Bad Brains: The NFL and Its Concussion Crisis

"Power concedes nothing without a demand; it never has and it never will."
-- Frederick Douglass

Football is a dangerous sport, with inherent health risks. When players suit up, put on helmets, and crash into each other, injuries are to be expected: broken bones, torn ligaments, sprains, contusions, etc. These are part and parcel with the sport. But what happens when science uncovers unexpected risks to players' physical and mental well-being? Shouldn't management be compelled to inform and protect its employees (players) of any potential long-term danger? These are the questions that the National Football League attempts to handle in what has become one of the most-talked about issues in professional sports over the last couple of years: concussions and the attendant brain trauma concussions cause.

Each year, during any given season, roughly 15% of football players suffer a mild traumatic brain injury. According to the Centers for Disease Control and Prevention, the odds are even worse for teenage athletes: Nearly 2 million brain injuries are suffered by teenage players each year. The likelihood of suffering a concussion is three times higher for football players than the second most dangerous sport (women's soccer). Further, according to Grantland.com, high school football players who suffer three or more concussions are nearly 10 times more likely to exhibit multiple abnormal responses to head injury, including loss of consciousness and persistent amnesia.

Defining concussions and chronic traumatic encephalopathy
A concussion is defined as "An injury to a soft structure, especially the brain, produced by a violent blow and followed by a temporary or prolonged loss of function." The force of such a blow causes the brain to move so quickly through the cerebrospinal fluid that it slams into the skull itself. The impact can cause bruising to the brain, tearing of blood vessels, and nerve damage.

One doesn't necessarily have to lose consciousness to have a concussion. Those who have experienced repeated concussions are susceptible to chronic traumatic encephalopathy (CTE), "a degenerative disease that affects the brain and believed to be caused by repeated head trauma resulting in large accumulations of tau proteins, killing cells in regions responsible for mood, emotions, and executive functioning," according to The Concussion Blog. Symptoms of CTE include cognitive impairment, dementia, depression, memory loss, concentration or attention issues, disorientation, confusion, tremors, speech problems, and loss of one's senses. CTE is quite similar to -- and is often misdiagnosed as -- Alzheimer's disease in that those who suffer from it often experience memory loss, mood disorders, and depression.

Concussions haven't always been called by that name. Either out of ignorance or obfuscation, when a player would suffer head trauma, the league -- announcers, coaches, league officials -- used coded language to mitigate the extent of the injury. For example, a player who had been concussed would be deemed "shaken up" on a play. The team might release a statement that a player had been "dinged up" or "buzzed."

The terms used to describe brain trauma are still somewhat nebulous and misleading. Some concussions in the league are diagnosed as "minor." In reality, there are no minor concussions: Brain trauma is brain trauma. In the 1990s, players with concussions would often receive smelling salts on the sidelines and were sent directly back onto the field to continue playing. It was not unheard-of for players to suffer multiple concussions in the same game. Why jeopardize the career, and the physical well-being, of a player? The answer involves copious amounts of money.

Football is big business
Let's get this straight: The NFL is a business first and foremost. And it's a big business. Huge. Last year, the NFL generated $9 billion in revenue. It holds nearly $1 billion in assets and will pay its commissioner, Roger Goodell, nearly $20 million in 2019. Of the big three American sports (i.e., baseball, football, and basketball), it ranks first.

There was a time when baseball was uniformly considered America's pastime. Not anymore. It was always surprising to me that baseball was ever America's favorite child, considering football is predicated on the very elements that have always driven this country's collective consciousness: controlled violence, gaining and controlling territory, a complex hierarchy of authority, and the idea of men preparing for and entering battle.

Absent official rites of passage to manhood in American youth, football has long been a surrogate of sorts, a way for teenage boys to prove themselves, to reappropriate the bluster and bravado and nihilism of what it means to become a man. But at what cost? These battles take place on the gridiron, every Friday night for millions of high school players, every Saturday afternoon for collegiate players, and Sundays for most professional football players. Having played both sides of the ball for a three-time state championship football team, as autumn sets in and a chill fills the air, I've been guilty of parroting one of the sport's biggest cliches: "This is good hitting weather!" The chorus of pads smashing, shoulder pads cracking, and helmets crashing: The players love it. The fans love it. Most of all, the NFL owners love it.

While the NFL enjoys unparalleled financial success and popularity in this country, it has done so without concern or regard for the long-term welfare, both physically and financially, of its key constituents: its players. Within two years of retirement, 78% of former NFL players have gone bankrupt or "are under financial stress."

As a thriving business, the league has failed to divest its energies and harness its myriad resources for its own employees. Any organization worth its salt needs to nurture its four key stakeholders: its customers, its investors, its employees, and the world at large. Fans seem happy. But the problem with the NFL (including Goodell, the teams' owners and general managers, and the head coaches) is that it has shown concern primarily for its investors. That is, to the companies who can help propagate the money-and-power dynamic that keeps the league atop television ratings, jersey sales, stadium attendance, etc. This financial success has come at the expense of players' health.

