By Matt Chaney, for ChaneysBlog.com<\/p>\n
Posted Tuesday, May 7, 2019<\/p>\n
I.\u00a0 Introduction<\/p>\n
II. AMA Confronts Brutal Football, Condemns Boys Game<\/p>\n
III. JAMA<\/em>\u00a0Editor is Heavyweight of Football Debate<\/p>\n IV. Fishbein Sells Safer Football, Safer Cigarettes for AMA<\/p>\n V.\u00a0 Conclusion<\/p>\n Copyright\u00a0\u00a92019 for original content and historical arrangement by Matthew L. Chaney, Four Walls Publishing<\/em><\/p>\n 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\u2014including for brain damage of players.<\/p>\n The American Medical Association was ally of King Football through recurring controversies of the 20th<\/sup> century. JAMA<\/em>, prestigious journal of the AMA, protected the collision sport in debates from the Depression Era through Vietnam War.<\/p>\n During the 1950s and \u201960s, AMA publications and rhetoric were overrun with authors and theorists of sports medicine. Their safety claims proved critical in preserving youth football from abolition.<\/p>\n Football friendliness of the AMA turned hypocritical in the 1980s, blatantly exposed. JAMA<\/em> 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.<\/p>\n The AMA convention backed Lundberg as critics responded from America and abroad.<\/p>\n \u201cTheir position is almost laughable,\u201d Dr. Ferdie Pacheco, boxing physician and TV commentator, said in 1985. \u201cI think people need to remember a few things about the AMA. It represents less than 50 percent of doctors in the country. It\u2019s not a scientific [research] group. It\u2019s a politically oriented lobbying group.\u201d<\/p>\n \u201cIf the group really cared about safety in athletics, it would have picked on other sports\u2014football, for starters\u2026 They picked on a flea when there are some real elephants out there.\u201d<\/p>\n \u201cThe only problem the AMA encounters in this mission is one of discrimination,\u201d stated Melvin Durslag, news columnist. \u201cIf, in the interest of life and health, it asks for the abolition of boxing, how can it explain auto racing and football?\u201d<\/p>\n \u201cIn [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?\u201d<\/p>\n 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<\/em>, or “CTE.” Lundberg came to acknowledge mistakes, sort of.<\/p>\n \u201cOver 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,\u201d Lundberg commented for Medscape.com in 2016. \u201cAfter 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.\u201d<\/p>\n \u201cUntil 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\u2019s Crimson Tide to a 34-14 victory over the University of Southern California in the Rose Bowl on January 1, 1946\u2026 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.\u201d<\/p>\n \u201cSo, my huge bias delayed confessing reality,\u201d Lundberg continued. \u201cFootball blows to the head damage the brain. We now have so much evidence, both clinical and, especially, from autopsies\u2026 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.\u201d<\/p>\n Dr. Lundberg still believed boxing should be outlawed but amended his stance to endorse banning football for ages 12 and under. The former JAMA<\/em> editor also still believed football officials, their repetitive pledge to devise safe contact sport.<\/p>\n II. AMA Confronts Brutal Football, Condemns Boys Game<\/strong><\/p>\n By turn of the 20th<\/sup>\u00a0century, football advocates had their talking points together for recurring debate over field brutality. In 1900, football’s latest \u201creform,\u201d officials touted new rules, modern equipment, medical supervision, and trained coaches to instill \u201cproper tackling.\u201d<\/p>\n Officials and associates promised \u201csafe football\u201d 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.<\/p>\n Self-anointed \u201cfootball experts\u201d 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.<\/p>\n Football policymakers had stock claims for preventing \u201cconcussion of the brain,\u201d rampant in their forwarding-colliding sport.\u00a0Traumatic insanity<\/em>\u00a0of 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.<\/p>\n 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.”<\/p>\n Personnel pledged \u201copen play\u201d and rules enforcement would eliminate cerebral concussion. The 10-man flying wedge had been banned years ago, they reminded, and smaller \u201cmass\u201d formations were under control.