'It's As Though Brain Damage Were Popular': Inside America's Most Dangerous Sport

American football has never been more dangerous, or more successful. Sanjiv Bhattacharya butts heads with a sport in crisis. And, weirdly, not...

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It's an ordinary Tuesday night in March, on the floodlit training ground of the Tampa Bay Buccaneers, in Florida, and Schenique Harris, a 43-year-old mother of eight, is quick-stepping on the balls of her feet, elbows at her side.

"Hud! Hud!"

The coach blasts on the whistle, and she sprints headlong into a bright orange tackling dummy.

"Whoo!" A big cheer goes up.

"You go girl!"

And then the next mum lines up to try. There are 100 here today, giggling through the drills. This isn't a mum's league, or some alternative to Zumba. This is a matter of life and death. Harris's son Leonard plays for the Buccaneers, and like all the mums, she wants to know if he's going to be OK. They've all heard the horror stories of players who have contracted CTE – chronic traumatic encephalopathy – a deadly form of brain damage akin to Parkinson's or Alzheimer's. So the NFL has been running a series of "mums' clinics" since 2013 in which coaches and ex-players persuade mothers, of high school kids mostly, that it's safe to let little Johnny, or big Leonard, play.

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"We show them that tackling has changed," says Scott Hallenbeck, the director of USA Football, a national body formed in 2002 to train and certify coaches. "Before, coaches would teach kids to 'bite the ball' – put your face right on the ball. 'Screws to numbers' is another one – you put the screws on your face mask on the numbers on their chest. But now, we teach heads-up football. It's all about 'sky the eye'. You strike upwards with the shoulder, not the head."

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The "Heads Up Football" campaign, mums' clinics and USA Football itself are all responses to a crisis. The future of America's favourite sport is at stake. Since 2008, there has been a 29 per cent drop in children aged six to 12 playing tackle football. A Bloomberg poll found that half of Americans did not want their sons playing the game. And pros are leaving the sport earlier and earlier. In the space of a few weeks in March this year, Pittsburgh Steelers linebacker Jason Worilds walked away at 27, Jake Locker of the Tennessee Titans quit at 26, and then the San Francisco 49ers linebacker Chris Borland became the youngest ever player to retire, at 24. He said, "I'm concerned that if you wait till you have symptoms, it's too late".

The symptoms of CTE are well known at this point, given the litany of high profile tragedies. Typically players report memory loss, depression and disorientation. They become unpredictable. Their lives fall apart. They turn to drugs and drink, and some commit suicide. Pittsburgh Steeler Terry Long, 45, drank antifreeze. Fellow Steeler Justin Strzelczyk, 36, was killed in a car crash after a 40-mile police chase in New York. Jovan Belcher, 25, of the Kansas City Chiefs shot his girlfriend dead before killing himself. And so far, two players have shot themselves in the heart specifically to preserve their brains for research – Dave Duerson, 50, of the Phoenix Cardinals, and former San Diego Charger, Junior Seau, 43, who had left the league only two years previously.

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In a 2012 murder-suicide meltdown, Kansas City Chief's linebacker Jovan Belcher shot dead his girlfriend Kasandra Perkins, orphaning their three-month-old baby Zoey 

We know that these men suffered CTE. When a football player dies in this way, scientists rush to the scene, saw open his skull and "harvest" his brain, shipping it to Boston University, where the neuropathologist Dr Ann McKee puts it under a microscope. So far, of the 91 ex-NFL brains she has examined since 2008, 87 show CTE – a 96 per cent correlation. Cristiano Ronaldo's less likely to score from the penalty spot. To be fair, McKee may have only selected brains that show symptoms, but still, the statistics are alarming.

Is this the end of American football? That spectre has been raised by the likes of writer Malcolm Gladwell, no less; the concussion crisis as an "existential threat". And yet, the sport has never been bigger. In 2015, the NFL put on the biggest Superbowl ever – the largest audience in American TV history (120.8m). A month into the 2014 season, the top seven rated TV shows of that week were all NFL (another first). Two of America's top three sports are football: the NFL at number one, then baseball and college football (with basketball at fourth). Fantasy football has a record 33m players. And, like Billy idol's "Rebel Yell", the NFL wants more, more, more. In 2010, the commissioner Roger Goodell announced he wanted to grow a $10bn business to $25bn by 2027. (By comparison, the Premier League broke $5bn in revenues in 2013–'14.) It is developing markets in Mexico, Brazil and China, and in October, the League's expansion reached England again, when the Miami Dolphins and the New York Jets, among others, played at Wembley.

