Play Ball!

Earlier this month, National Football League officials, team owners, and sports fans were shocked when Kansas City Chiefs linebacker Jovan Belcher shot and killed his 22-year-old girlfriend Kasandra Perkins before turning the gun on himself.

Belcher is the fourth football player to die of a self-inflicted gunshot wound in 2012.  Former players Michael Current, Ray Easterling and Junior Seau all killed themselves earlier this year, highlighting the fact that current and former NFL players have a rate of suicide that is far greater than what is seen in the general population.

The reasons for this trend are unclear. Some researchers believe that the physical demands of professional football lead players to use anabolic steroids illicitly in order to get a competitive boost. In addition to the physical toll, use of these drugs can have profound psychological effects. Steroid abuse can lead to uncontrolled aggression and violent behavior (colloquially called ‘roid rage’). In addition, long-term use has been associated with paranoid delusions, extreme jealousy and suicidal ideation.

It seems increasingly more likely, however, that this trend is a result of brain damage resulting from head injuries — particularly concussions — that are a frequent occurrence in high-speed contact sports. When retired Chicago Bears player Dave Duerson killed himself in 2011, he left a suicide note requesting that his brain be donated for research on a concussion-related brain damage.  A subsequent autopsy found that he was suffering from chronic traumatic encephalopathy (CTE), a disease common in those with a history of concussive head injuries. Symptoms include dementia, tremors, impaired speech, deafness and profound clinical depression.

It now seems that this progressive neurodegenerative disease is quite common among players of contact sports like football and ice hockey. A recent study published in the journal Brain looked at brain samples taken after death from 85 men who had histories of repeated concussions, 80 percent of whom showed evidence of CTE. Of the 68 men diagnosed posthumously with CTE, 50 were football players, including 33 who had played professionally. This may explain why the NFL is facing a number of lawsuits from former players suffering the consequences of long-term brain damage and from insurance companies who are being asked to bear to costs of treatment and compensation for these injuries.

As the link between the frequent concussions that are a part of contact sports and brain damage in later life has become more and more clear, the NFL and other professional leagues have begun to act. For example, the National Football League now requires that any player suffering a concussive blow be removed from the game. They are also barred from returning to practice for at least a day. This is a good start, but this new policy doesn’t go quite far enough. A concussion can take days or weeks to heal even in the absence of physical symptoms, so a player may return to the field and absorb even more blows while his brain is still recovering.

What’s particularly troubling, however, is not what’s happening on Lambeau Field or in the MetLife Stadium, it’s what’s happening on high school and college football fields across the nation. Concussive injuries and the long-term damage they cause are not limited to professional players. Of the 68 men with CTE enrolled in the study I mentioned earlier, six played football only in high school and another nine played up through college. While the NFL now has strict rules about removing those with concussions from play, they also have an army of trained staff and team physicians looking for these sorts of injuries. Your average high school or small college team does not. Moreover, a ‘walk-it-off’ mentality still pervades most sports; injured players are unlikely to disclose to their coach or other players when they are hurt.

The protective equipment used by those playing at the high school or college level may also be inadequate. The only safety standards for football helmets were written in 1973 by the National Operating Committee on Standards for Athletic Equipment, a consortium founded and supported by the helmet manufacturers themselves. Under that standard, helmets should be tested regularly and discarded when they fail to meet safety requirements. For financially strapped school districts in particular, however, testing and replacing faulty equipment is simply too expensive. No wonder then that industry experts estimate that over 600,000 high school players are wearing helmets that fail to provide adequate protection, or why concussion rates in youth football continue to rise.

Football, hockey and other contact sports are and will remain an important part of American culture. In fact, I believe that most kids should play some sort of team sport. They teach important values like responsibility, sportsmanship and cooperation. However, kids and parents alike need to educate themselves about the dangers of concussive injuries by reviewing safety literature developed and distributed by groups like the CDC and the National Federation of State High School Associations. We need to ensure that protective equipment is new and appropriately tested, yet still recognize the limitations of such safety gear. Finally, athletes, trainers and coaches need to be willing to acknowledge when a potential injury has occurred and remove that player from the field immediately.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on December 13, 2012. It is also available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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