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Dr. Joseph Maroon

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.

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.

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    Let's start off talking about your role and your history with the Pittsburgh Steelers.

    ... In the early '80s I was invited by [team owner] Mr. Dan Rooney to consult with the Pittsburgh Steelers relative to head and neck injuries. These were the days of Joe Green, Lynn Swann, Terry Bradshaw. I was asked to evaluate the individuals when they had concussions or neck or low back problems. Subsequently, in the mid-80s or so, I was asked to be the official team consultant in their surgery to the Pittsburgh Steelers. At that time Coach Chuck Noll was the head coach.

    Those were pretty amazing times.

    Well, they certainly were. Four Super Bowl championships in the '70s, and some of the greatest athletes to play football in the NFL.

  2. Ψ ShareOn the development of the ImPACT test

    You at some point felt that football needed more objective information in the case of the concussion, that we didn't know enough. Define why. Why did you come to that conclusion? How did that come about?

    ... In 1990 I told Coach Noll that his starting quarterback couldn't play the next week. I think it was the Dallas Cowboys at the time. He said,"why not?" I said, "because he had a concussion." The guidelines at the time indicated that with a concussion a minimum of two weeks of rest and non-contact was in order

    And he [Noll] challenged that. He said: "He looks good to me. He knows his plays. He's very active and has no complaints. If you want me to keep an athlete from playing football, you have to give me objective data, not your opinion or some specious guidelines." I was somewhat affronted by that and taken aback. Here's a coach telling me, a brain surgeon, when an athlete should or shouldn't play. And when I thought about it a little bit more, he was right.

    So I went back and thought about it, and I called my associate, Mark Lovell, who is the chief of neuropsychology at that time at the hospital I was practicing in, and I said: "Mark, here's the problem. What objective data do we have that I can say very reliably, 'You shouldn't play football'?"

    Mark, studious, the scholar that he is, went to the library, looked at all the literature and determined that there were no good psychological tests, cognitive tests, that we could administer at the time in an easy manner to effectively obtain the data that Coach Noll wanted.

    So he created a series of cognitive tests and reaction-time studies that I went back to Coach Noll, and also Dan Rooney, and I said, "If you really want objective data, we need to baseline the whole team." And they thought about it and said, "OK, if you think that's the best way to go in terms of preventing injuries, then you do it." And we did do it.

    Over the next three to four years, we continued to refine the test, and the Steelers then became the first team in the NFL to use neuropsychological testing as a tool to help assess when an athlete can return to play.

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    Tell me the story about Merril Hoge and his situation, and the leaving, coming back. He was one of the guys that you first did these tests with. Explain that story and what it resulted in.

    Well, Merril Hoge was on the Steelers' team when we went back, and Mr. Rooney and Coach Noll said, "You can test the team." So we baselined Merril Hoge. We had a neuropsychological baseline. Then when he was traded to the Chicago Bears and had a concussion with the Bears, he came back to us for evaluation because we had a good baseline. At that time there was a marked disparency between his baseline and his subsequent taking of the test.

    Twenty-nine years old.

    Yes.

    What do you tell him?

    Again, you have to assess each individual individually in terms of their total concussion history, their complaints, their symptoms. We learned that Merril had had previous concussions, and that the effects of this last concussion were lingering for several weeks and longer in terms of his ability to concentrate. His attention span, his reaction time were all significantly diminished, and for a prolonged period of time. And at that time we sat down with him and we said, "Look, we think you may be at additional risk if you return to play and have another concussion or more in terms of long-term brain effects."

    So what happened?

    So he heeded our advice, and he decided to give up his football career. And the rest is history, as you know. He got into a much better career in terms of an ESPN commentator.

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    The worries over long-term effects -- what did you mean by that? What were your worries? What were the concerns at that point?

    As neurosurgeons, we've known for many, many years that blows to the head can lead to long-term permanent sequelae, usually in the context of relatively severe injuries -- car accidents, motorcycle accidents, running into bridge abutments and things of this nature. So that clearly it's been recognized that you can have major personality disturbances, cognitive processing from head injuries. And we now had an objective way to actually measure that and take precautionary measures as need be. ...