This is the fascinating paradox of football. Even as the bodies stack up, along with evidence of CTE, the sport just keeps growing. It's as though brain damage itself were popular. So football is dying and thriving at once. It is a tower whose foundations are crumbling and yet they keep adding more floors. This is a story about cognitive dissonance.

For instance, in January, a study in the Journal of Neurology showed that retired NFL players who started playing before the age of 12 showed greater impairment than those who started later. One of the authors, Robert Cantu, Professor of Neurosurgery at Boston University, stressed that children are especially vulnerable to head trauma: "Young brains are housed in disproportionately big heads, which are on very weak necks, so you get the bobble-head doll effect. To allow your child to be subjected to repetitive head injuries at an early age is, to me, just insane."

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The report was like a tackle – first the hit, then the takedown – because if the supply of young players dwindles, the NFL loses twice over. Not just future athletes but future fans; people care less about a sport they have never played. And yet four days after the study came out, the NFL put on the biggest Superbowl ever.

How can this be?

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The best book on football's CTE crisis has the answer in the title: League of Denial, by the ESPN reporters Mark Fainaru-Wada and his brother Steve. From the moment CTE was diagnosed in 2002, the NFL fought it. Before then, boxers called it "punch drunk", or dementia pugilistica. But then "Iron" Mike Webster, a former Hall of Fame Pittsburgh Steeler, died at 50, 11 years after retirement. A beloved player, his life had spiralled horribly. Angry and paranoid, he was in constant pain, and his nerves were so shot he couldn't sleep unless his son tasered him. His marriage collapsed. He wound up living in a pick-up truck. And he blamed football for it all. He even accumulated an arsenal of weapons and talked about killing NFL officials.

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The official cause of death was a heart attack, but the forensic pathologist at the autopsy, a young Nigerian named Bennett Omalu, refused to leave it there. He'd read that Webster had shown post-concussion syndrome and suffered depression, so Omalu examined his brain. A devout Catholic, he believes in life after death and, as he told Frontline (US equivalent of Panorama), he speaks to the bodies on his table: "I said to him: 'Mike, you need to help me. Let's prove them wrong. You are a victim of football, but you need to help me wherever you are.'"

What he discovered may change sports forever – not just football, but hockey, rugby, and even soccer where brain trauma due to heading is not uncommon. The story of Omalu and Webster, and the NFL's response, is the subject of a Will Smith movie, Concussion, out this Christmas, .
"There's a protein called tau in every healthy neuron," says Robert Stern, Professor of Neurology at Boston University. (The world's leading CTE scientists are at Boston University, such as McKee, Cantu and Stern. Omalu is no longer involved.) "Think of it as the railroad of the nerve cell, it carries information from one part of the neuron to another… But after brain impact, the tau becomes tangled, the railroad tracks are destroyed and eventually the nerve cell dies. Webster's brain showed a lot of tangled tau."

It was just one case, one scientific paper, and in its aftermath nothing much happened. But then a young ex-wrestler, Chris Nowinski, began scouring the literature on concussions. A Harvard graduate (wrestling name "Chris Harvard"), he had suffered post-concussion syndrome himself, and wanted to understand it. But there wasn't much out there, besides Omalu's findings. So, Nowinski decided to pitch in. Though not a scientist himself, he would help in sourcing brains for Omalu and other researchers. Whenever a football player died, he would call the grieving family and ask for the brain, a story he tells in his book Head Games.

Terry Long played right guard for the Pittsburgh Steelers from 1984 to 1991. In 2005, aged 45, he died after drinking antifreeze

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Brain by brain the damning science emerged, showing that CTE wasn't only caused by concussion but also by lower level "sub-concussive" injuries. And instantly, the NFL went on the attack. Their methods echoed the way Big Tobacco fought the facts about cancer, or the way the fossil fuel industry fights the facts about global warming. When facts threaten a profitable institution, there's a playbook — hire your own scientists, sow doubt, attack reputations and insist on more research. As Naomi Oreskes writes in Merchants of Doubt: "The whole doubt-mongering strategy relies on creating the impression of scientific debate." And for the NFL, that impression would be generated by its own hastily convened body, the comically named, "Mild Traumatic Brain Injury Committee" (MTBIC).

Between 2003 and 2009, MTBIC scientists published papers denying that any NFL player had experienced chronic brain damage as a result of concussions. They argued that football weeded out the weak – if you made it to the pros, you were less susceptible to concussion. And, according to one December 2005 paper published in science journal Neurosurgery, "Professional football players do not sustain frequent repetitive blows to the brain". Never mind that the opening sequence for Monday Night Football, America's leading NFL show, shows two helmets smashing into each other. Nor that the NFL's retirement board had written that Mike Webster had been left permanently disabled by "head injuries he suffered as a football player".

