Concussion Inc.

by Irvin Muchnick

  A week earlier, at the opening game at Sacramento’s John F. Kennedy High School, tight end Reginald Wilson “went up for a pass, was hit in the back, and then hit his head on the ground. Paramedics took him to the hospital and he stayed through the weekend,” reports Hugh Biggar of the Sacramento News & Review. Coach Chris Palumbo told Biggar that Wilson “lost feeling in his legs and had memory loss,” but is making a “remarkable recovery” and will soon return to school.

  The day before the Sacramento incident, 17-year-old Kainen Boring sustained a traumatic brain injury from a helmet-to-helmet collision on the practice field of Bledsoe County High School in Tennessee. He was declared brain-dead a week later, and on Sunday his family took him off life support.

  Young Boring’s “personal trainer,” Houston Thomas, told the media, “They said it was a perfect form tackle. But for whatever reason it made just a freak accident.”

  At last word, a second high school player in Tennessee, Tucker Montgomery, still lay in a coma.

  Unless I’ve lost count of the necrology maintained by author/­blogger Matt Chaney, there are already 14 American football fatalities this year, including 13 kids, three of them from athletic collisions. (The other head-trauma victim was a college player, 22-year-old Derek Sheely. Most of this year’s deaths seem to be heat- or heart-related, not from contact, though the disclaimer is hardly reassuring about the overall phenomenon.)

  On this Sunday’s NBC prime-time football game, the lions and the Christians forged on. America’s poster child for glory, demonizing, and redemption, Michael Vick, got concussed in front of 24 million viewers. Announcers Al Michaels, Chris Collinsworth, and Michele Tafoya blabbed misleadingly about a “neck injury” and how Vick was spitting up blood because he “bit his tongue.” Even when the trainer for Vick’s Philadelphia Eagles did the right thing and led him to the locker room, per new National Football League protocols, the opportunity to speak the truth about traumatic brain injuries was lost.

  In half a century of watching televised sports, this may have been the most disgraceful display by commentators I have ever seen. And that’s saying a lot, since I was also in front of the tube when the same NBC wildly speculated as to the identity of the 1996 Centennial Olympic Park bomber, which fueled a witch-hunt of a wrongfully accused man.

  By Monday morning, all was back to normal for the NFL and its fans … sort of. For those who have Vick on their fantasy league teams, the main question was whether he would be good to go next Sunday.

  25 September 2011..........

  In two emails yesterday to the media relations staff, I asked the Philadelphia Eagles the identity of the “independent neurologist” who cleared Michael Vick to play today. I later forwarded the message to their counterparts at the National Football League office.

  There has been no response.

  The NFL’s return-to-play protocols following concussions, which were promulgated in 2009, state that a player “should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant.”

  This morning’s Philadelphia Inquirer does not name the “independent neurologist” on the Vick case. Nor does anyone else appear to have done this. The Inquirer does quote Vernon Williams, medical director of the Kerlan-Jobe Center for Sports Neurology in Los Angeles, saying, “There is some evidence — and this isn’t completely worked out — of what we call injury-induced vulnerability. Once the brain has been concussed, in many people it is easier for them to suffer a second concussion.” Williams adds, “As you increase physical exertion and demand on the brain and body there’s a risk you have in a return of symptoms. Think about the differences in your exertion level, your adrenaline between practice and a game — there’s a pretty significant difference there.”2

  Chris Nowinski, of the Sports Legacy Institute and Boston University’s Center for the Study of Chronic Traumatic Encephalopathy, continues his rhetorical tiptoe through the tulips, saying some of the right things while coming off more like an NFL bureaucrat than an independent public health advocate. Nowinski told Newsday he would have been happier to see Vick “err on the side of caution” and not play. According to Newsday, “Nowinski thinks the NFL is doing ‘a much better job’ of determining when it’s safe to play. But as the NFL notes in its policy, a critical element of managing concussions is ‘candid reporting of players of their symptoms.’”