  5. Ψ Share
    Others on this topic:
    CTE: Discovery of a New Disease
    The questions that remain about CTE

    Let's talk about CTE [chronic traumatic encephalopathy], because it's the most confusing element of all of this and of the arguments that are out there. CTE to some extent brought a lot more attention to the issues. When you saw the CTE debate coming up, what were your thoughts? Is there a positive/negative side of what has been said and sort of what the debate has been about so far?

    I think that they're both positive and negative. Clearly, the papers by [Dr. Bennet] Omalu, by [Dr. Ann] McKee and others now have brought a focus and a heightened awareness of the potential problem of multiple concussive or subconcussive blows.

    Initially, not only I but other independent, non-NFL affiliated individuals commented on the papers and thought that there was overreaching, overstatements, extending the observations too far. And I think clearly as it's evolved with more cases, we're learning more about it.

    But there still is no consensus on the clinical diagnosis of this prior to an autopsy. And there's also discussion on both sides of the fence on the neuropathological substrate that is indeed purported to be CTE.

    Explain. What do you mean by that?

    Neuropathology is the study, looking at the brain tissue, in this case with special dyes and special stains. In the first case reported, for instance, there are two criteria for the diagnosis of Alzheimer's disease, if you would: the beta amyloidal plaques, which are proteinaceous sticky things that cause inflammation in the brain, and the neurofibrillary tangles, which are the disintegration of the tubules, the microtubules in the axons of the brain that die and cause inflammation.

    Some brains have a lot of amyloid with CTE; some have a lot of neurofibrillary tangles. And there's no uniform pathological substrate underlying diagnosis that's uniform in all of these cases. There's no uniformity in it, which is debated by neuropathologists in the various papers recently published.

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    Explain to me, because I think it's very important, CTE, the idea that this is this new disease or however you would want to define it, is out there. It's sort of on the outskirts of all the research that had been done before. ... This is more looking at the long-term effects and therefore in some ways is more difficult to understand, and possibly a more dangerous illness in some way. In fact, in some ways, if some of what Omalu is saying holds true, it kind of refutes the idea that you're safe as long as the concussion is handled correctly or not. Explain to me from your point of view how CTE changes the argument or doesn't.

    I don't think CTE necessarily changes the argument. I think what CTE does is it sharpens our focus, and it makes us perhaps more careful, more fastidious about how we evaluate the particular athletes.

    I don't think contact sports are going to be thrown away or given up because of the fear of CTE. Possibly. There are inherent risks if you drive in Indianapolis 500 if you're an Nascar race driver, and if you play football or lacrosse or soccer, there are inherent risks of head injury.

    I think the best that we still have is if there is a concussion, if there is a transient disturbance of neurological function, one should not return to that game or that contact [sport] until there's a completely normal neurological examination, [until] the patient is asymptomatic and you return to baseline on your neuropsychological test.

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    But if it's subconcussive hits that are the problem, and you know football is based on thousands and thousands, in every single play there's subconcussive hits of some sort, is that more difficult to handle, in a way? ...

    I think we're very early in the evolutionary understanding of CTE. We don't know the other confounding factors. A certain percentage of the individuals diagnosed with this have had steroid abuse, alcohol abuse, other substances abuses. We don't know the concussion history in many of these, and there may be other confounding factors in terms of the genetics that we simply don't understand.

    Clearly it's a contribution in my opinion. It's sharpened our focus, and it's helped us actually develop better guidelines for managing these individuals.

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    You talked about it a little bit already, but when Dr. Omalu put out his first report in 2005, what was your opinion of it?

    My opinion was, this is an incredible observation. I think it was an important paper, and very similar to Daniel Kelly, who was a neurosurgeon in California, Alex Valadka, who is a neurosurgeon in Texas who read the paper, and he was asked by the editor to review the paper. They both stated that we have to be careful in extrapolating this to all of sports, that more studies are needed. It's a very good, interesting scientific paper; more studies are needed. ...

    ... I know you weren't a member of the MTBI [NFL's Mild Traumatic Brain Injury Committee] or anything else at that point, but did you think it was appropriate for the NFL to demand a retraction?

