Coming to a bookstore and TV near you tomorrow is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time. Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.
In all honesty, if you have followed any part of this issue nothing revealed in either medium (thus far in the book) is seen as “BREAKING NEWS” rather an illustration of what has been happening with the research arm and policy makers of the National Football League, with regards to concussions.
In what I have been able to read thus far both Steve Fainaru and Mark Fainaru-Wada have done a good job of telling the hidden secret. The Fainau’s went as deep as they possibly could without the help of the league itself, even as far as getting one of the original researchers to recount some of the possible misgivings in the past.
By utilizing the real stories of players that met an early demise (Mike Webster most notably) the information has an emotional connection with the reader. While reading this you understand why this information may have been so valuable to the families and friends of those that could have been effected by repeated head trauma.
It doesn’t take a brain surgeon to tell you that repetitive brain trauma is bad for you, but the problem here is that some research and information sponsored by the governing body of the professional sport denied there was a link – while at the same time admitting behind closed doors there may be a link or worse a growing problem. Through the Commissioner change of Paul Tagliabue to Roger Goodell there was a quick statement from the league recognizing the link;
“It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems,” the league spokesman Greg Aiello said in a telephone interview.
However, this statement from Aiello was quickly washed in with the minutia of this current concussion crisis and varying research produced by the league itself. In an excerpt from an ESPN story (can’t release any of what is not already published) this complex dance of getting the proper research can be seen;
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.”
This part excerpt is key for many reasons, it highlights the possible selection of data or simply not caring enough about the missing data to make sound conclusions. Mark Lovell along with Micky Collins were/are major figures within ImPACT – this part of the book and excerpt not withstanding they have done good work in their careers, however this information which the Fainaru’s obtained brings a whole different light on what was transpiring behind the scenes. Granted this interaction between Barr and Collins is a he-said-he-said situation the net effect is that information was missing to form sound conclusions; moreover it seems as though those making policy changes and statements about player safety in regard to concussions was selectively choosing which data it was going to use. FWIW, the idea of having baselines and a test that can objectively measure concussion recovery is “doing good” and Collins was reported as saying. However at what cost and what lengths are people willing to go?
I can imagine the book was given a tidy little bow to finish upon (still getting there), when the NFL settlement was reached just prior to the season beginning. Or, perhaps the book completely underscores why the settlement had to happen from the leagues perspective. As one prominent attorney told me – paraphrasing – “could you imagine what would be found if there was actual discovery in this case?”
For those that want to know why some are deeply concerned with the health of the professional players and to an extent why this information needs to trickle down to the lower levels this book is one you need to put on your reading list. The Brothers Fainaru did tremendous work!
The Concussion Blog 
With due respect, please cite any work conducted by Maroon, Collins or Lovell post 1998 that has any merit? They call themselves scientists and they were little more than marketers. They manipulated data and failed to publicly renounce their misstatements. They sold Impact in a medically unethical fashion for years. Lovell now finds Jesus because he is caught. I don’t see him or any other member of the gang of three doling out money to the families of Terry Long, Mike Webster, Justin Strzelczyk or any other Steeler who died with brain damage (Lovell, Maroon and Collins along with Tony Yates were the team doctors – ImPact detected nothing).
All their papers should be examined for retraction. If they are on any faculty, they should be cashiered.
UPMC should immediately shutdown its so-called concussion clinic on ethical grounds. Outside investigators should audit all cases to see how it conducted business.
Finally, the NFL needs to fire them publicly including rescinding all consulting arrangements. All work conducted by these hacks for the NFL should also be made public especially their emails. ImPact should be removed from the sidelines. No one should have any confidence in a product sold by quacks.
By all reports their patients love their work…
I would be curious how many former Steelers or wives and children of dead Steelers would agree. Or, for that matter, would Sid Crosby agree with the statement.
Being well-promoted and endorsed by the NFL is not the same thing as clinical excellence. Getting over on a vulnerable and ignorant public is not much of trick.
