Brain Teasers
Issue   |   Tue, 11/13/2012 - 22:31

If you play or have played football at any level, chances are you at least know of someone who has experienced severe and/or long-lasting sequelae from a head injury. Followers of this year’s Amherst football team know the story of Ryan Silva ’14, and, unfortunately, his saga is not unique. A few years ago, this issue hit close to home when a now-19-year-old man, previously a middle school football teammate of mine, was involved in a head-injury horror story. In the fall of 2008, as a high school sophomore, this young player — we’ll call him “Chris” — suffered a catastrophic subdural hematoma as a result of an in-game impact. Thanks to the efforts of his surgeons, Chris survived, but, to spare you the details, his life will never again be anything close to normal. Even if you are a casual football fan who has never personally witnessed an ordeal of this kind, you probably know what happened to Junior Seau last spring; if you watched ESPN around that time, you undoubtedly heard about the emerging findings of abnormally prevalent brain trauma, early-onset dementia and suicide among former professional football players. Most recently, the College came into the national spotlight this October when Paul Butler ’66, a retired surgeon who was my father’s classmate and football teammate here, proposed banning the youth football program in the town of Dover, N.H. Although it was largely overshadowed by other events at the time, Mr. Buter was soon afterward profiled in The New York Times as part of the larger question of the safety of football.

At the Homecoming game this past Saturday, another family friend and class of ’66 alumnus (who happens to be an M.D. specializing in neuroregenerative therapies) struck up a friendly conversation with me. It wasn’t long before he asked me, “So, what do you think of the whole Paul Butler situation?”

I was a little surprised that, as a sports fan with a burgeoning interest in neuropsychiatry and public health, I wasn’t able to come up with a better response to that question. In fairness to myself, though, I have to admit that this is not a straightforward problem. After all, football is as close to an American cultural icon as it gets. Even the most safety-minded among us have a hard time accepting the fact that one of our most beloved pastimes might be flat-out dangerous.

Yet, in making his claim, Dr. Butler cites “overwhelming evidence” in the literature that football — not just at the professional level, but going down as far as Pop Warner — endangers the brain to an unacceptable extent.

On one level, this shouldn’t really be news to us, since football is a collision-based sport: there’s necessarily going to be some bashing of heads, and injuries are going to result from that. Someday, I will get a chance to do a more thorough review of the literature to which Dr. Butler refers, but, just having played in high school, I know that it’s very difficult to avoid getting “banged up” during a football game: why would the head be exempt from that? Opponents of the idea that football is too dangerous, particularly those of an older generation, often point to the fact that, twenty, thirty or more years ago, severe head injuries were far less common. Naturally, this is partially attributable to the collective level of awareness — back then, nobody knew what a concussion was or how to spot it, so such injuries were diagnosed less often. But we also have to face the stark reality that the game has changed. Even if we can’t fully explain the phenomenon, we have mountains of data to support the fact that today’s game of football — at every level — is faster-moving and more violent than it used to be. So, it’s pretty safe to say, even if our awareness of concussions were “modern,” that we wouldn’t be having this conversation if it were 1980.

Could it be, then, that Dr. Butler is right and that, given the increased size and strength of athletes, football really isn’t safe anymore? But what about the overwhelming majority of kids, teenagers and adults who emerge from their football careers completely unscathed? It’s not as if anybody coerced them into playing in the first place — most kids, I would think, play football because they want to — and it seems more than a little unfair to deprive them of a valuable athletic and human experience with the goal of trying to minimize risk. If we were to have a moral obligation to discourage young athletes from playing football, then we would definitely also have a moral obligation to deter our young men and women from serving in the military, right? Of course, that proposition dictates a whole array of deeper questions, the answers to which, upon closer examination, aren’t always what we’d like them to be. And, moving to the higher-profile cases of brain-damaged NFL linebackers: how many of them repeatedly played through obviously worrisome symptoms like headaches and dizziness and made a manageable injury into a permanent scar by their own doing? Of course, there’s really no data that can tell us this. So, to the idea that football is dangerous enough to enough kids and young men that it should be a social concern, I say: not so fast.

But that’s certainly not to minimize the clinically significant risk that we know does exist. And the good news is: there are solutions to this problem. Newer and safer helmets have already been designed to minimize the force of in-game impact. My high school team used one of these helmets, the Xenith brand, and, anecdotally, I can report that we sustained fewer total concussions in my junior and senior years — when we used the Xeniths — than in my first two years, when we used the more traditional Riddell helmet. Of course, Riddell, who is under contract with the NFL through the end of next season, disputes the idea that its product is substandard, but several major studies have shown otherwise. Additionally, many NFL players who have tried the Xenith (with the brand name blacked out!) swear by them, insisting that the helmets have reduced the post-collision wooziness that they used to think was just part of the game.

So, if technology really exists that is at worst the same as and at best much better than the industry norm, why not standardize better-designed helmets before considering banning the game? In the next five years, it will also interest me to see what kind of effect the NFL rules changes regarding helmet-to-helmet contact have on the head injury rate. I have heard more than one Sunday announcer lament that “you just can’t play the game the right way” if you’re worried about being penalized for an unsafe hit. Well, if we were to take Dr. Butler’s suggestion, you couldn’t play the game at all — you be the judge.

As much as stories like Chris’ have a strong emotional impact on all of us, common sense needs to prevail.