Concussion Inc.

by Irvin Muchnick

  Excuse me — but since when did public health agencies become middlemen for private interests? Where did I miss that step in my civics classes?

  The idea of the feds laundering a tax-deductible check from the Tobacco Institute for “further study” of the harmful effects of teen smoking would be ridiculed into oblivion. Yet that is precisely what is going on here with the NFL’s “model of public-private partnership.”

  I always thought the National Institutes of Health relied on taxpayer funding, from which it was supposed to help prioritize and fund medical research. I didn’t know its mission included brokering a particular industry’s calculated largesse.

  The NFL already has funded the Centers for Disease Control’s “Heads Up” campaign of “concussion education.” By definition, this had the arbitrary effect of framing concussion education as something less urgent than “just say no to football.”

  Now the NFL owns NIH, too. And few citizens are even talking about what that means. Congressman Fattah is among those who are bragging about it.

  1 November 2012..........

  A case in Texas continues the litigation trend we’ve been discussing. Since 2008, Oscar Cordova III has been disabled after surgery for a fractured skull and brain clot sustained in a junior varsity game. The family sued not just the Mission Consolidated Independent School District, but also Pittsburgh-based ImPACT Applications, Inc., for the software that allegedly informed a school athletic trainer’s decision to clear Cordova to resume exercise.

  Like the Dougherty suit in New Jersey, the Cordova case does not appear to include slam-dunk evidence of a premature ImPACT-based return-to-play recommendation following a concussion. The New Jersey facts are ambiguous on the ImPACT-based part of the equation: the extent to which those who authorized return to play in fact relied on this new school district tool. The Texas facts leave open questions on the return-to-play part of the equation: it appears the youngster might not have gone back into a game, where a second collision episode ensued. (Possibly, “return to exercise” will prove to have included hard drills and hitting in team practices.)

  Though this factor could end up being a hurdle for the Cordova plaintiffs, their scenario does mark another step in the growing exposure of ImPACT and those who point to it as a solution. The most recent amended petition in Hildalgo County district court calls ImPACT’s marketing, I believe accurately, “fraudulent and misleading” because it “claims, suggests, or implies its product can detect traumatic brain injury without proper medical diagnosis, lulling consumers into a false sense of security.”13

  Thanks to Nate Rau of Nashville’s Tennessean for reporting on the existence of the Cordova case and for passing along the document.

  5 November 2012..........

  Paul Anderson, whose Concussion Litigation Reporter is easily the most comprehensive resource in its field, informs me that the Cordova family’s case against the Mission School District in Texas, and ImPACT Applications, Inc., has settled. The terms are confidential.

  In his full analysis, which can be accessed only by subscribers, Anderson writes:

  ImPACT has drawn fire from the scientific community for failing to identify concussions and prematurely allowing athletes to return-to-play. According to recent media reports, a series of studies concluded, “the false positive rate appears to be 30 percent to 40 percent of subjects of ImPACT … [it] may even increase th[e] risk” of returning to play too soon.14

  24 November 2012..........

  The fat is in the fire. The NFL claims to be fighting obesity in our kids. But obesity is fighting the NFL.

  If the NFL is right and I am wrong, I wonder why the league’s retirement system has been reduced to weight-baiting as a tactic to resist paying disability benefits to former players. This has come up most recently in the litigation by Jimmie Giles, a tight end for Tampa Bay and others in the ’70s and ’80s.

  Independent Football Veterans organizer and blogger Dave Pear chronicles Giles’ win over the league in federal court in Maryland. Judge Ellen Hollander’s ruling is a thorough demolition of the illogic of the NFL retirement board (on which Players Association appointees, such as the late Dave Duerson, sit alongside management reps).15

  Pear writes that at one point the balky benefits dispensers of the Bert Bell/Pete Rozelle Retirement Plan “even tried to use the fact that Jimmie was ‘overweight’ and it was pointed out to them that Jimmie’s teams had certainly never considered him overweight in his position as a tight end during his entire career!”

