NFL's plight on brain injuries not over

The league can use its massive platform to address what will soon be third leading global cause of death, but will it?

Veteran quarterback Ben Roethlisberger gives a thumbs-up to fans while being carted off the field after suffering a concussion.
Tom E. Puskar/AP

The instant-analysis requirement of up-to-the-second digital media meant that a winner and loser had to be derived from the surprising settlement announcement last week between the National Football League and 4,200-plus former players suing their former employer. This was, after all, sports, where everything is secondary to a W or an L, and everything is urgent; the next game, the next season, are relentlessly imminent.

The near-unanimous sports-media view was that the NFL won, and would be done with foreboding headlines about its pending doom. By paying $765 million over 20 years to retired players, the 32 teams averted with a relatively small sum -- the NFL is a $10 billion annual business -- any admission of guilt, or legal discovery and eventual trial, which some inside and outside the industry speculated could have delivered a devastating, perhaps fatal blow to the game's future.

The ex-players contended that their concussion-related brain injuries were from football collisions that the league understood to be far more damaging than it admitted to players and the public. The players filed suit in 2011 to discover what the league knew about concussions, and when.

But urgency provoked by desperation caused the players to settle. Staring at the prospect of years of litigation before resolution, which could include defeat, the plaintiffs and their families needed money now to cope with endless complications of traumatic brain injury (TBI) in the once-robust lives of family and community patriarchs.

"The unfortunate thing is that the general fan, they see $765 million and they think it's a windfall for the players. It's great for … the guys that would fall in the category of needing immediate help," former player Kevin Mawae told The Associated Press. "But it's $700 million worth of hush money that they will never have to be accountable for."

The NFL wants the fans' focus to return to the season beginning Thursday rather than the disturbing images of incapacitated former gladiators. Others are not eager to see the door close. Some hope the settlement is neither a win nor a loss, but another chapter in a long, unresolved global story that is much bigger than the NFL.

"My hope is that some will reject the settlement and become the Curt Floods of pro football," said filmmaker and football fan Sean Pamphilon, invoking the name of the baseball player who more than 40 years ago challenged Major League Baseball's restrictions on player movement, eventually bringing about free agency. "The story needs (legal) discovery, because this game is still being marketed to children, and the league has to own (its responsibility to the problem). That's the disappointing part of this settlement. 

"You can't lead while you're hiding."

Dark story

Pamphilon grew up in the San Francisco Bay Area, a fan of flamboyant, reprobate quarterback Kenny Stabler of the Raiders. Now that Pamphilon lives in a Seattle suburb, he owns a replica jersey of Russell Wilson, the Seahawks’ second-year wunderkind QB and the acme of faith-based clean living.

“You couldn’t find more disparate characters,” he said. “That’s one way to measure my football tastes.”

Another part of his football tastes includes a passion for honest information regarding whether to allow his son, Alix, to play the game. The curiosity prompted Pamphilon to write and direct “The United States of Football,” a documentary eight years in development that is debuting in theaters around the country this month.

It’s the story that no one wants to know.
Hell, I don’t even want to know.

The movie chronicles the TBI-related deteriorations of older NFL players Mike Webster, John Mackey and others, then blends in the anxiety of younger retirees Kyle Turley and Sean Morey, who are experiencing early-stage losses of memory and emotional control. They are part of a generation of players who have learned a new medical term -- chronic traumatic encephalopathy (CTE) -- but do not know if they are destined to be afflicted with it, as was a famous contemporary, Junior Seau, a high-profile linebacker so tortured by CTE symptoms that he took his own life in May 2012 at age 43.

Former Pittsburgh Steeler Mike Webster, who died in 2002 at age 50.
Mitchell Layton/Getty Images

Pamphilon, after spending many months filming the fading lives of players and the impacts on their families, is sympathetic to the players’ decision to take the settlement now rather than wait years for an uncertain outcome.

He also knows the settlement is a signal to most fans who are experiencing some misgivings about the consequences of football, as well as to current players, that it's OK to stop thinking about the potential cruelties that await those who provide so much entertainment -- and income -- from mayhem on fall Sundays.

In the movie, Pamphilon’s self-narration expresses his own conflict as a football fan.

"It’s the story that no one wants to know," he says halfway through the film. “Hell, I don’t even want to know.”

But Pamphilon's documentary lets everyone in. His name may already resonate among sports fans as the filmmaker who in April 2012 released audio recordings of New Orleans Saints assistant coach Gregg Williams telling his defensive players to deliberately injure opposing players before a game with the San Francisco 49ers. Saints who "hit the head" and knocked opponents from the game were awarded cash bonuses. The scandal, dubbed “Bountygate,” resulted in the unprecedented suspensions of Williams, head coach Sean Payton and others.

In "The United States of Football," for the first time since the story broke, Williams is seen giving detailed instructions on aggravating previous injuries to 49ers, including a player with a history of concussions.

Protecting its brand?

Early on, Pamphilon had pitched his documentary to ESPN, his former employer, which expressed interest, providing help in various phases. But after the controversy around Bountygate, “they cut ties,” he said. "They insisted their brand be taken off our website.”

Kyle Turley, seen throwing an opponent's helmet during a game in 2001, is among the players profiled in the new documentary, "United States of Football."
Bill Haber/AP

A similar episode with ESPN happened last week around another documentary on the same topic, creating a national embarrassment for the NFL and the sports network. For 15 months, ESPN and PBS collaborated on “League of Denial,” a documentary scheduled for Oct. 8 release that is described this way on its website: “What did the NFL know, and when did they know it? In a special two-part investigation, Frontline reveals the hidden story of the NFL and brain injuries.”

