Garbage In, Then Garbage Out: Cover Up: NFL Caught With Pants Down

So much for the integrity of the National Football League. Despite decades of evidence indicating repeated blows to the head and brain, with or without the label of concussion, cause severe progressive neurological dysfunction, and more recent post-mortem pathological evidence indicating a history of repeated blows to the head and brain causes chronic traumatic encephalopathy, the NFL has persistently, as recently as the February 2016 Super Bowl, denied the game of football is related to brain damage.

Then, on March 14, 2016 Jeff Miller, the NFL senior Vice-President for health and safety admitted to a Congressional committee there is a link between playing football and suffering chronic traumatic encephalopathy. [View exact exchange with Rep. Jan Schakowsky, D-Illinois.]  Remarkably, this admission came after a court approved settlement to be paid out over the next several decades, in the range of 900 million dollars, for the players with neurological injuries and for families of those players who died.

In reality, this was primarily a legal maneuver by the NFL to end litigation accusing the NFL of concealing information and failing to exercise reasonable care.  Also, of particular interest, Mr. Miller’s admission came just 10 days before the mierda hit the fan revealing the NFL, at best, failed to reveal all data on brain injuries they should have disclosed; and/or they just frankly lied to protect their multi-billion dollar empire.

The Chicanery of the NFL Concussion Committee

On March 24, 2016 The New York Times published an article by Alan Schwarz and a team of journalists titled: “N.F.L’s Flawed Concussion Research and Ties to Tobacco Industry.” [View entire article online.]   For the last 13 years the NFL has based its dishonorable announcements about the safety of football on grossly erroneous data gathered from 1996 to 2001.  A series of published studies based on NFL data minimized the danger of head injuries. But these studies lacked scientific credibility and must now be considered not only invalid but also fraudulent.  Evidence gathered by the investigating journalists reveals a pattern of incompetent evaluations, clumsy or false reporting and feckless medical editing and publishing.  The cover-up continues:  this pattern of deception by the NFL is malicious, but also inept, unethical and buffoonish.

In 1996, Paul Tagliabue, the previous NFL commissioner, established a so called “concussion committee” after acknowledging the need for “independent scientific research to better understand the risks of concussions.”  The chairman of the committee, Dr. Eliot Pellman, who happened to be the team physician for the New York Jets, “emphasized that his group aimed to produce research that was Independent and meticulous.”  This statement turns out to be a travesty. The New York Times addressed the notion of an independent panel of experts:

“In fact, most of the dozen committee members were associated with NFL teams, as a physician, neurosurgeon or athletic trainer, which meant they made decisions about player care and then studied whether those decisions were proper. Still, the researchers stated unambiguously—in each of their first seven peer-reviewed papers — that their  financial or business relationships had not compromised their work.”

The make-up of the NFL Concussion Committee is a perfect example of the idiom: “Don’t let the fox guard the henhouse.”  Within itself this failure to rigorously insure there would be totally independent and unbiased reviews makes the committees’ reports a mockery. Instead the team evaluators were joined in their biased reports by the editors of the journal Neurosurgery (to be distinguished from the Journal of Neurosurgery). This blatant string of errors/omissions/lies prevented any objective consideration of the NFL data in regard to the serious issue of brain injury in football.  Such chicanery is compounded by the sloppy data used to draw erroneous conclusions.  The subsequent chain of fraud, as described by the NY Times smacks of the arrogance of NFL owners and officials.

The published papers, under the NFL’s guidance, perpetuated the high jinx by emphasizing the “completeness of the data,” and stating “It was understood that any player with a recognized symptom of head injury, no matter how minor, should be included in the study.” In reality the level of recognition of the injury process was reprehensible.  Documents in the committee’s peer review process (better described as a hoax) indicated “all N.F.L teams participated…all players were therefore part of this study.”   Which is not even close to the truth.

While the original charge of the Commissioner, as published in the journal Neurosurgery, “mandated all team physicians to complete and return forms whenever they examined a player with a head injury.”  Of course the NFL now quibbles and states the teams were “not mandated” to report, but only “strongly encouraged.”  In fact, the evaluations, the data reported and the publications were incomplete, incompetent and frankly a disgrace to the NFL and the medical community.

Fallacious Data, Based on Nonexistent Reporting

The unethical behavior and the outright lies of the NFL are so egregious there should be grounds for criminal prosecutions. How many brain injuries have occurred due to fallacious NFL reports will never be known.  I am embarrassed, still identifying myself as a neurosurgeon, at the negligent actions of the neurosurgeons involved in this NFL cover-up.  Here are some of the glaring facts reported by Mr. Schwarz and his team.