<\/p>\n Officials touted \u201clow tackling\u201d for headless hitting, teaching players to strike with shoulder and chest, eyes up, to avoid cranium shots. \u201cThe best way to learn tackling is with a dummy with head thrown to one side. That saves your head,\u201d said Dr. R.C. Armstrong, coach-physician in Brooklyn, 1899.<\/p>\n 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n In 1900\u00a0JAMA<\/em>\u00a0endorsed the football word of leaders like Walter Camp, who argued brutal play was isolated and \u201cunsupervised,\u201d existing only at small schools, clubs and sandlots. The\u00a0AMA Journal<\/em>\u00a0qualified university football as milder than \u201cgladiatorial combat\u201d and poked at naysayers, editorializing: \u201cAside 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.\u201d<\/p>\n \u201cThere is a chance for more thorough research into the effects of football on [human physiology],\u201d\u00a0JAMA<\/em>\u00a0stated, \u201cbut so far as the evidence is in, the particular charges made seem hardly justified.\u201d<\/p>\n 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.<\/p>\n Today\u2019s football by comparison\u2014some five million players, majority juvenile\u2014produces 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.<\/p>\n In 1902\u00a0JAMA<\/em>\u00a0staffers collected football reports and analyzed casualties. \u201cThus far the returns give 12 deaths, several fatally injured and over eighty seriously injured,\u201d editors announced in December. \u201cAmong 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.\u201d<\/p>\n The AMA editors weren\u2019t condemning football itself, just human factors.\u00a0JAMA<\/em>\u00a0called for officials to revise rules, once again, and to ensure enforcement by field referees. Editors opined \u201cit 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\u2026 brutality is utterly needless and deserves the severest condemnation and consign punishment.\u201d<\/p>\n But brutality was not<\/em> incidental of head-on football, only inherent. Danger element could not<\/em> be attributed to inept rules, bad technique, poor coaching and medical response. Vicious hits and harm were DNA of the sport, explicitly. \u201cIt is a mere gladiatorial combat; it is brutal throughout,\u201d said Karl Brill, Harvard All-American tackle who quit football. \u201cWhen you are opposed to a strong man you have got to get the better of him by violence.\u201d<\/p>\n “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.”<\/p>\n JAMA<\/em>\u00a0editors detected no safe football in 1903 and expressed chagrin for officials. \u201cThe fatalities and injuries\u2026 were probably not more numerous or more grave than in recent years,\u201d the journal editorialized. \u201cWhile 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.\u201d<\/p>\n JAMA<\/em>\u00a0editors still hadn\u2019t given up on football. They commended the game’s instilling campus pride and spirit, along with \u201chonest rivalry in manly sports and athletic exercises.\u201d The\u00a0Journal<\/em>\u00a0backed President Roosevelt in 1905,\u00a0 who blamed\u00a0brutality on \u201cdirty\u201d players and lousy referees, for his effort to cleanse football.\u00a0 The \u201copen game\u201d was Roosevelt\u2019s solution, and scores of colleges jumped the bandwagon, trumpeting presidential reform and \u201csafer football.\u201d This faction, led by Teddy’s alma mater Harvard, was merely bureaucracy to mushroom, become known as the National Collegiate Athletic Association, NCAA.<\/p>\n \u201cPresident Roosevelt is to be congratulated,\u201d\u00a0JAMA<\/em>\u00a0editors declared. \u201cIt was his vigorous protest and personal intervention which, more than anything else, brought the football rules committee to its senses.\u201d<\/p>\n 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. \u201cThe revised rules of the game have not fulfilled the hopes of the framers\u2026 speed and combination plays have proved almost as hazardous,\u201d observed a newspaper scribe. \u201cThe \u2018reformed\u2019 game has been abruptly ended in smaller cities in which players have been seriously injured or killed.\u201d<\/p>\n Roosevelt blamed college leaders and referees for failing to stiffen code against “unnecessary roughness.” The president insisted \u201cthere is no real need for considering the question of the abolition of the game.