By Susan E. Matthews
That playing football may cause head injuries so severe it leads to brain damage later in life is no longer news. The connection between playing in the National Football League (NFL) and a chronic traumatic encephalopathy (CTE), a brain disease associated with the buildup of tau and marked by depression, erratic behavior, and overall mental degeneration, has been shown by researchers and subsequently covered by the media several times over the last decade. What is news, however, is the length to which the NFL fought against the science that explored this connection, which is the subject of ESPN investigative reporters (and brothers) Mark Fainaru-Wada and Steve Fainaru new book, League of Denial. Fainaru-Wada, pictured left above, is a New York Times best-selling author who has previously written about steroid use in baseball, and Fainaru, right, won a Pulitzer Prize in 2008 for his international reporting for the Washington Post on the military's reliance on private security contractors.
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In the book, Fainaru-Wada and Fainaru expertly weave together the tale of several researchers' "eureka" moments as they first glimpsed the destruction evident in the brains of former football players whose careers were punctuated by a mental descent that often rendered them unrecognizable to their own families. Built around the case of the indomitable Hall of Famer and Pittsburgh Steeler Mike Webster, League of Denial shines light on the NFL's attempts to discredit the science by both publishing their own series of papers, authored by a rheumatologist rather than a neuroscientist, and by attacking those who published the truth about CTE. The NFL did all of this while, nonetheless, paying the Webster family millions of dollars because of the mental and emotional struggles Mike Webster went through in his final years. Self-professed football fans, Fainaru-Wada and Fainaru explore the complexity of realizing that a major source of American entertainment and culture may also be a public health crisis.
Everyday Health spoke with the authors about their book, and whether at the end of it, they'd still let their kids play football.
Everyday Health: If there were still doubts, do you think your book sets the record straight that playing a sport like football, and incurring multiple head injuries, increases the risk of brain damage and diseases like dementia, Alzheimer's and CTE?
Mark: To the dozen or so scientists who have been raising questions to the League for years -- those people don't believe there's any doubt whatsoever. But to hear the League talk about it, and perhaps a few other scientists, they're still raising question as to whether there's a link, which is somewhat interesting, because many of these medical people believe that they decided a long time ago.
Steve: I think we're moving beyond the question of whether football can give you brain damage. Now we're much more focused on how big is the risk, what people might be more at risk than others, how can we mitigate that risk, if we can.
EH: There has been a great deal of reporting on this issue, including, as you note in the book, Alan Schwarz's series in the New York Times. What did you realize was missing that propelled you to go out and research this book?
Steve: America's most popular sport -- one of the most influential cultural phenomenons in the country -- is now being debated as a potential major public health issue. I think what we found and what we hope we've brought is a real depth around what the NFL's role in this was, and how they went about dealing with it.
EH: You often note that the problem doesn't just affect the elite players in the pros, but may trickle down to the millions of kids who play football. What is the NFL's obligation to set an example for these kids?
Steve: I think first and foremost, the NFL's obligation should have been to take seriously the views of independent scientists who were warning them about this problem. Because the NFL does have a great impact on what happens at the lower levels. So, when you have the NFL over a long period of time denying that this is a problem, that was sending out a clear message to lower levels that this is not a problem.
EH: You liken the NFL's denial of the problem to the sinister efforts of tobacco companies, and you point out the flaws in the series of papers in Neurosurgery. Do you think that initially the link was clear enough that the comparison to the tobacco companies is warranted?
Mark: The place to me where it's most notable and relevant is more in the way the NFL handled this. It's a two-pronged attack of denial -- you have this attack on independent scientists who are suggesting this. Then you also have the creation of this committee [by Commissioner Paul Tagliabue] largely of NFL employees -- team doctors who have been putting players back in the field who don't believe there's a problem. It's headed not by a concussion expert or a brain expert, but a rheumatologist who ends up being his personal physician. And then, that committee puts out -- in a journal that's being edited by a consultant for the New York Giants football team -- a series of papers that minimize the risk of concussions and suggest that NFL players are impervious to this kind of issue, as if they're almost super human. That attack parallels the way big tobacco went about attacking the questions that were being raised about the dangers of smoking.
