League of Denial

by Mark Fainaru-Wada

  Maroon was perfectly suited to this next phase of the crisis, which favored entrepreneurship and not a little bit of self-promotion. The diminutive neurosurgeon was never more his father’s son than in these moments. Maroon’s dad had made his mark in the Ohio Valley providing diversions and respite to miners and travelers: a pack of cigarettes, a pull at a slot machine, a cheeseburger, and a fill-up along the interstate. Maroon, too, would prove himself an expert marketer. ImPACT, the product of his long-ago conversation with Chuck Noll, was, of course, a gold mine. Now, in response to the science he once had resisted, Maroon was endorsing concussion-resistant caps and repurposing his advocacy of wine and chocolate as the secrets to a long and healthy life.

  It brought Maroon new adherents to his brand of alternative medicine, along with other attention he hadn’t been seeking.

  The soaring concern about concussions led to a wave of state regulations designed to protect children, regulations like the Zackery Lystedt Law that Ellenbogen and others had helped pass in Washington and that the NFL had pushed in other states.

  One of the first states to adopt the legislation after Washington was New Mexico, and the issue caught the attention of Tom Udall, the state’s Democratic senator. Udall, a nephew of 1976 presidential candidate Mo Udall, once had been New Mexico’s attorney general. He had used that position to crack down on consumer fraud, going after telemarketers and other scourges. It was that aspect of the burgeoning concussion crisis that Udall thought most needed regulation, because so many of the new products making wild claims were aimed at children and their parents.

  Udall was drawn immediately to Riddell’s ongoing advertising campaign for the Revolution helmet and the company’s claim that the youth line of helmets reduced concussions by 31 percent. The claim, of course, was the by-product of the controversial NFL research now at the heart of the lawsuits. It also stemmed from the notorious UPMC study that had been funded by Riddell and coauthored by the company’s vice president of research and development, along with the ImPACT crew: Collins, Lovell, and Maroon. Udall focused on the potential conflicts of interest and the truthfulness of the claims, including the admission by UPMC that Riddell had distorted and misused the results.

  Udall sat on the Senate Commerce Committee, which provided oversight of the Federal Trade Commission. He sent a letter to the FTC requesting an investigation, expressing concern “about potential unfair and deceptive practices related to the sale of football helmets, especially those advertised for children’s use.” The letter included page after page of Riddell advertising—on the company website, in print, on YouTube—boasting that the Revolution helmet line reduced concussions by 31 percent. Udall cited as particularly egregious Riddell’s online description of the Revolution Youth helmet, in which the company touted an “extensive long-term study by the University of Pittsburgh Medical Center” as the basis for the claim. The study in fact had never tested the youth version of the NFL-inspired helmet.

  “These prominently displayed claims citing a prestigious medical institution and scientific journal give the overall impression that these helmets provide a significant safety improvement over other helmets and that this is strongly supported by research,” Udall wrote. “Yet there is actually very little scientific evidence to support the claim that Riddell Revolution helmets reduce the risk of concussion by 31 percent.”

  The FTC immediately opened an investigation into Riddell and other helmet companies that made similar claims. Udall and his aides thought the Riddell campaign had launched a wave of fanciful claims by companies seeking to capitalize on fears about concussions. “I really look at the UPMC study as what launched this whole era of concussion marketing claims in the area of sports equipment,” said one Udall aide. The senator and his staff ultimately would flag dozens of suspicious products. The makers of one mouth guard that Udall targeted, Brain-Pad, claimed that it could eliminate concussions entirely by creating what it called a “brain safety space.”

  Udall regarded Maroon as one of the industry’s worst offenders. In addition to his participation in the flawed Riddell study, Maroon had endorsed a dietary supplement called Sports Brain Guard that purported to “maximize the brain’s ability to heal and reduce inflammation.”

