“This 6-year study indicates that no NFL player experienced … cumulative chronic encephalopathy [brain damage] from repeat concussions. While the study did not follow players who left the NFL, the experience of the authors is that no NFL player has experienced these injuries.”
The NFL hadn’t actually studied retired players, but that didn’t stop the league’s experts from concluding that none had sustained long-term brain damage. Pellman and his colleagues would repeat this statement, in some form, over and over and over.
Except that not even the NFL believed it to be true.
The MTBI committee’s controversial assertion that football didn’t cause brain damage, which would create so much trouble for the NFL, was undermined by the league’s quiet dealings with Webster and other injured veterans. At the same time the MTBI committee was publishing its research, Bob Fitzsimmons, Webster’s lawyer, and a Baltimore attorney, Cy Smith, had taken the Bert Bell/Pete Rozelle NFL Player Retirement Plan to court to try to get more money for Pam Webster and the kids. The retirement board, of course, had determined in October 1999, while Webster was still alive, that he had had irreparable brain damage from repeat concussions related to his career. Webster’s cognitive difficulties, the board wrote, were “the result of head injuries [he] suffered as a football player with the Pittsburgh Steelers and Kansas City Chiefs,” a statement Fitzsimmons would describe as “the proverbial smoking gun.” Now, over four years later, Pellman’s committee—a separate entity but also under Tagliabue’s control—was denying in a prestigious medical journal that such injuries were possible.
As Fitzsimmons and Smith pressed their lawsuit, they obtained confidential documents that showed, among other things, that it wasn’t just Webster. The NFL retirement board had granted benefits to several other players with long-term brain damage. One was Gerry Sullivan, a contemporary and friend of Webster’s who played guard and center for the Cleveland Browns from 1974 to 1981. Sullivan had the usual litany of NFL horror stories. On one occasion, during a punt return, he recalled plodding down the field to try to catch Oilers return man Billy “White Shoes” Johnson, which he equated with “trying to catch a rabbit.” Sullivan was applauding himself for getting anywhere near White Shoes Johnson when another Oiler ear-holed him. “The first thing to hit the floor of the Astrodome was my head,” Sullivan said. “Back then, they just had about a half inch of Grass-Tex—some kind of poly product that looked like grass—and then a slab of concrete. They peeled me off the field.” The next thing Sullivan knew he was sitting on the bench, “vomiting on my jersey. Thankfully the Oilers had Earl Campbell. They had a really long sustained drive, and they were able to get me to where I was, you know, semi-functional.” Sullivan sucked on an oxygen mask while a trainer asked him how many fingers he was holding up. “We were really kind of thin on the offensive line; that might have been the reason I went back in,” he said.
When his career ended, Sullivan became chief operating officer of a company that leased automatic ice makers. A witty, self-deprecating man, he had been highly respected by his colleagues until, for no apparent reason, his moods began to vacillate between “manic hilarity and extreme anger,” according to a letter the company’s president wrote to the NFL retirement board. Sullivan threatened employees and punched holes in ice machines and walls. In 2005, based on the evaluations of several doctors, the retirement board awarded Sullivan “total and permanent” benefits related to his chronic brain injury.
Yet another document produced by the league showed that the same board had awarded permanent benefits to at least two other players whose doctors concluded they had gotten brain damage from playing pro football. The board redacted the names of those players, and the documents were stamped “confidential.”
