Football, the American Tragedy: Public Ignorance Persists on a Major Health Crisis

The NFL is receiving critical media attention for its failure to follow through with a promised commitment to advance scientific knowledge about the link between football and brain trauma. In 2012, the NFL promised $30 million to the National Institute of Health to help fund medical research related to the effects of football and concussions on mental health. But recent reporting suggests that the NFL only followed through with less than half of those funds, while ensuring that the money could not be used to fund a Boston University study on brain trauma and football, despite the “gift” supposedly coming with no strings attached. In the House of Representatives, an investigation from the Committee on Energy and Commerce concluded that the NFL acted “improperly in attempting to influence the outcome” of the grant-funding process, and as related to the Boston University study.

To make matters worse for the NFL’s public image, new medical research also spotlights the negative health effects of playing football. The most recent study published by the Journal of the American Medical Association (JAMA) adds to an already sizable volume of research documenting the negative health consequences associated with the sport. The study speaks to broader concerns over the progressive, degenerative brain disease, chronic traumatic encephalopathy (CTE). For those not familiar with CTE, it is caused by trauma via repeated hits to the head, which lead to the buildup of tau protein in the brain. The disease destroys neural pathways in the brain and is characterized by various symptoms, including confusion, memory loss, aggressive and depressive behavior, anxiety and even suicide. Medical researchers have linked CTE to playing football in numerous medical studies in the last decade.

The new JAMA study provides cause for concern, considering the prevalence of CTE among former football players. The study concluded that, of 202 brains that were examined of deceased football players, CTE was identified in 177 cases, or 88 percent of the time. Of NFL players, 110 of 111 displayed signs of CTE, compared to 48 of 53 college players, and three of 14 high school players. Of course, JAMA’s most recent publication is merely one of many that have linked CTE to football. Other prominent studies can be found here, here, here and here.

It would be foolish to ignore this sizable, albeit still emerging body of research as inconclusive in terms of assessing football’s mental health effects. The findings, confirmed across study after study, are perfectly clear: Football is dangerous to one’s health. Of course, there are limits to these studies, as with any research. For example, the new JAMA study relied on the individuals (and families) who voluntarily donated former football players’ brains for examination. This means that the individuals studied do not represent a random sample of the larger population of football players at the high school, college or professional levels.

The voluntary nature of previous studies on CTE means that it’s difficult to know for certain how “typical” the brains of those examined are, in comparison to others who have played, and are still playing football. Essentially, the body of individuals examined in medical studies is not fully representative of the body of players who have played football. Those who volunteer to have their brains examined in medical studies are likely individuals who already experienced symptoms of CTE. This problem is referred to as “selection bias” in the scientific community. CTE symptoms may not manifest themselves at all in the case of various football players who do not volunteer to have their brains examined.

Unfortunately, medical researchers estimate that CTE tests on living NFL players — which would allow for a much larger, and representative sample of participants in future studies — may be five to 10 years away. What percent of all high school, college and professional football players end up suffering from CTE? It’s difficult to know authoritatively with the limited data collected thus far. Still, with everything that’s now known about CTE, only the willfully ignorant will continue to ignore the intuitive conclusion that bashing your head repeatedly against the ground and into other human beings significantly damages one’s brain.

The pushback against efforts to spotlight the dangers of football is strong. NFL football was a $13 billion industry in 2016, and those revenues are projected to go up by another $1 billion in 2017 alone. This isn’t even counting the revenues generated at the collegiate level: Higher education institutions earn billions per year in media-generated revenues, not to mention the millions going to ticket sales, coach and other personnel incomes, scholarships and other expenses.

Under these circumstances, there is strong pushback against potential government regulation by NFL owners, the television networks and any other institutions profiting from football. Such regulation is unlikely to occur without mass public pressure for political officials to act. And the American public’s knowledge of the dangers of CTE is nowhere near where it needs to be to effectively pressure the government to action.

You might think that those who are familiar with the US’s biggest and most profitable pastime would already have a decent understanding of football’s dangers due to all the media coverage of CTE. But you’d be wrong. Social scientists, particularly those who study public opinion, have long understood that the public is often woefully under-informed or misinformed on important political, economic and social issues. This conclusion has been documented many times over in the field of research in which I’m active — public opinion studies.

