03/11/2013 03:23 pm ET Updated May 11, 2013

Death of the NFL: Part 2

In part one of this series, I suggested that the increased size, speed
and strength of today's NFL players are creating a dramatically more
impactful and damaging set of collisions. We have known for years of
the devastation these collisions wreck on every joint in the human
body. It has become crystal clear that the effects of blows to the
head affect emotions, memory, reasoning -- what it means to be human -- in
frightening ways. The ticking time bomb and undiagnosed health
epidemic that is developing consists of the cumulative effects of
millions of sub-concussive blows that are rarely recognized or
treated. The potential reticence of parents to allow their children to
play football at all, combined with the legal and insurance liability
highlighted in current lawsuits, poses a long-term threat to the game
of football.

David Epstein wrote Thursday on that new studies reveal the
deleterious effect of low-level hits. Epstein highlighted studies from
the University of Rochester and
Cleveland Clinic that showed elevated concentrations of the S100B
protein in the blood streams of college football players that suffered
sub-concussive hits. This presence of this protein is an indicator of
brain injury. Antibodies rush to reject the unwanted protein in the
brain and can result in destructive penetration of the blood/brain
barrier. This occurred with players who were not knocked out. Last
week I urged readers to contemplate the fact that an offensive or
defensive lineman who plays in high school, college and pro football
may suffer 10,000 of these sub-concussive hits.

It is time to take action to stem this damage. A damaged brain
threatens the very essence of personality and consciousness. The first
area to explore is prevention. Can each collision sport have rules
that minimize destructive hits and can we coach players from the day
they enter sports to avoid dangerous practices? Collision is the
essence of a sport like football, each play begins with massive bodies
colliding. There is no way to have so many bodies in motion at such
speed and not have collision. We can do everything possible to coach
and enforce rules that take the head and neck out of being the target
or tool for blocking and tackling. Heading the ball in AYSO can result
in lower test scores -- it needs to be eliminated. Can playing surfaces
be designed that have some give and flexibility on impact? If we can
send a rocket to Jupiter, can helmet designers find materials and
energy absorbing designs that are safer? Do mouth guards offer
protection. Football is a multi-billion dollar sport, shouldn't the
league put aside research and development funds to find better
protection? Are there any substances or nutrients taken internally
that can provide the brain with protection? It seems clear that
certain genotypes and alleles are predictors of concussion
susceptibility -- perhaps we should test athletes so they can weigh the
risk. Strengthening the neck muscles seems to offer some
protection -- shouldn't exercises to achieve that result be a mandated
part of preparation?

Better technology and monitoring are needed to chart all hits so that
sub-concussive hits are included. Technology exists today to measure
the degree of force occurring with hits -- it needs to be monitored and
perhaps displayed on the television monitor as pitch speeds are. A
neurologist needs to be on the sideline of every high impact sport to
ensure proper diagnosis and caution. A standardized regimen for rating
concussions with a corresponding "sit out" period needs to be
maintained. Most of these suggestions were part of the "White Paper"
we issued after I held concussion and player safety conferences in the
1990's. My conscience wouldn't permit me to represent athletes and
facilitate sending them into harm's way without raising awareness and
advocating safety change.

Baseline testing, developed by Dr. Mark Lovell, needs to occur prior
to play to provide a way of measuring how degraded mental faculties
are after a concussion occurs to insure that players are asymptomatic
at rest, on an exercise bike, and at practice before they return to
play. This can stop the dreaded "second concussion syndrome which can
occur when players return too quickly and are at higher risk for a
perfect neurological storm. There are new diagnostic tests on the way
which provide maximum accuracy. Remember that the adolescent brain is
at higher levels of risk and longer periods for recovery. Should we
mandate high school, college or League rules which disqualify a player
for continuing in the sport once they reach a mandated level of
repeated concussion damage?

Awareness and education are important. Athletes are in denial about
their physical health and safety and will take any risk to play.
Retired athletes suffering symptoms need to be aware of them and be
open in sharing the risks with younger players. Leagues, owners,
coaches, trainers, athletic directors, physicians, Players
Associations, parents and families, and the athletes themselves need
be committed to better prevention, monitoring and treatment. To his
credit, Commissioner Roger Goodell has taken more action on this issue
than all his predecessors combined. He knocked down the Berlin Wall of
Denial by convening a physicians' conference,mandating baseline
testing,encouraging players to report on other impaired players,
creating education and public awareness programs. More is needed.
Either this epidemic becomes a recognized public health issue with an
urgency to address or we risk the future of sports we love and the
pain of too many shattered lives.