The longer the Webster lawsuit went on, the more evidence surfaced that the NFL had been handing out benefits to brain-damaged former players for years. To win, Fitzsimmons and Smith needed to prove that Webster’s brain damage had left him disabled at the end of his career and not six years later, as the board had determined. This wasn’t hard, because all five doctors who examined Webster—including Edward Westbrook, the neurologist brought in by the NFL—had attested to this. Still, the retirement board fought it all the way to the appellate court, which awarded $1.8 million in benefits and damages to Webster’s family. The ruling stated flatly: “Mike Webster, the Hall of Fame center best known for anchoring the offensive line of the Pittsburgh Steelers professional football team from 1974 to 1988, developed brain damage as a result of the multiple head injuries he suffered as a player.” The ruling noted caustically that the NFL retirement board had asked the court “to do two things: first, to disregard the testimony of the Board’s own medical expert (in addition to all the others) … and, second, to hold that the absence of contemporaneous evidence is itself ‘substantial evidence.’ ”
But perhaps most interesting about the 35-page ruling was a footnote on page 28 in which the court referred to “eight other cases of … disability due to brain damage.” It was unclear who the players were—the names were never disclosed—but the United States Court of Appeals for the Fourth Circuit clearly was aware of them. Of course, so was the NFL.
This was indeed a curious situation: two NFL committees, both involved in health matters, with completely opposite views on the subject of football and brain damage. The NFL retirement board, charged with dispensing disability benefits to deserving former players, was headed by the NFL commissioner (a nonvoting member served on his behalf) and was made up of three owners’ and three players’ reps. That board, which consulted with neurological experts around the country to render its decisions, had accepted long-term brain damage as a fact of NFL life for some players. Pellman’s Mild Traumatic Brain Injury Committee, the NFL’s research arm, had been formed by the same commissioner and reported directly to him. That committee stated unequivocally and repeatedly that NFL players didn’t get brain damage. The MTBI committee went so far as to declare: “Professional football players do not sustain frequent repetitive blows to the brain on a regular basis.”
At first, opposition to the MTBI committee was limited to a few scientists who tried to prevent this assertion and its dubious corollaries from appearing in the pages of Neurosurgery. They were, not coincidentally, the same neuroscientists whose research had warned that the league was facing a catastrophic health crisis.
One was Kevin Guskiewicz, the earnest young researcher studying retired NFL players at the University of North Carolina. Guskiewicz was respected as a thorough researcher and an honest broker even when concussion experts began to split into warring factions over the NFL. But Guskiewicz could hardly believe what was happening to him. From his earliest memories—riding a bike to watch the Steelers from a hill in Latrobe to taping Merril Hoge’s ankles as an apprentice Steelers trainer—football was in Guskiewicz’s blood. His three kids were playing Pop Warner. Guskiewicz had hoped his research on depression and dementia would help make the sport he loved safer. Instead, he found himself under attack. When Guskiewicz published his seminal depression study, which showed that players who sustained at least three concussions were far more likely to be clinically depressed later in life, Hank Feuer, the Colts’ neurosurgeon and a member of the MTBI committee, dismissed it as “virtually worthless.” The fact that it was merely a survey—the most comprehensive one of its kind in the history of the NFL—made it worthless, according to the league’s doctors. “They didn’t have information from the doctors confirming it,” Ira Casson, the MTBI committee’s neurologist, told the New York Times. “They didn’t have tests, they didn’t have examinations. They didn’t have anything. They just kind of took people’s words for it.” (A decade later, Feuer would still describe Guskiewicz’s study as “the worst type of research that you can publish.”)
The crux of the NFL’s argument was that players were more likely to come clean with their coaches and team doctors than with independent researchers. But the reverse, in fact, was
true. Young and Hoge, after all, had pleaded with their coaches and team doctors to let them back on the field—even after the concussions that destroyed their careers. Hoge was so desperate that even after he was forced to retire, he called Joe Maroon at 2 A.M. to insist he could play. Numerous studies had shown that when athletes were asked directly by independent researchers, the incidence of concussions skyrocketed. Annual concussion rates in college were over 70 percent, and rates in the Canadian Football League were nearly 50 percent. Were NFL players’ brains really that different?
