Debating the Science of Concussions

by and Steve Fainaru

In September 2006, Roger Goodell took office as commissioner of the National Football League, inheriting the league’s mushrooming concussion crisis. For years, the NFL’s Mild Traumatic Brain (MBTI) Committee, set up by his predecessor Paul Tagliabue, had repeatedly insisted in scientific papers that there was no link between football and brain damage.

In Goodell’s first year in office he decided to hold a conference in order to get up to speed on the issue.

The following is an excerpt from League of Denial: The NFL, Concussions and the Battle for the Truth. Copyright © 2013 by Mark Fainaru-Wada and Steve Fainaru. Published today by Crown Archetype, a division of Random House. Reprinted by permission of the publisher.

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The NFL gathered all medical personnel — team doctors, trainers, neurological consultants — in one room to debate the science of concussions. Also invited was a small group of independent neuroscientists who had become known as “The Dissenters” for openly challenging the MTBI Committee, which they regarded as a sham. The Dissenters included Kevin Guskiewicz, a former Pittsburgh Steelers assistant trainer, and [Dr. Julian] Bailes, a former Steelers neurosurgeon, who had co-authored some of the earliest research showing higher rates of dementia and depression among football players; Bob Cantu, a neurosurgeon and one of the nation’s pre-eminent concussion experts; and Bill Barr, a former New York Jets neuropsychologist, who had come to believe the MTBI Committee had cherry-picked data to make its case that concussions were minor injuries.

The daylong meeting took place in a crowded, 218-seat amphitheater at Chicago’s Westin O’Hare. The audience was composed mostly of white men in coats and ties. Goodell made the opening remarks at 9:15 a.m., emphasizing the NFL’s commitment to the concussion issue and thanking the MTBI Committee for its work. The keynote speaker was Michael Apuzzo, a USC neurosurgeon and New York Giants consultant who had published the NFL’s controversial research in the medical journal Neurosurgery — despite the objections of reviewers like Bailes, Guskiewicz and Cantu. …

Apuzzo gave way to a series of 10- to 40-minute discussions on the topics of the day. Cantu spoke about guidelines for returning to play. Guskiewicz gave a presentation on the risks of returning to the same game. They were touchy subjects, the source of much of the hostility between the Dissenters and NFL. But the atmosphere was civil, even collegial. It could have been any dry medical conference.

Then Barr took the stage. His topic was ostensibly the “Role of Neuropsychological Testing in Return to Play Decisions.” But really he had shown up to firebomb the NFL’s research. As Goodell looked on, Barr repeated his allegations that [Dr. Elliot] Pellman — Tagliabue’s doctor — and another member of the MTBI Committee, [Dr. Mark] Lovell, had left out critical data from a study that supposedly had concluded that NFL players recover quickly from concussions. Barr alleged that the league had tossed out thousands of “baseline” tests that were used to measure changes in the brains of concussed players.

“I said that the data collection is all biased,” Barr said. “And I showed slides of that. Basically I pointed out that we had been obtaining baselines on players for 10 years, and when you look at the study it only included a small amount of data. My calculations were that their published studies only included 15 percent of the available data. Let’s put it this way: There were nearly 5,000 baseline studies that had been obtained in that 10-year period. And only 655 were published in the study.”

Barr hadn’t come right out and said it, but essentially he was accusing the NFL’s researchers of fraud. The implication was that Pellman and Lovell had purposely excluded data that didn’t support their findings. Those NFL researchers were in the room. Pellman was seated in the audience. Lovell, the director of the NFL neuropsychology program, had been asked to make his own presentation to the group. …

Lovell now found himself under attack in front of the new NFL commissioner. Cantu, one of Barr’s fellow Dissenters, watched from the audience, cringing. He’d had his own scientific disagreements with Lovell, but he felt Barr’s attack was inappropriate. “I really felt bad for Mark because I didn’t feel that was the setting to be exposed to all this,” Cantu said. Lovell tried to rebut the allegations. He told the audience that he had used all available data at the time of the study and that it was unclear why he might not have received all of the information.

The next scheduled speaker was Joe Waeckerle, a Kansas City Chiefs doctor and member of the NFL concussion committee. Waeckerle was scheduled to present a 10-minute “Editor’s View of the MTBI Research,” but according to Cantu, Waeckerle instead announced to the audience: “Well, we now have these ethics issues to assess.”

The NFL’s concussion summit had suddenly turned into an informal ethics inquiry, with Lovell as defendant.

At one point, according to Lovell, Barr was asked about the missing data: Did the NFL have them or not?

“Yes,” Barr replied, according to Lovell.

Barr said he did provide data to Lovell, but only up to 2000 — four years before the paper was published. After that, he said, he was never asked for the information. As a result, the league had only part of his data. He said Lovell and Pellman never set up an organized system to collect all the data that were being compiled by the individual teams. But when the NFL wrote up the study, it implied that the data were comprehensive.

The room debated the ethical questions surrounding the controversial study before deciding that Lovell hadn’t done anything wrong. “It came down in favor of Mark,” said Cantu, who was still uncomfortable with what had just unfolded. “The net effect was that he got exonerated in the open forum. But there was enough said before that it just was awkward, to say the least.” Barr agreed that the consensus was that Lovell “didn’t do anything intentional to not put data in there, but I don’t think anybody concluded he did a great job on that research.”

As the session broke up, Barr left the stage and made a beeline for the bathroom. “I had to take a wicked pee,” he said. As he walked out of the amphitheater, neuropsychologist Micky Collins, Lovell’s protege and business partner at ImPACT, followed him outside, fuming.

Collins chased down Barr before he could make it to the men’s room. “What are you doing!” Collins screamed, according to Barr. “You’re ruining everything! You’re an idiot! Everybody hates you!”

“He got his nose right up in my face, like managers in baseball when they get in the face of the umpire and they want everybody to know they’re arguing,” Barr said. “I’d never had anything like that before — where somebody is just right in my face.”

“Calm down, man,” Barr said he told Collins. “Micky, I feel like you’re going to hit me or something.”

Barr looked down the hallway. Television cameras were hovering nearby. Collins began to calm down, he said.

“You don’t understand what we’re trying to do,” Collins told him. “We’re trying to do good.”

“Micky, I don’t believe in the science you’re doing,” said Barr. Collins suggested that he come to Pittsburgh to see how he and Lovell worked [at ImPACT].

“Micky, you’re talking to me like you’re trying to convert me in a religion,” Barr said.

“You know what? It is kind of a religion,” said Collins, according to Barr.

Collins acknowledged that he had confronted Barr but said he never raised his voice. He said he was upset about Barr’s shabby treatment of Lovell.

“Bill, Mark Lovell is the most ethical human being I’ve ever met,” Collins said he told Barr. “For you to attack him is wrong. You look like a buffoon.”

Collins said he never compared ImPACT to a religion. “I would never use that language. That makes it sound like a cult; it’s creepy.” He said he merely told Barr that people gravitated to ImPACT “because it works.”

The NFL’s much-anticipated concussion summit already had featured an ethics probe and a near brawl involving two neuroscientists.

And it was only lunch.

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