Kevin Guskiewicz was more steeped in Steelers lore than any of his fellow neuroscientists. He had grown up in Latrobe, Pennsylvania, a small city east of Pittsburgh that in the late 1800s fielded one of the first professional football teams. The Steelers held their training camp each fall at Latrobe’s Saint Vincent College; as a kid, Guskiewicz would ride his bike to the school to watch his heroes, players such as Webster and Mean Joe Greene, from a hill overlooking the field. Guskiewicz’s father designed kitchens and bathrooms and, with Guskiewicz’s uncle, ran the Southside Inn, a bar that catered to steelworkers. When Guskiewicz was old enough, he worked the Saturday morning shift, pouring boilermakers at 7:30 A.M. At West Chester University near Philadelphia, Guskiewicz studied sports medicine and journalism. He wrote for the school newspaper, The Quad, and worked as a freelancer for the Philadelphia Inquirer. After he graduated, he applied to the prestigious Columbia University School of Journalism but was wait-listed. To say this minor setback was fortuitous for Guskiewicz would be the understatement of his life. At the last minute, he decided to apply to Pitt, which had a new master’s program in exercise physiology and sports medicine. Within a few years, newspapers would be a dying industry. The concussion business was booming.
Guskiewicz had sandy hair, blue eyes, and an earnest, down-to-earth manner that allowed him to fit in with everyone from players to trainers to brain surgeons. People found him immediately disarming. (Later, when Guskiewicz received a $500,000 MacArthur “genius grant,” he admitted he had heard of the award only because he’d seen a reference to it on an episode of Friends.) While studying at Pitt, Guskiewicz landed a job as an apprentice to the Steelers’ longtime trainer Ralph Berlin, aka the Plumber. As Berlin’s second assistant, he learned how to treat elite athletes and served as a gofer and ankle taper. The Steelers put Guskiewicz through graduate school. He thought about continuing on as a Steelers trainer, but he was about to get married and concluded that it was a difficult life in which to raise a family. On the advice of his mentor at Pitt, he applied to get his doctorate at the University of Virginia, where Jeff Barth, the “Grandfather of Sports Neuropsychology,” was waiting for him.
At Virginia, Guskiewicz worked with a local high school team and was immediately appalled by the way it treated concussions. “We were handling ankle sprains better than we were handling brain injuries,” he said. “It was scary.” Most of the research to that point had focused on cognition (Barth, Lovell, Collins, et al.); Guskiewicz, with the encouragement of another researcher, Dave Perrin, started to examine how concussions affected balance and motor skills. He found that the effect was often profound. He devised his own diagnostic tool to measure the connection between brain injuries and balance, and soon he too was publishing concussion research. Years earlier, when they had both been with the Steelers, Bailes and Guskiewicz used to hang out on the sideline during games—Bailes as an understudy to Maroon, Guskiewicz as an understudy to the Plumber—and now Bailes began inviting Guskiewicz to Florida to appear at concussion conferences and collaborate on research.
By then, Guskiewicz had finished his doctorate—his dissertation was titled Effect of Mild Head Injury on Postural Stability in Athletes—and was working as an assistant professor at the University of North Carolina in Chapel Hill. One afternoon during a conference in Florida, Bailes handed Guskiewicz a stack of papers: Woschitz’s questionnaires. Bailes had something big in mind. The data had suggested to him that the plight of retired NFL players, particularly their mental health, was far more desperate than had been known previously. His idea was to set up a research institute to examine the long-term health effects of playing professional football and other sports, and he wanted Guskiewicz to run it. If the idea sounded far-fetched and perhaps overly ambitious, it’s because it was—essentially an entire research institution born out of a bunch of six-year-old questionnaires stuffed into cardboard boxes. The players union agreed to provide some of the seed money, roughly $75,000, though that concerned Guskiewicz. He feared the center would be perceived as a vehicle for the union, the research it produced a tool for getting players more benefits. That was certainly one goal of the union, but not necessarily of the researchers. Guskiewicz bought some independence by persuading UNC’s vice chancellor for research to kick in $200,000. The fact that the center would be at UNC and not at the union offices in New York also helped. Still, three officials from the Players Association, including Frank Woschitz, were listed in the directory for the newly born Center for the Study of Retired Athletes.
Guskiewicz’s first task was to update Woschitz’s survey. “It was poorly constructed. I mean, it wasn’t anybody’s fault; it was probably just done by some office staffer that said, ‘Oh, here are the kind of questions I think we want to know about,’ ” Guskiewicz said. He decided to start from scratch, constructing a 10-page survey that would turn into the most comprehensive health study in the history of the NFL. The survey was divided into seven sections: Football History, Medical History, Concussions, Musculoskeletal Injuries, Health Status, Nutritional and Substance Use, and Personal Information. The hundreds of questions included:
How much bodily pain have you had during the past 4 weeks?
Have you felt downhearted and depressed?
Do you currently have a mental or physical condition that limits your ability to do the things you want to do?