But after a luncheon meeting between NFL executives and ESPN executives on Aug. 14 in New York, ESPN announced it was pulling out of the project and insisting to PBS that it remove ESPN’s branding from the website promoting the movie -- the same demand made of Pamphilon’s project.

Despite denials by the NFL and ESPN that pressure was brought to bear, the controversy was widely seen as another episode in which ESPN’s business interests with a lucrative partner overrode its journalism aspirations.  

“The NFL is doing whatever it can to squash this story,” Pamphilon said. “But now, after saying it’s a story no one wants to know, it’s a story you can’t avoid.”

As the concussion drama plays out in the worlds of sports, media and law, Dr. Richard Ellenbogen is watching closely, waiting to see whether the spotlight will land on a more important venue -- global health.

Traumatic brain injury is the No. 1 killer globally of young people – what are we going to do about it? It’s not a football problem. It’s a global health problem.

In 2010, the NFL, seeing the concussion issue whipping into a wildfire, pushed out the doctors in charge of its previous “mild trauma” program and asked Ellenbogen and Dr. Hunt Batjer, neurological surgery chairman at the University of Texas Southwestern Medical Center, to co-chair a new NFL entity: the head, neck and spine Committee. Ellenbogen is chairman of the neurological surgery department at the University of Washington and the attending neurosurgeon at Seattle’s renowned Harborview Medical Center as well as Children’s Hospital.

He and Batjer accepted the job with conditions: no pay, and no interference.

A chance to lead

For three years they have been pushing science and data on the NFL. The committee’s work is primarily responsible for persuading the NFL’s competition committee to alter significantly the rules of the game, and the sideline-diagnosis protocols for head injury, that attempt to put safety ahead of the macho machinations of the Bountygate culture. But more important, Ellenbogen wants to see something transformative come from the football travail.

“I understand everyone being cynical,” he said. “Throughout America, I understand the cynicism. But you know what? I don’t care who’s right or wrong (in the litigation settlement). I don’t care whether players were told or not told of the risks.

“At the end of the day, we (doctors) are patient advocates, and the grand question is this: Traumatic brain injury is the No. 1 killer globally of young people -- what are we going to do about it? It’s not a football problem. It’s a global health problem. If the NFL gets it right, the solutions will trickle down to everyone.”

Ellenbogen was citing a study by the World Health Organization that also forecast TBI will become the third leading cause of global death and disability for all ages by 2020. Because of increasing vehicle traffic in low- and middle-income countries with overpopulated urban cores, road accidents are a primary source, although other wheeled transportation such as bicycles and skateboards contributes.

Football injuries, said Ellenbogen, are an infinitesimal part of the problem. But when all sports are included -- he said the highest incident rates for concussions in sports are in girls’ soccer -- the health risk among younger people is significant. But he does not dismiss the attention given the NFL saga. In fact, he thinks it’s necessary to reduce risks for everyone.

Quarterback Brett Favre lies face-down after suffering a devastating hit.
Andy King/AP

Ellenbogen came into the NFL’s crisis too late to do anything about the past. Nor was he in the loop regarding the settlement; he was called by NFL officials as a courtesy an hour before the news broke nationally, and was as surprised as nearly everyone else.

But he knows that the platform the NFL has is immense, evidenced by the two documentaries released within a month of each other this fall. Ellenbogen appears in “The United States of Football” after having spent several hours with Pamphilon. But when approached by a PBS producer Aug. 12 -- two days before the fateful lunch between NFL and ESPN execs -- to be interviewed for “League of Denial,” he refused.

He saw the title, and the trailer on the movie’s website, and was furious that he was asked to participate at the end of the project instead of the beginning.

“It seems like most of the film is in the can,” he wrote in an e-mail to producer and reporter Jim Gilmore. “Simple question. How do I provide balance … or am I there to be the proverbial fall guy for organized sports?”

Changes coming

Ellenbogen is a fan of football and most sports -- “The day we outlaw collision sports is the day I leave this country” -- and his goal is to use the big data provided by the NFL to find ways to reduce athlete risk. As an example, his group analyzed information on every concussion in the NFL and discovered that, contrary to the belief that nearly all concussions came from defenders delivering blows to the heads of ball carriers -- now forbidden -- 28 percent of concussions were delivered by ball carriers dropping their heads and colliding with defenders.

That is why you will see, starting Thursday, penalties called on offensive players when they instigate helmet-to-helmet collisions -- an NFL first. Commentators and players were already decrying another sissifying of the game during the exhibition season, and lamenting the impossibility of officiating a sport with so many rules against what has been taught for so long.

But the independent facts do not lie. And if facts are not enough, there are two words for which there are no comebacks: Junior Seau.

Since the time in 2010 when scientific findings began altering the rules of the game, NFL concussions are down 40 percent, Ellenbogen said. College football, high school football and pee-wee football have taken their cues from the NFL and adopted many of the changes.

“The NFL is the gold standard,” he said. “It has the financial resources to deal, and they are deadly serious about learning from this.

“We can guess all day what the motivations were that created the settlement. It doesn’t matter to me. I have 87 patients in my charge, and few of them are football players. We need this opportunity to find common cause.”

The NFL committed to pay $765 million in a debatable attempt to make up for what happened. But none of that money goes to current or future players. That is up to the NFL and what it is willing to share about what it did wrong to reduce the chances of it happening again.

Can’t lead while hiding.

Art Thiel is co-founder of

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