As doctors, we often witness the howling anguish of cognitive disease. We meet patients sodden with uncontrollable mood swings, watch their faces mottle with determination as they fight to recall the three words—blue, monkey, table—we asked them to remember just minutes ago. Their families are gutted; they mourn losing their devoted partner to a bullet in slow motion. Our patients sob, rage, scream. They think Jimmy Carter is president. They cannot remember who they are. To occupy their attention, we grant them string to play with like kittens. Stacks of washcloths to fold and unfold, over and over. They are usually our elders, not young muscled men.
We have a duty to protect our patients. In light of clear evidence tying even subconcussive trauma to traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE), we throw a flag. We are increasingly convinced that supporting the National Football League (NFL) represents a collective agreement to ignore the brutal suffering of bodies, particularly black bodies. In the past, American culture, and medicine specifically, have been slow to condemn public health crises that afflict communities of color. Football is another iteration of this willing racial bias.
When evidence of a prescription opioid epidemic hit the streets, we acted. Though previously, the criminal justice system claimed jurisdiction for opioid overdoses among people of color—labeled as heroin addicts and felons—this time around we recognize it as a public health crisis. White-coated citizens are changing prescribing practices, training to use Narcan and Buprenorphine. Our surgeon general developed national strategies. Our president declared a state of emergency.
We are responding. We are working to safeguard citizens, as our oath demands. We aren’t gathering in groups to eat hot wings, drink beer, and watch the spectacle unfold.
And yet we sponsor tailgates, gamble in fantasy leagues, invite the neighborhood over for Sunday Night Football. It’s almost un-American not to participate in the pastime that sits on everyone’s lips come Monday morning rounds.
In 2014, the NFL finally conceded that 30 percent of players will leave our living rooms to suffer the heartbreaking cognitive disabilities familiar to colleagues in neurology, psychiatry and geriatrics. NFL athletes have a fourfold increased risk for Alzheimer’s and ALS. A 2017 study revealed that 99 percent of NFL players examined had visible evidence of CTE on autopsy. In any other situation, an attack rate this high for an inconsolable, preventable, life-altering disease would incite urgent, unified action. The fact that it hasn’t says something too. Whose powerful interests hush the damage?
Impelled by the alarming injuries of former teammates—and the grief of their families—more than 4,500 NFL players joined together in a class action suit against the league, “accusing it of concealing the dangers of concussions and rushing injured players back onto the field while glorifying and profiting from the kind of bone-jarring hits that make for spectacular highlight-reel footage.” The NFL agreed to a $765 million settlement, but these reparations pale in comparison to the $14.2 billion of revenue it earned in 2017 alone.
Thousands of athletes fear a future where they cannot repeat the three words—blue, monkey, table—they were just asked to remember. Fear spending hours sparring with scraps of yarn. Fear verbally and physically battering their families. The culture of the Football Industrial Complex is a public health risk. But we aren’t treating it like one.
On the third day of Black History Month in February 2019, Super Bowl LIII blared across a hundred million homes. It didn’t invade our living rooms. We welcomed it in. This year—just past the 400th anniversary of American slavery—we should remember that while 70 percent of NFL players are black, only 9 percent of managers and exactly zero percent of league CEOs and presidents are. The scene of “white coaches and owners judging young men—the majority of them African American—based on physical prowess, the same criteria used at slave auctions,” gathers further discomfort when we interrogate why “football fever tends to run so hot in those states where slavery was legal and Jim Crow died hardest.” We are reminded of football’s distinct racialization and capitalist fervor when we ponder why—at a time when the U.S. can export everything from blockbuster films to warfare—does American football get stuck at home?
This is a story of racism and exploitation. It is a story of color: both green, and black. The memories of our failures—the malice of the U.S. government’s experiment in Tuskegee, the victims of Mississippi appendectomies, the current unconscionable maternal mortality rates of black women—should guide our decisions today. Given the demographic majority of black men in football, it’s likely CTE disproportionately damages communities of color. Like many of their peers and ancestors, it’s likely they’re out there. Suffering. Silently. Silenced.
When we watch and cheer, we willfully decide to ignore suffering. We snub Zac Easter, who executed himself at 24 after insisting, “I want my brain donated because I don’t know what happened to me and I know the concussions had something to do with it.” We discount Aaron Hernandez, who hung himself at 27 after instructing his fiancée to, “Tell my story fully but never think anything besides how much I love you.” We overlook Tyler Hilsinki, who blasted a bullet into his skull in college. When the 21-year-old’s brain was examined under a microscope, it looked weathered, injured. Like the brain of a 65-year-old.
Pull back the curtain to reveal the damage writhing off-screen. From CTE to mass incarceration and the devastation of health care inequities, if we really took a long, hard look across the veils that buttress our comfort, we wouldn’t be able to swallow the destruction. We’d have to do something.
We have to do something. NFL players are just the tip of the iceberg. These stories arrive from big league players, but also capture the suffering and suicides of amateur athletes. The damage of CTE is incremental and cumulative. It begins early, when they’re just boys toddling in backyards, gritting teeth in middle school fields, crashing into each other under the ovation of coaches and crowds. This is the bigger picture.
The thousand-or-so professional NFL players are vulnerable to misinformation, markets and managers, but they have a capacity for deciding the risks they are willing to sustain. Ten-year-olds do not. The culture that the NFL commodifies is without a doubt intended for consumption by millions of children who cannot consent to the head traumas that reverberate into developing brains and across entire lifespans. This is an issue of public health that spans the efforts of pediatricians as well as geriatricians.
We remember the hours spent vibrating with community in anticipation of Super Bowl Sunday. The jovial bickering between 49ers-fan-uncles and diehard Chiefs-aunts. It’s painful to recognize that something that brought us joy is rotten. We have inadvertently celebrated the disposability of black bodies who pay the toll for our entertainment. We have settled into a willingness to look away by allowing CTE’s torment to be shuttled out of sight. Like the veterans we laud as heroes then abandon to homelessness, the melting pot we applaud while baring teeth at our borders, we flood these athletes with adoration before letting them wither, out of mind.
The silence of the medical community is blaring. Our failure to recognize CTE as a health crisis is permissive: If doctors allow it—it must not be a big deal. In this way, our passive observation is a form of sponsorship. Our knowledge about social determinants of health dictate that we cannot simply wait on the back end to fold heartrending disease into our hospital wards like washcloths. We have to confront maladies further upstream—closer to the source. In 20 years, when the data on CTE spills out—more convincing and less silenced than ever—will we look back on our actions and shudder? Or will we be proud that we took a knee?