\u201d He said malicious players were culprit, not wholesome collision football, although he wished it \u201cless homicidal.\u201d<\/p>\n The\u00a0AMA was souring on hocus-pocus about reforming football. \u201cIt 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,\u201d\u00a0JAMA<\/em>\u00a0editorialized. \u201cThe question that naturally arises is whether the game is worth the candle.\u201d<\/p>\n Tackle football wasn’t worth it for boys, said critics who denounced \u201cjunior\u201d play emerging at schools, clubs and sandlots. The anti-movement included college coaches and players who disavowed boys football\u2014and doctors of the American Medical Association, chirping up from hinterland offices to organization headquarters.<\/p>\n The AMA and its Journal<\/em> 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.<\/p>\n AMA honchos,\u00a0editors among them, ruled agenda-setting, finances, and group communication from the non-profit’s headquarters in Chicago. The setup smelled like administrative \u201ctyranny\u201d to Kenneth W. Millican, who critiqued medical industry in 1906.<\/p>\n The AMA posed \u201ca formidable body\u201d in national membership and societal impact, Millican observed for\u00a0Medical Record<\/em>. \u201cIt 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.\u201d<\/p>\n Millican noted, or warned, that a handful of officials could act in defiance of AMA thousands. \u201cIssues will crop up in which the few\u2026 will dictate one course, while the majority will prefer another.\u201d<\/p>\n Junior football didn\u2019t divide the association, at least not in 1907. That December the\u00a0AMA Journal<\/em>, under editor Dr. George H. Simmons, condemned contact football for juveniles. The editorial, titled \u201cFootball Mortality Among Boys,\u201d began: \u201cWe 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.\u201d<\/p>\n JAMA<\/em> reported football produced 14 fatalities in 1907. Twelve of the deaths were of schools and sandlots, \u201cby whom the new rules are not so carefully followed.\u201d Regarding college football, editors would withhold \u201cfinal judgment\u201d until further consideration.<\/p>\n \u201cThere need be no hesitation, however, in deciding that football is no game for boys to play,\u201d\u00a0JAMA<\/em>\u00a0proclaimed. \u201cOf the whole fourteen killed the ages averaged something under eighteen years; none was over twenty.\u201d<\/p>\n Editors alluded to a football belief that players had but shelf life in the maw, often rendering youths \u201cused up\u201d before collegiate competition. \u201cIf 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!\u201d the Journal<\/em> cracked.<\/p>\n \u201cWe 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.\u00a0\u201cIt 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 \u2018sport,\u2019 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?\u201d<\/p>\n The\u00a0JAMA<\/em>\u00a0bomb invigorated foes of kids football\u2014doctors, lawmakers, educators, parents, college coaches, players, journalists\u2014on their crusade that fell short of establishing legal bans before World War I.<\/p>\n But AMA hierarchy wouldn\u2019t threaten King Football again, for the century and beyond, child combatants notwithstanding. On the contrary, AMA brass and publications would demonstrate unseemly patronage for \u201cyouth football,\u201d wholly inappropriate per medical standards and juvenile law, in time ahead.<\/p>\n III. JAMA<\/em>\u00a0Editor is Heavyweight of Football Debate\u00a0<\/strong><\/p>\n 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. \u201cInjuries on the football field are a major concern,\u201d Pennsylvania doctors observed in 1937. \u201cWhile there are about 70,000 college students playing football this fall, there are 700,000 high school boys.\u201d<\/p>\n \u201cAuthorities of the game have endeavored to make it safer for the players,\u201d added the medical society, noting historical failures. \u201cDespite whatever may be done to minimize football injuries, there will be more than 70,000 injuries on gridirons of the United States this fall.\u201d<\/p>\n Then medical sarcasm:<\/p>\n \u201cGet that ball!\u201d<\/p>\n \u201cHit that line!\u201d<\/p>\n \u201cLet\u2019s go, team!