A League In Denial?

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    Dr. Bennet Omalu   Forensic pathologist who discovered CTE

    A forensic pathologist, Omalu conducted the autopsy of Pittsburgh Steelers center Mike Webster, which led to his discovery of a new disease that he named chronic traumatic encephalopathy, or CTE. He is currently the chief medical examiner of San Joaquin County, Calif. and a professor in the UC Davis Department of Medical Pathology and Laboratory Medicine. He spoke to FRONTLINE’s Michael Kirk on March 25, 2013.

    So, Dr. Omalu, there is a secret meeting, an off-the-record meeting after the Terry Long case where you are told the implications of what it is you were doing. I know you can't tell me who was at the meeting or won't tell me who was at the meeting, but what was said?

    ... So there was a meeting arranged. It was held late at night, around 8 p.m. -- people flew in from different places -- at the University of Pittsburgh Medical Center. There were about seven people at the meeting, so I showed them the slides.

    One of the doctors there was a prominent NFL physician. So after the slide viewing, we started discussing the cases, the implications, and the NFL doctor at some point said to me, "Bennet, do you know the implications of what you are doing?" I looked. He was on my left. I said, "Yeah, I think I do." He said, "No, you don't."

    So we continued talking, talking. At some point he interrupted me again: "Bennet, so do you think you know the implications of what you are doing?" I said, "I think I do; I don't know." He said, "No, you don't."

    So we continued talking again. Then a third time he interrupted me, and I turned to him, and I said, "OK, why don't you tell me what the implications are?" He said, "OK, I'll tell you." He said, "Your work suggests or is suggesting or is proving that football is a dangerous sport, and that if 10 percent of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football."

    So I looked at him. I shrugged about it. And he said to me: "So you need to be very careful. You need to tone it down. Don't speak to the press. Just focus on the science."...

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    Chris Nowinski   Co-director, BU Center for the Study of Chronic Encephalopathy

    A Harvard football player turned professional wrestler, Nowinski’s experience following a debilitating concussion led him to found the Sports Legacy Institute, a nonprofit dedicated to research and education around head injuries. He spoke to FRONTLINE’s Michael Kirk on June 12, 2013.

    One of the great things we talked to Ann about that's just a great story is, she goes to the MTBI [Mild Traumatic Brain Injury] Committee. ... What's your version of what happened? Were you there? Were you invited?

    I was there. I wasn't invited.

    That's even better. So take me to the meeting. Take me to what happens, and what your and Ann's aspirations were and what your experience actually was.

    At some point after the 2009 Super Bowl press conference, the MTBI Committee of the NFL reached out to Dr. McKee and invited her down to present to them. She was being given the opportunity to show the science, and we knew going in that they were doubting it.

    She wanted me to join her because I think she thought it would keep them honest, and she wanted a kind of witness to what happened, because she had no idea I think how they were going to treat her. I think she hoped it would be a great scientific meeting. ...

    So she said, "I'm happy to accept this, but I want to invite -- Chris is going to join me as a collaborator." And they said no. They said, "No, Chris isn't invited." So she said, "OK, well, then I'm not coming," and then they said, "We'd love to have Chris." [Laughs.]So I came and sat with her, and they had a couple of other experts come in, in neuropathology and tau. And she presented her work.

    Take me in the room. Where do you go? What's it like? Is it in the NFL building?

    Oh, yeah. So we're at the NFL headquarters on Park Avenue. We get our pictures taken for security, and we head on up to a very, very fancy conference room, nice wood paneling, jerseys and trophies in the glass. It was probably 15 members of the committee. There were two of their defense attorneys, and there were a couple outside experts.

    We were surprised by the attorneys. But I don't know. The attorneys were very busy taking notes.

    What were they doing there, do you think?

    I think the attorneys were there to figure out what the researchers had and what to be prepared for down the road. They were clearly thinking about it already. ...

    So Dr. McKee presented; Dr. Dan Perl, [then-director of neuropathology at the Mount Sinai School of Medicine and a consultant to BU's Alzheimer's Center], presented; Dr. John Mann from Columbia, [a neuroscientist and psychiatrist who specialized in suicide research]; Peter Davies, [an international leader on Alzheimer's research]. And there were questions about CTE, if it fits.

    The interesting thing about the committee was, you know, the committee had gaps in knowledge. They had different types of experts. What they did not have in that room on the committee were neurodegenerative disease experts who really should understand CTE. I mean, there was traumatic brain injury people. And that was one of the big shifts that happened here, is that we went from talking about this as a traumatic brain injury problem to a degenerative disease problem, and it required a whole different way of thinking and a whole different group of experts.

