Head-on collision

The NFL's strategy seemed not unlike that of another powerful industry, the tobacco industry, which had responded to its own existential threat by underwriting questionable science through the creation of its own scientific research council and trying to silence anyone who contradicted it. There are many differences, but one is that football's health crisis featured not millions of anonymous victims but very public figures whose grotesque demises seemed almost impossible to reconcile with their personas. One eight-year NFL veteran would kill himself by drinking antifreeze. Another prominent player would crash his Ford pickup into a tanker truck while leading police on a high-speed chase. Two players, Dave Duerson and Junior Seau, would fire handguns into their chests; Seau used a .357 Magnum that his family didn't know he owned to shoot himself in a guest room of his beach house filled with the memorabilia of a legendary 20-year career. As the crisis grew, the brains of those famous players became valuable scientific commodities. A macabre race ensued among researchers to harvest and study them -- even while the bodies were still warm. Minutes after Seau's body was carted out of his house, his oldest son, Tyler, began getting calls seeking his father's brain.

The story is far from over. Nearly 6,000 retired players and families would ultimately sue the league and Riddell for negligence and fraud. Their argument was that the NFL had "propagated its own industry-funded and falsified research" to conceal the link between football and brain damage. One week before the start of the 2013 season, the NFL settled the case -- agreeing to pay the players $765 million, plus an expected $200 million in legal fees. The NFL did not admit wrongdoing, but the settlement hardly resolved the question at the core of the league's concussion crisis: How dangerous is football to one's brain? Unlike smoking, there was no scientific consensus about the risks of playing football. One neurosurgeon connected to the NFL said children were more likely to sustain a brain injury riding a bike or falling down. Another neurosurgeon, also connected to the league, called for abolishing tackle football entirely for children younger than 14.

WHEN ROGER GOODELL took over as NFL commissioner in September 2006, it was hard to ignore how his predecessor, Paul Tagliabue, had dumped a mushrooming health crisis in his lap. In 1994, Tagliabue had created the NFL's Mild Traumatic Brain Injury Committee, a research body that insisted repeatedly -- in scientific papers and public statements -- that NFL players were impervious to brain damage. The MTBI Committee was run by a man who would become Tagliabue's personal physician, Elliot Pellman, a rheumatologist and New York Jets doctor who had no previous experience in brain research. "Commissioner Goodell inherited a nightmare, truly inherited a nightmare," said Bob Stern, a Boston University neuropsychologist who soon would become involved in the crisis. "He inherited a cover-up."

Concussions weren't initially at the top of Goodell's agenda. At the time he took over, his primary concern was how to divide the NFL's expanding riches, which would soon approach $10 billion a year. The climate had changed quickly with the publicity surrounding severely brain damaged players such as Hall of Fame Steelers center Mike Webster and Hall of Fame Colts tight end John Mackey and the obvious disconnect between their horrifying personal stories and the benign attitude of the league's doctors. By the spring of 2007, the league had convened a concussion summit to get the new commissioner up to speed on the developing crisis.

The NFL gathered all medical personnel -- team doctors, trainers, neurological consultants -- in one room to debate the science of concussions. Also invited was a small group of independent neuroscientists who had become known as "The Dissenters" for openly challenging the MTBI Committee, which they regarded as a sham. The Dissenters included Kevin Guskiewicz, a former Pittsburgh Steelers assistant trainer, and Bailes, a former Steelers neurosurgeon, who had co-authored some of the earliest research showing higher rates of dementia and depression among football players; Bob Cantu, a neurosurgeon and one of the nation's pre-eminent concussion experts; and Bill Barr, a former New York Jets neuropsychologist, who had come to believe the MTBI Committee had cherry-picked data to make its case that concussions were minor injuries.

The daylong meeting took place in a crowded, 218-seat amphitheater at Chicago's Westin O'Hare. The audience was composed mostly of white men in coats and ties. Goodell made the opening remarks at 9:15 a.m., emphasizing the NFL's commitment to the concussion issue and thanking the MTBI Committee for its work. The keynote speaker was Michael Apuzzo, a USC neurosurgeon and New York Giants consultant who had published the NFL's controversial research in the medical journal Neurosurgery -- despite the objections of reviewers like Bailes, Guskiewicz and Cantu. Barr, who by then had developed perhaps the least charitable view of the proceedings, described Apuzzo's presence as "very strange. To me, it was like whatever pact they signed with the devil about having him publish their findings, he probably said, 'You guys owe me. I want to talk at the conference.'"

