After the article was posted, Schwarz emailed me: “Nicely done.”
On January 24, I emailed Schwarz, in part, “On or off the record, your choice: do you intend to explore the Maroon/Riddell fault line? If not, why not? Any insights from your valuable perspective would be appreciated.”
Schwarz again declined comment — but not before first going out of his way to say that Dr. Maroon had been “obviously (and surprisingly) quite generous to me” in comments in a recently published New Yorker article, and to make sure that he, Schwarz, was satisfied that my “motives” in asking the question were pure.
Now that Schwarz’s thin skin has been pierced and he is giving his crypto-assurance that Joe Maroon is a non-story, it’s time to reemphasize that Maroon is not a good guy in the NFL concussion narrative and has not been for years. Why didn’t Schwarz press Maroon on the history of his enabling of Riddell helmet hype, rather than allow the doctor to get away with a quote triangulating the FTC investigation and distancing himself from the company? Intuitively, this made no more sense than Maroon’s parallel survival as a member of the NFL’s Mild Traumatic Brain Injury Committee for years (up to the present) beyond the exposure of his and other league doctors’ commercial conflicts of interest in Congressional hearings and in the media (some of them well-drawn stories by Schwarz himself).
This is not an attempt to brand a triviality into the main timeline. As the Pittsburgh Steelers’ neurosurgeon, Maroon was on the front rank of the apologists and deniers when Dr. Bennet Omalu identified the breakthrough cases of chronic traumatic encephalopathy in Mike Webster and Terry Long. Is there a better word in the English language than “lie” for the statement by Maroon that Long’s team medical file showed no concussions — a falsity chronicled by Chris Nowinski in his book Head Games? (After Maroon’s categorical denial, Omalu produced a 1987 letter by Maroon about treating Long for a concussion.)
Any way you slice it, Schwarz’s Mount Olympian dismissal of the very idea that Maroon might be more than a bit player in the national sports concussion scandal ignores a clear and chilling through-line. Maroon’s and colleagues’ articles for the journal Neurosurgery (whose editor-in-chief through much of the period was a New York Giants consultant) downplayed concussion syndrome, beat the drum for pseudo-objective neurocognitive testing in return-to-play standards, and were the direct antecedent of the current state-by-state campaign to put the costs of newfangled concussion management software on the backs of high school sports programs. (The runaway market leader in this field is the for-profit ImPACT system owned by Maroon and some of his University of Pittsburgh Medical Center colleagues.)
The DNA of this whole process is evident again in Maroon’s work for Riddell. That is why I argue that the federal government will solve nothing, and indeed will be aiding a whitewash, if it stops at a probe of the helmet industry.
Finally, if Alan Schwarz’s “reasons” for treating Dr. Joseph Maroon with kid gloves in the pages of the New York Times cannot be articulated even though the reporter initiated a reference to them in an unsolicited communication, then I am not the only reader with “reasons” to question whether the reporter’s impenetrable code here is a public service.
3 June 2011..........
In a January New Yorker article on the concussion crisis in football, writer Ben McGrath quoted Pittsburgh neurosurgeon Joseph Maroon speaking admiringly of Alan Schwarz, the New York Times reporter who created this beat and more recently was nominated for a Pulitzer Prize. Schwarz, said Dr. Maroon, is “the Socratic gadfly in this whole mix.”
Unlike Socrates, however, Schwarz asks questions that are carefully and corporately adumbrated. The resultant national spirit of cautious inquiry into a stunningly broad public health story is being driven by our Newspaper of Record. This process has the effect of protecting powerful and moneyed interests.
