YOUR MONEY OR YOUR MIND?:

When to Hang It Up: The money in big-league sports has helped fuel enormous advances in sports medicine. But is the long-term health of athletes being sacrificed for teams' short-term gain? Leaving it all on the field. (Seth Mnookin, May 6, 2007, Boston Globe Magazine)

Last October, Chris Nowinski, a former varsity football player at Harvard and onetime World Wrestling Entertainment competitor, released Head Games, a book that details what Nowinski calls “football’s concussion crisis." For the 28-year-old Nowinski, who received two of the six concussions he’s aware of while playing college ball, this was no mere academic exercise. Before his premature retirement from wrestling, Nowinski was kicked in the back of the head with such force his opponent thought he might have broken his foot. (Even though much of the action in professional wrestling is scripted, many of the moves are real, and wrestlers experience injuries ranging from broken bones to concussions.) Nowinski blacked out in midair; his failure to complete his next “scripted" move momentarily threw the match into confusion. Two months later, Nowinski took a boot to the chin. Again, he became unaware of his surroundings. The next night, Nowinski, who felt as if he were in a “fog" for days, was on the losing end of what’s called a table match, which is exactly what it sounds like: The loser gets thrown through a table. A few weeks later, Nowinski tried to get back into the ring, but after a couple of fights, the WWE wouldn’t let him continue because of his condition. He would never get in the ring again.

As he soon discovered, the effects of his multiple concussions were not over. Twenty-four hours after his last match, Nowinski was in a hotel room in Indiana with his girlfriend. He woke up in the middle of the night, confused. “I found myself facedown on the floor, surrounded by shards of glass," he writes in Head Games. “I looked to my right. The nightstand was broken, and its glass surface was shattered. The lamp and the alarm clock that had been on the night stand were on the ground." As Nowinski tried to get his bearings, he heard his girlfriend crying out his name, and as he turned around, he saw her huddled in terror on the bed. She told him she had awoken to Nowinski’s otherworldly screams; he looked, she said, as if he were trying to climb up the hotel room’s walls. These days, he lives in fear of what his future will bring. He sometimes struggles with names. Is that normal forgetfulness? Or a harbinger of what’s to come?

Nowinski, like virtually all of the people advocating for more attention to the dangers of playing despite debilitating injuries, argues passionately about the harm faced by teenagers, whose developing bodies are especially vulnerable. At the beginning of his painstakingly researched book, Nowinski writes of 12-year-old Kyle Lippo, 16-year-old Osten Gill, and 17-year-old Edward Gomez. The three boys died within months of one another in the fall of 2003. All three deaths occurred soon after the boys played in football games, and two of the cases were clearly connected with blows to the head. Lippo, a trombone-playing Boy Scout from Round Lake, Illinois, asked his coach if he could sit out because of a headache. Five minutes later, his coach asked him if he wanted to go back in. Lippo started crying. “It hurts real bad," he said. He died after being airlifted to a local hospital. Deaths like these could be avoided, Nowinski says, if the public were better educated about the risks of playing with injuries. Cantu, who wrote the preface to Head Games, agrees.

A month after Nowinski’s book came out, Andre Waters, an NFL safety from 1984 to 1995, shot himself in the head. After reading about the suicide, Nowinski, suspecting that Waters had been suffering from a traumatic brain injury, persuaded Waters’s family to send sections of his brain to Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh. Omalu was a natural choice: He had examined the brains of Mike Webster and Terry Long, two former Pittsburgh Steelers who died young and experienced post-concussive brain dysfunction. (Webster went through periods of homelessness after retiring from football. He died of heart failure in 2002 at age 50 while suffering from dementia. Long, who doctors said had “punch-drunk syndrome," committed suicide in 2005 by drinking antifreeze. He was 45.) After studying tissue samples, Omalu said Waters’s brain resembled that of an 85-year-old with Alzheimer’s, and he believed the damage was caused or severely exacerbated by Waters’s many concussions.

