Summary of the 2015 INS Public Lecture

I wrote a summary entitled 'Discussing the Truth About Football’s Safety' on a public lecture which discussed the safety of professional football and efforts of The Football Players Health Study.

The lecture, lead by moderator Nita Farahany, was held as part of the 2015 INS Annual Meeting in Chicago and included presentations from Alvaro Pascual-Leone, I. Glenn Cohen, and Damien Richardson. The summary was included in the November issues of the society's Neuroethics Newsletter.

Lecture Summary /

Moderator Nita Farahany with presenters Alvaro Pascual-Leone, I. Glenn Cohen, and Damien Richardson, left to right. (Gillian Hue)

Discussing the Truth About Football’s Safety

The 2015 INS Annual Meeting opened with a public lecture entitled, "Is Professional Football Safe? Could We Make It Safer? Perspectives from Neuroscience, Law, and Ethics," involving panelists Alvaro Pascual-Leone, I. Glenn Cohen, Damien Richardson, and moderator Nita Farahany. The group discussed the work of The Football Players Health Study at Harvard University and the need to determine in what ways American football is affecting players who rise through the ranks and compete at its highest levels.

Moderating the lecture, Nita Farahany explained that despite intensifying scrutiny of football's safety, we must accept that it will continue to be played and should thus find ways to make it safer for the players throughout the entirety of their careers. She also touted the model used by the Football Players Health Study (FPHS) as well-suited for addressing complex neuroethics issues of this nature—characterized by the utilization of empirical evidence to identify interventions which may improve the overall health of affected populations.

Alvaro Pascual-Leone, a neurologist at Harvard Medical School, was tasked with explaining this study, its goals, and current limitations. He was quick to frame the discussion in terms of risk versus benefits, conceding that while football is dangerous, due to acute injuries and cumulative health risks, scientists also know too little about the health benefits of playing football and the causal relationships underlying all health outcomes of former players to render a verdict on its overall safety.

Pascual-Leone was especially adamant that studies linking concussions and chronic traumatic encephalopathy (CTE) will need a more robust sample size before causal relationships and prevalence statistics can be definitively determined. In concluding remarks, he added that while recently published CTE research data is accurate, the way the information has been presented in the media—extrapolating the study's conclusions to all football players—is inaccurate and that it remains a responsibility of scientists to control misinformation making its way into the public debate.

He stopped well short of being a "CTE-denier," but illustrated his point of needing more robust data by showing that while the FPHS is by far the largest health study of former National Football League (NFL) players, with approximately 2,500 survey respondents, he feels they will need to reach at least about 10,000 of the 15,000 former players (70%) before they can be confident about making any definitive health claims. In the near term, survey data from players' survey responses is helping determine on what organ systems researchers should focus their attention, what potential pilot studies to conduct, and how research will need to be translated into meaningful treatment measures for current and former football players.

I. Glenn Cohen, a professor at Harvard Law School, focused on questions of personal autonomy and the existing health apparatus which serves current players. He explained that while individuals should have the right to play football and pursue it as a career regardless of the health risks, to do so properly requires access to reliable and unbiased information about the benefits, risks, and what it means in the context of their personal health situations. The quality of such information is currently not where it needs to be and the advice many players receive comes from medical professional employed by the team, whose interests greatly overlap with the players but are part of a health system structured for the benefit of the team rather than the health of the individual.

As Cohen sees it, the largest challenges ahead involve developing a clearer understanding of the risks associated with playing football, managing conflicts of interest present in the structure of the NFL, and installing the right communication plan to reach players to aid in their decision making processes. He also stressed that moving forward he hopes players can successfully set the agenda for how their health needs are being met and realized.

The third panelist, Damien Richardson, is both a former NFL player and a physician and orthopaedic surgery resident at Banner University Medical Center. Richardson provided a glimpse into the injury risks associated with football throughout one's career, highlighting the prevalence of injuries affecting high school and collegiate athletes and the increased risk special teams packages pose for lesser-known role players fighting for roster spots in the NFL.

Richardson also discussed how earning the players' trust is critical to the success of the study, both in recruiting participants and in designing successful health interventions. Because many former players feel they didn't have enough control over their health decisions—due to the potentially strong influences from family, trainers, and coaches to play—many are hesitant to immediately trust anyone who says they care about their wellbeing. When asked directly if he would have still made the decision to play football with his current understanding of the risks, Richardson hinted through a casual shrug and a smile that he likely would have still played and said he definitely would have changed the way he played the game, probably adjusting his style as a battering-ram defensive back.

In the final question and answer period, the panelists described how some previous rule changes aimed at improving player safety have merely shifting the types of prevailing injuries, not necessarily reducing injuries altogether. While some of these results may be desireable, Pascual-Leone stressed the need to anticipate unexpected consequence as the sport and its safety measures continue to evolve. In addition, the panelists wrestled with determining who is responsible for player safety, with Farahany suggesting that those who benefit the most—namely the owners, staff, and players—may need to take the lion's share of responsibility for in-game safety and the lifelong health of players.

And while neuroscience would ultimately like to determine if it's safe to play football and meaningfully contribute to the parent's dilemma whether or not to let their children participate, the panelists showed reluctance that such questions should ever be answered in definite terms. Instead they stressed the need to provide players with an accurate portrait of the true health risks and consequences of playing football—what Richardson said NFL players often refer to as "the truth" about football's safety—so that players past and present can make fully-informed health decisions about playing the game they love.