The Long Run: the Impact of Brain Injuries on the NFL

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The Long Run: the Impact of Brain Injuries on the NFL

Brian Kenny: Chronic Traumatic Encephalopathy or CTE can lead to conditions such as memory loss, depression and dementia. The disease is widely believed to stem from repetitive trauma to the head. Today, we'll hear from Professor Richard Hamermesh about his case entitled, "The National Football League and Brain Injuries." I'm your host, Brian Kenny, and you're listing to Cold Call.

Richard Hamermesh teaches in the MBA and Executive Education Programs at Harvard Business School, and he was the faculty chair of the School's Healthcare Initiative. He's an expert on the business issues affecting healthcare policy and delivery. Richard, welcome.

Richard Hamermesh: Thank you, Brian. Pleasure to be here.

BK: So this is a case that is ripped from the headlines. Without getting too detailed on the medical side, could you just give a quick rundown on brain injuries and what we know about them with all the research that's been done?

RH: Right. I should add right here, I'm not a doctor or a medical person. What I know is what I've read, but clearly, repeated blows to the head, repeated concussions, particularly when they start at a young age, particularly when people return to normal activity too quickly, have long-run effects—very serious, long term effects. These effects have been documented through work done at Boston University, where they've been collecting brains of NFL players. They can do pathological studies, and it's very clear that a large percentage of players have CTE.

BK: It think it's 95% was the most recent number of the brains that they've looked at.

RH: Of the brains they've looked at. But the brains they looked at, let's be clear, are patients who died early and were showing signs of dementia in their fifties.

BK: Fair enough.

RH: So they're not looking at the brains of the 75-year-old. I mean, Mike Ditka, for example, is still alive. He played with a leather helmet at Penn State. He's still alive and fine, so who knows why he did it. By the way, just as an aside, Ditka's view is that we should go back to the leather helmets with only one nose guard because he felt, when you were wearing a little, thin leather helmet, there's no way you would use your head as a spear. He said, to protect them, we've put on the equivalent of a tank on their head, and they go around bashing people with it. So I'm not going to take a side on that one, but it's—

BK: It's an interesting notion.

RH: An interesting notion. And then you get the linkages to not only dementia, which is bad enough, but to aggressiveness and spousal abuse. The NFL is a $10 billion business. It's the most popular sport in America, so these incidents make the headlines. Sometimes, the aggressor, the player has behavior problems; [maybe] their upbringing didn't put them in the best place. But in others, there are changes that are going on in their brains that make them more aggressive.

BK: And you cite that in the case. You also cite the terrible spate of suicides, which really brought this to the surface. Brand name players like Junior Seau, at the age of 43, took his own life.

RH: Junior Seau. You have to go five years before you can go over to the Hall of Fame. Everyone knew he was a Hall of Famer. He didn't make it those five years.

BK: So the NFL is the employer in this case. And now they know that repeated blows to the head can cause CTE, so the case really revolves around the steps that they took or didn't take in some instances to address this. Talk a little bit about their response.

RH: I think you have to talk about it in two parts. There seems to be a lot of evidence that, when this first emerged as a potential issue in the nineties, it was ignored. There were some studies and they were put under wraps. That was pretty deplorable, and there was a lawsuit as a result by retired players saying that, “this information was kept from us.” At the time of the case, the settlement is being negotiated, but that is now done. A billion-dollar settlement for these players who played prior to a certain time, and who agreed to abide by the terms of the settlement. But that part of the history is sort of over and out. One can talk about it and critique it.

The more relevant issue is what about today? The risks are well-known. No one's hiding it, and the question becomes, back to the course I teach, what are the employers' responsibilities? Where do they begin? Where do they end? What steps are necessary?