The New York Times found that most teams failed to report all their players’ concussions. Over all, at least 10 percent of head injuries diagnosed by team doctors were  missing  from  the  study,  including  two sustained by  Jets  receiver  Wayne  Chrebet, who retired several years later after more concussions. Dr. Pellman, the Jets’ physician, led the research and was the lead author on every paper.”

It is important to note the cases reported were only those diagnosed with a concussion.  At that time the standards for the diagnosis of a concussion were very lax and no doubt, hundreds, if not thousands of traumatic brain injuries were not reported, as mandated, because they did not meet the unknown criteria for a concussion. If a player was able to walk off the field of play without assistance or direction, they were not evaluated and not diagnosed.  In fact, some players who had to be carried off the field were not part of the database. [Read online.]

In a careful review the journalists found some teams reported no concussions in the entire 6 year span of reporting. “The Cowboys do not have a single concussion in the database, which covers 6 seasons.” But injury reports to the media noted quarterback Troy Aikman “sustained four [concussions] during the time” of this study. There is a picture of him being helped off the field but his injury was not part of the NFL study.

Similarly, the San Francisco 49ers listed no concussions from 1997 through 2000. Yet, there is a picture of quarterback Steve Young lying unconscious on the field. His injury was listed on an injury report for the media, but was not part of the published database for the NFL study.

If the injuries to these high profile all-pro quarterbacks were not included in the study, how many players, linebackers,  offensive and defensive linemen on less notable and less  successful teams   were not reported?  The conclusion is clear:  all information and conclusions provided by the NFL must be considered worthless.

Diagnosing a Concussion: Who’s Credible and Who’s Not

One more statement by The New York Times is worth noting:

“Some injuries were more severe than what was reflected in the official tally.  According to [concussion] committee records, St.  Louis Rams quarterback Kurt Warner sustained a concussion on Dec. 24, 2000, that healed after two days. But Mr. Warner’s symptoms continued, and four weeks later he was ruled out of the Pro Bowl with what a league official described as lingering symptoms of that head injury.”

With time, more fully independent information became available which contradicted the data of the NFL Concussion Committee, (see previous posts to this blog titled Neuron Holiday and Our Imminent Circus Maximus) and the work of the committee drew sharp criticism.  With the clanging hubris of brass cojones the NFL responded to the critics with the following condescending statement:

“We are aware the findings from the NFL confront some popular opinions,” they wrote, “but believe this study stands on its merits based on physician evaluation of injury and quality assurance of the data.”

Now we know the NFL data is not only worthless but deliberately misleading.  There are now voluminous scientific studies, not sponsored by the NFL, documenting the effects of repeated blows to the head and brain.  Just recently, 3 April 2016, the Journal of Neurosurgery, a publication of the American Association of Neurological Surgeons and also known as the Harvey Cushing Society (again this is a different publication than the journal Neurosurgery published by the Congress of Neurological Surgeons) published 13 carefully peer reviewed articles studying sport related traumatic brain injury.  Here are just four of the references:

  • Pan, James, et al. Sports-related brain injuries: connecting pathology to diagnosis.  Neurosurgical focus, Vol. 40, No. 4:E14.
  • Shen Ban, VIN, et al. The Science and questions surrounding chronic traumatic encephalopathy. Neurosurgical Focus, Vol 40, No 4: E15.
  • Hobbs, Jonathan G., et al. Sports-related concussions: diagnosis, complications, and current management strategies. Neurosurgical Focus, Vol 40, No. 4:E5.
  • Zuckermanm, Scott L., et al. Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis. Neurosurgical Focus, Vol 40, No. 4:E9.

I belabor the reader of this post with this list of references to emphasize there is a large volume of world-wide publications on this topic,  and the overwhelming conclusion is:  there is indeed a serious and dangerous relationship between sports-incurred head and brain injuries and long term neurological consequences.  I included the last citation in regard to arachnoid cysts to emphasize the associated or comorbid complications of brain injuries. Also, I still harbor anger because I discovered an arachnoid cyst in a soldier who sustained a traumatic brain injury while on active duty and the Medical Review Board refused to recognize the significance of the arachnoid cyst, the TBI or the combination of the two diagnoses.  This was in face of the soldier having documented seizures after his TBI.  The soldier left active duty without a Medical Board determination, but with very strong recommendations (from me) he seek remediation through the Veterans Administration.