    I remember at one point one of the NFL doctors asking: "Couldn't you be misdiagnosing this? These all look like they could be frontal lobe dementia." And Ann said: "Well, I was on the NIH [National Institutes of Health] committee that defined how you diagnose that disease. So no, they're definitely different diseases." She had the experience, and they didn't.

    Did you sense a sort of condescension from them, from the doctors? She certainly does.

    As a white male it's hard for me to always pick those things up. I mean, the questions were certainly not posed in a -- always in a respectful manner, I'll say it that way. That's sometimes just how scientific meetings go. Whether it was -- I'll let Ann discuss the sexism part. ...

    The results of the meeting? Any tangible, other than "Thank you and goodbye"?

    No. I think afterward there was a little bit more of a respectful tone through the media. I actually do think that they started believing what they were seeing, started believing Ann. Ann is a great presenter, and she's incredibly credible. And I think there was actually a shift in the room going from "This is all stupid" to "You know, maybe there's something to this." I mean, there wasn't any real follow-up or anything, but I do think there was a --

    And also there was the concern, again, are we being used so they can say we brought them in and what they have is terrible? But it wasn't done that way. ...

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    Dr. Ann McKee   Neuropathologist at Boston University

    Dr. Ann McKee is the director of neuropathology at the Department of Veterans Affairs in Bedford, Mass. In her research, McKee has discovered the disease in dozens of former football players. This is the edited transcript of an interview conducted with FRONTLINE's Michael Kirk on May 20, 2013.

    So when you go, what are you expecting? What is it like? Where was it?

    Well, I'm a little intimidated. It's a big, fancy building. You know, it's New York. And I walk in, and it's a big, long table with a lot of men, almost all entirely men. I don't feel like it's a friendly crowd. But I'm going to, you know, show them what I have. ...

    OK. So you're at the table. There they all are. It doesn't feel -- it's male.

    It's very predominantly male.

    Right. And it doesn't feel welcoming? Is that the word for it?

    Well, they were very polite, but I know what I'm up against.

    What?

    I'm up against a lot of doubters. I'm up against people who don't think that any of this holds any water. So fine. I'm just going to show them what I have. And they kept interrupting. They kept interrupting and saying: "Well, there, see? You don't have -- " They had a lot of preconceptions about what they thought trauma did to the brain. In fact, one of the comments was: "You have no evidence of any trauma. You've shown us this tau, but there's no trauma." And actually, then I did show them that, on the brain of Wally Hilgenberg, there were traumatic lesions. There were what we call contusions. They're indisputable, indisputable evidence of trauma.

    And then one of their biggest problems was, "That pathology that you showed is not anywhere where we would expect to see the effects of trauma, so it can't be related to football." And it was like, you know, just because you have these preconceptions about what trauma does to the brain, this is what the brains show. So I think you might be wrong about where trauma affects the brain. But it was things like that. ...

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    Dr. Ann McKee   Neuropathologist at Boston University

    Dr. Ann McKee is the director of neuropathology at the Department of Veterans Affairs in Bedford, Mass. In her research, McKee has discovered the disease in dozens of former football players. This is the edited transcript of an interview conducted with FRONTLINE's Michael Kirk on May 20, 2013.

    And what's your sense of why they would be so hard on you about this?

    I don't know why they were hard on me. I mean, I think they did not want to believe it. At some point, it isn't so much about the data you present; it's about whether you believe the data. I did feel like it was against their beliefs, and I was going to have to change their beliefs, and they didn't want to. They were convinced it was wrong. And I felt that they were in a very serious state of denial.

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    Dr. Ann McKee   Neuropathologist at Boston University

    Dr. Ann McKee is the director of neuropathology at the Department of Veterans Affairs in Bedford, Mass. In her research, McKee has discovered the disease in dozens of former football players. This is the edited transcript of an interview conducted with FRONTLINE's Michael Kirk on May 20, 2013.

    What's their belief? Football is OK? Football is not dangerous? What?

    This is caused by something else. This is the guy is taking drugs. This is the guy is taking steroids. This is their lifestyle; this isn't football.

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    Dr. Ann McKee   Neuropathologist at Boston University

    Dr. Ann McKee is the director of neuropathology at the Department of Veterans Affairs in Bedford, Mass. In her research, McKee has discovered the disease in dozens of former football players. This is the edited transcript of an interview conducted with FRONTLINE's Michael Kirk on May 20, 2013.

    So how did you feel at the end of it? So you walk out of there. Walk out with us. Tell us what that felt like. How did they say, "Goodbye. That's it. We're done with you"?

    They were very polite, you know. They offered us lunch. You know, "Thank you for coming." Very polite. "We don't believe anything you said," but very polite. (Laughs.) You just sort of decompress afterward.