Remember, if something or someone is endorsed by the NFL, it is only because they are doing a valuable service, such as, concealing and conflating science or paying a stiff fee to the league.
Dear Mr. Fink,
After reading the numerous libelous comments made by Jbloggs, perhaps it is time to disallow anonymous comments on your site.
its an open forum… take that up with him…
This reply is directed to the content of pliska’s response pattern reflected and displayed in several of the individual’s TCB blog comments
1- According to LaHaye & Phillips (1982) ACTIVE expressions of anger include, and are not limited to,
sarcasm
ridicule
humiliate
slander
bully
provoke
From my perspective, your various blog comments clearly reflect these components.
2 – In your illogical and apparent emotionally filled attacks towards J Bloggs, you appear to be attacking him and Not his perspectives as you do not present evidence to support your opinions.
YOUR FOCUS on the person and NOT the evidence reflects MAJOR FALLACIES in LOGIC…
These fallacies follow: Ad hominem and tu quoque… along with a flavor of Red Herring
Definitions for Ad hominem and tu quoque:
The ad hominem (“against the person”) and tu quoque (“you, too!”) fallacies focus our attention on people rather than on arguments or evidence.
In both of these arguments, the conclusion is usually “You shouldn’t believe So-and-So’s argument.”
The reason for not believing So-and-So is that So-and-So is either a bad person (ad hominem) or a hypocrite (tu quoque). In an ad hominem argument, the arguer attacks his or her opponent instead of the opponent’s argument
Definition for Red Herring:
Partway through an argument, the arguer goes off on a tangent, raising a side issue that distracts the audience from what’s really at stake.
Often, the arguer never returns to the original issue.
for example: the “….jackhammers….” statement
(info re fallacies obtained from unc.edu website, 2013)
Speaking of anonymous BS, who or what the heck is a ‘pliska’? He or she smells like a blowhard yak for Lord Football… Incidentally, libelous statements in this context must qualify as patently false and committed with gross negligence or reckless disregard for truth. The expert Joe Bloggs simply defames the football quacks with true statements. Libel has nothing to do with it here, but I think ‘pliska’ gets that, unless acting as complete moron and not merely as football shill.
Joe,
Are you saying the “gang of three” recklessly put people back to play to soon? So how can you use Sid as an exmaple – out for months… Also, Lovell and Collins only came to UPMC in 2000? So how can they be all to blame for the issues in the 70’s? In addition, Lovell no longer works for UPMC or the steelers, and never made RTP decisions that was the head team physician. In addition, doesnt the research show that athlete athletes who were tested via ImPACT on averge sit out longer than athletes who did not take the test. So how is that a bad thing?
Pliska,
Libel presumes making false factual statements.
Please review articles from the following:
Peter Keating of Sports Illustrated in 2006 conflict of interests;
Irv Muchnick did an e-book: UPMC: Concussion Scandal Ground Zero (Concussion Inc.);
If you viewed League of Denial Mr. Lovell accepts the conclusions of his NFL articles were deficient;
Joe Maroon according LoD twitter Joe Maroon was responsible for telling Dr. Omalu to hang it up;
What happened to $2,1MM NIH study conducted by UPMC comparing fMRI to ImPact? Did they report their financial interests? I can find nothing published.;
Bill Barr has made it clear in numerous sources that his data was excluded from a NFL-wide study by Mr. Lovell;
You might also want to look into Sen. Udall’s displeasure with the marketing of Riddell helmets especially the use of research to sell helmets; and
Richard Ellenbogen and Robert Cantu called the research conducted by NFL m-TBI committee garbage. Mr. Lovell and Joe Maroon were members for 16 years.
After 19 years we know very little about sports concussions because of actions detailed above.
Dr. El,
Lovell claims to continue advise the players union after he was removed from the m-TBI committee.