In the Concussions section, the survey first defined for the former players what a concussion actually was:
A concussion is a blow to the head followed by a variety of symptoms that may include any of the following: headache, dizziness, loss of balance, blurred vision, “seeing stars,” feeling in a fog or slowed down, memory problems, poor concentration, nausea, or throwing up. Getting “knocked out” or being unconscious does NOT always occur with a concussion.
The survey went out in 2001. The response was overwhelming, an indication of how badly the players wanted to be heard. Guskiewicz sent out surveys to all 3,683 living members of the NFL Retired Players Association; 2,552—over 69 percent—sent it back. The survey highlighted more completely what the original had only hinted at: More than 60 percent of the players reported sustaining at least one concussion during their careers; nearly a quarter had had at least three. More than half said they’d lost consciousness on the field or experienced memory loss at least once. But perhaps the most disturbing finding was the apparent correlation between the number of concussions and depression. Players who reported concussions were three times as likely to report that they were depressed. Guskiewicz wasn’t immediately sure why this was so, but he theorized that the concussions or the symptoms of the concussions—perpetual headaches, memory loss, erratic moods—were causing it.
Guskiewicz knew more than anyone the implications of where his research was headed. He was a former NFL trainer, albeit an apprentice, and a die-hard Steelers fan. Bailes, his colleague, was a former NFL doctor. “We’re not here to paint an ugly picture of life in the NFL,” Guskiewicz told the Los Angeles Times. But he added: “These injuries are a hazard of their occupations.”
Guskiewicz continued to drill down. He followed up that survey with one that focused on mild cognitive impairment—the interim stage before full-blown dementia, characterized by memory loss, erratic behavior, and language difficulties. This time, 1,399 former NFL players and their close relatives participated. The results were even more ominous: Players who reported at least three concussions were five times more likely to be diagnosed with early signs of dementia. Part of the reason this finding was so devastating was the nature of the way concussions occurred. Guskiewicz had looked at college football players and found that those who experienced one concussion were much more likely to incur another one and then another. There was something about the initial trauma that primed the brain for further injury, especially when it had not had time to heal. The structure of Guskiewicz’s NFL study—a survey conducted largely by mail—raised some questions about its accuracy. The players were self-reporting, after all
, some many years after they had played. But the surveys were anonymous, and experience suggested that players underreported their injuries. Most were like Gary Plummer, who upon hearing the definition of a mild concussion concluded that he’d had hundreds.
The study’s conclusion was blunt: “Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.”
Guskiewicz kept going. He now focused on the earlier finding suggesting that concussions triggered depression. He isolated players reporting at least three concussions and found that they were three times more likely to be diagnosed with clinical depression.
Guskiewicz observed these results with pity and sadness. What had happened on the field to players such as Al Toon, Merril Hoge, and Troy Aikman was certainly powerful. But Guskiewicz—in his lab at UNC, away from the fans and the pressures of the NFL—was discovering something even more profound: a persuasive argument that concussions were not only an inevitable part of professional football but often led to misery and torment later in life—not only for the players but for everyone around them. The results were “daunting,” he wrote, “given that depression is typically characterized by sadness, loss of interest in activities, decreased energy, and loss of confidence and self-esteem. These findings call into question how effectively retired professional football players with a history of three or more concussions are able to meet the mental and physical demands of life after playing professional football.”
Guskiewicz, Bailes, and their colleagues made it clear that they believed that the game itself was causing something destructive and insidious to occur deep inside the brains of huge numbers of retired players. Football-induced concussions, they wrote, “can result in diffuse lesions in the brain.… These lesions result in biochemical changes, including an increase in excitatory neurotransmitters, which has been implicated in neuronal loss and cell death. A potential mechanism for lifelong depression could be this initial loss of neurons, which could be compounded by additional concussions, eventually leading to the structural changes seen with major depression.”
Translated, their hypothesis was this: Football causes brain damage. Guskiewicz and his colleagues were laying out a scientific explanation for all the ominous research that had preceded it: why concussions were hardly “minor” brain injuries; why they seemed to repeat themselves and come in clusters, inflicting more and more damage; why they led to devastating consequences such as depression, memory loss, and dementia, in much higher rates than in the general population; and why those symptoms sometimes never went away.
A more explosive theory was hard to imagine. But at this point it was just that—a theory. Detecting those changes in the brain of a retired professional football player would require one key missing element: The player would have to be dead.
Beyond Leigh Steinberg’s awareness campaign and the disturbing science that continued to emerge, there was another—largely unspoken—reason the NFL’s concussion culture was changing: In 1996, in Waukegan, Illinois, Merril Hoge was suing the Chicago Bears.
Technically, Hoge was suing only the team doctor and his primary employer, an Illinois hospital, but his complaint was an indictment of the way the Bears had handled his treatment before he was driven out of football. After his retirement, Hoge had plenty of time to ponder what had happened to him. As his brain recovered, he had taken a job as a football analyst for ESPN, a job at which he excelled. Still, he felt he wasn’t the same person. At home, trivial matters set him off—his kids whining, the smallest mishap; one day his wife asked to borrow his toothbrush, and it was all he could to do keep himself from exploding. Bright lights tormented him, and so he installed dimmers in every room of his house. His ESPN colleagues knew that the film room had to be dark when he entered. “Managing my state is every day,” he said.