    Well, again, if you read what the people of the NFL wrote and what the comments were by those who disagreed, I think there are two positions with it. That was a very aggressive approach by the NFL to demand a retraction. And I think Dr. [Kevin] Guskiewicz and a few other commenters on that felt the same way, that there were very good points made in that editorial written by the individuals, but possibly overreaching. ...

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    There were a couple of things that Omalu says which are certainly pushing the envelope. One of the things he told us, and I'd love to get your opinion, we were asking him, so how much is this a problem? For instance, if you were talking about the NFL players playing today, what percentage of the NFL players probably have some sign of CTE in their brains? And he said to us, "All of them." Is that an example of what you're talking about? What's your opinion of that type of statement?

    I think that there's absolutely no scientific basis for saying that. Now, it could be his impression and his opinion, and he's entitled to his opinion, but in terms of any scientific basis for that, absolutely zero. ...

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    You eventually become involved with the meeting. I think you were helping to set it up with Omalu and Dr. [Julian] Bailes and Dr. Peter Davies and yourself. Why did that come about, and your involvement in it? Take us to that meeting. What were the goals?

    Well, I think with the papers that were being published and the observations made, clearly in the interest of protecting athletes and finding as much as we could about this problem, it was very reasonable to have someone like Dr. Peter Davies, who was a professor in the pathology department at Einstein Hospital in New York and an expert at Alzheimer's and neurodegenerative disease himself, he was selected as an independent observer to view the slides of Dr. Omalu relative to seven individual players that have been diagnosed to date at that time.

    Being an associate and colleague of Dr. Bailes, who was an associate of Dr. Omalu, I was asked to put together a meeting with Dr. Davies so that he and I could meet with Dr. Omalu and Dr. Bailes at the WVU Medical Center in Morgantown. On Oct. 1, 2008, we went there and indeed had the opportunity to review the slides, the actual tissue slides of the brains of seven NFL athletes and one pro wrestler who had been diagnosed with chronic traumatic encephalopathy.

    And your thoughts going into the meeting, and how they changed or evolved or stayed the same as you were there, with what you were saying?

    Again, as a neuroscientist, I'm always looking to gain new information, new insight into ways that I can better do my job. So I felt that this was a very important meeting to have the opportunity to look at these individuals' brains so that when we were reviewing these -- kind of eerie in one sense, having personally known some of these individuals.

    But it was a very worthwhile meeting, I think, and very cordial, very open and an honest, open discussion.

    What came out of it? ... What did you think afterward? Did you change your mind in any way whatsoever?

    I wouldn't say it changed my mind. It actually opened up my mind to even more questions. In comparing each of the brains and noting the number of abnormalities, the neurofibrillary tangles and the beta amyloid plaques, which are the hallmarks of neurodegeneration in a brain, when we compared all seven of these, there was non-uniformity. There was one or two brains [that] had more beta amyloid plaque; others had neurofibrillary tangles; others had both. The genetic markers, the apolipoproteins that were measured in the blood on these individuals, was not indicative of the marker that usually is associated with neurodegeneration.

    So the non-uniformity, the various histories, the genetic markers not being what we thought they would be actually resulted in more questions for me than answers.

    In what way? What did it tell you? What did all that evidence seem to tell you?

    Well, there appeared to be something -- clearly, they were not normal brains, clearly. So we had an abnormality here. But I don't think at that point it was really clearly defined. ...

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    The last thing about the meeting, it's been widely reported that one of the things you said to him was, "Dr. Omalu, do you know what this means?" And I just wanted to ask you, what did you think it meant?

    Well, here we were looking at these eight athletes, and my question was just that: What does this mean? How prevalent is it? What are the causes? Are subconcussive blows really what caused this? Are there other factors that may be involved?

    So it was really a question: What does this mean? Clearly abnormalities. And it was a rhetorical question for myself as well in a sense of we clearly need to study this more.

    Because of the potential ramifications?

    Clearly the potential ramifications. We're seeing it today in terms of the athletes who are much more aware. There's a major cultural shift that's occurred in the NFL over the last eight to 10 years because of this and because of the work of many investigators in terms of the awareness of concussions.

    When I first started in the NFL in the '80s, early '90s, it was smelling salts, shake it off, and the athletes would frequently deny any types of concussion injuries.