Guskiewicz thought that what was going on was obvious: The NFL wasn’t promulgating science; it was trying to protect its business. Later, when he was asked to deliver the commencement address at his alma mater, West Chester University, Guskiewicz described his stunning realization that rather than helping his favorite sport, his research had been perceived as “incriminating toward arguably one of the most popular and profitable industries in America.” His findings were “the last thing the NFL wanted to hear,” Guskiewicz told the graduates. The league went into “damage control mode,” using its own scientists to try to “put out the fire” and discredit him. He dismissed the work of the NFL’s committee as “industry-funded research at its best.”
As the papers continued to roll out in Neurosurgery, Guskiewicz, who was one of the peer reviewers, savaged them. “Very suspect,” he called the latest. But seemingly there was no stopping them. Bob Cantu, the Boston neurosurgeon who was serving as sports section editor of the journal, said he was equally opposed to the papers and tried to get them killed. Like Guskiewicz, he had come to believe that the NFL’s research arm had set itself up as protector of the league. “The feelings that we had from the articles were that the authors were being self-serving to the NFL and that’s what the NFL wanted,” Cantu said, “and that they would ingratiate themselves to the NFL if they essentially produced data that would make the NFL look good and, in the process, maybe solidify their positions with the NFL.”
“The flaws were too great,” Cantu said. “We didn’t think they should be published.”
But when Cantu went to Mike Apuzzo—the editor in chief and neurological consultant to the New York Giants—the response was always the same, he said. Apuzzo told him: “This is important information that readership wants to hear. I will give you and the other reviewers the opportunity at the end of the paper in the comments section to comment about the weaknesses of the paper and your negative feelings about it.” But Cantu, like Guskiewicz, felt that was inadequate. “Nobody really seriously reads the comments at the end of the paper,” he said. “And the person, no matter how bad the comments are, can simply say, ‘Well, I got cited in a peer-reviewed journal that’s very respected and prestigious.’ The damage is done.”
Cantu was 74 and had authored more than 350 scientific publications over 45 years by the time he was interviewed for this book. He said he had never seen another “instance where essentially the editor stepped in and went against what the reviewers’ comments were.”
Cantu felt Apuzzo’s close relationship with Tagliabue and the NFL had influenced his judgment. “I know that Michael discussed meeting with the commissioner and how he enjoyed it, and I think that’s totally appropriate,” Cantu said. “But at the time he first mentioned that, it didn’t dawn on me just how enamored with the whole thing maybe he was. Because as time would roll on there was one article after another of questionable accuracy.”
But Cantu felt that wasn’t all of what was going on. “I don’t want to give the impression that [Apuzzo] was cherry-picking what went into the journal based on just his view of the NFL,” he said. “I think he was letting NFL things in because he thought they were hot. They sizzled and would sell the journal, and the journal would have a greater readership, a greater interest and drive because of it.”
Under Apuzzo’s editorial retrofit, Neurosurgery had effectively doubled in size. Total submissions rose 285 percent. Ad revenue increased dramatically. In his USC bio, Apuzzo wrote that reader penetration under his leadership “increased astronomically, from 6,000 in 1992 to 13 million in 2005,” because the journal was bundled on a data platform with elite publications such as JAMA and the New England Journal of Medicine. Asked if he thought the NFL papers contributed to Neurosurgery’s success, Cantu replied: “I’m probably not in a position to know with certainty, but if I were to take a calculated guess, immensely.” One reviewer described the NFL papers as “an irresistible read.”
A USC spokeswoman initially offered to set up an interview with Apuzzo for this book, which, she wrote, “sounds like a great project.” But when she contacted him, Apuzzo declined and said he did not believe his participation would “benefit him or the university,” the spokeswoman wrote. Apuzzo did not respond to numerous e-mails and calls.
