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Could Neurology Have Done More to Avert the NFL Concussion Crisis?

by Gina Shaw

Could neurologists and neurosurgeons have done more to challenge the National Football League (NFL) on its handling of concussion in team players? That’s one of the questions raised in a provocative two-part documentary on PBS’ “Frontline.” (The first part aired yesterday, and the second will air next week on Oct. 15.)

     The show, “League of Denial,” takes a detailed, back-to-the-beginning look at the evolving saga of chronic traumatic encephalopathy (CTE), the NFL, and how the developing body of evidence regarding serious brain damage to players was handled — or mishandled — by the leadership of the most powerful entity in US professional sports.

     The first hour of the “Frontline” documentary focused on Webster’s story, and the immediate (and fierce) response from the NFL. Three members of what was then called the NFL Concussion Committee (none of whom were neuropathologists) wrote to the journal Neurosurgery, which had published Dr. Omalu’s findings, and demanded a retraction.

     There was no retraction — but, according to Mark Fainaru-Wada, one of the two brothers who made the film and wrote an accompanying book, League of Denial: The NFL, Concussions, and the Battle for Truth (Crown Archetype) published this month — the NFL spent the next several years engaged in an active campaign to discredit the science behind CTE, and used the venerable journal Neurosurgery to do it.

“The NFL published all 16 of its papers [aimed at refuting the evidence of CTE] in Neurosurgery,” Fainaru-Wada told Neurology Today. “People told us that this was entirely unheard of, that you would have this one journal acting as a ‘house organ’ for the NFL. As it turned out, the journal’s editor at the time, Michael Apuzzo, MD, was also a consultant to the New York Giants.” 

      While the NFL itself waged a formidable battle to deny CTE for the next five years, Fainaru-Wada alleges, leading neurologists and neurosurgeons — even those who helped to develop the science of CTE — could have done more to challenge the league on the issue. 

      “Dr. Robert Cantu, one of the foremost authorities on the issue, was the section editor at Neurosurgery at the time,” said Fainaru-Wada. “He was the first stop on those NFL papers, and he’s told us that he went to Apuzzo to suggest that those papers were not legitimate and the authors were being self-serving to the NFL, but Apuzzo overruled him. But Cantu didn’t resign his position: he stayed on as sports editor.”

     Robert Cantu, MD, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, told Neurology Today he stayed on in hopes of making his voice heard. “Regardless, it was pretty clear that all of those papers were going to see publication in that journal. Even though I was overruled, at least they allowed me — although I ultimately tired of it — to write sidebars with my opinion.”

         Julian Bailes, MD, co-director of the NorthShore University HealthSystem Neurological Institute, based in Evanston, IL, worked with Dr. Omalu to identify CTE in Mike Webster’s brain and was a coauthor on other papers with him on CTE. He himself was a former team physician for the Steelers and knew Mike Webster both professionally and personally.

      He said that the denial of CTE at first wasn’t limited to leaders of the NFL. “I had the same emotion and reaction myself. There was disagreement about what was causing what we were seeing, and there was even denial that it was real. I think to some degree it was understandable. But I also think things have changed.”

    It’s hard to blame the NFL for being reluctant to accept the concept of CTE when it has taken a long time for the medical community to do so, notes Jeffrey Kutcher, MD, associate professor of neurology and director of Michigan NeuroSport at the University of Michigan. “Do I wish they had done all this earlier? Yes, I do. But I also wish that we in the medical community had been involved in this sooner as well. Neurologists have just started taking this seriously within the last five years or so.”

     Dr. Kutcher also pointed out that the science behind CTE and the effect of contact sports on the brain is still very much an evolving body of work. Clearly, he said, there is much that remains unknown about CTE. “Even if it is a rare occurrence that a former NFL player, or someone who plays a lifetime of contact sports, will go on to have a degenerative disease, we now understand that it is a risk. But this is an extremely complicated pathophysiological construct that we are trying to put together, even today, and I worry that the way the media has focused on this issue may be driving people away from participation altogether, and that would be a travesty.”

     For the extended discussion by neurologists on the NFL and the concussion crisis, stay tuned for our full-length article in the Oct. 17 issue of Neurology Today.  See our previous coverage of concussion here: