League of Denial

"Frontline" tackles the NFL’s concussion crisis

Published on October 8, 2013by Kathleen Bachynski

On October 3, 2013, NFL commissioner Roger Goodell sent a 1,000 word email to 10 million football fans. His message highlighted the league’s emphasis on safety, noting its “Heads Up Football” program, which educates coaches in proper tackling techniques and concussion management. Goodell concluded that “Football will remain the hard-hitting, physical sport that you love.”

But just how safe can such a hard-hitting, physical sport be? On Tuesday, October 8 at 10pm ET/9pm CT, “Frontline” airs its new documentary, “League of Denial: The NFL’s Concussion Crisis.” Based on investigative reporting by ESPN journalists Mark Fainaru-Wada and Steve Fainaru, “League of Denial” examines the NFL’s role in an ongoing debate over the impact of those tough hits on players’ brains.

‘League of Denial’

“League of Denial” tells an extraordinary story at a time when the NFL’s position on the risks of concussions is rapidly changing. As recently as 2007, the NFL assured its players in a pamphlet, “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly.” By 2010, however, the NFL bluntly warned that traumatic brain injuries “may lead to problems with memory and communication, personality changes, as well as depression and the early onset of dementia.” And in August 2013, thousands of former players who sued the NFL, alleging the league had hidden its knowledge of concussion risks, agreed to a $765 million settlement.

This powerful documentary is therefore highly timely and relevant to anybody with an interest in football and sports safety debates. As noted in the “Frontline” press release, League of Denial “draws on over 200 interviews with scientists, doctors, and former players, including some of the NFL’s all-time greats.” Unfortunately, the NFL would not cooperate with the Fainaru brothers. Nor would they talk to “Frontline.” And the NFL ultimately influenced the decision of ESPN to pull out of the documentary. Nonetheless, “League of Denial” benefits from an impressive variety of perspectives in telling this complex story that affects so many different groups and interests.

League of Denial opens with images of factory workers doing dangerous jobs. These images implicitly remind viewers that the Pittsburgh Steelers have a lot in common with the steelworkers for whom they’re named. Not only are they both tough and hard workers, they also perform their jobs under highly risky conditions.

Although League of Denial focuses on the stories of professional NFL players, it also addresses the potential impact of the sport on a more vulnerable group: youth players. Millions of American children play football and are exposed to any health risks the sport might pose. So understanding both the short-term and long-term hazards is an important public health issue.

The documentary makes clear the impact of the NFL on all levels of play. Not only are NFL players role models for children learning the sport, but NFL-sponsored research has dominated our understanding of the safety of football. In fact, the NFL has explicitly extrapolated its findings based on professionals to youth players. For instance, even though they had not studied children, NFL researchers asserted “it might be safe for college/high school football players to be cleared to return to play on the same day as their injury.”

Making the call on the legitimacy of the science

Indeed, one of the most disturbing aspects of this story is the NFL’s efforts to deny and discredit other researchers’ findings while furthering its own scientific agenda. As presented in “League of Denial,” the NFL’s dismissal of independent researchers’ work at times has carried with it sexist and racist undertones. Dr. Ann McKee, co-director of Boston University’s Center for the Study of Traumatic Encephalopathy, noted receiving a chilly reception as an independent female scientist presenting her findings to a room of male NFL doctors. In the documentary, she states, “I don’t want to get into the sexism too much, but sexism plays a big role when you’re a doctor of my age.” Meanwhile, Dr. Bennet Omalu, a Nigerian-born forensic pathologist who carried out the early pioneering work on chronic traumatic encephalopathy (CTE) on the Steelers’ legendary center “Iron Mike” Webster and others featured in the “Frontline” documentary, felt his work was regarded as “voodoo” rather than medicine.

Conversely, to assert his credibility, Ira Casson, the co-chair of the NFL’s Mild Traumatic Brain Injury Committee, repeatedly declared that he was “a man of science.” NFL and non-NFL affiliated researchers frequently relied on different data, or widely divergent interpretations of the same data, in an area of considerable scientific uncertainty. “League of Denial” raises many questions about whose research is portrayed as trustworthy and whose research can be discredited.

Nonetheless, with an obvious interest in preserving its own bottom line, the NFL remains the most important influence on brain research in this area. In our interview, Mark Fainaru-Wada observed the critical role of money in determining how research is conducted. “Nobody’s contributing more than the league is, and the money’s got to come from somewhere. So in that sense it’s a positive thing. But do you really want the NFL basically to be driving the science at this point?”

Overtime with fundamental issues in public health

At the conclusion of the documentary, the narrator notes that although fundamental questions remain to be answered, the future of football seems secure for now. But even if the link between brain trauma and neurological disease were widely acknowledged, would fans begin to turn to other sports?

Fainaru-Wada and Fainaru doubt it. Steve Fainaru observed in our interview, “I think right now the answer is no. I think we knew this intuitively before we started this project, but now it’s really dramatically apparent to us how incredibly popular the NFL is. So the idea that people are just going to be turning away in horror from the sport, I just don’t see that happening any time soon.”

As long as football remains America’s most popular sport, we have some difficult public health questions to consider. Just how big and severe is the risk of long-term brain damage from the repeated hits that are part of the essence of football? Is tackle football an appropriate sport for children? What should parents know? What policies would best ensure player safety? How should brain injury research be conducted so that it is as informative and trustworthy as possible?

“League of Denial” is a compelling, provocative documentary that will help spark and inform this conversation. We encourage you to watch it, send us your thoughts and questions, and stay tuned for more analyses. At the 2×2 project, we’ll be asking experts for their take on the documentary and the public health issues it raises, including whether CTE is an epidemic in the making.

Edited by Dana March