\u201d<\/p>\n Many skeptics of cleansed football turned cynical by the 1940s, and debate blew up in public. Juvenile participation was flash-point topic, football\u2019s 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.<\/p>\n 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<\/em> editor, print columnist, and recognized czar of the monolith association.<\/p>\n Dr. Logan Clendening analyzed tackle football from a medico-legal perspective, finding gross negligence, malicious disregard on part of game organizers. \u201cWhat is the excuse for all this death, suffering and disability that compares with war?\u201d Clendening posed, insinuating blame for medicine, government and education.\u00a0\u201cIt doesn\u2019t \u2018make men\u2019 as the coaches argue. It isn\u2019t good sport. It has become one of the stupidest games on earth for the spectator.\u201d<\/p>\n 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. \u201cNote once more the preponderance of high-school injuries,\u201d Clendening emphasized in his column, \u201cwhich supports my contention that boys of high school are not physically matured enough to stand the gaff, at least until they are seniors.\u201d<\/p>\n 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. \u201cThe 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.\u201d An estimated 1.2 million school days were lost by injured players every year.<\/p>\n Like many physicians, Clendening logically associated brain damage of pugilism, known as \u201cpunch drunk\u201d disorder in literature, to the same likelihood for football colliding. \u201cThe condition is not confined to boxers, and may occur in football players or to anyone who receives a severe blow on the head,\u201d he observed.<\/p>\n Dr. William Brady agreed, having linked brain damage to school football for years in his columns, since Harrison Martland\u2019s 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.<\/p>\n 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.<\/p>\n \u201cIt is bad enough for college freshmen to attempt to train for football,\u201d Brady commented in December 1949. \u201cIt is absurd and shameful to permit the \u2018sports\u2019 of the community to use growing boys of high school age as stooges in the football burlesque.\u201d<\/p>\n \u201cFootball is a grown man\u2019s game, and high school boys, even lanky ones, are not full-grown men.\u201d<\/p>\n Meanwhile, a national audience awaited Dr. Morris Fishbein of the AMA, expressing his view of boys football hyped for release 24 hours after Brady\u2019s from Chicago.<\/p>\n Fishbein was an impact leader of American opinion for three decades, a voice of reach rivaling the president\u2019s in any year. Fishbein was known as editorial pen of various AMA publications he founded, and synonymous for JAMA<\/em>. But Fishbein fame was culturally ingrained for his popular press. His syndicate columns ran weekly in newspapers and Reader\u2019s Digest<\/em>. His medical encyclopedias stood ready in countless homes, revered as gospel. Fishbein\u2019s voice was heard through every radio on AMA broadcasts, and the indefatigable personality visited thousands of locales, a celebrity on speaking circuit.<\/p>\n 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 \u201cconcussion\u201d as the game\u2019s No. 1 problem.<\/p>\n IV. Fishbein Sells Safer Football, Safer Cigarettes for AMA<\/strong><\/p>\n JAMA<\/em> Editor Dr. Morris Fishbein knew Dr. Harrison Martland as colleague, having published the pathologist\u2019s landmark study on \u201cpunch drunk\u201d 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.\u00a0 Dr. John W. Perkins characterized brain matter as egg yolk during injury, jolted by inertia, bashing into cranial walls. Perkins discussed \u201ctraumatic cerebral lesions\u201d attributed to \u201cold injury,\u201d different than gross destruction of acute subdural hematoma. And Journal of the American Medical Association<\/em> published Perkins\u2014in 1896.<\/p>\n Fishbein saw a host of doctors link brain damage to tackle football after Martland\u2019s 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<\/em>\u2014yes, CTE\u2014coined by Drs. Karl M. Bowen and Abram Blau. Football referee Dr. Eddie O\u2019Brien said excessive contact caused punch drunkenness. Coach Jim Crowley, one of the legendary Four Horsemen, reduced full-contact scrimmages for his Michigan State players, blaming \u201cpunch drunk\u201d risk. Countless sportswriters made the connection.