  My interpretation here is that Nowinski’s overarching theme from the Vick controversy is the league’s potential liability for a player’s disability or death. And such liability is mitigated by the double-­reverse protocols of consulting an unnamed “independent neurologist.” The NFL is further protected if Vick did not “candidly report” his symptoms.

  I would much rather have seen Nowinski say something on behalf of the millions of people who will watch today’s Eagles–New York Giants game, and the millions of families of youth football players who are being misled by the opaque baloney at the NFLHealthandSafety.com website. Some of that nonsense spews from Dr. Joseph Maroon, neurosurgeon for the Pittsburgh Steelers and medical director for World Wrestling Entertainment; Maroon’s University of Pittsburgh Medical Center was involved in the review of Vick’s neurocognitive tests, according to ESPN’s Sal Paolantonio.

  If Nowinski anywhere has joined me in calling for public disclosure of Vick’s “independent neurologist,” I missed it.

  26 September 2011..........

  One of the wisest observers of the Michael Vick scenario is a coach and trainer named Sal Marinello. Though not well known to readers of this blog, he is a fine example of what I call the fatalistic wing of the concussion debate — honorable sports industry professionals who don’t deny the magnitude of traumatic brain injury but who, in my view, need a nudge toward recognizing that their fatalism is neither pragmatic nor acceptable when it comes to tackle football funded and promoted by, for example, public high schools.

  Marinello’s credentials include USA Weightlifting certified coach; president of the Millburn-Short Hills (New Jersey) Athletic Club; assistant men’s basketball coach at Montclair State University; and head athletic development coach for both Mercy College (New York) men’s lacrosse and Chatham (New Jersey) High School.

  Here’s his take, via email, on Vick: “Despite the post-game comments, anyone who watched the Eagle game could see that a) Vick certainly was not OK and b) the Eagle game plan reflected this. He also took several shots to the head that seemed to affect him. Since he broke his hand and will be out three to four weeks, he will get the ‘rest’ he needs.”

  More important, there’s a longer essay on Marinello’s blog entitled “There Is No Such Thing as Safer Football”; the money paragraph:

  Tobacco will never be outlawed, and neither will football. Education has resulted in fewer people smoking, and the attention paid to the risks and dangers will probably have the same effect on football. Will fewer kids play? Probably. Is this a bad thing? Probably not, and for a variety of reasons.3

  You have to appreciate Sal’s candor — three days after he posted this piece, his own son broke his arm playing football.

  But you also have to wonder whether he’s asking the right question. Sure, tobacco will never be outlawed. But do high school recreation centers include cigarette vending machines? (Sal disagrees with my analogy. He retorts, “What would you say when parents and residents of a town do not complain about having — or want — the machine in the school? This scenario more aptly describes the current situation.”)

  Another smart observer in the fatalistic camp is Buzz Bissinger, author of Friday Night Lights. I am not trying to put words in Bissinger’s mouth, but my sense is that — like Marinello and unlike, for example, Alan Schwarz, Chris Nowinski, and Dr. Rob
ert Cantu — Bissinger isn’t searching for an imaginary sweet spot in football safety. Though he recognizes that the game can be improved around the margins, he also understands that its blood sport essence is athletically unalterable.

  The Marinellos and Bissingers have to be careful, though, because their positions get appropriated by yahoos and libertarian wackos. In Bissinger’s case, he has written movingly about the passion play of football in places like Texas; if he is saying that elites are acting drastically when they seek to tamper with popular mass entertainment on the basis of intellectual abstractions, he has a point.

  But I don’t think the evidence of epidemic health damage to American youth is any more an abstraction. At the very least, the fatalists and the idealists need to join forces to remove the blinders from the deniers.

  Here’s your Michael Vick medical report, Version 2.2:

  Today Philadelphia Eagles coach Andy Reid said Michael Vick “has a hand contusion — not a break.”

