Category Archives: News Analysis

AMA Doctors Favored Football in Historic Debates

By Matt Chaney, for ChaneysBlog.com

Posted Tuesday, May 7, 2019

I.  Introduction

II. AMA Confronts Brutal Football, Condemns Boys Game

III. JAMA Editor is Heavyweight of Football Debate

IV. Fishbein Sells Safer Football, Safer Cigarettes for AMA

V.  Conclusion

Copyright ©2019 for original content and historical arrangement by Matthew L. Chaney, Four Walls Publishing

American medical organizations are prone to fumble the issue of tackle football, to chop-block Hippocratic Oath, by shielding the injurious game from criticism and accountability—including for brain damage of players.

The American Medical Association was ally of King Football through recurring controversies of the 20th century. JAMA, prestigious journal of the AMA, protected the collision sport in debates from the Depression Era through Vietnam War.

During the 1950s and ’60s, AMA publications and rhetoric were overrun with authors and theorists of sports medicine. Their safety claims proved critical in preserving youth football from abolition.

Football friendliness of the AMA turned hypocritical in the 1980s, blatantly exposed. JAMA editor Dr. George D. Lundberg called for a ban on boxing, citing brain trauma, while simultaneously deeming the gridiron acceptable, including for juveniles. Lundberg, a closet football fan, argued that boxers intentionally inflicted TBI while gridiron harm was incidental, free of malicious intent.

The AMA convention backed Lundberg as critics responded from America and abroad.

“Their position is almost laughable,” Dr. Ferdie Pacheco, boxing physician and TV commentator, said in 1985. “I think people need to remember a few things about the AMA. It represents less than 50 percent of doctors in the country. It’s not a scientific [research] group. It’s a politically oriented lobbying group.”

“If the group really cared about safety in athletics, it would have picked on other sports—football, for starters… They picked on a flea when there are some real elephants out there.”

“The only problem the AMA encounters in this mission is one of discrimination,” stated Melvin Durslag, news columnist. “If, in the interest of life and health, it asks for the abolition of boxing, how can it explain auto racing and football?”

“In [an NFL] game the other day between Dallas and Philadelphia, Tony Dorsett was rammed head-on by a tackler clad in the conventional helmet of iron-like plastic. Tony was knocked colder than Duluth, Minnesota. Does the AMA feel this was helpful to his brain?”

Lundberg and AMA associates clung to their position into the 2000s, until overwhelmed by emerging evidence of brain damage in football players, chronic traumatic encephalopathy, or “CTE.” Lundberg came to acknowledge mistakes, sort of.

“Over the years, many physicians have asked me why I was so avid in my condemnation of boxing and completely quiet about the hazards of American football,” Lundberg commented for Medscape.com in 2016. “After all, blows to the head damage the brain, whatever the sport and whether or not the person delivering the blow is paid. I have always considered the moral difference between boxing and football to be stark.”

“Until today, I have never answered those critics. I am biased. I have been in love with American football at least since Harry Gilmer led Alabama’s Crimson Tide to a 34-14 victory over the University of Southern California in the Rose Bowl on January 1, 1946… I never stopped loving the Tide. I was a skinny kid but I was fast and I could catch any ball thrown near me. Three broken arms later, I gave up playing.”

“So, my huge bias delayed confessing reality,” Lundberg continued. “Football blows to the head damage the brain. We now have so much evidence, both clinical and, especially, from autopsies… Just as in boxing, it is not only the knockout-defined concussions but the multiple, repetitive sub-concussive blows that tear small blood vessels and brain fibers each time the movable brain bounces around inside the rigid skull.”

Dr. Lundberg still believed boxing should be outlawed but amended his stance to endorse banning football for ages 12 and under. The former JAMA editor also still believed football officials, their repetitive pledge to devise safe contact sport.

II. AMA Confronts Brutal Football, Condemns Boys Game

By turn of the 20th century, football advocates had their talking points together for recurring debate over field brutality. In 1900, football’s latest “reform,” officials touted new rules, modern equipment, medical supervision, and trained coaches to instill “proper tackling.”

Officials and associates promised “safe football” would finally materialize, fulfilling the stated mission since 1887. They said common transportation killed more than the gridiron, citing accidents of horsepower, bicycles, boats and railroads.

Self-anointed “football experts” dismissed publicized death counts as inaccurate and exaggerated by newsmen. The experts conducted their own surveys and announced more research was needed, from in-house, to determine true risk and outcome of playing fields.

Football policymakers had stock claims for preventing “concussion of the brain,” rampant in their forwarding-colliding sport. Traumatic insanity of head blows, linked postmortem to microscopic hemorrhages of brain tissue, wrought mental disorders recognized in clinical literature. Some families and doctors, communicating in public, believed traumatic brain injury had spurred violence and suicide in their athletes of football and boxing.

To quell concern, football coaches and trainers hawked new helmets, their creations of patent leather and pneumatic rubber. Headgear was trial-tested on players, and promotional text for a leading model, 1900, stated: “The head harness was formerly of felt, but of late years a solid leather headpiece has been invented. It is made of the heaviest English oak-tanned leather… This headgear is ventilated and is made with a double crown to protect the entire top of the head; it breaks the force of any blow received.”

Personnel pledged “open play” and rules enforcement would eliminate cerebral concussion. The 10-man flying wedge had been banned years ago, they reminded, and smaller “mass” formations were under control.

Officials touted “low tackling” for headless hitting, teaching players to strike with shoulder and chest, eyes up, to avoid cranium shots. “The best way to learn tackling is with a dummy with head thrown to one side. That saves your head,” said Dr. R.C. Armstrong, coach-physician in Brooklyn, 1899.

Football advocates from all walks rallied for game preservation. They said criticism was groundless, repetitive, heard from jealous wimps with no grasp of manly sport.

Theodore “Teddy” Roosevelt, fervent football fan, railed against game adversaries. The rising politician and Harvard alum vowed his sons would play football and build character from injury experience. Roosevelt enjoyed the grandstanding, such as cheering from sidelines at games, highly visible, fist-pumping like a player he wasn’t in college. Shrewdly, Roosevelt reaped political capital in votes and favors, because millions loved football like him.

Anybody could claim anything, really, in defense of beloved football. Hardly anyone tracked the reform phases and failures in some 25 years of American blood-letting. Indeed, headless contact had been tried for a decade already, fixing nothing, along with more theoretical concepts.

Football spectacle was a national institution, economically, socially and ideologically. Casualties were acceptable price for the preferred entertainment, and many if not most physicians cared nothing of “football hurts.” Many had played the game.

In 1900 JAMA endorsed the football word of leaders like Walter Camp, who argued brutal play was isolated and “unsupervised,” existing only at small schools, clubs and sandlots. The AMA Journal qualified university football as milder than “gladiatorial combat” and poked at naysayers, editorializing: “Aside from its apparent dangers, which are probably less real than might be thought, it has its merits as an athletic exercise, and evidently demands more than mere muscle.”

“There is a chance for more thorough research into the effects of football on [human physiology],” JAMA stated, “but so far as the evidence is in, the particular charges made seem hardly justified.”

Football carnage continued, predictably, including for elite programs like the Yale juggernaut of Camp. Emergency response and trauma care were primitive, useless to save victims of severe brain bleed or spinal dislocation, among football damages. Infection ravaged injured athletes in this era before penicillin antibiotics. Football death occurred of bone fracture, organ trauma and skin laceration, sometimes years after mishap, for lack of treatment.

Today’s football by comparison—some five million players, majority juvenile—produces tens of thousands of bone fractures annually. Higher numbers of variously wounded enter surgery. Incidents of brain trauma, largely undiagnosed, likely reach millions. The contemporary American gridiron would kill and maim like warfare, massively, if relying on medicine of a century ago.

In 1902 JAMA staffers collected football reports and analyzed casualties. “Thus far the returns give 12 deaths, several fatally injured and over eighty seriously injured,” editors announced in December. “Among the serious casualties of the game this year we have fractured skulls, injured spines, brain injuries resulting in insanity, as well as broken legs, ribs, collar-bones, etc. To be a cripple or lunatic for life is paying high for athletic emulation.”

The AMA editors weren’t condemning football itself, just human factors. JAMA called for officials to revise rules, once again, and to ensure enforcement by field referees. Editors opined “it would seem that something might be done by those in charge of college athletics at least, to modify the roughness of the game and somewhat reduce its risks… brutality is utterly needless and deserves the severest condemnation and consign punishment.”

But brutality was not incidental of head-on football, only inherent. Danger element could not be attributed to inept rules, bad technique, poor coaching and medical response. Vicious hits and harm were DNA of the sport, explicitly. “It is a mere gladiatorial combat; it is brutal throughout,” said Karl Brill, Harvard All-American tackle who quit football. “When you are opposed to a strong man you have got to get the better of him by violence.”

“I fail to see where the gray matter in a man’s head is exercised at all, nor am I able to see how football is the intricate game some proclaim it to be. Neither do I see how the game can be reformed or remedied.”

JAMA editors detected no safe football in 1903 and expressed chagrin for officials. “The fatalities and injuries… were probably not more numerous or more grave than in recent years,” the journal editorialized. “While we do not wish to be considered as opposing legitimate athletic sports, we believe that in this particular game the human wreckage far outweighs the good resulting from three or four months of athletic exercise and training.”

JAMA editors still hadn’t given up on football. They commended the game’s instilling campus pride and spirit, along with “honest rivalry in manly sports and athletic exercises.” The Journal backed President Roosevelt in 1905,  who blamed brutality on “dirty” players and lousy referees, for his effort to cleanse football.  The “open game” was Roosevelt’s solution, and scores of colleges jumped the bandwagon, trumpeting presidential reform and “safer football.” This faction, led by Teddy’s alma mater Harvard, was merely bureaucracy to mushroom, become known as the National Collegiate Athletic Association, NCAA.

“President Roosevelt is to be congratulated,” JAMA editors declared. “It was his vigorous protest and personal intervention which, more than anything else, brought the football rules committee to its senses.”

Optimism flattened in 1907. The Roosevelt reform hadn’t reduced risk of football, but did inspire scary colliding in open field, injurious as mass scrums. Critics howled, charging folly for so-called Debrutalized Football. “The revised rules of the game have not fulfilled the hopes of the framers… speed and combination plays have proved almost as hazardous,” observed a newspaper scribe. “The ‘reformed’ game has been abruptly ended in smaller cities in which players have been seriously injured or killed.”

Roosevelt blamed college leaders and referees for failing to stiffen code against “unnecessary roughness.” The president insisted “there is no real need for considering the question of the abolition of the game.” He said malicious players were culprit, not wholesome collision football, although he wished it “less homicidal.”

The AMA was souring on hocus-pocus about reforming football. “It was hoped that the open game, introduced by changes in the rules, would take away much of the stigma that has attached to the sport because of accidents, but that hope has proved illusory,” JAMA editorialized. “The question that naturally arises is whether the game is worth the candle.”

Tackle football wasn’t worth it for boys, said critics who denounced “junior” play emerging at schools, clubs and sandlots. The anti-movement included college coaches and players who disavowed boys football—and doctors of the American Medical Association, chirping up from hinterland offices to organization headquarters.

The AMA and its Journal comprised the most powerful entity in U.S. medicine, and likewise stood suspect for heavy handedness in health and trade. The curious relationship with gory football lent credence to allegations.

AMA honchos, editors among them, ruled agenda-setting, finances, and group communication from the non-profit’s headquarters in Chicago. The setup smelled like administrative “tyranny” to Kenneth W. Millican, who critiqued medical industry in 1906.

The AMA posed “a formidable body” in national membership and societal impact, Millican observed for Medical Record. “It can be powerful for good or for evil; in which direction its influence will be cast will depend entirely upon the character of the few men who from time to time must inevitably control its destiny.”

Millican noted, or warned, that a handful of officials could act in defiance of AMA thousands. “Issues will crop up in which the few… will dictate one course, while the majority will prefer another.”

Junior football didn’t divide the association, at least not in 1907. That December the AMA Journal, under editor Dr. George H. Simmons, condemned contact football for juveniles. The editorial, titled “Football Mortality Among Boys,” began: “We called attention early in the season to the fact that deaths and serious injuries were resulting from football, in spite of the claims made that the new rules would give comparative exemption from the dangers of the unreformed game of three years ago.”

JAMA reported football produced 14 fatalities in 1907. Twelve of the deaths were of schools and sandlots, “by whom the new rules are not so carefully followed.” Regarding college football, editors would withhold “final judgment” until further consideration.

“There need be no hesitation, however, in deciding that football is no game for boys to play,” JAMA proclaimed. “Of the whole fourteen killed the ages averaged something under eighteen years; none was over twenty.”

Editors alluded to a football belief that players had but shelf life in the maw, often rendering youths “used up” before collegiate competition. “If football were to be prohibited for students under eighteen and this weeding-out process stopped, then surely there would be more deaths among the older players!” the Journal cracked.

“We may not be able to stop the game, even if it were desirable to do so, but we can prevent some of its evil results,” editors concluded. “It is clear that persons of delicate build or of immature development should not be allowed to engage in football. If we must have this gladiatorial ‘sport,’ would it not be better to adopt gladiatorial methods and have the game played only by fully-developed men who had passed a severe physical examination before beginning the course of training?”

The JAMA bomb invigorated foes of kids football—doctors, lawmakers, educators, parents, college coaches, players, journalists—on their crusade that fell short of establishing legal bans before World War I.

But AMA hierarchy wouldn’t threaten King Football again, for the century and beyond, child combatants notwithstanding. On the contrary, AMA brass and publications would demonstrate unseemly patronage for “youth football,” wholly inappropriate per medical standards and juvenile law, in time ahead.

III. JAMA Editor is Heavyweight of Football Debate 

Organized tackle football for boys and adolescents grew rapidly after World War I, expanding through the Depression Era at schools, clubs and parks. Casualties rose in relation. “Injuries on the football field are a major concern,” Pennsylvania doctors observed in 1937. “While there are about 70,000 college students playing football this fall, there are 700,000 high school boys.”

