Dr. Clif Cleaveland

A reader recommended that I read "League of Denial: The NFL, Concussions, and the Battle for Truth." This compelling narrative is necessary reading for football coaches, trainers, players and their parents and anyone who cares about the game.

Along with a PBS "Frontline" report on Oct. 8, 2013, the book presents a damning picture of professional football's efforts to downplay the long-term consequences of concussions among players.

Authors Mark Fainaru-Wada and Steve Fainaru are investigative reporters for ESPN. Despite the network's close ties to professional sports, the two spare no one in their study of the NFL and its approach to head injuries and their consequences.

Publicity of head injuries among professional footballers led the NFL to establish its Mild Traumatic Brain Injury Committee in 1994. Chaired by a rheumatologist, the committee commissioned a series of papers that were published in a friendly journal of neurosurgery. The papers downplayed the frequency, seriousness and long-term consequences of concussions. Some papers were published despite criticism of their validity by some members of the committee.

The NFL strategy began to unravel with the death and autopsy of Mike Webster, a legendary center for the Pittsburgh Steelers. After retirement, his behavior became progressively erratic, and his life fell apart. He died at age 50. Examination of his brain by pathologist Dr. Bennet Omalu showed a distinctive, new form of degeneration, subsequently labeled chronic traumatic encephalopathy (CTE). Subsequent studies of brains from multiple players confirmed that CTE was seen only in the brains of individuals subjected to repeated head trauma.

The NFL dismissed these findings along similar findings in two other NFL players. The three had histories of multiple blows to the head during their careers, but the league downplayed reports of the effects of repeated concussion. It also sought to discredit Omalu, a Nigerian with impeccable professional credentials.

A battle ensued during subsequent years among competing researchers seeking to autopsy the brains of other former NFL players.

In response to increasing criticism, the NFL and its Players Association established Project 88 to provide financial support for former players who suffered dementia that might be attributed to head injury. The project honored John Mackey, a legendary tight end for the Baltimore Colts, who died following years of worsening dementia.

Growing concern for the safety of football players caught the attention of Congress. In a House Judiciary Committee hearing on Oct. 28, 2009, Representative Linda Sanchez, D-Calif., linked the NFL's denials of links of dementia to repeated concussions to the tactics of the tobacco industry decades earlier in denying links of cigarette smoking to lung cancer.

A class action lawsuit was filed by attorneys representing 4,500 retired football players who contended that they suffered from head injuries sustained during their careers. On Aug. 29, 2013, a deal was struck in pre-trial mediation. The NFL, an $11 billion-per-year industry, agreed to pay up to $765 million over 65 years to provide medical care for dementia, Parkinson's disease and other neurological illnesses related to football injuries among the parties to the lawsuit.

On Jan. 14 of this year, federal Judge Anita Brody rejected the settlement as inadequate to meet the likely financial needs of the players involved. The final amount of money available to this group of former players will likely be substantially higher.

Last year, a pilot study at UCLA of five former players offered the prospect of diagnosing CTE during life. Brain scans and neuropsychiatric testing identified characteristic functional and structural changes in each subject.

Head injuries in athletes represent an important public health issue. Reports cannot be discounted or hidden. The NFL has tightened its regulations relating to concussions by requiring independent assessment of injured athletes by a medical specialist. Penalties are assessed for blows to the head or helmet-to-helmet contact. Even so, concussions occur too frequently, and injured players may be returned to action too soon.

The following steps are advisable:

• An independent, national, data bank of sports-related head and spinal cord injuries should be established to collect and analyze reports annually from football teams at the professional, collegiate and high school levels. The results should be publicized.

• Research should be independently funded to evaluate equipment and training practices to determine what improvements are feasible that would lower the risk of injury.

• Additional funding should be directed toward research that identifies early CTE changes in athletes so that further exposure to head injury could be eliminated.

A great sport can be maintained without endangering the health of its participants.

Contact Clif Cleaveland at cleaveland1000@comcast.net.