  What Vick has for sure is bruised feelings.

  What he might also have is another concussion, days after being cleared by an “independent neurologist” whom neither the Eagles nor the NFL will name.

  30 September 2011..........

  Michael Vick medical reports are subject to further review, like Vietnam War body counts. But as this article was being written, he was assuring one and all of the “100 percent chance” that he will start Sunday’s game at quarterback for the Philadelphia Eagles. Since the 49ers are the Eagles’ opponent, Bay Area television viewers will be complicit in the next rubber-necking twist of the increasingly grotesque Vick saga.

  Reformed criminal, repentant canine abuser, astonishingly gifted athlete … Vick brings the whole package to the uniquely American story of industrial death and disability in sports. An unsound mind in an unsound body.

  Two weeks ago, he got knocked silly when he was thrown into his own lineman in a nationally televised game. However, the NFL’s cowardly partners at NBC didn’t dare call it a concussion. The “C” word, you see, is nearly as taboo as “Voldemort” was for Harry Potter’s friends.

  After an “independent neurologist” cleared him, Vick got rushed back to the starting lineup last Sunday. My pleas to the Eagles and the NFL to provide the name of this vigilant descendant of Hippocrates went unheeded. Where did the “independent neurologist” get his medical degree, I wonder — a correspondence course in the Bahamas?

  Perhaps the “independent neurologist” will apply for a position on the panel of experts soon to be appointed by the federal Centers for Disease Control and Prevention, and charged with developing national guidelines for management of concussions in school sports programs. If he’s not available, then I’m sure Joseph Maroon of the Pittsburgh Steelers, the University of Pittsburgh Medical Center, and World Wrestling Entertainment — whose team carefully reviewed Vick’s neurocognitive results last week against his “baseline” tests — will be glad to buckle up his chinstrap.

  Even before Vick got knocked out of the game with the New York Giants by a hand injury, he was fuzzy and ineffective. “Not right today,” “just didn’t seem like he was 100 percent,” “something was off,” Fox professor of footballogy Howie Long mumbled.

  Vick first complained that NFL referees weren’t giving him his fair share of roughing-the-passer penalties. Then he took it back.

  The Eagles first said Vick’s right (non-throwing) hand was broken. On Monday, they said nah, it was just a boo-boo. Darn that ancient and unreliable X-ray technology!

  So the next installment of the Vick soap opera, As the Stomach Turns, resumes on schedule. “From where we sit — contusion or break — Michael Vick must sit this week. He needs to get his mind and hand right,” Philadelphia blogger-columnist Frank Ward wrote. From where we sit, in front of our TV screens, he has to play. There are NFL standings and fan-league fantasy standings at stake. I wish Vick no ill, but if more comes his way, the opportunity to educate should not be missed.

  Tony Basilio, a radio sports-talk host in Knoxville, Tennessee, who has interviewed me about pro wrestling, encouraged me to keep it up. “What Philly did with Vick disgraceful,” Basilio wrote on Twitter. “Somebody’s going to die on an NFL field soon.”

  3 October 2011..........

  Michael Vick, at the Philadelphia Eagles’ news conference yesterday after his team lost for the third time in four games: “I heard Steve Young a couple of weeks ago mention when he played it was a sense that came over him and the sense was ‘Over my dead body — I will not lose this game. I will not let this guy in front of me beat me.’ It’s just that ‘over my dead body’ perspective you have to take.”

  Metaphorically speaking only, of course.

  I think.

  17 October 2011..........

  Will Carroll, @InjuryExpert on Twitter, writes the “Fantasy Football Expert” column for the Sports Illustrated website. His new one, as he puts it, wonders whether the National Football League’s concussion policy is failing.4

  To review the latest installment of the Michael Vick traumatic brain-injury saga, Vick returned to play yesterday just a few plays after taking a blow to the head that obviously left him groggy. (My post earlier today wrongly said Vick sat out a single play; I am correcting that.)