“Authorities of the game have endeavored to make it safer for the players,” added the medical society, noting historical failures. “Despite whatever may be done to minimize football injuries, there will be more than 70,000 injuries on gridirons of the United States this fall.”

Then medical sarcasm:

“Get that ball!”

“Hit that line!”

“Let’s go, team!”

Many skeptics of cleansed football turned cynical by the 1940s, and debate blew up in public. Juvenile participation was flash-point topic, football’s growth sector, and supporters dug in. Questions loomed regarding medical ethics, child protection and education policy in America. Many doctors proposed to ban tackle football for youths under driving age.

The fray drew star physicians of mass media, debating youth football. The three biggest medical names of print and radio proffered opinions: Drs. Logan Clendening and William Brady, syndicated newspaper columnists, and the AMA heavyweight, Dr. Morris Fishbein, Journal editor, print columnist, and recognized czar of the monolith association.

Dr. Logan Clendening analyzed tackle football from a medico-legal perspective, finding gross negligence, malicious disregard on part of game organizers. “What is the excuse for all this death, suffering and disability that compares with war?” Clendening posed, insinuating blame for medicine, government and education. “It doesn’t ‘make men’ as the coaches argue. It isn’t good sport. It has become one of the stupidest games on earth for the spectator.”

Clendening, who collected injury cases from newspapers, paid a clipping service for the 1941 football season. Thousands of casualty reports were harvested, immense news data for medical follow-up. “Note once more the preponderance of high-school injuries,” Clendening emphasized in his column, “which supports my contention that boys of high school are not physically matured enough to stand the gaff, at least until they are seniors.”

Clendening, proponent of forensic medicine, attributed 23 deaths to football in the year, including 14 schoolboys and 8 sandlot players. For disabling injury, he detected high rates. “The chances are one-to-four [a schoolboy] will receive an injury sufficiently serious to lay him up. The chances are one-to-five that he will receive a permanent injury that will last through life.” An estimated 1.2 million school days were lost by injured players every year.

Like many physicians, Clendening logically associated brain damage of pugilism, known as “punch drunk” disorder in literature, to the same likelihood for football colliding. “The condition is not confined to boxers, and may occur in football players or to anyone who receives a severe blow on the head,” he observed.

Dr. William Brady agreed, having linked brain damage to school football for years in his columns, since Harrison Martland’s microscopic study of deceased boxers. Brady had written for newspapers 35 years, a trailblazer among medical columnists. He regularly ripped boys football, inciting hate mail from schoolchildren and adults.

Brady challenged any ethical physician, acting objectively, to deem tackle football suitable for youths. Brady identified schools as football dens of bully recruitment, where faculty and students groomed boys to play. Anti-football administrators concealed sentiments from local football hordes, Brady alleged, and parents avoided interceding for sons.

“It is bad enough for college freshmen to attempt to train for football,” Brady commented in December 1949. “It is absurd and shameful to permit the ‘sports’ of the community to use growing boys of high school age as stooges in the football burlesque.”

“Football is a grown man’s game, and high school boys, even lanky ones, are not full-grown men.”

A national audience awaited Dr. Morris Fishbein of the AMA, his comments on school football hyped for release 24 hours after Brady’s from Chicago.

Fishbein was an impact leader of American opinion for three decades, a voice of reach rivaling the president’s in any year. Fishbein was known as editorial pen of various AMA publications he founded, and synonymous for JAMA. But Fishbein fame was culturally ingrained for his popular press. His syndicate columns ran weekly in newspapers and Reader’s Digest. His medical encyclopedias stood ready in countless homes, revered as gospel. Fishbein’s voice was heard through every radio on AMA broadcasts, and the indefatigable personality visited thousands of locales, a celebrity on speaking circuit.

Presumably Dr. Fishbein would judge collision sport for kids in medico-scientific manner, given his reputation and so much at stake. Presumably Fishbein of the AMA, trusted by millions, would act free of bias or politics favoring King Football. Presumably Fishbein was fully informed for his grid proclamation, having premiere access to football files, medical literature and contacts surrounding the sport. He had written extensively of football risks, ranking brain “concussion” as the game’s No. 1 problem.

IV. Fishbein Sells Safer Football, Safer Cigarettes for AMA

JAMA Editor Dr. Morris Fishbein knew Dr. Harrison Martland as colleague, having published the pathologist’s landmark study on “punch drunk” in 1928. Fishbein knew of “traumatic insanity” of the 1800s, or should have. Such brain damage was visible under microscope following the Civil War, in full autopsy of dead sufferers.  Dr. John W. Perkins characterized brain matter as egg yolk during injury, jolted by inertia, bashing into cranial walls. Perkins discussed “traumatic cerebral lesions” attributed to “old injury,” different than gross destruction of acute subdural hematoma. And Journal of the American Medical Association published Perkins—in 1896.

Fishbein witnessed a host of doctors link brain damage to tackle football after Martland’s boxing revelations, among them Irving S. Cutter, James A. Barton, Edward J. Carroll, Jr., and Ernst Jokl. A particular medical term was established in 1940, chronic traumatic encephalopathy—yes, CTE—coined by Drs. Karl M. Bowen and Abram Blau. Football referee Dr. Eddie O’Brien said excessive contact caused punch drunkenness. Coach Jim Crowley, one of the legendary Four Horsemen, reduced full-contact scrimmages for his Michigan State players, specifying “punch drunk” risk. Countless sportswriters made the connection.

Regardless, Fishbein himself would not associate traumatic brain disorder with football, not publicly, and microscopic autopsy wasn’t yet performed on a deceased player to impress him either way. Fishbein’s clout could’ve made that happen, his demanding football pursue obvious research in wake of  Martland findings—examining a) brain damage in deceased players and b) cognitive deficit in the living—but he kept quiet.

Fishbein identified mental illness as endemic in America but blamed “high-tension” society and factors such as child labor, which he labeled “a great menace to future citizens.” The possibility of a nationalized head-knocking dogma, perpetuated through rites like head-ramming football, sanctioned violence, wasn’t broached by Fishbein.

Dr. Fishbein also schmoozed around football types since his days at University of Chicago, then featuring great teams of Amos Alonzo Stagg. Fishbein had known late coach Knute Rockne, who joked to Collier’s about a punch-drunk lineman for Notre Dame. Fishbein was friend of George Halas, NFL owner and Bears coach who designed a football helmet. Fishbein welcomed doctors of fledgling “sports medicine” to JAMA pages, having published their articles and letters since taking over editorial around 1920. A socialite, Fishbein enjoyed football games even if dropped at his college alma mater.

During holiday season of 1949, Dr. Fishbein watched a high-school football game in Chicago then informed a reporter of his stance on juvenile participation. His comments hit news wires on Dec. 20, the day following remarks of Dr. William Brady.

Fishbein of the AMA believed tackle football should be preserved for the Boomer Generation, including juveniles. “The number of deaths and permanent injuries do not warrant the elimination of the game from a high school athletic program,” he said. “In reality, basketball and boxing are much harder on youths than football. I believe boxing should be banned in high schools.”

“Football, in my opinion, is not too dangerous a sport for high school boys.”

Fishbein parroted classic talking points of football advocates. He said play was safer because of rule changes, sound coaching, trained athletes, and, of course, modern equipment. Fishbein said plastic hard-shell helmets, joint creation of football and the military, were finally preventing head injury. “Formerly, helmets were actually a weapon,” he reasoned. “Now they are a protective piece.”

With Fishbein’s blessing, high school football counted as AMA Approved—a real trademark that was household cliché, recognized everywhere. The AMA granted its “seal of approval” to institutions, groups, products and services. Supposedly each was vetted for promoting health in some manner. Most significantly, every vendor or organization bought advertising in AMA publications, with collections payable to Fishbein’s office in Chicago.

AMA approval was displayed and broadcast everywhere, adorning medical schools, hospitals, practices, skin lotion, milk, food, cod liver oil, funeral homes and motorcycle helmets, among the array. Wheaties cereal was AMA-approved, “Breakfast of Champions,” as an advertiser with Fishbein.

Critics were legion with many from inside the AMA. Columnist Dr. Brady ridiculed the association for decades as a member, focusing his ire on Fishbein, bitter rival on issues like football and cigarettes. The two exchanged editorial putdowns, squabbling over scientific standards and news ethics, among topics. Brady honed in on dark “approval” business of the AMA, naturally.

“Doctors on the Make,” Brady headlined his national column in early 1950, following Fishbein’s overdue departure from the AMA. Brady had dropped membership a few years before. “I couldn’t stomach the way the nominal officers of the AMA permitted the dictator, now deposed, to insult them,” he stated.

Brady derided Fishbein as the “Great Pooh-Bah” formerly in charge of the “comic weekly” Journal. Brady charged corrupt trade and communication, “a racket whereby the American Medical Association ‘accepts’ and grants its seal of approval or acceptance to the thousand and one medicines, foods, gadgets, methods, processes and even patents. This racket beats any similar scheme of popular magazines as a means of assuring a huge advertising revenue.”

Cigarettes weren’t exactly AMA-approved, not explicitly. But Fishbein valued tobacco advertising for his Journal, exceeding $100,000 in annual revenue after World War II. Cigarette makers appreciated him likewise. The rhetoric of Dr. Fishbein, a public-relations specialist with medical doctorate, effectively shielded Big Tobacco—a JAMA cash cow along with drug companies—through controversy of the early 20th century.

Doctors increasingly recommended against smoking, citing potential risks and conservative ethic of Do no harm. Many were smokers themselves, one form or another.

In 1939 an expectant mother was advised to halt cigarettes by her physician, so she wrote a medical columnist for his opinion. Dr. George W. Crane answered in print, stating no definitive evidence yet existed of smoking’s harm during pregnancy. “On the other hand,” he added, “there is no clear-cut evidence to prove that use of tobacco may not exercise injurious effects on the unborn baby.” Dr. Crane affirmed the recommendation a pregnant mother shouldn’t smoke.

Dr. Fishbein rationalized differently in his column, lending benefit of doubt to cigarette use, not human health, in the matter of smoking during pregnancy. While Fishbein acknowledged harm to the unborn “seems certain” he attached the caveat: “Many additional studies, are required, however, to determine whether the harm is sufficient to prevent smoking in moderation by prospective mothers.”

And so it went according to Fishbein of the AMA, in a quarter-century of addressing tobacco use, until 1949. He didn’t deny risks but wouldn’t condemn the popular activity, always conjuring positives for smoking, always advocating more research. Fishbein suggested casualties were negligible with millions of adults puffing billions of cigarettes. He hit the fact thousands of doctors smoked cigarettes, right in sync with the focus campaign of Big Tobacco.

A blitz of cigarette advertising made buzz for the theme of doctors in love with cigarettes. Physicians in photos and illustrations were featured lighting up at work and leisure. “More Doctors Smoke Camels Than Any Other Cigarette” was a slogan indelibly stamped in American conscious of the period. Print pages, placards and billboards were plastered for years of ridiculous images.

Fishbein blamed excessive smokers for any harm documented. He maintained extremists grew ill for their own abuse of cigarettes and cigars. In contrast “safer smoking,” by the blossoming term, was an innocent pleasure for adults to indulge. Clinicians theorized smoking comforted users with beneficial “psychological effects,” Fishbein told audiences.

Fishbein said cigarettes in moderation could relieve anxiety and hunger pangs, or serve as mental stimulant. Fishbein advised smokers purchase only fine processed tobacco, avoiding the “hard, coarse, commoner varieties” that certainly didn’t advertise in JAMA. Fishbein quoted an expert who said, “Speaking generally, tobacco smoking in moderation is not injurious to grown-up people.”

While willing to reach for positives about cigarettes, Fishbein downplayed studies linking maladies of heart, lungs and circulatory system, always suggesting invalid research. “From the available evidence there is no ground for any startling announcement about smoking,” Fishbein proclaimed in his newspaper column.

He approached tackle football same as tobacco use, conservatively guarding the activity if not human participants. At end of 1949 Dr. Morris Fishbein was popular for his football stance, but charade of safer cigarettes hastened his demise at the AMA. Fishbein resigned under pressure, primarily for his nasty opposition to group insurance and subsidized healthcare. That battle pitted Fishbein, “Medical Mussoli,” versus President Harry S. Truman, and the doctor went down.

Fishbein also took heat for posing as cigarette scientist, with the besmirching JAMA and the organization. “The stately American Medical Association finds itself on the spot about cigarette advertising. Its official Journal accepts cigarette company advertising—but it finds the medical claims rather embarrassing,” editorialized the Des Moines Register.

Fishbein and the AMA were guilty of “ardent promotion of cigarette smoking,” Dr. William Brady decried in column. “To be sure, Doctor Fishbein is no longer in the saddle, but it remains to be seen whether the organization will regain the prestige the AMA enjoyed before it went commercial.”

V. Conclusion

In 1953 cigarette advertising was dropped by the AMA, which acquiesced to angry members, public pressure, and mounting conclusions of tobacco risk. The association abruptly denounced cigarettes as dangerous, and the convention in San Francisco unveiled “startling” new research. “A team of medical experts reported that cigarette smoking shortens human life… and definitely causes higher death rates from heart disease and cancer,” media reported.

But the association didn’t deviate on collision football, maintaining status quo. The group continued to endorse tackle football for children and adults, promoting “benefits of sound health.” Simultaneously, the Journal crusaded against television for concern of child viewers; doctors said “horror shows” likely posed “adverse medical and psychological implications” for kids. JAMA, pulling major press, called on the television industry to fund valid research on risks. Meanwhile the AMA still avoided confronting football for essential brain studies, three decades after Martland on boxing.

JAMA instructed parents to closely monitor television for content harmful to young minds. In stark contrast, regarding football, the AMA wizards told worrisome parents to back off, lest they damage male psyche of sons.

“To anxious parents of sons who want to play football, the best advice is—let them. No, that is not enough. HELP them to play it safely,” declared Dr. W.W. Bauer, AMA-Approved health columnist for newspapers. “When a high-school boy wants to play football, this cannot be denied him without possibly doing injury which may be worse than he is likely to sustain on the properly supervised playing field.”

