National Football League Commissioner Roger Goodell announced Wednesday an initiative intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries.
As part of the initiative, Goodell said, the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research — in addition to the $100 million previously pledged by the league to medical and neuroscience research.
The Play Smart Play Safe initiative also requires hiring a physician to serve as the league’s chief medical officer. The physician will work with each team’s medical staff and establish an independent scientific advisory board to consider head injury research proposals.
Since 2002, the NFL has made 42 rule changes to protect players, in addition to staffing each game with 29 medical professionals, Goodell noted in his statement.
Is this new initiative another Hail Mary to assuage critics? The NFL’s history suggests that some hard lessons may have been learned.
Suicides and lawsuits
The NFL’s commitment to player safety has been in the spotlight since forensic pathologist Dr. Bennet Omalu’s 2002 identification of chronic traumatic encephalopathy, or CTE, in the brain of former Pittsburgh Steelers center Mike Webster, who committed suicide at age 50. CTE is a progressive, degenerative disease set off by repeated head trauma.
Nearly a decade later, former Chicago Bears defensive back Dave Duerson, 50, committed suicide, aiming a gun at his chest rather than his head so his brain could be preserved and studied. Boston University researchers made a postmortem diagnosis of CTE.
In 2012, 80 concussion-related lawsuits on behalf of more than 2,000 NFL players were combined and filed as a single class-action lawsuit in federal court. The players accused the NFL not only of negligence but of failing to notify them of the link between concussions and brain injuries.
Three years later, a federal judge gave final approval to a settlement in the lawsuit. This agreement provided up to $5 million per retired player for serious medical conditions associated with repeated head trauma and reportedly could cost the league $1 billion over 65 years. The deal also called for baseline medical exams for retired NFL players and monetary awards for those who are diagnosed with Alzheimer’s, Parkinson’s disease, dementia, amyotrophic lateral sclerosis and certain cases of CTE.
Over the years, the NFL has made rule changes, added independent health monitors to spot potential concussions and fined players and teams for not following the league’s concussion protocol. Despite these efforts, it continues to be in the spotlight for its handling of concussions.
Most recently, there were protests after the the NFL’s season opener on Thursday, when Carolina Panthers quarterback Cam Newton took several helmet-to-helmet hits from Denver Broncos players. Only one penalty was called.
According to the league’s website, during the two minutes between the time Newton was hit and when the next play began, medical personnel spoke with the quarterback and requested to see video of the play. After the game, no concussion diagnosis was made.
Still, on Sunday, NFL public relations official Brian McCarthy tweeted that the league would review the Newton call.
“I am skeptical,” Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, said of the new initiative. The NFL “has a terrible track record in concussion and CTE research, and 2016 may be their worst year yet for ethically handling research.”
He believes the league fraudulently promoted the supposed benefits of Heads Up Football, a safety program aimed at recruiting young children to tackle football, using preliminary data that it knew were unpublished and eventually found to be untrue.
“The fraudulent data, it is worth noting, is still being promoted on their new website,” he said, adding that “the NFL could not accept the results of the gold standard independent grant review process from [the National Institutes of Health], so they withdrew their money and are creating their own ‘independent’ process.”
Diagnosis and treatment
Others see the new NFL’s renewed commitment to safety as significant.
Bob Murphy, associate athletics director at Georgia State University, is waiting to “see how it plays out” and hoping for the best. The National College Athletics Association did something similar, he said, and bringing a lot of useful attention to the issue. In May 2014, the NCAA partnered with the Department of Defense in a $30 million effort to fund a clinical study of concussion and head impact exposure.
Another voice in college sports agrees.
“This is a critically important initiative,” said Dr. Semyon M. Slobounov, director of Penn State University’s Traumatic Brain Injury Research Laboratory. As someone who is “on the sidelines with Penn State Football,” Slobounov likes to “make sure I see the evolution of an injury right from that time it happened on the sideline, go to the lab and follow up the kids for the duration of the injury.”
Previously, Slobounov conducted a study of traumatic brain injury in children for NFL medical charities, which paid for his work. He is not currently funded by the league.
He explained that part of the importance of this initiative is due to the fact that the industry — from neuroscientists to sports medicine physicians — still does not agree on the definition of concussive injury, symptoms and treatment.
“My personal belief is that lots of cases are not reported,” Slobounov said, adding that many cases are undiagnosed or improperly diagnosed and so might cause serious problems later in life.
Finally, some see excitement in the proposal.
“Anytime the NFL brings this up, it shines more light on the problem,” said Dr. Sam Gandy, director of the NFL Neurological Center at Mount Sinai Hospital, whose work is not funded by the NFL.
Mount Sinai’s center is one of five where a retired player experiencing neurological issues can come for an evaluation. Although the evaluation is funded by the NFL, ongoing treatment is not, and Gandy’s services are voluntary.
“Physicists and imaging people and biochemists have been working on this problem for some time,” he said, explaining how until recently, CTE has only been diagnosed in postmortem brains, never in live brains. More money for research of traumatic brain injuries could only help, he suggested.
Looking to the future, he described recent work in the area of brain scans, essentially an offshoot of the research of Alzheimer’s disease, another neurological disease that causes memory and functional loss primarily in older adults. He noted that the brain scans are based on the buildup of certain proteins, and though they may not detect every concussive injury, it is progress.
Also from the Alzheimer’s world, there are new drugs being tested to treat CTE, Gandy said: “Not only do we have the first ways to see CTE, we also have the first ways to touch it with a drug.”
