How sure are we that football leads to CTE?

[ By on August 03, 2017 ]

When I meet people and let them know I’m from Pittsburgh, it becomes immediately evident that I am a football fan.  Given that, how are we to interpret the information about the relationship between football and Chronic Traumatic Encephalopathy?

First, it must be emphasized that this is a “convenience sample” meaning that it is not necessarily representative of all football players.  Indeed, these players donated their brains for research; one could ask why they did so.  Second, the evaluations were completed “blind” which means that those observing the brains did not know whose brain it was or whether they had played football for a long time in a high hit position.  In addition, the evaluations were replicated four times.  Third, the study lacked a comparison or “control” group.  Finally, this work on CTE is still relatively new.  One should always be cautious about interpreting studies this new.  The scientific process generally corrects for early mistakes or misinterpretations, but the process needs time to work.  Though there are meaningful limitations to this study, the results are worth considering.

The most striking finding is that 110 of 111 former NFL players showed signs of CTE with symptoms that were “frequently severe.”  This is a stunning result, even with the sampling qualification mentioned above.  I thought the NYT did a good job contextualizing this by saying “even if every one of the other 1,200 players had tested negative — which even the heartiest skeptics would agree could not possibly be the case — the minimum C.T.E. prevalence would be close to 9 percent, vastly higher than in the general population.”  In addition, I thought the NYT’s article was exceptionally well done.  For some, the narratives about the study participants may have evoked emotion.  For me, the images of the brains were almost too much for me to take.

So, what are the ethical questions we need to consider?  For me, the closest one is “Should I continue to watch and support the NFL?”  By my watching games, the NFL makes money off of my behavior.  This money pays players (in addition to owners and the NFL industrial complex). I think there is a direct link between my behavior and the seemingly clear outcome for these players.  From a utilitarian standpoint, I do not see how I can justify the pleasure I gain at the expense of their health, functioning and longevity.  One moment on the pleasure of watching football…  I am a Steelers fan, while the Flynns are Jets fans.  I clearly have more pleasure!  But seriously, the real pleasure I derive from the game is that it connects me to people.  My family has always spent Sundays – and sometimes Mondays and Thursdays – together around the game and good food.  I loved talking with my father about football and it gives me a reason to call my siblings.  It is a great connector.  In addition, celebrating sport seems to be a healthy thing in communities, helping to drive us to lead active and social lives.  The benefits of the NFL are not trivial to me.  And there are many fans out there, so one might make the claim that the number of fans and their resulting pleasure outweigh the small number of players affected in the long run.  But this omits a sense of justice from our evaluation.  To evoke Rawls a bit, if we didn’t know whether we’d be the player or the fan, would we design a game such that playing it very likely leads to irreversible brain damage?  I think not.

Given my profession, I must also consider whether football ought to be played at the high school level.  I work with young adults in an independent high school with a football program.  Thankfully, the incidence of CTE in the high school brains was far lower.  In fact, given the sample size, I would say that the conclusions are nowhere as strong as they are for the NFL players.  Most of our students don’t go on to play college football, though a small percentage do.  Very, very few would ever play in the NFL.  I wish I could I could get a concrete answer about how high the risk is, but the science is just not there yet.  So, what questions should we ask?

Are we putting the students who play football at a school like mine at risk for CTE?  We teach the students to tackle in a safe way.  We limit the number of days per week that they can tackle.  We have very conservative concussion policies that have been considered exemplars.  We participate in research programs with experts in order to be sure that we are operating under the safest conditions.  We have the best safety equipment money can buy.  We monitor concussions in football and in other sports.  Though the data vary from year to year, football is not the sport with the highest number of concussions (per student).  The answer to the question I posed is that we are doing our very, very best to minimize head impacts, but it would be impossible to say with certainty that we are not putting our students at any risk.  However, this would be true about participation in other athletic programs as well, so an examination of the data for each would be useful.

If the risk is not zero, should we continue to support a football program?  This is a question I will not and could not answer as an individual.  This is a community level conversation that needs to be contextualized with the risk / reward ratio of many different programs including sports, the arts and transportation.  Clearly it is impossible to live or educate students in a zero risk environment, but what risks are too high?  Does football in an independent school exceed that threshold?  I do not think we can answer that question yet.



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