Concussion Inc. (32 page)

The Marinellos and Bissingers have to be careful, though, because their positions get appropriated by yahoos and libertarian wackos. In Bissinger's case, he has written movingly about the passion play of football in places like Texas; if he is saying that elites are acting drastically when they seek to tamper with popular mass entertainment on the basis of intellectual abstractions, he has a point.

But I don't think the evidence of epidemic health damage to American youth is any more an abstraction. At the very least, the fatalists and the idealists need to join forces to remove the blinders from the deniers.

Here's your Michael Vick medical report, Version 2.2:

Today Philadelphia Eagles coach Andy Reid said Michael Vick “has a hand contusion — not a break.”

What Vick has for sure is bruised feelings.

What he might also have is another concussion, days after being cleared by an “independent neurologist” whom neither the Eagles nor the NFL will name.

30 September 2011..........

Michael Vick medical reports are subject to further review, like Vietnam War body counts. But as this article was being written, he was assuring one and all of the “100 percent chance” that he will start Sunday's game at quarterback for the Philadelphia Eagles. Since the 49ers are the Eagles' opponent, Bay Area television viewers will be complicit in the next rubber-necking twist of the increasingly grotesque Vick saga.

Reformed criminal, repentant canine abuser, astonishingly gifted athlete … Vick brings the whole package to the uniquely American story of industrial death and disability in sports. An unsound mind in an unsound body.

Two weeks ago, he got knocked silly when he was thrown into his own lineman in a nationally televised game. However, the NFL's cowardly partners at NBC didn't dare call it a concussion. The “C” word, you see, is nearly as taboo as “Voldemort” was for Harry Potter's friends.

After an “independent neurologist” cleared him, Vick got rushed back to the starting lineup last Sunday. My pleas to the Eagles and the NFL to provide the name of this vigilant descendant of Hippocrates went unheeded. Where did the “independent neurologist” get his medical degree, I wonder — a correspondence course in the Bahamas?

Perhaps the “independent neurologist” will apply for a position on the panel of experts soon to be appointed by the federal Centers for Disease Control and Prevention, and charged with developing national guidelines for management of concussions in school sports programs. If he's not available, then I'm sure Joseph Maroon of the Pittsburgh Steelers, the University of Pittsburgh Medical Center, and World Wrestling Entertainment — whose team carefully reviewed Vick's neurocognitive results last week against his “baseline” tests — will be glad to buckle up his chinstrap.

Even before Vick got knocked out of the game with the New York Giants by a hand injury, he was fuzzy and ineffective. “Not right today,” “just didn't seem like he was 100 percent,” “something was off,” Fox professor of footballogy Howie Long mumbled.

Vick first complained that NFL referees weren't giving him his fair share of roughing-the-passer penalties. Then he took it back.

The Eagles first said Vick's right (non-throwing) hand was broken. On Monday, they said nah, it was just a boo-boo. Darn that ancient and unreliable X-ray technology!

So the next installment of the Vick soap opera,
As the Stomach Turns
, resumes on schedule. “From where we sit — contusion or break — Michael Vick must sit this week. He needs to get his mind and hand right,” Philadelphia blogger-columnist Frank Ward wrote. From where
we
sit, in front of our TV screens, he has to play. There are NFL standings and fan-league fantasy standings at stake. I wish Vick no ill, but if more comes his way, the opportunity to educate should not be missed.

Tony Basilio, a radio sports-talk host in Knoxville, Tennessee, who has interviewed me about pro wrestling, encouraged me to keep it up. “What Philly did with Vick disgraceful,” Basilio wrote on Twitter. “Somebody's going to die on an NFL field soon.”

3 October 2011..........

Michael Vick, at the Philadelphia Eagles' news conference yesterday after his team lost for the third time in four games: “I heard Steve Young a couple of weeks ago mention when he played it was a sense that came over him and the sense was ‘Over my dead body — I will not lose this game. I will not let this guy in front of me beat me.' It's just that ‘over my dead body' perspective you have to take.”

Metaphorically speaking only, of course.

I think.

