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2013, The Year Football and the NFL Changed Forever

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2013 is turning out to be a watershed year for our understanding of the dangers inherent in playing football. The lens through which we view the relationship between football and brain trauma is now in HD. In addition to what we learned from impact studies, PET scan research and treatment possibilities, a superb documentary film about the NFL and brain trauma aired on PBS. What we now know has offered glimpses as to how to make football safer going forward. This is a year worth reviewing. Let's begin with its most surprising research.

When the words marijuana and football are seen together, it's typically because a player has been busted for using the drug. What other reason could there possibly be? Well, as it turns out, there is an important connection between the two.

In a study published this year, it was reported that there are substances in marijuana -- cannabinoids containing a variety of antioxidants -- that have shown to be effective in reducing the damage caused by trauma to the brain. In an article published in the September issue of the Concussion Litigation Reporter, Clint Werner, a medical marijuana researcher, was quoted as saying:

Severe head injuries automatically trigger the production of an excessive amount of neurotransmitters called glutamates. When there are too many of these chemicals in the brain, they can initiate a chain reaction of cell degradation and impairment. The cannabinoids, which we find in marijuana, work as effective antioxidants, potentially neutralizing the glutamate activity and stopping the cascade of neuronal damage that can follow.

This sounds as if the best thing a football player can do after suffering a concussion is smoking a joint. But that would be playing fast and loose with the facts. The preliminary data with cannabinoids suggest that the optimal doses are at micro levels, far smaller than the amounts that typically occur by inhaling the drug. Since nothing else is currently available to treat brain trauma, the importance of this research cannot be overstated.

Earlier in the year, Dr. Gary Small published a pilot study that found tau protein, the signature of Chronic Traumatic Encephalopathy (CTE), in the brains of 5 former NFL players by using PET scans. The results of this study sent shivers down the spine of the NFL and changed the conversation about CTE forever. It wasn't just about autopsies anymore.

More recently, on September 24, the New York Times reported the results of four studies that monitored hits to the head in children. Using the Head Impact Telemetry system (HIT), a sensor based technology developed by Dr. Stephan Duma, 120 football players ranging in age from 7 to 18 were followed over a two-year period of time.

Both the number of hits and magnitude sustained by the players were a lot higher than expected. Most unsettling was the finding that boys as young as 7 experienced hits comparable in magnitude to those of much older players. In addition, the researchers found that most of this impact occurred during practice. Needless to say, contact drills have now been dramatically reduced.

The most dramatic moments of the year came in late August and early October. On August 29, the NFL settled its lawsuit with the 4,500 former players, who sued claiming negligence regarding the league's handling of concussions. In exchange for $765 million, the players agreed to release the league from any liability, or an admission that the players' injuries were caused by football.

Then, only six weeks later in October, as if choreographed by a God with a sense of irony, PBS's Frontline aired League of Denial. This documentary chronicled the NFL's systematically distorting, denying and deleting information surrounding concussions. The league did everything and anything to avoid responsibility for a reality that was now apparent to everyone: the violent collisions that occur in professional football cause brain damage resulting in CTE.

So what can we expect going forward? The following is a possible scenario:

From the moment a boy begins playing football, the HIT system tracks his every play. The data is stored by frequency, directionality and intensity of impact. Based on these numbers, an algorithm evaluates and decides when a player should be removed from the game or not allowed to play at all. A player's impact profile is computerized and made available like other medical information. Beginning at the collegiate level, periodic PET scans are used to monitor for CTE.

The primary reason why this isn't going to happen any time soon at the high school and collegiate level is cost. It's expensive to use the HIT system making it prohibitive for many schools. That said, if insurance companies begin demanding the implementation of the system for liability reasons, schools might be forced into using it.

Money, however, is not problematic for the NFL. You would think that the league would jump at the chance to make the game safer and themselves look better. In fact, the league has actively avoided implementing this since 2010, when they had a pilot program using HIT ready to go. They never pulled the trigger nor gave an explanation as to why. It wouldn't be a stretch to assume the NFL is terrified as to what the impact read-outs might look like. Better to keep putting this research off then have the g-force numbers plastered all over ESPN.

Ironically, the players don't want the HIT system either. For them, both playing time and money may be negatively impacted by its implementation. Hines Ward, former wide receiver for the Steelers said in 2012, "for a doctor to read a computer and tell me how hard I've been hit and to pull me out of a game, that won't sit well with a lot of players." Don't expect this issue to be one the players nor the owners lobby for during the next collective bargaining negotiation.

So what's left to make the game safer? Well, we started with marijuana and that's where we're ending. It's somewhat ironic that a drug, whose most common side effect is memory problems when used recreationally, is now being heralded as a treatment for brain trauma.

There is, however, one rather large and obvious obstacle -- the drug is a banned substance. Even in states with medical marijuana laws, it's still somewhat problematic because of player contracts that prohibit its use.

It's difficult to make a case for not allowing individuals who have suffered severe brain trauma to use a drug that is safe and efficacious. As was pointed out in the Concussion Litigation Reporter, "It would be like prohibiting a nuclear plant worker from using potassium iodide or prohibiting a Peace Corps worker from being vaccinated against dengue fever or some other exotic disease."

Until things change, Peyton Manning is only one of two reasons why a player might want to play for the Denver Broncos.

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