[House Hearing, 111 Congress]
[From the U.S. Government Printing Office]
LEGAL ISSUES RELATING TO
FOOTBALL HEAD INJURIES (PART I & II)
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST AND SECOND SESSIONS
OCTOBER 28, 2009 AND JANUARY 4, 2010
Serial No. 111-82
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.govFOR
LEGAL ISSUES RELATING TO FOOTBALL HEAD INJURIES
(PART I & II)
LEGAL ISSUES RELATING TO
FOOTBALL HEAD INJURIES (PART I & II)
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST AND SECOND SESSIONS
OCTOBER 28, 2009 AND JANUARY 4, 2010
Serial No. 111-82
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.gov
U.S. GOVERNMENT PRINTING OFFICE
53-092 WASHINGTON : 2010
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092104 Mail: Stop IDCC, Washington, DC 20402�090001
COMMITTEE ON THE JUDICIARY
JOHN CONYERS, Jr., Michigan, Chairman
HOWARD L. BERMAN, California LAMAR SMITH, Texas
RICK BOUCHER, Virginia F. JAMES SENSENBRENNER, Jr.,
JERROLD NADLER, New York Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia HOWARD COBLE, North Carolina
MELVIN L. WATT, North Carolina ELTON GALLEGLY, California
ZOE LOFGREN, California BOB GOODLATTE, Virginia
SHEILA JACKSON LEE, Texas DANIEL E. LUNGREN, California
MAXINE WATERS, California DARRELL E. ISSA, California
WILLIAM D. DELAHUNT, Massachusetts J. RANDY FORBES, Virginia
ROBERT WEXLER, Florida STEVE KING, Iowa
STEVE COHEN, Tennessee TRENT FRANKS, Arizona
HENRY C. ``HANK'' JOHNSON, Jr., LOUIE GOHMERT, Texas
Georgia JIM JORDAN, Ohio
PEDRO PIERLUISI, Puerto Rico TED POE, Texas
MIKE QUIGLEY, Illinois JASON CHAFFETZ, Utah
JUDY CHU, California TOM ROONEY, Florida
LUIS V. GUTIERREZ, Illinois GREGG HARPER, Mississippi
TAMMY BALDWIN, Wisconsin
CHARLES A. GONZALEZ, Texas
ANTHONY D. WEINER, New York
ADAM B. SCHIFF, California
LINDA T. SANCHEZ, California
DEBBIE WASSERMAN SCHULTZ, Florida
DANIEL MAFFEI, New York
Perry Apelbaum, Majority Staff Director and Chief Counsel
Sean McLaughlin, Minority Chief of Staff and General Counsel
C O N T E N T S
Wednesday, October 28, 2009first date deg.
Legal Issues Relating to Football Head Injuries (Part I)....... 1
Monday, January 4, 2010second date deg.
Legal Issues Relating to Football Head Injuries (Part II)...... 265
October 28, 2009first date deg.
The Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
The Honorable Lamar Smith, a Representative in Congress from the
State of Texas, and Ranking Member, Committee on the Judiciary. 3
The Honorable Tammy Baldwin, a Representative in Congress from
the State of Wisconsin, and Member, Committee on the Judiciary. 5
The Honorable Daniel E. Lungren, a Representative in Congress
from the State of California, and Member, Committee on the
The Honorable Mike Quigley, a Representative in Congress from the
State of Illinois, and Member, Committee on the Judiciary...... 17
The Honorable Darrell Issa, a Representative in Congress from the
State of California, and Member, Committee on the Judiciary.... 18
The Honorable Henry C. ``Hank'' Johnson, a Representative in
Congress from the State of Georgia, and Member, Committee on
the Judiciary.................................................. 18
The Honorable Bob Goodlatte, a Representative in Congress from
the State of Virginia, and Member, Committee on the Judiciary.. 19
The Honorable Bill Pascrell, a Representative in Congress from
the State of New Jersey
Oral Testimony................................................. 20
Prepared Statement............................................. 26
Mr. Roger Goodell, Commissioner, National Football League
Oral Testimony................................................. 29
Prepared Statement............................................. 31
Mr. DeMaurice Smith, Executive Director, NFL Players Association
Oral Testimony................................................. 37
Prepared Statement............................................. 39
Dr. Gay Culverhouse, Ed.D., former President, Tampa Bay
Oral Testimony................................................. 44
Prepared Statement............................................. 46
Dr. Andrew M. Tucker, M.D., Member, NFL Mild Traumatic Brain
Injury Committee and Team Physician, Baltimore Ravens
Oral Testimony................................................. 59
Prepared Statement............................................. 62
Dr. Robert C. Cantu, M.D., Chief of Neurosurgery Service, and
Director, Sports Medicine, Emerson Hospital, Concord, MA
Oral Testimony................................................. 66
Prepared Statement............................................. 68
Dr. David R. Weir, Ph.D., Lead Author, NFL Player Care Foundation
Study of Retired NFL Players
Oral Testimony................................................. 72
Prepared Statement............................................. 74
Mr. George Martin, Executive Director, NFL Alumni Association
Oral Testimony................................................. 77
Prepared Statement............................................. 79
Mr. Merril Hoge, Retired NFL Player
Oral Testimony................................................. 82
Prepared Statement............................................. 84
Dr. Eleanor M. Perfetto, Ph.D., M.S., wife of Ralph Wenzel,
former NFL Player
Oral Testimony................................................. 120
Prepared Statement............................................. 122
Mr. Tiki Barber, Retired NFL Player
Oral Testimony................................................. 126
Mr. Dick Benson, High School Football Safety Advocate
Oral Testimony................................................. 127
Prepared Statement............................................. 129
Mr. Christopher Nowinski, Co-Director, Center for the Study of
Traumatic Encephalopathy, Boston University School of Medicine
Oral Testimony................................................. 133
Prepared Statement............................................. 139
Dr. Ann C. McKee, M.D., Associate Professor, Neurology and
Pathology, Boston University School of Medicine
Oral Testimony................................................. 153
Prepared Statement............................................. 156
Dr. Joseph Maroon, M.D., Vice Chair, Department of Neurosurgery,
University of Pittsburgh
Oral Testimony................................................. 196
Prepared Statement............................................. 198
Dr. Julian Bailes, M.D., Chairman, Department of Neurosurgery,
West Virginia University School of Medicine
Oral Testimony................................................. 211
Prepared Statement............................................. 214
Dr. Joel Morgenlander, M.D., Professor of Neurology, Duke
University Medical Center
Oral Testimony................................................. 219
Prepared Statement............................................. 222
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
Letter from the Institute for Social Research (ISR) to the New
York Times, submitted by the Honorable Lamar Smith, a
Representative in Congress from the State of Texas, and Ranking
Member, Committee on the Judiciary............................. 4
Article from The New Yorker, submitted by the Honorable Tammy
Baldwin, a Representative in Congress from the State of
Wisconsin, and Member, Committee on the Judiciary.............. 7
Letter from Roger Goodell, Commissioner, National Football
League, submitted by the Honorable Bill Pascrell, a
Representative in Congress from the State of New Jersey........ 23
Phamphlet submitted by the Honorable Linda T. Sanchez, a
Representative in Congress from the State of California, and
Member, Committee on the Judiciary............................. 114
Information from the Sports Legacy Institute submitted by
Christopher Nowinski, Co-Director, Center for the Study of
Traumatic Encephalopathy, Boston University School of Medicine. 135
Paper entitled ``Building the Enlightened Warrior,'' submitted by
Dick Benson, High School Football Safety Advocate.............. 145
Review Article entitled ``Chronic Traumatic Encelphalopathy in
Athletes: Progressive Tauopathy After Repetitive Head Injury,''
submitted by Ann C. McKee, M.D., Associate Professor, Neurology
and Pathology, Boston University School of Medicine............ 169
Article from The New York Times submitted by the Honorable John
Conyers, Jr., a Representative in Congress from the State of
Michigan, and Chairman, Committee on the Judiciary............. 241
Prepared Statement of Brent Boyd, disabled retired player,
concussion victim of the National Football League, submitted by
the Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
January 4, 2010second date deg.
The Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
The Honorable Linda Sanchez, a Representative in Congress from
the State of California, Committee on the Judiciary............ 271
The Honorable Steve Cohen, a Representative in Congress from the
State of Tennessee, Committee on the Judiciary................. 272
Mr. DeMaurice Smith, Executive Director, NFL Players Association
Oral Testimony................................................. 275
Prepared Statement............................................. 277
Dr. Joseph C. Maroon, M.D., Professor and Vice-Chairman,
Department of Neurosurgery, University of Pittsburgh Medical
Oral Testimony................................................. 280
Prepared Statement............................................. 282
Mr. David Klossner, Director, Health and Safety, NCAA
Oral Testimony................................................. 285
Prepared Statement............................................. 287
Mr. Bob Colgate, Assistant Director, National Federation of State
High School Associations
Oral Testimony................................................. 295
Prepared Statement............................................. 297
Mr. Scott Hallenbeck, Executive DIrector of USA Football
Oral Testimony................................................. 304
Prepared Statement............................................. 306
Mr. Lemuel Barney, Detroit Lions Hall of Fame Player
Oral Testimony................................................. 321
Prepared Statement............................................. 323
Mr. Bennet I. Omalu, M.D., Co-Director, Brain Injury Research
Institute, West Virginia University
Oral Testimony................................................. 325
Prepared Statement............................................. 327
Dr. Ira R. Casson, M.D., former Co-Chairman, NFL Mild Traumatic
Brain Injury Committee
Oral Testimony................................................. 334
Prepared Statement............................................. 336
Mr. Dan Arment, Assistant Director, National Federation of State
High School Associations
Oral Testimony................................................. 347
Mr. P. David Halstead, Technical Director, Southern Impact
Oral Testimony................................................. 348
Prepared Statement............................................. 351
Mr. Vincent R. Ferrara, Founder and CEO, Xenith, L.L.C.
Oral Testimony................................................. 354
Prepared Statement............................................. 356
Dr. Randall R. Benson, M.D., Assistant Professor of Neurology,
Wayne State University
Oral Testimony................................................. 382
Prepared Statement............................................. 388
Dr. Jeffrey Kutcher, M.D., Director, Michigan Neurosport
Oral Testimony................................................. 399
Prepared Statement............................................. 402
Mr. Christopher Nowinski, Co-Director for the Center for the
Study of Traumatic Encephalopathy, Boston University School of
Medicine, President and CEO, Sports Legacy Institute
Oral Testimony................................................. 410
Prepared Statement............................................. 413
Mr. Kyle Turley, retired NFL Player
Oral Testimony................................................. 421
Prepared Statement............................................. 427
Mr. Robert L. Schmidt, Chairman and Co-Founder, Vincent T.
Oral Testimony................................................. 437
Prepared Statement............................................. 440
Mr. George Martin, Executive Director, NFL Alumni Association
Oral Testimony................................................. 451
Prepared Statement............................................. 454
Mr. Luther Campbell, trainer of professional athletes
Oral Testimony................................................. 457
Prepared Statement............................................. 463
Mr. Bernie Parrish, retired NFL Player
Oral Testimony................................................. 468
Prepared Statement............................................. 472
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
Prepared Statement of the the Honorable John Conyers, Jr., a
Representative in Congress from the State of Michigan, and
Chairman, Committee on the Judiciary........................... 266
October 28, 2009first date deg.
Material Submitted for the Hearing Record
Prepared Statement of the Honorable James Moran, a Representative
in Congress from the State of Virginia......................... 481
Material submitted by the Honorable Steve King, a Representative
in Congress from the State of Iowa, and Member, Committee on
the Judiciary.................................................. 482
Response to Questions submitted to Roger Goodell, Commissioner,
National Football League, by the Honorable Linda T. Sanchez, a
Representative in Congress from the State of California, and
Member, Committee on the Judiciary............................. 486
Follow-Up Material submitted by Roger Goodell, Commissioner,
National Football League....................................... 490
Post-Hearing Questions submitted to Roger Goodell, Commissioner,
National Football League....................................... 492
Letter from Roger Goodell, Commissioner, National Football
League, to the Honorable Steve King, a Representative in
Congress from the State of Iowa, and Member, Committee on the
LEGAL ISSUES RELATING TO
FOOTBALL HEAD INJURIES (PART I)
WEDNESDAY, OCTOBER 28, 2009
House of Representatives,
Committee on the Judiciary,
The Committee met, pursuant to notice, at 10:02 a.m., in
room 2141, Rayburn House Office Building, the Honorable John
Conyers, Jr. (Chairman of the Committee) presiding.
Present: Representatives Conyers, Scott, Watt, Jackson Lee,
Waters, Delahunt, Cohen, Johnson, Quigley, Weiner, Sanchez,
Wasserman Schultz, Smith, Coble, Goodlatte, Lungren, King,
Jordan, Poe, and Rooney.
Staff Present: (Majority) Eric Tamarkin, Counsel; Jason
Everett, Counsel; Elizabeth Kendall, Counsel; Perry Apelbaum,
Staff Director and Chief Counsel; Brandon Johns, Staff
Assistant; Reuben Goetzl, Staff Assistant; (Minority) Daniel
Flores, Counsel; and Sean McLaughlin, Chief of Staff and
Mr. Conyers. Good morning. The meeting will come to order.
Everyone that plays football at any level knows it is a
dangerous sport. In fact, everyone that watches it knows it is
a dangerous sport. There should be no surprise when a football
player separates his shoulder, twists an ankle, busts a knee.