Three months later, in February of this year, Ted Johnson went public with his struggles with depression and memory loss in the two years since he retired from the Patriots. Johnson attributed his difficulties to concussions he received during his playing career and spoke specifically about an incident that occurred in August 2002. According to Johnson, Patriots coach Bill Belichick went against the advice of the team’s trainer and insisted Johnson participate in full-contact practice drills just days after an exhibition game in which Johnson had been hit so hard that he blacked out. Johnson received another concussion that afternoon in practice, and, he says, his life has never been the same. He retired after the 2004 season, and the past two years have been the most brutal of his life. (Belichick has said that Johnson should have told him he wasn’t ready but also has expressed regret over how the situation unfolded.)

Because of the revelations involving Nowinski, Waters, and Johnson, football fans may soon be discussing second-impact syndrome and post-concussive syndrome as often as they talk about groin pulls or dislocated shoulders. Ironically, if not for research fueled by professional sports, the sad sagas of Johnson and Waters and Long might have been seen as tragic, isolated incidents.

Still, even now, advances in sports medicine don’t always mean that athletes are receiving the best possible care. There’s a long history of focusing solely on athletes’ playing careers when considering their medical treatment – think of the retired catchers who no longer have any cartilage in their knees or the once-proud linebackers who can’t walk on their own. And only recently has the sports world begun to collect data on major professional athletes after their playing days are over. (The research conducted today doesn’t focus as much as on smaller leagues and less popular sports because the financial stakes there are so much lower, making it less likely that players will push themselves – or be pushed – to the point at which they risk life-altering injuries.)

“For a long time, there was nothing but anecdotal evidence about the lives of athletes once they were out of sports," says Dr. Kevin Guskiewicz, the director of the University of North Carolina’s Center for the Study of Retired Athletes. Guskiewicz, who founded the center in 2001 with Dr. Julian Bailes, says he “wanted to find out what was really going on, and base that in science. And what we found was that a lot of the anecdotal evidence ended up being true." The center’s best-known studies have focused on just the type of post-concussive brain injuries that are receiving so much attention today.

“I might be able to limp through this ankle sprain and still be OK 10 years from now," Guskiewicz says. “But when we talk about brain injuries, you can’t limp through them. It’s scary. And when we talk about people dying on the playing field, it’s most often a high school athlete who still has an immature brain. With more advanced players, with National Football League players . . . there would very well be long-term depression or early-onset dementia." Among other things, he’s studying whether some people are predisposed to those conditions.

Guskiewicz is fighting an uphill battle, and often it seems as if virtually no one in professional sports is really paying attention to the type of research he’s doing. Earlier this year, NFL Players Association head Gene Upshaw said it was a player’s responsibility to decide when he could and couldn’t play. “If a coach or anyone else is saying, ‘You don’t have a concussion, you get back in there,’ you don’t have to go, and you shouldn’t go," Upshaw said. “You know how you feel. That’s what we tried to do throughout the years, is take the coach out of the decision making." That statement is so patently ridiculous it would be risible if the consequences weren’t so dire. In the moments after someone sustains an injury, he is the person least able to properly diagnose himself: The adrenaline coursing through his body serves as a natural painkiller. Concussions – which, by their very definition, leave a player disoriented – add a whole other wrinkle. And football players, who don’t have guaranteed contracts and live in fear of losing their jobs to the next guy on the depth chart, are infamous for not acknowledging injuries. Even without all of those factors, 20-something athletes who have never known life outside of sports are not famous for making decisions that realistically consider their futures.

While the NFL’s Mild Traumatic Brain Injury Committee has been disturbingly slow to adopt – or even consider – recommendations made by researchers like Cantu, Guskiewicz, and Omalu concerning mandatory time off the field following a concussion, at least the league has started to analyze data it has collected on its own. In the National Hockey League, the players union has permitted teams to gather information about concussions so long as they don’t analyze any of what they collect.

“They’re afraid we’re going to say there are situations in which players can’t be out there," says a New England-based doctor who has worked with the league and who, like many physicians actively involved with professional sports teams, asked to remain anonymous to maintain their relationships. “The union won’t allow that. They want to ‘protect’ – and I’m fully aware of the irony there – their members’ right to go out and play whenever they want. Because God forbid they should lose their place on the first line."

At a minimum, you can't have folks with a monetary interest in the guys playing make the decision about whether it's in that player's own best interest.

Posted by Orrin Judd at May 6, 2007 12:00 AM