Apuzzo gave way to a series of 10- to 40-minute discussions on the topics of the day. Cantu spoke about guidelines for returning to play. Guskiewicz gave a presentation on the risks of returning to the same game. They were touchy subjects, the source of much of the hostility between the Dissenters and NFL. But the atmosphere was civil, even collegial. It could have been any dry medical conference.

Then Barr took the stage. His topic was ostensibly the "Role of Neuropsychological Testing in Return to Play Decisions." But really he had shown up to firebomb the NFL's research. As Goodell looked on, Barr repeated his allegations that Pellman -- Tagliabue's doctor -- and another member of the MTBI Committee, Lovell, had left out critical data from a study that supposedly had concluded that NFL players recover quickly from concussions. Barr alleged that the league had tossed out thousands of "baseline" tests that were used to measure changes in the brains of concussed players.

"I said that the data collection is all biased," Barr said. "And I showed slides of that. Basically I pointed out that we had been obtaining baselines on players for 10 years, and when you look at the study it only included a small amount of data. My calculations were that their published studies only included 15 percent of the available data. Let's put it this way: There were nearly 5,000 baseline studies that had been obtained in that 10-year period. And only 655 were published in the study."

Barr hadn't come right out and said it, but essentially he was accusing the NFL's researchers of fraud. The implication was that Pellman and Lovell had purposely excluded data that didn't support their findings. Those NFL researchers were in the room. Pellman was seated in the audience. Lovell, the director of the NFL neuropsychology program, had been asked to make his own presentation to the group.

Lovell felt sick -- literally. At four that morning, he had woken up vomiting, the result of a seafood allergy that had flared up after he'd gorged himself on crab legs and shrimp at a banquet the night before. "I was vomiting for like five hours," he said. "Then I had to give two presentations in front of 200 people in this highly charged [atmosphere]. You literally had people sitting on one side of the room and the other." Lovell thought he might not make it. "I was deathly ill," he said. "I didn't think I'd be able to present, and I knew how that would look." Steelers doctor Tony Yates, who was also Lovell's physician, bailed him out by giving him Zofran, a medication used to treat nausea after chemotherapy.

Lovell now found himself under attack in front of the new NFL commissioner. Cantu, one of Barr's fellow Dissenters, watched from the audience, cringing. He'd had his own scientific disagreements with Lovell, but he felt Barr's attack was inappropriate. "I really felt bad for Mark because I didn't feel that was the setting to be exposed to all this," Cantu said. Lovell tried to rebut the allegations. He told the audience that he had used all available data at the time of the study and that it was unclear why he might not have received all of the information.

The next scheduled speaker was Joe Waeckerle, a Kansas City Chiefs doctor and member of the NFL concussion committee. Waeckerle was scheduled to present a 10-minute "Editor's View of the MTBI Research," but according to Cantu, Waeckerle instead announced to the audience: "Well, we now have these ethics issues to assess."

The NFL's concussion summit had suddenly turned into an informal ethics inquiry, with Lovell as defendant.

At one point, according to Lovell, Barr was asked about the missing data: Did the NFL have them or not?

"Yes," Barr replied, according to Lovell.

Barr said he did provide data to Lovell, but only up to 2000 -- four years before the paper was published. After that, he said, he was never asked for the information. As a result, the league had only part of his data. He said Lovell and Pellman never set up an organized system to collect all the data that were being compiled by the individual teams. But when the NFL wrote up the study, it implied that the data were comprehensive.

The room debated the ethical questions surrounding the controversial study before deciding that Lovell hadn't done anything wrong. "It came down in favor of Mark," said Cantu, who was still uncomfortable with what had just unfolded. "The net effect was that he got exonerated in the open forum. But there was enough said before that it just was awkward, to say the least." Barr agreed that the consensus was that Lovell "didn't do anything intentional to not put data in there, but I don't think anybody concluded he did a great job on that research."

As the session broke up, Barr left the stage and made a beeline for the bathroom. "I had to take a wicked pee," he said. As he walked out of the amphitheater, neuropsychologist Micky Collins, Lovell's protege and business partner at ImPACT, followed him outside, fuming.

Collins chased down Barr before he could make it to the men's room. "What are you doing!" Collins screamed, according to Barr. "You're ruining everything! You're an idiot! Everybody hates you!"

"He got his nose right up in my face, like managers in baseball when they get in the face of the umpire and they want everybody to know they're arguing," Barr said. "I'd never had anything like that before -- where somebody is just right in my face."

"Calm down, man," Barr said he told Collins. "Micky, I feel like you're going to hit me or something."

