League of Denial

The NFL could make the claim that its football players did not sustain brain damage only because such a thing could only be determined post mortem and no one had yet examined the brain of a dead former player. That changed when Mike Webster’s body was autopsied in 2002. Typically, Webster would not have had an autopsy because he had died unsuspiciously of a heart attack. However, the chief deputy coroner of Allegheny County was a Steelers fan and knew of Webster’s fall from grace. Suspecting that Webster’s problems made him a candidate for deeper examination, the coroner impounded the body for the neuropathologist on duty, Bennet Omalu. Omalu, a specialist in diseases of the central nervous system, had been born in Nigeria 32 years earlier and immigrated to the United States at the age of 26. Although Omalu knew little about American football—the authors argue that it “would have been almost impossible to locate a human being within a 200-mile radius of Pittsburgh who was more ignorant of the sport” (150)—he had seen news reports detailing Webster’s tragic final few years.

Omalu did not find outward signs of a damaged brain, but knowing Webster’s history, and given his own experience of finding brain damage in a recently autopsied battered wife, Omalu chose to slice the brain and study it further. What he found was something that he had never seen before—a buildup of tau protein similar to what occurs in an Alzheimer’s brain, but the tau tangles were in the cortex and not the hippocampus, which is the opposite of Alzheimer’s disease. Omalu sought a second opinion from a more seasoned neuropathologist, who concurred, then a third opinion from Steve DeKosky, an internationally renowned expert in Alzheimer’s, who also agreed that “Omalu had discovered a new syndrome” (163).

From studies of the brains of deceased boxers decades earlier, it had been proven that repeated head trauma resulted in similar tau tangles, a condition that came to be known as dementia pugilistica. What was found in Webster’s brain would be known as chronic traumatic encephalopathy, or CTE. When Omalu was ready to publish his research, he and the other two scientists involved all believed that their discovery would be welcomed by the NFL. The authors explain that the scientists “would all look back and reflect ruefully on how naïve they had been” (165). 

In beginning Chapter 9, the authors make the argument that “NFL Commissioner Paul Tagliabue had created a research arm that exactly mirrored his skepticism about the so-called concussion crisis” (166). This was evident in the next paper the MTBI committee published in Neurosurgery, which made the claim that no NFL player had experienced brain damage from repeat concussions. The claim was made despite the fact that the NFL had not studied retired players. The NFL’s claim would be problematic not only because of what was found in Webster’s brain, but also because of the disability ruling that the League’s retirement board had made in his case years earlier, in which it determined that Webster had sustained brain damage from repeat concussions in his career. Fitzsimmons, Webster’s attorney, would describe this point as “the proverbial smoking gun” (168). It was also discovered that the retirement board had made the same ruling for other retired players as well—that they had sustained brain damage from their football careers. The rulings in those disability cases directly refuted what the League’s new research arm was now declaring.

As the MTBI committee continued to roll out papers published in Neurosurgery, the committee and the journal itself came to be viewed by the leading scientists in concussion research as nothing more than “industry-funded research” set up to protect the league (171). Even Bob Cantu became a dissenter of the published research, but Apuzzo saw the papers as hot and trendy because they were written by the NFL’s own research committee. The battle lines were being drawn in concussion research: the NFL’s research arm featuring Pellman, Casson, Feuer, and the creators of ImPACT, Maroon and Lovell, on one side and the scientific dissenters—Cantu, Bailes, Guskiewicz, and Bill Barr, a neuropsychologist employed by the New York Jets and New York University Medical Center— on the other. 

Neurosurgery agreed to publish Omalu’s research concerning Webster in 2005. According to the authors, this decision “set up competing narratives in the same medical journal: One said that NFL players didn’t get brain damage from football, and the other said they did” (188). Upon its publication, the MTBI committee got to work criticizing Omalu’s research and even called for the paper to be retracted. Omalu and his co-authors fought back, and the paper stood. 

At roughly the same time that Omalu’s paper made it into Neurosurgery, he had another bombshell revelation that he considered could be a secret weapon against the MTBI committee’s protests: Omalu had discovered another case of CTE in a deceased former player. The player, Terry Long, had played alongside Webster on the Steelers offensive line for several seasons in the 1980s. Like Webster, Long had used steroids as a player, and like Webster, his life had turned tragic after his retirement. After two unsuccessful suicide attempts, Long killed himself in June of 2005 by drinking antifreeze.

The NFL was in attack mode against Omalu, but he had found supporters within the small group of concussion researchers. Bailes and Guskiewicz had found signs of dementia in living players but had been dismissed by the NFL in the same way. Cantu had fought against the publication of the MTBI committee’s papers but had been shot down because of the weight carried by the League’s name attached to its research. A new ally for Omalu emerged in Chris Nowinski, but he was an activist rather than a scientist. Nowinski had played football at Harvard and then moved on to professional wrestling, where he suffered a number of concussions and visited Cantu for treatment. Nowinski was writing a book on the concussion crisis and sought out Omalu as an interview subject.

Nowinski offered to supply Omalu with yet another brain of a deceased former player. Omalu agreed to study the new brain, but the pair would need to obtain the brain tissue from the medical examiner and get permission from the dead player’s family. The player, Andre Waters, a 12-year NFL veteran as a safety with the Philadelphia Eagles and Arizona Cardinals, committed suicide by shooting himself in the head in 2006. Waters also had brain damage, and this time the story became national news, featured prominently in the New York Times on January 18, 2007. As the authors explain, “that was the day the NFL’s concussion problem hit the mainstream” (204).