Then-commissioner Paul Tagliabue – essentially the head of the NFL – dismissed media reports as "pack journalism". And MTBIC scientists such as Ira Casson and Elliot Pellman accused Omalu of fraud, demanding he retract his findings. Omalu told Frontline that he was even accused of attacking the American way of life: "Some of them said, 'What is Nigeria known for, the eighth most corrupt country in the world? Who are you to tell us how to live our lives?'"

Few comparisons are less flattering than Big Tobacco, and yet the pattern of denial and obfuscation is so similar. Just as the tobacco companies denied knowledge for decades, the League still hasn't admitted a causal link between football and CTE, as an admission would open the floodgates to litigation. But the NFL can't survive as the Big Tobacco of sport because it needs to be loved, not loathed. So, for the sake of PR, Goodell has changed tack, from playing offence to damage control. The MTBIC has been disbanded, its scientists laid off, and the League's gestural donations to CTE research now go to unbiased, federally funded bodies like the National Institute of Health. But still, it avoids the subject wherever possible; CTE remains the brain-damaged elephant in the room. In his increasingly rare interviews, Goodell slips tackles by saying that he would sooner leave the science to the scientists. But he can't equivocate forever.

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"This issue is a ticking clock," says Leigh Steinberg, the agent on whom Jerry Maguire was based, now a leading voice on CTE. "This affects memory, consciousness, what it means to be a human being. It's one thing for a retired athlete have aches and pains when he bends over to pick up his child. It's another thing to not recognize that child."

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No sport is quite so American as football. The cheerleaders, the spectacle, the stopping for commercials. It never caught on elsewhere; a rare symbol of American cultural isolation. But in the US, it eclipses all others. More high-school boys play football than the second and third sports combined. It's the sport of Friday Night Lights, of small town religion, the local gridiron, a field of dreams and heroes.

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"You know why it's central to our identity?" says Buzz Bissinger, writer of Friday Night Lights. "Because it's violent. America was built on violence. We have the myth of the gunslinger, the rugged individual. Anyone who says, 'I love it because it's beautiful' is full of shit. This is the Romans and the lions. It's a gladiatorial spectacle."

It was conceived during a brief lull in American violence, in the late 1860s and early 1870s, a shortfall that football would fill. The older generation had fought the Civil War and then gone west to subdue the Indians. But that left their sons with no wars to fight or lands to conquer, so how could they prove their toughness? According to Michael Oriard, an ex-player turned historian and author of the book Brand NFL, the elites of Harvard and Yale devised football as "a testing ground, a way to regenerate an effete upper class". America's favourite sport was born of a crisis of masculinity.
At first, it was nothing but violence, a crude mimicry of military conflict. Teams lined up like armies and concentrated their force to breach defences and advance into enemy territory, maiming the opposition if possible. There was no throwing the ball back then, no glimmer of grace. It was just collision and hurt, as close to Orwell's "war minus the shooting" as there had ever been. And men died routinely. In 1905, so many died (19) that President Teddy Roosevelt insisted that the rules be rewritten. Only then, inspired by the Wright brothers, did the ball take flight and the ground war was complemented by aerial assault, the glorious arc of the ball sailing over the carnage below.

For writer Chuck Klosterman, the ball's flight exemplifies football's tendency to innovate, which in turn explains its enduring appeal. "Soccer and baseball institutions want the sport to stay the same for all time," he told the podcast Radiolab earlier this year. "But football's constantly evolving and adopting new ideas and new technologies." In 1994, for instance, coaches started talking to quarterbacks through a radio in the helmet. New offences and plays keep revolutionising the way the game is played. In order to keep things competitive, the NFL instituted a socialistic revenue-sharing model to help smaller teams. The draft is a similar innovation that allows weaker teams first pick of the best players.

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In other words, Klosterman argues, the way the NFL operates is highly progressive and open to new ideas, while "the morality of the game, its biggest draw, is that the strongest and toughest win. So, football is built for the American way of thinking," he says. "It allows you to think about the game in a progressive, liberal way, but spiritually, the heart of it can be this old conservative mindset. And that's what most people want. They want to think of themselves as progressive, but they feel conservative."

It says something about football's current plight that last year, in The New York Times, Klosterman felt the need to defend the ethics of enjoying football at all, a sport that attorney Michael Kaplan, representing brain trauma victims, described as "a concussion delivery system". The players aren't coerced, Klosterman argued, they're aware of the risk. So all football's popularity means is that "we love something that's dangerous. And I'm OK with that."