The recent polls on public recognition of football’s effects are sobering. On the one hand, there is a general concern with the negative effects of football on players’ health. A University of Massachusetts national poll from July 2016 found that 94 percent of Americans agreed that concussions and other head injuries from sports represent a serious public health issue, with 65 percent saying these injuries are a “major problem,” and only 6 percent saying they are not a problem. Furthermore, the poll found that 85 percent believed that science demonstrated that playing football may cause CTE in players, while 87 percent agreed that CTE constitutes a “serious public health issue.” On another positive note, another recent poll finds that 4 out of 5 Americans reportedly oppose allowing children under 14 to play tackle football.

On the other hand, most Americans appear to be thoroughly ignorant regarding the full extent of the dangers accompanying football. A January 2017 Reuters poll found that 73 percent of American adults said it was “very likely” or “somewhat likely” they would allow their sons to play football if they showed interest. Only 19 percent said they were “not very likely” or “not at all likely” to do so. Among those who said their children could play, the most common reason cited was “teaching work ethic and discipline.” Unsurprisingly, the most common reasons given by those who would prevent their children from playing were “physical injury” and “brain injury.” Importantly, the likelihood of allowing one’s children to play football decreased significantly as one’s level of education increased.

Most Americans are in denial about just how harmful football is to the human brain. They believe that by taking extra precautions, football can be made safer. A December 2015 Harris poll found that 79 percent of Americans and 84 percent of football fans agreed that “aggressive tackles that can lead to head injuries” should be restricted in youth football. Three of five respondents also agreed with limiting aggressive tackles in the NFL. The problem with this sentiment, however, is that over the years, the NFL has already taken this “precaution” in numerous ways, by whistling plays dead when a player loses his helmet, and by prohibiting unnecessary roughness, head-to-head contact and “roughing [of] the passer.” These efforts appear to be enough for football fans, considering that 57 percent of them believe the new rules introduced by the NFL in 2010 were effective in limiting head injuries.

Most Americans lend support to the notion that football can be made safer with additional protocols. As the 2015 Harris poll found, 83 percent of the public supports a rule that football players at all levels be required “to take a set amount of time off from playing to recover” following head injuries; 82 percent agree with the introduction of “a standardized test to determine if and when injured players can return to the field.” What is missing from these attitudes, however, is a recognition that contact football, no matter how many precautions are taken, remains an inherently violent and dangerous sport. Recent research on CTE finds that it is not the big hits, manifesting themselves in concussions, that pose the major threat to the human brain. Rather, it is the accumulated impact of sub-concussive blows to the head that pose the greatest risk.

Simply put, there is no way to make American football “safe.” But this fact has long been obscured by NFL propaganda, from Commissioner Roger Goodell on down to team owners and PR agents, who insist that added precautions can mitigate the dangers inherent in smashing one’s head into things repeatedly for months and years on end. Americans in general, and football fans and players in particular, are downplaying the dangers inherent in their favorite sport. As a nation, we are deluged with advertisements, sports commentary and other hype in the mass media that glorifies a sport that’s damaging the brains of America’s youth. It takes a noxious dose of laziness and willful ignorance not to notice the physical threats this sport poses, which have been carefully documented in the medical community.

Fortunately, critical public awareness of the dangers of football has grown in recent years, even if it is nowhere near where it needs to be. At some point (preferably now or in the near future), Americans need to begin a serious discussion about how to limit the negative effects of a sport that wreaks destruction against the human body. One place to start would be to pass a law banning contact football in middle schools, high schools, and public colleges and universities. Such a law could be passed by the national government, or if it’s not willing, by state and local governments. If the NFL wants to profit from the physical destruction of young minds, it should subsidize its own private youth clubs, rather than benefit from countless taxpayer dollars allocated to developing football players through the public high school and higher education pipeline. The tragic irony is that institutions of learning are contributing millions of dollars per year to a sport that damages the brains of student athletes, all in the name of entertainment and student “pride.” We will need to radically rethink our educational priorities moving forward if we want to limit the very real threat of football to American youth.