Does Joe Maroon still work for the Steelers? Does Mickey Collins handle the NP testing for the Steelers? Who makes the decision on return to play with the Steelers for concussions? Might it be Tony Yates who was the head of NFL Physicians for years.
Did the m-TBI committee, members included Maroon and Lovell, and this was highlighted in last nights broadcast publish journal article that stated that NFL players could return to play same day and suggested that you could infer this to have relevance to younger players. Their publications speak for themselves including the recent laughably bad Collins article that suggested young children should play football. I defer to Cantu on this matter.
As far as, RTP being longer for those using ImPact, having not seen the article, is it not true for any NP test? Was there a selection bias in the study? Was RTP compared to schools using SCAT or simply having an ATC? Correlation is not causation. Who authored the article? Did the authors report any conflicts?
it’s your forum, you should learn to moderate it appropriately
Moderate my way or your way? You’re not looking too good here, anonymously I might add (the very same thing you suggested I leave out)
OK, thanks for coming!
This seems to be very personal to you. How do you know that ImPact showed nothing? I don’t believe ImPact was in use when Mike Webster played football. Why do you seem so bitter toward the “gang of three”?
Impact was not in use during Webster’s career just his decline. What about Jeff Harting? He is falling apart at 41, Steeler center, of 2006 SuperBowl team – see this weekends PPG.
Not bitter but bemused. Doctors lie not only to their patients but also the public.
They cook research so the sponsor Riddell can sell lots of new concussion resistant helmets.
How many lives do these fellows have to destroy through malpractice before they are held to account?
One of the funniest lines out of Lovell’s maw was quoted in a story on NFL.com,
“I need to emphasize this, and I have always said this: I don’t think that ImPACT or any other test should be used in a vacuum,”
Really, pass your ImPact and you are good to go. Only need a valid baseline every two years. Wait, we have data you don’t need a baseline. Wait, wait you can take it at home unsupervised. Oh yeah we paid for all our publications and failed to report conflicts of interest.
Enough.
I believe you are seriously misinformed about the treatment protocols at the UPMC concussion center. Have you read the Riddell concussion research? While it was flawed, it still showed no improvement in concussion prevention while wearing a Riddell helmet.
This may be out of line in the chain – this is reply to Pliska 1st reply.
The Riddell research was not just flawed it was basically a fraud. I read it on first publication. Maroon et al. were paid 80K each as remember failed to list conflicts on the paper such as they owned ImPact. Spare me the nonsense that UPMC protested the use of the paper in Riddell marketing because it was years later after congressional attention. Ironic that protest letters are on file but know public protest made (CYA). No need to offend another NFL affiliate.
As far as UPMC, the place is an ethical circus and since it one of the few large employers left in Western Penn is under no scrutiny from the local press.
If the protocol is now so advanced, why isn’t the brain trust publishing hard data on the long-term outcomes of its patients? I think Maroon has been on the Steeler payroll since 1992 and Lovell since 1993 or 1994. By now, given its preferred NFL status, it probably has a most data on NFL players. Open the books, how many of these fellows are currently impaired.
Let Bill Barr, Chris Randolph or Ralph Benedict help in the review. All of them refused to use ImPact on the Jets, Bears and Bills only to be replaced by Lovell’s people. The finding might be enlightening.
Maybe it’s your writing style. You come across as an angry person with a grudge to bear. Did you get fired from there? Did they steal your thunder? What gives?
I would never work for someone dumber than I am. It would disqualify the gang of three. I also did not work for UPMC. Its reputation for blood sucking the Iron City is nonpareil. Not a good place to work.
As far as my tone, it is simple. For years these clowns have been running around marketing drivel. They have disparaged numerous competent scientists and clinicians; cooked data; and failed to report conflicts. If this was not sports medicine, all of them would have been openly mocked and ridiculed. Instead, they were banked by the NFL and did a grave disservice to every level of sport.
Do you think openly and actively misleading the a patient is wrong? Do you think openly and actively misleading children and their parents about the dangers of repetitive head trauma is wrong? Do you believe that someone who did so because they financially enriched themselves is even worse than those who are simply ignorant?