    Did you think you'd turned anybody in the room, made anybody more aware, broken the ice a little bit with some of them?

    No.

    No change.

    No change. I felt I understood them better. I felt I understood that they weren't on the same page as I was.

    You understood them better in the sense that you knew what you were up against?

    Yeah, I had a better idea how firmly they believed what they believed. ...

    So did it change in any way, or help you come to any conclusions about how hard the road was going to be for you and Chris and anybody else who was involved in this issue?

    I think it just made us more determined. If you really look at it, I felt what my job or my duty was was to let people know what I was finding as accurately and as factually as possible, and if they didn't want to hear about it, I was just going to keep presenting it until people get it. I knew that it wasn't going to be something people wanted to hear. It's not good news, but it's something they have to hear. I think it just made us dig our heels and think, OK, it's just going to be a really long uphill battle. ...

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    Leigh Steinberg   Former NFL agent

    The inspiration for the movie character “Jerry Maguire,” Leigh Steinberg is a former sports agent who once represented NFL stars such as Troy Aikman and Steve Young. In the 1990s, he organized conferences to educate his clients about the risks of concussions. He spoke to FRONTLINE’s Jim Gilmore on March 29, 2013.

    Because I mean, you had invited the NFL to all these conferences.

    Eventually [former chair of the Mild Traumatic Brain Injury (MTBI) Committee Dr.] Elliot Pellman came, I think to the second one.

    2008 I think.

    I think he came there. But the point is that for the entire history of football until then, the NFL denied this was an issue. And there was no way for players to know, because the lead physician was telling them that there was not a problem.

    And his reaction to you?

    I think in Sports Illustrated he called me "a fear monger" or some words to that effect, and it -- guilty.

    And your thoughts on his role?

    What did he know, and when did he know it? What did he know, and when did he know it? If it was ignorance, they should have known. They should have known because the issue is so critical. And there's a whole subtext here which is this feeling that football's somehow different, that men need to be manly; being manly equates to taking insane risk to accepting insane levels of damage, and that any challenge to that way of thinking is unmanly; that rules changes that protect a quarterback are putting a dress on the quarterback; that we're sissifying pro-football somehow; that players are not brave enough, to which I say to anyone who's ever attempted to think that way, if you haven't played the game, go suit up on any practice field and just take one hit, just one, and come back and we'll talk about it. ...

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    Leigh Steinberg   Former NFL agent

    The inspiration for the movie character “Jerry Maguire,” Leigh Steinberg is a former sports agent who once represented NFL stars such as Troy Aikman and Steve Young. In the 1990s, he organized conferences to educate his clients about the risks of concussions. He spoke to FRONTLINE’s Jim Gilmore on March 29, 2013.

    The use of violence, the glorification of violence, what's the effect of that? ...

    ... What's a more powerful image in football than a violent hit? And it began to be a subject that was glorified. There were actual shows showing the hardest hits. NFL Films marketed different DVDs which were The Hardest Hits. The actual logo of Monday Night Football is two helmets hitting together. And it became part of the popular jargon -- you know, "He knocked him silly"; "He knocked him to the moon"; "He rung his bell."

    No one ever concentrated on who was getting hit and what the consequences of the hit were. And remember, if this hit is celebrated, then when that athlete goes back to the locker room his teammates celebrate with him, he's congratulated. He goes to film study, he's congratulated. Every time he knocks someone silly, he receives adulation, so we began to glorify that hit. ...

    So I'm watching players get hit in the '80s and in the '90s, and intuitively it strikes me that something negative must be happening when someone's head is getting hit. But no one in the NFL says there's any problem. As a matter of fact, the league physician in 1994 issues an advisory that there is no evidence that one concussion leads to another, that one concussion in a short period of time combined with another leads to anything that's negative, and that a whole series of concussions leads to long-term consequences.

    So I began to think I can't continue to represent athletes -- and we went to doctors over and over and over again with athletes who had suffered these concussions and asked: "You know, how many are too many? When does this start doing long-term damage? When does someone think about retiring?" They had no answers. ...

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    Related topics:
    The Players Vs. The NFL

    Lisa McHale   She was shocked when her husband, who had never had a concussion, was diagnosed with CTE.

    McHale’s husband Tom, a former Tampa Bay Buccaneers lineman, was the sixth former NFL player to be diagnosed with CTE. Here, she describes her shock at the diagnosis, particularly since she had never known Tom to be diagnosed with a concussion. McHale now works as director of family relations at the Sports Legacy Institute. She spoke to FRONTLINE’s Jim Gilmore on May 21, 2013.

    The legal cases that are going on right now, are you a member? Why did your family become plaintiffs in this case? ...