But over the past several years, an increasing number of
retired players have developed long-term memory and cognitive
diseases such as dementia, Alzheimer's, depression, and chronic
traumatic encephalopathy (CTE). And it comes much later than
after their careers end. As a matter of fact, sometimes it is
not even detected until the autopsies, after they are dead.
These are not the types of risks most players or their families
ordinarily associate with the game of football.
As the National Football League is a monopoly by way of
congressional sanction in 1970, whose existence was
legislatively sanctioned, the causes and pervasiveness of these
football injuries warrant Federal scrutiny. I say this not
because of the impact of these injuries on the 2,000 current
players and 10,000 retirees associated with the football league
and their families, I say it because of the effect on the
millions of players at the college, high school, and youth
levels. My 13-year-old-son plays a game at 4:30 at Cranbrook
The questions before us are several. How serious is the
problem? What can be done about it? And where do we go from
There appears to be growing evidence that playing football
may be linked to long-term brain damage. For example, a 2003
University of North Carolina study found that professional
players who suffered multiple concussions were three times more
likely to suffer clinical depression than the general
population. A follow-up study in 2005 showed NFL players
suffering concussions had five times the rate of cognitive
impairment. And retired players were 37 percent more likely to
suffer from Alzheimer's than the population as a whole. Earlier
this year, the University of Michigan released a study that
found that 6.1 percent of NFL players over 50 years of age
reported they had received a dementia-related diagnosis--a
statistic five times higher than the national average. Players
age 30 through 49 showed a rate of 1.9 percent of dementia-
related diagnosis 19 times that of the national average.
Last week, The New York Times prepared an analysis of the
data from the NFL's plan to reimburse retired players for
dementia-related medical expenses, which found similar data.
Medical researchers also cite autopsies performed on numerous
former NFL players, who following their death, were diagnosed
to be suffering from CTE brain disease. And some of these
deceased players: we remember Mike Webster, a 50-year-old,
nine-time Pro Bowl center for the Pittsburgh Steelers who died
regrettably a penniless recluse, sleeping on the floor of a
Pittsburgh train station. Terry Long, 45-year-old ex-Steeler
who died after drinking antifreeze. Andre Waters, a 44-year-old
former safety with the Philadelphia Eagles, who suffered from
chronic pain and depression and later shot himself in the
Today Dr. McKee will testify that former Detroit lions
offensive lineman Lou Creekmur was tormented by CTE so much
that in his final years he lost the ability to speak, and
frequently turned violent. Lou was a player who was not the
victim of multiple concussions, and he reportedly never missed
a game during his 10-year career.
The National Football League is performing its own long-
term study, and has largely sought to discredit these reports
or some of the conclusions drawn from some of these reports.
The football league described the reports as flawed.
Dr. Ira Casson, the co-chair of the NFL's Mild Traumatic
Brain Injury Committee, denied the linkage on six separate
occasions. When asked whether there was any linkage between
playing football and CTE, Dr. Casson stated that it has never
been scientifically, validly documented. The league said the
recent University of Michigan study was flawed and that further
study was necessary. The New York Times data released last
week, was, they said, for self-promotional and lobbying
purposes of the union. Given there is no consensus between the
league and its players and the medical community about the
causes of these cognitive disorders, it should come as no
surprise there is little agreement about how to respond.
Former players believe it is unconscionable that the
current disability plans only permit a full disability award
for conditions developed within 15 years of retirement. Such a
limit, they argue, makes no sense for diseases that frequently
take more than 15 years to manifest themselves.
Player advocates also ask why there has not been more done
to limit the likelihood of long-term brain injury. For example,
giving the Players Association input in the selection of team
doctors and trainers, granting players unlimited access to
their medical records, requiring that all injuries be reported
to the league and the Players Association, and limiting the
frequency of full contact drills to cite some of the
possibilities that exist.
The NFL responds that it has set up a no-fault compensation
scheme, paying ex-players with dementia up to $88,000 a year,
and has instituted rule changes to limit serious injuries and
develop standards for concussion management. However, when it
comes to making further changes in its disability plan to
account for long-term injuries, the NFL asserts that that is a
subject for collective bargaining. Now, the answer to how to
resolve these differences and where we go from here is the
realization that we need an expeditious, independent review of
And so I am asking all parties and their personnel to make
their records available to us to permit such review and
analysis. The request goes to the NFL, NFLPA, relevant medical
researchers, NCAA, and the National Federation of State High
Now, when it comes to public health issues, I do not
believe it is adequate for the league or the Players
Association to hide behind a collective bargaining agreement.
Surely, an $8 billion a year industry can find it within its
budget to make sure players are adequately protected and that
any victims of long-term brain disease are fairly compensated.
The serious issues presented in today's hearing are life and
death issues. They go to the heart of our Nation's most popular
sport. And equally importantly, they affect millions of players
of all ages and their families.
I would like now to invite our distinguished Ranking
minority Member, Lamar Smith, for his opening remarks.
Mr. Smith of Texas. Thank you, Mr. Chairman. Mr. Chairman,
the recently released University of Michigan study of retired
NFL players indicates that overall, retired professional
football players are, in fact, in good health. The New York
Times has suggested that the study also points to higher than
normal rates of dementia or other memory-related problems among
former players. But the study does not support that view. And
prior studies have been argued to point both ways. While we
need to take this issue seriously, we should not jump to any
conclusions. As the lead author of the Michigan study has
stated, ``The study did not conclude that football causes
dementia.'' Highly publicized claims that the study supports a
link between football and dementia stem largely from The New
York Times misreporting on the content of the study. The
study's authors have drawn this misreporting to The New York
The authors stressed that they do not believe ``Any
responsible scientist would conclude from the study that
retired football players had higher rates of dementia than any
other group,'' which was alleged by The New York Times. Mr.
Chairman, I would like unanimous consent to put a letter to The
New York Times from the study's authors----
Mr. Conyers. Without objection, so ordered.
[The information referred to follows:]
Mr. Smith of Texas [continuing]. Into the record. Thank
you, Mr. Chairman. Mr. Chairman, the authors also underscore
that ``The comparison study used for dementia dramatically
understates the true rates of dementia in the American
population.'' In other words, according to the authors
themselves, the rates of dementia for retired NFL players ``are
likely comparable to the American population in general.'' So
we need to be careful about what conclusions regarding dementia
and other memory problems we draw from the most recent look at
retired players' health.
Professional football is the most popular spectator sport
in America. It is important that the league and its players
take every effort to make pro football as safe as reasonably
possible. The NFL should continue to study the potential long-
term effects of head injuries on player health. The league
should also study whether equipment improvements or stricter
rules enforcement could help to reduce any long-term impacts of
head injuries. And, of course, college and high school
officials should do the same. But Congress should not attempt
to influence the upcoming collective bargaining process the NFL
and its players union are about to undertake. We should also
avoid the temptation to legislate in this area. Football, like
soccer, rugby, and even basketball and baseball, involves
contact that can produce injuries. We cannot legislate the
elimination of injuries from the games without eliminating the
The retired players study concludes, ``The study finds
retired players to be in very good stead overall. Their history
of physical fitness shows up in lower rates of diabetes and
cardiovascular disease. Playing in the NFL was a very positive
experience for most retired players.'' Congress can highlight
the potential long-term consequences of playing professional
football through hearings like this one, but the NFL does not
need Congress to referee this issue. While many of us would say
that we are fans of football, Monday morning quarterbacking
does not necessarily qualify us as experts. Both teams are at
the table here today, or will be shortly, and we should work
together to find a solution where both the players and the
Mr. Chairman, I look forward to the witnesses' testimony,
and hope that this hearing will result in neither in
exaggerating the problem of injuries, nor in downplaying the
need to look for ways to reduce injuries. Mr. Chairman, thank
you, and I will yield back.
Mr. Conyers. Thank you very much, Mr. Smith. Did Jim Brown
of Cleveland come in yet?
Out of the natural generosity of my heart, I am going to
allow three people to make 2-minute statements. Ms. Baldwin,
Mr. Quigley, and Hank Johnson. If you agree to that, you will
be recognized. So we will start off with Tammy Baldwin of
Ms. Baldwin. Thank you, Chairman Conyers. I want to thank
you for holding this important hearing, as well as extend my
thanks to our many witnesses who have taken the time to be with
us this morning. I also want to acknowledge the presence of Mr.
Willie Wood, a retired NFL player from the Green Bay Packers.
As a proud Packer fan, I would like to boast for a moment or
two about Mr. Wood. He made the All Pro team nine times in his
12-year career, and played in both Super Bowl I in 1967 and
Super Bowl II the following year. Thanks in no small part to
Mr. Wood's impressive work as a starting free safety for the
Packers, Green Bay won both of those inaugural Super Bowls. He
finished his 12 NFL seasons with 48 interceptions, which he
returned for 699 yards and two touchdowns. Mr. Wood was
inducted into the Pro Football Hall of Fame in 1989.
Mr. Chairman, I know that Wisconsinites and Packer fans
across the country are grateful to Mr. Wood for an incredible
career. While we all know what an outstanding player he was
during his seasons with the NFL, I think there is less
awareness or understanding of the hardships that players like
Mr. Wood endure later in life because of a lack of health care
coverage. Mr. Wood is currently living in an assisted care
facility, and his NFL pension of a little over $1,100 per month
is not enough to pay all of his bills. Although he is the
beneficiary of what is known as the 88 Plan, these funds are
often not enough to cover his monthly medical care. So Mr. Wood
relies on the charity of others.
These situations are unfortunately not uncommon among
former NFL players suffering from disabilities, and even
dementia. We have lots of questions, and that is why we are
having this hearing today. I look forward to learning more
about the issue from our expert witnesses. Mr. Chairman, I do
ask unanimous consent to submit for the record an article
called Offensive Play that appeared in The New Yorker.
Mr. Conyers. We will be happy to introduce that into the
Ms. Baldwin. Thank you.
[The information referred to follows:]
Mr. Conyers. Dan Lungren, California.
Mr. Lungren. Thank you very much, Mr. Chairman. I just make
several points. Number one, I appreciate this hearing, although
I am surprised that this hearing takes precedence over us
reconsidering the major elements of the PATRIOT Act which have
to be determined in our effort on the war on terror before they
expire. Secondly, I must say that I had the good fortune of
getting to know John Mackey through Jack Kemp, and have seen
the deterioration of that great man, a leader in the NFL and
the players union, and believe that an investigation of the
kind of injuries suffered in the NFL and other levels of
football is appropriate.
And third, I hope that beyond everything we are dealing
with here, that the greatest thing that can come out of this is
serious studies as to the impact of the use of equipment, the
head as a weapon in football, and the rules to protect players
that will not only affect the NFL, college, but high school as
well. Too often I hear on television commentators talking about
the great hit. And you examine the hit, and it is often a hit
used with the head or not an enforced rule against head hits,
both on the pro, the college, and the high school level. And if
there is any one thing we could do, it would be to show that it
is not a game to destroy people's brains with respect to the
misuse of helmets and the misuse of the head during football.
I love football, I grew up loving football, I happened to
go to Notre Dame, I know a good number of guys who played in
the NFL, but we ought to face facts. Football is a great game,
but using the head in the way it has developed, with the
protection of the helmet, people don't understand you don't
have to worry about breaking teeth any more and breaking jaws,
but because we have that comfort, too often the helmet encasing
the head allows players to believe they are invulnerable
because we can't see the injury.
The injury is impactful, the injury is long lasting, and we
ought to at least get as much information as we can so we can
be honest about the decisions we make. Thank you very much, Mr.
Mr. Conyers. Thank you, Mr. Lungren. Mike Quigley of
Mr. Quigley. Thank you, Mr. Chairman. Well then, let me try
to focus this on a broader scale. If our concern is that
perhaps we should be dealing with the PATRIOT Act or other
matters of perhaps greater importance, let me try to put it on
a broader scale.
The NFL is the role model for high school players. It is
important to understand the extent of the risk these athletes
take when they step on the field each week. And it is natural
to center our attention on the professionals who fill our
Sunday afternoons. But I think it is absolutely critical that
in addition to focusing on the athletes who play in front of
season ticket holders, that we remember the ones who play in
front of their family, friends and peers on Friday nights.
The norms of the NFL, for better or worse, become the norms
of high school football players. While contact and collision
are inherent to the game, so too is a certain code that comes
to the game that you go back to the huddle no matter how badly
you are hurt, that you play no matter how badly you are hurt,
that full contact drills all the time are okay, that you don't
need water in a sufficient basis when you prepare. So what I
guess I am getting to here is whatever we address and deal with
the NFL goes beyond the concerns that we have with NFL players.
It goes to those young people who play on Friday nights
throughout our country. And while we can't do everything to
change the dangerous nature of the game, we want to ensure that
the NFL is doing everything in its power not only to provide
for the well-being of its players, but to set the right example
for the millions of high school football players who follow
their lead. Very, very few of them will become NFL players. But
they still can be hurt and still can have long-lasting injuries
as a result of their play and what they follow on Sunday
afternoons. So I hope that one of the benefits of today's
discussion is that it serves as a launching point to broaden
the discussion on the precautions that can be taken to increase
player safety at all levels. Thank you.
Mr. Conyers. Thank you. Darrell Issa of California.