  “If the players on the field and the announcer in the stands all thought that Vick had symptoms of a concussion,” Carrol writes dryly, “it has to make one wonder what the medical staff saw that took it the other way. Perhaps it was dirt in Vick’s eyes, but it’s more likely that they were just blowing smoke in ours.”

  I care very little whether the NFL’s concussion policy is working. But the national concussion policy, based on the NFL’s model and representations? That’s another matter. If the league’s titular policy committee chairs, Drs. Richard Ellenbogen and Hunt Batjer, don’t speak up about the Vick follies, they’re not only over their heads — they’re out of the game.

  21 October 2011..........

  The recent concussion developments involving, in particular, Michael Vick of the Philadelphia Eagles and Jahvid Best of the Detroit Lions have reminded even the most football-centric journalists of a distressing truth: there are no independent neurologists — independent of the National Football League teams of these injured players, that is — assisting, much less being given final authority, in return-to-play decisions. Certainly not within games.

  (The Eagles asserted that an “independent neurologist” cleared Vick before the game against the New York Giants, but refuse to name him or her. As for the “dirt in the eye” and “wind knocked out of him” incident last Sunday in the game against the Washington Redskins . . . forget about it.)

  But there’s an even more fundamental NFL medical issue that is well known but not widely or clearly reported: a number of team physicians, or the institutions employing them, have tangled financial relationships with their clubs. These call into question their ability to provide down-the-middle player diagnoses and return-to-play advice.

  For example, the University of Pittsburgh Medical Center is a corporate sponsor of the Pittsburgh Steelers, in addition to being its preferred health care and sports medicine provider. (UPMC has the same relationships with Pitt sports teams, but those are intra-institutional and more intuitive.)

  NFL spokesman Greg Aiello told me that sponsorships do not compromise medical care: “League policy is that team hospital, medical facility, or physician group sponsorship cannot involve a commitment to provide medical services by team physicians.” Aiello also pointed out that Article 39 of the new collective bargaining agreement with the NFL Players Association details “Players’ Right to Medical Care and Treatment,” stating: “The cost of medical services rendered by Club physicians will be the responsibility of the respective Clubs, but each Club physicians’ primary duty in providing player medical care shall be not to the Club but instead to the player-patient.”
/>   The CBA does seem to attempt to tighten the principle that a team physician’s primary duty is the care of the player, regardless of contractual relationships with teams outside the four corners of the medical-services contract itself. As a pro football beat writer put it to me, “All players are allowed to choose their own surgeons for surgeries, but clearly teams like when players use the teams’ docs.”

  The NFL’s position is that there is no linkage between sponsorship contracts and medical services. But as the breaches of the league’s professed new culture of “concussion awareness” and extra caution reach farcical levels — and I am far from the only one saying as much — it is worth underscoring that the NFL’s heavily lawyered verbiage of doctor independence and true Hippocratic independence are not one and the same.

  28 October 2011..........

  Kris Dielman, an offensive guard for the San Diego Chargers, suffered a “violent” and “scary” grand mal seizure on the team plane returning from Sunday’s game against the New York Jets, in which Dielman had returned to play following an in-game concussion.

  Mike Florio of NBC Sports’ Pro Football Talk comments:

  Here’s hoping that the NFL decides in the wake of this incident to implement meaningful procedures aimed at spotting concussions and getting players who have suffered concussions out of games — and that every lower level of the sport eventually will follow suit. Anyone who has been paying any attention to high school football lately knows that the culture has not yet changed, and that as a result players are staying in games when they simply shouldn’t be.

  It’s time for the NFL to provide real leadership on this issue, not lip service aimed at placating Congress and/or CYA memos intended to satisfy the lawyers.5

  Hope away. Dielman told the San Diego reporters, “I just banged my head a little bit. Now I gotta deal with it.”

  30 October 2011..........