17 October 2011..........

Will Carroll, @InjuryExpert on Twitter, writes the “Fantasy Football Expert” column for the
Sports Illustrated
website. His new one, as he puts it, wonders whether the National Football League's concussion policy is failing.
4

To review the latest installment of the Michael Vick traumatic brain-injury saga, Vick returned to play yesterday just a few plays after taking a blow to the head that obviously left him groggy. (My post earlier today wrongly said Vick sat out a single play; I am correcting that.)

“If the players on the field and the announcer in the stands all thought that Vick had symptoms of a concussion,” Carrol writes dryly, “it has to make one wonder what the medical staff saw that took it the other way. Perhaps it was dirt in Vick's eyes, but it's more likely that they were just blowing smoke in ours.”

I care very little whether the NFL's concussion policy is working. But the national concussion policy, based on the NFL's model and representations? That's another matter. If the league's titular policy committee chairs, Drs. Richard Ellenbogen and Hunt Batjer, don't speak up about the Vick follies, they're not only over their heads — they're out of the game.

21 October 2011..........

The recent concussion developments involving, in particular, Michael Vick of the Philadelphia Eagles and Jahvid Best of the Detroit Lions have reminded even the most football-centric journalists of a distressing truth: there are no independent neurologists — independent of the National Football League teams of these injured players, that is — assisting, much less being given final authority, in return-to-play decisions. Certainly not within games.

(The Eagles asserted that an “independent neurologist” cleared Vick before the game against the New York Giants, but refuse to name him or her. As for the “dirt in the eye” and “wind knocked out of him” incident last Sunday in the game against the Washington Redskins . . . forget about it.)

But there's an even more fundamental NFL medical issue that is well known but not widely or clearly reported: a number of team physicians, or the institutions employing them, have tangled financial relationships with their clubs. These call into question their ability to provide down-the-middle player diagnoses and return-to-play advice.

For example, the University of Pittsburgh Medical Center is a corporate sponsor of the Pittsburgh Steelers, in addition to being its preferred health care and sports medicine provider. (UPMC has the same relationships with Pitt sports teams, but those are intra-institutional and more intuitive.)

NFL spokesman Greg Aiello told me that sponsorships do not compromise medical care: “League policy is that team hospital, medical facility, or physician group sponsorship cannot involve a commitment to provide medical services by team physicians.” Aiello also pointed out that Article 39 of the new collective bargaining agreement with the NFL Players Association details “Players' Right to Medical Care and Treatment,” stating: “The cost of medical services rendered by Club physicians will be the responsibility of the respective Clubs, but each Club physicians' primary duty in providing player medical care shall be not to the Club but instead to the player-patient.”

The CBA does seem to attempt to tighten the principle that a team physician's primary duty is the care of the player, regardless of contractual relationships with teams outside the four corners of the medical-services contract itself. As a pro football beat writer put it to me, “All players are allowed to choose their own surgeons for surgeries, but clearly teams like when players use the teams' docs.”

The NFL's position is that there is no linkage between sponsorship contracts and medical services. But as the breaches of the league's professed new culture of “concussion awareness” and extra caution reach farcical levels — and I am far from the only one saying as much — it is worth underscoring that the NFL's heavily lawyered verbiage of doctor independence and true Hippocratic independence are not one and the same.

28 October 2011..........

Kris Dielman, an offensive guard for the San Diego Chargers, suffered a “violent” and “scary” grand mal seizure on the team plane returning from Sunday's game against the New York Jets, in which Dielman had returned to play following an in-game concussion.

Mike Florio of NBC Sports'
Pro Football Talk
comments:

Here's hoping that the NFL decides in the wake of this incident to implement meaningful procedures aimed at spotting concussions and getting players who have suffered concussions out of games — and that every lower level of the sport eventually will follow suit. Anyone who has been paying any attention to high school football lately knows that the culture has not yet changed, and that as a result players are staying in games when they simply shouldn't be.

It's time for the NFL to provide real leadership on this issue, not lip service aimed at placating Congress and/or CYA memos intended to satisfy the lawyers.
5

Hope away. Dielman told the San Diego reporters, “I just banged my head a little bit. Now I gotta deal with it.”