Mr. Issa. Thank you, Mr. Chairman. And as a Member both of
this Committee and the committee on steroids next door, I want
to thank you for taking up this issue. I believe that when
Government Oversight and Reform began looking at steroids with
a bent toward a union negotiation that had failed, I believe
that we didn't realize at that time that we could be as
successful as we were in getting professional baseball to get
steroids out, to have testing, and for that to fall down into
college and high school ball, where today I believe that we
have done a better job of eliminating that on our young
I believe that at its best, that is what we are going to do
here. We are going to cause the ongoing union negotiations to
focus on prevention, on dealing with changes in officiating,
and we are obviously going to see behind closed doors the NFL
deal with the question of how much do you pay up front and how
much do you hold back for the long-term care of athletes. I
believe that it is appropriate that we not judge those
negotiations, because ultimately there is only so many dollars,
and those dollars have to be allocated by a form of negotiation
in which we are not participants. But when it comes to changes
in the tolerance at professional and collegiate level of, if
you will, head butting and other techniques that are growing
and growing in their use, and as a result, leading to
unnecessary head injuries, I think your leadership will be long
appreciated for the fact that if we make it an issue here in
Congress, it becomes an issue at the bargaining table. It
ultimately will make a difference in the next USC-Notre Dame
game, which means a lot to my colleague, and I am sure to all
of us. I thank you and yield back.
Mr. Conyers. Thank you very much, Mr. Issa. The last one on
our side is Hank Johnson. Last one on the other side is Bob
Goodlatte. Hank Johnson of Atlanta, Georgia.
Mr. Johnson. Thank you, Mr. Chairman, for holding this
important hearing. I am glad this Committee is taking the
opportunity to look at how football head injuries have the
potential to affect one's quality of life. Today we will hear
testimony from several witnesses who will discuss the necessity
of independent research as well as the importance of
incorporating any findings linking concussions and cognitive
damage into preventive practices. Failing to have research that
is independent could easily mislead the public into
underestimating the serious impact of football head injuries.
In the long run, the old mantra of perseverance has the
dangerous trickle-down effect of influencing over a million
children who play high school football and the thousands who
are injured every year. ``Walking off the pain,'' as it is
called, in an NFL game turns into ``walking it off'' in a
Little League game, as young children are, often encouraged by
parents and coaches, attempt to imitate what they view as the
noble behavior of their football heroes and gladiators. This
behavior is clearly dangerous. And a refusal to recognize and
respond to this danger is reckless and irresponsible.
Not only are the direct impacts of these head injuries
dangerous, the trickle-down effects on high school and college
players are very real and can be fatal, as we will hear today.
I look forward to hearing the witnesses' testimony on this very
important and urgent necessity to conduct an independent study
on the cognitive impact of football head injuries and the legal
ramifications of this brain damage. I thank the Chairman again
for allowing me to make an opening and yield back the balance
of my time.
Mr. Conyers. Thank you, Mr. Johnson. A senior Member of the
Judiciary Committee from Virginia, Bob Goodlatte.
Mr. Goodlatte. Mr. Chairman, thank you for holding this
hearing. I want to take the opportunity to welcome Tiki Barber,
a great star of the New York Giants, now retired, who hails
from my hometown of Roanoke, Virginia, and who will be
testifying on the second panel, I believe, and can share a lot
with us. He and his brother Ronde not only were great stars in
the NFL, but also at the University of Virginia, and prior to
that in the City of Roanoke in football played there, in high
So they can share this perspective with us at each level of
competition. I also want to note the great work that he has
done in promoting football and recreation and athletics in
general. He and his brother have sponsored camps and other
activities, and I have seen firsthand their great passion for
our young people.
I also want to associate myself with the remarks of the
gentleman from California and as well the Ranking Member. I
share the concern about some of the practices that take place
in football, and I think this is a great opportunity for us to
learn more and to shine a spotlight on this issue. But I also
associate myself with the remarks of Mr. Smith in saying that
while we do want to pay close attention to what is going on
here, I do not think the Congress should inject itself into the
negotiations between the NFL and its players. Nor do I think
that, as some have proposed here in the Congress, the Congress
should engage in legislation that would allow or prohibit
certain types of plays from taking place in high school or
college or major league athletics.
Quite frankly, that is something that should be left to
other people who are in better places and better positions
around the country to make those decisions. And we here, the
amateur quarterbacks on the House Judiciary Committee, should
not take up that kind of micromanagement of American athletics.
So I thank you, Mr. Chairman, for having this hearing today and
allowing us to learn more about this issue.
Mr. Conyers. Of course, we would never do anything like
that. We have a distinguished Member of Congress, the founder
and chair of the Congressional Brain Injury Task Force, Bill
Pascrell. He has been at all our hearings. He sometimes thinks
he is a Member of the Judiciary Committee. And we would like
him to begin this discussion today. We welcome you back again
to the Committee, Mr. Pascrell. All other Members that have an
opening statement, we will take it into the record. And we
welcome you again before us.
TESTIMONY OF THE HONORABLE BILL PASCRELL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pascrell. Thank you, Chairman Conyers and Ranking
Member Smith, Members of the Committee, for having me here to
speak on a very important topic of brain injury. It has become
part of my life, literally.
Mr. Chairman, you have done a great job in bringing
together a wide array of experts to discuss what can be a
difficult and very controversial topic. These wounds may be
invisible, but the consequences are very real. You have taken a
stand to ensure that these consequences are addressed. As
cofounder and co-chair of the Congressional Brain Injury Task
Force, which is comprised of over 130 Congressional Members
from both sides of the aisle, since its founding in 2001, it
has been the task force mission to expand the understanding and
public awareness of brain injury. Mr. Chairman, Mr. Ranking
Member, educating members and the general population has been
the most difficult effort of this task force. In recent years,
the task force has taken a greater focus on brain injuries that
have become the signature injury of the Iraq and Afghanistan
It is estimated that as many as 20 percent of soldiers
returning from Iraq and Afghanistan have sustained a brain
injury. The brain injuries of our soldiers have spurred
Congress to make unprecedented investments in brain injury
research, research that will benefit soldiers and civilians
alike for years to come. And we have done this in a bipartisan
fashion. The same way that we have gained greater understanding
in research from the brain injuries from our soldiers, we
should also take this opportunity to learn from the injuries of
In recent months, the task force has placed considerable
attention on the issue of so-called mild brain injuries,
specifically on concussions, which affect everyone from our
soldiers in the battlefield to our children who play on various
sports fields. In fact, the task force held a panel discussion
that featured two of your witnesses today, Dr. Tucker, who is
the team physician of the Baltimore Ravens, Mr. Nowinski, who
is director for the Center for the Study of Traumatic
Encephalopathy. These discussions and the growing number of
studies, like the one commissioned by the National Football
League, open our eyes to the implications of head injuries.
Unfortunately, these consequences hit close to home. On October
the 16th, 2008, Ryne Dougherty, a 16-year-old from Montclair,
New Jersey, tragically died from a brain hemorrhage after
returning to play football without fully recovering from a
concussion sustained earlier in the season. I hope you
understand what I am laying before this Committee.
In the later panel, you will hear the story of the untimely
death of another young athlete, Will Benson. Please listen
carefully so that we can work together and do something about
preventing these things from happening. These stories are not
unique to these young men. According to the Centers for Disease
Control and Prevention, as many as 3.8 million concussions
related to sports and recreation are estimated to occur each
year. After sustaining one concussion, an athlete becomes as
much as four to six times more likely to sustain a second
concussion. I also want to point out that recent studies show
that girls may be at higher risk for concussions and face
longer recovery times. Clearly, this is a problem that can
impact all children.
In fact, Mr. Chairman, it is startling to see the numbers
within a sport that we usually don't associate with problems of
brain injury, soccer. And I have never seen a soccer game with
anybody wearing any kind of protective head gear. I want to
point out that recent studies show that girls may be at higher
risk. I repeat that because study after study shows this. This
is not something that is picked off a shelf. These are
scientific studies. A recent study from the Center for Injury
Research and Policy at Nationwide Children's Hospital in
Columbus, Ohio, also found that as many as 41 percent of
concussed high school athletes may be returning to play too
And I would suspect that when we look into this further,
when the NFL does its studies, that that will be the
centerpiece of whatever we are going to do in the future. Many
colleges and professional athletic associations, including the
NFL, have all adopted guidelines for the management of
However, much of this information has not made its way to
our local middle schools or high schools. I think that is
imperative. This is serious business when you see how many of
these concussions are taking place and how many children are in
jeopardy of losing their lives. In response to the growing
problem, last November I introduced the Concussion Treatment
and Care Tools Act, better known as the ConTACT Act, with Todd
Platts, who is the leading Republican in the task force. He is
co-chair with me. Early in 2010, we expect that this bill will
be heard. The ConTACT Act is designed to provide our schools
and coaches with the tools they need to ensure that student
athletes receive the proper care for concussions regardless of
the sport that they play. Because varied and conflicting
concussion management guidelines have caused confusion, the
ConTACT Act provides for the establishment of a consensus set
of guidelines that work for schools by bringing together a wide
range of experts.
This bill also incentivizes the adoption of guidelines by
schools to ensure that student athletes receive the proper care
and are given adequate time to recuperate before they are
returned to play. Need I say that it doesn't matter how young
or how old you are, or what sport you play, or whether you play
professional football, this should be a guiding principle of
our research. In 2006, I worked with the Brain Injury
Association of New Jersey to provide grants to New Jersey
schools for the purchase of these technologies that are
available. The ConTACT Act provides funds for the adoption of
these technologies in our Nation's middle and high schools. If
we are seeking the kinds of tangible long-term consequences of
brain injuries as revealed by recent studies of NFL players,
you have state of the art equipment and access to the best care
available, then we have to consider what this means for our
young athletes. Because damage to a maturing brain can be
catastrophic, it is even more important to ensure that we
understand these consequences and that the proper care is
provided to young athletes. I am happy to report this morning,
and I just received it, that both the National Football League
and the National Football League Players Association have
endorsed the ConTACT Act. The letter is before me if anyone
cares to read it.
Mr. Conyers. We will accept it into the record.
[The information referred to follows:]
Mr. Pascrell. Thank you, Mr. Chairman. If we are
encouraging young people, I will be closing, to be healthy
athletes who embrace ideas like teamwork and doing their best,
then this Congress must do everything it can to protect them as
they participate in sports. That is what we call fair play. It
is my hope that this hearing will generate a national
conversation, spur innovation in equipment, lead to action
regarding brain injury and the implications that these findings
have for athletes of all ages, male and female in all sports. I
thank you again, Mr. Chairman and Mr. Ranking Member, for
holding this important hearing, and I would gladly answer any
questions if there are any.
Mr. Conyers. There are plenty, but we are not going to go
into it today. But we do welcome your coming with us again and
the work that you and your caucus is doing in this regard. So
we thank you so much, Bill Pascrell----
Mr. Pascrell. Thank you, Mr. Chairman.
Mr. Conyers [continuing]. For kicking us off.
[The prepared statement of Mr. Pascrell follows:]
Prepared Statement of the Honorable Bill Pascrell, Jr.,
a Representative in Congress from the State of New Jersey
Mr. Conyers. The first panel consists of Merrill Hoge,
George Martin, Dr. David Weir, Dr. Robert Cantu, Dr. Andrew
Tucker, Dr. Gay Culverhouse, Mr. DeMaurice Smith, and the
Commissioner of the National Football League, Roger Goodell.
We welcome you all, urge you to take your seats. The
current Commissioner of the National Football League is also
the son of Senator Charles Goodell, who was both a Member of
Congress and a United States Senator. Roger Goodell played
football himself in college, and he has been with the National
Football League for many years. We appreciate his good work,
his cooperative spirit that he brings to these hearings. And we
will accept all of your written testimony into the record and
invite you--we welcome you all and invite you, Mr. Goodell,
Commissioner, to begin our discussion.
TESTIMONY OF ROGER GOODELL, COMMISSIONER,
NATIONAL FOOTBALL LEAGUE
Mr. Goodell. Thank you, Mr. Chairman. Ranking Member Smith,
Members of the Committee, I submitted a full statement and
would ask it be included in your record. Since becoming
Commissioner of the National Football League a little more than
3 years, I can think of no issue to which I have devoted more
time and attention than the well-being of NFL players, and
particularly our retired players. I want to review what we have
done in the past 3 years and make clear that we are not
finished. Our initiatives generally for retired players include
the following: Since I became Commissioner, we have made a wide
range of improvements in both the benefits and the
administration of the disability plan. We have doubled the
minimum benefit and lengthened the time within which players
can apply for benefits. We have retained a new independent
medical director. We have reduced red tape. We have simplified
the process for applicants and their families and sped
disability determinations. Each of these changes was made at
our initiative. As we proceed with the current round of
collective bargaining, we look forward to making further
improvements in this plan. Apart from the disability plan in
2006, we created the 88 Plan, which provides up to 88,000 per
year for any former player and his family who has dementia or
Alzheimer's. Those players do not need to show that their
condition is related to football. We have developed and funded
new medical benefits for retirees, including programs for joint
replacement surgery, cardiovascular and prostate cancer
screening, spinal care, assisted living arrangements, and a
discount card for prescription drugs. Retirees are eligible for
these benefits at no cost to themselves. In each successive
collective bargaining agreement since 1993, we have increased
pension benefits and done so retroactively. We want that to
And as we negotiate with the NFLPA for a new agreement, the
clubs have again identified retired player pensions as a
specific priority, and look forward to discussing our proposals
with the union. Through these and other benefits, retired
players will receive more than $100 million in 2009. And I have
committed to our retirees, and I will repeat that commitment
today, that we will not reduce or eliminate funding for these
benefits based on the status of our collective bargaining
agreement, and we will continue to accept new applications for
disability or 88 Plan benefits.
