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Dr. Clif Cleaveland

In 1906, President Theodore Roosevelt convened a meeting of college presidents to address a rising tide of serious injuries and deaths among collegiate football players.

Eighteen deaths and scores of serious injuries, including skull and spinal fractures, prompted the meeting. Roosevelt called for reforms in the game to make it safer. Changes in rules and subsequent improvement in protective equipment led to safer games.

In October 2014, President Barack Obama hosted a White House meeting of sports officials, medical experts and concerned parents to address concussions in athletes. It is not clear if this meeting will have a lasting influence.

In addition to acute injuries, attention in recent years has focused upon chronic traumatic encephalopathy (CTE), a progressive neurological disease detected in autopsied brains of former football players, especially those who had played professionally. CTE is characterized by dense deposits of a protein called "tau" that disrupt the brain's delicate architecture and function.

Before their deaths, former players with CTE exhibited a variety of symptoms, including depression, impaired judgment, confusion and aggressive behavior. Some had dementia resembling Alzheimer's disease. Others suffered from Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease), a progressively debilitating neurological illness.

In March 2016, in testimony before the U.S. House Committee on Energy and Commerce, NFL Senior Vice President for Health and Safety Jeff Miller acknowledged for the first time a direct link between football and degenerative brain disease. Prior to this, senior NFL officials had either denied the connection or dodged the question.

The most recent documented case of CTE is that of Kevin Turner, who died in March 2016. Turner began playing tackle football at age five. He recalled coaches telling him to lead with his head. An accomplished running back at the University of Alabama, he was a third-round draftee of the New England Patriots, starring as a fullback, noted especially for his blocking skills. He subsequently played for the Philadelphia Eagles before neck injuries ended his eight-year career.

In 2010, Turner was diagnosed with ALS. He became a lead plaintiff in a class-action lawsuit that sought damages from the NFL for chronic brain diseases attributed to injuries sustained as professional players.

In April 2016, the Third Circuit of the U.S. Court of Appeals approved a settlement of $1 billion for former NFL players with cognitive and neurological diseases who retired before July 7, 2014, and family members of players who died before that date. Payouts have been delayed because a small number of parties to the lawsuit opted out of the settlement and want the case reviewed by the U.S. Supreme Court. Turner's family would receive $5 million if the payout began today.

Turner willed his brain and spinal cord to the VA Boston CTE Center, the referral center for study of the disorder. Earlier this month, Dr. Ann McKee, the center's director, announced at a press conference that Turner's brain exhibited unusually severe CTE for a person of his age.

The most recent update from the Boston "brain bank" documented CTE in 90 of 94 brains of former NFL players, 45 of 55 former collegiate players, and six of 26 high school players.

At present, there is no agreed-upon methodology, either blood test or imaging study, to document CTE during life.

A study in the journal Neurology in January 2015 concluded that NFL players who began competition in tackle football before age 12 were more likely to suffer learning and memory problems as adults.

More recently, a study reported in October in the journal Radiology raises serious questions about the effect of repetitive blows to the heads of young football players. Twenty-five boys, ages 8 to 13, had hits to their helmeted heads recorded by sensitive devices during a single season. No player was clinically diagnosed with concussion during the season.

At the end of the season, sensitive imaging studies (diffusion tensor imaging) detected a correlation between the number of head impacts and changes in the white matter of players' brains.

This is a single study with a small number of participants, but it should raise a red flag about the participation of young boys in tackle football or other sports where physical impacts are common.

CTE must be regarded as a public health issue potentially affecting the 6 million participants in American football. Important safety issues and long-term consequences of injuries have yet to be addressed in a comprehensive manner. Parents and coaches are owed better information than they currently receive about ongoing studies. Sports media owe the public updated reports on both the cause and prevention of CTE.

Contact Clif Cleaveland at