Concussion Inc. (24 page)

When young Ryne was first concussed, the Montclair High School program was just beginning to use ImPACT, and he was among the first group of football players there to take a “baseline” examination of their cognitive functions. Discovery may clarify some of these facts and whether ImPACT played substantially into the return-to-play recommendation of the Doughertys' physician, Michelle Nitti.

There are so many open questions here, it's hard to know where to start. Since Ryne had already suffered two concussions, a baseline test at that point made no sense. Indeed, even those with a kinder assessment than I of ImPACT's value would be forced to agree that a
midseason
baseline test for Dougherty's teammates was oxymoronic, as well. In any case, school officials said Ryne's particular test was considered invalid at the time because one of the kids in the room during the session was behaving disruptively … whatever that means.

My tentative takeaway is that this episode illustrates not the potential of ImPACT, fully installed and used precisely as designed, but rather the never-ending pitfalls, loopholes, fine print, and literally deadly caveats associated with a product aggressively marketed to high schools as a solution, if not
the
solution, to prevention of “second concussion syndrome.” Not to mention the legal exposure associated therewith.

I further contend that the ultimate lesson of all these cases will be the tail-chasing, bottomless-budget-pit inanity that is “concussion awareness.” You can mandate the staffing of an athletic trainer. You can mandate the purchase of ImPACT. You can mandate contracting all the paraprofessionals and support personnel — real or phony, certified or simply earnest — to interpret the data. But who makes the call to send the kid back out there to get head-banged again?

And when the worst happens — as it inevitably will, time and again, despite layer upon new layer of expensive, unproven, ass-­covering measures — who will foot
that
bill?

The taxpaying public doesn't yet seem terribly exercised by the ramifications of turning teenagers into human cannon fodder for Friday night lay religious services. But one diligently spotlighted narrative at a time, the rationalizations let loose by “concussion awareness” are destined to send the dollars flowing in a different direction.

9 May 2012..........

During the 1981 Major League Baseball players' strike, I traveled to Norfolk, Virginia, to watch the New York Mets' top farm club at the time, the Tidewater Tides. As I would confirm over the years in attendance at more minor league games at all levels, there are only a handful of genuine prospects on the field at any given time, even in Triple A. The overall skill level is such that routine relays, rundowns, and double-­play balls get bungled, and baserunning is atrocious. Why, the '81 Tides even had a first baseman named Ronald McDonald!

In the developmental product, a good 80 to 90 percent of the roster consists of filler: guys either chasing delusions or playing for the love of it, who are under professional contract only because every team needs 25 players. They're cogs in the machine. They're part of the cost of refining those one or two or three diamonds in the rough.

This principle — the meritocratic bell curve of God-given talent — applies to all sports. But as we are now learning with accelerated alarm, only in football does it have profound public health implications.

Football is more than a game — and in case you're wondering, that is not a compliment in this context. Football is a kind of lifelong lifestyle, burdening its enthusiasts with the unintended dead weight of long-term mental disease. It is a game meting out not just wins and losses, but life and death.

And that is why I say, with gathering conviction supported by crystallizing science, that any fellow parent who lets his son play public high school tackle football, at an age clearly before both his brain has developed and he has agency to decide for himself, should have his own head examined.

In a recent radio interview, I was accused of advocating a “nuclear option” when I reject the idea that youth football can be saved from itself through a combination of better helmets, new rules, more careful coaching, and abracadabra state laws, which will force public school systems to turn their sports fields into triage centers and their locker rooms into neurocognitive testing laboratories. But the only thing I'm really calling for is the dissemination of better information in support of better choices.

The toothpaste of “concussion awareness” is out of the tube, oozing like spinal fluid. When all the solutions have been implemented and (mostly not) paid for, more or less the same critical mass of bad outcomes will happen anyway. These include, silently, insidiously, the killing of brain tissue over time. And if I happen to be exaggerating a tad, who among us really want to volunteer their sons for the next generation of guinea pigs in the “control groups” of NFL-underwritten “peer-reviewed literature”?

Yes, football promotes some good values, such as teamwork and community. So does the marching band. So does the school drama group. So do basketball, volleyball, and crew, not to mention math study gangs. (Oops, that last example was a rhetorical mistake — it exposes me, once and for all, as a “pussy.”) Let's seek our bonding opportunities elsewhere, and let's leave the risks and astronomical preventive and medical costs to private clubs catering to the genuinely elite, the unambiguously professionally tracked jocks.

Last week I got a call from Tom Farrey, the fine investigative reporter for ESPN's
Outside the Lines
. We spent some time picking each other's brains, so to speak, on concussions. But as the conversation moved along, I told Tom that I thought he'd already spotlighted much of the problem in his book
Game On: The All-American Race to Make Champions of Our Children
.

A lot of people believe the trouble with youth sports is that they aren't
professional
enough, in the sense that too many of the coaches don't know what the hell they're doing, in terms of both athletic technique and sports medicine and safety. For my money, these activities are, instead, too
professionalized
: rather than pushing the bodies and minds of our young people toward some larger purpose, they become obsessed with the mannerisms, recklessness, and brass-ring-grasping of the one-dimensional superjocks, the celebrity wannabes.

In every healthy society, there's a mix of elements of patriarchy and matriarchy. Only in Football America, it seems, have our mothers been reduced to enablers. If these voices of pragmatism and safety have not been drowned out altogether, they've been channeled into the cottage industries of Concussion Inc.: desperately trying to make an untenable state of affairs just a little less untenable.

Meanwhile, the national male football death and disability toll mounts.

10 May 2012..........

On Tuesday's
Outside the Lines
on ESPN, Matt Chaney, a good friend of this blog, debated Merril Hoge, the network commentator whose own NFL career was aborted by concussions.