What the science says
Though scientific data on CTE and its effects are relatively nascent, concussions and the severity of their after-effects has been known for years. More than 4,000 former NFL players have joined a single class action lawsuit against the league for willfully obscuring critical information about the effect of repeated trauma to the brain. These players allege that the NFL has known about the long-term damage that concussions can cause, but failed to provide its employees (players) with adequate warning about the causal link between multiple concussions and later-life cognitive decline.

In 2005, a series of clinical studies conducted by independent neurologists determined multiple concussions cause problems such as dementia and depression. The brains of deceased players were studied and were found to have CTE present; the neurologists found that the CTE was in fact triggered by repeated brain trauma (read: multiple concussions). The NFL's Concussion Committee denied any link between concussions and cognitive decline, and even asked that the article be retracted from the scientific journal in which the studies were published. Ironically, the NFL's committee contained no neuropathologists, yet they were attempting to discuss and refute neuropathological findings.

In 2007, the league scheduled a summit on concussions. According to the NYSBA Journal, independent scientists were invited to come and present their findings on concussions and concussion-related trauma. After the summit's conclusion, the NFL still maintained its stance that research "has not shown that having more than one or two concussions leads to permanent problems." In 2008, Boston University's Dr. Ann McKee, co-director of the Centerfor the Study of Traumatic Encephalopathy, stated "There is overwhelming evidence that [CTE] is the result of repeated sublethal brain trauma." Still, the NFL (via Dr. Ira Cason) denied any link between the two, stating, "There is not enough valid, reliable or objective scientific evidence to determine whether ... repeat head impacts in professional football result in long-term brain damage."

In September 2009, the NFL commissioned a study by the University of Michigan, which found that NFL alumni suffered from Alzheimer's disease (or similar memory-related illnesses) at a rate 19 times the normal rate for men ages 30 to 49. As a result, Congress announced it would hold a hearing to discuss these findings. Finally, the NFL (later in 2009) admitted what medical research had been indicating for several years, with NFL spokesperson Greg Aiello tellingThe New York Times, "It's quite obvious from the medical research that's been done that concussions ... lead to long-term problems."

Here it is, in black and white: the NFL demonstrated a failure to warn its employees about critical danger, and now the league is suffering the consequences. It could threaten the financial livelihood of the NFL itself.

We've seen this before
This type of subterfuge is nothing new. For years, big tobacco denied any causal correlative between cigarette smoking and various forms of cancer/ill health. Once the science caught up, the evidence became undeniable, and tobacco companies were forced to admit culpability.

In 2006, a U.S. District Court found tobacco companies guilty of deceiving the public about the health risks of smoking. The judge on that trial wrote that the companies, including British American Tobacco, Altria/Philip Morris, and RJ Reynolds, among others, acted "with a single-minded focus on their financial success and without regard for the human tragedy or social costs that success extracted."

We don't yet know the full scope and depth of those football players who suffer from the condition, but as research and science advance, CTE will likely be uncovered as a pervasive problem among football players of all shapes and sizes, and of all ages. According to research conducted by the Boston University Center for the Study of Traumatic Encephalopathy, the brain tissue of 18 of 19 deceased former NFL players have tested positive for CTE.

The real catalyst for CTE as an emerging high-profile issue can be attributed, in large part, to the investigation behind a number of former NFL players committing suicide. NFL alumni such as Dave Duerson, Andre Waters, Terry Long, and most recently, Junior Seau (whose family is now suing the NFL), have committed suicide. They and 30 other former NFL players have been diagnosed, post-mortem, with CTE.

CTE has been present in professional boxers for many years, but the same public outcry never hit the sports media as hard as it has for professional football. In boxing, there is no central governing body to implement safety rules, to investigate impropriety, or to look out for the general welfare of its combatants. Boxers sustain brain trauma and have no recourse, they have no support system with which to voice their concerns. The brutality was there for all to see, and perhaps this is, at least in part, why the sport has been relegated to the shadows, a marginal sideshow that is no longer considered a major player on the U.S. sports scene.

Years ago, before the effects of pugilistic dementia were publicly known, the sport was broadcast on national television every Saturday for the nation to see. Now, boxing has been reduced to the periphery. With the NFL, there's far too much money and popularity to simply sweep these injuries under the rug and move along. Unlike in boxing (where there is no union), football players belong to a union and have forced the issue with NFL management via class action lawsuits, forcing the NFL's hand.

An unavoidable danger
The evidence regarding the link between football and brain trauma is undeniable, and the NFL has recently refined and altered its rules in an attempt to decrease the number of concussions its players suffer each year. This is an impossible task: the violent collisions during football plays are an integral and inextricable part of the game as it was originally constructed. It is unrealistic to attempt to legislate out the fulcrum of the sport. Players are being penalized and fined for hits that were considered routine and legal only a few seasons ago. While the NFL rules committee appears to focus on highlight-reel hits, it is the sub-concussive blows, the ones offensive and defensive linemen experience on every single play, that are just as dangerous as the more visible ones other players suffer.