<\/p>\n Regardless, Fishbein himself would not associate traumatic brain disorder with football, not publicly, and microscopic autopsy wasn\u2019t yet performed on a deceased player to impress him either way. Fishbein\u2019s clout could’ve made that happen, his demanding football pursue obvious research in wake of\u00a0 Martland findings\u2014examining a) brain damage in deceased players and b) cognitive deficit in the living\u2014but he kept quiet.<\/p>\n Fishbein identified mental illness as endemic in America but blamed \u201chigh-tension\u201d society and factors such as child labor, which he labeled \u201ca great menace to future citizens.\u201d The possibility of a nationalized head-knocking dogma, perpetuated through rites like head-ramming football, sanctioned violence, wasn\u2019t broached by Fishbein.<\/p>\n 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\u2019s<\/em> 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 \u201csports medicine\u201d to JAMA<\/em> pages, having published their articles and letters since taking over editorial around 1920. A socialite, Fishbein enjoyed football games even though the sport had been dropped at his college alma mater.<\/p>\n 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.<\/p>\n Fishbein of the AMA believed tackle football should be preserved for the Boomer Generation, including juveniles. \u201cThe number of deaths and permanent injuries do not warrant the elimination of the game from a high school athletic program,\u201d he said. \u201cIn reality, basketball and boxing are much harder on youths than football. I believe boxing should be banned in high schools.\u201d<\/p>\n \u201cFootball, in my opinion, is not too dangerous a sport for high school boys.\u201d<\/p>\n 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. \u201cFormerly, helmets were actually a weapon,\u201d he reasoned. \u201cNow they are a protective piece.\u201d<\/p>\n With Fishbein\u2019s blessing, high school football counted as AMA Approved\u2014a real trademark that was household clich\u00e9, recognized everywhere. The AMA granted its \u201cseal of approval\u201d 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\u2019s office in Chicago.<\/p>\n 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, \u201cBreakfast of Champions,\u201d as an advertiser with Fishbein.<\/p>\n 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 \u201capproval\u201d business of the AMA, naturally.<\/p>\n \u201cDoctors on the Make,\u201d Brady headlined his national column in early 1950, following Fishbein\u2019s overdue departure from the AMA. Brady had dropped membership a few years before. \u201cI couldn\u2019t stomach the way the nominal officers of the AMA permitted the dictator, now deposed, to insult them,\u201d he stated.<\/p>\n Brady derided Fishbein as the \u201cGreat Pooh-Bah\u201d formerly in charge of the “comic weekly\u201d Journal<\/em>. Brady charged corrupt trade and communication, \u201ca racket whereby the American Medical Association \u2018accepts\u2019 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.\u201d<\/p>\n Cigarettes weren\u2019t exactly AMA-approved, not explicitly. But Fishbein valued tobacco advertising for his Journal<\/em>, 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\u2014a JAMA<\/em> cash cow along with drug companies\u2014through controversy of the early 20th<\/sup> century.<\/p>\n Doctors increasingly recommended against smoking, citing potential risks and conservative ethic of Do no harm<\/em>. Many were smokers themselves, one form or another.<\/p>\n 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\u2019s harm during pregnancy. \u201cOn the other hand,\u201d he added, \u201cthere is no clear-cut evidence to prove that use of tobacco may not exercise injurious effects on the unborn baby.\u201d Dr. Crane affirmed the recommendation a pregnant mother shouldn\u2019t smoke.<\/p>\n 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 \u201cseems certain\u201d he attached the caveat: \u201cMany additional studies, are required, however, to determine whether the harm is sufficient to prevent smoking in moderation by prospective mothers.\u201d<\/p>\n And so it went according to Fishbein of the AMA, in a quarter-century of addressing tobacco use, until 1949. He didn\u2019t deny risks but wouldn\u2019t 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<\/em>, right in sync with the focus campaign of Big Tobacco.