    Now, much more frequently, they are coming to the sidelines saying, "Hey, I got dinged," or, "Hey, I'm a little foggy." They don't want to be put in the position that in the past athletes simply didn't give it a second thought.

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    How different is this game on the sidelines than it is when you're watching television? How much more violent does it seem? How much has it changed, or has it changed over the years? ...

    It's a very serious game, and it goes back to the high school physics principle that force is equal to mass times acceleration. We now have much bigger masses. We have faster fields. We have faster athletes. And we have much greater forces. And these forces get translated into knee injuries, shoulder injuries, head injuries, neck injuries. And the quickness, the speed of the game, the speed of the athlete all contribute to what is surprising not more injuries.

  13. Ψ ShareOn joining the NFL's Mild Traumatic Brain Injury Committee

    Let's talk about MTBI a little bit. We talked to Steve Young a little bit because he, of course, was one of the -- it was [Troy] Aikman and Young and Hoge, of course, and others that sort of motivated people first, I suppose, or early on to sort of talk about the seriousness of concussions. It also led to [then-NFL commissioner Paul] Tagliabue just to create the MTBI. Just tell me a little bit about that important point and why the MTBI was established.

    I think it probably really started with Al Toon in 1992, wide receiver for the Jets, who ended up having problems with concentration, memory, attention, and ended up retiring, probably prematurely, because of that. And then subsequently Merril Hoge, who, again, had post-concussion syndrome.

    From the historical accounts that I've read, Tagliabue decided at that point that this is an issue that needs to really be looked into. And at that time the MTBI Committee, [Mild] Traumatic Brain Injury Committee of the NFL, was formed with the express guidelines of looking at the epidemiology, the biomechanics, the equipment and all aspects relative to concussions and concussion prevention, as well as neck prevention. ...

    You don't become a member until 2006. At that point when you join, what's its role, how it's run, and just how it was organized so that it helped to advise the NFL? What were the dynamics of how it was created or how it was run?

    It was a large group, cross-sectional physicians of neurologists, emergency medicine physicians, neurosurgeons, neuropsychologists and biomechanical engineers who all had the absolute purpose of what can be done or what should be done to prevent head and neck injuries in the NFL, and looking at the epidemiological data, the previous studies that have been done, and then what action needs to be taken or can be taken realistically to prevent head and neck injuries.

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    And why was it important for this committee to publish its reports, the famous 16 reports that were put out? Why even should they be the ones that were putting out those reports?

    Well, I think it's an indication of the seriousness and the intent of the NFL and the committee to share the data that was accumulated in the NFL with other individuals, other scientists, other schools, colleges, high schools, again for the express purpose of hopefully preventing injuries.

    And your grading of the papers in general -- positive, negative, having had some problems -- how do you view those papers?

    Well, I think as in all scientific papers, they published data that was somewhat difficult to gather from multiple teams, multiple positions, sometimes different guidelines in terms of definitions. But there was a very serious intent to do the best they could with the data and extrapolate the facts in as honest a way as they could.

    And these data were published in a journal, Neurosurgery, which is an international journal of neurosurgery. One of the great things about that journal is that they invite critics to read the papers, comment on the papers, and the positives and negatives are right there in print by similar experts, both praising and at times castigating the results of the article. But the whole purpose is to build a foundation of information and data that can be kicked around a bit, that can be modified. It can be eventually refined and accepted.

    So your overview, then, of the debate over the fact of whether the NFL should or should not been doing these reports? Some people say it was the best science at the time; other people say it was questionable industry-funded research and suggest it was something like the tobacco industry doing studies about lung damage. What's your overview?

    Again, I think that's -- these critics have their own way, have their own reason for criticizing that. It's like Pfizer publishing a paper on Lipitor, the most common drug used for lowering cholesterol. If you pick up The New England Journal of Medicine, every week there's an article by a drug company publishing data that they've done from very large controlled studies. The reason is they have the funding to do it. If in today's world you try to get funding to do a study that the NFL did through their NFL charities and the grants that they made to the charitable contributions, [you] probably would never get done. So I think they were doing the best they could with the resources at the time. ...