We have also tried to understand the needs of our retirees
and their families. I have met with hundreds of them across the
country. We have commissioned the University of Michigan phone
survey that Dr. Weir will discuss. We learned a good deal from
the report, and are actively following up with the 56 players
who report memory problems. I know that a specific matter of
interest is concussions and their effects. We know that
concussions are a serious matter, and that they will require
special attention and treatment. And in this area, I have been
clear. Medical considerations must always come first.
Decisions regarding treatment of players with concussions
and when they can resume play must be made by doctors and
doctors alone. We are changing the culture of our game for the
better. Again, it is important to look at what we have done. In
addition to research that has led to better equipment, we have
made numerous rule changes to sharply limit the kinds of hits
that lead to concussions. We have also emphasized proper care
and education. Prior to 2007, we took a number of steps, with
the active participation of the NFLPA and its medical director.
We held an open medical conference on concussions. Many of
the doctors here today participated and shared their findings.
We developed new educational materials for players and their
families, and the doctors developed new guidelines for
management of concussions that have reinforced a clear trend
toward increasingly conservative care. The NFLPA and I jointly
communicated these initiatives to all players, owners, head
coaches, doctors, and trainers, and they were of course widely
publicized. So we welcome the union's interest in this subject
and look forward to continued collaboration. Just 2 weeks ago I
met with Dr. Cantu in Boston. Based on that discussion, I have
asked John Madden, who is now a special adviser to me, to work
with a group of coaches to identify new practice techniques, or
practice techniques that have been used in the past, that could
reduce the risk of head trauma outside of the games themselves.
We must continue to learn from and base our decisions on
science, but we cannot stand by while research continues. So we
will continue to have a singular focus on player safety and do
all we can through equipment changes, rules, education, and
medical care to make the game as safe as possible. We will also
support all manner of ongoing research. One other outcome of my
discussion with Dr. Cantu is I expect shortly to be able to
announce the NFL support for ongoing research into CTE. We
recognize that our example extends to young athletes who play
football. Accordingly, through USAFootball we have distributed
material on concussions developed by HHS and the CDC to 9,000
youth programs across the country. And the USAFootball Web
site, visited by as many as 200,000 people each month, contains
a wealth of information on concussions and other health and
safety issues. We will continue to do more to disseminate
information and to emphasize safe and fair play.
In conclusion, Mr. Chairman, our goal will continue to be
to make our game as safe as possible for those who love to play
it, and to give our retirees the support and respect they
deserve. Thank you.
Mr. Conyers. Thank you very much, Mr. Commissioner.
[The prepared statement of Mr. Goodell follows:]
Prepared Statement of Roger Goodell
Mr. Conyers. Our next witness is Attorney DeMaurice Smith,
who did his thing in varsity track and field, went on to law
school, University of Virginia Law School, worked in the U.S.
Attorney's office, served under Eric Holder when he was a
Deputy Attorney General, as a trial lawyer, was President of
the Assistant United States Attorneys Association, and has
received many awards. And we welcome you. We have your
statement. And we encourage you to expound on it in the time
that you have.
TESTIMONY OF DeMAURICE SMITH, EXECUTIVE DIRECTOR, NFL PLAYERS
Mr. Smith. Yes, sir. Good morning, Mr. Chairman, Ranking
Member Smith, Members of Congress, Congresswoman Sanchez, and
others. Thank you very much for the opportunity to testify this
morning. I would also like to take the time to welcome and
thank Ms. Sylvia Mackey, wife of John Mackey, as well as Mr.
Wood. Other former players are also in attendance. Mr. Brent
Boyd and I welcome each and every one of them, and thank them
for their attendance today. As executive director, my number
one priority is to protect those who play and have played this
game. There is no interest greater than their health and their
safety. Let me say this again. The safety of our players is
paramount. Mr. Chairman, you and this Committee deserve immense
credit and appreciation for consistently bringing this issue of
concussions, brain trauma, health and safety in the sport of
football to the forefront. This Committee and this hearing will
be a turning point on this issue. My hope is that this day will
serve as a marker denoting the day that we are committing
ourselves to finding the right answer. It will influence not
only this game at the professional level, but the one that so
many of us love for our players in college, high school, and in
I have one simple declaration on behalf of those who play
and those who played this game. We are committed to getting the
right answers, to work with everyone who has the goal of
protecting our players, and to serve as a model for football at
every level. Given that commitment, I acknowledge that the
players union in the past has not done its best. We will do
better. To men like John Mackey, to men like Brent Boyd, to men
like Mr. Wood, and to families of Mr. Mike Webster and to Andre
Waters, and to those organizations like the Gridiron Greats
that stand with us, I commit and we commit this as our primary
mission. We will not fail them. I will not fail them. Both
myself and the current retired players of the National Football
League are committed to getting this answer right. I was
elected by the board of player reps in March of this year.
Since that time, we have taken the following steps to address
this issue. In May of 2009, we created the NFL Players
Concussion and Traumatic Brain Injury Committee to address two
critical issues, the diagnosis, treatment, and prevention of
concussions and TBI in active players, and second, the long-
term cumulative effects of TBI in NFL players as patients, to
analyze and study this issue of NFL players as patients, and
how these effects can be reduced or eliminated.
This Committee, funded by the players, will act as a
superconductor of current and future studies, and is charged
with one overarching goal, to get the answer right. Two weeks
ago I met with all of the chapter presidents and steering
committee members who represent the retired players of the
National Football League. This 40-person Congress of former
players that represent and make up the NFL Retired Players
Association is an organization with over 25 years of history.
At that meeting, they all embraced the creation of this
committee and joined our call to have the National Football
League release all aggregate medical information that has been
collected over the years to benefit both current and retired
Third, several players have dedicated their bodies to
medical science in the effort to provide researchers with the
best information to aid those who will play this game in the
future. This body of retired players also had several players
who are willing to do the same thing. Not only to help the
players who are playing this game today, but as they have done
in the past, to stand up for the people who will play this game
tomorrow. Because they know that it will be their sons, it will
be their daughters who are playing sports that will benefit
from this research. For the first time ever, the Players
Association medical director, Dr. Thom Mayer, is present at
every meeting, including collective bargaining meetings that
deal with player health and safety. He will chair the Players
Traumatic Brain Injury Committee.
Finally, Mr. Chairman, to everyone here, to the retired
players, to those who are watching us across the country, the
players of the National Football League will not bargain for
medical care. We will not bargain for health and safety. We
will not bargain for basic provisions of the law as patients.
We will continue to work with the league, but medical care is
not and will never be just a collective bargaining issue. While
all players understand that professional football is a violent
game, we must do our best to keep them informed of the game's
potential consequences. Yes, it is true that professional
football players are the best, most well conditioned athletes
in the world, but even those blessed with tremendous athletic
gifts are vulnerable to severe injuries. We must know and
embrace all of the medical data to prevent, treat, and manage
the long-lasting effects of these injuries. Mr. Chairman, I
welcome any questions, am prepared to submit any other
information that you may request, and am happy to be here
[The prepared statement of Mr. Smith follows:]
Prepared Statement of DeMaurice Smith
Mr. Conyers. Thank you, Attorney Smith.
Our next witness is the daughter of the late Hugh
Culverhouse, the first owner of the Tampa Bay Buccaneers, Dr.
Gay Culverhouse. She has an MA and a doctorate in education
from Teachers College, Columbia University.
While her father was owner of the Buccaneers, she served in
administrative roles within the team and eventually became its
president. She is in the process of concluding her work on a
book entitled, Violence: The Underbelly of the National
Football League, which was prompted by learning about the
deteriorating health of her former players who suffered from
She has received many other degrees and honors, and I am
very happy to have her before us here today.
TESTIMONY OF GAY CULVERHOUSE, Ed.D.,
FORMER PRESIDENT, TAMPA BAY BUCCANEERS
Ms. Culverhouse. Thank you us, Mr. Chairman, and thank you,
Committee, for giving me the opportunity to address you today.
It is a great honor for us.
Mr. Conyers. Pull it closer.
Ms. Culverhouse. I will just yell.
In 1974, my father was awarded the expansion team in Tampa,
Florida. And, from that point on, I have been intimately
involved in football. Prior to that, I did go to the University
of Florida. The years I was there, Steve Spurrier was the
Heisman Trophy Award winner.
Yes, I am a grandmother of six children, and I feel like
these people's grandmother here because I have been involved in
football for so long.
The one thing that I would like to bring to your attention
that I think that I can have a unique perspective on is--Mr.
Goodell spoke to the medical aspects and having the doctors
make these decisions.
One of the things you, as a Committee, need to understand
very clearly is the fact that the team doctor is hired by the
coach and paid by the front office. This team doctor is not a
medical advocate for the players. This team doctor's role is to
get that player back on the field, even if that means injecting
the player on the field.
I have seen a wall of players surround a player, a
particular player, and seen his knees injected, seen his hip
injected between plays and him back on the field. This is
inexcusable. And I want you to understand the role that the
medical community has in facilitating these concussions.
The players get to a point where they refuse to tell the
team doctor that they have suffered a concussion, as well. They
do not self-report because they know there is a backup player
sitting on the bench ready to take their position. Most of
their contracts are back-end loaded with performance bonuses.
They need those extra yards and those interceptions in order to
make their salaries.
The team doctor goes to the combine, where he goes over the
medical records and helps the team coach choose the incoming
players for the next season. He is involved in the draft
process because he evaluates how severe that knee injury was in
college, or that concussion. He is part of the selection
process. So he has a very vested interest in that player's
success on the field.
The team doctor dresses as a coach on the sidelines, and he
acts in many ways as a coach on the sidelines. He is not an
independent advocate for the player. If a player chooses
independent medical counsel, he is considered to be not a team
player. He becomes a pariah to the team. We have to stop that.
We also need to have at every game an independent
neurologist or neurosurgeon on the sidelines who takes care of
either side in the game, who is not prejudiced, who is
independent, who can make an independent judgment if he sees a
player in a huddle throwing up.
Something needs to be done about this medical care. You
cannot leave it in the hands of the team physician to make
these decisions. And the players are at the point now where
they will not self-report because they need the money. They are
a disposable commodity. There is a draft coming up every April,
and these players fight to hold on to their jobs. And they
welcome shots and anything else that will keep them on the
field. This is, in my idea, inhumane.
And I have watched it since the early 1970's, and I will
tell you that it has not changed. Do not be fooled that, since
I left the game in 1994, that this game has changed. You can
see the discussions on whether Tim Tebow of the University of
Florida should play against LSU. My grandson is 9 years old.
Tim Tebow is his idol. You better believe my grandson is going
rush back out there and play. We need an independent doctor on
the sidelines to tell my grandson ``no.''
I appreciate the opportunity to address you. Thank you.
[The prepared statement of Ms. Culverhouse follows:]
Prepared Statement of Gay Culverhouse
Mr. Conyers. Thank you very much, Dr. Culverhouse.
Dr. Andrew Tucker, medical director of the Union Memorial
Sports Medicine Program in Baltimore; fifteen years' experience
providing primary medical care to professional, collegiate,
scholastic, and recreational athletes; head team physician for
the Baltimore Ravens, and serves on a number of advisory
committees focused on performance-enhancing agents, mild
traumatic brain injury, and cardiovascular health. And, as I
understand it, is currently the president of the National
Football League Physicians Society.
He has written chapters on various subjects, sport health
topics, including concussions. And I will put the rest of his
resume, which is pretty long, into the record, as I will with
all of the other panelists.
[The information referred to follows:]
Mr. Conyers. Dr. Tucker, we are very pleased that you could
be with us today.
TESTIMONY OF ANDREW M. TUCKER, M.D., MEMBER, NFL MILD TRAUMATIC
BRAIN INJURY COMMITTEE AND TEAM PHYSICIAN, BALTIMORE RAVENS
Dr. Tucker. Thank you, Mr. Chairman.
I will correct one piece of information. I am past
president of the NFL Physicians Society, immediate past
I have been a team physician in the NFL since 1991 and a
member of the NFL Committee on Mild Traumatic Brain Injury
since its inception in 1994. From both perspectives, I have
seen positive changes both in the science and in the culture
related to the injury of concussion in the NFL and would like
to summarize these for you now.
First, from the perspective of the concussion committee
member. In 1994, when Commissioner Paul Tagliabue requested
that a committee be formed to determine what was known about
concussions in sports and to study every facet of the injury as
it related to the game of football, it revealed a stark
reality: We did not have much scientific data on sports-related
Evaluation and treatment guidelines were well-intentioned
but not based on solid science. Major helmet manufacturers told
us that their products had not changed substantially in many
years. Their products were adequately protecting players from
catastrophic brain injuries, but there was no stimulus for
innovation to decrease the risk of concussion.
The first several years of the committee activity
concentrated on understanding the very basic epidemiology, the
who, what, why, where, when of the injury. And that study
continues even today.
In parallel work, the committee enlisted the help of highly
respected biomechanical people from academic communities in the
United States and Canada to study concussions in professional
football in new and creative ways.