<\/p>\n 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. \u201cMore Doctors Smoke Camels Than Any Other Cigarette\u201d was a slogan indelibly stamped in American conscious of the period. Print pages, placards and billboards were plastered for years of ridiculous images.<\/p>\n Fishbein blamed excessive smokers for any harm documented. He maintained extremists grew ill for their own abuse of cigarettes and cigars. In contrast \u201csafer smoking,\u201d by the blossoming term, was an innocent pleasure for adults to indulge. Clinicians theorized smoking comforted users with beneficial \u201cpsychological effects,\u201d Fishbein told audiences.<\/p>\n 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 \u201chard, coarse, commoner varieties” that certainly didn’t advertise in JAMA<\/em>. Fishbein quoted an expert who said, \u201cSpeaking generally, tobacco smoking in moderation is not injurious to grown-up people.\u201d<\/p>\n While willing to reach for positives about cigarettes, Fishbein downplayed studies linking maladies of heart, lungs and circulatory system, always suggesting invalid research. \u201cFrom the available evidence there is no ground for any startling announcement about smoking,\u201d Fishbein proclaimed in his newspaper column.<\/p>\n 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, \u201cMedical Mussoli,\u201d versus President Harry S. Truman, and the doctor went down.<\/p>\n Fishbein also took heat for posing as cigarette scientist, with the besmirching JAMA<\/em> and the organization. \u201cThe stately American Medical Association finds itself on the spot about cigarette advertising. Its official Journal accepts cigarette company advertising\u2014but it finds the medical claims rather embarrassing,\u201d editorialized the Des Moines Register<\/em>.<\/p>\n Fishbein and the AMA were guilty of \u201cardent promotion of cigarette smoking,\u201d Dr. William Brady decried in column. \u201cTo 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.\u201d<\/p>\n V. Conclusion<\/strong><\/p>\n 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 \u201cstartling\u201d new research. \u201cA team of medical experts reported that cigarette smoking shortens human life\u2026 and definitely causes higher death rates from heart disease and cancer,\u201d media reported.<\/p>\n But the association didn\u2019t deviate on collision football, maintaining status quo. The group continued to endorse tackle football for children and adults, promoting \u201cbenefits of sound health.\u201d Simultaneously, the\u00a0Journal<\/em>\u00a0crusaded against television for concern of child viewers; doctors said \u201chorror shows\u201d likely posed \u201cadverse medical and psychological implications\u201d for kids. JAMA<\/em>, 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.<\/p>\n JAMA<\/em> 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.<\/p>\n \u201cTo anxious parents of sons who want to play football, the best advice is\u2014let them. No, that is not enough. HELP them to play it safely,\u201d declared Dr. W.W. Bauer, AMA-Approved health columnist for newspapers. \u201cWhen 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.\u201d<\/p>\n \u201cA great many parents base their apprehensions on an overemphasis of the hazards connected with playing football,\u201d 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.”<\/p>\n \u201cThe 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.\u201d<\/p>\n 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.<\/p>\n 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\u2019s playbook, merely replicated of late by Big Tobacco.<\/p>\n JAMA<\/em> 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<\/em>, melded right in at association publications and confabs. Football was AMA-approved like never before.<\/p>\n Dreams, concepts, gadgets, experts\u2014all came stylish again in America. Anything seemed possible in the Space Age, including safe smoking and safe football.<\/p>\n \u201cFootball can be a killer and a maimer,\u201d JAMA<\/em> intoned, \u201cbut for the player it is also a wholesome and valuable experience that\u2014like life itself\u2014can be made safer.\u201d<\/p>\n 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\u00a0<\/em>Spiral of Denial: Muscle Doping in American Football,\u00a02009<\/a>.