by Amelia Hood

 

On December 25 of last year, a timely movie called Concussion was released. The movie dramatizes the work of Dr. Bennett Omalu, a forensic pathologist who first identified chronic traumatic encephalopathy in deceased professional American football players. Since the original exposé in 2009, concussions and their long-term effects on football players has become a topic of controversy in medical and sports realms. Under pressure from medical professionals and the general public, the National Football League has taken steps to prevent concussions by banning headfirst tackling, requiring the presence of independent neurologists, and defining more conservative return-to-play rules after a head injury.

 

There is much controversy on the topic, even among medical professionals. Various position papers call for actions ranging from giving players consent forms summarizing risks to their health, expanding non-tackle football for youths, and giving more weight to team physicians’ recommendations regarding a player’s status. Other debates address the ethical conundrums of dual loyalties experienced by team physicians and their ethical responsibilities to their players/patients, paternalism vs. autonomy in accepting the risks of playing football, and how these things differ between adult players and children. These debates and sports organizations’ responses orbit the difficult facts that football players suffer more concussions than other athletes, and that repeated concussions have devastating short-term and long-term effects.

 

Meanwhile, it’s the best time of year to be an American football fan. On Monday night, an exciting NCAA national championship game ended with the Alabama Crimson Tide victorious. The National Football League is entering playoff mode, to culminate on February 7 with the Super Bowl, a unifying ceremony bordering on sacred ritual. This event attracts around 100 million viewers each year, but Americans’ dedication to football is evident throughout the season. The National Football League raked in $12 billion last season (despite some bad press), and is expected to top that amount this year. Beyond professional and even collegiate football (an enormous industry in its own right with an enormous following), over 4 million youths play in school or club leagues throughout the country.

 

Football and football players embody a set of values revered by the fan base and, arguably, by many Americans. Football players are the perceived pinnacle of masculinity: they are ruthlessly competitive, violently determined, and are known to push the limits of what is safe, or even what is mandated, to achieve superiority on the field. Individual players are lauded for self-sacrifice, playing through pain and injury, and “putting the team first.” Players are seen as role models, especially for young boys, and their successful embodiment of this brand of masculinity makes them worthy of being labeled ‘heroes’ and the accompanying paycheck.

 

As team physicians and other medical professionals negotiate the best ways to protect their patient-players from traumatic brain injuries, this unwavering belief system presents a daunting challenge. The ability of medical professionals to uphold ethical duties to ensure patients’ health, as well as the ability for the patient to autonomously accept risk are both severely hindered by externalities of culture (not to mention economics). The best sideline evaluations, the most conservative return-to-play rules, independent neurologists, and consent forms with the most comprehensive medical information all fail to address the culture of American football in which traumatic brain injuries abound. These steps may, however, signal the start of a shift in values, allowing players’ health to become a bigger priority.

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