Asking Serious Questions

As it is my fundamental belief questions are always much more important than answers, I would like, at this point, to ask a few questions.  First, when faced with a decision about your child playing football (or soccer, hockey, rugby) will you place greater reliance on data from the studies produced by the N.F.L or the studies of worldwide medical experts published in an array of peer reviewed journals?  Second, do you need to know potential complications before the injuries, or just deal with them after they happen? And third,   is it fair and reasonable to expect an informed consent process noting all known risks, complications and expected long term outcomes?

In the April 4, 2016 edition of Sports Illustrated (SI) writer Michael McCann addressed the revelations of the New York Times article with a short piece titled “Shield Law: the latest revelations about the NFL and head trauma may add a dent to the league’s image on the subject, but they probably won’t penetrate the legal defenses.”  [View online.] The term shield refers to the ubiquitous symbol of the NFL behind which the current commissioner, Roger Goodell, and owners hide from their ethical responsibilities.   SI focused entirely on the NFL’s ability to avoid a court proceeding that would reveal  the malevolent lies and manipulation of data, as well as the callous lack of concern over the health and safety of the players who perform at the owner’s behest and help make the NFL a 13-billion-dollar-a-year enterprise.

SI notes one of the NFL’s legal defenses is the concept of preemption. This means an agreement with the NFL Players Association which stated “health disputes would be resolved through arbitration” and would prevent this being brought to court. However, this assumes both parties come to the table without hiding data.  The agreement should be nullified by now indisputable, well documented NFL malfeasance.

The ongoing legal ooze keeping Roger Goodell out of the witness box is bolstered by the following belief raised by the SI article:

“Retired players will never be able to demonstrate that their problems arose from playing in the NFL, rather than in college or high school or from some other activity. Even if the NFL used flawed data, it wouldn’t necessarily prove that any particular player suffers from a neurological   problem because of playing NFL football.”

It seems, at the moment, the NFL feels it is immune to public outrage over their insensitive and malicious lack of concern for the health and safety of its players.  The information in The New York Times investigation did not reach the local media and was readily disregarded by both local and national sports media. Even NPR did not, as far as I know, report on the behavior of the NFL?  Is anybody asking serious questions?

What are the long term consequences of NFL apathy, negligence, deception and ignorance?  If the NFL, this paragon of football eminence, is not the standard of excellence and integrity in this field of endeavor, who is going to be? Do they not understand it will not be very long before medical science will be able to objectively measure the impact of repeated blows to the head and the brain at all ages and stages; and establish when such injuries lead to long term chronic neurologic impairment?

On April 19, 2016 Dr. Francis Condi presented a study to the American Academy of Neurology documenting that “diffusion tensor imaging, a sensitive MRI scan, found more that 40% of retired National Football League players had signs of traumatic brain injury.”  This research was in living players. Thus it is no longer necessary to wait for post-mortem examination to detect trauma to the brain.  How will the NFL brush this information away? Or, how will they cover up the biological markers (blood tests) that are now being utilized to detect brain trauma (axonal injury) within hours of the injury (as reported in the March 25, 2015 Journal of Neurotrauma and the March 13, 2016 on-line JAMA Neurology)?

Who will be at the forefront in preventing such injuries, protecting our youth, limiting repeated blows on the cerebral cortex? Will the NFL place the health and safety of the players before greedy profit?  When will professional football become the entertainment farce of professional wrestling? Boxing has lost the audience to the mayhem of Mixed Martial Arts, where the object of both violent sports is to injure the brain of the opponent.  Will football disappear before leaders with moral courage and integrity make the necessary changes to honestly assess and prevent injuries, rather than continuing efforts to conceal the horrible cost of this game?

Evidence is, the National Football League has no plans to answer any of these questions.  The public, the media, our legislative bodies are not yet convinced there is a problem.  I am waiting for parents to take on this fight.

Finally, The New York Times article goes to some length to establish a link between the NFL and the Tobacco Industry. But this incestuous relationship is no surprise. Since the NFL has blatantly ignored or concealed information about the safety risks of football, why would the NFL not seek consultation and guidance from an industry who made concealing health risks an art form?  Roger Goodell, now better known as Roger the Dodger, has developed considerable skill in dodging the truth while playing the pied piper for the greedy NFL owners.