  An endorsement from Maroon—described as “part of the NFL’s Traumatic Brain Injury Committee”—ran on the product’s website: “Over the past 30 years, as a practicing neurosurgeon, I have treated thousands of athletes with sports related concussions—players from the NFL, NHL, NBA, NCAA and all the way down to kids playing youth sports.… A major consequence of a concussion is inflammation of the brain and the subsequent cascade of biochemical events that results in brain damage.… I have personally recommended [this] product, SPORTS BRAIN GUARD, to athletes at all levels following concussions.”

  On October 19, 2011, the Senate Commerce Committee gathered for a hearing on “Concussions and the Marketing of Sports Equipment.” At one point, Udall asked Jeffrey Kutcher, an associate professor of neurology at the University of Michigan and chair of the American Academy of Neurology’s sports neurology section, about the truthfulness of the Riddell/UPMC study. Kutcher replied that “there is no significant data” to make the claim that the helmet reduced concussions 31 percent.

  “And you can see why a parent who would be concerned about concussions with all the increasing awareness that is out there would see something like this and think, ‘I am going to get a really protective helmet for my child,’ ” said Udall. “And really, what we are talking about is something that is very, very misleading.”

  “Well, I can see that, and I do see that every week in my clinic,” said Kutcher. “I see patients coming in with their parents saying they want to buy the new helmet: ‘This is the concussion helmet. What do you think about it?’ That is a very real conversation I have all the time.”

  “And they are asking you that question over and over again?” said Udall.

  “Correct.”

  As for the Maroon-endorsed Sports Brain Guard, Kutcher said: “There is no data that this type of thing will help prevent concussion at all, really.”

  Maroon wasn’t asked to testify. Not surprisingly, he saw it differently when interviewed for this book. Like Lovell, Maroon claimed to have played little role in the Riddell study even though his name was on the paper and he was a cofounder of ImPACT. He remained unapologetic about the products he endorsed, including Sports Brain Guard, which soon was taken off the market amid the controversy. After decades in medicine, Maroon said he truly believed in the healing properties of the products he was touting. In the middle of helping the NFL figure out the implications of CTE, he sent a copy of his book The Longevity Factor, along with a supply of dietary supplements, to Peter Davies, the neuropathologist brought in by the league to evaluate Omalu. “Now just don’t forget to take your fish oil!!” Maroon wrote in an e-mail. Maroon ingested the products he endorsed. He prescribed them for his patients and wrote about them in his books. Besides, he reasoned, what was the alternative? “Tell me what medicine is going to prevent concussion or treat concussion, what medicine is out there?” he said.

  “I’m 72 years old; I’m 72 years old,” said Maroon, looking trim and dapper one afternoon in his office at Pittsburgh’s UPMC Presbyterian Hospital. “I’m doing what I believe. And I really mean it that way. I believe this. This is what I would do for me. This is what I’d do for my kid and what I do for my patients. So it can be said to be crackpot. But tell me what you’re doing better?”

  In November 2012, the FTC ordered the makers of Brain-Pad, the mouth guard, to stop making claims that their product reduced concussions. The agency also sent warning letters to 18 other marketers of “anti-concussion” products. Six months later, the FTC closed its investigation into Riddell and other helmet companies. In a letter to Riddell, Mary K. Engle, the FTC’s associate director for advertising practices, wrote that the agency had concluded the UPMC study “did not prove that Revolution varsity football helmet
s reduce concussions or the risk of concussions by 31%.” The UPMC study also didn’t prove, as Riddell had claimed, that the Revolution Youth helmet had that effect, because the study never looked at those helmets.

  But the FTC had decided not to sanction Riddell. That was partly because the company, after years of making the UPMC study the centerpiece of its national marketing campaign, had “discontinued use of the 31% claim,” Engle wrote.

  The NFL had long prided itself on its PR machine. Now the machine was facing its greatest challenge. Since its inception, the NFL had played on the country’s primal urges, promoting itself as a refuge for legally sanctioned violence. That would obviously have to change. With former NFL stars shooting themselves in the chest to spare their brains and thousands of players suing the league, the task of remaking football’s image would not be an easy one.