\u00a0Chaney\u2019s study for graduate thesis, co-published with the University of Central Missouri in 2001, analyzed print sport-media coverage of anabolic substances\u00a0in football from 1983-1999. Email him at\u00a0<\/em>mattchaney@fourwallspublishing.com<\/a>\u00a0or visit the website for more information.<\/em><\/p>\n Select References<\/strong><\/p>\n 13 Die, Scores Hurt in Football Games. (1907, Nov. 28). Waterloo Press<\/em> IN, p. 2.<\/p>\n 30-Day Smoking Test Proves Camel Mildness. (1943, Sept. 15). [Advertisement.] Nevada State Journal<\/em>, Reno NV, p. 7.<\/p>\n 130 Attend Annual Rotary Club Football Banquet Monday Night. (1946, Dec. 10). Logan Daily News<\/em> OH, p. 6.<\/p>\n A Lady Admirer Of High Kicking. (1889, Nov. 9). Wilkes-Barre Evening News<\/em> PA, p. 4.<\/p>\n A Fifteen-Year-Old. (1891, Sept. 24). Salina Republican<\/em> KS, p. 3.<\/p>\n A Public Service. (1931, June 16). Waterloo Courier<\/em> IA, p. 6.<\/p>\n A Story from a Mad House. (1886, July 19). Camden Courier-Post<\/em> NJ, p. 1.<\/p>\n \u201cAbuse of Sport is Not Excuse for Prohibiting It\u201d\u2014Roosevelt. (1907, Feb. 24). Detroit Free Press<\/em> MI, p. 13.<\/p>\n Adams, J. (2005, June 14). Push for ban on boxing is still hotly debated. Louisville Courier-Journal<\/em> KY, p. K4.<\/p>\n Affairs at Rutgers College. (1890, Oct. 12). New York Times<\/em> NY, p. 3.<\/p>\n AMA Drops Seal Of Approval Program. (1955, Feb. 18). Shamokin News-Dispatch<\/em> PA, p. 1.<\/p>\n AMA Silences Dr. Fishbein as Spokesman for Medicine. (1949, June 7). Wilmington News Journal<\/em> DE, p. 14.<\/p>\n A.M.A. Hierarchy Dodgers Real Reforms in Medicine. (1949, Feb. 15). Detroit Free Press<\/em> MI, p.6.<\/p>\n Amputate Right Leg Following Old Football Injury. (1904, Nov. 17). Louisville Courier-Journal<\/em> KY, p. 7.<\/p>\n Armor for Football. (1900, Nov. 11). Chicago Inter Ocean<\/em> IL, p. 45.<\/p>\n At a Recent Meeting. (1903, April 7). San Francisco Chronicle<\/em> CA, p. 6.<\/p>\n At the Training School at Elwyn. (1892, June 15). Philadelphia Inquirer<\/em> PA, p. 1.<\/p>\n Athletics and Health. (1913, Jan. 14). Rutland Herald<\/em> VT, p. 11.<\/p>\n Bachynski, K.E. (2016). No game for boys to play: Debating the safety of youth football, 1945-2015<\/em>. [PhD dissertation.] Graduate School of Arts and Sciences, Columbia University: New York, NY.<\/p>\n Bachynski, K.E. (2019, January). \u201cThe duty of their elders\u201d\u2014Doctors, coaches, and the framing of youth football\u2019s health risks, 1950s-1960s. Journal of the History of Medicine and Allied Sciences<\/em>, 74(1), pp. 1-25.<\/p>\n Balch, H. (1959, July 25). Hush Puppies. Orlando Sentinel<\/em> FL, p. 16.<\/p>\n Barnes, B.S. (1926, March 6). Suppuration of the shoulder joint: Report of two cases. Journal of the American Medical Association<\/em>, 86 (10), pp. 686-87.<\/p>\n Barton, J.W. (1929, May 7). Meaning of \u2018punch drunk\u2019 given explanation by physician. San Bernardino County<\/em> Sun<\/em> CA, p. 6.<\/p>\n Battle Lines Set As Officials Differ On Smoking Report. (1964, Jan. 13). Wilkes-Barre Times Leader<\/em> PA, p. 1.<\/p>\n Bauer, W.W. (1953, Sept. 25). Better Health: Is football dangerous? Vancouver Province<\/em>, Canada.<\/p>\n Bauer, W.W. (1954, Oct. 27). Health For Today: Football injuries. Vancouver Province<\/em>, Canada, p. 7.<\/p>\n Bauer, W.W. (1955, Sept. 12). Today\u2019s Health: What about football? Pittsburgh Sun-Telegraph<\/em> PA, p. 24.<\/p>\n Bauer, W.W. (1955, Nov. 10). Health For Today: Keeping athletics safe. San Francisco Examiner<\/em> CA, p. 57.<\/p>\n Baxter, D. (1951, Jan. 2). Socialized medicine. Clovis News-Journal<\/em> NM, p. 7.<\/p>\n Bearzy, H.J. (1947, Nov. 8). Physical medicine in the prevention and treatment of athletic injuries. Journal of the American Medical Association<\/em>, 135 (10), pp. 613-16.<\/p>\n Because He Suffered. (1888, Feb. 17). Cincinnati Enquirer<\/em> OH, p. 5.<\/p>\n Bennett, A.E., & Hunt, H.B. (1933, March). Traumatic encephalitis: Case reports of so-called cerebral concussion with encephalographic findings. Archives of Surgery<\/em>, 26 (3), pp. 397-406.<\/p>\n Berg, L. (1936, Nov. 25). Something On Your Mind: \u201cPunch drunk.\u201d Brooklyn Eagle<\/em> NY, p. 14.<\/p>\n Beyer\u2019s Promise to Quit Medical Field Cheats Jail. (1928, Dec. 21). Brooklyn Eagle<\/em> NY, p. 1.<\/p>\n Big Ears of Crazy Men. (1888, Oct. 25). St. Louis Post-Dispatch<\/em> MO, p. 7.