Cantu valued his position at Apuzzo’s prestigious publication. For that reason, he said, he never threatened to resign when Apuzzo published the NFL’s research over his objections. “I didn’t go to the mat with the editor, in all honesty, because I felt that he would just strip me of being section editor,” he said. “I liked being in that role, and I didn’t really want to lose it. And I believed I would have lost it if I simply said, ‘It’s me or these articles.’ ”
“Oh, for God … Jesus,” responded one former member of the MTBI committee when Cantu’s remarks were read to him. “I mean, think about what you’re saying here. He’s the section editor. He’s putting his name out there as a section editor. Right? And he’s telling me that the general editor told him, ‘You have to do this,’ and he didn’t make a ruckus? He didn’t walk away? He’s the man of great ethics, the man on the white horse?”
Others also felt Cantu was trying to have it both ways, trying to disavow science that he in fact commissioned and presided over. Another former MTBI member, interviewed during the 2012 election cycle, called Cantu “the Mitt Romney of doctors. You can never pin the guy down. He flaps in the wind.”
But there were distinct sides now to the NFL’s concussion crisis. On one side was the National Football League, promoting the worldview that everything was fine. On the other side were neuroscientists such as Guskiewicz and Cantu and Bailes. That side was small but growing. Collectively, the researchers who stood up to the NFL became known as the Dissenters.
Up to that point, Mark Lovell had managed to steer clear of the controversy building around the NFL’s committee. Armed with Tagliabue’s letter of endorsement, he continued to travel the country, selling teams on his concussion test. By the mid-2000s, most had embraced it in some fashion. Lovell was the director of what had become known as the NFL Neuropsychology Program, a lofty title that he never bothered putting on business cards. He considered his presence on the MTBI committee a sideline, a perk on top of his main job running the sports concussion program at the University of Pittsburgh Medical Center. One of Lovell’s favorite spots in the world was a retreat in Pennsylvania’s Amish country where he’d often get away to write and reflect. The hideaway fit how he perceived himself: low key, with an innate desire to lie low.
That was all about to end.
Now Pellman and the MTBI committee wanted to gather the results of the NFL Neuropsychology Program and see what they said about the ability of pro football players to withstand concussions. Pellman, of course, had no background or expertise in neuropsychological testing. No matter. As head of the NFL’s concussion committee, he again appointed himself lead author on the study. At this point, the conclusions of NFL Paper Number 6 would have surprised no one. It was all part of the same narrative. Pellman and his colleagues wrote that the results “corroborated” the league’s earlier findings that NFL players “demonstrated a rapid recovery.” NFL players also “did not demonstrate evidence of neurocognitive decline after multiple concussions,” they wrote. The findings, finally, “support the authors’ previous work, which indicated that there was no evidence of worsening injury or chronic cumulative effects of multiple MTBIs in NFL players.” The r
esponse to the paper also was predictable: Guskiewicz, Cantu, and Bailes recommended killing it. Without that option, they spiced their appended comments with words like “unfortunate,” “preliminary,” and “premature.”
But the criticism was about to take a more serious turn. Lovell, who signed off on the paper as a coauthor, would take a major hit. The league had gathered the data for the study from the network of neuropsychologists Lovell had spent years assembling. One was Bill Barr, the team neuropsychologist for the New York Jets. Barr by then had moved his practice to NYU Medical Center, where he was chief neuropsychologist at the Comprehensive Epilepsy Center. Barr viewed the Jets gig as something of a lark and a career builder. Each Sunday, he watched the game on TV. Whenever his wife tried to pry him off the couch, he’d respond: “Hey, I’m working here!” Most of the “psycho neurologists” around the country knew one another, so it wasn’t surprising that Lovell also was acquainted with Barr. Their history wasn’t totally amicable. In the 1990s, when Micky Collins was an up-and-coming researcher, Lovell and Barr both had recruited him as a research fellow. Collins had picked Lovell, to whom he remained devoted. “I never thought Bill forgave me or Micky for that,” Lovell said. But Lovell and Barr had stayed on good terms, even publishing together. In 2004, the same year the NFL’s treatise on neuropsychology came out, Lovell and Barr coauthored a chapter on American football in a textbook on brain injury in sports.
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