by Michael Lax, MD, MPH

The news that almost one third of NFL football players can expect to suffer the effects of brain trauma made headlines in major media. While it is not surprising that large men, often leading with their heads, bashing each other week after week suffer some consequences, what was unexpected was how many players are likely to be injured, and that the NFL actually acknowledged this reality.

Obviously, the findings lead to the question of what to do about it besides compensate the injured. In the context of workplace injuries the injury rate in this industry is tremendously high and the severity of the resulting health conditions, including life altering and shortening conditions such as Alzheimer’s disease, chronic traumatic encephalopathy, and Parkinson’s disease should raise serious alarm bells and initiate efforts to reduce the injury rate.

A major question is whether players can really be protected from head trauma given the way the game is played and the personal protective equipment that is available. The League put administrative controls in place a year or two ago, trying to limit certain types of contact to avoid butting heads, but injuries continue to occur. Helmets, the primary protective gear are technologically limited and cannot be designed to really protect the brain from serious trauma. Professional football is an example of work that cannot be made safe, at least without fundamentally altering the way the game is played.

As might be expected, some (many?) voices are calling for the game to be banned, and parents are being urged not to let their kids play tackle football. Others are defending the game and a common argument the defenders use is that professional football players are highly paid and knew the risks going in. They freely chose to take the risk, and others should not be denied from making the same choice.

Our freedom to choose in all areas of life is an idea that is American as apple pie. But the idea of “choice” requires closer examination. Although we like to think of ourselves as individuals who are capable of objectively analyzing every situation and making choices through our reasoning ability, the reality is that our choices occur in a context. That context allows us to see some things and not others, filtering our reason through personal experience, emotional response and who knows what other influences.

To illustrate: how does an NFL football player “choose” to become an NFL football player? To be an NFL player is to join the ranks of an elite group who enjoy all the perks of being a celebrity: fame, fortune, prestige, admiration. If a kid is big and talented, dreams of an NFL future can be stoked early on and nurtured through a long march through high school and college. Other less glamorous possibilities pale in comparison, especially for kids who don’t see other avenues for themselves, or without a scholarship wouldn’t be going to college. Dazzled by the promise of such a glamorous future, how likely is it that a kid is going to listen to the statistics regarding head injuries and future health problems and make a decision to seek some other less traumatic, and much less exciting career path? In this context can a young person ever really be said to ‘understand’ the risks? He is too busy trying to rationalize the risk away because that NFL future is just too hard to let go of.

NFL football is a multi billion dollar business and the owners, team employees, uniform and equipment manufacturers, merchandise makers and sellers, stadium food vendors, sports media, cities collecting tax and other revenue, and the rest of the massive enterprise are all depending on the continuing popularity of the game to keep the money and profits flowing. Toward this end, the product has to continue to satisfy the audience, which has come to expect the excitement of tough men hitting each other as hard as they can. Maximizing the violence, maximizes the excitement and maximizes revenue.

In this enterprise, the players are simultaneously central and peripheral. Obviously the players make the game what it is and star players are celebrated endlessly. But once a player gets old and loses a step, or gets injured they are unceremoniously dumped in favor of someone else who will get the job done better. The game depends upon a continuous pipeline of fresh young players to replenish the ranks thinned by those cast aside. The point is that professional football is not only responsible for ignoring the epidemic of head injuries for so long, but also for painting the picture and creating the system that entices young people into the pipeline, knowing full well that the dream is unachievable for the vast majority who try, and that many will suffer head injuries along the way, often long before they even get close to the NFL. Untold numbers of young people, their lives altered forever, are unmentioned by the NFL’s late epiphany.

The result is an as yet unknown number of high schoolers, college players, and professionals suffering the effects of football induced brain trauma. And likely all of them, after they are injured, will lament the ‘choice’ they made to chase the dream.

So what should be done?

Any other industry found to be this hazardous to its workers would probably be shut down. Since that’s not likely to happen (though maybe a player should file an OSHA complaint and see what happens), other actions are possible. First would be an aggressive campaign to reduce the legitimacy of NFL football as a sport, and to characterize it for what it really is, gladiatorial combat to entertain the masses. Parents might think long and hard before giving permission for their kids to participate, communities might pressure their schools to get rid of their football programs, and people could stop going to NFL games. This would have to be coupled with efforts that are serious and effective in opening up other avenues to fame and fortune, or at least a decent living, for kids who otherwise might see chasing the NFL dream as their only way out of poverty and what they see as dead end lives.

Michael Lax, MD, MPH is medical director of the Occupational Health Clinic Centers and based in Syracuse, NY.