I had a chance this past week to read the book League of Denial and see the PBS documentary by the same name. Some thoughts about the story of the NFL and concussion research (focusing mostly on the book which provides a more detailed narrative):

1. I know some fans are already complaining of “concussion fatigue” but it is hard to think of football the same way after hearing this story. For decades, we have held up players for their toughness and yet it may be ruining their brains.

2. The human story in all of this is quite interesting. This includes some of the former football players who have been driven to the edge by their football-related brain injuries. At the same time, the story amongst the doctors is also pretty fascinating, the chase for fame, publishing articles, and acquiring brains. Running through the whole book is this question of “who is really doing this research for the right reasons?” Even if the NFL research appears to be irrevocably tainted, are the researchers on the other side completely neutral or pure of heart?

3. The whole scientific process is laid out in the book (glossed over more in the documentary)…and I’m not sure how it fares. You have scientists fighting each other to acquire brains. You have peer-reviewed research – supposed to help prevent erroneous findings – that is viewed by many as erroneous from the start. You have scientists fighting for funding, an ongoing battle for all researchers as they must support their work and have their own livelihoods. In the end, consensus seems to be emerging but the book and documentary highlight the messy process it takes to get there.

4. The comparisons of the NFL to Big Tobacco seem compelling: the NFL tried to bury concussions research for a few decades and still doesn’t admit to a long-term impact of concussions on its players. One place where the comparison might break down for the general public (and scientific research could change this in the near future): the worst problems seem to be in long-time NFL players. When exactly does CTE start in the brains of football players? There is some evidence younger players, college or high school, might already have CTE but we need more evidence of this to be sure. If that is established, that perhaps kids as young as junior high already have CTE and that CTE is derived from regular hits at a young age (not the big knock-out blows), the link to Big Tobacco might be complete.

5. It is not really part of this story but I was struck again by how relatively little we know about the brain. Concussion research didn’t really take off until the 1990s, even as this had happened with football players for decades. (One sports area where it had been studied: boxing.) Much of this research is quite new and is a reminder that we humans don’t know as much as we might think.

6. This also provides a big reminder that the NFL is big business. Players seem the most aware of this: they can be cut at any time and an injury outside of their control could end their careers. The league and owners do not come off well here as they try to protect their holdings. The employees – the players – are generally treated badly: paid well if they perform but thrown aside otherwise. This may lead to a “better product” on the field but the human toll is staggering.

7. How exactly you change people’s opinions, both fans and players, regarding concussions will be fascinating to watch. It will take quite a shift among players from the tough-guy image to being willing to consider their futures more carefully. For fans, they may become more understanding as their favorite players consider what concussions might do to their lives. Will the NFL remain as popular? Hard to say though I imagine most fans this past weekend of football had little problem watching lots of gridiron action Saturday and Sunday.