Photo: Nathan Rupert/CC BY-NC-ND 2.0 (Flickr)

How the NFL Sidelined Science—and Why It Matters

, science and policy analyst, Center for Science and Democracy | October 25, 2017, 4:47 pm EST
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Football was not just the most important social activity on weekends in New Jersey growing up, but it was woven into the family and community in which I grew up. My dad played football in his small town Vermont high school along with his older brother who went on to play college football at the University of Vermont. Hence, weekends at the Reed household were for screaming at TV sets or from real-life bleachers and theatrical displays of cheering played out in falling off of couches and crashing onto floors.

Football players have always carried a sort of badge of honor for playing America’s favorite sport, but it wasn’t until recently that that badge began to carry even more weight due to emerging knowledge about what even just a few years of executing football plays could mean for their quality of life down the line.

Even if you don’t closely follow football, you are likely aware that the NFL has been at the center of the news cycle in recent months, with players kneeling during the playing of the national anthem to protest racial injustice and police brutality. The players’ protest has drawn fire from a number of directions, including the White House. (Here at UCS, our staff joined with the campaign #scientiststakeaknee, supporting these players’ right to protest and the importance of their cause.)

But these protests aren’t the only way that the NFL has come into the spotlight. It’s increasingly clear that the repeated head injuries many football players experience can cause long-term damage—but the NFL has worked hard to bury these facts.

The NFL’s foray into CTE science

A powerful slide from Dr. Ann McKee’s presentation summarizing her findings on CTE at the Powering Precision Health Summit. The BU Brain Bank most recently analyzed 111 brains of former NFL players, finding that all but one had signs of CTE.

The NFL spent years, beginning in the 1990s, working to control the science behind the health consequences of repeated head injuries incurred while playing football. By doing so, the company infringed on its players’ right to know and ability to make informed decisions about their health and career paths. And as the NFL failed to do its due diligence to conduct honest science on the game, players were consistently told to return to play after collisions only to be left with debilitating health issues and devastated family members.

The NFL’s actions closely track with the tobacco and fossil fuel industries, and include examples of just about every tactic in our “Disinformation Playbook,” which are documented in Steve Fainaru and Mark Fainaru-Wada’s 2013 book, League of Denial. Just a few uses of the plays include:

The Fake: The NFL commissioned a Mild Traumatic Brain Injury (MTBI) committee that published a series of studies in the journal Neurosurgery in the early 2000s, which downplayed the risks of repeated head injuries by cherrypicking data and using incomplete data on the number of concussions that were reported during games.

The Blitz: Bennett Omalu, the pathologist who first discovered CTE in an NFL player, faced opposition from the NFL which called for the retraction for his article on the subject in 2005 and then called his second study “not appropriate science” and “purely speculative.” The second chair of NFL’s brain injury committee, Ira Casson, later attacked and mocked Boston University neuropathologist, Dr. Ann McKee, for her work on CTE.

The Diversion: Ira Casson acquired the nickname “Dr. No” by the authors of League of Denial as he willfully refused to accept that repeated head injury could lead to long-term brain damage in football players, even though he spent years studying boxers and had concluded that the sport was associated with brain damage. In a 2010 Congressional hearing on football brain injuries, he held tight to his denial of the link, telling members of Congress that, “My position is that there is not enough valid, reliable or objective scientific evidence at present to determine whether or not repeat head impacts in professional football result in long term brain damage.”

The Fix: The NFL was able to manipulate processes in order to control the science on head injuries sustained while playing football. The editor-in-chief of the journal Neurosurgery in which all of the MTBI’s studies were published was Dr. Michael Apuzzo, a consultant for an NFL football team. The peer review process for this journal, unlike others, allowed papers to be published even if reviewers were harshly critical and rejected the science as long as the objections were published in the commentaries section of the paper. Despite harsh criticism from reviewers who were prominent experts in the field, Dr. Julian Bailes and Dr. Kevin Guskiewicz, the MTBI got away with publishing a series of papers downplaying the health risks of playing football.

In 2016, the NFL finally admitted that there was a link between playing football and the development of degenerative brain disorders like CTE after denying the risks for over a decade. The NFL has since changed some of its rules and has dedicated funding to help make the game safer for players, protections that President Trump argues are “ruining the game.” Trump’s blatant disregard of the evidence on the health impacts of playing football is beyond disappointing but not at all surprising, considering the way that this administration has treated science since day one.

From NFL player to science champion

Chris and I behind the scenes after a full day filming the PSA this August.

I have been fortunate to meet and spend time with former NFL player and science champion, Chris Borland, who has turned his frustration with the league into support for independent science on the impacts of playing football for its child and adult players. Yesterday, he spoke at a scientific conference on the role of the media and others in communicating the CTE science to the general public, so that we all have a better understanding of the risks of playing football, especially during youth. He also spoke about the emerging science on biomarkers that will help diagnose CTE in living players in the near future.

