July 26, 2010

N.F.L. Asserts Greater Risks of Head Injury

By ALAN SCHWARZ

The National Football League is producing a poster that bluntly alerts its players to the long-term effects of concussions, using words like “depression” and “early onset of dementia” that those close to the issue described as both staggering and overdue.
The poster, soon to be hung in locker rooms leaguewide, becomes by far the N.F.L.’s most definitive statement on the cognitive risks of football, which it had discredited for most of the past several years as academic studies and reports of deceased players’ brain damage mounted.
The new document also warns players that repeated concussions “can change your life and your family’s life forever,” a clear nod to retired players’ wives who have spoken out on the issue, occasionally before Congress. A draft of the poster also features photographs of unnamed youngsters in various sports with the reminder, “Other athletes are watching.”
The new poster, which will also become a brochure given to all players, presents a stark change in league approach. It replaces a pamphlet given since 2007 that said, “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is treated properly,” and also left open the question of “if there are any long-term effects of concussion in N.F.L. athletes.”
The sobering new warning could affect not just the behavior of current N.F.L. players and youth athletes, but also how retired players’ claims of cognitive decline are handled under the disability plan operated jointly by the league and the players union.
“That poster is shocking,” said Domonique Foxworth, a cornerback for the Baltimore Ravens. “It gives people facts before they take risks. But it’s not exactly a new revelation.”
Matt Birk, the Ravens’ center, said: “To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.”
Greg Aiello, a league spokesman, said in an e-mail message that the poster, spearheaded by the league’s new head, neck and spine medical committee and written in collaboration with the players union and the Centers for Disease Control and Prevention, “is intended to present the most current and objective medical information on concussions and will be distributed to the players and clubs in the near future.” He said Commissioner Roger Goodell provided his full support.
“We took a very firm stance,” said Dr. Thom Mayer, the union’s medical director and a member of the committee who worked on the text. “This is a clear step forward in educating players.”
The poster lists symptoms that players should look out for, including headaches, confusion, memory problems and feeling more emotional, and warns them not to ignore symptoms.
Beyond detailing the symptoms and severity of head injuries, the poster extends the league’s broad redirection in concussion policy since last fall. Then, the league adopted stricter rules regarding when players can return from head injuries, and then only with an independent neurologist’s permission.
Other changes to playing rules, practice procedures and equipment are being considered, with history suggesting that alterations could be adopted at the college and youth levels.
The new language is a glaring departure from words used by the league’s old concussion committee, whose comments and research that played down the evidence of concussion risks eventually led to its chairmen’s resignations. Their successors, who directed the poster project, Dr. H. Hunt Batjer and Dr. Richard Ellenbogen, did not return phone messages Monday.
The league’s reversal is not necessarily complete. On April 30, an outside lawyer for the league, Lawrence L. Lamade, wrote a memo to the lead lawyer for the league’s and union’s joint disability plan, Douglas Ell, discrediting connections between football head trauma and cognitive decline. The letter, obtained by The New York Times, explained, “We can point to the current state of uncertainty in scientific and medical understanding” on the subject to deny players’ claims that their neurological impairments are related to football.
Mr. Lamade did not return a message left Monday at his law firm, Akin Gump Strauss Hauer & Feld in Washington. Mr. Aeillo said the league would comment on the letter at a later time.
Brent Boyd, 53, a Minnesota Vikings lineman in the 1980s, is among scores of players whose symptoms of early-onset dementia have been ruled ineligible for the considerably higher disability payments given to players with on-field injuries. That denial took place soon after the last of three plan-chosen doctors ruled in 2001 that a particular concussion Boyd sustained “could not organically be responsible for all or even a major portion” of his condition.
Denied the higher benefits by the disability board, Mr. Boyd has been fighting to reverse the decision ever since. Two months ago, another of his appeals was denied because, the reply noted, “There are no changed circumstances,” and Mr. Boyd refused to see a fourth doctor.
Mr. Aiello and a union spokesman, George Atallah, declined to discuss any possible effect the new poster might have on disability claims. Most likely, the onus will remain on players to assert that their individual conditions did derive from professional football — similar to how players must handle worker’s compensation claims — although that assertion could gain credence with the league’s imprimatur.
Meanwhile, the most immediate effects of the new poster could be on the mind-set of current and future players. Mr. Birk said that some players would still try to play through head injuries “because the culture is so strong, but it’s a good start.”
Mr. Foxworth said: “Ninety-nine percent of the people who put helmets on don’t get the payback we do, but they’re taking the same risks. It’s probably more valuable to them than it is to a lot of us.”
Chris Nowinski, a co-director of the Sports Legacy Institute and an advocate for youth concussion awareness, said he was relieved to learn about the new language. “The old pamphlet that said ‘no evidence of any long-term effects,’ it slowed down progress — it helped create a latency environment when the evidence showed great urgency for change,” he said. “There’s a greater need for culture change on the lower levels. When coaches and people around the games don’t have all the information, simple documents and simple messages are the most important.”