported on Sept. 16, 2005.
The Nov. 6, 2006, issue of ESPN The Magazine detailed the growing concerns that many top sports doctors have with the MTBI committee's methods and conclusions. Among other things, the Magazine's report showed that the committee didn't include hundreds of neuropsychological tests conducted on NFL players when studying the effects of concussions on the results of such tests. It also revealed that Pellman had fired William Barr, a neuropsychologist for the New York Jets who was concerned that Pellman might be picking and choosing what data to include in the committee's research to get results that would downplay the effects of concussions.
After that article appeared, Pellman went silent. Instead, Dr. Mark Lovell, another member of the committee and a leader in the field of neuropsychological testing in sports, went on ESPN's "Outside the Lines" to reply. "It's a very important issue. It needs to be studied scientifically, though," he said about non-NFL research showing an association between concussions and mental impairment in former football players. "It's very important to do this work. It's just we're in the middle of doing it at this time."
And now, Andre Waters.
"Whatever its cause, Andre Waters' suicide is a tragic incident and our hearts go out to his family," the NFL said in a statement released to the media Thursday afternoon. That statement concluded: "The league has a traumatic brain injury committee that will begin studying retired players later this year regarding concussions and depression."
After more than a dozen years of studying concussions, the NFL is -- still -- just getting around to examining the long-term effects of head trauma but still -- still -- refuses to acknowledge the validity of outside research on the subject. As Julian Bailes, chairman of neurosurgery at West Virginia University, told ESPN The Magazine, the MTBI committee "has repeatedly questioned and disagreed with the findings of researchers who didn't come from their own injury group."
The explanation is straightforward, if depressing. The NFL has used the work done so far by its concussions committee to justify league practices. And if that research turns out to be flawed, and those practices turn out to be dangerous, the league could face massive liability, financially and legally.
In December 2004, Pellman, Lovell and their colleagues published the sixth of an ongoing series of papers in the journal Neurosurgery. In that report - and over the objections of several of the scientists who reviewed it - they stated: "The results of this present study support the authors' previous work, which indicated that there was no evidence of worsening injury or chronic cumulative effects of multiple MTBIs in NFL players." Their study found "no evidence" of "widespread permanent or cumulative effects of single or multiple MTBIs in professional football players."
No worsening injury, no cumulative effects, no widespread permanent damage from concussions.
Indeed, Pellman, Lovell et al found that, on average, NFL athletes didn't show a decline in brain function after suffering concussions, or after three or more concussions, or after taking blows to the head that kept them out a week or more. Despite blistering criticism over the study's small sample size and voluntary participation, these are the results that made it into print, and these are the results to which the league points when arguing that it doesn't put players at unnecessary risk.
As independent research continues to paint a different picture, the NFL is finding itself pushed further and further out on a limb. It's getting harder to deny the assertions of outside doctors and former players that concussions are linked to lasting problems.
"It's skating on dangerously thin ice to argue that there's no connection between multiple concussions and a decline in brain function, and it's amazing that the league continues to do so," says Chris Nowinski, author of "Head Games: Football's Concussions Crisis." (Nowinski is the man who obtained permission from Waters' family for Omalu to examine Waters' brain.)
Yet it also would be difficult for the NFL to turn its back on its own research and admit it has a long-term concussions problem. The league is well-known in legal circles for tenaciously fighting even minor disability claims, and the last thing it wants to face is a flood of lawsuits by athletes who suffered head injuries and kept playing.
"There is the potential for bankrupting the league pension and disability plan if the NFL had to honor claims of disability brought by players who have concussions," says Michael Kaplen, a New York lawyer who specializes in brain injuries.
Some doctors and former players have long suspected that the NFL has always intended to use the MTBI committee's work as a bulwark against just such liability. One of the scientists who reviewed the committee's work for Neurosurgery told ESPN The Magazine: "They're basically trying to prepare a defense for when one of these players sues. ... They are trying to say that what's done in the NFL is OK because in their studies, it doesn't look like bad things are happening from concussions."
But as the concussion committee's studies turn out to be flawed or incomplete and outsiders are linking concussions to serious illness and even death, the NFL is going to need a new strategy. Its same old dismiss-and-wait statement on Andre Waters shows it's still looking for one.
Peter Keating writes about sports business for ESPN The Magazine. His book, "Dingers: A Short History of the Long Ball," is available now on Amazon.com.