Like many Americans, my in-laws have a Thanksgiving Day tradition of watching football and a Black Friday tradition of going shopping. Both of these are full contact sports, but only one of them will prove to be deadly for thousands of Americans.
That is because concussions — known clinically as mild traumatic brain injury (or MTBI) — are common in football. They are also common in other contact sports like soccer, hockey, boxing and martial arts.
Concussions are one of the most frequent traumatic brain injuries, occurring more than 1.5 million times a year in the United States alone. They happen when a blow to the head or body, a fall, or some other impact causes the brain to smash into the skull.
Symptoms of a concussion can range from a mild headache, blurred vision and disorientation to a loss of consciousness, convulsions and even memory loss. These symptoms usually subside within a few hours, but can last for days, weeks and even months. Unfortunately, there is no real treatment for a concussion other than physical and cognitive rest.
For most people who suffer a concussion, there are thankfully no lingering or long-term effects. But that is not the case for many athletes. Repeated concussions can result in a condition known as chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease characterized by impaired speech, deafness, amnesia, depression, anger and dementia. We now know that a significant percentage of amateur and professional athletes are likely to be suffering from CTE.
When retired Chicago Bears player Dave Duerson killed himself in 2011, for example, his subsequent autopsy found that he was suffering from CTE. So too was Hall-of-Fame linebacker Junior Seau, who took his own life in 2012. Just last week, the family of Frank Gifford revealed that the football legend also suffered from the debilitating effects of this disease.
In fact, one study of men who had histories of repeated concussions found that 80 percent showed evidence of CTE; most of these men had played football in high school, college or professionally. Similarly, a posthumous study of 91 brains of former professional football players found that 87 (a whopping 96%) tested positive for that neurodegenerative disease.
Despite this, and despite numerous lawsuits by former players and their families, professional organizations like the National Football League (NFL) have been slow to act.
In 1994, the League established its Mild Traumatic Brain Injury Committee with the stated goal of studying the effects of concussions and other head injuries among NFL players.
However, it wasn't until 2003, nine years later, that the Committee produced its first report. Despite mounting evidence to the contrary, that report concluded that there were no long-term health consequences associated with the repeated concussions sustained by many professional athletes.
It took another six years, and a Congressional inquiry, before the League established clear rules on when a player can return to the field after suffering a suspected concussion.
It wasn't until this season that the NFL created an independent spotter system, allowing athletic trainers and health professionals stationed on the sidelines and in the press box to stop the game for a medical timeout should they suspect that a player has suffered concussive injury.
But even that system seems to be ineffectual. During last Sunday's game against the Seattle Seahawks, Pittsburgh Steelers quarterback Ben Roethlisberger took a hit that clearly left him staggering. He had difficulty getting off the ground after being tackled, and was clearly disoriented. Nevertheless, the game wasn't stopped, and Roethlisberger completed an additional nine plays before removing himself from the game for "vision problems" (a clear sign of a concussion).
The same thing happened two weeks ago, when St. Louis Rams quarterback Case Keenum suffered an obvious concussion but continued to play. In neither case, however, have the teams been penalized despite these clear violations of the NFL's own concussion protocol.
In a commentary that I wrote nearly two years ago, I railed against the reluctance of the NFL and other professional sports leagues to take the problem of concussions seriously. Nothing has changed. Despite new protocols designed to prevent a concussed player from returning to the field, the teams, the coaches and the players continue to ignore the rules. NFL-led investigations into cases like Roethlisberger and Keenum go nowhere; there are no fines or penalties imposed. It's simply business as usual.
And that's exactly the problem. Professional football is a business, and a lucrative one at that. Even the NFL's lauded $1 billion concussion settlement, a one-time payout that would provide medical care and treatment for thousands of former players suffering from CTE, is a drop in the bucket for a franchise that makes tens of billions of dollars a year in tickets, merchandise, sponsorships and broadcast deals.
On the gridiron, money matters more than lives. Until we tackle that problem head on -- be it through regulations, policies or heavy fines -- nothing is going to change.
A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of the Bioethics Program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its two NIH-funded research ethics training programs in Central and Eastern Europe and in the Caribbean Basin.
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