Assessing the Damage

Author: Matt Storin ’64

Boston University never played Notre Dame in football and, in fact, dropped the sport in 1997. Yet the large, private research institution on the banks of the Charles River is presenting a disturbing challenge for Notre Dame and all of organized football from Pop Warner to the NFL.

Researchers at BU believe they have established a definitive link between repetitive blows to the head, as experienced by many football players, and the onset of degenerative brain disease, specifically Chronic Traumatic Encephalopathy (CTE). Not all neurological scientists agree with some or all of BU’s conclusions. “There are lots of skeptics, but also there are many [researchers] who have absolutely no problem with it,” says Dr. Ann McKee, director of Boston University’s CTE Center. “As far as the basic concept, that’s accepted.”

In fact, after years of denials, the National Football League in 2009 essentially, if not specifically, agreed with McKee and her colleagues. Combined with relentless reporting by Alan Schwarz of The New York Times, the research by BU and others ultimately led to a settlement between the NFL and more than 4,500 former NFL players or their estates, nearly two dozen of whom were former Notre Dame players (see related story, page 36). No exact figure exists for the pending decisions on individual players, but the cost should approach $1 billion. Though the NFL clearly admits to a link between head blows and cognitive disabilities, critics of the settlement maintain that the NFL stopped short of recognizing the CTE disease itself in future cases.

I am, like many who read this magazine, a fan of Notre Dame football and also football in general. (Dr. McKee is also a football fan, having spent her undergraduate years as a Wisconsin Badger.) A Notre Dame graduate and, in 1963, a head football manager, I’ve also been a staffer and faculty member. But being a Notre Dame alum perhaps means you never drift too far from underlying moral issues. And that’s part of the problem facing collegiate football today.

Is the possible health risk ultimately a game-killing problem, or is it a solvable problem? For the moment, the good news from a fan’s point of view is that in months of research for this piece, I have not encountered one concussion expert or lawyer who predicted an end to football.

Debate within the scientific community on what has been sufficiently proved has continued. But let us first examine the relationship between the research — and its accompanying publicity — and the game of football as we know it today.

Football has always had its critics. In Scribe, his 2014 memoir, Boston Globe sportswriter Bob Ryan said, “Football is a barbaric game. In a more civilized, more genteel society, no one would even think of sanctioning such an activity.”

When it comes to the college game, one of the strongest advocates for more research and better treatment of concussions is a Harvard-educated former pro wrestler — yes, a Harvard Man was a pro wrestler — Chris Nowinski. “The mission of the university is education,” he says. “How do you justify subjecting people to degenerative brain disease as part of the education mission?”

Nowinski co-founded the Sports Legacy Institute, an advocacy group on these issues, and has partnered with BU’s CTE Center, which concentrates on research. The 43-year-old Nowinski, billed as “Chris Harvard,” suffered several concussions in his wrestling career — some of it is apparently on the level — and fears he could be a candidate for CTE.

The scientific tussle

Traumatic Brain Injury (TBI) has been studied since the 1920s. For decades the research focused on boxing. The present-day attention to degenerative brain disease affecting football players was jump-started when Mike Webster, a beloved offensive lineman for the Pittsburgh Steelers, died in 2002 and was posthumously diagnosed with CTE. Before he died, Webster, alienated from his family and bankrupt, often lived out of his pickup truck and could barely utter a coherent thought. The suicides of former players Dave Duerson ’83 of the Chicago Bears in 2011 and Junior Seau of the San Diego Chargers in 2012 accelerated the attention. But the studies had been underway for years. Among them:

—As of its latest report, BU’s CTE Center has examined the donated brains of 90 former NFL players and, as of June 30, detected CTE in 86 of them, including former Notre Dame All-Americans Duerson and Pete Duranko ’66, who died in 2011.

— Though it could establish no definitive link to football, a cohort mortality study by The National Institute for Occupational Safety and Health in 1994 examined 3,349 players who played at least five full seasons from 1959 to 1988. Findings showed that while NFL players lived longer than the average American male, the risk of death associated with neurodegenerative disorders was about three times higher among the NFL group.

