Print and Go Back NFL [Print without images]

Friday, April 20, 2007
NFL retools approach to concussion research

By Peter Keating
ESPN The Magazine

The National Football League has insisted publicly that it is not planning to alter the way it researches or regulates concussions. But behind the scenes, the NFL's controversial concussions committee is undergoing the biggest changes in its 13-year history.

As the Sports Concussion Institute held its first summit Friday in Marina del Rey, Calif., signs were pointing toward major changes afoot in the NFL. The league's Committee on Mild Traumatic Brain Injury (MTBI) has been re-evaluating everything from its membership to the data it has collected. has learned:

•  NFL commissioner Roger Goodell has told the concussions committee to involve new researchers in its work, according to a source familiar with the committee's activities. As a result, its ranks might expand again. (In January, the committee added three new members, all with extensive neurosurgical experience: Joseph Maroon, the Pittsburgh Steelers' team neurosurgeon and vice chairman of neurosurgery at the University of Pittsburgh; Joel Morgenlander, professor of neurosurgery at Duke University; and Thomas Naidich, professor of radiology and neurosurgery at Mount Sinai School of Medicine.)

Roger Goodell
NFL commissioner Roger Goodell has mandated baseline neuropsychological testing for all players for the first time this season.
•  The concussions committee has been criticized in the past for its insularity. But as it prepares to launch a long-awaited study on the long-term impact of concussions on players, the NFL group finally will consult outside scientists and studies.

"We're going to reach out to other people, to all the experts in MTBI, and try to have an open, meaningful scientific dialogue," said one committee member.

The NFL Players Association also expects to have additional influence on the league's research plans.

"We expect to have a seat at the table for virtually anything that occurs from this point forward," said NFLPA medical director Thom Mayer, who talked with the committee April 10 about how to study retired players.

•  An October story in ESPN The Magazine detailed how committee researchers didn't include hundreds of neuropsychological tests conducted on NFL players when studying the effects of concussions on the results of such tests. In response, the committee has gone back to team doctors and consultants whose data was not included and asked them for test results.

This effort, however, has not borne fruit. The committee has not received new data, according to one of its members.

"I didn't send anything back," said one former team consultant. "Why now? It's ridiculous. I talked about it with colleagues of mine who are in the same situation, and we were like, 'Now they're trying to acquire the data -- after they've published [their findings].'"

•  The committee has also subjected its research findings to a new round of statistical analysis, according to two of its members.

"We gave all the papers to statisticians," said one member. To date, the committee does not believe it needs to change any of its conclusions.

The NFL has declined to comment on the concussions committee.

Outside the Lines
On Sunday, "Outside the Lines" will examine the journeys of two men who have become unlikely partners in the common belief that brain damage from repeated concussions in football can lead to depression, dementia and suicide. One is a former pro athlete whose career was ended by concussions; the other is a doctor who worked on the autopsies of two former NFL players.

In addition, "Outside the Lines" takes a close look at Mark Lovell's ImPACT test and its use by the NFL, and explores whether it is good science to have a member of the league's concussions committee analyzing data and helping set policy using a product in which he has a financial interest.

Guests include Garrett Webster, the son of late former NFL center Mike Webster; and ESPN The Magazine's Peter Keating. "Outside the Lines" is hosted by Bob Ley. Tune in Sunday at 9:30 a.m, ET, on ESPN.
The NFL's concussion policy has come under intense scrutiny in recent months.

Last October's ESPN The Magazine investigation reported that several of the nation's leading sports concussion experts had harsh criticism for the research methods of the league's concussions committee and the expertise and tactics of its then-chairman, Elliot Pellman. In November, former player Andre Waters committed suicide; two months later, the New York Times reported that Pittsburgh pathologist Bennet Omalu had found that Waters' brain was equivalent to that of an 85-year-old man, and that multiple concussions had caused or severely worsened his brain damage. Just before the Super Bowl, former player Ted Johnson told the New York Times and the Boston Globe he suffers from depression and mental lapses and is addicted to amphetamines, and that he blames concussions for his problems. And on Feb. 26, Pellman resigned as chairman of the committee.

Goodell's expressed interest and the imperative to figure out what concussions are doing to players over the long haul has some observers hopeful the committee will find a way to work with other researchers.

But as one longtime critic of the committee put it: "Some people say they are just shuffling the same cards with Pellman stepping down. But I am guardedly optimistic, especially because the commissioner seems to want to move things in a good direction."

Others wonder how well the league actually will play with others, given a long history of shunning studies that it didn't commission. The concussions committee has steadfastly pursued a path of examining the biomechanics and effects of concussions one variable at a time, and has aggressively disputed the scientific validity of alternative studies. Meanwhile, NFL Charities, which funds football-related research grants of all kinds, has rejected several proposals to take different approaches to concussion research.

"Their process is a joke," said Kevin Guskiewicz, research director at the Center for the Study of Retired Athletes in Chapel Hill, N.C., which has studied the long-term effects of concussions by conducting extensive surveys of retired NFL players, and which has received research funding from, among other sources, the NFLPA.

"We have applied for funding from many places, and have been accepted by some and rejected by some," Guskiewicz said. "Usually, when someone rejects you, they will explain why and detail what you can do to improve your chances if you resubmit. When we got rejected by NFL Charities, I was wondering where the second, third, fourth, fifth pages were to the letter."

Gerald Maher, who has developed a mouth guard that he says can reduce concussions by protecting the brain from blows to the mouth and jaw, has had similar experiences. Maher is the team dentist for the New England Patriots, who have reported unusually few concussions in recent years. And since 2004, Mike Haynes, the NFL vice president for player development, repeatedly has urged Maher to ask for league funding to fit a group of players with mouth guards and study their effects. In 2004, Maher applied for a research grant and never heard back from the league. In 2006, he applied again, and was rejected in a one-page note.

"We have something that NFL players are already using effectively, and they don't want to take a look at it," said Mark Picot, vice president of Maher's company, Mahercor Laboratories in South Weymouth, Mass. "There are 31 teams trying different methods to prevent concussion. If they don't have your ear to the ground, looking for markers among all the clubs, what are they doing?"

The NFL concussions committee recently announced it will study mouth guards, but that it will use its own techniques, including testing crash-test dummies outfitted with movable jaws.

"We will do the bench research first, meaning that before you try to correct for all the variables involved in studying humans, you test dummies and then see if there's something more to look at," said Joseph Waeckerle, president of Acute Care and Emergency Specialists in Leawood, Kan., and a member of the concussions committee.

For the moment, then, the tension continues between its methods and outside research, but the committee is being prodded to change its ways.

"We've never claimed our data was the best in the world, we've claimed it's an advance over what came before, and there's something to be said for that," Waeckerle said. "We have advanced research in this field more in the past 10 years than anyone had in the prior 100 years. I'm not saying we're where we want to be yet, but we are on the right path."

Peter Keating writes about sports business for ESPN The Magazine.