It is time to not only hold UPMC and the gang of three to account but also every single paid NFL shill for the costs imposed not only on their patients but also the larger society.
How many parents were kept in the dark by these fools and had their children damaged as a result? How many NFL players children will grow up with a damaged or dead father?
No doctor or scientist who engaged in this deception should have a license or an academic position.
I look forward to your considered answers.
There is no question that the NFL is in a league of denial in regards to the impact of concussions. We do have to extend to them a thank you for the work they have started on the issue, and now it has uncovered many more elements to be addressed.
Lets talk about the real issue here..education of parents. We need to continue to educate parents on the impacts of football on these young players, who have NO voice in the world of concussions. We need to stop putting helmets and pads on five year olds and erase the myth that they will not be successful at youth sports unless you start at age 5. As more and more parents start to see the impact of multiple concussions on their children, decisions are being made to not play impact sports such as youth football. A wonderful analogy that is used with youth is the concept of a egg being tapped multiple times, until finally that one final tap, as light as it can be will break the egg. We need a coalition that is not vested in itself, is instead, vested in education.
Doug Andreassen
Great comments and observations but we also have to look be reminded that this goes beyond a football issue. Concussions and brain injuries occur every day in athletes across the board. We have to make wise decisions to keep our children safe and also wise decisions on how to treat injuries in our children. The key to that is the education that the NFL and many others do not really want to offer, especially when it comes to the long term ramifications of mutiple concussions. I have watched a grown man die of CTE and young people lose their identities and their ability to succeed in school as a result. Neither are pretty pictures.
And I could not agree more with the idea that it is pure myth that children will never be successful athletes if they don’t start at an early age. Kids need to be kids and the adults in their lives desperately need to make educated and intelligent decisions about what the priorities should be in their young lives. Sports and activity…yes; at the sacrifice of all else…no! And frankly, I would take getting my child’s brain back the way it used to be over any level of success in any sport!
It is important to note that ImPact is merely a screening device…not a comprehensive assessment.
Furthermore, a major professional concern with ImPact besides validity, reliability and conflict of interest issues raised in the literature…
is an apparent premise of ImPact…that only very limited areas of the brain need to be screened…for RTP decisions to be rendered.
World renowned neuropsychologists Reitan & Wolfson (2000) strongly cautioned that many researchers who have examined mild brain injury have typically NOT employed comprehensive neuropsychological test batteries in their methodology.
The authors perceive this as a MAJOR FLAW in evaluating the impact of mild brain injury, because they firmly believe that standard neuropsychological test batteries have frequently been shown to be sensitive to both focal and diffuse brain damage.
They also pointed out that researchers typically have limited their assessment and focus due to:
a premature presumption that neuropsychological impairment is limited to a rather narrow range of deficits, and that a restricted range of tests is all that is required for adequate neuropsychological assessment.
Our clinical experience suggests that mild brain injury produces diversified and even widespread neuropsychological losses in some patients (p.97).
Why does no one worry about the guy on a road crew who runs a jackhammer for 30 years.
I do not believe this is the case. The NFL has just become notable for its denial of the effects of ongoing concussions. I think you will find that those who are educated, are concerned about any person who has experienced a concussion and repeatedly puts themselves in a situation to be injured in the same way. The problem in the NFL has been a tool to draw attention to the brain injury itself and what is best practice to deal with it. If this attention helps my son and others who were brain injured in other sports and/or activities, I am happy for the attention.
Obviously Joe Bloggs is the all knowing authority about all UPMC research and clinical treatments, I await any further knowledge you can impart on us to make us dumber…
Reblogged this on Broken Brain – Brilliant Mind and commented:
Leading up to another story I am publishing in a little bit about “the new science of concussion recovery”. Give this a read — especially with reference to Micky Collins, who is featured in the OutsideOnline story coming later. This is a great read, for starters.