'League of Denial' shines a light on the NFL's approach to tackling American Football-induced brain injury
By Michael Beattie
13 October 2013
Pittsburgh Steelers Hall of Fame center Mike Webster.
A professional NFL player is involved in between 1,000 and 1,500 collisions each season, many of which can exert forces on the body of 20G or more – the equivalent of being hit by a car at 35mph.
The toll on the athletes’ bodies is well-documented and largely accepted as a part of life in an unashamedly attritional sport, but the impact of these collisions on the brains of players throughout their careers has now been brought to light by PBS documentary “League of Denial”, broadcast in the United States last week.
Over time, constant collisions with the head can result in chronic traumatic encephalopathy (CTE) – a progressive degenerative brain disease that can only be definitively diagnosed after death. A number of cases of CTE have been discovered in players and former players at autopsy, notably following the suicides of Pittsburgh Steeler guard Terry Long in 2005, 14 years after his career ended, and two-time Super Bowl winner David Duerson, who killed himself with a gunshot to the chest at the age of 50 in 2011, stating that his brain was to be donated to the medical research in Boston investigating CTE. Former San Diego Chargers linebacker Junior Seau ended his life in the same manner a year later at the age of 43, less than three years after playing his final game in the NFL.
Players with CTE battle depression, memory loss, and in some cases dementia as a result of changes in the brain tissue brought on by repeated trauma. Dr Bennet Omalu performed the groundbreaking autopsy on former Pittsburgh Steelers centre Mike Webster in 2002, the poster-boy for brain injury who filed the first American Football-related brain injury disability claim in 1997, six years after his retirement.
“I had to make sure the slides were Mike Webster’s slides,” Omalu told the documentary team. “I looked again. I saw changes that shouldn’t be in a 50-year-old man’s brains, and also changes that shouldn’t be in a brain that looked normal.”
CTE represents a watershed moment in professional sport: “a public health crisis that emerged from the playing fields of our 21st-century pastime,” in the words of Mark Fainaru-Wada and Steve Fainaru, co-authors of the book ‘League of Denial’ that provided the basis for the two-hour documentary. Originally a co-sponsored project between Frontline and ESPN, the sports network removed its name in August. Central to ‘League of Denial’ is the question of the NFL’s knowledge of the impact of such concussion injuries – both what they knew and when they knew it.
Webster’s physical and mental state was assessed by five doctors, including one sanctioned by the NFL. All five found a man unable to concentrate, prone to angry outbursts and unable to sleep, his life having unravelled to the point where he found himself divorced and living in his car.
The claim was approved in 2000, two years before his death at the age of 50, and with it came an admission from the NFL that the sport can cause permanent brain injury – but the statement remained uncovered for years. The league launched a 15-year in-house committee into the issue and implemented a series of rule changes to reduce the number of head-on collisions, issued a pamphlet to all players called "What Is a Concussion," launched a project to educate children about avoiding head injuries, and donating $30 million to the National Institutes of Health to study brain disease.
Yet in the face of congressional hearings and mounting medical evidence, the NFL remains tight-lipped on the link between the sport and permanent brain damage – a link that would expose the multi-billion dollar industry to liability claims that could potentially run into billions of dollars itself. The NFL has consistently argued, in the words of commissioner Roger Goodell, that “the link between football and CTE is unclear.”
From a scientific standpoint, the statement stands. Tau, the corrosive protein found in the brain tissue of those suffering with CTE, can only be examined after death. To date, the 54 brains tested by Boston University’s Center for the Study of Traumatic Encephalopathy – 52 of which show indications of CTE – come from players who showed symptoms of extreme deterioration before their death, creating a natural bias in the test sample.,That will change in future as a number of otherwise healthy retired players having signed up to donate their brains to the study after their deaths.
In spite of their stance on the issue, in August 2013 the NFL paid out $765m to 4,500 former players to settle their claim that the league had covered up the link between professional American Football and brain injury. The settlement included a stipulation that the NFL was not accepting responsibility for the head injuries, ruling out any liability for future claims, while avoiding a court case prevented closer scrutiny of the quality of the league’s research into the issue.
While the book and documentary may have little impact on the engagement of NFL fans with the sport, the issue of vulnerability among youth and high school players will be of greater concern to parents of aspiring players. The juvenile brain is lighter than the adult brain and therefore more vulnerable to “disruption," while the cumulative nature of the injury means some players could begin to show signs of CTE before reaching college, let alone the professional game.
In the meantime, questions remain about the NFL’s stance, most notably the success of those rule changes designed to reduce collisions with the head. The league will not be rocked off its axis by the Fainaru brothers' investigation, but as former New York Giants linebacker Harry Carson put it: “The NFL has given everybody 765 million reasons why you don't want to play football.”