Keeping Score

New Book, and PBS Documentary, Details NFL’s Concussion Denial

When it comes to managing head trauma, the NFL failed for years

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In League Of Denial, the highly-anticipated Frontline documentary airing on PBS Tuesday night, Ann McKee, a neuropathologist who has spent the better part of eight years examining the brains of deceased ex-NFL players, makes two eye-raising claims. The first concerns her assessment of chronic traumatic encephalopathy (CTE), a degenerative brain disease associated with head trauma. Since 2005, McKee has studied the brains of 46 ex-NFL players, and found CTE in 45 of them. “I’m really wondering if every single football player doesn’t have this,” says McKee. ESPN had partnered with PBS on this project, but backed out at the last minute; network chief John Skipper called McKee’s comment “over the top.” (The New York Times reported that the NFL pressured ESPN, a league business partner, to sever the partnership; both the NFL and ESPN deny this).

The second comes more than halfway through the film, when McKee is recounting a 2009 meeting at the NFL’s offices. The league’s regrettably named Mild Traumatic Brain Injury (MBTI) committee invited McKee to present some of her CTE research, which was creating a serious PR headache for the NFL. The room was filled with men who kept interrupting her, and questioning the link between concussions and brain damage. “They were convinced it was wrong,” says McKee. “I felt that they were in a very serious state of denial.” What was driving some of this skepticism? “Sexism is part of my life,” says McKee. “And getting in that room with a bunch of males who already thought they knew all the answers – more sexism. I mean, it was like, ‘oh, the girl talked. Now we can get back into some serious business.'”

The film then turns to a Henry Feuer, a neurological consultant for the Indianapolis Colts who was in the room that day, for a response. His tortured reply was one of the most confusing, yet compelling, moments of the movie. It left this viewer thinking McKee totally had a point.

For long-time followers of the NFL’s concussion crisis, League of Denial — and the accompanying book by a sibling pair ESPN journalists, Mark Fainaru-Wada and Steve Fainaru —  might fall just a few yards short. Based on the foreboding tone of the film’s trailer, which was teased to audiences in August, and ESPN’s divorce from Frontline, there was some expectation that the project would bring the NFL to its knees. Though League of Denial has no such bombshell revelation, it’s a first-rate piece of reporting  (Over the past year, has periodically published some of the findings). League of Denial adds crucial detail, texture, and news to the concussion story, which despite the NFL’s best efforts, isn’t going away.

(MORE: For Retired NFL Players, Concussion Settlement A Safe Bet)

Besides McKee’s sexism allegation, League of Denial reports that the editor of the journal Neurosurgery, which published a series of NFL-authored papers that downplayed the effects of concussions — studies that were widely panned in the scientific community — was a consultant for the New York Giants. The neurosurgeon, Michael Apuzzo of USC, published the studies despite the objections of Neurosurgery’s sports section editor, Robert Cantu, one of the world’s most prominent concussion experts. By denying the seriousness of concussions for so long, the NFL did public health a serious disservice. All levels of football — college, high school, and most importantly, pee-wee — inevitably follow the NFL’s example.

The film is incredibly comprehensive. If you haven’t been following the concussion story closely, it’s a must-watch: the narrative flow will keep your attention, and you’ll be instantly up to speed. A few other moments stand out. Viewers are reminded that the NFL has long glorified violence. In its graphics package, Monday Night Football used to feature helmets crashing together. In one NFL Films production, the narrator says, “on this down and dirty dance-floor, huge men perform a punishing pirouette. The meek will never inherit this turf.” Piano keys flitters over a montage of head collisions. “In the pit, there is more violence per square foot than anywhere else in sport.”

Former super-agent Leigh Steinberg, the inspiration for the Jerry Maguire movie character, recalls taking with client Troy Aikman in a dark hospital room after the 1994 NFC championship game: Aikman had to leave the game, which his Dallas Cowboys won, after taking a knee to the head. According to Steinberg, Aikman asked him where they were, why they were there, who the Cowboys played, and whether they won. Five minutes later, Aikman suddenly asked the same questions. Steinberg gave him the same answers. Maybe ten minutes later, the process repeated itself. “It terrified me,” Steinberg says. (The scene would have benefitted from Aikman’s recollection, if he had any. If Aikman — now the lead NFL analyst for Fox Sports– was asked to comment but refused, the film should have made that clear).

Doctors emerge as heroes. Along with McKee, Bennet Omalu, a Nigerian-born neuropathologist who diagnosed the first NFL player with CTE — former Pittsburgh Steelers center Mike Webster — is the most intriguing character. According to League of Denial, the NFL has tried to discredit Omalu’s work for years. After his study on the Webster case was published in Neurosurgery, Omalu thought the league would seek him out for consultation. Instead, leaders of the MBTI committee attacked his work, and asked him and his co-authors to retract the paper. ESPN The Magazine writer Peter Keating calls the NFL’s tactics “a nuclear missile strike on a guy’s reputation.”

The MBTI committee even wrote that “there is inadequate clinical evidence that [Webster] had a chronic neurological condition.”  But in 1999, the league’s own disability board awarded Webster full benefits, due to his deteriorating cognitive state, and concluded that “his disability is the result of head injuries suffered as a football player with the Pittsburgh Steelers and Kansas City Chiefs.” The NFL was saying two different things. According to League of Denial, the NFL also worked to prevent Omalu from studying the brain of Junior Seau, the ex-San Diego Chargers star who shot himself in 2012. The league comes across as paranoid and petty.

After Congress compared the NFL’s concussion denials to the behavior of Big Tobacco, in 2009 the league finally acknowledged that concussions can cause long-term brain damage. The league added stricter punishments for helmet-to-helmet hits, stricter guidelines for returning to the field post-concussion, and reduced the number of full-contact practices. Still, when NFL commissioner Roger Goodell is now asked if he acknowledges a link between football and CTE, he punts the question to the researchers. “There’s no more acknowledging a link exists,” says Mark Fainaru-Wada in the film. “There’s ‘the science is still emerging, and we’re really going to do long-term studies on this. And we’re going to figure out if there’s a link.'” (In an interview with TIME last November, Goodell did say “it doesn’t take a lot to jump to the conclusion that constant banging in the head is not going to be in your best interest.”)

The NFL’s recent $765 million settlement with over 4,500 former players, who were suing the league over its concussion policies, probably speaks for itself. “I think everyone now has a better sense of what damage you can get from playing football,” Hall of Fame linebacker Harry Carson says near the end of the film. “And I think the NFL has given everybody 765 million reasons why you don’t want to play football.”

(MORE: NFL Settles Concussion Suit – Is It A Win For Player Health)