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    The other point that was made was, the concussion does not involve significant risk of a second injury. How do we view that? The other thing was the chronic cumulative effect; there were none; that in fact that was not a problem. Are those incorrect as we view them now? Were those overstatements? Was there a bias there?

    Well, even today, if a concussion is managed appropriately, meaning complete absence of symptoms, complete return neurologically, complete return to baseline, there's some question as to whether or not there is additional -- well, first of all, we feel that it is safe for these individuals to go back to playing whatever sport it may be. We don't think there's a significant additional risk if all of those guidelines are being met. If those guidelines aren't being met, then I think there is significant risk.

    But that ignores to some extent this issue of CTE, doesn't it? And again, I understand that we don't know enough about CTE. But doesn't that statement, to some extent, ignore the possibilities of damage due to CTE?

    Not really. If the only way, according to those who are postulating that CTE is due to subconcussive blows, the only way to eliminate that possibility is not to play contact sports, it's the only way, we don't know the risk, is my point. We don't know the risk. We know the risk if you go back before your brain is cleared. Yes, the problems are more likely to occur. But if there's been complete clearing and return to normal, we don't know the risk.

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    This is the quandary. This is the big question. How long do we wait to get an answer about what the risk really is then? Because it seems to some extent, we don't totally know what the risk is here due to a lack of studies that sort of definitively define what the ill effects of CTE are.

    Let's start with what we know. We know that if an athlete returns to a contact sport while still symptomatic, not returning to baseline in ImPACT [Immediate Post-Concussion Assessment and Cognitive Testing], and not having a normal neurological examination, he's at risk of having significant brain damage. That's why Merril Hoge, that's why others have been kept out and advised to not return to sport. We know that.

    We don't know, if an athlete has had a concussion and completely cleared and goes back to playing, what is the risk of him developing CTE.

    We believe it is extremely small because of the millions of athletes -- at the high school level, 1.5 million a year; at the college level, 250,000 a year; at the professional level, 2,000 a year -- who have played football and haven't developed CTE. I had three concussions in college playing for Indiana University. I'm interested in CTE. Is there long-term effects? But I think the incidence has to be extremely small.

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    One of the other things in the statement that the NFL was making back then -- and we're talking really 2007 up to 2009 -- is that there were no long-term effects as long as concussions were handled correctly. But doesn't the Merril Hoge case, to some extent, define that that is not always the case?

    Well, again, referring back to that paper, they said they did not detect any long-term effects, that that was really in the course of probably no more than a year or so in which they were monitored. And not only Dr. Guskiewicz but I also challenged that statement, because they didn't have the long-term data to make that statement.

    Again, it's like Dr. Omalu saying, "Everyone who played in the NFL has changes of CTE in their brain." There's no data to support that. And the NFL at the time didn't have long-term data beyond a year. They didn't see any long-term effects in that period. But that was the situation.

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    So do they have a problem then? Because one of the things that they did during that period of time is every NFL player got a brochure that was handed to them from 2007 to 2009 that defined the fact that there is no worries about long-term effects as long as concussions are handled correctly.

    Well, at the same time they gave out that brochure, they stipulated and added new criteria for return to play, and we said those in terms of completely asymptomatic and normal neurological examination and return to baseline on your ImPACT test.

    Based on those facts, we do not know if there is a long-term effect from playing after you've completely gone back to normal. We don't know that. We don't think so. The data that they had at the time did not show that there was a long-term effect, but that's why we need more studies.

    The reason I bring it up is because the lawyers, they point to this brochure as being a smoking gun, that it was unfair to the players not to define this more clearly. And what they will argue is that it kept in the dark the players who were playing from 2007 to 2009; that in fact the reality was that the scientific data wasn't there to make that statement.

    I'm not going to get into a legal argument here. But I've worked with NFL players for over 20 years now, and I don't think I've ever met one NFL player who didn't know that if you got hit in the head too hard you could have a brain problem. And I don't know one Indianapolis 500 or Nascar driver who doesn't know that if you have an accident you can get hurt. So I'm not sure what the implications of that are.

  19. Ψ ShareHow the NFL is addressing youth football safety

    ... What's your overview about the concerns that the right message is sent down to younger players by doing what's right on the NFL level?

