THE FATE OF FOOTBALL: Part 2 of 4
BOSTON — The painting of the “The Catch” hangs behind the desk of Dr. Ann McKee in her Boston University School of Medicine office, and Dallas Cowboys defender Everson Walls still watches helplessly while a leaping Dwight Clark snags Joe Montana’s spiral in the end zone at Candlestick Park.
But in this rendering of that signature moment of the 1981 NFC Championship Game, when Clark’s touchdown haul propelled the 49ers to the Super Bowl while Walls and the Cowboys went home, there is deeper meaning to certain elements of the painting: the freckled gray sky hovering over the stadium is actually the artist’s symbol for healthy brain tissue, while the burnt orange and brown-colored bands within Candlestick — what appear to be cheering fans — are representative of brain tissue ravaged by the degenerative disease, chronic traumatic encephalopathy, better known as CTE.
The work of art is a poignant metaphor for the life’s work of McKee and the crusade she continues to champion along with her BU School of Medicine colleagues — untangling the complex and many-layered conundrum of CTE and other neurodegenerative diseases and their link to football.
Clark, the 49ers hero in that famous play, is 60 now and battling amyotrophic lateral sclerosis (ALS), known as Lou Gehrig’s disease. During a recent appearance at Levi’s Stadium (the 49ers’ current home), Montana introduced Clark to the audience. When Clark addressed the crowd, his speech was halted and his body already appears to be weakened by the disease.
“I think you all know I’m going through a little thing right now, and I need your prayers and thoughts,” Clark told the crowd. Walls, now 57, says the news of Clark being diagnosed with ALS “hit me hard,” and Walls adds that he and former teammates and opponents he keeps in touch with discuss their concerns about neurological diseases and other health issues that may surface in their future.
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McKee, who grew up in Appleton, Wis., where she says she played backyard football with her brothers during her childhood, is the director of Boston University’s CTE Center and a professor of neurology and pathology, as well as one of the leading scientists at the forefront of CTE research. McKee says “it’s almost un-American to say that you want to change football,” but she knows from her years of research in the field that unless the gladiator-like sport of football evolves, unless new changes are implemented to try to reduce the violent, brutal aspects of the game, the established link between CTE and football will continue to cloud the sports landscape and society as a whole.
Already the NFL and thousands of former players reached a nearly $1 billion settlement in the massive class-action concussion lawsuit, where the plaintiffs accused the league of covering up the long-term health dangers of repetitive hits to the head in order to protect the NFL shield and image. (According to court documents related to the settlement, “20,367 registrations have been received, including 17,142 from retired NFL football players and their representatives; 104 notices of monetary awards have been issued to class members, representing $154,103,567 in payments that have been or will be made; with $67,802,846 in payments already made.”)
The heart-wrenching stories of former players suffering from neurodegenerative diseases and the pain endured by their families and friends in the fallout, continue to reverberate. And scientists like the ones at Boston University continue to announce new sobering statistics pertaining to these neurological maladies.
“In a tragic way, we’ve gotten accustomed to it,” says McKee, referring to the CTE issue. In a Boston University study on CTE published this past summer and which McKee co-authored, 111 brains of deceased former NFL players were analyzed and 110 showed evidence of CTE, a disease that, for now, can only be diagnosed post-mortem. Doctors and scientists have determined that CTE is caused by repetitive hits to the head and brain, and the symptoms associated with the disease include depression, mood swings and aggression.
“I really do feel (CTE) is something we need to address as a country,” says McKee. “This is a sport that’s the most popular in the United States. I’ve been to schools and colleges where their major financing is through the football teams. But we can’t ignore this issue where some individuals are at risk for long-term degeneration. We really need to start putting resources into figuring this out and treating it.”
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The late NFL players Junior Seau, Dave Duerson, Frank Gifford and Ken Stabler, to name just a few, were all diagnosed with CTE, and Seau and Duerson committed suicide with gunshots to the chest to allow for their brains to be intact so their families could donate their organs to science. In Duerson’s case, he transitioned into a successful businessman after his playing days, only to fatally shoot himself in 2011, when he was 50.