  Tight ends are an interesting test of the obesity hypothesis, for both sides of this argument: these guys are part interior linemen, part “skill position” pass receivers. As every casual fan knows, the real career fatsos are the defensive tackles and offensive guards, who fling their girth, free-range and steroid-fattened alike, into the trenches on every play. Orlando Brown, who died last year at 40, is a good example. I don’t think their families care whether they suffered from brain trauma or drug abuse or obesity — they’re all prematurely disabled or dead just the same.

  By the same token, I don’t believe the parents of America require a single-bullet scientific theory before resisting sending their kids, head-first or heads-up, into the NFL’s particular public-spirited division of the conveniently urgent war on obesity.

  19 December 2012..........

  Meet the new “Dr. No” of CTE — Kevin Guskiewicz.

  In the community of dissident retired NFL players, Dr. Ira Casson has gone down in infamy as “Dr. No.” He is the league medical consultant who denied to everyone, even Congress, the link between football head-banging and skull-swiveling, and the phenomenon now clearly identified by researchers as chronic traumatic encephalopathy.

  I nominate Guskiewicz as successor to the Casson Endowed Chair in Industry-Induced Denial. This one has some added kick, since Guskiewicz — chair of the Department of Exercise and Sport Science at the University of North Carolina — was a recipient last year of a MacArthur Foundation “genius fellowship.”

  It is one of the agonies of this story that many so-called experts are really just politicians in white lab coats. Not satisfied with faculty tenure, intra-disciplinary renown, and other perks of minor celebrity, they go for powerbroker status. In the process, they sell themselves on the idea that fame and access — their particular coin of the realm — are not only good for others as well, but also public-spirited even in excess.

  Here and there, I’ve criticized Boston’s Sports Legacy Institute and the Boston University Center on CTE for succumbing to these temptations. But nearly three years after unwisely accepting a $1 ­million NFL grant, the Boston folks are showing signs of finding their sea legs in this crucial public health fight. This may be because the NFL has moved on to bigger game — including subsidies of the National Institutes of Health and Centers for Disease Control, and co-opting female youth sports bloggers into promoting the oxymoron of “safe football” — but I don’t care about what might motivate them. What I do care about is that Dr. Ann McKee (who was always uniquely outspoken) is blasting the equivocations of the recent international “concussion summit” in Zurich. Chris Nowinski is ripping the NFL’s latest pawn of a concussion committee co-chair, Dr. Richard Ellenbogen. And Dr. Robert Cantu is no longer speaking with forked tongue about the need to eliminate tackle football for kids under 14.

  But then there’s Guskiewicz.

  Guskiewicz told Joe Nocera of the Times, “My 16-year-old and my 12-year-old played football this year. They had a great experience.” He added that studies like those of the Boston group “clearly show that CTE exists in players without a history of concussions, but they haven’t completely connected the dots.”16

  Imagine the intellectual timidity of having a forum like the Times and using it to emphasize that they haven’t completely connected the dots. Queue up the tobacco company executives!

  Guskiewicz, being of
sound, indeed genius-level, mind, also told ESPN, “The vast majority of the neuroscience community does not believe that research has yet identified a causal relationship linking repetitive head trauma in football and CTE; I include myself in that.”

  This is all part of what Congresswoman Linda Sánchez, in House Judiciary Committee hearings in 2009, called the “slow walk” of the football industry and its hangers-on regarding the discretionary assessment of injured pinkies … oh, excuse me, the progressively damaged brain tissue of a significant slice of our male children.

  Parents who wait for the experts’ “consensus” to coalesce in peer-­reviewed, theoretically perfected, non-conflicted research are playing what Chris Nowinski has aptly termed “a gambler’s game” with their sons’ mental health. America’s parents, instead, need to be voting with their instincts — and their feet.

  And with no thanks to Kevin “Dr. No” Guskiewicz.