“A great many parents base their apprehensions on an overemphasis of the hazards connected with playing football,” Bauer commented. “Between the ages of 15 and 25, when most of the football activity occurs, accidents to pedestrians and motor-vehicle fatalities of the same age group are 15 times as frequent.”

“The relative safety of the game, despite its reputation for roughness, should prompt parents not to interfere with the athletic activity of their boys including football.”

Dr. Bauer talked the timeless points and promises of grid safety, echoing again nationwide. Anti-concussion helmets, “heads up” tackling, everything was in the offing once more.

And more doctors preferred football than any other sport, based on quotes and testimony flooding multimedia. Promoting doctor approval was a page from King Football’s playbook, merely replicated of late by Big Tobacco.

JAMA was establishing trend for journals by stabling sport doctors and academics, including Allan J. Ryan, Augustus Thorndike and Fred Vein. The MDs and PhDs, specialists of newly formalized sports medicine, melded right in at association publications and confabs. Football was AMA-approved like never before.

Dreams, concepts, gadgets, experts—all came stylish again in America. Anything seemed possible in the Space Age, including safe smoking and safe football.

“Football can be a killer and a maimer,” JAMA intoned, “but for the player it is also a wholesome and valuable experience that—like life itself—can be made safer.”

Matt Chaney is an author, editor, and consultant on public issues in sport, specializing in American football. Chaney, MA in media studies, is a former college football player and coach whose books include Spiral of Denial: Muscle Doping in American Football, 2009Chaney’s study for graduate thesis, co-published with the University of Central Missouri in 2001, analyzed print sport-media coverage of anabolic substances in football from 1983-1999. Email him at mattchaney@fourwallspublishing.com or visit the website for more information.

Select References

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A Fifteen-Year-Old. (1891, Sept. 24). Salina Republican KS, p. 3.

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Football Officials Alerted to Brain Damage, Concussion—80 Years Ago

Contemporary experts of law and medicine in sport discuss an historical news period, 1928 to 1933, when football officials learned of brain risk to players, understood research questions—and even devised a sideline concussion test

By Matt Chaney

Posted Saturday, January 31, 2015

Copyright ©2015 by Matthew L. Chaney

During football season in 1928, late October, American sports pages headlined ominous findings of fledgling research on brain damage in boxers:

“’Punch Drunk’ May Apply in Other Sports”

“American Medical Association Publishes Article Raising Question”

The accompanying news report quoted Dr. Harrison S. Martland, of Orange, N.J., whose newly published case studies of deceased boxers revealed a “punch drunk” syndrome to become known as “chronic traumatic brain injury.”

Utilizing microscopic pathology, Martland had identified diseased brain cells of boxers “due to single or repeated blows on the head or jaw,” he said, warning that likely all athletes of contact sport were at risk.

Research avenues were obvious and urgent for football leaders and officials of more activities in America.

“The condition can no longer be ignored by the medical profession or the public,” Martland said, long ago—and wowing experts today.

“Dr. Martland’s observation was spot-on,” said Bob Fitzsimmons, legendary sports attorney, during an email exchange this week. “Unfortunately it took over 80 years to follow his advice, even though the problem was right before us all the time.”

“If only the stakeholders in football would have heeded Dr. Martland’s warnings in 1928…,” said Paul D. Anderson, sports-injury lawyer and professor, “the science of football-related brain injuries would have been exponentially advanced and numerous lives could have been protected.”

“Instead, the stakeholders and guardians of football were willfully blind.”

Here is full text of the 1928 Associated Press report published in Sports sections nationwide:

NEW YORK, Oct. 20 (AP)–The “punch drunk” condition of boxers has stepped into the medical field for determination whether others than boxers get it.

The American Medical Association has issued in its Journal an appeal by Harrison S. Martland, M.D., of Newark, N.J., to find out the nature and extent of this state, which he says fight fans describe as “punch drunk, cuckoo, goofy, cutting paper dolls or slug nutty.”

The symptoms in slight cases are a “very slight flopping of one foot or leg in walking, noticeable only at intervals, or a slight unsteadiness in gain or uncertainty in equilibrium.” In severe cases “there may develop a peculiar tilting of the head, a marked dragging of one or both legs, a staggering, propulsive gait.” Finally, marked mental deterioration may set in.

“I am of the opinion that in punch drunk there is a very definite brain injury, due to single or repeated blows on the head or jaw. I realize that this theory, while alluring, is quite insusceptible of proof at the present time.”

Dr. Martland suggests that if punch drunk exists in the form he suspects [then] it afflicts others than boxers and that establishment of the facts is important to courts and labor compensation boards in handling head injury cases. He foresees disadvantages in the field which may be opened for “so-called expert testimony” and says:

“While most of the evidence supporting the existence of this condition is based at this time on the observations of fight fans, promoters and sporting writers, the fact that nearly one-half of the fighters who have stayed in the game long enough develop this condition, either in a mild form or a severe and progressive form, which often necessitates commitment to an asylum, warrants this report. The condition can no longer be ignored by the medical profession or the public.”

The Martland story is a “great” artifact, said Fitzsimmons, who represented family members of Mike Webster, the deceased, brain-damaged NFL lineman at center of landmark court action a decade ago. The Webster estate won $2 million in retroactive disability payments from the league and players union, setting legal precedent for claimants of brain injury from football.

Harrison S. Martland paved the evidential path. The pioneer sport neuro-pathologist, longtime medical examiner of Essex County, N.J., was also known for identifying disease states in workers of radium processing. Martland compiled boxing case studies until his death in 1954, and authorities of football like Fitzsimmons feel indebted.

“Much still needs to be done but I am encouraged by the numerous doctors and scientists who are now studying and researching CTE,” Fitzsimmons said. “Advances are being made and hopefully treatment is not far off.”

Two modern pathologists are prominent for their postmortem series on football players, beginning with former Pittsburgh ME Dr. Bennet Omalu, a friend and colleague of Fitzsimmons who’s now a county medical examiner in California and subject of a feature film in production.

Following Webster’s death at age 50 in 2002, Omalu delivered the groundbreaking micro-autopsies identifying chronic traumatic encephalopathy, or CTE, in brain tissue of the Steelers icon and more deceased NFL players.

At Boston University, Dr. Ann McKee has found brain disease in 78 of 82 NFL players analyzed postmortem, damage of impacts including hallmark tauopathy. “We have known about CTE since the 1920s, when it was first associated with boxing,” McKee said, speaking recently in Texas.

“CTE results in memory loss, mood swings, change of behavior, and sometimes suicide.”

Dr. Lester Mayers, a New York physiatrist and author of journal reviews, is versed in the literature lineage of brain trauma in athletes dating to boxing’s earliest. “Dr. Martland cautiously pointed out that evidence of [the boxing] affliction was anecdotal at that time,” Mayers stated this week in email.

“Since then, many studies of professional and amateur boxers utilizing a variety of [research] techniques have found that greater than 50 percent suffer substantial brain damage and disability. The significance of these findings is that the extent of brain damage correlated best with the number of non-concussive impacts experienced by the fighters over their careers.”

“There seems to be an obvious parallel with the current experience unfolding in football.”

Mayers knows the football maw close range, as former medical director for athletics at Pace University, where he treated casualties of all games. Mayers doesn’t see much if any wiggle room for football and its inherent violence, regarding improvement for so-called safety.

“Anyone who watches football games at any level from the sidelines, junior through professional, will observe the constant occurrence of head impacts intrinsic to the game—500 to 1,000 per season according to Helmet Impact Technology,” Mayers observed.

“I believe that when the extent of resulting brain injury and disability is better documented in future studies that football participation will decline substantially, placing the future of the game at risk.”

Some researchers, typically funded by football interests, say more studies are needed to draw conclusions about collision risk for the brain. They note longitudinal studies have yet to be performed on living players—without adding that football organizers have avoided exactly that research since Martland’s call 87 years ago.

Central New York clinical psychologist Dr. Don Brady, PhD, PsyD, NCSP, researches sport concussion and provides consultation for NFL retirees, their families, and other athletes. Brady has studied the literature of sport-related concussion for three decades, devouring Martland but taking his review deeper, back to 19th century research. Dr. Brady rebukes the notion that accumulating discovery isn’t documenting football danger.

Information such as the 1928 Martland news “serves to further thwart attempts by concussion revisionists and manufacturers of doubt to ignore, deny, minimize and sanitize the existence of adverse medical history accounts…,” Brady stated in email, “that pertain to brain injury or concussion in sports and other life aspects.”

“Concussion history literature of the 1800s and early 1900s is rich with documentation on the adverse effects of both sport and non-sport-related concussion.”

Attorney Paul Anderson concurred, discussing historical information in context of present-day lawsuits by thousands of former NFL players and families.

“Dr. Martland’s [1928] statement is another bullet in the plaintiffs’ chamber when they seek to prove the NFL knew or should have known about the long-term, devastating effects of repeated blows to the head,” Anderson, representing family of late college player Derek Sheely in an NCAA lawsuit, wrote for ChaneysBlog.

For more regarding what football organizers have known about brain trauma, and when, see below the annotated timeline of news articles from 1982 to 2001, first posted at ChaneysBlog in 2012.

*******

Public fallout for Dr. Martland in 1928 emanated primarily from boxing circles.  “His brains are scrambled from taking them on the chin,” cracked a dim pugilist, unwittingly affirming Martland theory [and, no, the doctor wasn’t a boxer].

Martland won more support than opposition for his conclusions about chronic TBI in boxers. A powerful opinion leader in Martland’s camp was Dr. Morris Fishbein, widely known official of the AMA, for his four decades in spotlight as editor of Journal of the American Medical Association.

Fishbein endorsed the boxing research in this installment of his syndicated newspaper column, “Daily Health Talk”:

Punches in Prize Ring Often Injure Brain

By Dr. Morris Fishbein

Pugilists know the condition that results from a terrific pounding in the prize ring in which the recipient of the mauling suddenly finds himself unable to move his legs, dizzy, or as it is commonly expressed, “out on his feet.”

Dr. Harrison S. Martland recently read before the Pathologic society of New York a discussion of the condition called “punch drunk,” which the fighters themselves all characterize by the terms “cuckoo,” “goofy,” “cutting paper dolls,” or “slug nutty.”

He points out that the condition usually affects fighters of the slugging type who are usually poor boxers and who take considerable head punishment, seeking only to return a knockout blow.

It usually takes the fighter one or two hours to recover from a severe blow on the head or jaw. If he has been “punch drunk,” he may notice later a flopping of one foot or leg in walking, and sometimes mental confusion lasting several days.

Dr. Martland is convinced that the condition called “punch drunk” results from a definite brain injury due to a single or repeated blows on the head or jaw which cause multiple small hemorrhages in the deeper parts of the brain.

In the late stages, therefore, the disease resembles the condition known as shaking palsy or Parkinson’s disease.

He has presented microscopic studies of the brains of persons who have developed this condition, showing the pathologic changes which occurred in the brain, and which substantiate his point of view.

Furthermore, he presents the names of 23 fighters who have been “punch drunk,” and their present condition indicates the permanence of the physical changes.

The AMA and JAMA already stood opposed to boxing at outset of the Depression Era, and membership immediately adopted Martland studies for accruing argument.

AMA ethical policy then and now essentially outlines Hippocratic creed of Do no harm, or When in doubt, protect the patient. To recommend avoidance of pugilism, especially for children, amounted to simple rationale for America’s leading medical body.

But AMA and JAMA simultaneously supported dangerous football, curiously or hypocritically [see news timeline below for the dichotomy in recent decades].

Fishbein himself publicized perhaps the first sideline concussion test, apparently referencing a 1933 NCAA publication detailing the protocol, Medical Handbook for Schools and Colleges: Prevention and Care of Athletic Injuries.

Fishbein addressed traumatic brain injury in football and symptoms to watch for, reporting the following in newspapers:

Most serious of all [football] injuries are those affecting the brain and the skull. A concussion of the brain means that the brain tissue actually has been bruised, with possible small hemorrhages in the tissue.

The first sign of such injury is loss of memory for recent events. The least important sign is a slight dizziness. But coaches and trainers should not, however, be unimpressed when a player comes out of a sudden impact with another player merely slightly dizzy or dazed.

The first thing to do in any such accident is to put the player immediately at rest, to determine extent of the injury. When a player has had a head injury, he should be put into a reclining position, questioned as to the headache and dizziness and given the test as to his memory for recent events.

If he cannot remember the names of his opponents, which side is on the offensive, the score, the day of the week, or similar matters, it is not safe to permit him to play again. If, however, he merely is dizzy, he should be permitted to stand and move about, to determine whether he has lost his sense of balance.

Any sign of a loss of sense of balance is serious, and the player should be removed from the contest.

Fishbein was channeling the NCAA publication, undoubtedly.

Kansas City attorney Paul D. Anderson has studied the 1933 NCAA document. And he keeps seeing perfect fits of additional information, then and now, like the historic news items about Martland, the AMA, and brutal sports.

“The doctors [from 1928 to 1933] clearly identify a causal link between football-related head blows and punch-drunk syndrome,” Anderson surmised.

*******

A 2007 episode of Friday Night Lights on NBC centered on a lawsuit against a high-school football coach, for failure to instill “proper tackling” in a player who ended up paralyzed by a helmet hit. This TV show was based on fact, not fiction.

Heads Up, football coaches and wives, because you’re legally liable for the theory of “head up” or headless hitting by players, the alleged “technique” and accompanying rules proven inapplicable and unenforceable since at least 1976.

Yes, coaches are legally responsible for ensuring that headless hitting is applied in tackle football, which is, lest anyone forgets, a forward-colliding frenzy that pits large, helmeted combatants to ram each other. No one can actually teach and instill Heads Up nonsense, of course, revived by NFL commissioner Roger Goodell and league offspring USA Football.

Nevertheless, coaches of all levels are integral to the show of “proper technique.” The vast majority serve public lip service, promoting Heads Up for every gullible news reporter, of the legion.

