The NFL has bigger concerns than sagging television ratings, questionable quality of play, and restive players complaining the league wants them to behave like the football version of “Westworld” robots. Those are cosmetic threats to the league’s popularity. The idea that prolonged exposure to football can be fatal is an existential threat.
It seems far-fetched that football could go the way of boxing and fade from the national sporting consciousness. But medical science is flagging the frightening toll the game can take. It’s forcing us to confront the moral dilemma no one wants to acknowledge when they settle in on the couch on Sunday and start tallying fantasy points.
Science says football killed former Patriots fullback Kevin Turner. Diagnosed with ALS (amyotrophic lateral sclerosis), he died in March at age 46. Turner played a position where he was a head-first human battering ram. A postmortem study of his brain done by Boston University researchers indicated he had the most severe stage of chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to repeated brain trauma.
“Football causes CTE and CTE causes motor neuron disease, and he died of the effects of motor neuron disease,” said Dr. Ann McKee, the director of the BU CTE Center who studied Turner’s brain. “I do think it’s fair to say. I think that’s fair to say — football caused his death.”
McKee, one of the leading CTE experts and director of neuropathology at VA Boston Healthcare Systems, announced in a BU CTE Center presentation Thursday that Turner’s acute case of CTE, which can only be diagnosed in the deceased, led to a clinical diagnosis of ALS. McKee said Turner’s brain didn’t have any of the proteins typically associated with ALS but did have a high presence of tau, a protein that kills brain cells that is associated with CTE, which has been identified in 91 of the 95 brains of former NFL players she has studied.
The scientific and medical argot can be convoluted and confusing in terms of defining Turner’s cause of death, ALS or CTE. What isn’t is that Turner died from playing football.
Those are chilling words for the folks in the NFL. When doctors start using a word like exposure to refer to the health risk inherent in playing it portends another type of end zone for football. Exposure is a word reserved for asbestos, radiation, or tobacco. And football exposure starts well before players reach the NFL.
“It clearly seems to be the risk is undoubtedly increased by exposure,” said Dr. Robert Cantu, clinical professor of neurology and neurosurgery at the BU School of Medicine. “The greater number of years and the earlier you start taking trauma are both risk factors, and Kevin started playing at age 5 and played into his 30s, a 25-year exposure.”
Faced with a concussion lawsuit by former players that resulted in a $1 billion settlement that is still being challenged by some plaintiffs, the NFL has been on a crusade to make the game safer. It has altered playing and practice rules and reformed the game’s culture to reduce collisions and concussions. It has put protocols in place to try to identify concussed players and prevent them from further endangerment.
According to the league, it has made 42 rule changes since 2002 focused on player safety.
The problem, experts say, is that counting concussions won’t prevent cases such as Turner’s.
McKee said there are subconcussive impacts that occur in practices or games at every level of football that are silent injuries.
“I think even we thought it was concussions in the beginning,” said McKee. “The science has evolved. All the work to date is that concussions don’t correlate with CTE, rather it’s the length of playing time, the years of exposure to trauma, and the subconcussive impacts that correlate to severity and risk of CTE.”
The NFL is walking a tightrope on the CTE issue. It wants its players educated. But it doesn’t want to highlight a potentially dangerous side effect of football that could cut off its feeder system and scare away participants at the grass-roots level.
But having an owner on the NFL’s Health and Safety Advisory Committee, Jerry Jones, call a link between CTE and football “absurd” is baleful ignorance.
The NFL did not respond to a request for comment.
The assumption is that today’s players understand the risk of playing football in a way their predecessors could not. That they’re aware their consent comes with a potential price.
But they might not grasp the compounding risk of years of pounding until it’s too late.
“It’s absolutely fact that the majority of the players playing the sport don’t know the risk because they’re children,” said former Harvard football player and pro wrestler Chris Nowinski, the co-founder and CEO of the Concussion Legacy Foundation. “Part of the NFL’s strategy is to keep the focus on concussions because every sport has concussions. Football needs to shift the focus to CTE as the real problem.”
Turner’s case was “unprecedented” for an athlete his age, according to McKee.
“The kind of ALS he had would only happen with CTE. His case was remarkably severe,” she said.
ALS is considered rare. The Centers for Disease Control and Prevention said in August that the most recent research showed an incidence rate in the US of five cases per 100,000 people. ALS can be genetic, but most cases are of unknown origin.
McKee has identified 17 cases of athletes diagnosed with ALS where posthumous pathology revealed the presence of CTE. Twelve of those cases were football players. Three were professional boxers. One was an amateur boxer who had also served in the military. One was a soccer player.
But there are hundreds of football players who had similar career paths and experiences to Turner who didn’t develop ALS symptoms.
There are other factors — genetic, nutritional, and environmental — that contribute to CTE risk that McKee and Cantu acknowledge research hasn’t pinpointed yet.
Football isn’t going to its grave any time soon. It’s too embedded in our culture and consciousness.
But it sent Kevin Turner to his grave far too soon.