In the past four months alone, McKee and her BU colleagues, including Dr. Robert Stern and Dr. Jesse Mez, have authored three studies on CTE, including the one published in July that details the test results of the former NFL players and test results of college and high school players, too. A September BU study underscored the seriousness of the issue of repetitive hits sustained playing football as it pertains to pre-adolescent athletes. The study said children who play tackle football before the age of 12 may experience “impaired mood and behavior” and other neurocognitive problems later in life.
“The study showed that participation in youth football before age 12 increased the risk of problems with behavioral regulation, apathy and executive functioning by two-fold and increased the risk of clinically-elevated depression scores by three-fold,” the BU study says. “Youth exposure to football may have long-term neurobehavioral consequences.” But the study stops short of recommending specific policy changes, instead stating that “additional research studies” must be completed to make informed decisions about safety measures in youth football.
NFL commissioner Roger Goodell and the $14 billion league continue to put forth the message that safety of its players is a top priority, and an NFL spokesperson says the league “is committed to encouraging and supporting scientific research related to the diagnosis and treatment of concussion and associated conditions, including CTE.”
College and youth football programs have taken steps toward making the game safer — whether it’s no more tackling during in-season practices or Pop Warner football eliminating kickoffs. But with the football conversation in the last decade dominated by concussions, brain trauma and brain disease associated with playing football, will the sport look dramatically different 20, 50 years from now?
Will the game exist at all?
“I don’t believe that football will be the same sport even five years from now,” says former Washington quarterback Joe Theismann, who was in Manhattan Oct. 10 as part of a fundraiser for the Joe Namath Neurological Research Center at the Jupiter (Fla.) Medical Center. “If you look back five years previous, we’ve seen the game evolve and change as far as the safety factor goes — neurologists on the sideline, the protocol that we have into concussions right now, all of the things that we’re trying to do from a safety standpoint.
“It is a violent contact sport. That’s something you’re never going to get away from. I know it’s become much more wide open,” adds Theismann. “I just saw (former Raiders linebacker) Ted Hendricks not too long ago. I reminded him of the day he tried to plant me in Oakland-Alameda Stadium on the 50-yard line, literally picked me up and tried to put my head in the sand. It was a different type of a game then. I’m sure both the Players Association and the league will continue to try and do everything they can to protect players.”
McKee, however, says there have to be wholesale changes to the sport, even if spectators are presented with a markedly different product to watch.
“I’m concerned about the future of football, because we have paid a lot of attention to concussions,” says McKee. “We are more aware of concussions. But it’s really the repetitive minor injuries, the ones that are asymptomatic that occur on almost every play of the game, the sub-concussive hits, that’s the big problem for football. Is there a way that we would actually recognize the game of football with fewer tackles and fewer collisions? I’m not sure. But I think that’s the direction we’re going to have to go. Bigger fields? Fewer players on the field? I think we are ultimately going to have to change some of the major rules of the game.”
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Now in his 24th season at the coaching helm of the Harvard University football program, Tim Murphy says he is “a lot closer to the end of my coaching career” than the beginning. Murphy has compiled a glittering resume that includes nine Ivy League championships, the last of which came in 2015.
But Murphy does not live in a Crimson bubble, and the 61-year-old is well aware of the lightning rod issue of concussions and CTE as they relate to football. Last year, Murphy and his seven Ivy League football coaching peers unanimously approved a mandate of no tackling during practices throughout the football season. Murphy is also a proponent of changes at the youth level, and he thinks organizations like Pop Warner should adopt a flag football only policy.
The veteran Crimson coach remains “bullish” about the sport going forward, however. Murphy says the football guardians at the pro, collegiate and high school levels have taken and continue to take the necessary steps and measures to improve the game’s safety.
“Generically speaking, all of these brain trauma issues certainly weigh heavily on coaches. You want to be as educated as you possibly can. But I can say with complete conviction that I am bullish on the future of football,” says Murphy. “Why? When I played (football) in the ’70s — high school, college — we had three-a-day practices. We hit every day. If you look at the way the culture has changed, the rules to protect student-athletes in the college game, the practice regimen and the sports medicine science of brain trauma, we absolutely, positively can and have done a very solid job of mitigating a lot of these issues.”
Murphy cites two of the most famous hits in the history of the game — Eagles linebacker Chuck Bednarik leveling Frank Gifford in a 1960 Giants-Eagles tilt, which caused Gifford to miss the entire next season; and the Jack Tatum hit on Patriots wide receiver Darryl Stingley in a 1978 preseason game. The latter hit by the Raiders safety nicknamed “The Assassin” left Stingley paralyzed for the remainder of his life.