30 October 2011..........

The NFL is “investigating” the Kris Dielman incident. But the league can't investigate itself on the question of whether it even gives a damn. For all its outrageousness, the fact that Dielman continued on the field is just another manifestation of the ultra-competitiveness of pro football. They can all say they'll take measures to ensure that it doesn't happen again, but inevitably it will.

That Dielman was on a cross-country flight hours later, however, is something else entirely. Even I know that you don't get on an airplane in the immediate aftermath of a head injury, and I have none of the medical degrees amassed by such NFL experts as Ira “Dr. No” Casson and Joe “Sports Brain Guard” Maroon.

Does the NFL care even a little bit about the health of its players? Does anyone else care that the NFL doesn't care?

What the general public has yet to grasp is that the pro game is both better and worse on safety than the amateur game. Worse, of course — because it is competitive and dollar-driven to the exclusion of all else. But also better — because it has resources. At lower levels of football, the NFL can only be aped, less competently … by definition, less
professionally
…
off the field as well as on it.

And that is why youth football is doomed. Having-it-both-ways good intentions will not save lives and protect public health.

29 February 2012..........

Kris Dielman retires.

..........

1
deadspin.com/5841793/michael-vicks-head-injury-is-the-nfls-worst-nightmare
.

2
“Vick's return comes with risks,” Philadelphia Inquirer, September 25, 2011.

3
www.healthandfitnessadvice.com/the-healthy-skeptic/there-is-no-such-thing-as-safer-football.html
.

4
See
sportsillustrated.cnn.com/2011/writers/will_carroll/10/17/­michael-vick-concussion2/index.html
.

5
profootballtalk.nbcsports.com/2011/10/27/report-kris-­dielman-had-seizure-on-plane-after-concussion/
.

RITALIN — THE NEW GROWTH HORMONE

18 April 2011..........

Here's a story you'll be hearing a lot more about in six months or six years: National Football Leaguers — followed by college, high school, and youth league football players — soon will be gaming corrupt Pittsburgh Steelers/World Wrestling Entertainment doctor Joseph Maroon's “ImPACT” concussion management software system by taking the amphetamine-family drug Ritalin before being retested to assess their recovery from head injuries.

According to one concussion expert I've spoken with, this has already started happening at the NFL level. And of course it makes perfect sense. Ritalin is the medication prescribed most notoriously for “hyperactive” kids and sufferers from ADD (attention deficit disorder), with the goal of improving mental focus. Inevitably, professional athletes and their handlers would seize on Ritalin's ability to mask the fact that they hadn't entirely “cleared the cobwebs” from recent blows to the brain. (The phrase in quotes was used last week in an admirably candid interview by Fox TV commentator Terry Bradshaw, 62, discussing how concussions during his own Hall of Fame career have proceeded to impair his quality of life.)

With the assistance of a doc with a promiscuous prescription pad — if not simply a friendly pharmacist who doesn't need to get too rigorous about the whole script thing — a player who “got his bell rung” can ease the process of identifying whether the diagnostician in front of him is holding up three fingers or four. Which, in more technologically sophisticated form, basically describes the ImPACT program that Maroon and University of Pittsburgh Medical Center colleagues have successfully pushed on the sports establishment — aided by authoritative-sounding articles in journals such as
Neurosurgery
.

Yet somehow this same class of esteemed researchers went 74 years between the 1928 discovery of dementia pugilistica (“punch-drunk syndrome” in boxers) and that of chronic traumatic encephalopathy in athletes in other contact sports. It took a Nigerian-born forensic pathologist, Dr. Bennet Omalu, to come across the latter almost inadvertently in autopsies of retired Steeler Mike Webster and others. Since Omalu wasn't well connected or sufficiently coached in how far he was supposed to go in his scientific conclusions, his follow-up articles on CTE got unofficially blacklisted from
Neurosurgery
until very recently.

Meanwhile, Dr. Maroon — pillar of the community, 70-year-old ironman competitor, supplement huckster — forges on.