Bissinger goes further: the danger is the point. "The thrill of the hit is incredible," he says. "Your heart beats faster, it can change the tenor of a game. Because this is also a game of intimidation. If you knock the shit out of someone, they're not going to go after you anymore."

But concussion isn't the only ethical issue that dogs modern football. There's a whole string of them. The recent rash of domestic violence scandals, for example, notably the running back Ray Rice who knocked his fiancée out cold in an elevator, caught on video; the League came under fire for only suspending him for two games. Then there's the NFL's business model in which teams (actually "franchises") routinely hold host cities over a barrel by threatening to move, charge local taxpayers and pay no tax themselves on the grounds that the League is a charity (paying Goodell $44m per year).

Meanwhile, college football, the NFL's supply pool, generates billions but pays its athletes nothing as it considers them "amateurs", a system frequently likened to slavery. The author Taylor Branch, the most eminent historian of the civil rights movement, writes of "the whiff of the plantation". Bissinger compares all college sports to slavery. And in his withering polemic, Against Football, Steve Almond, writes: "two-thirds of players are black and the NFL fuels the most insidious and intractable stereotypes about such men. That they're inherently animalistic." Players are bought and sold by exclusively white owners, and described by television commentators as "studs" and "beasts". It's no coincidence that football's heartland is the South, the former Confederacy.

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In some ways, football is a period piece, like Mad Men, with values belonging to a past whose prejudices we see clearly now. For all its innovation when it comes to rules, the sport remains a bastion of retrograde masculinity. Women are eye candy. Men in tight pants clinch and huddle, but revolt when a player actually comes out, as Michael Sam did last year, a brilliant college player who was drafted, then discarded by the NFL, and now plays his football in Canada. The old machismo doesn't fly in our feminised culture. Men are more sensitive now, more empathetic. Gender is less easily defined. And brawn is a wilting measure of a man. Pencil-necked geeks have inherited the Earth. The cultural terroir of the sport has changed. This is another reason – besides CTE – why the league campaigns to keep boys in the sport. Just as football grew out of one assertion of masculinity, 150 years later it is being undone by another. Nineteenth century men wanted to show their elders how tough they were, but the current generation is sending a different message that it rejects a world of aggression, where physicality reigns. For Leigh Steinberg, this even extends to America's role in the world. "For football to fade is like reducing the emphasis on physical force, on a military approach," he says. "It's like a foreign policy of isolationism instead of engagement."

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My own suspicion is that football's predicament reflects America's morphing sense of self. Since CTE was diagnosed in 2002, the US has weathered a series of blows – wars have been lost, the economy has collapsed. What happens when a superpower is revealed to be less than super, or its power is found wanting? In politics, the right wants to return to a more glorious time, to restore American greatness; witness the rise of Donald Trump. And in popular culture, superhero movies have exploded: a counterweight to this sense of vulnerability. What the superpower can't do, the superheroes can. Americans are turning to fantasies for consolation. And football has always allowed them to dream; those bulked-up giants with shoulder pads and helmets already look like something out of Marvel or DC comics.

This is where the dissonance lives: even though football harkens to a past that it's time to move away from, it's still a comfort during times of change. Though America's role in the world has diminished, and the American Dream feels more remote than ever, fans are restored by their teams.
"Football is an expression of national confidence," Steinberg says. "And our confidence has been knocked. We don't feel we're winning economically, China and India are ascendant. And internally, American exceptionalism has been challenged in a way that hasn't happened since the Sixties."
With futures uncertain, jobs insecure, and now the national sport also in trouble, where can fans turn? Prince said it best, in "If I was Your Girlfriend": "Would you run 2 me if somebody hurt u, even if that somebody was me?"

"When the Rice scandal broke, there was a lot of antipathy and anger toward the NFL," Steinberg says. "But how did people express that? They went out the next Sunday and watched games in record numbers. Football was their escape."

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Ask the NFL about CTE and emails go unanswered, calls unreturned. Eventually, a committee of publicists set up some phone interviews, most of them monitored. But what's clear is that the League no longer denies the science, or attacks scientists. Instead, it stresses its durability, its willingness to adapt.

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Look at the incremental changes, they say, the Heads Up Football scheme and the new rules which penalise "crown of the helmet" hits. Look at the emerging technologies, what Scott Hallenbeck of USA Football calls "an arms race in terms of creating new equipment". A helmet is in development with sensors to communicate impact data to a central computer, and there's a sensor device that goes behind the ear and can measure linear and rotational forces.