Meanwhile, the unfortunate few coaches—and their families—become legal shields for King Football, as targets for lawsuits. Individual  homeowner’s insurance becomes exposed for paying potential settlement or damage award, among liabilities.

Since 1971, coaches, colleges, schools, youth leagues, local government and helmet makers have been sued over “head up” or “proper contact”—and with no backing of the prime purveyors like Goodell, who quickly acknowledge lacking scientific proof for Heads Up when pressed.

Lawsuit plaintiffs—from whom Goodell effectively insulates—are player casualties of football’s predictable severe injuries, calamities occurring much more frequently than reported by game-funded “studies” posted on a website from University of North Carolina in Chapel Hill.

Contemporary plaintiffs include a former NAIA college player, Nathaniel Seth Irvin, whose lawsuit alleges he suffers concussion damage “as a result of bad coaching and improper helmet use” during the 1980s, reports The Chicago Tribune.

In California, the mother of a quadriplegic former Pop Warner player is suing coaches, their wives, and youth-league organizations. Crystal Dixon alleges in the court complaint that her son, Donnovan Hill, was paralyzed in Pop Warner football for “a negligent tackling technique he was taught and instructed to use by his coaches.” Hill was 13 when paralyzed during a game in 2011.

Defense attorneys replied: “To encourage aggressive play in football is simply to encourage participants to play the game as it should be played.”

Such lawsuits could also target football players and referees.

I played and coached in college football 30 years ago, when the so-called anti-butting rule of the NCAA and national high schools—supposedly banning the striking of a helmet facemask for initial contact—was already a joke.

And we coaches at Southeast Missouri State didn’t have to specifically instruct players to ram. We only lined them up to play the dumb game, which inherently dictates head-on collision between opposing players, clashing from opposite directions. This is a very simple matter of modern football covering law–ramming–because of natural physics and shatterproof head armor.

The idea of chest-bumping and “shoulder leverage” in football with modern helmets isn’t only impossible. It is quackery for the public presentation today. And every football official above low-informed knows it, especially coaches who played.

Yet cultural authorities like the American Medical Association have espoused “head up” versions first devised by a coaches association in 1961, then pumped by AMA press releases in 1967—despite medical literature’s lacking a peer-reviewed article on the concept, still, much less one credible researcher to sign his or her name.

No Heads Up theorist claims responsibility yet, not academically, scientifically or legally.

That should say everything for anyone.

*******

This year’s Super Bowl City serves as ‘Cautionary Tale’ for subsidizing sports and more questionable entertainment ventures.

Read past the hype or rhetoric about being an “NFL City,” and Glendale, Ariz., is almost bankrupt for building stadiums and hosting events like the Super Bowl. And monetary shocks spread further, affecting greater Phoenix and taxpayers across the state.

“To fiscal conservatives, Glendale serves as a cautionary tale for suburban cities across the United States that want to throw public money at professional sports projects,” note Associated Press writers Josh Hoffner and Jaques Billeaud, for this week’s must-read analysis.

“Overall, it’s a bad move for cities,” said Kurt Altman, attorney for the Goldwater Institute. “As much as they say it’s going to make the city a destination, it just doesn’t.”

A mathematical reality confronts any region for public giveaways to the NFL and other sports like the NHL (the garage league utterly underwritten by American taxpayers):

There can be no public payoff unless a sport franchise imports new consumers and industry from out of state. But that never happens.

The glittering civic toys of subsidized stadiums and entertainment districts merely steal in-state customers from local businesses, those paying full taxation and operating without government aid.

Even a region’s temporary injection of Super Bowl fans, corporate sponsors and major media produces negligible return for public coffers—or just more red ink.

In Glendale, the tax-paying citizenry will lose millions this week over the Super Bowl, says Jerry Weiers, the mayor tasked with sorting out a sports mess left by predecessors in city government.

The municipality is dropping “huge amounts of money on overtime and police and public safety costs associated with hosting the Super Bowl but getting very little in return,” report Hoffner and Billeaud.

Elsewhere, Missouri, does Gov. Jay Nixon get it about public subsidy for the NFL?

Jay Nixon proposes dropping a half-billion dollars in state resources on yet another football stadium in St. Louis—only 20 years after taxpayers opened a new dome for the Rams, a project still carrying millions in debt.

Does the Missouri governor need help, or logic, to ascertain necessary and priority need for appropriating public assets?

Supplement: News Timeline on Brain Trauma in Boxing, The NFL and NCAA

Articles from 1982 to 2001

By Matt Chaney, 2012

1982, Dec. 4:  “Dangerous Games That People Play,” by Ira Berkow, New York Times. News commentary discusses risk and injury of hazardous sports and activities in the United States, citing a report of the American Medical Association [AMA]. Berkow notes, with boxing under renewed threat of elimination in America, that brain injuries are well-known in football too, comparing the gridiron’s “almost casual list of the maimed… those [players] suffering the routine concussions, neck injuries and assorted broken segments of the anatomy.” Berkow writes: “There are more deaths occurring in college football and in motorcycle racing and in sky-sailing than in boxing. Relatively few [authorities], it seems, have vigorously propounded abolishing any other sport besides boxing since 1905…”

1983, Jan. 14:  “Physicians’ Journal Calls For a Ban on Boxing,” by John Noble Wilford, New York Times. News analysis discusses JAMA editorials urging ban of boxing in America, CAT-scan studies of living boxers revealing “brain damage,” and response of boxing officials, including their proposals to reduce risks. “Editorials in today’s issue of the Journal of the American Medical Association urged the banning of boxing in light of new evidence suggesting that chronic brain damage was prevalent among fighters,” Wilford writes. In Britain, a study of living boxers, professional and amateur, determines chronic brain damage is “most predictable” for a career in the ring.

1983, Feb. 15:  “The Ring Commission Hearings,” by Jim Lehrer, Monica Hoose, and Peggy Robinson. MacNeil/Lehrer Report [transcript]. PBS Television show addresses congressional hearings on boxing in Washington, with replays of day’s lawmaker questions and witness testimonies on Capitol Hill. Discussion includes boxing deaths and more notorious beatings of the 1970s-80s, arguments on potential ban or government regulation of a continued sport, so-called safer boxing conducted as “a science,” and an AMA doctor’s pointing to tackle football in America for producing severe head injuries as well. “I think a similar kind of injury occurs in any contact sport,” says Dr. Russell H. Patterson, Jr., neurosurgeon and AMA official. “Football is a good example, and we’ve seen some serious head in juries in football. … The blow is the same whether it’s in boxing or in football. It’s just in boxing it’s small, repetitive blows but maybe spread over many years and almost daily in its occurrence.” Robert Lee, U.S. Boxing Commission president, says, “The past year, 1982, has been filled with controversy with all too many people calling for a ban on boxing. Yet how many of these same people call for a ban on high-injury sports such as skiing, football, hang-gliding, auto racing, scuba diving or mountain climbing?”

1983, June 12:  “Boxing and The Brain,” by David Noonan, New York Times. News analysis discusses the following: boxing hearings and debate; medical literature since 1928 and physiology of brain injury; child fighters such as a 13-year-old who died of brain injury; concepts of safer boxing like “body punching”; noticeable speech difficulties of boxing great Muhammad Ali, age 41; and Dr. Ira R. Casson, a Long Island neurologist conducting a study series on boxers who would later work for the NFL. The known permanent brain damage of boxing includes “a clinically diagnosed condition called dementia pugilistica, also knows as chronic encephalopathy of boxers and best known as punch-drunk syndrome,” Noonan writes. “As the information about chronic encephalopathy in boxers has accumulated over the years, several distinct clinical symptoms and their apparent pathological causes have been identified.” Casson—who someday would lead NFL studies on brain injury—views radiological imaging of Ali’s brain, for Sports Illustrated, and says, “That’s the kind of CAT scan that I’ve seen in a number of former and long-term boxers.”

1983, June 20:  “Doctors Debate What To Do About ‘The Sweet Science,’ ” by Brenda C. Coleman, The Associated Press. News report discusses AMA proposal to eliminate publicly funded boxing, convention debate over the proposal, a new study that finds repeated blows causes brain damage in boxers, and similar research on college football players. “Any sport whose objective is to injure another human being is an abomination,” says internist Dr. William F. Dowda. “There’s absolutely no moral justification for a sport that condones a brain concussion.” Differing viewpoints were heard on convention floor, including from Dr. Russell H. Patterson, Jr., AMA official and chairman of the American Association of Neurological Surgeons [AAN], who says research shows brain damage is “not a problem” among amateur boxers. “Patterson also pointed to a study of 11 Eastern colleges that showed the incidence of accumulated head injury in football was at least as high as in boxing,” Coleman reports.

1983, June 23:  “AMA Delegates: Ban Amateur Boxing,” no byline, Washington Post. News report discusses debate over the formal AMA call to eliminate boxing in municipal leagues, schools, colleges and more government entities such as the military, along with establishing federal regulation of professional boxing. “The AMA’s action comes at a time of increased interest in boxing regulation following the death last November of South Korean fighter Duk Koo Kim of head injuries…,” The Post reports. “I think their [AMA delegates’] position is unreasonable,” says Sig Rogich, chairman of the Nevada State Boxing Commission. “I think if they’re going to categorize risk factors in boxing as a professional sport, then they should use the same philosophy with other sports.”

1984, May 7:  “Concussion Routine in Other Sports; Boxing Safety Praised,” by James Christie, Toronto Globe and Mail. Commentary discusses the following: growing outrage over boxing, led by doctors who want downsizing or bans in America, Canada and Britain; Canadian measures for “reasonably safe” boxing, including sidelining knocked-out fighters for 30 to 60 days; and need for concussion protocol in other sports, particularly tackle football. “This is one of the biggest problems we’ve had at the university level,” says Dr. Bruce Stewart, neurologist and medical director of the Ontario Athletics Commission. “People get knocked out routinely in football, get revived and could be back in for the next series of plays. What this does is demonstrate to me that in boxing we’re being properly cautious about the welfare of our athletes.”

1986, Nov. 7:  “Johns Hopkins Begins Boxing Study,” no byline, The Associated Press. News report discusses pending research, a four-year study of amateur boxers and football players in select cities, for assessing brain damage among control groups and evaluating neuropsychological [NP] testing for possible method of early detection. “A 14-member research team will travel to three or four cities in the South, Southwest and Eastern seaboard to locate boxers, football players and youths in the same age group as the athletes who do not play contact sports and can serve as controls in the study,” The AP reports. “Col. Don Hull, the president of the USA Amateur Boxing Federation, said information gathered from the study will be important to all amateur sports.” Dr. Walter Stewart, epidemiologist at The Johns Hopkins School of Public Health, says, “We are going to collect data and let the chips fall where they may.”

1986, Nov. 10:  “The Agony Must End,” by Paul Zimmerman, Sports Illustrated. News analysis discusses NFL injuries that “continue at an unacceptable rate,” including “fractures, concussions and bruises that play havoc with America’s No. 1 sport.” While some football-funded researchers claim a safer tackle game at hand, designed to reduce head and spinal injuries in particular, the armored, high-speed violence of pro football—collisions administered and absorbed, impacts head to toe, and other physical stresses that discombobulate—is unprecedented danger for the SI writer Zimmerman, a former college player and game historian, and Miami Dolphins head coach Don Shula. “Some of the collisions I’ve seen are really severe,” Shula says. “I’ve been happy for quite a while to be on the sidelines.” Zimmerman has interviewed numerous muscle dopers in the NFL and NCAA, and blames anabolic steroids and other powerful prescription drugs, like pain-killing shots and pills, for bloodshed in the modern game. “The result is higher-speed collisions by larger people, a ferocity of hitting never before seen in football or any other sport,” Zimmerman writes.

1987, Feb. 26:  “Boxing Doctor Says Peril Exaggerated; Other Sports Said Riskier as Brain Study Launched,” by Al Sokol, Toronto Star. News analysis discusses the following: boxing controversy as medical associations recommend  downsizing or banning the sport; measures for less risky or safer amateur boxing; danger of tackle football, and a Johns Hopkins longitudinal study on young boxers that includes American football players as a control group. “The stand against boxing taken by both the AMA and the Canadian Medical Association comes partly from the intuitive sense that getting hit in the head by a punch is not healthy and partly from a growing body of scientific evidence,” Sokol writes. Dr. George Ginter, a Kentucky anesthesiologist and pro boxer, says, “I totally disagree with the American Medical Association’s stand regarding the neurological damage resulting from boxing. College and pro football rank higher than boxing in terms of causing long-term disabilities.” But Boston neurosurgeon Dr. Robert Cantu supported the AMA perspective, as vocal opponent of boxing and staunch football advocate himself, promoting ideas and rhetoric of “safer” tackle football in America—and destined to someday lead an NFL-funded research team verifying brain damage in deceased football players, teens and older. Commenting on boxing in 1987, Cantu dismisses touted measures of “safer” pugilism. “A doctor at ringside is like a priest at a hanging,” Cantu says. “Neither improves the safety of the event.”

1989, March 9:  “Boxing Causing Dozens of Military Hospitalizations Yearly, Study Finds,” by Brenda C. Coleman, The Associated Press. News report discusses debate over injuries in Army boxing and research, which finds head injuries responsible for 68 percent of hospitalizations in the military sport. “Evidence that boxing produces irreversible brain damage is now as indisputable as the link between cigarette smoking and lung cancer,” the researchers state. Navy boxing coach Emerson Smith disagrees, as chairman of a safety committee overseeing amateur fighting. “Since they have mandated gloves and headgear that we did research on for all boxing programs in the United States, the injury statistics are far, far less than probably all your contact sports,” Smith said. “In football, you have the kids that are paralyzed, the kids that die. I don’t believe there’s any high school or college… where you have contact sports where you’ll eliminate all serious injury.”

1989, March 10:  “Boxing Safety Studies Disagree,” by Steve Woodward, USA Today. News report discusses conflicting outcomes in studies on brain risks of young boxers, with results of research commissioned by the U.S. Amateur Boxing Federation portraying the sport in “safer terms” than the Johns Hopkins study, published by JAMA. Boxing advocates questioned the number of brain injuries cited in the JAMA article, suggesting it too high and wondering if many study subjects were unfit to box in the first place. Johns Hopkins researcher Dr. Walter Stewart responds thusly: “Clearly I would say that some people should not be boxing, just as some should not be playing football.”

