Four years ago when the National Football League (NFL) signed a lucrative contract extension with its television partners, Mark Cuban—noted entrepreneur, businessman, and television personality—took to Twitter and interviews to prophesize the imminent decline of the NFL, saying, “I think the NFL is 10 years away from an implosion…Just watch. Pigs get fat, hogs get slaughtered. When you try to take it too far, people turn the other way.”
While we have to wait several more years to truly evaluate Cuban’s assessment, there have been a number of troubling indications that portend trouble for the NFL. For two straight seasons, television ratings have declined at an alarming rate. While the numbers are consistent with overall changes in viewership, the league’s alarm bells are ringing. On another front, the controversy surrounding social awareness issues has driven a pick between players and owners as well as between the league office and its noted sponsor—Papa John’s. These controversies reflecta greater national conversation about how we view our nation.
Despite these trials, any one of which could be considered a disaster on their own, many would contend that the greatest issue facing the National Football League is Chronic Traumatic Encephalopathy (CTE), a degenerative brain condition that occurs in individuals who have had head injuries. The NFL has wrangled with the spectre of brain trauma for the past decade. The high profile death of former New England Patriot, Aaron Hernandez, and the acclaimed 2015 biography of Dr. Bennet Omalu, M.D., Concussion, have made CTE a national topic of concern. Most recently, Rob Gronkowski, the New England Patriots’ star tight end, flirted with retirement in reaction to the physical toll the sport has on its professional players.
CTE is characterized by ‘Tau’ protein clumps spreading throughout the brain and killing brain cells. The disease typically affects military veterans and athletes—some of the few groups regularly exposed to repeated head trauma. Unfortunately, it can only be diagnosed post-mortem. Symptoms usually surface years after the onset of head trauma but steadily worsen over time. CTE initially affects mood and behavior (usually when the patient is in their late 20s or early 30s); however, problems with memory, thinking, and dementia occur as the disease progresses. This second cluster of symptoms usually appears in patients in their 40s and 50s. While the disease itself cannot be treated yet, symptoms can be targeted to provide relief.
The association between CTE and repetitive hits to the head seems sound since every single person diagnosed with CTE has a history of multiple head traumas. It is particularly interesting that even sub-concussive impacts play a huge factor in the disease. It is not a disease that can be monitored by the number of concussions sustained, but it develops over the course of hundreds or thousands of minor impacts and traumas to the head.
In light of our still evolving understanding of this disease, ultimate caution should be advised. The misconception is that CTE is confined to sports like football and boxing. In reality, it has been linked to many sports from soccer to basketball. At this early stage, the safest route involves a combination of education and precaution. It is unreasonable to upend the fundamental rules of football and other contact sports this early in the disease’s discovery. However, properly warning players and parents—at all levels—should be a mandate. For armed forces around the world, investigation into technology that can mitigate the trauma caused by blasts and other impacts from war should commence.
It is important to understand that CTE is not a disease that will develop after one concussion or even after playing sports or serving in the military for a long time. There is almost certainly a genetic component to the disease that makes some people more likely to develop CTE. We do know that trauma at a young age and a long exposure to head impacts makes it much more likely to develop this disease. As awareness increases and more brains are donated and examined in the brain bank devoted to CTE, it is likely that our understanding and reaction to the condition will take a more concrete form. Where needed, we must make changes to the way we play sports and make new provisions in the rules and gear we use with the ultimate goal to better protect our heads from harm. It is imperative that everyone, from the NFL commissioner, to the elected official, to the casual fan be receptive to changes that will allow our athletes–at every level–to keep their head in the game.