  In 1970, when the NFL and the AFL officially merged, the league produced a coffee table book that offered an unusually frank assessment of life in the NFL. Half-naked players were seen lounging in a trainer’s room next to miles of athletic tape and drawers filled with painkillers; armored gladiators walked single file toward an unseen battlefield; piles of humanity fought in the muck, a boiling mass of indistinguishable arms and legs.

  The NFL let the players tell the story in their own words, interspersing their quotes with meditations on war and aggression from philosophers and psychiatrists:

  “Football is a violent game. You are physically attacking another person. To do this, you almost have to change your personality, to break down some of the things taught you, because this is not accepted in our society.”

  —Howard Mudd, guard, San Francisco 49ers

  “Violence, in its many forms, [is] an involuntary quest for identity. When our identity is in danger, we feel certain that we have a mandate for war.”

  —Marshall McLuhan, War and Peace in the Global Village

  “It’s a feeling of exhilaration. Boy, you really knocked the hell out of that guy. You just feel great because you hit somebody.”

  —Ernie Stautner, tackle, Pittsburgh Steelers

  “There is, in the modern community, no legitimate outlet for aggressive behavior. To keep the peace is the first of civic duties, and the hostile neighboring tribe, once the target at which to discharge phylogenetically programmed aggression, has now withdrawn to an ideal distance, hidden behind a curtain, if possible of iron.… The main function of sport today lies in the cathartic discharge of aggressive urge.”

  —Konrad Lorenz, On Aggression

  The NFL took the violence at the core of the sport and turned it into art. The book, The First Fifty Years, was produced by “the creative staff of National Football League Properties, Inc.,” the league’s licensing arm. It had the same raw and hagiographic feel as the work produced by NFL Films, another project Commissioner Pete Rozelle had funded. Sports Illustrated would famously call NFL Films “perhaps the most effective propaganda organ in the history of corporate America.” The company’s origin story has been told and retold, mirroring in many ways the birth of the modern NFL. The founder, Ed Sabol, was a former overcoat salesman who received a 16-millimeter Bell & Howell movie camera as a wedding present and later used it to film his son’s high school football games. Sabol ultimately left his job and created a production company. He somehow persuaded Rozelle to let him shoot the 1962 NFL Championship Game between Green Bay and New York; the 28-minute production was a wild success, and thus was born NFL Films.

  Sabol soon joined forces with his son Steve, an art major and film lover who infused the enterprise with a style that combined pieces of his favorite artists and movies: the tight close-ups of clawing hands and rock in the 1946 film Duel in the Sun; the use of light and shadow by the Renaissance masters; Leni Riefenstahl’s epic presentation of the 1936 Olympics; the sweeping musical scores of movies like Gone with the Wind. The highlight reels produced by NFL Films were tales of heroism and sacrifice. Amid the martial music that stuck in every fan’s head came the “Voice of God,” John Facenda, who made a recap of a midseason game between the Chiefs and Vikings seem like the Battle of the Bulge. NFL Films would win more than 100 Emmys. They Call It Pro Football, the Sabols’ magnum opus, released in 1967, was recognized by the National Film Registry of the Library of Congress, which called it the “Citizen Kane of sports movies.” The film opens with Facenda intoning: “It starts with a whistle and ends with a gun.”

  Violence, stylized and exquisitely rendered, was always an inextricable part of the show, no less than was the case in the Martin Scorsese and Francis Ford Coppola films of that era. NFL Films pumped out titles such as Crunch Course, Strike Force, Moment of Impact, and The Best of Thunder and Destruction: NFL’s Hardest Hits. “In the NFL’s war zones, the most explosive weapon that can be deployed is a man’s body,” Facenda declares in Crunch Course.

  There was always one major difference between the NFL’s brand of art and everything else: “Unlike other forms of popular entertainment, NFL football is real—the players actually do what they appear to be doing—yet at the same time it is a creation of the media, and it generates some of the most powerful fantasies in our culture,” wrote Michael Oriard, a former Notre Dame and Kansas City Chiefs offensive lineman who went on to become Distinguished Professor of American Literature at Oregon State University. “The actuality of football is the source of its cultural power, but media-made images of that reality are all that most fans know.”