“Those (hits) really don’t happen anymore,” says Murphy. “They can’t happen anymore. I’m not saying that football is going to be a non-violent sport. I’m not saying that football is not at times a risky sport. But I do believe that we have a brighter future.”
Murphy’s optimism with regard to reducing bone-crushing tackles in the game may be a lofty one. Look no further than two hits this season.
In an Oct. 26 game in Baltimore between the Ravens and Dolphins, Baltimore quarterback Joe Flacco scrambles to his right late in the second quarter with the Ravens up 13-0, but when Flacco starts to slide near the Baltimore 10-yard line, Dolphins’ 6-foot-3 linebacker Kiko Alonso barrels in, all 233 pounds of him, and buries his right shoulder into Flacco’s head. The Super Bowl-winning signal caller’s helmet flies off upon impact, and Flacco looks dazed long after the play ends. He suffers a concussion and one ear is bleeding when he leaves the field. Flacco does not return to the game, but the Ravens win handily, 40-0.
“It was a bang-bang play. I hope (Flacco) is alright. I truly do,” Alonso tells reporters after the game. Alonso receives no league punishment for the hit.
Or take Danny Trevathan’s helmet-to-helmet hit on Green Bay wide receiver Davante Adams in a Sept. 28 game between the Bears and Packers at Lambeau Field. When Adams makes a third-quarter catch and is stopped after a short gain, Trevathan, the 6-foot-1, 239-pound Bears linebacker, plows his helmet full-force into Adams’ facemask, which sends Adams to the turf, and his mouth guard flying. Adams is eventually carted off the field on a stretcher after suffering a concussion in Green Bay’s 35-14 win. Trevathan receives a two-game suspension that is later reduced to one game on appeal.
“Those hits (by Bednarik and Tatum) back then were exceptions. Look, a lot of guys got clotheslined, got hit hard and in a very dangerous fashion,” says Walls, the former Cowboys and Giants defensive back who played in the NFL from 1981 to 1993. “The protection has improved, but the speed and size of players has increased. As much as any hit today won’t look like the ones back then, they have the same impact. Guys are still getting concussions. If two huge guys are coming at each other on the field — the contact might not have the same outcome, but it has the same effect. Your brain still feels it.”
McKee says that the price these players often pay down the road is what is most disturbing.
“Those guys look invincible out there on the field. They look amazing. They look like nothing is hurting them,” says McKee. “Then to see the tragic stories, and see them so affected later, it’s horrible. I think for anybody it becomes more difficult to watch (football).”
McKee adds that at the collegiate level, it is especially difficult for administrations at Division I colleges and universities to look past the financial boon a big-time football program brings.
“I think they’re between a rock and a hard place,” says McKee. “In fact the football team brings in all the money for every other sport in some cases. With the football program for the alumni being so important, they’re in a difficult position. I’m sure they want to embrace the safety. I’m sure they really do want the best for their athletes, and ultimately they want their alums to develop and have the most productive, successful careers in life that they can. But it’s a financial consideration and I’m not sure how they resolve it.” Murphy says that he’s experienced no resistance from Harvard’s administration with regard to eliminating the football program due to the current climate and the spotlight on CTE and football. “The answer is ‘no’ for this reason – we’re on the cutting edge of mitigating as many of these factors as we can,” says Murphy.
There is a consensus on one issue among McKee and her BU colleague Dr. Robert Stern, Hall of Fame Jets quarterback Joe Namath, and Ivy League football coaches Murphy and Dartmouth’s Buddy Teevens: eliminate tackling in youth football programs like Pop Warner.
“I definitely agree about the future of youth football being flag,” says McKee. “There’s just more and more evidence that the youth brain is particularly susceptible to the injury — thin necks, big heads. They’re not as coordinated, they’re not as skillful. For many reasons, I think the wave of the future is flag football for youth.”
Namath says if he had to dial back the clock, there would be no “Broadway Joe” leading the Jets to a Super Bowl III victory over the Colts. Namath says he would have preferred the baseball diamond over the gridiron.