Though I'm hard on Maroon, I am somewhat sympathetic about the shortcomings of ImPACT. People who know a lot more about the subject than I do say it can be a decent tool. “I use it to scare players and their parents when they get complacent about a concussion,” a high school trainer explained to me. “ImPACT does establish a baseline of certain neurological functions, and it has value. But concussion management is still a subjective thing.”

The problem with ImPACT is that it was overhyped as a solution, at the expense of attention that should have been paid to more central considerations: prevention and unbiased, non-commercialized basic research.

The result, I fear, is that medical paraprofessionals like this trainer, and all of amateur sports in America, will find themselves in the same pickle with concussions that we already face with steroid abuse. (That's assuming there is any more such a thing as an amateur sport — which anyone who last week viewed the PBS
Frontline
documentary on high school football might be led to question.) In recent decades, elaborate specialized cat-and-mouse protocols were set up to test athletes' urine, but the most ambitious and resourceful among them simply moved on to human growth hormone, which doesn't show up in their pee-pee.

Ritalin potentially is the HGH of concussion testing. I didn't expect ever to find myself typing the words “I feel for Roger Goodell,” but the NFL commissioner has a point when he jawbones for HGH blood testing during collective bargaining with the Players Association. Now, in order to demonstrate responsibility for the health of its athletes and, more importantly, the overall gross national mental health, the league will have to do more than cite the very limited ImPACT system, along with the very limited and inaccurately targeted $20 million in research the league has spent — mostly to bolster the clinical-corporate yes men epitomized by Joseph Maroon.

20 April 2011..........

One of the seminal national magazine articles on chronic traumatic encephalopathy — “Game Brain” by Jeanne Marie Laskas in the October 2009 issue of
GQ
— suggests that the Ritalin trail also extends to the post-career agony of brain-damaged football players.

“Game Brain” tells the story of the late Pittsburgh Steelers Hall of Famer Mike Webster's descent into mental illness and homelessness, and the postmortem discovery of his CTE by Dr. Bennet Omalu. In 1997, Laskas writes, Webster met Bob Fitzsimmons, a lawyer who is now on the board of directors of West Virginia University's Brain Injury Research Institute: “Mike Webster sat down and told Fitzsimmons what he could remember about his life. He had been to perhaps dozens of lawyers and dozens of doctors. He really couldn't remember whom he'd seen or when. He couldn't remember if he was married or not. He had a vague memory of divorce court. And Ritalin. Lots of Ritalin.”
1

21 April 2011..........

Today's column by Alex Marvez, FoxSports.com's lead NFL writer, confirms our story earlier this week on how Dr. Joseph Maroon's ImPACT concussion test can be manipulated by taking the drug Ritalin and by other means.
2

The Marvez piece draws from interviews he and former quarterback, and NFL most valuable player, Rich Gannon conducted on their Sirius radio show with brain imaging expert Dr. Daniel Amen and with Ronnie Barnes, the New York Giants' vice president of medical services. The FoxSports link also embeds Marvez's earlier video report on Dr. Amen's work.

Writes Marvez: “Baseline testing is the crux of the NFL's new ‘go/no-go' concussion policy. Any player who suffers a head injury must now pass a six- to eight-minute test that measures such elements as cognitive thinking, memory, concentration, and balance. Those results are then compared to how the player scored in the preseason to determine clearance for an in-game return.”

But Amen told him that a number of his player patients have said “they purposely do bad on the testing to start, so if they get a concussion it doesn't affect them.” Amen also verifies that using Ritalin is another potential form of cheating. “Ritalin will work,” Amen said. “It helps boost activity to the front part of the brain. In my mind, it's not the first thing I would do to rehabilitate a concussion, but it would be on the list of things to do.” The doctor underscored that this practice is “not approved or a smart thing to do.”

..........

1
www.gq.com/sports/profiles/200909/nfl-players-brain-­dementia-study-memory-concussions
.

2
See “Players could try to beat concussion tests,”
msn.foxsports.com/nfl/story/NFL-players-could-try-to-beat-concussion-tests-042111
.