Heads up: time to say goodbye to football

If football was a drug, it'd be banned.

Craig Klugman | Aug 4 2017 | comment

Suppose a prescribed drug caused brain damage in 99.1% of people who took it. Would you take the drug?

How long before that drug was pulled from the marketplace and the lawsuits against the manufacturer began? What if that drug made the company $7.2 billion per year? What if those who took the drug became celebrities for a brief period of time? Would you consider taking it then? Most rational people would refrain from the medication and the FDA would remove it from the market.

If you substitute the word “football” for “drug,” then you know the results of a new study in JAMA, which definitively proves that football is bad for one’s health.

In the study of 111 brains of former NFL players donated to the researchers, 110 (that’s 99.1% of the sample) showed evidence of chronic traumatic encephalopathy (CTE). Researchers examined a total of 202 donated brains. Ninety-one brains came from non-NFL players including those who played in pre-high school; high school; college, semi-pro, and Canadian Football League.

Of those brains 66 showed evidence of CTE (72.5%). The percent of players with CFL increases with the level of football play (which is a substitute for number of years in the sport and number of likely concussions).

Level of Play	Percent of Brains Showing CTE
Pre-High School	0%
High School	21%
College	91%
Semi-Pro	64%
CFL	88%
NFL	99%
*Maez, Daneshvar, Kiernan 2017

The severity of the brain’s CTE was correlated with the level of play as well. One hundred percent of high school player’s brains had mild CTE and 86% of professional players had severe CTE. The NFL players held a variety of different positions (even kickers showed signs of CTE).

This is not a new disease. It was first described in 1973 in an examination of 15 boxers. The condition is associated with repeated head trauma as often happens in professional sports like U.S. football.

The disease is manifested in changes to the brain structure, which can be seen after death. Symptoms of the conditions in the living include memory problems, impaired executive functioning, behavior and personality changes (such as depression, impulsive behavior, and suicidality), and parkinsonism.

Perhaps the scariest thing about CTE is that all of the safety gear football players wear does little to protect them against concussive injuries according to a 2017 review in the American Journal of Neurosurgery:

“Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.”

One would think that if a condition afflicts 99% of participants and there is no protection against it, that the activity would be banned. However, that neglects that the NFL is a $7.2 billion (annual) industry.

The 2017 Super Bowl game was watched by 111.3 million people (nearly one-third of the U.S. population). In 2011, nearly 27 million people watched football on Sunday afternoons. (However, viewership of football started dropping in 2016.) Still, that many eyeballs mean a lot of advertisers want to purchase screen time from television networks.

The question as to why, even in the face of strong statistical evidence, football continues is that (a) it is popular and (b) it brings in a lot of money.

Also consider the mythology of football as an “American Game” that represents the male spirit—toughness, fighting against the odds, and very physical. I lived about a decade of life in Texas where football is king and is a sacred part of the culture. Football has been an avenue out of poverty through college scholarships and well-paid players.

You know what else used to be a major part of American culture—cigarette smoking. What is important, “cultural,” and lucrative can change.

Smoking used to be the best performing industry in the U.S. Now, smoking has declined to fewer than 1 5% of adults. Smoking today is still associated with lack of education and poverty. Both smoking and football have been viewed as “ways out” of the cycle of structural poverty (whether through distraction or a one-in-a-million shot) that plagues the U.S. The long-term health effects for both activities are dire.

In medicine, the current gold standard is to make decisions based on the scientific evidence. Such evidence was the reason to create a cultural and legal shift against tobacco smoking (especially cigarettes) in an attempt to reduce the morbidity and mortality for which smoking was responsible.

The time has come to do the same for football. Other sports commonly associated with head injuries like soccer and hockey can change to be safer. Hockey can penalize players who start fights or who hit above the shoulders.

A 2012 study found that creating rules against bodychecking led to a significant decrease in injuries. Soccer can eliminate heading. In fact, hitting a soccer ball with one’s head has already been banned in youth soccer.

But to make football safer would require changing the game significantly, removing tackling (imagine the excitement of a televised professional flag football game), designing helmets that offer real protection, and not permitting minors to be involved in the game, to name a few efforts.

Even then, until these safety protocols are created, scientifically proven, and adopted, the dangers of participating in football far outweighs the risks of entertainment and moneymaking.

One could argue that adult players can give informed consent to participate and even if they were shown the evidence, many probably would still agree to play.

However, minors cannot legally consent. Parent’s rights are often limited when their choices place a child in harm’s way. So even if professional football continues, youth participation in the sport should be immediately ended since CTE is a cumulative disease that represents a clear and present danger against which there is no protection.

I am not saying that we can only participate in activities with no risks, but that the level of risk in football exceeds what is rational and reasonable.

Banning football, banning youth participation in football, and dramatically changing the game are the only ethical options to this great American pastime. Our entertainment and profits cannot come at the cost of the health of others.

Professor Craig Klugman, Ph.D. is a bioethicist and medical anthropologist at DePaul University. This article was originally published at bioethics.net, the website of the American Journal of Bioethics.

August 4, 2017

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There is an interesting mix of other articles today, including one that will probably make football players indignant, and a novel argument against sex-reassignment surgery. And don't miss the terrific New Yorker video of the Double Dutch Skipping competition held at the Lincoln Centre this summer.