I don’t think anyone from the Riddell helmet company is going to jail after Congress, the Consumer Product Safety Commission, and the Federal Trade Commission are finished probing how the company ran hard and fast with ambiguous data from a safety study underwritten by the NFL. Nor do I think anyone should, based on what we so far know, despite the Purple Heart that Schwarz awarded himself last week in a bush league email complaint about my blog’s coverage: “I kill myself for six months to expose a serious safety problem — and even conspiracy — in youth football, cause sweeping changes (some about to be announced) and investigations by the CPSC and the FTC …”
Schwarz, who used to write books analyzing baseball stats, is in his element when he verbally slaps around the leadership of the National Operating Committee on Standards for Athletic Equipment. He is obviously less comfortable confronting figures like Dr. Maroon, a team physician for the Pittsburgh Steelers who remains, inexplicably, a quotable authority even though he is facemask-deep in the concussion scandal.
It would behoove the most celebrated concussion reporter in American journalism to press Maroon for better answers. Instead, Schwarz has allowed Maroon to distance himself from the NFL’s Riddell helmet study, which the doctor co-authored with, among others, the company’s chief engineer, and which Riddell then exploited in its promotion.
Ah, but Maroon is not an issue, Schwarz asserted to me — “for reasons of which you are totally unaware.” If that’s true, then this titan of communications needs to do some more communicating.
One upshot of Schwarz’s incomplete coverage is that ImPACT has been purchased by an estimated 10 to 15 percent of high school football programs across the country, often under the mandates of new state “safety” legislation. I believe that, rather than shifting the NFL’s public health tab to already financially beleaguered school districts, we should be talking seriously, not as a throwaway line, about whether high school football is medically, legally, and educationally sustainable.
Somehow the Times has not seen fit to print the devastating critique of ImPACT by Christopher Randolph, a neurology professor at Loyola University Chicago’s Stritch School of Medicine, in the journal Current Sports Medicine Reports. (Credit for first publicizing Randolph’s work goes to Matt Chaney.)
Randolph wrote, “There is no evidence to suggest that the use of baseline testing alters any risk from sport-related concussion, nor is there even a good rationale as to how such tests might influence outcome.” He added that independent studies of ImPACT show a level of reliability “far too low to be useful for individual decision making.” In sum, youth sports programs using it are investing in a false sense of security.
And what, I ask Alan Schwarz and the New York Times, would Socrates have to say about that?
8 June 2011..........
No doubt some readers think I’m doing an excessive metaphorical tap dance on Dr. Joe Maroon. The same readers may also wish I’d call a halt to my proverbial soft shoe on Alan Schwarz of the New York Times, the baseball statistical nerd who, by his own modest account, “[killed] myself for six months to expose a serious safety problem — and even conspiracy — in youth football.” Maroon praises Schwarz in the New Yorker, Schwarz quotes Maroon uncritically in the Times, and Schwarz tells me flatly that Maroon is a not an issue in the larger national sports concussion scandal “for reasons of which you are totally unaware.”
I point these readers and others to author-journalist-blogger Matt Chaney’s January 28 post, “Brain Expert Omalu Wants Longer Rest for Concussed Football Players.”4 The subhead of Chaney’s article is “Sideline concussed juveniles for three months, says the breakthrough neuropath; Neuropsychological testing lacks validation and might be harmful, critics caution; NFL players rebuke theory of ‘safer’ football through their ‘behavior modification.’”
Here’s most of the section headed “Critics Doubt Efficacy of NP testing for concussion diagnosis, ‘return to play’”:
Today’s general view that concussion management works or can work in tackle football is rendered highly suspect,
if not effectively discredited, by independent review and mounting adverse opinion of experts and witnesses like players.
Linebacker [Scott] Fujita notes he hasn’t been measured on neural baseline for two NFL seasons. Might not matter, anyway, for NP testing has taken a systematic beating by reviewers of late. Observations and findings of medical literature from 2005 to 2010, listed without full author groups or first names, include:
Randolph et al., 2005, for Journal of Athletic Training: “Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion, no NP tests have met the necessary criteria to support a clinical application at this time. Additional research is necessary to establish the utility of these tests before they can be considered part of a routine standard of care . . . until NP testing or other methods are proven effective for this purpose.”