Game videotape of actual concussive injury on the field of
play was studied and analyzed. Researchers were able to
recreate laboratory reconstructions of collisions of helmeted
test dummies that accurately represented what was happening to
players on the field. In effect, this had never been done
Research breakthroughs resulted in many tangible benefits,
which are listed in your statement, and I will just highlight a
Number one, helmet design. The information that we shared
with helmet manufacturers was a critical stimulus to the first
substantive changes in helmet design in many years and provides
us with some optimism that the risk for concussion in players
at all levels--not elimination, but the risk of concussion in
players of all ages might decrease with these improved designs.
Secondly, helmet testing. Because we have a valid
laboratory protocol for recreating the conditions that result
in concussion on the field, this laboratory set-up can be used
to evaluate the new products that I just spoke about.
Thirdly, the interaction with NOCSAE, also part of helmet
testing. NOCSAE, as you may know, is the committee that
establishes safety standards for sports equipment, including
helmets, the same helmets that our players wear, the same
helmets that our children wear. The biomechanical research
allowed us to understand that the speeds and forces associated
with injury and concussion in the NFL were quite a lot
different from what they were using to test helmets. Thus, our
open dialogue with NOCSAE has resulted in modifications in how
helmets are tested for efficacy.
And as the commissioner reminded us, number four: rules
changes. A greater understanding of how concussions occur on
the field has been shared with the National Football League and
provides the Competition Committee with valuable, objective
information to make rule changes to protect players and make
the game safer.
I would like to also take a couple of moments to talk about
neuropsychological testing and, also, the study of retired
Neuropsychological testing has been utilized in the study
of neurological patients for over half a century. Our
colleagues in Pittsburgh and other academic centers were
leaders in developing neuropsych testing for the evaluation of
brain injury in athletes in the early 1990's. The test has
evolved into a valid and reliable evaluation and management
tool for sports-related concussion.
Our committee was instrumental in supporting the use of
this technology across all NFL teams in the mid to late 1990's.
Today, its use is mandated for all NFL clubs. The committee's
support of this tool was also instrumental in promoting the use
of the evaluation and treatment of athletes at all levels of
Retired players: The study of retired players remains
probably the most concentrated focus of our committee's
activities today. While other researchers have published
findings from survey and questionnaire data that suggest that
recurrent concussions may increase the risk for chronic changes
in brain function in retired players, our committee has noted
this, we regard it as valuable, we regard it as concerning, and
we regard it as not yet definitive. These are due to
limitations in research methods, which will be spoken about.
The committee is supervising a study of retired players
that involves comprehensive neurological testing and imaging
with a control group of men who have played college football in
order to more definitely ascertain whether playing professional
football is associated with increased risk of brain dysfunction
in the retired athlete.
The issue of chronic traumatic encephalopathy in former
players has been and will be a most vigorously examined,
debated, and scrutinized topic among experts inside and outside
our committee. Some experts believe autopsy findings of former
football players are due solely to the effects of trauma, while
other experts feel repetitive head trauma and repetitive
concussions are only a piece of the puzzle of a very
complicated issue. The committee has hosted scientific
exchanges on this topic as recently as May and will have
another meeting next month.
Lastly, education: Education of our own medical staffs,
players, coaches, and team administrators has been a priority
of our committee since its inception. The first educational
symposium was soon after the committee started in the mid
1990's. The most recent one was in Chicago in 2007, and another
is being planned for 2010.
Ongoing concussion education is regularly a part of our
scientific interchanges at the combine in Indianapolis on an
annual basis. And we have shared our knowledge and experiences
with our colleagues in sports medicine through our biannual NFL
team physician meetings.
Clearly, the last 15 years has been a time for important
advances in concussion research and clinical care. While our
committee has published 17 articles from our research, we
hardly admit that we have all the answers. Our charge remains
overseeing quality research for the benefit of our active and
retired players and to advance the science of sports-related
My last perspective is that of a team physician. There are
many challenges to evaluating and treating concussions in
athletes of all ages. While the injury is easy to diagnose in
some cases, there are other situations in which--many
situations, actually, in which an athlete who has sustained a
concussion is difficult to diagnose.
With concussion, as with any other medical issue, the
medical staff is dependent on the athlete giving us accurate
information to help us make a diagnosis and properly care for
Team physicians and athletic trainers have long observed
two primary barriers to this important exchange: First, the
athlete for too long has thought that being dinged or mildly
concussed is simply part of the game and not important
information to share with their medical staff. Secondly,
athletes want to compete and they want to play, and they tend
not to give us information that might result in restriction to
I feel strongly that, not only in NFL players but, as well,
my high school and college athletes, these barriers of, number
one, lack of patient education and, number two, a conscious
reluctance to share information are much less imposing now than
they were 10 or 15 years ago.
Finally, as a team physician at all levels of competition,
I certainly evaluate and manage concussions differently today
than I did 15 years ago. While we try to understand the
potential effects of head injury on our currently retired
players, I don't think it is wise to indict the care being
provided today's players based on reports treated a generation
or more ago. I am truly optimistic the care being rendered to
today's athletes will prove very beneficial to the retired
athletes of tomorrow.
Thank you, Mr. Chairman.
[The prepared statement of Dr. Tucker follows:]
Prepared Statement of Andrew M. Tucker
Mr. Conyers. Dr. Tucker, we thank you for your statement.
I am now pleased to recognize Dr. Robert Cantu, clinical
professor of neurosurgery, Boston University School of
Medicine; author of over 300 scientific publications, including
21 books on neurosurgery, sports medicine, and lots of chapters
on peer-reviewed papers and others of the like.
He has served as associate editor of Medicine & Science in
Sports & Exercise. He is still doing a lot of health things
himself. And we will put this very extensive resume into the
[The information referred to follows:]
Mr. Conyers. And I welcome you to the Committee. We are
pleased and honored to have you here.
TESTIMONY OF ROBERT C. CANTU, M.D., CHIEF OF NEUROSURGERY
SERVICE, AND DIRECTOR, SPORTS MEDICINE, EMERSON HOSPITAL,
Dr. Cantu. Thank you, sir.
Mr. Chairman, Members of the Judiciary Committee, I am
honored to be here today, and thank you for allowing me to
provide this testimony.
I am a neurosurgeon who has spent the past 30 years of my
career focusing on issues pertaining to sports-related
concussion. As the author of the first return-to-play
guidelines after a football concussion nearly 30 years ago, I
have been fortunate to be able to participate in the
development of and be a coauthor of numerous international--
Vienna, Prague, and Zurich--as well as national--the National
Athletic Trainers' Association and the American College of
Sports Medicine--return-to-play guidelines for athletes
following a concussion.
We are here today because there is a growing awareness of
the public health crisis we are facing due to long-term
consequences of football-related brain trauma. Over the past
several years, there has been growing and convincing evidence
that repetitive concussive and subconcussive blows to the head
in NFL players lead to a progressive neurogenerative brain
disease called chronic traumatic encephalopathy, CTE.
This Judiciary Committee hearing was scheduled soon after a
newspaper report of an NFL-funded research study of 1,063
former NFL players who were given a lengthy telephone survey,
which concluded, among other questions, that the incidence of
dementia and memory-related diseases was 19 times higher than
the national average in the 30-to-49-year-old age group and
nearly six times higher in the over-50-year-old age group.
While this comes as no surprise to those of us at the
Center for the Study of Traumatic Encephalopathy at BU, as we
have found all brains studied so far of NFL players who played
after the age of 25 to have full blown CTE, the question
remains, was this survey and their findings accurate? And I am
sure we are going to hear more of that shortly.
Unfortunately, the diagnosis of dementia cannot be made on
a phone survey, and the term ``memory-related diseases'' is not
a precise medical term. Thus, this study design is highly
flawed. But even though it is flawed, it has had a positive
effect of increasing the public awareness of this important
I am not here to debate the merits of this study but to
point out that we have, in my opinion, a serious public health
problem today resulting from repetitive head trauma too often
experienced by NFL players. But the problem is much bigger than
the NFL. It affects football players at all levels, including
college, high school, and youth leagues. And it is not just
football. It is all sports at high risk of brain injury,
especially hockey, soccer, lacrosse, among others, that is at
risk for CTE.
The brain does not know what caused it to be violently
shaken inside the skull: a football helmet-to-helmet hit, a
left hook to the jaw, a check against the boards, or even a
blast injury in military combat. The response in all may be the
conversion of a naturally occurring brain protein, tau, T-A-U,
into a hyperphosphorylated form that is toxic to nerve cells
and their connections and causes death of nerve cells and
disruption of their connections.
While our research shows that this abnormal accumulation of
tau is widespread throughout the brains of individuals with
CTE, it is especially concentrated in the medial temporal lobe
structures, as Dr. Ann McKee will point out for you, and thus
leads to a clinical triad of recent memory failure progressive
in extreme cases to dementia, depression, and lack of impulse
While CTE has been mostly reported in the world's
literature in boxers and for the longest period of time, over
80 years, nearly 20 cases in the last several years have been
reported from individuals that formally played in the NFL. In
our group, we have recently reported a case of CTE in a man who
only played football at the college level. So, obviously, some
of these individuals have entered the NFL already with
incipient, if not full-blown, CTE. Our group has even found the
beginning of CTE in an 18-year-old high school athlete who died
of rugby-related head trauma.
Now that we are aggressively looking for CTE, there has
been a 40 percent increase in the recognized cases in just the
last 2 years alone. And we believe this is but the tip of the
Thus, I believe we have a serious public health problem and
a massive underappreciation of what head trauma, especially
multiple head traumas, at both the concussive and subconcussive
levels, can lead to. There is no doubt that these injuries do
lead to an incurable neurodegenerative brain disease called
CTE, which causes serious progressive impairments in cognition,
emotion, and behavior control, even full-blown dementia.
Obviously, not every athlete who experiences head trauma
develops this disease. Future research will reveal additional
important factors that make some athletes more prone than
others to developing CTE.
But the public health crisis is already here, and we cannot
afford to wait any longer to make changes to the way we play
sports, especially sports like football that is today being
played in a way far different than it was initially conceived.
Blows to the head, as we have heard earlier, need to be
minimized through rule and technique changes, especially in
those sports such as football.
[The prepared statement of Dr. Cantu follows:]
Prepared Statement of Robert C. Cantu
Mr. Conyers. Thank you very much.
We now turn to Dr. David Weir, who is currently a research
professor at the University of Michigan's Institute for Social
Research, specializing in research on the measurement of
health-related quality of life, the use of cost-effectiveness
measures in health policy and medical decision-making, the role
of supplemental health insurance in the Medicare population,
and has had recent research projects commissioned by the NFL
Player Care Foundation.
He was awarded the Cole Prize for best paper in the Journal
of Economic History twice, in 1984 and 1995, and the Alfred P.
Sloan Research Fellowship.
I presume, Dr. Weir, that you are not connected with the
University of Michigan Injury Institute recently formed there.
Mr. Weir. No.
Mr. Conyers. All right. We welcome you, and we look forward
to your testimony.
TESTIMONY OF DAVID R. WEIR, Ph.D., LEAD AUTHOR, NFL PLAYER CARE
FOUNDATION STUDY OF RETIRED NFL PLAYERS
Mr. Weir. Thank you, Mr. Chairman and Members of the
Committee, for inviting me here today.
The Institute for Social Research at the University of
Michigan is committed to the use of social science survey
research to serve the public interest. And we are always ready
to respond to you, as representatives of the public interest.
I appreciate the opportunity to set the record straight on
our study of retired NFL players. Faced with the aging of the
U.S. population, we are all looking for policies and programs
to serve the needs of people after a lifetime of hard work.
This unique population of retired football players is an
intriguing place to look for challenges and solutions.
Our study had two broad goals: The first, at the request of
the NFL, was to describe the population of retired players
across a wide range of topics, from marriage and family life to
health, to economic circumstances. In an environment of
sensationalized press accounts, they sought some basic facts on
which to create or improve programs to serve the needs of
The second goal, at our suggestion, was to lay the
foundation for future research that could follow up on specific
health problems or other areas of need. I am pleased to say
that the NFL agrees with us that further research on the
dementia issue is warranted, and we are now actively planning
that follow-up effort.
Our initial telephone survey found that retired
professional football players are, to put it mildly, a diverse
and fascinating group. On average, they are highly
accomplished, productive members of their communities,
churches, and families. They suffer from aches and pains in
shoulders, knees, backs, and necks that make difficult
activities that many of us take for granted. Most are in
comfortable financial circumstances, though many report having
received bad financial advice somewhere along the way. Most
have health insurance and are able to get the health care they
need. They are proud of their achievements and of their time as
For every such generalization, there are individual
exceptions. There are retired players in poverty or without
health insurance. Some don't particularly like the NFL. There
are some who claim their knees don't hurt.
This diversity is particularly true for the issue of
cognitive impairment and dementia that is the focus of the
hearing today. In our telephone interviews, 96 percent of NFL
retirees report that they do not have such problems. But 4
percent do, and, in some cases, the disability and the need is
Depending on the severity of the problems, which our study
could not assess, those numbers may or may not indicate an
elevated risk from a career playing football. We can't draw a
conclusion, and no responsible scientist would do so.
Those who assert that the rates reported by former players
definitively show a higher risk do so by greatly
underestimating the extent of dementia and cognitive impairment
in the general population. I wish it were rare, but it is not.
It is a major public health challenge facing the country.