Life happens to be risky. This is an issue we debate in class and people can have their view. I do think that both the players and the owners—these are successful business people who didn't become successful by accident, Bob Kraft here in Boston being the really good example. I think that, on a number of dimensions, they're doing the right things. There have been rules changes. There are more medical personnel around, independent medical personnel. There are concussion protocols. And very important, the players are represented by a union, so there is a collective bargaining agreement, where all of this gets agreed to.

It will be very interesting when this current contract expires in a few years what the players ask for. Will they ask that 1% of revenues out of the owner's pocket build a fund? Will they demand more rules changes, what have you? But keep in mind, the players have mixed motives, too. They have a short duration of time where they can earn lots of money. And they don't want to stop this goose from laying golden eggs either, so I think that, moving forward, in terms of from a legal liability perspective and so on, that the owners will be well-protected, as long as they continue to be vigilant and responsible.

BK: The players talk about their reaction to this in the case, too. Overall, they don't seem as concerned about brain injuries as they do about leg injuries.

RH: Right, and a lot of the rules changes have made hits to the head illegal, but loosened up hitting other parts of the body. The effect of the brain injury is felt in the future. Human beings of all sorts, not just football players, have trouble dealing with consequences that are way out in the future. But again, the number of incidents of concussions taking place in NFL games has gone down each of the last four years. So that's a good thing.

The issue is the data coming in—that what's also critical is how early you started banging your head against other people. For those who started in high school, the effects accumulate. There have been no studies of kids who played in high school, but played Pop Warner, played in high school, played in college, and then weren't drafted. That's a huge group, bigger than the group that's playing the NFL. No studies have been done on them. So to me, in terms, the case is set up to sort of make it an either-or. If you're an owner, do you think we should be investing in new equipment, in new rules? Or maybe it's time to sell your franchise before the deluge, so to speak. I think we're a ways away from needing to sell, where franchise values will start going down, but take the long view. Take the 40-year view.

BK: What do you see in 40 years?

RH: If parents tell their kids: “You're not playing football, sonny. Here's a soccer ball or here's a baseball or a tennis racket. My kid isn't playing football.” You will slowly see a diminution of popularity of this, and at some point, and things turn, slowly, slowly, and then, there's an inflection point. I've had four club seats to the Patriots since they've been in the new stadium. But the thought, when one of these incidents occurs during the week before the game, and I'm either at a game or watching on television, I say to myself, “Richard, are you any different than people going to watch the gladiators fight in the Coliseum?”

BK: I've heard that analogy many times.

RH: That's one of those thoughts that you sort of hope will disappear quickly.

BK: But you're right, over time, we may not be able to look away in good conscience.

RH: Exactly. As norms of society shift, will the game go away? No. Do some percentage of the population still smoke cigarettes? Yes. People do all sorts of things. But again, for the students and for the case, I think the case has the obvious virtue. This is such a topical area.

BK: Some people listening, most of the people listening, probably don't play football at any level. And they might be thinking, “this is a problem for football players.” But you have an interesting take on why this should matter to pretty much everybody.

RH: Right. When you teach it and think about it, there are other industries where there are hazardous conditions. We have regulations for those. There still are accidents, as we well know, and even where the regulators, OSHA, try to stay active, they tend to be underfunded. We have mining accidents still. But I raise the issue, when I taught the case, of whether—because the phenomenon is that these players are going for the short term gain, make the money when they can, and then they'll deal with the consequences later. So I think human beings do tend to make these tradeoffs, and then we, as employers, what are our responsibilities for this?

Life is dangerous. We all will expire. But on the other hand, I don't think anyone would argue that employers have a responsibility, legally and certainly ethically, to do no harm to their employees. That's what the case is about. We try to raise these larger issues of: what are the responsibilities? No one who runs a business wants to think that they're causing trauma, or death, or dementia, and that's the issue that we try to deal with here.

BK: Richard, thank you for joining us on Cold Call.

RH: Thank you.

BK: You can find this case, along with thousands of others, in the Harvard Business School case collection at HBR.org. I’m Brian Kenny. Thanks for listening to Cold Call, the official podcast of Harvard Business School.