Here’s Chris’s take on why we should be standing up for science and exposing and fighting back against the disinformation playbook:

Chris and I are also featured on this week’s Got Science? podcast. Listen below:

In carrying out plays from the Playbook to sideline science, companies like the NFL break a simple social responsibility to “do no harm.” Take a look at our brand new website detailing the case study of the NFL along with 19 other examples of ways in which companies or trade organizations have manipulated or suppressed science at our expense, and find out how you help us stop the playbook.

Photo: Nathan Rupert/CC BY-NC-ND 2.0 (Flickr)

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  • Robert Beckman

    With just a few changes, this article could be titled: “How the DOD/VA Army medicine sidelined science — and why it matters for service members [and athletes and civilians] with TBI/PTSD/Concussion.” For over a decade, naysayers have maintained that “there is nothing we can do for your brain injury. Be resilient, rest, follow the Concussion Protocol, take your pills, engage in talk therapy, lead degraded lives with your ‘new normal’ and get another appointment to talk to your counselor.” The Military medicine and the VA intervene with hundreds of drugs, countless computer games and unproven devices — none of which has been approved by the FDA for use with traumatic brain injury or Concussion. [ http://bit.ly/2yNfsJl ]

    Consider the parallels between the DOD/VA/Army (and NFL) denials about treating wounds to the brain, and NFL denials about links between football brain injuries and CTE:

    The Fake: DOD/VA/Army conducted five studies that are rooted in bogus science that has been denounced as corrupted all over the world.
    The Blitz: HBOT researchers have had their medical licenses threatened and HBOT technicians have been warned about decertification of licensure.
    The Diversion: When the actual data in government studies showed that HBOT is safe and effective in treating wounds to the brain and that patients all improved, the Army and paid consultants invented “the ritual of HBOT” as a placebo – some mysterious set of coincidences that was responsible for hundreds of positive results across dozens of clinics, over many years, all over the world.
    The Fix: Surgeons General of the Services, and the VA in general, genuflected to the Army’s SG command that HBOT did not work, even when their own researchers issued retractions and showed evidence that hyperbaric oxygen therapy ought to be used for TBI/PTSD/Concussion.

    Billions of dollars are being poured into diagnosing Concussions, Traumatic Brain Injury and PTSD. Virtually nothing is being invested in treatments that actually treat and help heal underlying wounds to the brain. Yet, treatment for Concussion/TBI/PTSD is available all over the USA. 1000+ Hyperbaric Oxygen Therapy (HBOT) clinics can provide HBOT and other proven alternative therapies to treat brain injuries caused by concussion, regardless of how or when the concussion occurred. Using HBOT and adjunct therapies, the TreatNOW Coalition, veterans and researchers and clinicians working largely pro bono, has helped restore brain health to over 2,600 concussed patients with traumatic brain injuries and post concussion symptoms, including professional athletes, active duty and retired veterans, and victims of accidents, assault, stroke and falls. [For decades of Research and Science on HBOT for brain wounding see: http://bit.ly/2zag4t5 ]

    BACKGROUND
    The topic of brain injury due to concussion has been exploding in the news media, particularly over the past 10 years: NFL players, military veterans and college and High School athletes are now known to suffer concussions from situations not previously known to cause concussion. Brain concussion can occur without directly striking your head against a solid structure, but simply from shaking your brain around or by proximity to an explosive force. We have become aware of the dramatic injury effects of repeated concussion. However the cutting edge evaluation and treatment strategies have not been brought to the public. Many athletes, service members and citizens continue to suffer because they and their doctors are unaware, and they have not been treated.

    If you are reading this, probably you or someone you know has experienced a concussion and not fully recovered. Hyperbaric Oxygen Therapy [HBOT] promotes brain wound healing through mechanisms of suppressing inflammation, increasing by 20X the amount of oxygen available to injured brain cells, growth of blood vessels and new neurons, promoting stem cell mobilization, and direct cellular healing through increased oxygen delivery. Put simply, HBOT increases a wide variety of beneficial brain-healing processes and interrupts destructive processes in the destructive “Neurometabolic Cascade of Concussion” like inflammation and cell death. Researchers have an accumulation of before and after brain scans and videos demonstrating the positive healing effects of HBOT for concussion, some received decades ago.

    Coincidentally, in April 2011, Army Secretary John McHugh made it official: Soldiers could get Purple Hearts for traumatic brain injuries. Hundreds of thousands of service members with “invisible wounds” were finally recognized as having suffered physical damage to their brains, in addition to the psychological consequences of their physically wounded brain. What did not follow in either the Army or the NFL was the answer to the obvious question: What are we doing to heal those damaged brains?

