The possible link between football injuries and brain disease emerged first from a poll of retired players and then gained credence from postmortem examinations of the brains of former National Football League players and other athletes. The medical researchers who performed the brain studies pronounced the evidence persuasive, but the former longtime head of the NFL's committee on concussions remains unconvinced despite the league's recent acknowledgment of the connection.
The NFL Players Association had polled retirees about their health in 1996 and '97 in conjunction with Julian Bailes, a team physician for the Pittsburgh Steelers and chair of neurosurgery at West Virginia University School of Medicine. In 2000, the association helped fund the creation of the Center for the Study of Retired Athletes at the University of North Carolina in Chapel Hill.
Kevin Guskiewicz, the center's executive director, re-examined the earlier data and in 2001 released startling findings about concussions. More than 61 percent of retired players reported having suffered concussions; 10 percent had sustained five or more in their careers. And 73 percent of those who suffered concussions — including more than half of the retirees from the 1980s — said they had never been restricted from play after the head trauma.
Two years later, using questionnaires from nearly 2,500 retirees, the center found a somewhat high incidence of depression — about 10 percent. Significantly, the likelihood of suffering from depression was twice as high among the ex-players who had suffered three or more concussions in their careers. The HBO program “Inside the NFL” aired a feature on the study.
The death of Pittsburgh Steeler Hall of Fame center Mike Webster in 2002 led to the first anatomical demonstration of brain disease in ex-players. Webster retired in 1990 after 17 seasons; he suffered from severe mental conditions over the next decade until dying of heart failure in 2002 at age 50.
Webster's physician had noted “chronic concussive brain injury” on the death certificate. When Bennet Omalu performed an autopsy as a neuropathologist with the Allegheny County medical examiner's office, he found structural damage to the brain akin to the conditions diagnosed since the 1920s in boxers as “dementia pugilistica.” Omalu published his report of “chronic traumatic encephalopathy” (CTE) — the first ever in a football player — in a medical journal in spring 2005.
Later that year, Omalu also found evidence of brain disease in an autopsy of another ex-Steeler lineman, Terry Long, who committed suicide in 2005 at age 45. Omalu attributed Long's depression to CTE caused by football injuries. The Steelers' team physician labeled the conclusion “speculative.”
Omalu again labeled football injuries the likely cause of the depression and ultimate death of Andre Waters, a former defensive back for the Philadelphia Eagles, who committed suicide in 2006 at age 44. Omalu said Waters' brain showed deterioration akin to that of an 85-year-old man with Alzheimer's disease.
Waters' death came to Omalu's attention thanks to Christopher Nowinski, a former Harvard football player and professional wrestler who had suffered a career-ending concussion in 2003. Nowinski's experience led him into research that produced a highly critical book about pro football and concussions, Head Games. When Nowinski read Waters' obituary, he recognized telltale clues of post-concussive syndrome. Knowing of Omalu's work on the Webster and Long cases, Nowinski helped persuade Waters' family to allow Omalu to perform an autopsy.
Research by Christopher Nowinski, a former Harvard football player and professional wrestler, focused national attention on the link between pro football and concussions. (Getty Images/Stephen J. Boitano)
Nowinski also played a catalytic role in giving the issue a national audience. While working on his book, he had met sports journalist Alan Schwarz, then an occasional contributor to The New York Times. Nowinski told Schwarz of the findings on Waters; Schwarz saw the import of the story and in 2007 took it to the Times, which published his coverage of the issue and then hired him full time. In the three years since, Schwarz has been indefatigable on the story — with articles often highly critical of the NFL's stance.
For its part, the NFL claimed to be doing its own research on head injuries and coming up with different conclusions. A series of articles published in 2004 in Neurosurgery, the same journal that had carried Omalu's report on Webster's case, reported finding no decline in brain function after concussions. But, as Nowinski writes, peer-review comments published with the articles sharply disputed the methodology and the conclusions.
Nowinski next collaborated with researchers Robert Cantu and Ann McKee at Boston University in 2008 to form the Center for the Study of Traumatic Encephalopathy. Over the next two years, Cantu and McKee did postmortem brain examinations of 12 ex-athletes. Most were ex-NFL players, but they included an ex-collegiate player who died at age 42 and an 18-year-old high school player. All 12 examinations showed evidence of brain disease — the buildup of a toxic protein known as tau, which initially impairs brain functioning and eventually kills brain cells.
Using slides to show the difference between a healthy and a diseased brain, Cantu told the House Judiciary Committee in October there was “ongoing and convincing evidence” of a link between sports concussions and long-term illness. But David Weir, a University of Michigan researcher who conducted a study for the NFL, testified there was no proven link between football injuries and dementia.
Testifying before the committee in a second hearing in January, Ira Casson, the physician who had co-chaired the NFL's Mild Traumatic Brain Injury Committee, again questioned the evidence of a connection. Casson acknowledged the evidence of pathology that Cantu and McKee had found but questioned their attribution of the disease to football. “Head trauma may be playing a role,” Casson stated. “But even if it is, we do not know if the significant head trauma occurs in childhood, adolescence or at a later time in life.”
Casson had resigned from the NFL committee in October 2009 as the pressure from Congress and the news media was increasing. In December, NFL communications director Greg Aiello appeared to acknowledge the connection between concussions and later illness in a telephone interview with Schwarz, the Times reporter. “It's quite obvious from the medical research that's been done that concussions can lead to long-term problems,” Aiello said.
— Kenneth Jost