  13 January 2013..........

  Robert Griffin III is a marvelous athlete, an electrifying performer. Let’s hope the mishandling of his knee injury only temporarily detains him, and his fans’ enjoyment of him on the field.

  But I’m a little bored by the controversial apportioning of blame for the fiasco that allowed him to continue in a Washington Redskins playoff game past the point where sidelining him would have been the competitively prudent, not to mention the humane, thing to do. Does the lion’s shame of the responsibility go to the heartless coach? To the stubbornly persistent player? To the dangerously unmanicured turf?

  How about to the culture of football? In case you’re wondering, that’s a fancy way of saying “all of the above.”

  In a piece today on ex–Miami Dolphin Jason Taylor, the Miami Herald’s Dan Le Batard fills in some blood-curdling novelistic detail on the real life of a National Football League gladiator.17 As I will explain below, even this powerful article misses what I think is the public health punchline. Le Batard writes, “[A]s the rules change but the culture really doesn’t … we think we know this forever-­growing monster we are cheering on Sundays. But we don’t. We have no earthly idea.”

  And here’s Taylor’s poetically graphic answer to The Question: “Would I do do it all again? I would. If I had to sleep on the steps standing up for 15 years, I would do it.”

  The few readers of this blog and other viewpoints like it, and the many who refuse to face the factory-processed ingredients of their obsessive entertainment sausage, believe the conveniently unreflective Taylor solves their moral dilemma — that the ongoing commitment of national resources to the development of thousands of Jason Taylors a year, on NFL and college football rosters, is just the way it is, a human inevitability, a social contract for metaphorical mustard gas and neutron bombs.

  But there is another way, other than the catchall “choice,” of looking at this version of certified American virility and the death-and-disability sentence it imposes on our population’s health, happiness, and productivity. For too long, football-think has dominated, even monopolized, soulcraft in our sports literature. It does not have to be so forever.

  After taking note of Taylor’s self-image and that of the world he inhabits (“His mentor, Dan Marino, has a quote up on one of the walls in [the injury treatment section of the team facility], something about how being in the training room doesn’t make you part of the team”), let’s take inventory:

  Painkiller shots on the bottom of the foot — more than one before every game if the first one misses the sweet spot and simply causes more pain. (Not so much as to completely numb the foot — otherwise you couldn’t run on it — but enough to enable you to play on it “better than my backup would have.”)

  Regular epidurals for a herniated back disk. (Wait! I thought only “weak” women, not manly men, subjected themselves to epidurals, and only when they were giving birth … )

  Pre-game hits of Toradol. (’Cause you have to mask the pain from the injury, and from the injection to mask the pain of the injury. Le Batard notes that the types of painkillers Taylor used are linked to causing injuries he didn’t know he had, or simply knew about and doubled-­down on masking, such as the compounding foot injury plantar fascitis.)

  Surgery for “compartment syndrome.” (Nerve damage and a life-threatening blood-pressure jump followed an unfelt kick to the calf. Could have required amputation of the leg if the operation had not been done on an emergency basis. But it was — happy ending!)

  Post-surgery staph infection requiring the insertion of a catheter in armpit. (And infecting and endangering the skin surface where the catheter resided for a half-hour each day by practicing and playing through the condition.)

  Sideline neurologists? Sideline neurologists?? SIDELINE NEU­ROLOGISTS??? (Where is Jim Mora Senior when you need him?)

  The crisis in the feeder circuits of our football system — peewee leagues and public high schools — won’t be solved with more medical personnel, with more ImPACT tests for phony return-to-play decisions following concussions, with more EMR units diverted to this game’s calculated and ongoing emergencies, and away from all the spontaneous ones in our daily private lives.

  No, the football crisis will be solved when every single league and team, at every level, is sufficiently funded to replicate the measures of the $10-billion-a-year NFL. Hand out as many painkillers, oral and needle variety, as it takes. Provide as many epidurals and catheters as the traffic will bear. Let no space-age helmet technology at the top not be subsidized in bulk at the bottom.