Steve: But there is a fundamental difference between football and smoking. Smoking has no real public utility. Nobody really loves smoking. We, as a culture, are completely addicted to football -- 100 million watch the Super Bowl. The NFL is a $10 billion industry, largely because so many people watch it. That's a real fundamental difference because we get a lot out of it.
How this plays out is going to be really interesting if it turns out that, as [researcher] Ann McKee says, that the number of NFL players who have this disease turns out to be shockingly high -- what is that actually going to mean?
EH: There are a couple of times where it's suggested that if the NFL just owned up to the risk, disclosed the risk, then, because of the love for the game and the fact that football players are well compensated for their efforts, the game would go on. Do you think that if the NFL disclosed the risks there would still be enough people willing to play?
Mark: To me, the idea that the NFL is somehow going to go away has always seemed to be miscast. It's a $10 billion industry and it's really an endemic part of our culture. I think our goal throughout the book was just to inform people as much as we possibly could. Whether the League is publicly and aggressively stating there's a connection or not, the information is now out there, right? So people can make those informed decisions, particularly at an NFL level, and the game can be what it is.
Steve: To me the big question -- the heart of the question -- is the prevalence issue, and what are we ultimately going to know about how many players get it. Once we know that, or we have a better understanding of that, people are going to be able to make much more informed decisions about how they feel about it and whether they want to play.
EH: You talk about so many gimmicks, like Riddell's revolution helmet, designed to protect against concussions. Do you have any hope that something could make the game safer, or lessen the impact of the blows?
Steve: I think that's another real, fundamental question that we don't know the answer to. If you listen to [researcher] Ann McKee and others, the problem is not the most glaring blows that we see -- these big hits where a wide receiver gets blown up and is carried off. The dangerous part is just this incessant head banging that occurs on every play jostling your brain, and that can give you brain damage
I think the answer is that right now there isn't anything on the market that's been shown to reduce concussions. So, are we hopeful? I think we're hopeful around the diagnosis. I don't know that, given what a concussion is, we're hopeful it can be eradicated.
EH: Do you think the NFL right now is finally making a good-faith effort to be honest about the health concerns?
Mark: I do think the NFL right now is very much promoting itself around the issue of safety. They have assembled a very serious group of researchers to tackle this problem, and that's different obviously than the original crew.
But at the same time, when Commissioner [Roger] Goodell is asked this question about whether there's a clear link between football and long-term brain damage, he says this is something we're going to let the medical community decide. First, that's the same response that he gave to Congress back in 2009 that lead them to so much criticism and trouble. Also, there's a large body of researchers now who think that that issue has been settled, long-settled, and that we're now into another phase of the science that is prevalence, how many people get it, how can we mitigate it if we can, who gets it, those kinds of things. So in that sense, I think some people would argue that's a really unhelpful response.
EH: What's your advice to former football players who know they've experienced concussions in play and are concerned about their health?
Steve: Something that's really sobering for both of us was to speak with the families of players who have been through this and to see firsthand what they went through -- this is a real thing. Hundreds of players are dealing with issues now. Some of the people that gave us so much enjoyment for so long are now dead because of it. And the way they died and the suffering that they're going through is not something we would want for any of our loved ones or families. These were players that built the League. For a period of years, the NFL did not do them a great service. So we would hope that if they feel like they need help, that they go out and get it, that they take advantage of the settlement if it goes through, and use that to get help, so they can get better care than the people that preceded them.
EH: Harry Carson has said his grandkids aren't playing football. Would you let your sons play?
Steve: I do think it's pretty dramatic that Harry Carson, a Hall of Fame player came out and said that he doesn't want his kids playing football and he doesn't want his grandkids playing football. Other former players have said the same thing.
For me personally, I'm in the same place as lots of other Americans, and I don't know the answer to it. My son has hinted at wanting to play football, but he hasn't decided to go for it yet. For me, it gets at this core question of the prevalence, which is what we don't know. No one can put a number on it. It's not like smoking where I know that if my son takes up smoking, that's going to be a bad thing for him on a whole number of different levels, so I don't want him anywhere near a cigarette. But this is different -- football is a great game.
"New Book, League of Denial, Explores Connection Between Brain Damage and Football" originally appeared on Everyday Health.