1990, May 22:  “Head-High Tackles: How Long Can Footy Have Them?” no byline, London Herald. News analysis discusses Britain’s boxing controversy and increasing concern for brain injuries across contact sports, particularly rugby or Australian Rules football, where some clubs already employed “baseline” NP testing. “Boxing people, when confronted with the claim that their sport is unreasonably dangerous, inevitably point the finger straight at [rugby] football as a sport more likely to give an athlete brain damage,” The Herald states. Rugby officials rebuke the allegations, noting their safety measures and declaring relative few concussions occur. An anonymous neurosurgeon, identified as a former rugby player, says high hits were the single threat and could be outlawed by new rules. “The real problem in Australian Rules is not the normal game; it’s the excessive violence and shirtfronts. As long as everyone does things sensibly and the king-hits are kept out of football, the risks are minor.”

1991, Jan. 19:  “Jabs Cause The Brain Damage,” no byline, South Australian Advertiser. Aussie news commentary discusses the following: boxing as gladiatorial sport in western civilization, violence as public spectacle or popular culture; apparent Parkinson’s symptoms in Muhammad Ali; crystallizing medical consensus that repetitive, sub-concussive blows cause long-term cognitive impairment; and injury comparisons, boxing and other activities such as American football. “The controversy over boxing is fueled more by emotional and moral questions than by any overwhelming death toll,” the Advertiser piece opines. “Even though more than 300 professional boxers have died in the past 20 years, a recent American survey put its fatality rate at .13 boxers per 1,000 participants—compared with .3 for college football [players], 1.1 for scuba divers, 5.1 for mountaineers, 5.6 for hang gliders, 12.3 for sky divers, and 12.6 for horse racing [jockeys]. The recorded [boxing] injury rate also is low. In the United States a two-year study of 6,000 amateur boxing bouts revealed an injury rate of 1.43 percent, compared to a rate of 4.75 percent for professional boxing and 46 percent for high school football, a figure which would probably translate quite comfortably to Australian Rules or rugby in Australia.”

1992, December 7:  “Toon Out,” by Albert Kim, Sports Illustrated. News report discusses sudden retirement of NFL receiver Al Toon and his “postconcussion syndrome,” other cases of severe brain injuries in pro football, and ever-increasing awareness within the sport of potential long-term dysfunction for casualties. “Although there is no evidence to show that concussions [in football] can lead to permanent brain damage, most medical experts believes that repeated blows to the head can have dire consequences,” Kim reports. Richard Weiss, team doctor for the Buffalo Bills, says, “Think about boxing. Suffering a large number of concussions over a period of years more than likely leaves some permanent residue.” The “normally articulate and quick-witted” Toon, as Kim describes, is subdued, groggy and suffering memory loss a few weeks following his ninth diagnosed concussion in eight NFL seasons. “There are some inherent dangers in playing football…,” Toon says. “But when you get something like this [concussion syndrome], you’ve got to take it more seriously. You’ve got to think past just, Can I play on Sunday?”

1994, Jan. 28:  “Neurologist Discusses Concussions on The Gridiron,” by Noah Adams, All Things Considered[transcript]. National Public Radio show discusses growing attention to concussions football as Super Bowl nears, including public speculation of long-term brain damage to players, with interview of Dr. Peter Tsairis, team neurologist for the New York Giants. “Are there retired players who… have permanent damage because they had too many concussions?” Adam poses to Tsairis, concluding the show. “I don’t know how many of these players go on to develop dementia,” replies the Giants doctor, “which is a term that we use where there’s permanent structural change on a molecular level to the—to the brain that they cannot remember certain things, when they lose their memory. And you see this a lot in boxers who’ve gone on after their years in boxing and developed dementia problems. We don’t have that much experience with football players who’ve had multiple concussions. I don’t know of any article that’s been written on the subject. I know it’s been done with boxers, but not with football players.”

1994, Jan. 28: “That’s Enough for Buffalo Linebacker Cornelius Bennett,” no byline, Agence France Presse. International news report discusses injuries for Super Bowl teams, including Dallas quarterback Troy Aikman’s widely publicized memory loss of a concussion sustained during the previous week’s NFC title game. The report states: “When told a boxing trainer would suggest six weeks of rest after a concussion, Aikman said, ‘Did you tell him I have a Super Bowl to win? I’m not given the luxury of waiting til then.’ ” Jim Kelly, Bills quarterback, admits “second thoughts” about his brain injuries, especially given the decades of publicized concussions to NFL quarterbacks. “I’ve had six or eight of them and it’s a scary, scary feeling,” Kelly says. “You don’t know where you are at. The emptiness in your mind, let alone your gut, comes when you wake up trying to figure out why everybody is staring at you. It makes you wonder, ‘Is the game worth it?’ But it is.”

1994, Oct. 29:  “Illinois Firm Gives Aikman New Protection,” by Lorraine Kee, St. Louis Post-Dispatch. News commentary discusses star names who’ve suffered concussions in NFL, past and present—including Toon, Merrill Hoge, Roger Staubach, Harry Carson, Joe Montana, Aikman—and a doctor’s linking football to boxing for brain trauma and damage. “Of course, concussions aren’t news to these guys [NFL players],” Kee writes. Aikman says, “You have to be somewhat concerned by concussions, but it’s something you just have to deal with. I don’t want it to get out of hand. I want to live a normal life after pro football.” Dr. Kenneth R. Smith, neurosurgeon at St. Louis University Hospital, says, “It’s kind of like boxing injuries; if you get knocked out a lot of times, your brain will eventually have some diseased process going on. Usually, when the natural nerve cells die, they do not recover.” The specialist adds that multiple impacts to head and spine “could produce a permanent injury and a whole series of these could lead to a possible degeneration later on in life.”

1994, Nov. 1:  “Not Just Boxers [Who] Can’t Answer The Bell,” by Stephen Brunt, Toronto Globe and Mail. Canadian news commentary identifies hypocrisy in supporters of tackle football, including American neurologists, who condemn boxing for brain damage while claiming to see little or none in their nationalistic collision sport. “Professional boxing exists on the verge of extinction…,” Brunt writes. “What is thriving, though, is the greatest sports-entertainment complex in the world, the game that owns Sunday afternoons, NFL football. … What’s the difference between that and being knocked out in a boxing match?” Brunt notes lengthy layoff for concussed athletes in boxing, unlike football, where “after a quick whiff of smelling salts” the injured return to contact, then the writer poses: “Does a 300-pound lineman making full, head-to-head contact have as much brain-jarring impact as a perfectly timed blow delivered with a gloved fist? You’d have to think so. Does the football helmet offer sufficient protection? Obviously not sufficient to prevent players from routinely having their bell run… And when that same helmet becomes the top of a projectile hurtling through space, it also contributes to the damage done.” Football supporters criticized boxing for intent to injure, implying sanctity of their sport, but “watch [NFL lineman] Bruce Smith bearing down on [quarterback] Joe Montana,” Brunt intones, “and then try to convince anyone that his purpose is anything other than doing as much damage as possible. Just as in boxing, there is a direct reward for disabling a foe…” In conclusion, Brunt heckles American medicine and science for obvious see-no-evil perspective regarding NFL dangers: “So where is the AMA now, why isn’t professional football being cast as the last refuge of barbarianism, the way boxing is? Probably because football is not a fringe activity run by the Don Kings of the world, but a mainstream colossus. Probably because football is so tied to corporate and academic institutions and is run by bright, white lawyers. … Probably because the same people who would be doing the condemning have a brother or father or son who has at some level been involved in the game. In other words, probably because of divisions of taste, and class, and money—not [violent] content.”

1994, Nov. 5:  “Staff Is Ready for Severe Hits: Impact of Concussions Isn’t Lost on Vikings Doctors,” by Curt Brown,Minneapolis Star Tribune. News report discusses concussion awareness in an NFL franchise, including for symptoms like headache, blurred vision and memory loss, knowledge expanding among medical staff, coaches and players of an NFL team in 1994—tumultuous year of publicized brain-injury cases for the league, especially of star quarterbacks flattened on television. “If I could give players any advice, I’d say don’t ignore the signs,” says Hoge, a year after retiring for multiple concussions, such as the re-bleed or “second impact” brain injury that rendered him comatose, hospitalized in ICU. A concussion “can clear up and you can function normally,” Hoge continues. “But that doesn’t mean you’re right. This is messing with your brain. You can damage your life. You can go into a coma. You can even die from it.” Longtime Vikings team physician Dr. David Fischer says: “Perhaps awareness has been heightened with fans and players, but our medical staff has always been fairly sensitive to post-concussion syndrome.” Research remains fledgling regarding long-term effects of brain impacts football, with the NFL just committing itself to studies, but some 65 years of medical literature continues documenting brain damage of boxing, like “chronic encephalopathy,” through cellular pathology of deceased athletes and longitudinal study of the living—and the Vikings doctor knows as much, among several NFL team physicians speaking publicly. “In boxing, surely we’ve seen how repetitive head trauma can cause all types of long-term problems,” Fischer says. “But how many blows it takes, what severity over length of time, we don’t know. Dennis Green, Vikings head coach, says, “Concussions are not new to football, but we have a fair understanding of when a guy is safe to return and when he isn’t. It’s up to the doctor if he can or can’t go.”

1994, Nov. 20:  “Dazed and Confused: Merril Hoge and Other Veterans Are Finding Out Why Concussions Have Become Serious Head Games,” by Jerry Crasnick, Denver Post. News analysis discusses the following: brain concussion as “the most highly publicized injury of the 1994 season”; NP testing’s employ around the league, along with balance assessment of players, more intuitive methods to detect concussion symptoms; widespread concern, or talk, for guarding against dreaded “SIS,” second-impact syndrome; rhetoric on brain damage of tackle football; NFL concussion tracking and data compiled annually at the University of Iowa; and insider agreement that modern football is highly dangerous, with large, helmeted athletes sprinting and colliding in open field. “Sometimes the damage the brain sustains is permanent…,” Hoge says. “Twenty years down the line they can’t come in and give you a new joint. It’s irreversible.” Cris Collinsworth, former NFL player turned TV commentator, says: “Once you get out of football, you look back and say, ‘I can’t believe I ever did that.’ It’s insane. My wife tells me all the time that she’s glad I don’t play anymore.” Greg Aiello, NFL director of communications, says league rate of concussions isn’t changing despite public spotlight on the issue. “Obviously, it’s something we’d like to reduce,” Aiello says. “But if all the media attention suggests there’s been a sudden increase in concussions, that’s inaccurate.”

1994, Dec. 19:  “The Worst Case—Doctors Warn That Repeated Concussions Can Lead to Permanent Brain Dysfunction,” by Michael Farber, Sports Illustrated. This news analysis of the time’s most-read sports magazine discusses football brain trauma and potential or known brain damage in players of the American game, particularly in the NFL. “People are missing the boat on brain injuries [in football],” says neurologist Dr. James P. Kelly. “It isn’t just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.” Farber writes: “Some [NFL] veterans have gone through the neuropsychological sideline drills so often that even new concussion can’t make them forget.” Farber reports: “On Dec. 9, [Jets team internist Dr. Elliot] Pellman, Dr. Andy Tucker of the Cleveland Brows and Dr. Ira Casson, a New York neurologist, met with league officials, including commissioner Paul Tagliabue, to discuss concussions and suggest ways to cut down on their frequency.” Elsewhere, Dr. Cantu, neurosurgeon and NCAA-funded researcher of catastrophic brain and spinal injuries in American football, blames players who do not employ “proper contact” or “proper technique” for impacts—or Cantu’s controversial theory for colliding in the modern game without using heads, by avoiding contact of high-tech helmets built for ramming without skull fracture, but incapable of preventing brain trauma: “We know that people who have a concussion tend to have more concussions,” Cantu says. “Why? Two logical reasons. The first is that certain people can take a blow better than others; you see that in boxing all the time. But of equal, if not more, importance is how you play the sport [football]. If you keep playing like a kamikaze, if you tackle with your head, there’s more of a chance of being concussed than if you block or tackle with the shoulders.” Neuropsychologist Ken Kutner, PhD, says lingering “postconcussion syndrome” is more widespread among active and former players than is generally believed: “I counsel several [New York] Giants, past an present, but they don’t want their names known,” Kutner says. Meanwhile, Dr. Joe Maroon, Steelers surgeon, sees the possibility that football players could suffer “cumulative effect” from concussions, but Dr. Joe Torg doesn’t, Eagles doctor: “I know of no football player who has had residual neurological impairment from repeated insults to the head,” Torg says.

1995, March 4:  “Don’t Ban Boxing—Just Make It Safer,” by Joan Ryan, San Francisco Chronicle. News commentary discusses tenants of so-called safer boxing designed to save the blood sport from extinction or banishment, including “scientific” or finesse punching, larger gloves, stringent selection and review of referees, and stringent medical restrictions for fighters, assuring their fitness. “Don’t let them in the ring if they don’t belong there. You’d reduce about 85 percent of the problems,” says neuropsychologist Matthew Bowen, who boxed as an amateur. Former heavyweight champion Mike Tyson doesn’t care about a person he faces in the ring: “I try to catch my opponent by the tip of his nose,” Tyson says, “because I try to punch the bone into his brains.” Ryan, the pundit and confessed boxing fan, comments that “in the wake of yet another fighter leaving the ring on a stretcher with a blood clot in his brain, as happened to Gerald McClellan a week ago, I’m having a tough time arguing against those calling for drastic reforms or an outright ban of the sport.” However, “banning boxing altogether is unrealistic,” Ryan writes. “Plus, if we ban boxing for being too violent, we’d have to consider banning football, too. The incidences of flagrant violence have risen so high in the NFL that agent Leigh Steinberg recently gathered some of the country’s top brain doctors for a seminar with quarterback Steve Young, Troy Aikman, Warren Moon and other football clients who have sustained multiple concussions.”