Patel et al., 2005, for Sports Medicine: “Numerous guidelines have been published for grading and return-to-play criteria following concussion; however, none of these have been prospectively validated by research and none are specifically applicable to children and adolescents.”
Mayers, 2008, for Archives of Neurology: “Current guidelines result from thoughtful consensus recommendations by expert committees but are chiefly based on the resolution of symptoms and the results of neuropsychological testing, if available. Adherence to this paradigm results in most injured athletes resuming competition in one to two weeks.”
Duff, 2009, for ASHA Leader: “Indeed, the identification and management of concussion has become a growing public health issue. Considered to be the fastest-growing sub-discipline in neuropsychology, concussion management poses unique challenges and opportunities for those working with school-aged children… . There is no consensus on the best course of action for concussion management. In fact, there are as many as 22 different published guidelines for grading concussion severity and determining return to play… . Developers are working to collect data regarding reliability, validity, and clinical utility of these (NP) tools; independent replication is still forthcoming.”
Echemendia et al., 2009, for British Journal of Sports Medicine: “Post-injury assessment requires advanced neuropsychological expertise that is best provided by a clinical neuropsychologist. Significant international differences exist with respect to the training and availability of clinical neuropsychologists, which require modification of these views on a country by country basis.”
Covassin et al., 2009, for Journal of Athletic Training: “little is known about the use of baseline neurocognitive testing in concussion assessment and management… . We found that the majority of ATs (athletic trainers) are interpreting ImPACT results without attending a neuropsychological testing workshop… . The use of baseline testing, baseline testing re-administration, and post-concussion protocols among ATs is increasing. However, the ATs in this study reported that they relied more on symptoms than on neurocognitive test scores when making return-to-play decisions.”
Maerlender et al., 2010, for The Clinical Neuropsychologist: “Although computerized neuropsychological screening is becoming a standard for sports concussion identification and management, convergent validity studies are limited.”
Piland et al., 2010, for Journal of Athletic Training: “Obtaining (self-reported symptom) statements before a concussion occurs assists in determining when the injury is resolved. However, athletes may present with concussion-related symptoms at baseline… . In other words, some post-concussive symptoms occur in persons who have not sustained concussions, rendering the specificity of alleged post-concussive symptoms suspect.”
Schatz, 2010, for American Journal of Sports Medicine: “Computer-based assessment programs are commonly used to document baseline cognitive performance for comparison with post-concussion testing. There are currently no guidelines for how often baseline assessments should be updated, and no data documenting the test-retest stability of baseline measures over relevant time periods.”
Comper et al., 2010, for Brain Injury: “Despite the proliferation of neuropsychological research on sports-related concussion over the past decade, the methodological quality of studies appears to be highly variable, with many lacking proper scientific rigor. Future research in the area needs to be carefully controlled, repeatable, and generalizable, which will contribute to developing practical, evidence-based guidelines for concussion management.”
Eckner et al., 2010, for Current Sports Medicine Reports: “The sports medicine practitioner must not rely on any one tool in managing concussion and must be aware of the strengths and limitations of whichever method is chosen . . .”
Unfortunately, software packages like ImPACT, long criticized for its direct connections to the NFL, are widely employed as cornerstone for concussion evaluation and typically by untrained clients, as literature and news reports confirm.
17 June 2011..........
New York Times reporter Alan Schwarz, May 27 email to me: “As far as I know your concern with the coverage stems only from your Maroon-connection-to-Riddell-study issue. [I know that is not an issue] for reasons of which you are totally unaware …”
New York Times columnist George Vecsey, June 14 email to me: “The NYT has led that story for three years. What are you talking about?”
We all realize that the New York Times is the worldwide leader in worldwide leadering. But on the story of the pandemic of traumatic brain injuries in sports and entertainment, exactly where is the Times trying to lead us?
An examination of the Newspaper of Record’s coverage over the past six months suggests that the answer is it is leading us to a world made safe for the NFL and its $9-plus billion in annual revenues.