<\/p>\n Blood-Stained. (1902, Nov. 30). Louisville Courier-Journal<\/em> KY, p. B1.<\/p>\n Blue Ribbon. (1946, Jan. 23). [Advertisement.] Mansfield News-Journal<\/em> OH, p. 6.<\/p>\n Boshoff, P.H., & Jokl, E. (1948, May 1). Boxing injuries of the eyes. Archives of Ophthalmology<\/em>, 39 (5), pp. 643-44.<\/p>\n Bourne, G.C., & Schwab, R.S. (1949, September). Cerebral fat embolism: Report of a case with recovery. Archives of Neurology and Psychiatry<\/em>, 62 (3), pp. 355-57.<\/p>\n Bowman, K.M., & Blau, A. (1940). Psychotic states following head and brain injury in adults and children<\/em>. In Brock, S. [Ed.] Injuries of the skull, brain and spinal cord: Neuropsychiatric, surgical, and medico-legal aspects<\/em>. Williams & Wilkins: Baltimore MD.<\/p>\n Boy\u2019s Neck Broke in Football Game. (1902, Oct. 31). Hopkinsville Kentuckian<\/em> KY, p. 6.<\/p>\n Brady, W. (1925, March 26). Health Talks: The old lady Hygeia. State Journal<\/em>, Lansing MI, p. 4.<\/p>\n Brady, W. (1928, June 15). Health Talks: Youth and tobaccoism. Appleton Post-Crescent<\/em> WI, p. 6.<\/p>\n Brady, W. (1929, Feb. 1). Personal Health Service: For the sake of the children. Hartford Courant <\/em>CT, p. 10.<\/p>\n Brady, W. (1929, July 7). Sunday Health Talk. Atlanta Constitution<\/em> GA, p. E20.<\/p>\n Brady, W. (1929, Oct. 25). Personal Health Service: Our neurotic sports. Hartford Courant<\/em> CT, p. 10.<\/p>\n Brady, W. (1931, Dec. 31). Health Talks: Ha, parents, here\u2019s a hard one. Atlanta Constitution<\/em> GA, p. 6.<\/p>\n Brady, W. (1934, March 11). How do you like your milk? Brooklyn Eagle<\/em> NY, p. 52.<\/p>\n Brady, W. (1945, Sept. 13). Your Health: Negligible, eh? Davenport Daily Times<\/em> IA, p. 14.<\/p>\n Brady, W. (1948, May 5). Personal Health Service: Punch drunk school boys. Elmira Star-Gazette<\/em> NY, p. 12.<\/p>\n Brady, W. (1949, Dec. 1). Dr. Brady: Questions and answers. Atlanta Constitution<\/em> GA, p. 23.<\/p>\n Brady, W. (1949, Dec. 5). Your Health and Its Care: Football and youth. Medford Mail Tribune<\/em> OR, p.7.<\/p>\n Brady, W. (1949, Dec. 17). Personal Health: Doctors and booze. Saskatoon Star-Phoenix<\/em>, Canada, p. 22.<\/p>\n Brady, W. (1950, March 5). Personal Health: Doctors on the make. Hartford Courant<\/em> CT, p. 26.<\/p>\n Brady, W. (1950, April 30). How\u2019s Your Health? Newport News Daily Press<\/em> VA, p. 18.<\/p>\n Brady, W. (1951, May 21). Personal Health: Calling all physical ed instructors. Hartford Courant<\/em> CT, p. 6.<\/p>\n Brady, W. (1952, April 2). Health Talks: Parents advised to be wary of \u2018minor\u2019 sports injuries. State Journal<\/em>, Lansing MI, p. 17.<\/p>\n Brady, W. (1952, Nov. 27). Child football games cause injury, strain. Los Angeles Times<\/em>, p. B8.<\/p>\n Brady, W. (1954, Oct. 18). Personal Health Service. Kalispell Daily Inter Lake<\/em> MT, p. 6.<\/p>\n Brady, W. (1954, Oct. 25). Brady raps football as prep sport. Los Angeles Times<\/em> CA, p. B4.<\/p>\n Brutality of Football. (1905, Oct. 21). Journal of the American Medical Association<\/em>, 45 (17), pp. 1251-52.<\/p>\n Busch\u2019s Former Partner at Dances. (1888, April 25). Chicago Tribune<\/em> IL, p. 5.<\/p>\n Busse, E.W., & Sliverman, A.J. (1952, Aug. 23). Electroencephalograhic changes in professional boxers. Journal of the American Medical Association<\/em>, 149 (17), pp. 1522-25.<\/p>\n Calls Football a Curse. (1909, Dec. 23). Baltimore Sun<\/em> MD, p. 10.<\/p>\n Camp on Football Rules. (1903, Jan. 18). Cincinnati Enquirer<\/em> OH, p. 33.<\/p>\n Camp, W. (1888, Nov. 4). College kickers. Wilkes-Barre Leader<\/em> PA, p. 6.<\/p>\n Camp, W. [Ed.] (1890). Foot-ball rules and referee\u2019s book: American Intercollegiate Association<\/em>. A.G. Spalding & Brothers: New York NY.<\/p>\n Camp, W. (1890, April 14). Sporting.\u00a0Pittsburgh Press<\/em> PA, p. 4.<\/p>\n Camp. W. (1891, Oct. 10). The best way to win. Indianapolis News<\/em> IN, p. 11.<\/p>\n Camp, W. (1891, Nov. 29). On defensive play.\u00a0Brooklyn Eagle<\/em> NY, p. 12.<\/p>\n Camp, W. (1894). Football facts and figures: A symposium of expert opinion on the game\u2019s place in American athletics<\/em>. Harper & Brothers Publishers: New York NY.<\/p>\n Camp, W. (1895, Nov. 9). The substitute: A foot-ball story. Indianapolis News<\/em> IN, p. 11.<\/p>\n Camp, W. (1896, Dec. 14). Is it dangerous?