If the NFL truly cares about the health of its players, as it purports to, then the game cannot continue on in its current incarnation. It must be drastically altered or abolished altogether. Obviously, the NFL is not going to shut itself down, so it continues with the charade.

The problem is, many former players and their lawsuits, should they be successful, would cost the league hundreds of millions of dollars. In turn, this will cost the league's 32 insurers money as well, forcing them to raise premiums to compensate for the increased risk of lawsuits.

The NFL has deep pockets and might be able to sustain these financial losses, but as The New York Timeshas reported, football at other levels will suffer. Youth leagues, high school programs, and college programs would be forced, as a result of rising premiums, to raise fees or implement other severe measures such as asking players to sign away their right to sue schools/organizations. It's not unreasonable to foresee pee-wee football leagues, high schools, and even college programs shutting down altogether simply to avoid the potential financial disaster that could result from running football operations. Consequently, the NFL's very talent pool -- youths and teenagers plying their craft and aiming for the pros -- would simply evaporate. Just last month, a study published by UCLA researchers in the American Journal of Geriatric Psychiatry shows that CTE can be detected in living patients. This discovery is tremendously important in that we will now be able to diagnose exactly how many players, on all levels, are suffering from CTE.

The future is uncertain
Once we process these possibilities, we begin to see the full scope of the problem the NFL faces: Football in this country could conceivably not exist in 10 to 15 years. If that seems like an absurd supposition, consider that 40% of the stocks in from 1983's Fortune 500 list no longer exist.

The NFL's death will likely start with these liability lawsuits. Even the manufacturers of NFL equipment are not immune to the CTE fallout. According to Forbes, Riddell, the official helmet manufacturer of the NFL, now faces allegations from roughly 2,500 plaintiffs seeking damages for falsely marketing its helmets as having the ability to prevent or reduce concussions by substantial percentages (claiming roughly a 31% reduction in concussions).

If Riddell, once a public company but now owned by private equity firm Fenway Partners, is found to have willfully misrepresented the functionality of its product, it could suffer dire financial consequences. There is no helmet, no equipment, that can prevent concussions in football. Helmets were originally conceived so that players would stop breaking their necks and fracturing their skulls during football. They can't prevent or even markedly reduce concussions because the injury is internal -- the brain jars from the ferocity of the hit. Ironically, today's helmets likely contribute to concussions rather than reduce them, because players feel comfortable launching themselves at other players at higher speeds and with even more forcible impact.

As the NFL comes under fire from various angles -- lawsuits, public outcry, scientific research, and media scrutiny -- the league's backbone, its players (former and current), could ultimately be the tipping point in the demise of the NFL. Players are now expressly concerned over their own futures with regard to their physical and mental health. They are speaking out, and people are listening. Former Kansas City Chiefs running back Thomas Jones has decided to donate his brain to the Sports Legacy Institute to be studied for evidence of CTE. Jones has no idea how many concussions he has sustained in his 12-year professional career, but he fears for his mental well-being years down the line.

Former San Diego Chargers and New England Patriots safety Rodney Harrison has also been vocal in his concern over concussion-related trauma. Harrison says he is fearful over what could happen to him as a result of the estimated 20 concussions he has sustained over his career. Currently, Harrison says he now experiences symptoms of loneliness, isolation and anxiety. "I'm scared to death. I have four kids, I have a beautiful wife and I'm scared to death what might happen to me 10 or 15 years from now," Harrison told Bob Costas in a segment that aired this week. He claims that during his first five or six years in the NFL, he'd never even heard the word "concussion" mentioned by teams.

The beginning of the end
With the big game approaching this weekend, the NFL is poised for its most profitable annual event. The game will be played and millions around the globe will tune in to watch. Advertisers will spend millions for their ads to air during the game. The league's executives will enjoy the completion of yet another successful season. But make no mistake: the battle won't end on Sunday. Not for the players. As the final whistle sounds, they will take their helmets off and go home to their families, knowing that they may have decades more to fight, and that what is at stake for them extends far beyond the chalk lines of the football field or the dollars in their paychecks.

We are reminded that all empires are temporary. All rulers are greedy. When viewed under this lens, it's fitting that the NFL, which in its own films refers to its players as Roman gladiators, has set itself up for a tragic fall.

Jesse Goodman is a freelance writer who lives in Washington, D.C. He does not own shares of any companies mentioned.

The article Bad Brains: The NFL and Its Concussion Crisis originally appeared on Fool.com.

Copyright © 1995 - 2013 The Motley Fool, LLC. All rights reserved. The Motley Fool has a disclosure policy.