Hoge's setup was boilerplate apologia, though I must say somewhat more coherently articulated than his despicable attack a few days earlier on Kurt Warner for the corporate sin of thinking out loud in public about whether football was really a desirable activity for his own kids.

In his
OTL
confrontation with Hoge, Chaney lucidly cited the views on brain trauma by such distinguished doctor-researchers as Ann McKee and Bennet Omalu, and forcefully made the case that promises of future prevention and reform are the same-old, same-old in football history, and this time doomed by both a public health tipping point and sheer marketplace economics.

Hoge thereupon called Chaney “uneducated” and “ignorant” — two of the more inaccurate epithets one could pull out of one's anus to defame this courageous heat-seeking loose cannon. A cable talk shoutfest broke out.

I've also had a chance to view the ballyhooed
Intelligence Squared
debate over whether college football should be banned. It pitted writers Buzz Bissinger and Malcolm Gladwell against former players and current media types Tim Green and Jason Whitlock.

The debate was a hash, because this overbroad prompt, with its specter of prohibition, sucked everything but the kitchen sink into its vortex: not only the concussion crisis but also general sports and higher education corruption, the challenge of American competitiveness in the global economy, and, from the proponents of the measure, some fierce moralizing that might not have taken its own prescriptions entirely seriously. But, what the hell, that's the polarized format of these things.

Green and Whitlock, for their part, were reduced to simply citing football's powerful mystique, over and over and over, like subconcussive blows. Whitlock, in particular, kept returning to the theme that you had to be there, in the trenches, in the locker room, and in the great bootstrapping experience of the American melting pot, which had handsomely rewarded him. He appeared to have done no preparation beyond rehearsing this burly persona and wishing everyone else would lighten up and indulge the excesses of our cherished freedom — which he parsed as “free-dumb,” the right to choose consumption of tobacco, pornography, football, what have you. This blaze of intellectualism nearly blinded me.

Green touted the ritual of playing the national anthem as evidence that spectacled sports entertainment fosters community and nation-building. Playing defense with a more amiable, yet somehow even more shocking, dose of denial than even Merril Hoge, Green pooh-poohed the drumbeat of the past decade of TBI findings as hyperbolic neurosis, analogous to the concern that cell phone usage might cause brain cancer.

I don't know whether college football should be “banned.” But if Green is the best his side can produce, football at all levels is in big trouble. Compared to him, Dave Duerson was Stephen Hawking.

8 September 2012..........

If the NFL is serious about paying its fair share for the public health carnage wrought by its $10-billion-a-year global marketing colossus, the league can offer to underwrite catastrophic insurance for every amateur youth program that persists in enrolling kids in an activity of unavoidable fast or slow brain death — despite growing and widely accepted evidence that no one under the age of, at most, 14 should be doing this.

Instead, Roger Goodell and the NFL decided to take Congress and the news media out to dinner and a movie, in the form of a $30 million grant to the Foundation for the National Institutes of Health.

Congressman Chaka Fattah, the Pennsylvania Democrat who is Mr. Brain Research in Washington, couldn't be happier that the NFL has turned the federal government into an honest woman.

Advancing our knowledge and treatment in neuroscience requires a mix of public-private resources and partnerships. The National Football League is showing the way with today's generous, well-placed gift. This $30 million grant provides a model for significant ­public-private research partnership to learn more about how our brains function, develop, and misfire. The NFL and the FNIH are to be commended for joining up on this major step. I look forward to working with our federal science agencies and with private/nonprofit partners including the pharmaceutical industry, other businesses, sports, academic and research institutions, the military, the National Science Foundation, and other government research agencies to assure that we advance brain science in a cooperative fashion.

Meanwhile, what passes for healthy skepticism in consensus news commentary can be summarized as follows: “Great step. Of course it's just PR on the part of the NFL, and of course they've got to give a lot more. But let's hope this money enables valuable new research on traumatic brain injury.”

Excuse me — but since when did public health agencies become middlemen for private interests? Where did I miss that step in my civics classes?

The idea of the feds laundering a tax-deductible check from the Tobacco Institute for “further study” of the harmful effects of teen smoking would be ridiculed into oblivion. Yet that is precisely what is going on here with the NFL's “model of public-private partnership.”

I always thought the National Institutes of Health relied on taxpayer funding, from which it was supposed to help prioritize and fund medical research. I didn't know its mission included brokering a particular industry's calculated largesse.

The NFL already has funded the Centers for Disease Control's “Heads Up” campaign of “concussion education.” By definition, this had the arbitrary effect of framing concussion education as something less urgent than “just say no to football.”

Now the NFL owns NIH, too. And few citizens are even talking about what that means. Congressman Fattah is among those who are
bragging
about it.

1 November 2012..........

A case in Texas continues the litigation trend we've been discussing. Since 2008, Oscar Cordova III has been disabled after surgery for a fractured skull and brain clot sustained in a junior varsity game. The family sued not just the Mission Consolidated Independent School District, but also Pittsburgh-based ImPACT Applications, Inc., for the software that allegedly informed a school athletic trainer's decision to clear Cordova to resume exercise.

Like the Dougherty suit in New Jersey, the Cordova case does not appear to include slam-dunk evidence of a premature ImPACT-based return-to-play recommendation following a concussion. The New Jersey facts are ambiguous on the ImPACT-based part of the equation: the extent to which those who authorized return to play in fact relied on this new school district tool. The Texas facts leave open questions on the return-to-play part of the equation: it appears the youngster might not have gone back into a game, where a second collision episode ensued. (Possibly, “return to exercise” will prove to have included hard drills and hitting in team practices.)