1995, April 3:  “Information That Should Make Their Heads Spin,” by Bill Plaschke, Los Angeles Times. News commentary discusses new NFL initiatives and proposals, fostering “increased research and awareness of football head injuries,” that include the following: establishing a league committee of experts for brain-injury research and recommendations for prevention; reviewing helmet technology and banning dangerous models; mandating all rookies undergo “baseline” NP assessment for concussion monitoring throughout their careers; and establishing a league-wide “concussion grading scale” and “testing” so injured players can be diagnosed and sidelined until recovery. “If boxing can have these worldwide standards and rules that can keep certain fighters out of danger, it would seem that football could, also,” says Dr. David A Hovda, neurosurgeon and consultant on boxing’s health reforms. “This is a problem that needs to be addressed and studied now.” Another neurologist agrees, Dr. Janet Chance, who says: “Head injuries [in football] are a huge problem, and a poorly understood problem. There are some questions here that absolutely need to be answered.” But Dr. Elliot J. Pellman, Jets team doctor and chairman of the new NFL concussion committee, is unsure about for rapid progress because of monetary expense, time constraint and internal resistance: “Players run the show. If they don’t want to do something, it’s not going to happen,” Pellman says. “We suggest these things and owners are going to look at us like, What difference does this make?” Plaschke states: “It is this sort of attitude that may eventually drive an ex-player to his grave from Alzheimer’s disease. Many doctors now believe this occurs more frequently in those who have suffered multiple concussions.” The writer concludes: “The players still don’t scare and the owners still don’t care. You wonder what has to happen before they do.”

1995, Oct. 20:  “A No-Brainer: Football Leads to Concussions: Al Toon Will Attest That Symptoms Can Remain for Years,” by T.J. Simers, Los Angeles Times. News profile discusses life for former NFL receiver Al Toon with post-concussion syndrome, three years after football retirement, as he still experiences problems such as “emotional volatility.” Toon, a successful businessman, says, “There was a time when I thought of suicide. The act itself was never considered, but life was very frustrating.” Toon says there are more former players like him: “Very, very commonplace. You play the game of football, people get hit in the head. It’s no fluke.” Dr. Daniel Kelly, neurosurgeon at UCLA, believes that concussion management, if effective, would likely sideline many more players than what occurs, and for longer: “There are a lot of things we do not know yet, but the simplest thing would be to have [diagnosed concussed] players sit out a month,” Kelly says. “Of course, if you did that, you would probably have the quarterback, the running back and the tight ends sitting on the bench.” Leigh Steinberg, sports agent, says: “We won’t know for years what that impact of this will be. We may have an epidemic of Alzheimer’s and attendant problems 20 years from now with some of these players.”

1996, July 9:  “Concussion Potentially Most Dangerous Sport Injury: Blows to The Head Cause Brain Damage and The More Hits an Athlete Takes The More Chance of Permanent Injury: Little Research Conducted on Returning After Concussions,” by Shaun Powell, Newsday, New York, reprinted in Canada by The Vancouver Sun. In-depth news report discusses problems of concussion and more brain injury among athletes, young and old, including the following: no “firm” RTP protocol among various approaches for treating the concussed, disagreement marked by no consensus in defining the condition, and wide opinions regarding length of time needed for complete recovery; woeful injury reporting in American football, all levels, especially for subpar concussion diagnosis and recording overall; skull-preserving helmets that cannot prevent brain trauma while likewise encouraging head-on collisions; brain disease such as Alzheimer’s and Parkinson’s in former athletes of contact sports; mounting adverse research findings for contact sports, especially tackle football. “The attention given head injuries in recent years has put the sports world on alert and confirms the fears of medical experts. The concussion finds itself at the forefront of sports injuries,” Powell reports. “We are years behind when it comes to brain injury and what we can do to diagnose it and take care of it,” says Jets internist Dr. Elliot Pellman, chairman of the recently minted NFL Committee on Mild Traumatic Brain Injury. For Hall of Fame quarterback Roger Staubach, concussions figured “in my decision to retire,” he says, estimating he sustained 18 to 20 in football from high school to the NFL.

1996, Oct. 31:   “Experts Warn of Brain Damage,” by Sabin Russell, San Francisco Chronicle. News analysis discusses concussions suffered by the 49ers’ star quarterback Steve Young, growing medical opinion that football’s brain dangers are underestimated, and continued speculation on brain damage of postconcussion syndrome and/or multiple concussions in football. “The risk of serious brain injury with a concussion is very, very low. But when it does happen, it is very severe,” says Dr. Gordon Matheson, Stanford professor of sports medicine. “In the scheme of things, they [concussions] may be very minor. But they may also affect a player over the long haul,” says neurologist Dr. Janet Chance. Russell reports: “Dr. Lawrence Pitts, a University of California at San Francisco neurosurgeon, said ongoing neuropsychological surveys of athletes will ultimately determine whether or not repeated concussions cause permanent damage. Although there is ample [research] evidence that boxers can be permanently damaged in their sport… no one can claim football players have a similar problem. ‘It is very uncommon to see a football player knocked unconscious,’ he said. ‘In boxing, it’s a different matter.’ ”

1996, Nov. 15:  “Concussion Policy Should Be A No-Brainer,” by Paul Woody, Richmond Times Dispatch. News analysis discusses controversial segment of concussion “return to play” protocols, length of layoff for the injured athlete, a sidelining that could be minutes in football or months in boxing. Woody notes that 49ers quarterback Steve Young suffered two diagnosed concussions within 15 days, prompting the question whether the NFL star came back too soon, or dangerously, following the initial brain trauma, continuing: “In boxing in Virginia and most states, a fighter who even takes a technical knockout must wait 30 days before boxing again. If there is a knockout [unconsciousness], the boxer’s waiting period is 60s days.” But the NFL dismisses such boxing RTP protocol for the concussed in pro football, while apparently speaking for football at-large, juvenile and college levels that will follow same philosophy: “We have a committee of team and outside doctors who have been meeting and studying concussions for the past two years,” says NFL spokesman Greg Aiello. “They say it doesn’t make sense to have a rule to keep a player out for a specified period of time. Concussions are too complex. They have to be considered on a case-by-case basis.” An independent analyst disagreed, Dr. Michelle Miller, Virginia Commonwealth University Medical School, who believed boxing RTP parameters should be adopted by football: “I don’t know that it’s coming any time in the future, but it’s needed,” she says.

1996, Dec. 1:  “Heady Concerns: Concussions No Longer Comedic Material in NFL,” by Jonathan Rand, Kansas CityStar. News analysis discusses multiple concussions to star NFL quarterbacks Troy Aikman and Steve Young, and insider perspective on potential brain damage of football players, related to boxing, by Dr. Joseph Waekerle, Chiefs team physician, member of NFL concussion committee, and renowned trauma-care specialist. “It’s a big problem because football has approximately 250,000 concussions every year,” Waekerle says. “One in every five high school players has a concussion on a yearly basis. Now, we’re beginning to understand the potentially serious effects of concussions, especially repeated concussions.” Noting conclusions about second-impact syndrome or brain re-bleeding and susceptibility for multiple concussions, Waekerle says: “The third [vulnerability] is the chronic thing—all this becomes cumulative. A great example would be a boxer. That may occur to other professional athletes who suffer many concussive syndromes.”

1996, Dec. 20:  “Heads, You Lose: Football Concussions Hit Players at All Levels,” by Angelo Bruscas, Seattle Post-Intelligencer. News analysis discusses concussion debate in football, talking points to endure decades into future, including in regard to cultural awareness, modern helmets, risk-taking athletes, soft concussion definition, and gigantic athletes. “The whole subject of concussions has been taken way too lightly,” says Leigh Steinberg, sports agent who’s organized educational seminars for players and encouraged media to cover of the issue. “When Monday Night Football opens with two helmets crashing together and when videos of hardest hits are huge sellers, there’s a level at which concussions are glamorized and the subject is treated as fun without a consciousness of real ramifications.” Pediatrician Dr. Stephen Rice believes football’s ever-increasing sizes and modern equipment create action of terrible risks and casualties, by emboldening players to act as missiles like never before: “Did all this happen before and we were just missing it all? … Now you could run into a steel wall and nothing would happen to you. … In the days when players wore only leather helmets without facemasks, no one struck people with their heads. There was no protection.” Rice notes the fact modern helmets do not prevent concussion “because the helmet doesn’t stop the brain from moving around inside the skull.”

1997, Jan. 1:  “QB Concussions: A Heady Issue,” by Thomas Boswell, Washington Post. News commentary discusses NFL brutality ravaging quarterbacks, suggesting football stars could end up punch-drunk permanently, and endorses controversial countermeasure to arbitrarily monitor tackler intent and punish “cheap-shot” or “dirty” hits. “This season, football’s been getting its bell rung with regularity,” Boswell writes. “Every time a popoular quarterback gets his brain scrambled the game suffers a blow, too. As our gridiron heroes reach middle age, do we want them to remind us of addled boxing pugs? Do we want Troy Aikman to tremble like Muhammad Ali or Danny Wuerffel to be as bizarre and bitter as Joe Frazier?” Boswell reports a coach’s allegation of bounty-type hits on Wuerffel, star quarterback at University of Florida: “Obviously [Florida State] had some late hits [on Wuerffel],” says UF coach Steve Spurrier. “Obviously they could have pulled off. The intent of the hits was a little different than the other teams we play. Obviously somebody told them to try to knock him out of the game.” Spurrier suggests responsibility lies with the Florida State “coaching staff.”

1997, June 10:  “Carson’s Crusade Begins, Puts Focus on Head Injuries,” by Randy Lange, Bergen Record. News profile discusses cognitive and emotional struggles of former All-Pro Giants linebacker Harry Carson, who’s become one of the first players, like Al Toon, to openly discuss his post-concussion dysfunction and dark thoughts such as suicide. “A lot of players are hesitant to talk about the brain and being brain-damaged. It’s one of those things you don’t want to be associated with,” Carson says. “I think probably there are a whole bunch of players walking around who are experiencing mood swings and sensitivity to bright lights and loud noises, who are having headaches, and a whole host of other symptoms. … There was a time where I was depressed about it, and bad thoughts came to my head. I didn’t know what was going on, and I didn’t have anybody to talk to. Suicide? I thought about it. I was living but I didn’t have a life. My head was kind of in a fog. My daughter Asia kept me up. I told myself, ‘You do that, what’s going to happen to her?’ ”

1997, July 13:  “‘Iron Mike’ Webster Works on Strategy for Health Since Retirement; He Has Struggled With Troubles,” by Terry Shropshire, Akron Beacon Journal. News profile discusses the Hall of Fame lineman’s descent into increasingly publicized problems after retiring from the NFL, including poor health, debt, pending divorce and homelessness. “As good as times got, they got bad,” says Pam Webster, estranged wife of the Steelers great. “We’ve gone through times where we didn’t have enough money for toilet paper. There were times we didn’t have heat in the house. … Mike has always been a loner by nature. But there were times that people should have been there for him.” Mike Webster says: “I lived in the car for about a year and a half out of the last five years. … My issues are my issues and I’ll handle my issues.” Doctors speculate Webster suffers from congestive heart failure, but he and others worry about his brain, possible symptoms of post-concussive syndrome or Parkinson’s. “He’s really had trouble concentrating and focusing on certain things in order to function at an optimum level,” says Dr. Jerry Carter, personal physician. Webster acknowledges mind disturbances: “Some of the things I think about, horrify me,” he says.

1997, Sept. 22:  “Use Your Head,” by Joan Ryan, The Sporting News. News analysis discusses NFL forces keeping brain-injured players on the football field, beginning with competitive intent of both the player and his team, such as the controversial case of 49ers quarterback Steve Young. “It’s tough for someone like Steve to sit out when he feels fine,” says Leigh Steinberg, the star’s agent. “But you don’t know how much long-term damage you’re causing by continuing to play. Maybe it’ll cause Alzheimer’s. Maybe senility.” Dr. Larry Bedard, of the American College of Emergency Physicians, doubts effectiveness of so-called concussion management and RTP in sports: “[Concussions] tend to be misdiagnosed and minimized. Athletes are trained to tough it out. But there may be no such thing as a mild concussion.”

1999, Nov. 21:  “NFL players roughed up to know it hurts,” by Bill Gleason, South Bend Tribune. News commentary discusses postconcussion syndrome and the multiple concussions suffered by “punch-drunk” NFL players, while quoting football writer Jerry Magee, who recently endorsed boxing’s lengthy layoff for such athletes in his column for Pro Football Weekly. “It also must be said that boxing, for all its abuses, is more mindful of the well-being of its participants than is the NFL,” Magee states. “In Nevada a boxer who is knocked out cannot fight again for at least 45 days. In the NFL quarterbacks or players at any position who suffer concussions can play again within days. On a recent Monday evening, there was Troy Aikman quarterbacking the Dallas Cowboys only eight days after suffering the sixth concussion of his year. Many people who cover the NFL for newspapers, radio, and TV are around NFL players who are suffering through ‘post-concussion syndrome.’ ”

1999, Dec. 10:  “A Hard-Headed NFL Makes for Soft Skulls,” by Tim Green, USA Today. Guest news commentary by former NFL player discusses regular concussions in the league and endorses mouthpieces for helping prevent brain trauma, while noting longtime nicknames for head-injured players include “cardboard head” and, for those exhibiting lasting impairment and susceptibility, “paper head.” Green writes: “I’m not such a paper head as to think that mouthpieces will eliminate concussions. They help. And, if the NFL is as serious about safety as I think, there will be fewer… cardboard heads.”

