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David Roth | October 9, 2013

Into the light

The minds behind 'League of Denial' discuss the NFL's ongoing concussion crisis and what comes next

There are doctors, in offices and labs and on NFL sidelines, writing papers or examining thin slides of torment-stained brain tissue or looking into the glazed eyes of NFL players. There are the players themselves, the ones playing this dazzling and dangerous game on Sundays. And the ones whose careers are over, too many aging too terribly fast, wracked and out of sight in darkened rooms. There are the officials at the NFL, too, working to manage and mitigate the various types of damage inherent to this very violent, very profitable game. And there are the rest of us, talking about all this or not, thinking about it or not, but watching these games in the long shadow of a slow-motion crisis that is, if still not fully understood, increasingly undeniable.

Over the decades-spanning, still-unfolding story of the NFL's not-quite-confrontation with an increasingly unassailable brain trauma epidemic, this cast of characters has become quite large. The one thing these disparate actors have in common -- with each other and with ESPN reporters Mark Fainaru-Wada and Steve Fainaru, whose new book League of Denial is something like the definitive history of football's concussion crisis, and the basis for the PBS Frontline documentary of the same name -- is that they love football.

What sets these characters apart are their responses to what we increasingly know about the human costs.

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What sets these various characters apart, and has in many cases put them at odds, are their responses to what we increasingly know about the human costs of the violence that's so central to this game, and which makes football the thrilling spectacle it is. League of Denial is the story of a crisis -- each new revelation about the game's destructiveness makes any other term for it seem insufficient -- told through the people who discovered its size, seriousness and specific shape. It's also the story of how the NFL worked to obfuscate, obscure, bury and discredit these hard truths.

During Paul Tagliabue's tenure as NFL commissioner, the league's response alternated between high-handed dismissiveness -- in 1994, Tagliabue brushed off concussion concerns as a "pack journalism issue" -- to more active measures both covert and shockingly overt. In some cases, this meant the dismissal of an emerging scientific consensus; most shamefully, it manifested through smearing dissenting scientists while attempting to create a new, false consensus by railroading junk concussion science, commissioned by the NFL, into the scholarly journal Neurosurgery.

While commissioner Roger Goodell has brought seamless corporate deftness to the league's messaging after taking over for Tagliabue in 2006, the NFL's response is still defined by legalistic evasion and a steadfast insistence on not knowing what it does not want to know. That, and making sure that others will not know it, either. Earlier this year, the NFL reportedly pressured ESPN -- which had worked with PBS in producing League of Denial -- to take its name off the project. It did. No one from the NFL talked to the Fainaru brothers, or the filmmakers.

This story is not nearly over, of course -- there are still a great many games to be played, and, for all we've learned, much we don't know about the scope and scale of what football does to the human brain. But League of Denial should mark the closing of a door behind us, and a passage into a new understanding -- into a new if no more certain time in which players, fans, executives and everyone associated with the game knows what football does. What we don't know yet -- Dr. Ann McKee, a neuroscientist (and football fan) who has studied the brains of numerous football players, raises the possibility that everyone in the NFL has chronic traumatic encephalopathy (CTE) to some extent -- is scarier still.

What all involved will do with this knowledge -- how the NFL will change or won't to accommodate either the game's violence or ethically address its human and financial costs, whether and how we will watch now that we better understand what we're watching -- is not something we can know yet. But the evidence laid out in League of Denial brings to a close a queasy era of not quite knowing, and does so by bringing stories that were concealed or willfully misunderstood -- by a league that did not want to jeopardize a $10 billion business, and by those of us who watched more comfortably in the dark -- into the light.

So here, then, is another thing that unites us beyond the love of this brutal, beautiful, multiply difficult sport -- the shared challenge to face these questions and understand football as what it is, the challenge to do right by those who make the game what it is, and finally the opportunity to see if we can still love it.

I talked to the Fainaru brothers in their hotel room in New York City, as a storm dimmed and weighted a commanding view of Central Park. The brothers were headed to CNN afterwards, and then to the Metropolitan Opera's production of "Norma," in celebration of Steve's wife Maureen's birthday. They'd be back on the promotion treadmill the next day. That's the business, but also there is a lot of talking to be done on this subject. This conversation, too long in coming, is just getting started.

A First-Hand AccountFilmmaker Mark Pellington documents the dementia his father, Bill, suffered after his football career.

What struck me in 'League of Denial' was how overt the mis- and dis-information campaigns were pre-Goodell. But what we get from Goodell -- we're Very Concerned, We're Taking This Seriously, This Deserves More Study -- that's something we're familiar with because we hear it in our politics. But there's something foreign-seeming about the way this was all handled under Paul Tagliabue -- there was junky science getting railroaded into academic journals, these confident and very weird assertions that concussions happen every four games league-wide.

