Why the NFL is investing in health researchBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6626 (Published 05 October 2012) Cite this as: BMJ 2012;345:e6626
Concussion was just a normal part of football when Dave Duerson played for the Chicago Bears. Dismissed as “dingers,” or a guy getting “his bell rung,” blows to the head weren’t considered a medical problem unless the player was knocked unconscious.
But a few years after he retired, Duerson started to complain of headaches, then his speech began to slur and his vision blurred. His life collapsed, and he blamed it on the earlier concussions. He committed suicide in 2011, at the age of 50, shooting himself in the heart, with orders that his brain be donated to science to study the phenomena.
When Ann McKee, a neurologist at Boston University’s Alzheimer’s Disease Center, took a look she saw “tremendous abnormalities throughout the frontal cortex, which is the part of the brain that controls insight, judgment, and executive function,” she told a congressional briefing last fall.1 “There were virtually no deposits of β amyloids or nerve tangles, which characterize Alzheimer’s disease.”
McKee’s research has focused on the effects of sports related traumatic brain injury. She has seen the same patterns of damage in other athletes, including a 21 year old University of Pennsylvania football player who also committed suicide.
Stories such as Duerson’s have drawn increased attention to the health problems that athletes face, the need to better understand the biology behind those problems, prevention of injury, and how to evaluate and abet the healing process.
Traumatic brain injury is likely to be one of the areas included in the new sports and health research program being established with a $30m (£19m; €23m) donation from the National Football League (NFL).2 3 Announcement of the research initiative came on 5 September, just before the fall season kick-off for the league, which generates $9.5bn a year in revenue. Although the NFL has made substantial charitable contributions in the past, including to a high profile breast cancer awareness campaign, this is by far the largest contribution in its 92 year history.
The NFL also recently signed a research cooperation agreement on traumatic brain injury with the US army. A video of the panel discussion at the signing ceremony, which took place at the US Military Academy at West Point, illustrated the cultural and attitudinal barriers—to keep going and not let your team-mates down—that both organizations will have to overcome in order for concussions to be treated with the medical respect they deserve.4
Cynics point to litigation as a driving factor in the NFL’s growing concern for health. The league is facing 140 concussion lawsuits by more than 3000 current and retired players. Those have been consolidated into a single case, now before a federal judge in Philadelphia. The league contends that health issues are regulated under the collective bargaining agreement with the players’ union and that the case should be dismissed. The legal action has spawned at least one website that tracks the conflict (http://nflconcussionlitigation.com).
Walter J Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke at the National Institutes for Health (NIH), has been at the center of discussions with the NFL for the past six months over the research initiative.
“The NIH will fund research that is relevant to public health, so the match is not targeted for football players but is targeted toward major public health problems,” he told the BMJ. They have discussed five areas “where the NIH mission overlaps with NFL interests.”
The starting point was “the pathology of chronic traumatic encephalopathy, which is a hot topic now with both the military and athletic groups, and also for parents of kids who are playing sports,” said Koroshetz.
Much of the initial conversation around traumatic brain injury included getting a better sense of what constitutes injury and recovery; trying to differentiate people whose symptoms might resolve fairly rapidly from those at risk of more chronic problems; and trying to understand longer term consequences that “intersect with risk factors for Alzheimer’s, amyotrophic lateral sclerosis, and Parkinson’s disease.”
A new study of athletes who played in the league for at least five years found that they were four times more likely to die of Alzheimer’s disease and amyotrophic lateral sclerosis than were other Americans.5
Koroshetz said conversations with the NFL have expanded to include the features of acute joint injury that lead some people to a good recovery and others to develop chronic degenerative joint disease; how to identify young athletic people at risk of sudden cardiac death; and issues surrounding dehydration.
The NIH has sketched out areas for possible collaboration, but with no price tags attached, and has asked the NFL to decide which are its priorities. Koroshetz said, “Once they have decided the research plan, then they recuse themselves from anything related to what gets funded. It is treated just like any other NIH grant.”
Technically, the funding will come through a donation to the Foundation for the National Institutes of Health, a charity established by Congress in 1990 to facilitate public-private partnerships.
One of the foundation’s biggest collaborations to date is a $140m longitudinal project on Alzheimer’s disease involving neuroimaging, sample collection, and the search for biomarkers of early disease and disease progression. Nearly half of the funding has come from industry. The NFL commitment will be disbursed over three years in what many hope will be an ongoing public-private partnership that grows to include other professional sports groups.
Cite this as: BMJ 2012;345:e6626
Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; BR is an independent biomedical journalist who has written reports and other documents, either directly or as a subcontractor, for non-profit clients including the American Association for the Advancement of Science and the US National Institutes of Health.
Provenance and peer review: Commissioned; not externally peer reviewed,