  The images are seductive yet deceptive. Like war movies, the images soften and glorify the violence to the people who watch. The reality, like war itself, is far different. Those who get close to the NFL battlefield are left in awe of its ferocity and speed, the sheer sound of it, as memorable as giant waves crashing repeatedly on the shore. Andy Russell, the Steelers great, broke into the league as a third-team linebacker in 1963. In his first game, the starter, John Reger, collapsed after a brutal hit and swallowed his tongue. Reger went into convulsions on the field, like a man having a seizure. The team doctor searched frantically for a tool to pry open Reger’s jaw. Unable to find one, he chipped out his front teeth with a pair of scissors. Blood sprayed everywhere—onto the grass, the doctor, Reger’s white jersey. He left the stadium in an ambulance. A few plays later, the second-string linebacker sustained an ankle injury that also put him out of the game. Thus began Russell’s 12-year career.

  Now, for the first time in its history, the NFL needed a new image, one that instead of glorifying the violence deflected attention from the fact that it was driving men mad. The stakes were obvious. The NFL’s success depended not only on the buy-in of millions of fans for whom injuries were an acceptable and even attractive part of the entertainment but also on the parents who submitted their kids to the Darwinian system that led to the glory, however distant, of the NFL. Maroon, in his burst of candor after examining Omalu’s slides, had summed it up perfectly: “If only 10 percent of mothers in America begin to conceive of football as a dangerous game, that is the end of football.” Or as the Times blog had asked, “Is Tackle Football Too Dangerous for Kids to Play?”

  And so it came to pass that the NFL found itself reaching out to a new constituency: mommy bloggers.

  In the summer of 2012, Lorraine Esposito, a New York life and fitness coach, mother of two teenagers, and author of a blog that was published on WorkingMother.com, received an e-mail from Clare Graff of the NFL’s Corporate Communications Department:

  “As the mother of a little boy and someone who combs the headlines every day, I see all the stories about concussions in youth sports, as I’m sure you do as well,” Graff wrote. “Through working at the NFL, I’ve been lucky enough to interact with some of the country’s most respected neurologists, and I’ve learned a lot about concussions—what causes them, how to spot the symptoms, and how to treat and prevent them.

  “We’re inviting parenting/health writers and bloggers to the NFL offices in August, around the time kids head back to school and back to sports.
We want to hear what concerns you and your readers about youth sports and injuries, what keeps you up at night, and share some resources with you that may be helpful on the topic.”

  Esposito was thrilled to be invited to the “Youth Health & Safety Luncheon” at the NFL’s offices in New York. She was joined by about 50 people like her, mostly influential women who might be concerned about the continuing bad news about football and brain damage. The group was given a tour of NFL headquarters and introduced to the team that oversaw officials. The luncheon featured the commissioner; Scott Hallenbeck, the executive director of USA Football; Holly Robinson Peete, the wife of former NFL player Rodney Peete “and a football mom”; Elizabeth Pieroth, a neuropsychologist and head injury consultant to the Chicago Bears; and Kelly Sarmiento, a health communications specialist for the Centers for Disease Control and Prevention.

  Goodell spoke to the group about the need to change the culture of football. It wasn’t totally clear to Esposito what that meant, but she found Goodell solicitous, a good listener.

  “To his credit, he really wanted to know,” Esposito said. “I asked him to help me define what this cultural change really is. We started talking about the training and equipment. I said, ‘That’s not what I mean. What’s the culture you’re talking about?’ He said: ‘That is a great question, but I don’t have an answer for you.’ ”

  Still, Esposito came away convinced that the NFL was committed to creating a healthier and safer sport.

  Similar events followed. Amanda Rodriguez, who blogs under the name Dumb Mom, said she learned about some “myths that people should know about.… I think that my perception of concussions has changed dramatically. One, I feel like football gets a pretty bad rap as the most dangerous sport. I didn’t realize that kids were being concussed in other sports, especially soccer. We learned about that at the NFL. And most concussions don’t happen in a sport. Kids get concussed riding their bikes.”