What about the Tagliabue-era response to this crisis seems most foreign to you from a 2013 perspective?

STEVE FAINARU: I think it's just that. It was just so, the level of denial -- the consistent, profound level of denial. The way they were consistently denying this was ever a problem, while at the same time they were attacking independent researchers, many of whom loved football and loved the NFL, and were trying to warn them that, in fact, this is a problem the league should take seriously, that it involves many of the players who built the league. And I feel like that was stunning to Mark and me, when we got deeper and deeper into it, was how systematic it was, and how long it went on for.

MARK FAINARU-WADA: The idea that Paul Tagliabue would blame journalists for this ...

He called it "a pack journalism" story.

MFW: Pack journalism, right. It's a media problem. And then you see that the formation of the [Mild Traumatic Brain Injury (MTBI)] committee is so indicative of that perspective. Half of it is made up of NFL team doctors, who are the very guys putting players back on the field after they get knocked out or sustain a concussion and saying it's not a big deal. And then the head of the committee is [Dr. Elliot Pellman], who's a rheumatologist. No background in brain trauma issues whatsoever, and later he becomes Tagliabue's personal physician.

That decision seems to reflect a great deal of assumed impunity, or at least not caring how that might look. Goodell, in contrast, doesn't necessarily project a real passionate concern, but ...

The tone has changed. People can debate whether the substance has changed.

SF: The tone has changed. People can debate whether the substance has changed. But certainly the tone has changed from the way it was with Tagliabue.

If we assume that there is a good faith wish to remedy all this on the NFL's part, beyond a change in tone, is there any sense that -- beyond the concussion protocols -- anything is going to be done? And what could they do, short of radical rule changes or helmetless football?

SF: There are sort of two parts to that question. One is that they really are putting a lot of money into research -- $30 million to the NIH, $60 million with Under Armour and GE, and then assorted other grants. But I think the real question there is, given their history with the science, how much can we really trust them to be independent, and to follow the science wherever it goes?

The second part of the question, I think, is the harder part. If in fact, as Ann McKee and others have suggested, that it's the sport itself -- the repetitive nature of the sport that's causing this, how much can really be done? Short of, you know, not having players wear helmets or linemen down in three-point stances. And I think the answer to that is "not much," really. And if the prevalence of the disease is discovered to be as widespread as people believe it might be ...

That was 33 out of 34 brains examined by Dr. McKee showing signs of CTE ...

MFW: Now it's 52 out of 54 examined. They're not all Ann's brains, but that's where it is now.

SF: And that's just the last eight years.

With regard to the last eight years, it seems like there have been some advances at least in terms of more independent studies are finding their way into the public eye. But where was the science during the Tagliabue era -- from when people really started talking about it in the 1990s and then through the transition to Goodell. Was roughly as much as we know now known then, but it was kept more aggressively under wraps, or less aggressively reported?

MFW: There's more emerging everyday, but one of the things we track in the book is what did the league know, and when did the league know it. One of the earliest studies comes out in 2000 by Julian Bailes and Barry Jordan and they talk about a higher incidence of dementia in NFL players, and then studies subsequent to that, born out of that in 2003 and '05, I think.

SF: Right.

MFW: 2005, and that speaks again to a higher incidence of dementia and depression. Then you've got, in 2005, Bennet Omalu raising the specter with the first physical evidence. So, we talk about it in the book, there's a point where 10 to 12 neuroscientists are raising the alarm to the league, either directly or indirectly -- sometimes going straight to the league -- and rather than being embraced, being effectively shut out or denied. Including very pointed meetings we describe in the book, one in 2007 is in the excerpts, where the people presenting the evidence were just getting dumped on ...

Actually heckling and trolling, in the ESPN The Magazine excerpt, [NFL MTBI Committee member] Ira Casson rolling his eyes while someone is presenting evidence. Beyond being, obviously, well, dickish would seem to be the word for it, but beyond that, it just seems ineffective.

SF: For me, the question is how, in the face of this evidence, could they be so certain that this was not a significant issue?

Do you believe they actually did believe that?

there was a level of groupthink going on that led them to believe that they were right.

SF: You know, yeah, I do. I guess I do. I think there was a level of groupthink going on that led them to believe that they were right and everyone else was wrong.

MFW: To me, if you look at those papers, one of the most interesting things is the logic that's at play. And one of the pieces of this logic is that, "Hey, we're NFL doctors, and we're telling you that we don't see any signs of long-term damage in players." Now, they didn't study that, there's no paper that's an actual study, but they're telling you, "Look, we're NFL doctors, we see these players all the time, we know some of them in retirement, and so we haven't seen [evidence of serious brain trauma]." That's their scientific evidence of it not happening. That's it.