Bailes later contacted Omalu on a request from the American Association of Neurological Surgeons to examine Omalu’s research. Hoping the meeting could be an opportunity to involve the NFL, he brought MTBI committee member Joe Maroon. After Omalu showed the neurosurgeons his slides, Maroon appeared to finally understand the research and its implications, saying to Omalu, “If only 10 percent of mothers in America begin to conceive of football as a dangerous game, that is the end of football” (206).

Although the small group of dissenting researchers had been at war with the NFL’s MTBI committee for several years, that battle had been largely unseen by the public. However, now more and more powerful voices began to challenge the NFL’s system of denial. These voices included media giants such as the New York Times and ESPN and also former players. Harry Carson, a Hall of Fame inside linebacker for the New York Giants from 1976 to 1988, was one of those voices. Following his retirement, Carson suffered from migraines and depression and was diagnosed with post-concussion syndrome. In his Hall of Fame induction speech in 2006, Carson chided the NFL for seeming to discard former players, arguing “if we made the league what it is, you have to take better care of your own” (209).

Another voice speaking out belonged to Ted Johnson, a linebacker with the New England Patriots from 1995 to 2004. Johnson had also been diagnosed with post-concussion syndrome, and his two years of retirement were yet another horror story of emerging dementia. Johnson’s story was a new one in that his most serious concussion occurred when he was essentially forced to continue hitting by head coach Bill Belichick despite being still groggy from a previous one. One of the first major acts by the League indicating an acknowledgment of the issue became known as the “Ted Johnson Rule,” which created a hotline for players to contact in the case of improper concussion treatment. The League also responded with the establishment of “The 88 Plan,” referring to the number worn by 1960s-era Hall of Fame tight end John Mackey. Mackey, who became the first head of the NFL Players Association (NFLPA) in 1970, was experiencing advanced dementia at the time and confined to an assisted-living facility that his family could not afford. The 88 Plan provided up to $88,000 per year for players experiencing football-related dementia.

The League also reconfigured its MTBI committee, replacing Pellman as the chairman with Casson and Dave Viano, a biomechanical engineer. Although Casson was a respected neurologist who had authored a landmark study in 1982 that found numerous cases of brain damage in boxers, he would soon become the face and voice most closely associated with the NFL’s issue of denial. In 2010, Casson was interviewed for HBO’s Real Sports and repeatedly provided the one-word answer “no” to questions about whether evidence existed linking football with depression, with dementia, with early onset of Alzheimer’s, and finally with any long-term problem. The authors explain that Casson, “from that point forward became known to critics as Dr. No” (218).

Perhaps the biggest change taking place within the NFL as it slowly began to accept the seriousness of the issue was in leadership. Tagliabue retired in 2006. Taking over as commissioner was Tagliabue’s right-hand man, Roger Goodell. The authors argue that “it was hard to ignore how Tagliabue, as he walked out the door, had dumped a mushrooming health crisis in Goodell’s lap” (218). Following this change, the league planned a first-of-its-kind Concussion Summit for 2007 in which both the MTBI committee and the scientific dissenters such as Bailes, Guskiewicz, Cantu, and Barr would present their science. However, the man who had made the most important discovery, Omalu, was not invited. While the summit might have opened a deeper dialogue and opened some important eyes as to the reality of the crisis, it is likely best remembered for Casson’s reaction to Bailes’ presentation—eye rolling, mocking, and declaring that he was a man of science. 

Despite their significance to the NFL’s developing crisis, neither Omalu nor Nowinski were invited to take part in the league’s concussion summit. The two men met each other for the first time not long afterward and immediately established a partnership. Their plan was to affiliate their nonprofit organization, which they would name the Sports Legacy Institute, with a research institution and acquire the brains of dead athletes. Cantu and Bailes joined their cause, as did Fitzsimmons, the attorney who had helped Webster win his disability claim. It did not take the Sports Legacy Institute long to acquire its first brain. It belonged to Justin Strzelczyk, yet another former Steelers offensive lineman who played from 1990 to 1998 and seemed to lose control of his life after retiring. Strzelczyk had died two years earlier when he led police on a 37-mile chase through central New York before driving his truck head-on into an oil tanker. The group discovered that the medical examiner had preserved his brain tissue and sought to acquire it. Soon, Strzelczyk became the fourth confirmed former player with brain damage.

When the Strzelczyk story became national news, the NFL decided to try a new strategy to reinforce its denial: It would find its own expert to examine Omalu’s work. Peter Davies, the director of the Alzheimer’s Center at Long Island Jewish Medical Center and an expert in tau, was the NFL’s expert. Davies examined Omalu’s work and came away astonished, agreeing that the players were brain damaged and that this was indeed a new discovery, certainly not what the NFL wanted to hear. Davies, however, did leave the door open that steroid usage, or the combination of repeated concussion with steroid usage might have played a role in this pathology. Either way, it was bad news for the NFL’s culture of denial.

Also bad for that culture of denial was the fact that the news stories about the concussion crisis caught the eye of Congress. In September of 2007, the Senate Committee on Commerce, Science, and Transportation held a hearing titled “Oversight of the NFL Retirement System.” Brent Boyd, a former offensive lineman for the Minnesota Vikings, testified that he, too, knew that he had brain damage but could not qualify for benefits. Boyd’s most meaningful statement might have been when he likened the NFL to the “tobacco companies fighting against the link between smoking and cancer” (244). One witness who came to the League’s defense was Dave Duerson, a four-time Pro Bowl safety primarily with the Chicago Bears in the 1980s. Duerson, a player representative who stayed active with the NFLPA after retiring, was such a staunch defender of the League that he got into a shouting match with other witnesses in the halls of Congress after the hearing. The authors close the chapter pointing out that Duerson’s reaction seemed extreme and “out of character” (245).