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The Long Run: the Impact of Brain Injuries on the NFL

Brian Kenny: Chronic Traumatic Encephalopathy or CTE can lead to conditions such as memory loss, depression and dementia. The disease is widely believed to stem from repetitive trauma to the head. Today, we'll hear from Professor Richard Hamermesh about his case entitled, "The National Football League and Brain Injuries." I'm your host, Brian Kenny, and you're listing to Cold Call.

Richard Hamermesh teaches in the MBA and Executive Education Programs at Harvard Business School, and he was the faculty chair of the School's Healthcare Initiative. He's an expert on the business issues affecting healthcare policy and delivery. Richard, welcome.

Richard Hamermesh: Thank you, Brian. Pleasure to be here.

BK: So this is a case that is ripped from the headlines. Without getting too detailed on the medical side, could you just give a quick rundown on brain injuries and what we know about them with all the research that's been done?

RH: Right. I should add right here, I'm not a doctor or a medical person. What I know is what I've read, but clearly, repeated blows to the head, repeated concussions, particularly when they start at a young age, particularly when people return to normal activity too quickly, have long-run effects—very serious, long term effects. These effects have been documented through work done at Boston University, where they've been collecting brains of NFL players. They can do pathological studies, and it's very clear that a large percentage of players have CTE.

BK: It think it's 95% was the most recent number of the brains that they've looked at.

RH: Of the brains they've looked at. But the brains they looked at, let's be clear, are patients who died early and were showing signs of dementia in their fifties.

BK: Fair enough.

RH: So they're not looking at the brains of the 75-year-old. I mean, Mike Ditka, for example, is still alive. He played with a leather helmet at Penn State. He's still alive and fine, so who knows why he did it. By the way, just as an aside, Ditka's view is that we should go back to the leather helmets with only one nose guard because he felt, when you were wearing a little, thin leather helmet, there's no way you would use your head as a spear. He said, to protect them, we've put on the equivalent of a tank on their head, and they go around bashing people with it. So I'm not going to take a side on that one, but it's—

BK: It's an interesting notion.

RH: An interesting notion. And then you get the linkages to not only dementia, which is bad enough, but to aggressiveness and spousal abuse. The NFL is a $10 billion business. It's the most popular sport in America, so these incidents make the headlines. Sometimes, the aggressor, the player has behavior problems; [maybe] their upbringing didn't put them in the best place. But in others, there are changes that are going on in their brains that make them more aggressive.

BK: And you cite that in the case. You also cite the terrible spate of suicides, which really brought this to the surface. Brand name players like Junior Seau, at the age of 43, took his own life.

RH: Junior Seau. You have to go five years before you can go over to the Hall of Fame. Everyone knew he was a Hall of Famer. He didn't make it those five years.

BK: So the NFL is the employer in this case. And now they know that repeated blows to the head can cause CTE, so the case really revolves around the steps that they took or didn't take in some instances to address this. Talk a little bit about their response.

RH: I think you have to talk about it in two parts. There seems to be a lot of evidence that, when this first emerged as a potential issue in the nineties, it was ignored. There were some studies and they were put under wraps. That was pretty deplorable, and there was a lawsuit as a result by retired players saying that, “this information was kept from us.” At the time of the case, the settlement is being negotiated, but that is now done. A billion-dollar settlement for these players who played prior to a certain time, and who agreed to abide by the terms of the settlement. But that part of the history is sort of over and out. One can talk about it and critique it.

The more relevant issue is what about today? The risks are well-known. No one's hiding it, and the question becomes, back to the course I teach, what are the employers' responsibilities? Where do they begin? Where do they end? What steps are necessary?

Life happens to be risky. This is an issue we debate in class and people can have their view. I do think that both the players and the owners—these are successful business people who didn't become successful by accident, Bob Kraft here in Boston being the really good example. I think that, on a number of dimensions, they're doing the right things. There have been rules changes. There are more medical personnel around, independent medical personnel. There are concussion protocols. And very important, the players are represented by a union, so there is a collective bargaining agreement, where all of this gets agreed to.