One day, Hoge was working at a football camp when a woman walked up and berated him.
“You should be ashamed of the example that you set by going back and playing with a concussion,” she said. She grabbed her son and walked away.
Hoge sat for a moment, stunned. He thought: “She’s right, but she’s wrong.” Hoge believed that if he had been aware of the potential consequences of his injuries—brain damage, even death—he would have been wrong to go back on the field so quickly after his concussion in Kansas City, the one that had caused him to believe he could hear the ocean. But he didn’t. At that point, he still thought a concussion was like an ankle sprain or a pulled hamstring; no matter how bad it was, he could play through it. Five weeks later, when he was concussed a second time, it was too late. His career was over.
Hoge desperately missed football, and he soon directed his anger at the Bears’ team physician, John Munsell. Munsell worked primarily as an internist at Lake Forest Hospital. He had been the Bears’ doctor since 1978, sharing the duties with another physician. Munsell conducted preseason physicals and split time on the sidelines during home and away games. For this, the Bears paid him and his colleague an undisclosed retainer. Munsell treated not only the players but also, on occasion, coaches, team officials, and their families.
What transpired in Hoge’s lawsuit was a preview of the NFL’s troubles in the years ahead. Hoge was accusing Munsell of malpractice, but it went deeper than that. He argued that Munsell should have been aware of the latest developments in concussion research and applied them to his care. Instead, Hoge alleged, he was kept in the dark and allowed to continue to play despite his lingering symptoms. Hoge brought in the Pittsburgh Steelers brain trust—Maroon, Lovell, and Bailes—to explain the seriousness of concussions and the recent advances in diagnostic testing. Munsell argued that his treatment was state-of-the-art and that Hoge had had an obligation to inform the Bears’ medical staff of his symptoms.
“It was a difficult case; there was no real precedent,” said Robert Fogel, the Chicago lawyer who represented Hoge. “It isn’t like a lot of other football players were suing doctors over their mistreatment of concussions.”
Munsell was not an ideal witness for the defense. He acknowledged under oath that despite his role as team doctor he had no specialized training in sports medicine, nor had he read any medical literature on concussions. Before 1994, when Hoge’s injury occurred, “I don’t recall when I read an article in a book about a concussion,” he said. He seemed unaware of the most recent protocols for allowing concussed athletes to return to play.
Munsell did not take notes or keep records on Hoge’s brain injuries. Speaking of the night of the concussion in Kansas City, he said: “I didn’t carry a notebook or notepad or paper and pencil on my person, but I certainly would have had it been available to me.”
That night on the team plane, Munsell informed Hoge that he would not play the next week. After touching down in Chicago, he never examined Hoge again.
Hoge’s injury had occurred on August 22, 1994. Under questioning from Fogel, Hoge described the extent to which his injury was monitored:
“Merril, were you examined by any doctors from August 23rd till you returned to play August 29th?”
“No.”
“Did you have any conversations with any doctors from August 23rd to return to play on August 29th?”
“No.”
“Did you ever speak, and I mean in person, or on the telephone, with Dr. Munsell between August 23rd and August 29th when you returned to play?”
“No.”
“Merril, after August 22, 1994, did Dr. Munsell ever examine you before you returned to play?”
“No.”
“Did any doctor examine you before your return-to-play?”
“No.”
Munsell’s lawyers tried to show that Hoge had hidden his injuries from the Bears’ medical staff. This was the crux of Munsell’s argument: How could he be held responsible for failing to treat Hoge when he was never informed that the player still had symptoms when he went back on the field? Didn’t Hoge bear some of the blame?
Hoge knew football was a violent sport, yet he wanted so badly to continue playing that sport, he hid his injuries from the team doctor.
“We are dealing here with an intelligent man, not a child, not a person of suboptimal intelligence, but an intelligent adult,” Munsell said. “I believe there was a responsibility to be shared there.”
Munsell’s lawyer went through a long windup before raising this issue with Hoge on the witness stand.
Hoge seemed to be waiting for it like a power hitter sitting on a fastball.
“We could probably save a lot of time here: Nobody told me anything about my concussion,” he said. “Nobody told me about the signs and symptoms and what to be aware of. Had I known those things, you’re darn right: I would have told him. Would have been more than happy to tell him.
“But at that time, I knew nothing. I did not know what I was risking. We talk about fatality and brain damage; I should have known about that, you’re darn right I should have known. If I feel like I can perform and I’m doing everything possible to perform, I will perform. But we’re not going to compare knees and ankles here. We’re talking about a brain, far more important than any other part of our body. And I did deserve that.
“Dr. Munsell took me over as his patient; that is his obligation. Not to stick me on a plane, send me home, and have nothing to do with me again.”
The jury awarded Hoge $1.55 million—the last two years on his contract plus $100,000 for pain and suffering.
Not long afterward, the judge threw a wrench into Hoge’s celebration. He ruled that Fogel had failed to disclose a key piece of evidence: a letter from a Chicago neurosurgeon who believed that Munsell should not be held liable. A new trial was ordered, at which point Hoge and Munsell settled out of court.
League of Denial Page 14