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There is something sacrosanct about the game itself. It celebrates our ideals of battle and victory. It touches the divine, and not in just the inhuman abilities and sizes of the players. The numbers of fans bear this out. They not only find entertainment; they invest their passions in it. Many fans, in all outward appearances, worship the players, and treat the teams as a personal, religious, and tribal brand. Better than discussions with in-laws over Thanksgiving dinner, where all these aphasic dogmas compete, in the matter of football, one clearly wins. Religion, ethnicity, and team are even explicitly linked in some colleges: Go Irish!
A touch of the divine may explain why Mr. Thomas’s death and neuropathology have been met with words of no consequence, no change, and certainly no moratorium. Currently the NFL takes “no position” on low-velocity head impacts—impacts that, though they do not cause concussions, can cause CTE. Proposals so far have been designed around a single desire: Do not upset the boat. “Better helmets” are a laughable solution, as if any helmet could eliminate the full inertial force of a charging offensive lineman. Who knows, it might be paradoxically more sensible to have worse helmets, so the players routinely feel the impact’s force as nature intended, and consequently modulate their play. Sensors to measure helmet force and accelerations are the best start in a good-faith effort to collect data, but without medical outcomes, the numbers have no context. One NFL study will compare 120 retired players with 60 players with no game time. The study’s design is telling: a “placebo” group with nearly the same exposure, chosen to deliver negative results.
There is a “head, neck, and spine committee” that tries to keep things as safe as possible, akin to making a playground safe without getting rid of the hungry Grizzly bears. There is a new, moderately sensible policy about visible concussions: When symptoms surface in a player, that player cannot get on the field for one day, and the player must be examined and cleared by a neurologist before suiting up again.
How like theology it all is. With no effects on low-impact injuries, these words, studies, and positions allow fans to feel better about their revered amusement. The thousands of coaches, vendors, journalists, and merchandisers turn to their next tasks. Among all those who don’t wear the helmets, there is a serious moral hazard.
In my business, medicine, if a product caused a brain disease or death, then we would immediately work to define the risk. We would get the numbers, quantifying how many individuals are harmed compared to how many are exposed or treated. We would quantitatively define any resulting neurological damage and deficits, and try to define safe behavioral thresholds. Finally, we would perform a calculation: Do the risks of the product or behavior in question outweigh its benefits? Medicine is hardly perfect in this regard, and in the places it fails to quantify risk, faith-based reasoning reigns: witness herbal supplements.
But risk can be downplayed, especially if the culture doesn’t want to hear it. Adherents assign infinite benefit to something seen as divine. In relation, any evil can be permitted. Outright denial is the chief danger and most common tactic in the face of anything that might disrupt wishful thinking. A perceived immunity to risk is rarely an actual immunity to risk.
It is temporal distance from the human-sacrificing Aztecs that allows us to find their practice abhorrent, an example of a culture worshiping death and false celebrity. They were unable to elevate their culture out of Stone-Age technologies, unable to address their problems. Because they could not improve themselves with new medicines and new technologies, or put an end to their puny internecine wars, their empire came to an end. Yet they found their behavior reasonable. They were invested in their religion and culture, and found themselves as normal as we find ourselves.
We also declare ourselves different and more civilized than those today who watch dogs fight to the death, and those who in the ancient world watched gladiator death matches. We like to imagine there is a comfortable margin. After all, most of us watch these events via divine technology, each of us a modern Zeus, removed from visceral immediacy in the Olympus of our living rooms. But our view is suspect. The TV’s divine eye feeds an unchanged, insatiable, human lust for blood sport, death, and celebrity. When considering the victims, Owen Thomas and others like him, it is difficult to distinguish between their game and those we pretend to be so different.
What is the good? And where does it lie? I do not know. I am not a moral philosopher. Nor am I a fan, nor one whose salary depends upon not understanding football’s risks. I am a neurologist. Perhaps I place too great a value on brains, not enough on selling cars and beer, and not enough on divine amusements.
Other societies display barbarism, which is supported by seemingly sacrosanct cultural inertias. People fight cocks, kill albinos, or mutilate genitals. You can usually find internal efforts to stop these abominations. The efforts seem a far fringe and minority view. This isn’t, however, such a far fringe view for football. The American Academy of Pediatrics’ guideline on concussions has this to say, “When in doubt, sit it out.” Most see the wisdom when applied to concussed individuals. Current data introduces doubt into the perceived safety of multiple low-velocity impacts. It is reasonable to apply the same guideline to football in general, from junior-high to college and beyond.
I don’t anticipate action, even to sit out developing brains until we know more. Nor do I predict a ban on tackles, a weight limit, or an upper limit of traumatic exposure. What does it say about a society without support for a moratorium or limitations on this game? The silence is unflattering, as millions turn to their TVs.
Originally published January 11, 2011
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