    I think the NFL does have to be held accountable for their role in this, for their initial reaction for all of this, for their failure to act responsibly when the science was indicating a problem.

    I think they exacerbated the problem terribly by, while they were being warned of certain things, glorifying the big hits. ...

    I think it's irresponsible, I think it's wrong, and I think there's so much more that they need to be dong in terms of protecting younger kids. And then they need to be taking care of the athletes who will have been affected, because of the athletes' ignorance to the risks they were taking in playing. ...

    The NFL still says in 2009 they did come out and sort of say there does seem to be long-term consequences to concussions. But they still maintain that there is not enough evidence to prove that CTE has any connection to football. When you hear that, does it drive you nuts?

    Well, you know, I'd be interested in knowing what they think causes -- you know, getting these guys together and finding another correlation that correlates highly with these guys and not with everybody else than football.

    Yeah, the fact that they can continue to say that to me seems asinine. I think even most reasonable individuals will say, "OK, apparently, it caused it in these individuals, but they might want to make the case, well, for whatever reason, these guys were much more susceptible and that maybe all the other players don't have the same level of risk."

    Honestly, I hope to God they're right. But I think we are just beginning to see the tip of the iceberg in this. I don't think people have any concept how many people are out there struggling. ...

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    Chris Nowinski   Co-director, BU Center for the Study of Chronic Encephalopathy

    A Harvard football player turned professional wrestler, Nowinski’s experience following a debilitating concussion led him to found the Sports Legacy Institute, a nonprofit dedicated to research and education around head injuries. He spoke to FRONTLINE’s Michael Kirk on June 12, 2013.

    Let's go back to [NFL commissioner Roger] Goodell testifying. Your impression of how things went for him that day?

    I think the commissioner would say he had better days. I think he was giving the sorts of answers he gave to the football media that didn't question those answers, and Congress did. They said you run a multibillion-dollar company with injured employees and influence over the most popular game in this country and can't give a straight answer about whether or not you think CTE is real, whether or not -- you know, how you're dealing with this.

    It appears that that appearance made an impression, because what everyone says, the commissioner's a good person who does care about this issue. Although his job is to protect the league, I think he recognizes his responsibility. He's got a responsibility that goes beyond that. ...

    I take it the commissioner, after the hearings in Washington, especially right before the January ones, realizes this is an existential crisis for the NFL.

    At some point between the first and second hearing, I guess the decision was made at the NFL that they would change, and they did a 180 on this. And it happened very fast. I mean, they went from saying this isn't real to it's very clear from the evidence that CTE is an issue and we're going to adjust our game based on the science and try to make it safer.

    And you know, they did a lot of great things, from even just being honest about the risks, putting the poster in the locker room saying, "This game may cause dementia," and some of the efforts they did with the state laws on concussions and being an advocate for making sure young athletes get proper medical care. I mean, all that stuff was really great -- changing some of the rules to the game year after year, experimenting with things. I mean, it's been fun to watch how quickly certain things have changed on the field. ...

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    Dr. Joseph Maroon   Team neurosurgeon, Pittsburgh Steelers

    As team neurosurgeon for the Pittsburgh Steelers, Maroon and his colleagues developed a now widely used test to determine whether a football player should return to play after a concussion. He is a consultant to the NFL’s Head, Neck and Spine Committee. This interview was conducted by FRONTLINE’s Jim Gilmore on April 17, 2013.

    And your overview of the NFL's handling of this? The question, of course, the lawyers want to know is, what did they know, and when did they know it? Your overview of the NFL throughout these years.

    You know, my personal experience with Mr. [Roger] Goodell, [NFL commissioner], with the committee that I've been on, these are all men of integrity. And again, I believe it's to everybody's best interest to protect the players as much as possible, and I think that has been the intent, the intention. Yes, there have been critics; there have been disparaging comments and remarks. And the lawyers clearly have their own vested interest. And we'll see where it plays.

    And many times the future's defined by the dollar to some extent. It has a lot of power. I guess the threat, of course, is that the courts will make some decisions which will change the game?

    Possibly, but not eliminating it. The thing that really distresses me the most is the lessons, but not at the college [level], not at the NFL level. I'm looking at the high school level, where you have 1.2, 1.5 million kids learning leadership, teamwork, never quitting, perseverance, tenacity. These are the things that are missing in the youth of America now. These are the things that -- I don't want to get into our country, but these are the qualities that you learn from participating in team sports.

    And yes, we want to make it as safe as possible, but I wouldn't be here sitting talking to you today if it weren't for that kind of participation. To eliminate those kinds of activities because they're tough, or because you may have an injury, I think is removing an opportunity for the youth of our country to learn those valuable lessons that built the country.

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