— A 2013 study by BU and Harvard, using a self-report questionnaire on 730 college players, found that offensive linemen, a group experiencing frequent but “low magnitude head impacts,” develop more post-impact symptoms than other players even though they don’t report those symptoms as concussions.

— A separate 2012 BU study of 64 former players concluded they showed “more frequent problems with executive functioning and . . . symptoms may develop or worsen in their fifth decade of life.”

UCLA reported in May 2014 that it may be able to detect CTE by PET scan imaging but conceded there was no definitive clinical diagnosis of CTE in living individuals “at the present time.”

Not all researchers agree that a proven link exists between head injuries and CTE. Dr. Rudolph Castellani of the University of Maryland believes the possible link should continue to be studied but argues “the available evidence permits no conclusions as regards the pathogenesis of the reported findings.”

At a July 2014 conference on concussions in Chicago, Castellani suggested that CTE is not a degenerative brain disease. He said, “We have no business discussing [CTE’s having] a causative role in suicide, impulse control [issues], domestic disarray or any other functional disturbance.”

Moms Team, a respected online resource for parents of young athletes, has cautioned that media reports have outdistanced the actual science, citing a scarcity of peer-reviewed research, and created unwarranted fear. While agreeing that many questions about CTE remain to be answered, BU’s McKee contends that the link between blows to the head and the onset of CTE is “widely accepted” within the scientific community.

The issue has gained at least a toehold of belief in the ranks of players. In recent months, Anthony Davis, a 25-year-old offensive lineman for the San Francisco 49ers, announced his retirement over concerns about brain injury, reportedly agreeing to return $4.66 million in bonus money. Earlier this year, 49ers rookie linebacker Chris Borland, 24, also quit, citing health concerns. And Jack Miller, a 21-year-old offensive lineman for the Michigan Wolverines, quit, saying, “I’d be lying if I said that the concussion thing doesn’t scare me a little."

Dr. Bruce H. Dobkin, director of UCLA’s Neurological Rehabilitation and Research Program, offers another perspective. Consistent with what McKee said about the majority of scientists, he definitely sees a link between repeated blows to the head and cognitive impairment but believes more and longer studies are needed regarding CTE.

“Better clinical monitoring techniques are critical,” says Dobkin, who would like to see such additional evidence as counts of concussion and lesser traumatic injuries; wearable sensors and better sensor algorithms to assess the likelihood of brain injury shearing forces; and serial imaging using MRI sequences, PET scans and biochemical signals of connective nerve fibers injury. He thinks medicine is 10 years away from coming up with enough data that would argue for rules and equipment changes, and would need perhaps twice that time to develop effective “rescue” medication to ameliorate the effects of brain injuries.

All those lawsuits

Jason Luckasevic, a soft-spoken lawyer with the Pittsburgh firm of Goldbert, Persky & White, was the first to go to war with the NFL in 2011 after a physician friend, Bennet Omalu, discovered CTE in the autopsy of Mike Webster. Luckasevic insists he is “absolutely pro-sport” but says there is a difference in playing sports and “playing sports to save your brains.” He calls it the “difference between driving a car and driving a car without a seat belt.”

“Everyone still thinks CTE is a concussion injury,” Luckasevic says. “It is not a concussion injury or concussion disease. It is a repeated trauma-induced injury disease. Repeated blows to the head are causing this.” He knows that football as it’s played today is popular but, he notes, so was cigarette smoking in the 1950s.

Although he represents some former players in suits against the NCAA, Luckasevic says his primary concern is children playing in youth leagues or high school. “Is there some point in time where that becomes parental child abuse? I think what’s going to happen is that states are going to look at it hard when the science and medicine is there.”

He also believes the NFL will no longer be the battlefield. “Professional athletes will sign away their rights.” College players will fall somewhere in between, he thinks. But if youth football goes the way of tobacco, that would be a problem for the higher levels of the sport.