“That’s easy to answer knowing what I know now. I didn’t want to play football getting out of high school. I wanted to play baseball,” says Namath, who joined Theismann at the Oct. 10 Manhattan fundraiser. “I promise you that. What I know now is we need to be more careful, more selective. I don’t like the idea of some of these youth leagues starting at such an early age.
“The parents are the ones that get the kids to go into football for the most part. I don’t think these children that are 8, 9-years-old really want to get out there and get hit or hit,” adds Namath, 74. “But when mom or especially dad (ask), ‘Are you going to be tough?’… I would have played baseball.”
Murphy, the Harvard coach, says “the future of youth football is absolutely flag football,” and Dartmouth’s Teevens adds that “it’s incumbent upon coaches to be more progressive” when it comes to teaching the football fundamentals at an early age. “We have to minimize the contact while still teaching skill sets,” says Teevens.
But Murphy says changes at the youth football level might be hard to stomach in certain parts of the country where football is king.
“I will admit up front, part of that is political. (South) of the Mason-Dixon Line, you’re not going to win that battle,” says Murphy. “But those-age kids don’t need to be putting on helmets and running into each other. I really believe flag football is going to be a great solution to introducing young people to the sport.”
Stern, the Boston University director of clinical research at the CTE Center and a BU professor of neurology and neurosurgery, stresses that while “activity and athleticism in sports” is critical to a child’s development, at some point we need to draw the line on how much exposure to contact sports like football is good for a child.
“At what point is it inappropriate for parents, leagues and coaches to make decisions that force our kids to be exposed to these repetitive hits to the head and repetitive brain trauma during a period that we know is filled with extensive neurodevelopmental maturation? At what point is it inappropriate to say, ‘Go at it’? I’m a scientist, not a policy maker,” says Stern. “If an activity involves repetitive jarring to the most vital organ in the body during these developmental milestones, I think we might need to reconsider, or at least delay the initiation of that exposure.”
But one of Stern’s BU peers says the tackle vs. flag football issue needs to be an open dialogue.
“The state of the science is such that we don’t know. The American Academy of Pediatrics has stopped short of calling for a ban of tackling in youth football. You’re not going to prevent concussions. Whenever your body is in motion, you’re at risk for a head injury,” says Dr. Peter Cummings, a Boston University assistant professor who is board certified in neuropathology. “Where do you define what is safe? How do you mitigate that risk?”
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There have been 47 rules changes in the NFL since 2002, many of them designed to try and improve player safety. Unaffiliated physicians, paid for by the league, now are on both sidelines during preseason, regular season and playoff games. Trainers sit in auxiliary boxes during games and monitor injuries, and they have the authority to stop games if they feel a player’s health has been compromised during play. Players who get creamed in NFL games and who suffer head injuries must complete and pass a standard concussion protocol before they return to the field.
The league says it continues to pour millions of dollars into research – an NFL spokesperson says $40 million of a $100 million commitment to NFL’s “Play Smart, Play Safe” initiative has been allocated “toward medical research, primarily dedicated to neuroscience.” The league has partnered with the NFL Players Association and the medical and science communities in an effort to make advances on many fronts.
“We take full crash test dummies and recreate them in a laboratory — match millimeter by millimeter how the helmet moved on the field in a full laboratory reconstruction. We think within a three-year period, someone could develop an improved, better-engineered, all-purpose helmet. We believe that there are significant opportunities for reductions in concussions through improvements in helmets. We don’t say engineering is a panacea and will solve everything. It’s a systemic approach,” says Dr. Jeff Crandall, director of The Center for Applied Biomechanics at the University of Virginia and chairman of the NFL Engineering Committee.
“God knows it’s not a safe game,” says Super Bowl MVP Mark Rypien, who led Washington over Buffalo in Super Bowl XXVI. “What it has to come down to is parents — ‘What’s the best thing for my child?’ It’s unfortunate what they’re finding out now (about CTE), that they didn’t have those tools before. I probably would have been playing golf or something if my mom or dad knew. Or baseball, but I couldn’t hit a damn curveball.”
Rypien joined Dr. Barth Green at the annual Buoniconti “Great Sports Legends” gala Sept. 25 at the midtown Manhattan Hilton, a benefit for The Miami Project to Cure Paralysis and its development arm, The Buoniconti Fund. Hall of Fame Dolphins linebacker Nick Buoniconti’s son Marc, who was paralyzed from the neck down after he suffered a spinal cord injury playing college football, is the namesake behind the fund. Nick Buoniconti, 76, just announced last week that he will donate his brain to BU for CTE research after his death.
