Attack on Football 12/25/2015

Attack on Football 12/25/2015

Submitted by Sextus Empiricus on December 22nd, 2015 at 4:13 PM

Last March Jim Harbaugh stated to the press and presumably the majority of high school football coaches in Michigan that football was under attack.  Here is his response to one of the final questions of that spring presser…

How important is a day like this for recruiting? You have 800 coaches here, so in terms of getting to know people or reacquainted with people for the next recruiting class.
“Oh, sure. It's there. That's not the purpose of why we're doing this. [The purpose is] fellowship with other coaches. Guys that are ambassadors for the game of football and how important is that with football under attack these days that there are ambassadors for the game of football.

This was an interesting time in college football  The football media and more importantly the media at large were onto the concussion issue and smelled blood after PBS won a Peabody for League of Denial based on the book by Mark Fainaru-Wada and Steve Fainaru.

A month later John Harbaugh came out with his spring blog post Why Football Matters. It's clear that Jim and John are aligned on this Attack on Fooball (AoF).  If you haven't read that post – you probably should. 

There is a seasonality to this AoF and In this vein we about to enter into the evaluation period where a good deal of the meta discussion and policy making is done.  If that sounds conspiratorial … so be it … it's happening.

In some people's minds the AoF started with the science of dementia pugilistica which is more widely known now as chronic traumatic encephalopathy (CTE).  Unfortunately science didn't finish it.   In fact the science is just starting to roll on CTE.  Here is a PubMed index for concussion and CTE research papers by year since 1962.

 chart1_concussion

What most people would term "the AoF" actually started in 1994 when the NFL formed the first committee to understand concussion in the context of the spectrum of injuries to NFL players.  The ineptitude of that committee and the initial intention of the NFL to downplay head injury at all cost was the first battle in the attack Jim and John Harbaugh conjecture.  I've linked to the Frontline timeline above which is not definitive but provides a good run down.

The first AoF starts much earlier – as John Harbaugh outlines in his blog post…

In 1905, there were 19 player deaths and at least 137 serious injuries. Many of these occurred at the high school and college levels. Major colleges said they were going to drop football because the game had become too violent.

That’s when President Teddy Roosevelt stepped in to call a meeting with coaches and athletic advisers from Harvard, Princeton and Yale. He wanted to find a way to make the game safer. They made significant changes, introducing new rules like the forward pass and the wide receiver position. Those changes turned football more into the game we know it as today.

We made progress. Rules changed. Society evolved. The game advanced.

What John Harbaugh is saying here is misleading but he is right on point that football has been under attack before and survived.  That attack and the current AoF are different far more than they are alike however.

The current AoF came back to me again when I read this editorial in Forbes in response to the politicizing of football in regards to public health.  It turns out youth participation is lagging disproportionately along political boundaries.  Just as with other matters of science the importance of tying data to policy is paramount to doing the right thing.   Unfortunately like climate change, aids policy and many other economically and/or socially charged issues – concussion and CTE policy is not all about the data instead it involves compromise.

As John Harbaugh states in his post…

We’re at another turning point in our sport. The concussion issue is real and we have to face it.

We have to continue to get players in better helmets. We have to teach tackling the right way, and that starts at the NFL level. Change the rules. Take certain things out of the game. It’s all the right thing to do.

So there you go … there's something out there attacking Football.  For the purposes of this diary I'm calling that AoF.  Football has been attacked before but the current iteration started ~1994.  There is a scientific basis for this attack and the research is ongoing.  The current AoF is falling out along political boundaries (but in reality is more class based.)  But where and how are we seeing this crop up.

By far the biggest event this month regarding the AoF is the movie Concussion produced by Ridley Scott, written by Peter Landesman and starring Will Smith out in theaters on Christmas day.

There's been quite a bit of PR, publicity and spin going on with this movie as it will be coming out this week.  This more than anything else this month will possibly be the most talked about AoF event. 

Will Smith has been nominated for a Golden Globe for his performance as Bennet Omalu.  He's likely to get an Oscar nomination as well.  The movie unfortunately is not likely to get as much acclaim.  I will save judgment on that until it is released but the article on which the movie is based and the book created for the movie is a story based on the true events surrounding Omalu's discovery of CTE in MIke Webster's brain and his attempts to inform the NFL and the public of the danger.

Surrounding this human story is the much larger story of CTE itself and Football with a capital "F".  Having seen the documentary League of Denial there is little in actual content added from the GQ article the movie is derived from, which is not surprising since the article predates the documentary.  In fact there has been much in the way of CTE reporting and league reform since the original material this movie is based on came out.  But the movie is a theatrical movie and as such will probably reach a wider audience than the documentaries, articles and books that have covered this material since are capable of reaching.