    Current Practice

    Medicine struggles with treating physical injury to the brain, these “invisible wounds.” Medicine is slow to change and for decades the common myth about concussions is that there is no treatment and that most concussions heal on their own. Sadly, the standard protocol for Concussions and TBI is “watchful waiting.” [ A terrific presentation on Acute Concussion can be found at: http://bit.ly/2jwdUwI ]

    It is now common knowledge that if you have suffered a loss of consciousness you have had at least a mild concussion. But even a transient change in awareness or a feeling of “having your bell rung” signals some mild brain injury; you don’t need to be knocked unconscious to sustain a concussion. The new message is that an accumulation of those mild brain injuries initiates a process that can lead to short, medium and long-term damage, up to and including dementia. An estimated 15% of people who suffer a mild – moderate concussion do not return to their baseline within a year, but everyone who suffers a concussion is at risk.

    [Note: It is very common for people who have had a concussion injury to have headaches. Brain injury creates neuroinflammation. Force strong enough to cause concussion may cause whiplash injury; whiplash injury creates excess muscle tension and spasm. The muscles that travel through your neck attach to your head and you may have a tension headache. Tense muscles may also contribute to pinching your occipital nerves. Thus, physical therapy is often necessary for sports concussion, another adjunct therapy to help heal the underlying damage to the brain.]

    The Concussion Protocol is passive, not active wound healing

    Despite all that has been learned in the last thirty years by Hyperbaric Oxygen Treatment (HBOT) practitioners, the standard of care for concussions around the world remains “watchful waiting”. Whether in the military, professional sports, emergency rooms or sports in general, medicine generally takes a passive approach to concussions, with the exception that drugs are prescribed for a myriad of accompanying sequelae/afflictions. Most often, the patient recovers to a point where physical therapy is possible. The patient invariably regains some measure of movement, though quality of life may never be regained.

    The accepted protocol for concussions is observation and rest, sometimes aided by brain scans, interviews or questionnaires and/or mental-physical tests to aid in diagnosis. There is little to no mention of any intervention to treat and heal the underlying injury to the brain, unless it has caused brain bleeding and/or excessive swelling, in which case emergency interventions and surgery may be called for. Patients are told that almost all concussions eventually resolve themselves after some time. Pain medication is recommended where warranted.

    Current (passive) standard-of-care “Rehabilitation” after a significant brain injury can include such interventions as rest, physical and cognitive therapy, brain training, visual and auditory help, occupational therapy, talk therapy and preparation for return to play [in most cases] or a diminished lifestyle [10% or more of cases], typically on drugs to control pain, headaches and mood swings. It is common to hear that “70-80% or more fully recover before three months.” Fully recover? Unfortunately not. Multiple concussions are additive in the context of acceleration of damage. Research all over the world, especially in the US, is showing how multiple hits to the head, whether from sports or war, can lead to degenerative brain damage, depression, dementia and/or Chronic Traumatic Encephalopathy (CTE).

    Lately, a debate has broken out about whether “rest” is better than exercising as soon as possible. In few of the conversations, however, are you likely to hear a good answer to the question sometimes asked: “Why is exercise better than rest?” The incomplete answer is that the patient gets better faster. Why? Blood flow. But Why? Increased blood flow can deliver more OXYGEN to the brain and the site of the wound. If a little more oxygen is good, why not 10-20X more oxygen, coupled with suppression of swelling and a host of other salubrious benefits from HBOT, including proliferation of stem cells for healing?

    Sadly, there is almost never any mention of even basic nutrition or brain foods and supplements, much less any discussion of the one intervention that can have an immediate impact. In multiple peer-reviewed journals and articles worldwide, Hyperbaric Oxygen Therapy has been shown to help in the healing of underlying brain injury typically suffered in mild to moderate traumatic brain injuries, of which concussion is a sub-set.

    Help with HBOT is available. Call for assistance. http://www.TreatNOW.org

  • Ted Janusz

    Hello Genna, thank you for doing the research for your in-depth article and for sharing your valuable insights. And for keeping the community informed.

    Here are three additional resources on the topic you might find interesting:

    What is it like to live with a former NFL player who has CTE? An interview with Cyndy Feasel, author of After the Cheering Stops. https://www.linkedin.com/pulse/cte-interview-cyndy-feasel-author-after-cheering-stops-ted-janusz

    What happens inside the helmet of a ten-year-old football player? https://vimeo.com/230696433

    What will we tell our kids (and grandkids) about football as it existed in 2017? https://www.linkedin.com/pulse/back-future-cars-football-cte-ted-janusz/

    Keep up your GREAT work!