Sean Philpott: Keep Your Head In The Game

Jan 30, 2014

My hometown 49ers will not be playing in this Sunday's Big Game. Despite my disappointment, I nevertheless will be joining millions of my fellow Americans in the hallowed tradition of watching the Super Bowl. I will put my feet up on the coffee table, drink a beer or two, and cheer on the Denver Broncos as they face off against the Seattle Seahawks. I will also cringe every time the quarterback is sacked or a wide receiver is brutally tackled, imagining the lasting damage caused to both body and mind.

The problem, of course, is concussions. A concussion -- known clinically as an MTBI, or mild traumatic brain injury -- occurs when a blow to the head or body, a fall, or some other impact causes the brain to smash into the skull. Depending on the severity of the blow, symptoms can range from a mild headache, blurred vision and some disorientation to a loss of consciousness, convulsions and amnesia. Often these symptoms subside in a few hours, but they can last for days or even weeks.

Moreover, the long-term effects of repeated concussions -- common in football, hockey, boxing and other contact sports -- are still unknown but seem to be associated with an increased risk of dementia, Parkinson's, and mood disorders later in life. In some cases, patients may be diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease whose symptoms include tremors, impaired speech, deafness, and profound clinical depression. In one study of men who had histories of repeated concussions, 80 percent showed evidence of CTE. Most of these men were former football players.

The problem has become so pervasive that both the National Football League and the National Hockey League are facing a rash of individual and class action lawsuits filed on behalf of former players and their families. Those lawsuits contend that league officials knew about the link between repetitive concussions and neurodegenerative diseases for decades but never shared this information with the players.

In a 1994 Sports Illustrated article, for example, the head of the NFL's Mild Traumatic Brain Injury Committee described concussions as "part of the profession" and "an occupational risk" of being a professional football player. Despite this admission, and despite mounting evidence linking frequent concussions with brain damage in later life, the NFL waited until 2009 to tighten up its rules on when a player can return to the field after suffering a concussion. Borrowing from the tobacco industry's playbook, football league officials have also repeatedly said, including in Congressional hearings, that there is no connection between playing professional football and brain damage.

That strategy probably won't work. Just as lawsuits against cigarette manufacturers lead to radical changes in the tobacco industry, lawsuits against the NFL and other professional sport leagues will lead to changes in the way the football, hockey and other games are played.

One class action lawsuits, brought by more than 4,500 retired football players against the NFL, was settled in August for $765 million. Most of that money would be used to provide medical monitoring, benefits and compensation for injured players, but $10 million would also be set aside to fund additional health and safety research. Earlier this month, however, US District Judge Anita Brody rejected that settlement. Judge Brody's concern was that $765 million -- an average of $170,000 per plaintiff -- was inadequate.

In her ruling, Judge Brody expressed a concern that "not all retired NFL football players who ultimately receive a qualifying diagnosis or their [families] will be paid." She's probably right. Some health economists and insurance industry have estimated that the medical costs alone could top $2.5 billion.  Furthermore, the settlement could indemnify the NFL from future liability, leaving the rest of us to pick up the tab.

Unfortunately, time is running out for many retired players. I would not blame them, their families, the player's unions, or Judge Brody for accepting a woefully inadequate settlement. Many of these retired players need medical treatment and care, and they need it now.

The real problem is the continued reluctance of the NFL and other professional leagues to take the problem of concussions seriously, rather than treat it as a PR problem to be solved. The proposed settlement includes the unfortunate disclaimer that it is not "an admission by the NFL of liability, or an admission that plaintiffs' injuries were caused by football." It also doesn't require any meaningful reforms in how the league, the teams and the players deal with concussive injuries on the field. There are no fines, for example, for teams, coaches or players that willingly ignore the rules on when an athlete can return to the field after suffering a concussion. Finally, it provides little support for additional research in preventing or treating mild traumatic brain injuries.

Until we tackle this problem directly, protecting the health and safety of our athletes will remain a sideline issue.

A public health researcher and ethicist by training, Dr. Sean Philpott is Director of Research Ethics for the Bioethics program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York.  He is also Acting Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.

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