Medical historian explores how the science of repeated head injuries was established, and then forgotten

Note: When I mention "football" in this piece, I'm talking about American football.

The day after the Super Bowl, The Onion reprinted a headline from 2014, which, sadly, remains relevant. The headline read, "Super Bowl Confetti Made Entirely From Shredded Concussion Studies." Oof. How is The Onion always so incredibly spot on?

Also coinciding with this year's Super Bowl was a terrific article about the science of repeated head injuries, published in The New Yorker. The piece, written by Ingfei Chen, details findings of a study by medical historian Stephen Casper, who argues that the dangers of chronic traumatic encephalopathy (CTE) were once openly acknowledged by medical experts. In fact, doctors had raised alarm bells about the dangers of repeated head injuries—which have long occurred in football, hockey, boxing, and other contact sports—as early as the 1800s. However, in more recent years that knowledge has become "controversial," thanks to the powerful influence of sports organizations like the National Football League.

Through an examination of over 100 years of scientific and medical papers, Casper traced how this knowledge became established and then unlearned and forgotten. Unsurprisingly, what was once more or less settled science has been called into question by researchers affiliated with the sports industry. Chen explains that these industry-driven researchers:

argue that we still don't know for sure that head blows in football, hockey, soccer, or rugby can lead, decades later, to the dramatic mood problems, the personality changes, and the cognitive deterioration associated with CTE. These experts maintain that, before we rethink our relationship with these sports, we need scientific inquiries that meet highly rigorous standards—including longitudinal studies that would take fifty to seventy years or more to complete. In the meantime, millions of children and high-school, college, and pro athletes would continue butting heads on the field.

The thing is, there's already plenty of science saying exactly that—i.e. that head blows can cause very negative effects. Chen explains:

Casper believes that the science was convincing enough long ago. "The scientific literature has been pointing basically in the same direction since the eighteen-nineties," he told me. "Every generation has been doing more or less the same kind of studies, and every generation has been finding more or less the same kinds of effects." His work suggests that, even as scientific inquiry continues, we know enough to intervene now, and have known it for decades. It also raises important questions about how, and how much, old knowledge should matter to us in the present. If Casper is right, then how did we forget what's long been known?

The rest of the Chen's terrific piece traces the vast amounts of research showing how harmful repeated head injuries can be, and then turns to a discussion of how, in the mid-1990s, the literature started positing that we needed more research before coming to any definitive conclusions. This was a stark contrast to the decades of convincing research up to that point. Not surprising, this turn was connected to the influence of sports organizations like the NFL. Chen explains:

The NFL had convened a committee on mild traumatic brain injuries, which had begun producing studies; an international committee of industry-affiliated experts known as the Concussion in Sport Group produced reviews and consensus statements. Collectively, these researchers were creating a body of work that downplayed the risks of concussions. For centuries, autopsy studies had been a vital method for understanding disease: the postmortem discovery of lung tumors, for instance, had helped establish the dangers of asbestos. But a core contention of defenders of the contact-sports industry was that, no matter what pathologists uncovered in football or hockey players, causal links hadn't been demonstrated between repetitive head trauma and CTE. They pointed out, for example, that it was unclear how CTE lesions led to particular symptoms.

The outcome of all of this is that CTE skeptics have been able to re-frame debates about head injuries in sports, play semantics about what counts as a "concussion," and cast doubt about the harm repeated blows to the head are causing, all under the guise of "needing more research" to be "certain." Chen states:

Michael Buckland, a neuropathologist at the University of Sydney who directs the Australian Sports Brain Bank, told me that "we seem to have gone backwards in our understanding" of head injuries in sports. The Sports Brain Bank has identified CTE in twenty-two dead athletes, most of whom played rugby or Australian-rules football. Many aspects of CTE remain to be elucidated, Buckland said, but that doesn't negate the larger history of knowledge about blows to the head and neurodegenerative disease.

What gets counted as settled science has incredibly important implications for how sports are allowed to be played. Chen asks, "When does the state of knowledge obligate us to change contact sports further—or alter our views of them?" The obfuscation and erasure of previous-settled knowledge practiced by the CTE skeptics is thus allowing sports organizations to answer that question in ways that minimize their responsibilities to keep players safe. To have to follow the settled science showing how destructive head injuries can be might result in drastically changing the way some sports, like football, are played. It might even—God forbid—result in football as we know it no longer existing. I suspect the threat of this occurring is exactly why the CTE skeptics have become so powerful fighting against decades of established knowledge. And also, violent sports exist in part because there's huge demand for them, so in some ways fans of those sports are also complicit. Chen argues:

To a great extent, we collude as consumers of violence for the sake of entertainment. Damar Hamlin's terrifying cardiac arrest reminded viewers that NFL players aren't action figures; Tua Tagovailoa's multiple concussions, and their consequences, have shown that the NFL's much-touted concussion protocols have left plenty of danger in the game. And yet we keep watching—and, in some cases, signing our children up to play. As Casper sees it, American society is engaging in a self-deception rooted in old attitudes about punch-drunk syndrome. He notes that the old street slang applied to afflicted boxers—"slug nutty," "punchy," "slaphappy"—was largely pejorative; in surveying oral histories, literary works, and other similar sources, he has found that suffering athletes have often been stigmatized as lower-class, semi-deranged malingerers. Getting hit over the head became the stuff of jokes, as in the physical comedy of the Three Stooges.

I'd encourage you to read the rest of the article, it's a really great examination of how power, sports, and science intersect. And like I say every time I write about the darker side of sports, I'm not condemning folks who are sports fans. I am, however, encouraging folks at least to be knowledgeable about the sports they support.