Green, the chairman and co-founder of The Miami Project and a University of Miami professor of neurology, agrees with BU’s McKee that football must adopt changes to minimize the violent aspects.
“I think there will be a major emphasis on making the sport more skilled and less brutal. More coordination, skill and execution of plays, almost like a ballet,” says Green, 72. “All the emphasis before was on brute strength and now we’ve paid the price. My generation of players, a lot of them are suffering. Football is a violent sport, but Americans love it. If you take some of the violence out and emphasize the skillfulness and the strategy, Americans will re-embrace it and allow their kids to play. I think we’ve created a situation where people are suffering brain and spinal damage, and it doesn’t have to be that way.”
But Michael Kaplen, a New York attorney and a George Washington University professor specializing in brain injury law, says that unless tackling is eliminated from football altogether, no amount of rules changes will ensure safety of players at any level.
“Football is a concussion-delivery system. You cannot make it safe because after any hit, the brain is moving within the skull,” says Kaplen. “There is no such thing as safe tackling. This whole focus on CTE — while troubling in terms of the nature of the disease — is misdirected in terms of the problem. The problem is repetitive head trauma, where CTE is one of many end results. Repetitive hits cause brain damage.”
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Former Jets and Giants placekicker Cary Blanchard, who died of a heart attack Sept. 6, 2016 at age 47, was the quintessential family man, according to his ex-wife, Mindi. That is, until the final three years of his life.
“When Cary died, it was the end of three years of hell,” says Mindi Blanchard, a mother of three. “My oldest son (Blake) describes it as his dad went from Dr. Jekyll to Mr. Hyde. He went from being a family man who loved being with us, to yelling and screaming at his kids all the time. He was verbally and physically abusive to me. He cheated on me. He threatened to kill himself several times. He threatened to kill us. He got fired from his (post-football) job for theft. He left us and we wouldn’t know where he was for days.”
Mindi filed for divorce prior to Cary’s death, and she and her children (Cary was the father of all three) remained shell-shocked after his passing, perplexed as to what could have caused the dramatic change in their dad and husband. Mindi elected to donate Blanchard’s brain to science after he died and renowned pathologist Dr. Bennet Omalu — credited with discovering CTE — studied his brain. Nine months after Blanchard’s death, Omalu called Mindi with startling news.
“Omalu told me that Cary had CTE. We never thought he would have had CTE. He was a kicker. But I think football players always think it will never happen to them, that they’ll never get CTE,” says Mindi. “The results from Omalu gave me relief, gave my children some answers. Now I know what Cary was dealing with. I was told that the heart attack was caused by seizures, and the seizures were possibly sparked by CTE. He was the love of my life, and he’ll always be that. But the man I loved is not the man he became.”
Dr. Stern, the BU professor of neurology and neurosurgery, says one of the main goals in his research is to be able to diagnose CTE in the living within the next five to 10 years, and BU already announced in September that a CTE biomarker has been discovered which may make Dr. Stern’s goal realized sooner than that.
“It’s only through diagnosing CTE in the living that we’ll be able to move the field forward, to understand questions of incidents and prevalence, to truly be able to understand risk factors,” says Stern. “And eventually we’ll be able to conduct clinical trials of ways to treat symptoms, slow down the disease and maybe even prevent the symptoms from starting in the first place.”
McKee adds that diagnosing CTE in the living would help guide decisions on whether active players should continue competing or not.
“The other thing is we could probably come up with some effective rehabilitation or treatment strategies. I really think if we can diagnose it, especially diagnose it early, we can make an enormous difference. We’ll also have an idea how prevalent it is, how many hits, what kind of exposure leads to it, which is something we really can’t address now very easily with a post-mortem study,” says McKee.
But will such advances in science curtail the public’s interest in the sport? Will the youth football participation numbers drop? Or if dramatic changes to the game occur, will the brave, new version of football be popular enough to survive?
“I love football. There’s no reason the next generation of football shouldn’t be less contact and more skill,” says Dr. Green. “That’s not an anti-football statement. It’s ‘Let’s go and reinvent the wheel.’ I don’t want to see football go away.
“I want to see it changed.”