If there is a person who has not heard this material already it could be conceived as inflammatory.  There are reports of negotiations between the NFL and Sony Pictures in the media about the portrayal of the NFL.  It's hard to tell how much of that is publicity and how much is real.   Dave Duerson's family has also taken issue with Duerson's portrayal in the film.  If the book or reviews are any indication none of that is beyond the poetic license taken in any movie based on a true story.  The movie itself is more likely to suffer criticism cinematically than factually. So far the star power of Will Smith is the biggest selling point.

The biggest contribution of the movie to the AoF, besides perhaps being good at best, is the title itself.  In this respect Football is a loser.  By titling the movie Concussion – Sony has conflated concussion and CTE in a way that obscures the real nature of the movie.  It should by all rights be called Chronic Traumatic Encephalopathy or just CTE.  Though understandably that doesn't have a very catchy feel, naming the movie Concussion is a disservice to sport and public health.

Concussions and CTE are not synonymous.  Concussions do not cause CTE.  They don't really correlate even.  There are cases where CTE has been found where there is no recorded incidence of a concussion.  The only real correlation of CTE and behavior wrt football  is age of first exposure to the sport and/or duration of play – as in how many years one has played.

The two ailments are very different, but the movie is about CTE.  Concussions can be difficult to diagnose but they are diagnosable.  CTE is not diagnosable.  There are studies and scans that can be done and data that has been collected but for the time being the only definitive way to diagnose CTE is by post mortem – which is really what this movie Concussion is all about … not concussions.  Omalu makes his case through forensic autopsy for CTE not mild traumatic brain injury (MTBI) – which is the medical term for concussion.  In fact it's very difficult to diagnose a mild traumatic brain injury in a post mortem.  There is a tremendous amount of physical subtlety to MTBI which can only be determined clinically. 

Concussions have a "protocol" that has been instituted in the NFL this season of which all fans are more than aware.  Most people know someone who has had a concussion.  Concussions can be treated with rest.  CTE has some experimental treatment but not any established medical protocol.  It's very rare outside football players, boxers and hockey players.  Very few people know a person who has had it.  Finally and most importantly there is no NFL protocol to reduce CTE.  In fact as linked above – the league is being coy about funding research to detect it in vivo.

By equating concussions and CTE the issue of CTE is obscured.  Proponents of the AoF perhaps would not agree with that assessment but here's what I mean.  As different as concussions are from CTE to limit them is certainly a positive. At least you can treat them.  Blows concussive or not are the issue.  But repetitive sub concussive blows are just as likely to give an athlete CTE.  Nonetheless, Sony calls this movie Concussion.  If this doesn't seem a big deal… it is.

Previously I showed a comparison of articles in PubMed  on concussion and CTE.  That presented a very skewed perspective of the relative work being done on these conditions.  When you call concussion by it's technical term MTBI you get this…

chart2_concussion

What you call things is important not only to search engines but in matters of public health.  Concussion science has dwarfed work on CTE.  Rightfully so as many of our veterans, youth and elderly are at very high risk and it's common.  The long term consequences of MTBI are grave enough not to be conflated with CTE for which the prognosis is grim and since it can't be diagnosed … scary.

But now… thanks to Sony… when you search the web for concussion… you get movie times and locations and an IMDb listing for a movie about CTE.  LMGTFY link …

http://lmgtfy.com/?q=Concussion

 

Conflating CTE and Concussion does not serve any real public good and truly does attack football.  The AoF is really a battle for the hearts and minds of those who play the game and their parents.  By making concussion synonymous with CTE it becomes public fear mongering.

When Teddy Roosevelt helped fend off the first attack in 1905.  He did so not primarily as President of the United States, but rather as the parent of a freshman college football player.  There many differences between that AoF and the current attack or 'culture war' as John Harbaugh puts it.  The first one is money.  There is a mother lode more money in the game than a hundred years ago.  It changes everything…the motives and behavior of schools, conferences and leagues…the power of the players to set standards.  A second is elitism.  Back in 1905 Harvard and Yale were big players in football.  College itself was the refuge of the privileged.  History gets tricky when comparisons are made.  The greatest similarity is perhaps that fact that Teddy Roosevelt had a reason to intercede as a parent.

Though modern parents don't have a bully pulpit to bring about change like Roosevelt did in 1905 the call for reform of the current game is substantially going to come from parents of the todays high school and college athletes as well.  They need to do this without the attack on football setting the terms.