2000, May 15:  “Trying to Leave Concussions’ Dark Ages: Neurologists start to take sports hits more seriously,” by James C. McKinley, Jr., New York Times. News analysis discusses continuing problems of non-uniform concussion diagnosis and return-to-play protocols in the NFL and sport at-large, noting that only in “the past 15 years” are neurologist beginning to understand brain trauma and “how multiple concussions can lead to permanent damage.” Mark R. Lovell, a Detroit neurologist serving on the NFL concussion committee who designs NP testing for teams, dismisses concussion guidelines by the American Academy of Neurology: “We don’t know whether being knocked out briefly is any more dangerous than having amnesia and not being knocked out,” Lovell says. “We see people all the time that get knocked out briefly and have no symptoms. Others get elbowed, go back to the bench and say, ‘Where am I?’ ” League committee chairman Dr. Elliot Pellman dismisses standard guidelines for all cases as nonsense amid hype about brain injury in football: “You really have to hope that the doctors who deal with this have a lot of experience with it, use the tools available and are not affected by the outside din,” Pellman says.

2000, September:  “Lower Cognitive Performance of Older Football Players Possessing Apolipoprotein E4,” by Kenneth C. Kutner, David M. Erlanger, Julia Tsai, Barry Jordan, and Norman R. Relkin, Neurosurgery. Clinical study discusses possible genetic link to brain trauma and long-term damage in control groups involving 53 active “professional football players,” presumably of the NFL, and provides direction for priority research questions such as whether football impacts, both concussive and subconcussive, cause cerebral disease or what is known from boxing cases as CTBI, “chronic traumatic brain injury.” In review of literature available, the authors state: “To our knowledge, no previous published study has systemically evaluated the cognitive status of professional tackle football players. At least two different mechanisms may contribute to the development of chronic cognitive dysfunction in football players. First, cognitive impairment secondary to concussion may be cumulative. Football players occasionally experience concussive events through typical contact sport collisions, i.e., head-to-head, head-to-body, head-to-ground, and head-to-goal post collisions. Second, football players may experience subconcussive events through these same collisions during play and practice/training sessions. For professional boxers, CTBI has been associated more strongly with career length than with the number of knockouts and concussions, suggesting that subconcussive blows are an important primary environmental mechanism of neurological dysfunction.”

2001, April 17:  “Concussions Make Stars See Retirement,” by Jonathan Rand, Kansas City Star. News analysis discusses retirement of Cowboys quarterback Troy Aikman, who sustained 10 diagnosed concussions in 12 NFL seasons, and includes comments by league medical officials on state of league knowledge or study in brain trauma of players, which the NFL contends typically clears in days to a week, outside exceptional cases like Aikman and fellow quarterback Steve Young. “For whatever reason, they take much longer to get better,” says Dr. Elliot Pellman, Jets internist and head of league brain committee and research. “You also notice the injuries they are getting are the result of lesser blows. … Why are these individuals more susceptible to post-concussion syndrome? You look at them and there’s no long-term damage. There’s no scientific evidence that can tell you they shouldn’t go back and play. Others say, ‘Even though I can’t prove it, intuitively there’s something wrong. You shouldn’t go back.’ What you see publicly is that debate going on.” Dr. Joseph Waeckerle, Chiefs physician and league committee member, says: “There’s no gold standard to diagnose concussions or predict whether someone will have another concussion.” Leigh Steinberg, agent for Aikman and Young, expresses frustration with the NFL’s “slow” pace for research and answers. “I think the years have not brought any greater focus. The denial by the NFL continues,” Steinberg says, urging standardized NP testing and development of concussion-resistant helmet technology. Pellman responds to Steinberg: “That’s a lawyer talking about medicine. I don’t think it’s ever that easy,” Pellman says. “I’d like to see better helmets and better equipment, and that’s the kind of work we’re trying to do now and are actively promoting to helmet manufacturers. But neither we [researchers] nor the NFL are helmet manufacturers.”

Matt Chaney is a writer, editor, teacher and restaurant cook in Missouri, USA. Chaney’s 2001 MA thesis at the University of Central Missouri involved electronic search for thousands of news reports on performance-enhancing drugs in American football, a project inspired by his experience of injecting testosterone as a college player in 1982 (Southeast Missouri State). Email him at mattchaney@fourwallspublishing.com. For more information, including about Chaney’s 2009 book Spiral of Denial: Muscle Doping in American Football, visit the homepage at www.fourwallspublishing.com.

Cardiac Death Foils Medical Tracking in Football, All Sports

Risk of Sudden Death Understated in Football, Say Experts

Information Barriers, Autopsy Limits Promote Short Data

Sample 31 Player Cases Led by Cardiac Deaths, 2014 To-Date

By Matt Chaney

Posted Friday, October 24, 2014

As concern spikes again for deadly injuries in American football, field collisions have killed from two to five teenagers thus far in 2014, pending further analysis, and an exact number may remain in question.

Actual football mortality constitutes a much bigger picture, meanwhile, through incalculable player deaths that are indirectly related to the game.

Minimally two dozen American football players have succumbed in sudden death this year. Most of the cases are perplexing, challenging for accurate diagnosis and impractical for linking to football, according to contemporary studies and authorities.

Record-keeping is stifled, resulting in significant under-reporting of deaths overall in American sport, especially for cardiac disease, say experts.

For American football, sudden cardiac death (SCD) has been marginally recorded over some 120 years of casualty reporting−while likely being the leading cause of mortality in the game.

And a particular, robust SCD class has been practically excluded, left undocumented: Those active football players who die without  physical exertion, in daily life outside game activities.

Actually, say experts, an athlete’s restful or normal state can combine with previous exertion to induce cardiac arrest in some variations.

“Yes…,” affirms Dr. Kimberly G. Harmon, of the University of Washington, a leading researcher in sudden death among athletes, “exercise can cause changes in the heart in some conditions that may make SCD more likely either at rest or at death.”

This year at least seven American football players have died during sleep and minimally five have collapsed at home, on campus, or while shopping. See their cases amid the 2014 summaries below, hyper-linked to news reports.

The dozen dead were schoolboys and collegiate players who participated regularly in training sessions and games. Each was hours or days removed from his last athletic exertion.

Nine more players have collapsed during football-specific activities, such as games and practices, then died.

Additional cases likely have occurred this year, sudden deaths of active football players, but information is hindered, leading to skewed recording and analysis−and weak prevention.

Privacy law is one limitation but the research field relies too heavily on inconsistent news media, which traditionally generate the lot of football’s catastrophic casualties to become recorded. Thus final statistics are short regarding millions of players, most prepubescent.

“Current methods of data collection underestimate the risk of SCD,” conclude Harmon et al., in the group’s landmark 2011 research on collegiate sports. “Accurate assessment of SCD incidence is necessary to shape appropriate health policy decisions and develop effective strategies for prevention.”

“Deaths in high school athletes may be even less likely to be identified by media reports as opposed to higher-profile NCAA athletes,” the researchers surmise in their article for Journal of The American Heart Association.

Faulty U.S. Death Investigations Impact Medical Data on Sports

Proper postmortem exam is problematic for American SCD casualties in general, not only athletes. America’s current death-investigation system struggles with “widespread dysfunction,” as documented by government and media reviews in the past decade.

Only about 9 percent of all deaths are autopsied in this country, and cardiac disease can elude identification and diagnosis even under pathology exam.

“The coroner-medical examiner system in the United States is highly variable in quality,” says Harmon, the MD and professor of sports medicine and family medicine at UW, via email. “Coroners are often elected or appointed officials with their only requirement being graduation from high school.”

“In many cases (of sport SCD) forensic pathologists are not performing the autopsies and most of the time cardiac pathologists are not involved.”

The basic mission of coroner and ME offices nationwide is to rule natural causes or foul play in a death, “and not necessarily the actual pathology,” notes Harmon.

Verifying a possible sport link is impractical, typically impossible.

“Often the training of the pathologist is limited and budgets to run (microscopic) histology−which is critical in making a correct (SCD) diagnosis−are limited,” notes Harmon, who encounters the issues in her review of college cases.

“Often experts will come to different conclusions as to etiology or not be able to make a definitive call on cause of death.”

Common thread is lack of evidence and sound conclusion, for SCD incidents in football players, like 2013 prep fatalities reported in Michigan and North Carolina. For the latter case, The Fayetteville Observer editorial board criticized state pathologists and procedures.

“When young football player Evan Raines died last year during practice at Seventy First High School, his family had to wait more than a year to find out why,” the newspaper editorialized on Oct. 5, continuing:

“But they weren’t singled out for what appears to be a glacial work pace at the N.C. Medical Examiner’s Office. … And they weren’t singled out, either, for an autopsy report that was vague and incomplete. That, we have learned, is the prevailing condition, too.”

In Missouri, a local coroner acknowledges knowing little but to declare cardiac arrest as cause in the recent death of 22-year-old international student Kazadi Mutombo. The ruling was based on hearsay that the fit and athletic young man collapsed in workout clothes after visiting the YMCA in Joplin.

Autopsy proved fruitless; the coroner’s consultant pathologist detected negligible evidence of harm to Mutombo’s heart, which “appeared to be in good shape.”

“There’s just certain things you don’t find out from autopsies, and you’ll never know,” says Newton County coroner Mark Bridges.

Accurate Death Analysis Crucial to Surviving Family Members

Researchers estimate almost a third of SCD cases in athletes under age 35 produce “negative autopsy” results for the different forms. State-of-the-art, costlier analysis is needed.

“Because electrical and other (cardiac) conditions will not be detected, it is not unusual for a routine autopsy to conclude that the cause of death was indeterminate,” states a Michigan study.

“In such cases, heritable conditions such as cardiac ion-channel disorders are suspect and genetic analysis could help to elucidate the cause of death and prevent future deaths in families at risk.”

The call is universal among experts, to overhaul SCD tracking in sports such as American football, foremost for preventing congenital health calamities among athletes and their families.

Genetically inherited cardiac conditions include most cardiomyopathies, like “enlarged heart” or HCM, and the “channelopathies,” heartbeat malfunctions caused by the organ’s electrical current, becoming increasingly detectable in advanced assays.

“In the past decade, the emergence of the channelopathies, in particular long QT syndrome and catecholaminergic polymorphic ventricular tachycardia, has transformed the importance” of advanced analysis, observes Dr. Mary N. Sheppard, of the Department of Histopathology at Royal Brompton Hospital in London.

“Sudden unexpected death during exercise particularly can, in many families, bring to their attention a hitherto unsuspected cardiac condition which is inherited and may be diagnosed by screening first-degree family members,” Sheppard writes for her 2012 analysis published in British Journal of Sports Medicine.

“Missed diagnoses (or) wrong diagnosis can have catastrophic consequences for families in which other members are at risk of sudden death because they carry the defective gene for that condition.”

31 Death Cases Among Football Players, 2014 To-Date

This collection of death cases among active American football players in 2014 is a sampling of public reports, online news. This analysis does not purport to present any  accurate number or estimation of deaths caused or related to football activities.

See 31 annotated cases below, including fatal casualties of brain bleeding, cardiac disease, heatstroke, and pulmonary embolism, culled from reports in Google banks since January.

Twenty-seven teenagers are among this sample 31 deaths, which are comprised of 1 youth football player, 2 middle-school students, 19 high-school players, 8 collegiate players, and 1 adult in flag football. Case capsules are wholly constructed of news content.

The information requires medically specialized followup, vetting by a multi-disciplinary team that would include accredited epidemiologists and a cardiac histopathologist, among experts, for scientific qualification beyond raw data, which is news content.

No such research team has yet been funded and assembled for American football.

Additional deaths among active football players appear online: suicides, drug overdoses, and more unexpected casualty.

Further deaths reported around the sport, including of coaches and referees, also do not appear below.

Cases are collected and filed by Matt Chaney, MA, at email: mattchaney@fourwallspublishing.com.

My condolences to family and friends of every deceased athlete.

Oct. 17:  Jamond Salley, 16, Virginia, a 5-10, 203-pound lineman for Park View High School in South Hill, complained of a headache after contact during a game. Salley collapsed on the sideline of a brain bleed and was pronounced dead at hospital. Cause of death was blunt force trauma, according to the medical examiner’s office. Sources: WTVR-TV and SoVaNow.com.

Oct. 12:  Trey Taulton, 18, Texas, a 6-foot-1, 210-pound receiver for Mesquite Horn High School, died during sleep of “natural causes,” reports The Mesquite News.

Oct. 1:  Tom Cutinella, 16, New York, a linebacker and offensive guard for Shoreham-Wading River High School, sustained a brain bleed during a game of contact, say police. Cutinella died later at hospital and no autopsy results were available at time of this posting. Source: WFAN-TV.

Sept. 29:  Isaiah Langston, 17, North Carolina, a lineman for Rolesville High School, collapsed during a game on Sept. 26 and died three days later at hospital. A family member says cause of death was linked to a blood clot at the brain, reports WTVD-TV.

Sept. 28:  Andrew Madrid, 14, Texas, a football player for Marfa High School, collapsed while playing soccer with friends at the school on this Sunday. He died later at hospital. Sources: Big Bend Sentinel and KWES-TV.

Sept. 28:  Demario Harris Jr., 17, Alabama, a cornerback for Charles Henderson High School, collapsed of a brain bleed after making a tackle during a game on Sept. 26. Harris died two days later at hospital of a brain hemorrhage caused by contact during the game, says his father. Sources: People, WSFA-TV, and Dothan Eagle.

Sept. 28:  Jeremiah Pierce, 12, New Jersey, a youth player in Penns Grove Midget Football, collapsed during practice on Sept. 23 and died five days later at hospital. Results of any postmortem examination were not available at time of this posting. Sources: New York Daily News and South Jersey Times.

Sept. 1:  Miles Kirkland-Thomas, 16, New York, a 6-2, 295-pound lineman for Curtis High School, collapsed during football practice and was pronounced dead at hospital. Cause of death was hypertrophic cardiomyopathy or HCM, and obesity contributed, according to the medical examiner’s office. Source: Staten Island Advance.

Aug. 25:  Walker Wilbanks, 17, Mississippi, a lineman for Jackson Preparatory School, collapsed during a game on Aug. 22. He died three days later at hospital of over-hydration, or hyponatremia, according to Dr. Joe Pressler. Source: Clarion Ledger.

Aug. 24:  Marquese Meadow, 18, Maryland, a 6-2, 300-pound lineman for Morgan State University, collapsed at football practice on Aug. 10. He died two weeks later at hospital of heatstroke, according to the medical examiner’s office. Sources: Baltimore Sun and Washington Post.