Pay plenty of lip service to the alleged mental-health toll for the thousands upon thousands of professional and amateur athletes employed by the NFL or in its orbit — but also make sure all the opinion-making honor and commercial benefits are reaped by the very league-connected doctors whose corrupt research and false public statements brought us to this pass.
Last December 8 the Times led a story headlined “NFL Invites Helmet Safety Ideas” with these words: “With the federal government, state legislatures, and football helmets’ regulatory body already focusing on concussions and head protection, perhaps the most influential group of all — the NFL — convened its own summit of experts Wednesday to discuss possible reforms.”
Try to imagine a Times story in the 1960s, subsequent to the surgeon general’s report on the dangers of cigarettes, with a lead characterizing the Tobacco Institute as “perhaps the most influential group of all.”
One of the NFL’s “summit of experts” — quoted in paragraph three of the Times account with the searing insight “there’s still more questions than answers” — was Dr. Joe Maroon. (The line in Maroon’s résumé about being the medical director of WWE is scrubbed in Times coverage.)
There are already plenty of answers about Maroon himself, one of the root liars of the concussion saga. Yet the Times continues to inflict unfiltered Maroon on the concussion education of its readers. Most recently, Maroon, who says he welcomes the federal investigation of his NFL-funded safety study of Riddell football helmets, has been given Times news real estate for the lame explanation that he studied good but Riddell promoted bad.
Meanwhile, Dr. Bennet Omalu, who overcame Maroon’s obstacles to identify chronic traumatic encephalopathy in dead football players, has not appeared even one time this year in print editions of the Times. On February 26, the Times did run a blog item by Toni Monkovic, which allowed that Omalu once upon a time “figured prominently” in a breakthrough finding of brain damage in NFL players. Monkovic also quoted author-blogger Matt Chaney’s report on Omalu’s call to sideline all concussed athletes for three months.
In lieu of conducting this threshold debate in print, however, the Times has chosen to go yawn and on about
football helmets and neurocognitive testing. The latter is a field that Maroon and his UPMC colleagues, with their NFL affiliation, dominate via their for-profit concussion management software, ImPACT. This despite a substantial body of research — also unreported in the Times — arguing that neurocognitive testing in general, and ImPACT in particular, are at best ineffective.
And it’s not as if Omalu hasn’t been heard from lately in the CTE field: after several years of effective exile from the pages of the NFL-doctor-controlled journal Neurosurgery, he returned there under new management with a recent major article.
There’s no new management at the NFL itself. For the New York Times and reporter Alan Schwarz (whom the New Yorker quotes the corrupt Dr. Maroon praising), that seems to be what counts most.
19 June 2011..........
Let’s move beyond my criticism of Alan Schwarz and the New York Times. I want to impress upon everyone not just that the Gray Lady recently has fumbled the ball in the red zone, but also how to regain the lost momentum of its generally excellent coverage of the concussion crisis prior to this year.
The Times website’s March 13, 2010, interactive timeline, “The NFL’s Embattled Concussions Panel,” with references dating back to 1994, remains a great historical resource.5 Several things have gone wrong since then, in my view, beginning with the subtle co-optation of Schwarz, an inexperienced investigative reporter, which has paralleled that of his friend Chris Nowinski. It is hard to hear people nominating you for a Pulitzer Prize in Schwarz’s case, or to find yourself brokering a $1 million National Football League grant in Nowinski’s case, and retain your outsider’s edge. Someone whom the New Yorker quotes corrupt NFL doctor Joe Maroon calling “the Socratic gadfly” of concussion discussion is receiving accolades with strings: he also is being unofficially appointed the amanuensis of the ruling class.
Add to all this last fall’s loss of Democratic control of the House of Representatives, whose Judiciary Committee had conducted the most penetrating public hearings drawing the parallel between the NFL and the tobacco industry, and you have a recipe for tepid and hyped measures like helmet reform, along with acquiescence in spurious and cost-shifting post-concussion “management.”
Concussion Inc. Page 13