The follow-up study will address the major limitations of
the telephone study with regard to the measurement of dementia
and cognitive impairment. It will utilize the design and
methods similar to ones we have used in a much larger study
known as the ``Health and Retirement Study,'' which I have the
privilege to direct at the University of Michigan with funding
from the National Institute on Aging.
The methods and results of this approach to diagnosis of
impairment and dementia have been published in peer-reviewed
scientific journals. It is done in the home by trained
professionals and does not require travel or visits to clinics
that might exclude some participants.
With respect to individuals in the NFL study who did report
a memory-related illness, it will be important to distinguish
between the more severely disabling condition of dementia and
the more common but less disabling mild cognitive impairment.
The needs of these two groups are very different, and we will
assess the extent to which the 88 Plan created by the league
and the Players Association is meeting those needs.
With respect to individuals who did not report any memory-
related illness, we will seek to determine whether there is any
significant dementia or impairment in a sample of cases. By
comparison to studies using the same methods in the general
population, we would be able to say to what extent retired
professional football players differ in their rates of
impairment and dementia.
I understand the intense interest in this issue and the
impatience to have definitive answers. I have many friends who
are parents of teenage athletes, and I know how much it worries
them. We will not delay, but getting it right is more important
than getting it fast.
To those retired players who we will ask to participate in
the next stage of this research, I make the promise that we
will protect your privacy and we will report the truth.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Weir follows:]
Prepared Statement of David R. Weir
Mr. Conyers. Thank you very much, Doctor. We appreciate
Our next witness is George Martin, who is the National
Football League's all-time leader in touchdowns. And it goes on
from there, for quite a long time here.
Are you still playing?
Mr. Martin. No, sir.
Mr. Conyers. Last year, George Martin walked across the
country to raise money for medical care for the first
responders to the September 11, 2001, terrorist attack. He
raised close to $3 million for the families.
And, just this month, he was elected to be executive
director of the National Football League Alumni Association.
And we will put all of your resume into the record.
[The information referred to follows:]
Mr. Conyers. And we welcome you on that note. We are very
proud to have you here, sir.
TESTIMONY OF GEORGE MARTIN, EXECUTIVE DIRECTOR,
NFL ALUMNI ASSOCIATION
Mr. Martin. Thank you, sir.
Chairman Conyers, distinguished Members of the House
Judiciary Committee, my fellow colleagues, Commissioner Roger
Goodell and Executive Director DeMaur Smith, I sincerely
consider my presence here today to be both a privilege and an
honor: a privilege in the fact that, for a moment, I have a
respected platform on which to bring a rather alarming issue to
light from an extremely unique perspective; and honored by the
fact that I represent a constituency that will be observing the
outcome of these hearings from more than a casual perspective.
Therefore, I applaud these proceedings, and hopefully they will
represent the impetus and serve as the catalyst to effect
greater and even more meaningful responses to an ever-growing
As executive director of the NFL Alumni Association, the
recent medical findings surrounding head trauma in the NFL in
general, and concussions more specifically, though admittedly
inconclusive, has sparked sharp debate and generated
considerable interest within this industry.
While we, as concerned representatives of the Alumni
Association, find the initial medical research alarming, to say
the least, unlike my other esteemed colleagues here today--and
with all due respect, I am the only one here that can give
direct and actual firsthand accounts of the violence and the
often injurious aftermath of professional athletics, which, in
some cases, leads to an accelerated diminishing physical and
mental capacity and sometimes fatal human collateral.
As a former defensive lineman in the NFL for the last 14
years, I have had the unenviable experience of enduring life in
what is commonly referred to as the ``NFL trenches.'' And,
unfortunately, during that era, when violent tactical maneuvers
such as head slaps, forearm shivers, clothesline tackles, and
violent head-butts were commonplace among all facets of
football, although most have since then been eliminated, the
resulting severity of these combative interactions were
oftentimes trivialized and minimized by the powers that be,
usually referring to such incidents as simply ``getting your
bell rung,'' ``getting your clock cleaned,'' or ``having
cobwebs in your bonnet.''
You may ask the obvious question as to why: Why refer to
such antiquated and archaic behavior that has long since been
banned from use in professional athletics? The answer is rather
simple. Though the practice of such brutality has long since
vanished, the resulting delayed consequences remain present and
are feared to be more prevalent and widespread among our aging
NFL alumni population than any of us dared realize.
Today we acknowledge that such blunt force trauma is
inherently dangerous and, according to several recent studies,
most notably the Center for the Study of Traumatic
Encephalopathy, CSTE, of Boston University's School of
Medicine, is that such incidents can perhaps lead to premature
death among athletes.
The sum total of such medical afflictions such as chronic
traumatic encephalopathy, CTE, cannot be accurately measured
merely by commissioning a single study, as the all-encompassing
illness adversely affects each and every family member who
happens to be associated with the victim or the patient.
I reluctantly highlight this point by betraying a
confidence of a very personal friend who, over the course of a
professional lifetime, has meant the world to me as a mentor, a
teammate, a business associate.
After 10 seasons in the NFL as a highly respected running
back, this gentleman retired, seemingly to be the picture of
health. He diligently maintained a rigorous regiment of
athletic activities, while playing competitive tennis for at
least 3 days a week. He also maintained a healthy diet, and he
never varied five pounds above or below his optimum weight.
Additionally, he owns a string of fast-food franchises
consisting of more than 40 stores throughout the Northeast
region. Business travel, both domestically and internationally,
was a necessity and frequent occurrence. To say that he
maintained an active lifestyle would have been an
There were no overt signs of diminished capacity in his
lifestyle except for, one fateful day, after returning from a
business trip, he simply forgot where he parked his car. Upon
sharing the story with his friends, we all had an amusing laugh
at his expense and naively chalked it up to simple
happenstance. He himself would jokingly say on numerous
occasions, ``George, I guess I got hit too many times in the
This incident happened only 2 short years ago. However,
within the span of 24 months, this once vibrant, hyperactive
individual has been reduced to a mere shell of his former self,
who is now confined to self-imposed house arrest and, with each
passing day, slips further and further away from the dynamic
personality that we all once knew him to be.
The shame, the embarrassment, the degradation are but the
tip of the iceberg that he and his family are painfully
enduring each and every passing day. This unfortunate scenario
rings as a far too familiar refrain among many NFL alumni.
If my presence here today and my very public betrayal of
this deeply confidential situation of my former NFL colleagues
results in illuminating this potential catastrophic medical
calamity, then I would conclude that neither have been in vain.
The general consensus among most NFL alumni centers around
four primary concerns: First and foremost, prevention, so that
the perpetual cycle of reoccurrence of these situations in
sports itself is severely diminished or, better yet, totally
eliminated through innovative rule changes and enhanced
Secondly, proper diagnosis and effective medical treatment
without laborious and agonizing red tape that oftentimes become
a painful prelude that is discouraging and is completely
exacerbating an already dire situation.
Thirdly, that such medical treatment not result in a
financial catastrophic tsunami which predominantly wreaks
havoc, financial havoc, on the surviving family.
Finally, a more comprehensive study which should include a
veritable cross-section of alumni in order to accurately
determine the full extent of the problem among retirees who may
be predisposed to this insidious, debilitating medical
On behalf of the NFL alumni, we greatly appreciate this
forum in which to state our position on this vital manner.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Martin follows:]
Prepared Statement of George Martin
Mr. Conyers. That was very moving, and I am glad that you
were here to tell it.
Mr. Martin. Thank you, sir.
Mr. Conyers. Merril Hoge, former Pittsburgh Steelers, was
the team's starting running back for six seasons. He set the
team record for the most receptions by a running back, totaling
50 in 1988. But he suffered his first concussion with the Bears
during the 1994 season, in a game in Kansas City, and he was
back playing 5 days later.
But when he suffered his second concussion 6 weeks later,
it ended his career. He had to relearn how to read. Sometimes
get lost coming home from a restaurant that he had frequented
for years. He is now an analyst for ESPN national--an NFL
analyst. And even, sometimes, things can trigger problems about
concentration, and so forth.
We are very proud to have you with us. We realize because
of time constraints, and we received the concurrence of the
Ranking Member, to take you from the second panel and put you
on the first panel. And we are very pleased that you are here
to talk with us today.
TESTIMONY OF MERRIL HOGE, RETIRED NFL PLAYER
Mr. Hoge. Thank you, Chairman Conyers. I appreciate that.
And, Ranking Member Smith and Committee Members, it is an honor
to be here.
As mentioned, I played 8 years in the National Football
League: 7 for the Pittsburgh Steelers and 1 for the Chicago
Bears. In the prime of my career, a series of concussions cost
me my career and nearly took my life.
After my second concussion, I was escorted into the
training room, where I flat-lined. As they started to
resuscitate me, I popped back up, and they rushed me to the
emergency room, where I lay in ICU for 2 days. In the first 24
hours, I could not recall my wife, my daughter, or my brother,
who were there at the time.
I was confined at home for weeks, where I couldn't leave
unless somebody went with me. I had to learn how to read again.
I went through depression. And these major symptoms took nearly
2 years to recovery from.
Two things went wrong from my first concussion on a Monday
night game in Kansas City: First, I never saw a neurological
doctor. Second of all, I was cleared 5 days later to play the
game of football over the phone by a family practitioner.
Now, due to contrary testimony already, I will say this.
There has been significant changes in the National Football
League based on the NFL and the NFLPA. What happened to me
would not happen in the National Football League today. That
does not mean we are all the way there. We are on our way.
Something that is also extremely important that we all
understand, and that is why we are here: The brain is the most
vital and sensitive organ in our bodies. Without it, we do not
function, we do not operate.
That is why I am going to kind of broaden the scope, Mr.
Chairman, and ask that you help us establish a national
standard. Part of that national standard--and this is where it
can be somewhat of a calming and a soothing approach to this--
is that the standard be a part--part of the standard being that
a neurological doctor is always part of the evaluation of head
trauma, somebody who is trained for that. Secondly, within this
national standard, that a player, he or she, does not return to
play their particular sport until they are asymptomatic for 7
consecutive days at exertion and at rest after they have
cleared. If we established just those standards with all
football, we would have less tragic stories than we have to
Now, as I broaden the scope just a little further, let me
include our youth programs. Youth football from ages 6 to 14,
we have over 3 million kids playing football. That is twice as
many that exist in high school, college, or the NFL combined.
And we cannot forget them.
The reason I am somewhat adamant about this at this point,
I am a youth coach; I am active in youth football and other
sports. I am the head coach, I am the trainer, I am the
equipment manager, I am the cheerleader, I am the psychologist
all in one and especially in the early moments of injuries. My
experiences have truly helped me in critical moments in these
programs, but oftentimes I watch the sidelines with uneducated
parents dealing with our youth. And it is a grave concern.
Within that standard that I am trying to propose is because
I have never been a part of a program where there is a standard
or a protocol to head injuries; that if we were better educated
in that fashion, we would have less tragedies. So I am asking
you to help us with that. Help us create better standards,
better requirements, and better education.
And that we don't overreact, that we promote athletics, we
promote activity. What is one of the biggest concerns that we
have in our youth today within our society? It is obesity, the
health care issues that exist with that. So we cannot say
because of head trauma and concussions we must eliminate
sports. We must educate, we must properly evaluate and properly
take care of those athletes. If we do that and create a safety,
that will encourage more youth to be involved in our sports,
that we are properly taking care of them and educating them.
Now, I have met many times with Roger Goodell. My words
have not fallen on deaf ears. He has been genuine, sincere, and
committed to this issue and the health and benefit issues of
our former players. I have also met with DeMaur Smith many
times. My words have not fallen on deaf ears. He is also
genuine, sincere, and committed to helping this issue and our
And I address them for just a second. They are the people
that we cannot forget. They are the ones that created the stage
that I was fortunate enough to play on. I was part of building
a stage that the current player is playing on. And the current
player is continually building the stage in the National
Football League that future players will build on.
But, eventually, all will be retired players. And, too many
times, the NFL and the NFLPA has made it too difficult on our
retired players to get the proper care that they deserve. Being
here today gives me great hope that we may bridge the gap, not
only on this particular subject with brain trauma, but the
health care and the health issues that exist in the NFL.
Commissioner Conyers, I want to thank you for having me
here, and the rest of the Committee. Thank you for your time.
[The prepared statement of Mr. Hoge follows:]
Prepared Statement of Merril Hoge
Mr. Conyers. Well, thank you very much.
I have three questions. But you referenced the uneducated
parent. And I am not a very sensitive person, but would you
describe that uneducated parent with a little more specificity?
Mr. Hoge. Chairman Conyers, I actually would, and it is a
great question. And I have a great example that just happened
several weeks ago. And may I broaden the scope a little bit
from the uneducated parent to the uneducated coach that works
our youth sideline?
I had a young kid named Griffin who got up from a collision
and he was a little woozy. So he had sustained some type of
head trauma. As I pulled him to the side, ironically, his older
brother Jake helps coach. He is 25 years old. Now, Jake
obviously knows Griffin much better than I, although I know
Griffin very well. I wanted to address what was going on with
Griffin. I wanted to talk, I wanted to address a lot of
cognitive things that I am aware of now, from retrograde to
anterograde, to his name, to what play we just ran, to find out
where his senses were, looking at his pupils--some of the
things I know. Then I asked Jake to sit there and talk to him
and make sure that these didn't elevate from sickness to
Well, after 5 minutes, Jake ran up to me, and he said,
``Grif is ready to go back in.'' And I am like, ``No. Grif is
done playing.'' I just wanted to make sure that the symptoms
did not elevate so that we could get him to the hospital, then
after the game talk to his parents about monitoring him and
taking him to the doctor if necessary.