At least one lawsuit has been filed against Notre Dame by a former player. Steve Schmitz, who played as a receiver and running back in the late 1970s, and his wife sued, alleging degenerative brain disease as a result of Notre Dame’s “reckless disregard for the safety of an amateur collegiate football player.” The suit was dismissed from the District Court of Northern Ohio in September 2014 with the consent of all parties, meaning it could be refiled. Schmitz died in February 2015.

Although Schmitz’ case dates well before there were widespread concerns about head injuries, it is worth noting that Frank Varrichione, who played for ND in the 1950s, was included as a plaintiff in the NFL settlement case, as were other former Irish players.

The NCAA has worked to try to reach a settlement of all its lawsuits, providing screening of athletes for 50 years, millions of dollars for research and presumably benefits for those diagnosed with disease. As of the summer of 2015, the case remains unresolved.

Because there are fewer revenues for high school football, legal challenges at that level might represent a threat to the game, although that is hard to imagine in many parts of the country. Alex Pierscionek, now a college student, filed suit in Chicago this year charging the Illinois High School Association of a “systemic failure to manage concussions,” according to NBC News reporter John Yang, who said a similar suit has been filed in a U.S. District Court in Mississippi. Both suits seek to implement stricter safety rules and supervision.

Insurance companies also may play a part in the future of football. “I believe that concussions have the potential to be as significant as asbestos in terms of casualty litigation in the U.S.,” says Robert Rheel, an executive vice president with Aspen Insurance, on the website Risk & Insurance. Other insurance industry publications have written about the issue, but to date there have been no apparent restrictions on offering coverage.

Some experts believe the insurance industry could be a driver in pushing for changes in the sport, particularly at the high school level, where today the expertise and provisions for monitoring injuries are less consistent and, in some cases, less regulated than the college and professional ranks.

Notre Dame policies

Among the 86 brains in which Boston University found CTE, three were from Notre Dame alumni. Duerson and Duranko played at ND and in the NFL. The latter was diagnosed with amyotrophic lateral sclerosis, which BU has linked to CTE. Although McKee cautions that much is still not known about the causes of ALS, she estimates that 10 percent of CTE victims whose brains she examined suffered the symptoms of that disease. The third alumnus was Peter Grant ’83, who played high school football and hockey, and committed suicide in 2011. Former Notre Dame star wide receiver Pete Demmerle ’75 died in 2007 after being diagnosed with ALS, but he was not part of the BU study. Demmerle never played in the NFL, opting out after being drafted by the San Diego Chargers.

Dr. James Moriarity, chief of medicine at Notre Dame, has been involved with football since 1987. Although the avalanche of publicity over concussions has brought more scrutiny to programs at all levels, Moriarity says the University is not doing anything different than when he started here 28 years ago. “I really don’t think we have changed our policy; I think we’ve always been ahead of the curve on it. And we’ve always been conservative.”

Notre Dame, he adds, pioneered computerized testing of concussed athletes, to determine whether they can return to the field, and has always followed the accepted guidelines current in all of the various contact sports. And Moriarity says he has permanently barred some injured players from returning to the field.

That said, he concedes that football is a dangerous sport. “You’d have to be an absolute fool to go out on a limb and say it’s safe to play football from a long-term standpoint.” On the other hand, he maintains, unlike McKee, that there is no consensus among medical researchers as to whether concussions and other head injuries cause CTE or other degenerative diseases.

“The research on the long-term consequences of concussions is in its infancy, and I mean infancy. We really do not know,” he says.

He also points to issues besides head injuries. For instance, he says, athletes who have reconstructive surgery for a torn ACL (anterior cruciate ligament), a relatively common football injury, “are almost certain to develop osteoarthritis in that knee within 10 years. That’s a fact.” (Some medical literature I reviewed is a bit less certain but generally recognizes the risk.)

His job carries heavy responsibilities. “There wasn’t a Saturday that went by that you didn’t worry about what was going on on the field,” he says. He adds, however, that the presidents of the University, from fathers Hesburgh to Malloy to Jenkins, along with the athletic directors he has served, made his mission simple. They said: “Your job is to protect the athlete and do the right thing. As long as you do that, we’ll stand behind you. Deviate from that, and you’re done.”