Barr looked down the hallway. Television cameras were hovering nearby. Collins began to calm down, he said.

"You don't understand what we're trying to do," Collins told him. "We're trying to do good."

"Micky, I don't believe in the science you're doing," said Barr. Collins suggested that he come to Pittsburgh to see how he and Lovell worked [at ImPACT].

"Micky, you're talking to me like you're trying to convert me in a religion," Barr said.

"You know what? It is kind of a religion," said Collins, according to Barr.

Collins acknowledged that he had confronted Barr but said he never raised his voice. He said he was upset about Barr's shabby treatment of Lovell.

"Bill, Mark Lovell is the most ethical human being I've ever met," Collins said he told Barr. "For you to attack him is wrong. You look like a buffoon."

Collins said he never compared ImPACT to a religion. "I would never use that language. That makes it sound like a cult; it's creepy." He said he merely told Barr that people gravitated to ImPACT "because it works."

The NFL's much-anticipated concussion summit already had featured an ethics probe and a near brawl involving two neuroscientists.

And it was only lunch.

---

ANOTHER DISSENTER, Julian Bailes, presented in the afternoon. His assigned topic was "Does Concussion Lead to Pugilistic Dementia and Alzheimer's?" A stout, handsome man with a slight drawl and thick dark hair that he swept back from his forehead, Bailes was one of the top neurosurgeons in the country. He loved football so much that, after attending medical school, he had started his neurosurgery career in Pittsburgh mostly so he could work the Steelers sidelines. But Bailes had grown alarmed by what he believed was incontrovertible evidence that the sport he loved was destroying the brains of some former players.

Bailes, by his own admission, was a plodding presenter, but it was impossible to drain the drama from the moment. As Goodell and the league's medical hierarchy looked on, microscopic images taken from the brains of dead football players appeared on the screen. Bailes explained that the brown splotches in the images represented brain cells that had been strangled by the tau protein. [When healthy, tau stabilizes cell structure in neurons and the central nervous system. When compromised, tau can damage the cells to which it is attached.] The almost certain cause, Bailes explained, was repetitive head trauma related to football.

As Bailes went through one slide after another, he described the devastating symptoms produced by chronic traumatic encephalopathy, a neurodegenerative disease that had been detected in the brains of several deceased football players: depression, dementia, even suicide. It was hard to imagine -- the images seemed so benign, like flecks of paint on white marble. It was hard to connect the images to a man drinking antifreeze, Steelers guard Terry Long's means of killing himself, or to someone knocking himself unconscious with a stun gun, as Mike Webster had done before his death. Bailes didn't talk about that. He showed the slides and described what he thought was the cause. "The facts spoke for themselves," he said. "There wasn't really very much editorialization that I had to do. I tried to stay narrow and focus on just what the findings were. Having taken care of brain-injury patients for the previous two decades or more, I knew that the only cause that was known in medical science was this exposure" to head trauma.

As he spoke, Bailes scanned the audience for a reaction. He was feeling the weight of the moment. The conclusions he was delivering to the NFL and its new commissioner, he felt, were "extremely profound": Their game was causing brain damage. How much wasn't clear. But the results, combined with his own earlier studies on depression and dementia in living players, were ominous. Bailes' gaze fell upon a man seated in the first few rows. As sobering as the news was, the man seemed to be ... smirking.

Bailes looked closely. The smirker wasn't looking at him but at Ira Casson, a neurologist who had recently replaced Elliot Pellman as the new co-chair of the NFL's Mild Traumatic Brain Injury Committee. Casson, a balding New York neurologist, had earned the nickname "Dr. No" after repeatedly and emphatically responding "no" when asked on HBO's Real Sports whether football caused dementia, Alzheimer's or any other neurodegenerative disease.

Bailes turned to look at Casson. "I saw him rolling his eyes," said Bailes. He was stunned: The co-chair of the NFL's Mild Traumatic Brain Injury Committee was mocking him! Bailes had presented dozens of papers and had never witnessed anything like it. Struggling to describe what he felt in that moment, he called Casson's reaction "unprecedented, totally unprofessional, egregious ... What other word can I say? It was unbelievable, inappropriate, unbelievable."

Bailes kept going. When he got to the end, he was met with silence. "There were maybe one or two questions," he said. "It was a lack of interest, a lack of intellectual scientific medical curiosity. And absolutely no line to 'What's the next step?'"