Aug. 20:  Jason Bitsko, 21, Ohio, a 6-4, 280-pound offensive lineman for Kent State University, died during sleep at home. Final autopsy results are pending for public release. Sources: The Associated Press and WOIO-TV.

Aug. 16:  Will Wheeler, 17, Massachusetts, a 5-11, 165-pound defensive back for Central Catholic High School, died during sleep at home. Autopsy is planned, reportedly, but no results are yet available online. Source: Eagle Tribune.

Aug. 13:  William Shogran Jr., 14, Florida, a lineman for Sebastian River High School, collapsed at football practice then died at hospital. Heat illness possibly contributed, according to reports. Further information was unavailable at time of this posting. Sources: New York Daily News and WPTV-TV.

Aug. 11:  Zyrees Oliver, 17, Georgia, an offensive lineman for Douglas County High School, collapsed during football practice on Aug. 5. He six days later at hospital of over-hydration, say doctors. Further pathology results are pending but currently unavailable online. Sources: Atlanta Journal-Constitution and The Weather Channel.

Aug. 10:  Dan Malakoski, 36, Pennsylvania, collapsed while playing flag football and died at hospital, reportedly of cardiac arrest. Source: NewsItem.com.

Aug. 6:  Noah Cornuet, 16, Pennsylvania, a 6-2, 270-pound lineman for Burrell High School, collapsed at football practice then died at hospital. Reportedly, a non-cancerous heart tumor caused the death. Further information is unavailable online. Sources: WTAE-TV and Pittsburgh Post-Gazette.

July 21:  Shawn Afryl, 22, Minnesota, a 6-3, 310-pound offensive lineman for Winona State University, collapsed during a conditioning workout and died at hospital. Cardiac arrest reportedly caused the death. Sources: Chicago Tribune and Minneapolis Star Tribune.

June 30:  Sean Tillotson, 17, Vermont, a running back and tight end for Oxbow Union High School, died of a pulmonary embolism, a blood clot lodged in lung tissue, during an airport layover in Denver, Colorado. Tillotson was recovering from a second surgery on a knee that was injured the previous football season. Source: Valley News.

June 30:  Gage Meeks, 11, Louisiana, who was preparing to play football for Calhoun Middle School, became stricken at home and died at hospital. A doctor said cardiac arrest caused the death. Sources: KNOE-TV and Monroe News-Star.

May 21:  An unidentified boy, 14, New Jersey, collapsed while throwing a football during PE class and died at hospital. The incident occurred at Thomas E. Harrington Middle School. Source: Philadelphia Inquirer.

May 13:  MarQuavious Payne, 17, Georgia, a 5-11, 185-pound linebacker for Cedar Shoals High School, died during sleep at home. Pathology results are unavailable online. Source: Athens Banner-Herald.

April 27:  James Michael Creamer Jr., 15, New York, a lineman for St. Peter’s Boys High School, died in sleep at his home.  An allergic reaction or choking may have contributed to the death, say family members. Source: Staten Island Advance.

April 21:  Jaqwan Cephus McGill, 16, North Carolina, a 5-6, 155-pound running back for South Columbus High School, collapsed at a convenience store and was pronounced dead at hospital.  Autopsy was performed but results remain unavailable online. Sources: Fayetteville Observer and WECT-TV.

April 15:  Mekail Evans, 17, Alabama, a 5-10, 195-pound linebacker for Clay-Chalkville High School, collapsed and died at home following a workout. The teen had a heart condition that was previously undiagnosed, say family members. Sources: Trussville Tribune and Al.com.

April 6:   Ronald Cunningham, 19, North Carolina, a 6-2, 285-pound lineman for St. Augustine’s University, collapsed on campus, possibly of cardiac arrest, and died at hospital.  Cunningham had recently injured a knee in football practice and was awaiting surgery. Pathology results, if any, are unavailable online. Sources: WTVR-TV, WRAL-TV, Charlotte News Observer and Richmond Times-Dispatch.

March 25:  Will McKamey, 19, Maryland, a 5-9, 170-pound running back for the U.S. Naval Academy, collapsed of a brain bleed at practice on March 22 and died three days later in hospital, following surgery. No football contact distinguishable on video could be linked to the injury, say family members. McKamey previously suffered a severe brain bleed in football, 2012, when he was a high-school senior in Tennessee, but no surgery was performed after that incident and he returned to the sport. Sources: USA Today and TheDailyBeast.com.

March 8:  DaQuan Henderson, 15, South Carolina, a defensive lineman for Whale Branch Early College High School, died at a hospital. Henderson’s mother said her son had been diagnosed with irregular heartbeat and a coroner reportedly determined natural causes for the death. Further information is unavailable online. Sources: Beaufort Gazette and MarshelsWrightDonaldson.com.

March 2: Desmond Pollard, 17, Texas, a 6-2, 180-pound receiver for Gilmer High School, collapsed and died during a pickup basketball game. Pathology results, if any, are unavailable online. Sources: KLTV-TV and KYTX-TV.

Feb. 8:  Eddie Key III, 18, Nebraska, a 6-2, 270-pound lineman for Wayne State University, died in his sleep. Autopsy results reportedly list the cause as pulmonary edema, fluid buildup in the lungs caused by heart failure. Sources: KOLN-TV and Lincoln Journal Star.

Feb. 7:  Ted Agu, 21, California, a 6-1, 240-pound defensive lineman for the University of California-Berkeley, became stricken during a team conditioning session and died. Autopsy results released in spring reportedly listed the cause as hypertrophic cardiomyopathy, thickening of the heart, but the player’s family later filed a wrongful death lawsuit, alleging he had a known sickle-cell condition. Sources: The Associated Press, San Francisco Chronicle, and SFGate.com.

Jan. 17:  Joseph Cooks, 18, Florida, a 6-foot-2, 165-pound wide receiver for Southeastern University, died in his sleep. Pathology results, if any, are unavailable online. Source: Lakeland Ledger.

Matt Chaney, with a MA in electronic media studies, is an independent writer, editor, teacher, and restaurant cook in Missouri, USA. For more information, including about his book Spiral of Denial: Muscle Doping in American Football (2009), visit the homepage at www.fourwallspublishing.com. Email him at mattchaney@fourwallspublishing.com.

Cardiac Arrest Likely Kills Most in Football 2014

American football’s possible role in a player’s sudden death is difficult to assess, particularly in a case of cardiac arrest outside physical activity. But athletic exertion is presumably contributing to many player fatalities this year, among the sampling 21 cases in this review. 

By Matt Chaney

Posted Wednesday, August 20, 2014

American football, with but one player’s death of field collision so far in 2014, might be poised to inspire proclamations of “safer” play. Last year, eight players died of football contact, all teens.

But the violent game is only beginning its regular season, traditionally the deadliest calendar stretch. In 2013, for example, the second collision death did not occur until Aug. 16, opening a run of seven direct fatalities in 12 weeks of prep football.

And more young football players are dying unexpectedly in America—especially this year—amid circumstances such as collapsing during a workout, succumbing while asleep, and developing blood clots. These fatalities are largely unverifiable for solid link to the sport that poses bodily stresses beyond physical battering.

A 2014 sampling is below, 21 deaths of active players through Aug. 16, mostly teens, culled from reports online. Death investigation continues for many of these casualties while other cases have concluded without pathology exam.

When cause isn’t field contact, death investigation of an American football player meets obstacles for objective establishment or dismissal of a game link. Medical specialization is required for accurately diagnosing illness like cardiac arrest, for its varied forms, and the process optimally involves experts of multiple disciplines.

Postmortem analysis of a football player, however, is often left to unqualified officials who are merely available, such as a general physician or elected coroner—or no autopsy at all.

Bottom line, no research entity can accurately determine the true number of football-related deaths, and notably not the “National Center for Catastrophic Sports Injury Research” at the University of North Carolina in Chapel Hill. No party has succeeded despite a century of published statistics, incomplete yet widely repeated, because case-collecting cannot properly access and assess the sport’s vast domain.

The football data’s entire history is fault-ridden, in need of redefining and reclassification for disjointed and limited collecting since the Victorian Era, by parties such as news media, game-funded groups like the NCCSIR, and this reporter.

The problem is apparent in overview of football deaths to-date in 2014, particularly the select 21 cases below.

Cardiac arrest likely caused the majority of these deaths, which also include cases of heatstroke, apparently, but information is lacking in public reports.

Conjecture even lingers over the single collision fatality, Navy running back Will McKamey last spring, based on statements by his parents that seemingly absolve football for culpability.

Certainly, evidence of football’s role in many of these casualties will pass undetected, whether missed, lost or ignored.

Epidemiological study remains a lofty goal, therefore, on mortality risk and outcome in American football. Valid and reliable numbers on catastrophic casualties, including survivors, must be harvested from a injurious environment hosting four to five million players scattered over 50 states, with about 95 percent of the population being juveniles.

Such research, unforeseen at this time, would necessitate a massive commitment of money and expertise, along with extraordinary cooperation by athletes, families, and football officials.

The 2014 death cases below are compiled strictly of information available in Google banks, primarily news reports, and require qualified, specialized follow-up for medical designation.

Not included are the deaths of active football players such as suicides and drug overdoses.

My condolences to the families of deceased players.

 

21 Fatality Cases of American Football Players in 2014

From Google reports through August 20

By Matt Chaney

Email: mattchaney@fourwallspublishing.com

Jan. 17:  Joseph Cooks, 18, Florida, a 6-foot-2, 165-pound wide receiver for Southeastern University, died in his sleep. Pathology results, if any, are unavailable online.

Feb. 7:  Ted Agu, 21, California, a 6-1, 240-pound defensive lineman for the University of California-Berkeley, became stricken during a team conditioning session and died. Autopsy results released in spring reportedly listed the cause as hypertrophic cardiomyopathy, thickening of the heart, but the player’s family later filed a wrongful death lawsuit, alleging he had a known sickle-cell condition.

Feb. 8:  Eddie Key III, 18, Nebraska, a 6-2, 270-pound lineman for Wayne State University, died in his sleep. Autopsy results reportedly list the cause as pulmonary edema, fluid buildup in the lungs caused by heart failure.

March 2:  Desmond Pollard, 17, Texas, a 6-2, 180-pound receiver for Gilmer High School, collapsed and died during a pickup basketball game. Pathology results, if any, are unavailable online.

March 8:  DaQuan Henderson, 15, South Carolina, a defensive lineman for Whale Branch Early College High School, died at a hospital. Henderson’s mother said her son had been diagnosed with irregular heartbeat and a coroner reportedly determined natural causes for the death. Further information is unavailable online.

March 25:  Will McKamey, 19, Maryland, a 5-9, 170-pound running back for the U.S. Naval Academy, collapsed of a brain bleed at practice on March 22 and died three days later in hospital, following surgery. Football contact linked to the injury was indistinguishable on video of the practice, said family members. McKamey previously suffered a severe brain bleed in football, 2012, when he was a high-school senior in Tennessee, but no surgery was performed after that incident and he returned to the sport.

April 6:   Ronald Cunningham, 19, North Carolina, a 6-2, 285-pound lineman for St. Augustine’s University, collapsed on campus, possibly of cardiac arrest, and died at hospital.  Cunningham had recently injured a knee in football practice and was awaiting surgery. Pathology results, if any, are unavailable online.

April 15:  Mekail Evans, 17, Alabama, a 5-10, 195-pound linebacker for Clay-Chalksville, collapsed and died at home following a workout. The teen had a heart condition that was previously undiagnosed, said family members.

April 21:  Jaqwan Cephus McGill, 16, North Carolina, a 5-6, 155-pound running back for South Columbus High School, collapsed and died. Autopsy was performed but results remain unavailable online.

April 27:  James Michael Creamer Jr., 15, New York, a lineman for St. Peter’s Boys High School, died in sleep at his home.  An allergic reaction or choking may have contributed to the death, said family members.

May 13:  MarQuavious Payne, 17, Georgia, a 5-11, 185-pound linebacker for Cedar Shoals High School, died during sleep at home. Pathology results are unavailable online.

May 21:  An unidentified eighth-grade boy, 14, New Jersey, collapsed while throwing a football during PE class and died at hospital. The incident occurred at Thomas E. Harrington Middle School.

June 30:  Gage Meeks, 11, Louisiana, who was preparing to play football for Calhoun Middle School, became stricken at home and died at hospital. A doctor said cardiac arrest caused the death.

June 30:  Sean Tillotson, 17, Vermont, a running back and tight end for Oxbow Union High School, died of a pulmonary embolism, a blood clot lodged in lung tissue, during an airport layover in Denver, Colorado. Tillotson was recovering from a second surgery on a knee that was injured the previous football season.

July 21:  Shawn Afryl, 22, Minnesota, a 6-3, 310-pound offensive lineman for Winona State University, collapsed during a conditioning workout and died at hospital. Cardiac arrest reportedly caused the death.

Aug. 5:  Trey Aldrich, 16, Kentucky, a senior football player for Allen Central High School, died in his home. An autopsy was planned but further information is unavailable online.

Aug. 6:  Noah Cornuet, 16, Pennsylvania, a 6-2, 270-pound lineman for Burrell High School, collapsed at football practice then died at hospital. Reportedly, a non-cancerous heart tumor caused the death. Further information is unavailable online.

Aug. 10:  Dan Malakoski, 36, Pennsylvania, collapsed while playing flag football and died at hospital, reportedly of cardiac arrest.

Aug. 11:  Zyrees Oliver, 17, Georgia, an offensive lineman for Douglas County High School, died of over-hydration a few hours after football practice. Further pathology results are pending but currently unavailable online.

Aug. 13:  William Shogran Jr., 14, a lineman for Sebastian River High School, collapsed at football practice then died at hospital. Heat illness possibly contributed, according to reports. Further information was unavailable at time of this posting.

Aug. 16:  Will Wheeler, 17, Massachusetts, a 5-11, 165-pound defensive back for Central Catholic High School, died during sleep at home. Autopsy is planned, reportedly, but no results are yet available online.