The caution and concern that I have there is Jake could
very easily be a head coach in our youth program, and he was
willing to put his own brother back on the football field,
purely out of ignorance. And I understand that because me being
25 years old and being Jake and the lack of experience I had at
that time, I probably would have done the same thing.
And that is why I think standards and education would help
mistakes being made like that.
Mr. Conyers. Thank you so much.
My three questions are these.
Commissioner Goodell, is there a link between playing
professional football and the likelihood of contracting a
brain-related injury such as dementia, Alzheimer's, depression,
or CTE? And I also may ask Dr. Cantu to comment on it.
My second question is, Commissioner Goodell and Executive
Director Smith, will you agree today to open up your books,
records, files, personnel of the league's, its teams, so that
we may conduct an independent examination concerning brain-
And, Madam Dr. Culverhouse, how does it make you feel to
see your former players suffering from the repercussions of
poor choices made to prematurely put players back into the game
Mr. Goodell. Chairman, let me address your first question.
You are obviously seeing a lot of data and a lot of
information that our committees and others have presented, with
respect to the linkage. And the medical experts should be the
one to be able to continue that debate.
But our bottom line is, we are not waiting for that debate
to continue. We want to make sure our game is safe, and we are
doing everything we possibly can for our players now. And that
is why we have engaged aggressively in making changes to our
game. We have done some of the things that have been discussed
here on a variety of levels.
Let's start with the fact that we have made significant
rule changes to our game. Five rule changes this year alone
have been made that I think are improving the safety and
welfare of our players. They have had a positive impact in the
short term that they have been in place. And we will continue,
as we have done every year, to evaluate rule changes to make
our game safer.
Many of those changes this year were specific to head
injuries and making sure that we take certain techniques out of
the game that can be unsafe for our players, both in the short
term and potentially in the long term.
We have also engaged very aggressively on education. We
have worked with the Players Association, with our medical
doctors to create information that we can share with our
players and also with players at other levels. It is a very
important responsibility to set the right----
Mr. Conyers. Well, you have testified to that. But I just
asked you a simple question. What is the answer?
Mr. Goodell. The answer is, the medical experts would know
better than I would with respect to that. But we are not
treating that in any way in delaying anything that we do. We
are reenforcing our commitment to make sure we make the safest
possible deal for our----
Mr. Conyers. All right. Okay. I have heard it.
Dr. Cantu. Sir, in the world's literature, the majority of
chronic traumatic encephalopathy has been reported in boxers,
and it is reported at a younger age in boxers because they
probably take more head trauma than any other sport. But it is
not confined to boxers. Obviously, we are here today because of
this same entity due to head trauma in the NFL, but it has been
reported in a soccer player, it has been reported in rugby. It
has been reported in individuals that have head-banging
disorders. It has been reported in a clown that got shot out of
a cannon in a circus, and every time he got shot out of the
cannon it was like being concussed.
So, as I indicated, yes, I think there is cause and effect.
It is not unique to the NFL, though.
Mr. Conyers. Of course.
Commissioner Goodell and Director Smith, will you let us
see the records?
Mr. Goodell. The answer to that question is absolutely yes.
We first discussed this between the NFL and the NFLPA back last
spring. We are going to make all medical records available to
them. And we, of course, will do that for the Committee.
Mr. Smith. Yes, sir, of course we will.
Mr. Conyers. Thank you.
Ms. Culverhouse. Yes. As one could imagine, my children
were involved in football early on. I have a child born in
1972, 1973, and 1974. So they went with me to games, and they
developed favorite players, players that took the time to give
a handshake to my son or give my daughter a ride on his
In January, I learned that one of those players who had
stayed in Tampa, Tom McHale, and started a successful business,
Batman Wood, my son's favorite player because he wore bats
on his shoulders and his elbows and his knees and my son could
pick him out, was getting lost trying to drive home from
And I met with Batman and heard about his story and asked
him about another player that we had really liked, Jerry
Eckwood. And he said, ``Gay, Eckwood is really bad. He is
really bad.'' And I said, ``I have to find him, because I need
to help him.''
Same thing with Scott Brantley, a former Gator--I am big on
Gators--but a former Gator. And Scott Brantley is in--Scott
Brantley is in big trouble now. And he said to me this morning
as I was coming over here, he said, ``Gay, you have always been
a rebel, but you are a rebel with a cause. Make them hear that
we are hurt. Make them hear that we can't fill out all of their
forms. We can't do it. Our mental capacity isn't there to
answer the questions on the phone and fill out the forms. They
are missing those of us that are severely disabled.''
And so what I am doing with Randy Grimes and a number of my
players is I am filling out the forms, I am going through the
networks for them to access the benefits that they may be
entitled to--which are not enough to sustain them monetarily.
They are not enough. Five thousand dollars for a hip
replacement is not enough. I just had my knee done; I can tell
you that for a big fact.
But we have to get proactive for these players. So I am
going to Little Rock, Arkansas, to find Jerry Eckwood to take
him to the doctors myself and fill out the forms to get this
man the help he needs. I don't want to read about another one
of my players that is dead. I don't want to have to tell my
children their favorite gentle giant is dead. This isn't
working for me.
Mr. Conyers. Our Ranking Member, Lamar Smith.
Mr. Smith of Texas. Thank you, Mr. Chairman.
Mr. Chairman, I would like to address my first question to
Mr. Goodell, Dr. Tucker, and Mr. Martin. And I know you all
will come at the answer from different perspectives.
Mr. Goodell, you may want to address ways that you and the
Players Association can cooperate or new rules that might come
Dr. Tucker, you might address equipment.
Mr. Martin, you might have some comments from your own
My question is this. We have discussed a lot today about
the problems. We have discussed a lot about past actions that
have been taken. My question is, what future actions should we
take? What are the next steps to advance our understanding of
the problem of head injuries, to try to improve treatment and
to try to increase prevention of these head injuries?
So, even though you have different perspectives, if you
will talk about the future as opposed to the present or the
Mr. Goodell. Well, let me try to address that as concisely
as I can without repeating a lot of the testimony.
The first thing we have to do is continue to support this
research and make sure we put more and more into this research
so that we can find out what exactly are the medical facts.
That is first, and we will continue to do that.
The second thing we are going to have to do is to continue
to prevent these injuries in the best way we can. That is rule
changes that we have instituted that are making a difference.
Second is we made some--because of the research we have done,
made some very important changes to the equipment, particularly
in the helmets and the chin straps.
And these are important changes for us in making the game
The other issue that I would say is the education. I think
the big issue for us and for every player at every level and in
every sport, as was pointed out here, is to make sure they are
aware of the issues that come when you have a concussion. And
it is a serious injury, and you have to take it seriously and
get medical care.
Mr. Smith of Texas. Okay. Thank you, Mr. Goodell.
Dr. Tucker. At the risk of repeating some of the testimony,
I will speak a little bit more specifically to equipment.
We have made mention that research has shown that at least
concussions that occur in the NFL frequently occur in blows to
the side of the head and to the facemask. This information was
given to the helmet manufacturers, and they responded with
change--the first changes in many, many years.
The new helmets that have been rolled out in the last
handful of years at least test better in the laboratory. So we
are optimistic that the forces being imparted to the brain are
showing that they are decreased compared to the older helmets.
It won't eliminate concussions, but if we can decrease the risk
we will feel good about that.
It will take more time and more study and more meticulous
tracking of these injuries, which we have been doing for a lot
of years, to figure out whether the new helmets actually
decrease risk of concussion or the actual occurrence of
concussion in the National Football League.
Interestingly, over the last one to two seasons, the number
of concussions diagnosed and recorded have actually dropped
slightly, but I wouldn't make too much of that. I think it is
premature to say.
Mr. Smith of Texas. Okay. Thank you, Dr. Tucker.
Mr. Martin, any practical advice you have for us?
Mr. Martin. Yes, sir, I would like to add this, that I am
optimistic that, in this new spirit of cooperation, that we can
all come together with a unique plan to address many of these
But the three points that I am concerned about,
particularly as it relates to a lot of the so-called heroes or
our constituents, is that we must make sure that we determine
and identify where they are. Because a lot of them, you know,
they value their anonymity. And we want to make certain that we
have identified them and embrace them in this new era.
Secondly, we want to make sure that all of the splinter or
faction groups that currently exist out there are working off
of the same goal, to make sure that these are not isolated
incidents and we can address them collectively.
So I am very optimistic about this new era and this new
platform that we have of recognizing the severity of this. And
that is the message I am going to take from here.
Mr. Smith of Texas. Okay. Thank you.
I have to ask you a quick question. How much touchdowns did
you score on the interceptions or fumbles?
Mr. Martin. I have a total--and I will speak to Mr. Goodell
about this. I held the record for most touchdowns by a
defensive lineman, which was seven. However, I have one
touchdown as an offensive lineman, which would make it eight.
So I don't know how you----
Mr. Smith of Texas. We will correct the record.
Mr. Martin. So it is eight, sir.
Mr. Smith of Texas. Thank you.
Dr. Weir, my last question is for you, and that is in
regard to the University of Michigan study by the Institute for
Social Research. How was your study misrepresented, and what
impact has that had on the discussion and debate?
Mr. Weir. I believe, as I said in my testimony, it has been
misrepresented to the extent that it is asserted there is a
certainty that there is an elevated risk demonstrated by our
study, which I don't believe there is.
What is the harm in that? To the extent it focuses us on
safety, who is going to be against that? My concern, and I
think Mr. Hoge raised this very well, we have an epidemic of
obesity among children. Do we want to tell prospective junior
athletes there is a 19-to-one risk of dementia if you
participate in sports? I think that is a very damaging kind of
thing to have out there without really good scientific support
for making it.
So that would be my main concern, is that we are possibly
frightening people away from healthy participation in things
they should be in.
Mr. Smith of Texas. Thank you, Dr. Weir.
Thank you, Mr. Chairman.
Mr. Conyers. Mel Watt, North Carolina, distinguished Member
of the Committee.
Mr. Watt. Thank you, Mr. Chairman. And let me thank the
Chairman for convening this hearing. It has been very
And I especially want to express my thanks to the last two
witnesses, the former players in the NFL, for the very balanced
approach that they brought to their testimony.
Maybe I could get Mr. Smith to cut his microphone off over
there. Thank you.
I am also a big NFL football fan, and certainly observed
the change that has taken place in attitude about this issue. I
am a big Carolina Panthers fan and observed the Dante Wesley
hit that got him suspended and knew in my own mind that,
several years ago, the response to that would have been a 15-
yard penalty and that would have been the end of it. So I
understand that there is a change of attitude taking place
And the one thing that I try to discern out of these
hearings of this kind is what kind of public policy direction
we might take. So I am extremely appreciative to the last two
witnesses for their balance on that. Because, after all these
years, we still haven't taken any steps to outlaw or ban
boxing. And I don't think we are likely to take any steps to
outlaw or ban football. So we have to look at what the possible
adjustments are, short of that, that may be made either within
the sport or from a public policy perspective.
The one thing that I kept wondering about throughout the
testimony, particularly Mr. Goodell, Dr. Culverhouse, Mr.
Martin in particular, there seem to be financial incentives
that discourage athletes from being honest about their own
condition, even if they are capable of discerning their own
condition. All of the counterpressures are there for them to
get back into the game and be able to perform because there are
financial incentives associated with that.
Is there a policy in place already in the NFL, or is there
some kind of policy that you all might be able to think of,
that would minimize or eliminate that financial incentive by
assuring that a person who is diagnosed with a concussion and
has to miss a game as a result of the standards that I think
Mr. Martin or Merrill Hoge outlined--is there some way to build
a contract necessity that would shield those players against
the consequences of the medical conditions that they incur?
Mr. Goodell, Ms. Culverhouse, I would be particularly
interested, and Mr. Martin, in your response to that.
Mr. Goodell. Well, I would be happy to start.
First off, you do identify an issue. Self-reporting of
concussions has been an issue. And we have, I think by the
education that we have jointly done with the Players
Association and with the Player Advisory Committee, I think----
Mr. Watt. You are evading the question again, Mr. Goodell.
I asked you about contracts.
Mr. Goodell. Well, let me address that directly then, on
the contracts. If a player misses a game because of a
concussion, he is still paid. So the athlete still gets paid.
Mr. Watt. But there are financial consequences at the end
of the contract, the incentive compensation for games played,
for--that there are economic consequences that flow from that.
Is there a way to protect against that?
Mr. Goodell. There may be some incentive contracts that
would be hindered by that, depending on the length of time the
player was out. It would be something we would have to discuss
with the Players Association and try to see if there is a way
to address that.
Mr. Watt. Mr. Martin? Dr. Culverhouse? And my time has
expired. So I just won't interrupt you in your response.
Mr. Martin. I will take a stab at it. I am not quite sure I
have the answer to it, Mr. Watt, but I appreciate the question.
I am not quite certain if you can disincent an athlete
because of his predisposition to want to go out and perform. I
am not sure how you protect both his financial incentive to
want to go out and perform in light of being injured versus
disincenting him to protect him from the injury. That is a
difficult question, and I am afraid I don't have the answer.
