Monday, May 21, 2012

The NFL’s Concussion Problem Through the Lens of Public Health Issues

By Charlie Scaturro

Charles LeClaire/US Presswire
Football fans didn’t have much of a chance to digest the media spectacle that is now known as the NFL Draft before they were hit with the tragic news that Junior Seau committed suicide. Retired NFL players who came before Seau have struggled with their lives after football, some of these same retired players have even taken their own lives as a result of their struggles, but none of them were as good on the field, as well liked off the field, or played as recently as Seau. When you’re talking about people suffering and possibly taking their own lives, it doesn’t matter whether they were first ballot Hall of Famers or just another cog in the NFL machine; a life is a life and it’s tragic no matter what their place in NFL history was.

At the same time, because Seau was revered off the field and an All-Pro linebacker on it, his shocking suicide has further exacerbated the current head trauma crisis that has gripped the NFL. It’s still unclear how much of a role Seau’s 20 year NFL career played in his decision to take his own life a few weeks ago, but it’s safe to say that anyone who opted to ignore (or perhaps just hadn’t heard much about) the issue of head trauma in the NFL before Seau’s passing is paying attention now.

The vast majority of former players who are either living impaired lives as a result of the time they spent on a football field or those who decided to take their own lives as their condition worsened, are generally many years removed from their playing days and may or may not have ever been well known for the time they spent in the NFL. But not Seau. Since being drafted out of USC in 1990, the 6’3’’ linebacker was the face of the San Diego Chargers franchise, and he was one of the NFL’s iconic players of the 90’s. Seau continued to perform at a reasonably high level into the 2000’s, and the fact that any average football fan over the age of 10 would have known who Seau was before the events of May 2nd, makes his sudden and shocking death resonate louder than any other former player who has endured similar struggles away from the game of football.

The issue of concussions, head trauma, and CTE were already big points of emphasis for the NFL before Seau’s suicide, and the ongoing litigation between former players and the league has kept this issue on the media’s radar for well over a year. But after Seau, who was known for his toughness and incredibly strong will, took his own life, the common sentiment that jumped to most people’s minds was: “if this could happen to Junior Seau, it could happen to anyone.”

When viewing Seau’s tragic death in the broader scope of the NFL’s growing head trauma epidemic, what happened on May 2nd was most likely another case of a former player who dealt with depression and ultimately decided to take his own life after retiring from the game. A decision that probably had some correlation to the head trauma he suffered during his time playing football, and a decision that has unfortunately become more common among former players during the last decade.

The supposition that serious brain trauma is a probable side effect of playing football isn’t just something that the NFL should take steps to address, it’s something that should be viewed as a general issue of public safety. The experience of those retired players who have trouble remembering something that happened 10 minutes ago, who may or may not also be dealing with depression as a likely result of the head trauma they endured while playing football, affects more than just that individual.

Of course, it’s the former players who are suffering the most from these injuries and they are the ones who are at the center of this issue, but we’re also seeing that family members, friends, and the general quality of life for an entire group of the American population is being negatively affected. Considering the way in which we’ve seen these early cases of football related head trauma play out, it is clearly a dangerous situation and one that has the potential to get worse.

Additionally, there are thousands more who played football in Pee Wee leagues, Pop Warner, throughout high school, and in college, whose playing days also subjected them to potentially dangerous levels of head trauma that we’ll never hear much about because they never played in the NFL. All of the media attention that’s been generated during the last few years has certainly raised the public’s awareness of how serious recurring brain injuries can be, but it’s possible, even probable, that because of the time it takes for these symptoms to manifest themselves combined with the “it’ll never happen to me” attitude most of us possess, that many other former football players could be dealing with these issues as well and not even know it.

I don’t mean to overdramatize this issue, but it’s safe to say that the NFL has a big problem on its hands, and it is one that seems to be growing bigger by the day. However, this problem isn’t just the NFL’s; it is absolutely, without a doubt, an issue of public health as well.

Because the issue of head trauma is unlike anything the NFL has dealt with before, and because I truly believe this is as much an issue of public health as it is the NFL’s issue, I couldn’t find another way to discuss it without looking at other public health comparisons that are similar in some way. The comparison I’ve heard thrown around during the seemingly non-stop concussion debates that have raged in the weeks following Junior Seau’s suicide is smoking, and another one that shares a few similarities is seatbelt regulations.

With respect to smoking, there was once a time when not only were cigarettes not seen as harmful, but smoking was actually encouraged as a youthful, fun loving activity to take part in.

An entire generation of kids grew up thinking that cigarettes weren’t detrimental to their health (just like many generations of kids grew up playing football with no idea that their brains might be irreversibly damaged because of it), and if anyone knew about the side effects of smoking, this information wasn’t public knowledge. As the years have gone by, we’ve found out that smoking cigarettes is one of the worst things a person can do to their body, and even though many regulations have been put in place to educate people about the harmful short and long term effects of smoking, it’s still a prevalent part of life in America (even if they now cost $13 a pack in New York City and the places where you’re permitted to smoke continue to dwindle by the day).

Sure, NFL players knew there was a chance they would endure chronic joint pain and multiple surgeries after their playing careers came to an end, but the notion that their brains would be damaged was never a consideration.