  Maybe then the parents of youth football — not the adults of pro football who were programmed from an early age to skew the definition of manhood into Jason Taylorism — will tote up the real human and economic bill of their way of life. Maybe then they will exercise their … ahem … “choice.”

  30 January 2013..........

  The queenpin of Super Bowl hype week will be officially announced tomorrow. The National Football League Players Association, with funding enabled by the recent collective bargaining agreement with the league, is throwing $100 million — a hundred mil! — at Harvard University. The purpose is to study a few guys across time for … God knows what. The outcome, presumably, will be to make us all feel better about the football industry’s top-to-bottom prima facie battering of the American male brain.

  The stenographers of the news media — mesmerized by the Harvard brand, dazzled by the round numbers, and impressed by the activism of one of the nation’s most corrupt unions — will take it all down at the New Orleans press conference and add, “Amen.”

  Unraveling the scientific speciousness, public relations dissembling, and audacious money-changing of this do-nothing project requires an entire series of articles. Let’s get started.

  The study announcement is premised on a big lie, and it goes downhill from there. The lie is that “the NFLPA is alarmed that its members die nearly 20 years earlier on average than other American men.” In fact, life expectancy is not the issue — the preponderance of evidence is that pro football players live more or less as long as the general population. And the NFLPA full well knows it. This is what Hitchcock would call a MacGuffin: a non sequitur plot swerve of no relevance. The scandalous gross national product of football is its robbery of quality of life — plus all the associated and unaccounted-for public health costs. The phenomenon includes a constellation of discrete pathologies, to be sure. But the hub-and-spoke of the whole system is brain trauma.

  This leads to our next point about Harvard’s impending “landmark study”: it is no such thing. Rather, it is a game of running out the clock. The announcement will emphasize how our growing focus on chronic traumatic encephalopathy has made the public forget such equally urgent matters as “searing joint pain” and “heart disorders linked to extreme strength training.”

  (There is not a word about Toradol, the addictive drug that has been criminally over-prescribed by NFL doctors so as to mask both or
thopedic and neurological injuries.)

  Harvard’s kitchen-sink methodology, with a cohort of 1,000 guinea pigs at exorbitant cost, has the rest of the research community not only steaming with envy, but also howling with derision. According to the Boston Globe, a matched control study of the 100 healthiest and 100 sickest participants will be carried out at 26 sites — approximately eight patients per site. This pencils out to an annual cost-per-patient of nearly $50,000. Maybe lab technicians and tenure-pimping assistant professors will be getting two-way taxi fare every day.

  The NFLPA isn’t stupid. Well, it is stupid in the sense that its definition of members’ best interests is crabbed and thoroughly ­private-spirited. But DeMaurice Smith, executive director of an empire of collusion, knows where his nest is feathered. If you’re keeping the temperature of the football public, you can tell that there was more real outrage over Robert Griffin III’s knee injury than there was over Jovan Belcher’s murder-suicide.

  The Harvard study announcement, however, comes at a moment of hopeful counter-signs. With measured words and good timing, President Obama has finally said out loud a few words that might persuade some of America’s parents to begin the process of commencing to think about the possibility of considering whether they should weigh discouraging their sons from eliminating extracurricular options outside of football. (In response, Alex Boone of the San Francisco 49ers, who must be on everyone’s short list for NFL father of the year, told Scott Ostler of the San Francisco Chronicle, “If my son wants to play, he can do whatever he wants. He’s his own man.”)

  Also in the past week, the Centers for Disease Control’s National Institute for Occupational Health and Safety sent letters and fact sheets to all former NFLers who played for at least five years during the period 1959 through 1988. The CDC reported brain and nervous system disorders at three times the rate of the general population. (Lou Gehrig’s disease and Alzheimer’s were individually four times higher; Parkinson’s was about the same.)