It will be very interesting when this current contract expires in a few years what the players ask for. Will they ask that 1% of revenues out of the owner's pocket build a fund? Will they demand more rules changes, what have you? But keep in mind, the players have mixed motives, too. They have a short duration of time where they can earn lots of money. And they don't want to stop this goose from laying golden eggs either, so I think that, moving forward, in terms of from a legal liability perspective and so on, that the owners will be well-protected, as long as they continue to be vigilant and responsible.

BK: The players talk about their reaction to this in the case, too. Overall, they don't seem as concerned about brain injuries as they do about leg injuries.

RH: Right, and a lot of the rules changes have made hits to the head illegal, but loosened up hitting other parts of the body. The effect of the brain injury is felt in the future. Human beings of all sorts, not just football players, have trouble dealing with consequences that are way out in the future. But again, the number of incidents of concussions taking place in NFL games has gone down each of the last four years. So that's a good thing.

The issue is the data coming in—that what's also critical is how early you started banging your head against other people. For those who started in high school, the effects accumulate. There have been no studies of kids who played in high school, but played Pop Warner, played in high school, played in college, and then weren't drafted. That's a huge group, bigger than the group that's playing the NFL. No studies have been done on them. So to me, in terms, the case is set up to sort of make it an either-or. If you're an owner, do you think we should be investing in new equipment, in new rules? Or maybe it's time to sell your franchise before the deluge, so to speak. I think we're a ways away from needing to sell, where franchise values will start going down, but take the long view. Take the 40-year view.

BK: What do you see in 40 years?

RH: If parents tell their kids: “You're not playing football, sonny. Here's a soccer ball or here's a baseball or a tennis racket. My kid isn't playing football.” You will slowly see a diminution of popularity of this, and at some point, and things turn, slowly, slowly, and then, there's an inflection point. I've had four club seats to the Patriots since they've been in the new stadium. But the thought, when one of these incidents occurs during the week before the game, and I'm either at a game or watching on television, I say to myself, “Richard, are you any different than people going to watch the gladiators fight in the Coliseum?”

BK: I've heard that analogy many times.

RH: That's one of those thoughts that you sort of hope will disappear quickly.

BK: But you're right, over time, we may not be able to look away in good conscience.

RH: Exactly. As norms of society shift, will the game go away? No. Do some percentage of the population still smoke cigarettes? Yes. People do all sorts of things. But again, for the students and for the case, I think the case has the obvious virtue. This is such a topical area.

BK: Some people listening, most of the people listening, probably don't play football at any level. And they might be thinking, “this is a problem for football players.” But you have an interesting take on why this should matter to pretty much everybody.

RH: Right. When you teach it and think about it, there are other industries where there are hazardous conditions. We have regulations for those. There still are accidents, as we well know, and even where the regulators, OSHA, try to stay active, they tend to be underfunded. We have mining accidents still. But I raise the issue, when I taught the case, of whether—because the phenomenon is that these players are going for the short term gain, make the money when they can, and then they'll deal with the consequences later. So I think human beings do tend to make these tradeoffs, and then we, as employers, what are our responsibilities for this?

Life is dangerous. We all will expire. But on the other hand, I don't think anyone would argue that employers have a responsibility, legally and certainly ethically, to do no harm to their employees. That's what the case is about. We try to raise these larger issues of: what are the responsibilities? No one who runs a business wants to think that they're causing trauma, or death, or dementia, and that's the issue that we try to deal with here.

BK: Richard, thank you for joining us on Cold Call.

RH: Thank you.

BK: You can find this case, along with thousands of others, in the Harvard Business School case collection at HBR.org. I’m Brian Kenny. Thanks for listening to Cold Call, the official podcast of Harvard Business School.

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