While mounting evidence suggests that, like smoking, playing football can be hazardous to your long-term health, it’s interesting that not everyone who smokes or plays football for extended periods of time experiences serious health problems. There are plenty of former football players who are struggling with some form of dementia or depression, but there are also those who remain lucid and happy. Many people who have smoked regularly are diagnosed with some form of cancer or other smoking related health issue, but we’ve all heard about that 90-year-old woman who has smoked a pack a day for the last 60 years and is perfectly healthy.

In response to the findings that smoking cigarettes can be extremely hazardous to a person’s health, certain restrictions have been passed with the hopes that people will stop killing themselves one puff at a time, and the public perception of cigarettes is much different than it was 50 years ago. But cigarettes are still legal, and millions of people still smoke today knowing full well that what they’re doing has the ability to seriously damage their body. Of course, the fact that tobacco companies make billions of dollars a year and have a business interest to protect is no doubt the reason why they’re still operating, but the reason why doesn't matter as much as the fact that they're still in business. Many current and former NFL players have said in recent weeks that they would still choose to play football even with the knowledge that is emerging about concussions and brain trauma, just like many first time smokers choose to light up today knowing how detrimental cigarettes can be to their health.

It seems that as long as there’s a compelling reason (money in most cases) for something that is causing people harm to continue to be legal, and as long as there’s an important enough interest to be protected by keeping that potentially dangerous substance or activity around, it will continue to exist in some form or another. In both the case of smoking and the NFL, there are more than enough interests at hand and money to be made that it would be foolish to think either would disappear completely, but it seems like we’ve already begun to see the NFL change the way they operate in much the same way tobacco companies had to change the way they did business (at least from the outside looking in) after it became widely accepted that cigarettes caused cancer.

Former Jets receiver Wesley Walker echoed this sentiment when he was interviewed recently: "This is a business, and I'm not so sure they care about the players," Walker adds. "In the long run, it's about the money and it's a big business. They obviously have to do something to protect their image."

Walker would know better than most, and if he is indeed correct, the question becomes; who is protecting the players?

While medical research is necessary to show a strong correlation between smoking and various forms of cancer and playing football and brain injuries, proving that seatbelts save lives in car crashes isn’t nearly as complicated.

It’s a fact that you’re more likely to survive and endure less serious injuries in the event of a car crash when you’re wearing a seat belt as opposed to when you are not. The laws of physics dictate this logic, and you won’t find many sane people who will argue against it. Because of this, there are currently 49 states that have some kind of primary or secondary seatbelt law on the books that requires people to buckle up (with New Hampshire, whose sate motto is “Live Free or Die,” being the exception).

Of course, you could ask yourself why such a law exists when the only person you’re directly hurting by not wearing a seatbelt is yourself, and in this instance, it is somewhat similar to the way you could view what happens to football players who suffer brain trauma. The only person who is directly affected in both cases is the one who is making the choice to put themselves in a potentially dangerous situation, but at least in the case of seatbelt safety, 49 states have put their foot down and made it against the law to not buckle up (of course, it’s also worth pointing out that football players from the 70’s and 80’s had no idea they might be enduring serious brain injuries today, while the consequences of not wearing your seatbelt are obvious).

While there are some similarities, the seatbelt law to NFL comparison falls short in one key place. Football is a livelihood for many people; one that allows them to support their families and it’s also a business that generates billions of dollars every year. On the other hand, the only thing that not wearing your seatbelt accomplishes is that it gives some teenager (or adult for that matter) who thinks wearing a seatbelt is stupid a way to rebel against someone telling them to do something for their own good. At the same time, the risks associated with each would appear to be potentially damning, but you will find plenty of people who would rather play football even knowing what they know about potential brain injuries, and you will also find people who will not wear a seatbelt despite the fact that it might cost them their life should they get into an accident.

When it comes to states around the country opting to impose seatbelt regulations, the question that law makers probably asked themselves is: “Why not?” As in, why shouldn’t it be illegal to not wear your seatbelt? You might end up offending a few civil rights activists by telling them they HAVE to wear their seatbelts, but realistically, you’re enacting a law that will keep people safer and this law doesn’t infringe terribly upon anyone’s freedom. Such a law is hard to argue against no matter what you believe.

At the end of the day, the NFL’s current head trauma issue shares some similarities with both seatbelt regulations and smoking in the sphere of public health concerns, but considering that we know less about head trauma than we do about either smoking or not wearing your seatbelt, and considering the powerful players involved and America’s love for the game of football, it’s clear that the NFL’s situation is currently much more complicated.

One of the biggest differences between smoking, seatbelt laws, and the NFL’s current head trauma issue is that we don’t enjoy watching people smoke, nor do we enjoy seeing someone riding around in a car without their seatbelt, but there are millions of people who love football. Furthermore, despite the NFL’s recent efforts to tone things down, football fans still love watching that huge hit.

What we’re dealing with right now are many former players who are suffering debilitating brain issues that had no idea this was a possible side effect when they started playing football. It’s clear that the NFL needs to do whatever they can to help manage what these players are going through, and hopefully decrease the incidents of serious head trauma going forward, but what isn’t clear is how the NFL will accomplish this.  As long as there is football as we know it today, it seems inevitable that head injuries will continue to occur.

Even after examining other issues of public health that share some similarities, the current climate is uncharted territory for the game of football. Of course, the only thing more frightening and unknown than the NFL’s future is what appears to be happening to an alarming number of former players.  Whatever happens, I guess we always have the option of moving the NFL exclusively to New Hampshire.  Live Free or Die, right?

Depends who you ask.

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