Fans aren't always thrilled with these changes, or the way TV commentators now temper their delight at crushing tackles. "This is a mano-a-mano sport," Bissinger says. "You're in the trenches, it's pure competition. You can't edit the collision out of football, OK?"

But even so, Bissinger is consoled that football will prevail. These new rules are just a minor dilution, not the thin end of a wedge. "The NFL is too big to fail," he says. "And not just because it can pay people off, but because these small American towns, they got nothing else to look forward to on a Friday night." Or as comedian Bill Burr said, "the NFL commissioner could literally punt a baby across his office with his wingtips on. I'm still going to watch on Sunday. It's all I have."

According to Mark Waller, the NFL's Executive VP of International, American football plays an even more indispensable role in society than soccer does in the UK. "English soccer has an intense rivalry component. It can be divisive in some ways," he says. "But in the US, sports is a community celebration. It brings people together. And football's the pinnacle of that."

Besides, it's enormously profitable. Sport remains one of the last ways networks can attract viewers to live television, which advertisers love. (You can record the game to watch later, skipping the ads, but you'll likely already know the result, so the thrill is gone.) No self-respecting corporate giant is going to forgo record profits simply because its players are getting brain damage, especially if those players accept the risks. Michael Oriard describes this as "the nightmare scenario", football's degeneration into boxing, a fringe sport for the poor. "It's Rome," he says. "Rich folks watching poor kids destroy their brains for our pleasure." But, as he admits, it's already happening. "Rich parents are shifting their kids into hockey or lacrosse, sports poor kids don't have access to." And still, football seems just fine.

The science of CTE isn't definitive enough yet to hobble the sport. Since CTE can only be detected in the dead, the number of data samples is necessarily small and the pace of research is limited. It's still not clear why some players show CTE after head trauma, and others don't. "There may be lots of factors," says Richard Ellenbogen, a University of Washington neurosurgeon who sits on an NFL committee pro bono. "A 50-year-old football player has had billions of experiences. To say that head trauma is the major culprit is oversimplifying. And why head trauma from football especially? Life is a concussion sport." His skepticism is supported by an article in Neurology magazine from May. Every doctor I spoke to posited that genetics may make some players more susceptible to CTE than others. In the end, it boils down to the old Big Tobacco mantra, "more research is necessary".

"We were all convinced that peptic ulcers were caused by acid, so we treated it accordingly," says Ellenbogen. "But then, after 150 years, we discovered they're actually caused by bacteria. So we need to be careful. Equipoise is the word. Let's make football safer, of course, but weigh its benefits, too. There are health benefits to sports."

Meanwhile, at NFL headquarters, the vultures are circling, or rather the attorneys. As with Big Tobacco, lawsuits will likely do the greatest damage, even though to date, the NFL has got off lightly. In April, it settled a class action suit for $765m, which sounds more painful than it was – many players were excluded, the payments go out over 65 years, and anyway, it's small beer for a league that makes $1.2bn per season from a single (beer) sponsor, Anheuser Busch. But there are hundreds of potential litigants who sat out that lawsuit in the anticipation they'd do better on their own. And they well might. One reason the NFL has weathered the storm so far is because the pool of potential plaintiffs is limited; only families of dead players have a claim, and those living players who show severe impairment. It's a similar impediment to that which CTE researchers face. However, that pool may soon grow, and fast. The attorneys and the scientists are on the verge of a breakthrough.

"We're very close to detecting CTE in living athletes," says Robert Stern. "One way is a PET scan. But the one I'm most excited about is a blood test." Evidently, the tau protein is encompassed in a little bubble excreted from every cell in the body. And that bubble can cross the barrier between the brain and the blood stream. "If we can isolate those bubbles, and measure the abnormal tau, we'll be able to diagnose CTE in a blood test. It'll be routine," Stern says.

Could this be the death knell for football? If high school athletes can test for CTE after a few years of football, the number of players will plunge, while the number of litigants will explode. That blood test could be football's lethal injection. And in keeping with the dissonance that marks this whole story, this scientific breakthrough will likely be funded by the NFL. The blood test research may be funded by the National Institute for Health, to whom the NFL has pledged $30m as part of its new embrace-the-science approach.

In other words, the NFL, while marketing the sport's safety at mums' clinics, is funding the science that may prove otherwise. Something will have to give, some day. But until then, the games continue and the stadiums roar. And players and their mums keep their "eyes to the sky", hoping to keep the gathering storm at bay.

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