Moriarity predicts that changes will continue to take place to make the game safer and that before long tackle football will not be played until the high school level.

Public opinion

While more definitive medical answers are being sought, the game of football undergoes a bifurcated experience in the public realm. On the one hand are the disturbing medical reports from Boston University and elsewhere. On the other hand is the game’s popularity and its enormous revenues at the professional and collegiate levels. estimates the worth of Notre Dame football at $122 million annually, second only to the University of Texas.

Two Harvard Medical School professors who are heading up a study of football injuries for the NFL Players Association recently took to the opinion pages of the Pittsburgh Post-Gazette, following the NFL Draft, to counter some of what they said was a media exaggeration of the dangers. Doctors Alvaro Pascual-Leone and Lee M. Nadler wrote:

“No one can deny that football carries risk of injury, both minor and severe, and that some former football players struggle with disabling conditions that impact them and their families. Does this mean that we should strike fear into the hearts of the young men being drafted and their families? Does this mean we should end America’s sport?

“Not yet.”

As others have done, they pointed out that the research is still inconclusive. They will be attempting to get hundreds, perhaps thousands of former players to respond to questionnaires about their current state of health.

John Harbaugh, head coach of the NFL’s Baltimore Ravens, took to the team’s website this year with a paean to the game. In part, he said:

“This game asks a young man to push himself further than he ever thought he could go. It literally challenges his physical courage. It shows him what it means to sacrifice. It teaches him the importance of doing his job well. We learn to put others first, to be part of something bigger than ourselves. And we learn to lift our teammates — and ourselves — up together.

“These are rare lessons nowadays.”

Estimates vary widely as to whether fewer young people are playing football. reported a 9.5 percent drop in Pop Warner football between 2010 and 2012, but the National Federation of State High School Associations reported a slight uptick in participation last year after a dip in previous years. Total participation in high school football for 2013-14 was registered at almost 1.1 million. Dr. Julian Bailes, a leading expert on concussions who accepts the evident link between head blows and CTE, said in a 2013 interview with that he still allows his son to play football. Considering the benefits of team play, sportsmanship and sacrifice, he said, “parents and athletes have to weigh the benefit/cost ratio for them.”

A more pessimistic outlook was articulated in the January 31 issue of The Economist. The columnist called Lexington, who comments on U.S. issues for the British magazine, wrote: “During the second half of the 20th century boxing went from being a sport watched together by fathers and sons to something that dwells among the hookers and slot machines of Nevada. . . . Football will go the same way.”

True enough about boxing, but even in its glory years the sport was more occasional than the American ritual of weekly football games, and generally a feature of big cities. Boxing had nothing akin to football’s Friday Night Lights in small-town America.

At least two lines of research could threaten the future of football or save it, neither of them likely to come to fruition in the near future:

Live testing. UCLA, Boston University, the University of Pennsylvania and other research institutions are trying to find a clinically proven technique for determining in living individuals the presence of CTE. Were this to lead to mandated testing by the NCAA or high school associations, it could either minimize or dramatize the potential dangers of the sport.

Medical remedies for brain injuries. Notre Dame Professor Mayland Chang, along with a University of Missouri colleague, is working on such research, supported in part by a grant from NFL Charities. So are others, including Dr. Ping Lu of Harvard Medical School. This would be — no pun intended — a game changer.

Boston University’s McKee believes both of these lines of research could be successful in a matter of years.

Until overwhelming medical evidence proves football is dangerous for most of its participants, she sport will most likely thrive. There’s too much money to be made, too many careers to be advanced and fans to be entertained to say otherwise. The claims and counterclaims of researchers are not likely to be resolved for years. Which probably means public opinion, now still favorable to the game, will presumably be the most important factor in determining football’s future. But from gay rights to the Confederate battle flag, we’ve seen that public opinion in the age of instant communications can change quickly.

Matt Storin is a former editor of The Boston Globe who later served in the administration and faculty at Notre Dame until retiring in 2014.