Casson was now questioning Bailes' conclusions. Casson brought up his own experience with boxers and said these football cases were definitively not dementia pugilistica -- the boxer's disease -- as he understood it. The buildup of tau protein could have been caused by many factors, Casson said, including substance abuse and steroids. "He was really digging in and just totally unwilling to budge, and that was really their view on everything," said Barr, who was back in the audience. "They were like, 'Okay, I'll listen to you, but you're wrong. We gave you a chance to talk today, but you're wrong.'"

"I'm a man of science," Ira Casson declared.

Years later, that was the line that stuck with everyone. Casson repeated it throughout the afternoon as a response to conclusions with which he seemed to disagree.

"I'm a man of science."

The clear implication was that what Bailes had just presented was not science.

Even Collins, who had his own questions about Bailes' assertions, was stupefied by Casson's performance. "I just sat there thinking, Why is Ira Casson such an asshole?" he said.

Kevin Guskiewicz was apoplectic. It wasn't that long before that he and Bailes were standing together on the Steelers sideline -- Bailes a young neurosurgeon, Guskiewicz an apprentice trainer. As much as anyone, Bailes had helped launch Guskiewicz's career as a neuroscientist. Together, they had started the Center for the Study of Retired Athletes at the University of North Carolina, with the explicit goal of assisting and conducting research on former NFL players. Since then, they had surveyed and examined thousands. Many of the players were fine, Guskiewicz knew. Many were not. And now here was Ira Casson essentially heckling his partner and dismissing their work.

Guskiewicz thought the NFL's concussion summit had the makings of a Saturday Night Live skit, with Casson as the parody of a man in denial. "Oh, my gosh, as long as I live I'll never forget that day," Guskiewicz said. "I use that as a teaching point with my students. I'm like, 'The day that you have to stand up in front of a group and tell them that you're a man or woman of science, your credibility is shot, especially when you have nothing to put in front of people to convince them.' That was a bad, ugly, ugly day for the NFL."

When the doors flew open, the league tried to put a positive spin on it. A dialogue had been opened. Further research was needed. The league was planning its own study on retired players, which it predicted would bring clarity.

Apuzzo, the USC neurosurgeon who published the NFL's flawed research, lectured a motley collection of football writers and broadcasters on the vagaries of the human brain. He explained that a concussion was an "ephemeral kind of event" traceable to prehistoric times, "when people would have a concussion, appear to be dead and then rise. And what this did was to lead our ancestors in medicine 12,000 years ago to begin to bore holes in dead people's bodies thinking they were going to bring them back to life. So it's a very dramatic thing when that happens." As the editor of Neurosurgery, Apuzzo told the sports media, "I really am privileged to feel that I'm a journalist and a part of your family." But he was also the "principal neurosurgical consultant" to the New York Giants: "I triage the Giant players," he explained.

Despite what he had just seen, Goodell raised doubts about the assertions that NFL players were getting brain damage. "I'm not a doctor," Goodell said, "but you have to look at their entire medical history. To look at something that is isolated without looking at their entire medical history I think is irresponsible."

The rancor would spill into the ensuing days. Dave Viano, who co-chaired the MTBI Committee with Casson, tried to get Guskiewicz to sign on to a statement that doubts remained about the effect of repeat concussions. Guskiewicz said the statement was similar to one contained in a pamphlet released to NFL players that fall. That pamphlet contended:

Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly. It is important to understand that there is no magic number for how many concussions is too many. Research is currently underway to determine if there are any long-term effects of concussions in NFL athletes.

"How can you put out this statement? Do you really think you're going to pull the wool over the eyes of these people?" Guskiewicz said he wrote Viano, referring to league medical personnel who had attended the summit. "And he spouted back to me something like, 'That's insulting to me and to our committee that you would suggest that we're trying to pull the wool over anybody's eyes.'"

"Really???" Guskiewicz said he wrote.

"I was just like, 'Come on, get real. Who do you think you're talking to?'" said Guskiewicz. "That was when I realized that he was all about protecting the [league], its name, and not about his own integrity. And that's where I lost respect for him. I thought he was one of the few true scientists on that committee."

But Guskiewicz had detected a faint glimmer of hope right after he left the meeting. He had run into Jeff Pash, the league's general counsel and the No. 2 executive at the NFL. Pash, much to his surprise, was complimentary.

"Keep doing what you're doing," he told Guskiewicz.

Guskiewicz came to believe the concussion summit was "the game changer, the turning point," but not for the reasons the NFL would cite in the statement he'd refused to sign. Guskiewicz realized that Goodell and Pash "were in the back of that room saying, 'I've got a freaking train wreck on my hands here.'"

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