And it's proceeding from this weird mythic perspective, like, "I've treated these guys on the sideline, they're tough, they're not like the rest of us."

MFW: Right, right, and another one is "There's no problem with these guys returning to games after suffering concussions." And the logic to that is, "It's true because guys keep doing it." There's a sort of circular nature to the argument.

SF: And they're, in the papers, sort of patting themselves on the back, talking about how acutely they're able to diagnose these injuries. There's a sort of surreal quality about it. And I don't think it's a cover up in that sense -- that they were covering up the actual evidence. I think they really believed what they were writing, and I think what's really -- and Mark may disagree on this, because obviously we don't know what's in their heads -- but I do feel like after talking to these people and reading through the literature, that they truly believed all of it in the moment. And what's baffling to me, and baffling to a lot of people is ... why did they sustain that sort of level of certainty for so long, and then use that to attack anyone who contradicted them?

MFW: Right, and that's the piece that's even more hard to wrap your arms around in some ways. OK, if they believed all that -- and, as Steve said, I don't think we know because we can't get inside those guys' heads -- but if they did believe it, what would the logic have been behind such an aggressive attack on [dissenting voices such as] Omalu or McKee? Why wouldn't the response be, "Well, we really need to look at this, these are really startling and problematic findings"? "We're not sure the science is there, but let's all work together and take a look at this and figure it out." Instead of a hostile attack, which then does raise questions about what the mentality was. I think the groupthink thing was a huge part of it, but I don't know that they all believed it. I don't know.

SF: Or were they cowed by the people who did. Mark Lovell -- and there are other people in the book who go through these transformations -- it's hard to know what to make of it. One of the things that I think Mark and I are most proud of about the book is that, when you get into this level of detail -- there's nuance. There are characters like Ira Casson and Dr. Elliott Pellman who are, I guess you'd call them, the true unbelievers. But there are others who are living on in this gray area. On one hand, they've advanced the science in many ways. And on the other, they've been tarnished or tainted by their association with the NFL on this. It's interesting to watch the transformation that they go through.

There's something poignant about how the doctors that got involved in this were all superfans at some level -- Dr. Ann McKee keeps a cheesehead in her office, Dr. Julian Bailes has an autographed Jack Lambert photo -- and they seem to have had these intensely disillusioning engagements with the league. I don't know if you all are fans, I know this is your job, but to what extent is it possible for you to have faith that we might see a solution that makes sense and works going forward, having talked to these people and heard and seen what you've heard and seen?

MFW: It's true, virtually everyone you run into in this story loves football. Omalu's the only one who doesn't know a lick about football, doesn't know what the Super Bowl is. But everyone, including us, loves the sport. Steve's a season-ticket holder for the Niners, and we both love the game. But, you know, for me the question moving forward is less about "Can you trust the NFL given what they've done and how they've done it," and more what actually can be done, and do you want it to be done? The sport is violent, it's brutal -- and that's what it is, that's one of the things we love about it. The issue for us was always, let's write as informed a book as possible, and lay out everything that happened, and people can make their own decisions about it. And similarly, players can make their decisions about what they want to do about it.

I think that's what can be disheartening about the NFL's legal settlement with former playersbefore the season, was that -- while it doesn't expressly foreclose on the possibility of some change or some hope for another kind of resolution. But it's clear that, if the NFL wanted to pursue an ethical solution to the human cost of the externalities created by the game's inherent violence, it would cost a great deal of money.

I don't want the game to change. I like the sport, in all its brutality.

SF: I'll be perfectly honest: I don't want the game to change. I like the sport, in all its brutality. That's just the way it is. But at the same time, I can hold two thoughts in my mind. I love football, but I recognize now -- as a journalist and as a fan -- that these are real problems, that many of the people who built the league have suffered grotesque and horrible deaths, or have gone through terrible diseases along with those who love them, and that the sport is behind some of these things. The sport has to face that. We all have to face it. To ignore it would be wrong. But part of facing it is to acknowledge that it's real, and for people to know that it's real, and for the scientists to be able to do what they do. And then people can make their own decisions about whether they want to play or not. My guess is that probably 99 percent of the players in the NFL will continue to play, until it's proven that the prevalence of this thing is overwhelming. It's like smoking, in that way. But we're not nearly there yet.

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'League of Denial': Buy the book | Watch the Frontline documentary

Producer: Chris Mottram | Design: Josh Laincz Copy Editor: Kevin Fixler | Photos: Getty Images

About the Author

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David Roth is a columnist for SBNation.com and a co-founder and editor of The Classical and a person from New Jersey who lives in New York; he is not the David Roth from Van Halen or magic. He grew up as a fan of the New York Mets and New Jersey Nets, but is comparatively well-adjusted, considering.

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