John Billingsley elaborates on the import and implications of the troubling research results regarding the brain disease CTE and participants in contact sports, especially football.
Here is his Comment of the Day on the post, Ethics Quiz, Super Bowl Edition: Justin Timberlake’s Integrity:
I agree that with 99% of NFL players and 91% of college players showing CTE on autopsy there is no ethical justification for American football and we don’t need it. Do we actually need any contact sports? CTE has been demonstrated in participants in multiple other contact sports including basketball, boxing, ice hockey, rugby, soccer, wrestling, and baseball. Unfortunately, there is not as much information available about the rates of CTE in those sports. There was an autopsy study demonstrating CTE in the brains of 21 of 66 individuals who participated in different contact sports at various levels, but no CTE in the brains of 198 controls who had no history of participating in contact sports. A study looking at high school athletes who participated in various contact sports from 2005 to 2014 found that there were about 300,000 concussions annually. That study found that the sport with the highest rate of concussions adjusted for the rate of participation was girl’s soccer. A concussion does not mean CTE will develop but repeated head injury is the etiology of CTE.
How much risk of CTE is acceptable? In the study that showed 21 of 66 participants in contact sports with CTE, if those who played football are eliminated from the study, the number with CTE is about 5 in 35. Is a contact sport ethically acceptable if only 14% of the participants will suffer brain damage? Is it ethical to allow high school kids and younger to play contact sports at all? There are definite physical and psychological benefits from sports and exercise but those benefits can be achieved with non-contact sports.
Ethics Alarms 
Well Done!
The principal at the Diocesan Catholic high school I taught English at for two years in the mid-seventies didn’t want football at the school because of the discipline problems that came with having a football team. It was a new school. He just said no to football.
I always thought guys who played football were crazy. Now I’ve realized it was playing football that made them crazy.
I don’t think it’s ethical for schools to have football programs, or for youth football to exist.
And related to the discussion of integrity of Justin Timberlake is his usage of a video projection of Prince, while he had assured Sheila E. that he wouldn’t use a hologram of Prince.
I do not think there are any ethical considerations to using substantially unmodified existing video of a performer briefly during a tribute during a performance. Nor does it take any particular integrity to promise not to produce a halogram, and then not produce a halogram.
If Prince did not want videos of him shown in perpetuity, he would not have voluntarily filmed so many videos.
If Prince did not want halograms of him shown in perpetuity, he would not have recorded any. Since he did not, in fact, record any halograms while living, it would unethical to digitally produce one from existing footage in most circumstances.
I wonder what the incidence of CTE damage is among concert goers and head bangers at heavy metal shows.
Baseball? Baseball isn’t supposed to be a contact sport and actually adjusts rules to avoid injury. I don’t think it fits in this camp.
Basketball isn’t supposed to be a contact sport either, but it has mutated into something that wasn’t what the sport was meant to be. I’d expect concussion and CTE rates to be a bit high. If the sport went back to its roots, it might be better.
What about the “non-contact” sports? Swimming? Sometimes the swimmer misses the water when leaving the blocks or mis-times a backstroke and smacks the head.
There frankly must be a reasonable “acceptable” level of risk. I don’t know where the bar should be but tackle football is clearly beyond it. It would be ideal if a consensus could be reached without the government getting involved.
Would it be even possible to ban a sport? Lawn Darts are banned, but kits to put your own together are still available. Could you ban tackling? Would brothers risk criminal liability for tackling in non-football contexts. Could you ban “football”, but then reassemble the parts of football into a new sport?
Could you restrict waiving of liability for certain sports or categories of activities, increasing financial risk to hosts to disincentivize certain sports? How would this be tailored narrowly enough to not make hosting any sport financially ruinous when something goes wrong? Maybe insurance companies could refuse to cover football, or charge a fortune to do so?
Insurance is likely to be the hammer, and when liability suits start hitting helmet makers.
Funny that the PI bar is rife with ex-jocks. But yes, the plaintiffs lawyers will start winning suits against schools and Pop Warner and schools and leagues won’t be able to get insurance and the whole enterprise will souffle. May take a few decades, but it will happen.
Insurance can hammer all parties involved. Property owners, leagues, officials, coaches, and teams in addition to equipment manufacturers all aren’t going to be involved if they’re on the hook for damages. If insurance gets too expensive, it can price the sport out of existence.
I think you are correct that a legal ban on a particular sport would drive that sport to redesign itself to be just outside of the touch of that legal ban while trying to maintain as much similarity to the original as possible…which I think would amount to, in practice, being a legal imposition on internal sports rules.
Which I don’t see there being any real problem with. So instead of banning a sport, I don’t see a problem with a state regulating it (IF necessary) as it would any other industry (IF necessary).
That being said, as others have mentioned below, insurance costs will incentivize a great deal of change.
Bias in this case certainly seems to preclude, thus far as I’ve seen, answers to the questions of those who’ve played professional football and not appear to have been dramatically affected by the game, at least relative to CTE.
There are many ex football players leading normal lives, some of whom are in the public eye, or were for decades after playing the game (Troy Aikman, Pat Summerall, and probably quite a few more). Why has CTE not had the dramatic effects on them in the way it did Junior Seau?
The theory postulated above that football made the students aggressive seems foolish. All the football players I’ve known from high school through adult life were no different in terms of behaviors than a normal distribution of non players.
Of the football players I’ve known, they’ve all been pretty mellow people, including the father a friend of my daughter’s, who played several years professionally (Houston Oilers), and thereafter was a pharmaceutical sales rep.
I don’t deny the science, but there are still questions that need addressed; until then y’all seem to be making some assumptions and advocating ends that justify your means.
Like most illnesses, CTE varies in severity. At autopsy it is classified from stage I (least severe) to IV. People suffering from stage I and II may not appear to be having significant problems to people who don’t know them well. People who know them very well can usually pick out subtle changes in behavior and cognitive ability. Aikman and Summerall may have been in the lucky minority that did not suffer CTE or they may have been very high functioning people to start with so that they could still function well even with stage I or II CTE.
There are still many questions to be answered. It would be helpful to have players undergo psychological and neurological testing when they start their career and periodically to document any changes. Test results could then be correlated with findings on autopsy to better understand what is going on. I think it likely that players with more severe symptoms were more likely to have their brain donated. A larger sample of brains might show a lower percentage with CTE. However, I think the percentage would still be very high based on the study that showed that none of the brains of people who did not play contact sports had CTE while about 30% or those who played did. Of the 21 of 66 brains in that study that showed CTE, 16 of them had played football mostly at the high school or college level.
One thing that is pretty clear is that repetitive trauma to the brain is the cause of CTE. Trauma that is not severe enough to cause a true concussion can still contribute to CTE. How much trauma does it take to cause CTE? Nobody really knows and it undoubtedly varies from person to person and with the exact nature of the trauma. Another area for research.
The bottom line is that there is enough evidence to link repetitive brain trauma to CTE. Football is the sport that by its nature demands that the players repeatedly collide with each other causing repetitive trauma. A child’s developing brain is very sensitive to trauma. The significant risk for harm to children with no offsetting benefit requires that football be eliminated as a youth and high school sport at a minimum. Adults can make their own decisions.