    My perception is that the NFL is extremely sensitive to this issue, and they've done multiple things to address that. And working with the CDC, communicable disease center, they have videos, they have instructions, they have all sorts of aids that go out to high schools, to colleges, to even the Pop Warner, the youth leagues, informing them of proper blocking and tackling techniques, the management of concussions. They've been very supportive of the laws that have been passed now, I think in 48 states, in terms of proper management of concussions.

    They've promulgated with the NFL teams a buddy system, and if a player on your team looks like he has a concussion, they're encouraged to tell the coaches, to tell the trainers, "Hey, this guy looks like he's not functioning correctly." So I think that they've been very sensitive to this. They've been very proactive and doing an awful lot, aware of the responsibility that trickles down to all of the other teams.

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    Did you believe at the time, or was it the general consensus that NFL players were different than other people with concussions? Define that for us. ...

    ... In terms of the return to play, which I think is what you're referring to, returning to play quicker with less long-term effects, and the speculation has been why.

    One of them may have been the fact that some bodies, that those more concussion-prone individuals have been weeded out, if you would, before they got to the NFL. They're more tolerable to traumatic injuries -- and that could be any number of factors from genetic or otherwise, that they're responding better. We know that the older brain is more tolerant, older in terms of the age of the NFL players versus youth; they're more tolerable to concussive blows. And they do return quicker and are less injured with the same types of blows. So all of these factors were speculated as to why they had lesser long-term problems.

    And is that still the belief? ...

    I don't know if it's a firm belief. It's an explanation why they may have fewer concussions and respond seemingly quicker than a high school player, for instance.

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    So the data that's coming out and sort of as more was being understood, how did you bring that home to the Steelers? How did that affect the day-to-day affairs when you were working with guys at the Steelers?

    We've been rather I would say assiduous about handling concussions with the Steelers in terms of our ImPACT data for many years. When an athlete had a transient disturbance of neurological function, a concussion, the trainers, the other team physicians, were very careful and certainly erred on the side of caution whenever we would return an individual to play. So I think it's made us even more sensitive with the latest information coming out, not radically changed what we do.

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    Tell me how your feelings about subconcussive hits have evolved over the past years. Has there been much movement in the general sort of overview?

    I think that's another thing the NFL has done in terms of practice. They've reduced the number of days for actual contact during practice and sensitive to the possibility that subconcussive blows -- But if I did this, that's a subconcussive blow to my head. A subconcussive blow is like a fever. Is it 103, or is it 99.9? There's whole variations in this, and it's all lumped together. I'm not sure I know what a subconcussive blow is in terms of the physiology of the brain. I don't know.

    Does anybody?

    I don't believe so. I mean, this -- I've just had a subconcussive blow. I've hit myself in the head. I'm not unconscious. I don't have any dementia. I don't have any processing problem. And I'm fully alert. But that is a subconcussive blow.

    I guess the point is, every individual is different, and levels are very difficult to ascertain at this point with the information that's out there.

    Yes, we definitely need longer and more detailed studies of this. ...

  23. Ψ Share
    Others on this topic:
    The Future of Football
    What's the future for football?

    So lastly, you look into the future of all this, and what do you see for football? What are your worries? Where do you think we will be five years from now?

    I think we're already seeing significant changes in the game. If you look at the rules changes that have been made in terms of kickoffs, in terms of the running backs, in terms of protecting the quarterback, in terms of different kinds of hits, we're seeing major rules changes. I think we're going to continue to evolve in terms of equipment protection. I don't see the sport disappearing.

    Theodore Roosevelt in 1905, as you well know, convened a meeting because there were so many injuries and so many deaths in football that it led to the NCAA being founded and subsequent major changes.

    And I think what's happened, we're in this period of history in the last 10 years with [clinical and executive director of the University of Pittsburgh Medical Center Concussion Program] Micky Collins, with Mark Lovell, with [Sports Legacy Institute co-founder Robert] Cantu, with Bailes, with Omalu, all of us, it's been a major cultural shift.

    We've had congressional hearings. We've had laws passed in 48 states. It's a major cultural shift in sports, particularly related to football, in terms of trying to protect the athletes. I don't see it disappearing, but we're going to see continued change.

  24. Ψ Share
    Others on this topic:
    A League In Denial?

    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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