Ms. Culverhouse. I can say that it would be very difficult
for the NFL to mandate to the owners how to structure their
contracts. That would be a difficult thing, as I can tell you
that owners are like a bunch of mavericks, and it would be very
difficult to mandate to them how to have their players paid.
Because incentive bonuses are the way you get those players
back in the game and you win.
They don't molly-coddle. This is a business. It is a
blanking cut-throat business. The bottom line is making money.
And if their player ain't playing and the team is losing, that
is the bottom line.
Mr. Watt. Thank you, Mr. Chairman. I went over. I yield
Mr. Conyers. Senior Member Bob Goodlatte.
Mr. Goodlatte. Well, thank you, Mr. Chairman.
Mr. Chairman, I would like to direct my questions primarily
to Mr. Goodell and also to Mr. Smith. And it regards, first of
all, the problem that has been very, very well-described by
everyone on this panel today in terms of the risk of these head
injuries and the fact that this is something that starts
becoming a problem at a very young age, in junior high school,
high school, on up through college, and long before they get to
There are a number of good ideas that have been expressed.
Mr. Hoge had some very good ideas regarding neurological
examinations and with regard to 7 days, staying away from the
football field until they are asymptomatic for at least 7 days.
And I am sure there are a number of very good ideas that
medical experts and coaches and others could offer in this
But one of the problems is getting the information out. I
am not sure that, given the wide variety and changing opinions,
that this is suitable for legislation from the Congress.
But I am wondering, does the NFL during games use public
service announcements, for example, to educate young people and
their parents about the risks of head injuries and things that
could be done on a practical basis to avoid them in Little
League play and in high school and so on?
Mr. Goodell. The answer to that question is, I believe we
have used public service time. We could probably use more on
But I would tell you that the most important thing is, we
set the example on the NFL field. We saw just this past Monday
night when we had Brian Westbrook, a player, go down in a game
with a concussion. He was taken off the field. He did not come
back to the game. And it was done in a very cautionary and
And I think that is the message we need to send to people.
And we will look at the idea of whether we can give more public
Mr. Goodlatte. I missed that play. Did it involve a play
that required a penalty or some other action on the part of the
referees to indicate that this injury was sustained because of
inappropriate activity, or was it simply----
Mr. Goodell. It wasn't an inappropriate activity. It was
actually just a knee that hit to the back of a player, which
happens in our game and in other sports.
Mr. Goodlatte. Well, I mean, I wonder if you would review
the policy you have. I see many public service announcements
that promote various things on the broadcasts of professional
sports. And you could work with the broadcast companies to
promote greater information, just promoting the very ideas that
Mr. Hoge promoted.
And, Mr. Smith, I wonder what you think about that but also
what involvement the Players Association has in promoting
getting that kind of information out to young people and their
parents. Do you favor having greater contractual requirements
for the players to actually get out and, whether voluntarily or
as a part of their contract, be more engaged in communities
around the country to promote this kind of safety?
Mr. Smith. Congressman, our players are doing that right
now. And I think, to answer your question succinctly, I think
there are four or five things that we can actually do and, I am
proud to say, we are doing.
Our players in the National Football League, I believe,
should be the model. I think that Commissioner Goodell is
right, we have an obligation to set the standard. That standard
is the standard that will be followed in college, it will be
followed in high school, and it will be a role model for youth
football. Both of us are vitally involved in the USA Football
movement. We use that vehicle not only to encourage youngsters
to play football but to do it safely.
Third, our players are also a number of the individuals who
end up being coaches, not only in the National Football League,
but coaches on the college level, coaches on the high school
level, and, as Merrill indicated earlier, coaches on the youth
football level. So having our players understand and embrace
all of the information to make safe choices is yet another way,
in addition to PSAs, that we can get the message out.
Lastly, we do a tremendous amount of work on the Players
Association to get players to appreciate the best and the right
helmets to wear. We believe that if we advise the players and
give them all of the information, the most up-to-date
information, urge them to wear specific helmets, that is yet
another way that we serve to set the right example and to get
the information out to the people that you mentioned.
Mr. Goodlatte. Thank you.
It sounds like both of you are very committed to trying to
reduce these injuries, not only within the NFL, but in the
sport of football at large. And I think getting that
information down particularly to parents and coaches at the
high school level and college level is very, very important.
And I think you could both use more resources than are
devoted to it now to play a major role in that, since you are
the ultimate beneficiaries of that entire system that finds and
recruits the finest football players, gets them into the NFL,
and gives them the opportunities that they have and that all
Americans have to enjoy professional football.
Wouldn't it be the best path forward for the problems in
the NFL itself for the private parties to come up with the best
solutions? Are either of you arguing that the Congress should
be making this decision? And, if so, why?
Mr. Goodell. We are not arguing that. We think that we have
pushed research, we have pushed education. We have made changes
to our game, to the equipment.
We have made significant changes, which I am happy to put
into the record, with respect to the management of concussions.
I think we are doing a terrific job and a much better job, much
improved job of conservatively treating concussions and
managing them when they occur so we don't have incidents like
Merrill Hoge spoke about before.
So I think that we are doing a job that is important
because these are serious injuries, and we need to continue to
Mr. Smith. Congressman, we don't believe that legislation
is the only answer. One thing that we all know, just by all of
us being brought here today, is this great body not only can
spark public debate and serve to inform, to better the lives of
everybody through legislation, but also by having these
We have talked a lot today about a University of Michigan
study. But one of the things that will be entered into the
record is the fact that, over the last 10 years, there have
been hundreds of studies on this issue that have talked about
the links between on-field head trauma and the early onset of a
number of mental illnesses.
So while we are here, perhaps, because of the recent
articles and the news that has come out about a number of
players, the reality is, over the last 10 years, there has been
study after study after study after study.
And I do believe, to go back to your earlier point, how can
we do a better job? That is to understand and embrace these
studies as being game-changers and player safety and getting
that information out to all of the--not only the kids who will
play football from youth football going forward, but to the
coaches and to the parents who gladly have their kids be
involved in physical activity.
Mr. Goodlatte. Thank you.
Thank you, Mr. Chairman.
Mr. Conyers. Thank you very much.
Before I recognize Maxine Waters, we are pleased to
appreciate the presence of Jim Brown of the Cleveland Browns in
Thank you for joining us, Jim.
Mr. Brown. Thank you, Mr. Chairman.
Mr. Conyers. The distinguished gentlelady from California,
Ms. Waters. Thank you very much, Mr. Chairman and Members.
Before I raise a few questions, I would like to submit for
the record full disclosure of my husband's affiliation with the
National Football League, having previously played for at least
three teams: the Cleveland Browns with the great Mr. Jim Brown;
Pittsburgh; and the Washington Redskins.
And so I do have intimate knowledge, based on my
interaction with a number of players and owners, about the NFL.
Georgia Frontiere was a very close friend. And John Shaw, who
was president of the Rams, and Chip, the new owner, are
However, having said that, I remain extremely concerned
about the plight of football players, particularly some of the
older ones who worked and played when times were even a lot
more difficult for players.
Let me just ask Mr. Goodell: in the October 2009 issue of
GQ, we were told the story of Mike Webster, legendary center
for the Pittsburgh Steelers from 1974 to 1988. At the height of
his career, Mike Webster was publicly revered as an unstoppable
titan and formidable force in the league. And yet, shortly
before his death in 2002 at the age of 50, Mike Webster spent
his latter years homeless, suffering from dementia, while in a
contentious legal battle with the very organization that made
him a legend.
The GQ article called the legal dispute a battle against a
multi-billion dollar industry that seemed to have used Mike
Webster, allowed him to become destroyed, and then threw him
away like a rotten piece of meat.
I bring his case because he had dementia, which obviously
was associated with the years that he played. Why could he not
get taken care of by the NFL?
Mr. Goodell. Well, Congresswoman, this was before my time
as the commissioner. I will say, and I am happy to say, in our
current state right now, he would be eligible to participate in
our 88 Plan and would get the benefits of the 88 Plan,
regardless of whether that was caused by playing in the game.
Ms. Waters. How many players do you have out there who are
suffering now, or have suffered from, dementia, or from other
injuries related to playing football that have not been taken
care of because of your benefits packages of the past?
For example, I think you changed it, but I don't know,
those people who took early retirement were not eligible for
disability. Did you change that?
Mr. Goodell. Yes, we did. What we did was we opened a
window to allow them to come in and to get those benefits. So
we opened that window for about a 6-month period.
Ms. Waters. We know that the NFL and the NFL Players
Association are currently renegotiating their collective
bargaining agreements. What are you doing in this bargaining
that you are involved in now that will deal with the very issue
that we are talking about, related to brain injuries and
dementia and Alzheimer's and all those other things related to
these kinds of injuries? What are you negotiating that will
better recognize the injuries and how you are going to take
care of them, and their families?
Mr. Goodell. Let me take the first start at it, and De can
contribute to that.
I think both of us have identified that the plight of our
retired players is a priority in the----
Ms. Waters. I can't hear you.
Mr. Goodell. Both of us have identified in the collective
bargaining process that this is a priority for the owners and
for the players, to take better care of our retired players.
One of the reasons we conducted the survey that may have
been one of the impetuses for this hearing was to identify the
priorities that our players need to have addressed. There are
multiple issues that need to be addressed, as you point out
some of them. Some of them are medical. Some of them are
Ms. Waters. If you would excuse me, I would like to take
back my time. I appreciate where you are going.
We have heard from the NFL time and time again. You are
always studying, you are always trying, you are hopeful. I want
to know, what are you doing in the negotiations that are going
on now to deal with this problem, and other problems related to
the injuries that football players obtain, and its impact on
their health later on?
Mr. Goodell. Well, again, we are at the very early stages
of negotiations. But I believe that we will be addressing these
matters in a responsible fashion, that we will be able to come
back before you at some point in time and say that we have
addressed these in a way that is responsible.
In the meantime----
Ms. Waters. Mr. Chairman, I appreciate the opportunity for
I know my time is drawing to a close, but let me just say
this to Mr. Goodell and everybody who is here today, that I
think it is time for the Congress of the United States to take
a look at your antitrust exemption. I think that you are a,
what, $8 billion organization who have not taken seriously your
responsibility to the players.
The fact of the matter is, yes, people want to play. The
fact of the matter is they are going to be injured. And we
know, no matter what kind of helmet you build, no matter what
kind of equipment that you have, it is a dangerous sport and
people are going to be injured.
The only question is, what are you going to do? Are you
going to pay for it? Are you going to pay the injured players
and their families for the injuries that they have received in
helping you to be a multibillion-dollar operation? That is the
And I know that you do everything that you possibly can to
hold on to those profits. But I think the responsibility of
this Congress is to take a look at that antitrust exemption
that you have and, in my estimation, take it away.
I yield back the balance of my time.
Mr. Conyers. I thank the gentlewoman for her modest
The Chair recognizes Howard Coble, North Carolina.
Mr. Coble. Thank you, Mr. Chairman.
And thank you all for your testimony.
Mr. Martin, Dr. Culverhouse, and Mr. Hoge mentioned this in
their testimony. What does the alumni association have to say
to active pro, college, and high school players about the
importance of early and completely presenting to team
physicians any symptoms that may have been caused by
concussions, knowing full well, as has been pointed out,
players are plenty reluctant to do it for fear of maybe losing
a college scholarship or losing a lucrative pro contract?
What do you say to that, Mr. Martin?
Mr. Martin. Thank you very much for the question, sir.
First of all, I would say that one of the major activities
that alumni athletes have is to going back in the community and
giving back. And we ourselves position ourselves as examples,
both pro and con, both good and bad. And we have a platform
that we take very seriously. And it is my job and it will be my
responsibility to make sure that that is enhanced, particularly
as we are addressing these very serious issues.
The problem and the challenge that we have is disseminating
this information among a wide grouping of constituents and that
a lot of our members don't have this information. I think it is
vital that they receive it. And once we obtain that
information, we have to then be ambassadors to go back, as I
said in my earlier point, to make sure that there isn't a
propensity of these kinds of things happening down the line.
And that will be our charge.
Mr. Coble. And I am glad to hear you say that.
Mr. Smith, in a recent New York Times piece concerning
concussions, a former quarterback was quoted as having said,
quote, ``They are legislating hitting out of the game,'' closed
quote. We have had the same sort of comment from commentators,
often retired players, echoing the same sentiment during
television coverage of games.
This suggests, it seems to me, that some of the retired
players are concerned that the game is not tough enough anymore
as a result of the rules changes made to hopefully protect
players. How do you respond to that, Mr. Smith?
Mr. Smith. Congressman, last weekend, I met with the 40-
person congress who represents retired players. They talk about
the toughness of the game, but they also talk about the
lifelong injuries that they sustained, the loss of their
ability to keep a train of thought. When you talk to the Chair
of the wives organization, they will tell you a story about
players who are unable to move on Monday and Tuesdays. When I
watched Brian Dawkins walk down the steps, who is a safety for
the Denver Broncos, gingerly walk down the steps on a Monday
afternoon--and while I shook his hand and went to embrace him
he put up his hand and just said, ``Hey.'' Well, I don't think
there is anyone who plays football today who doesn't believe
that this is a very, very tough, tough game.
No, we are not looking to legislate hitting out of the
game. But, in the same way that this Congress has stepped in
historically, whether it was the NCAA almost 40 years ago or
whether it was other issues in professional sports, to ensure
the safety of the players, this body works when you call a
hearing like this, where you ask us tough questions, where we
put forth information.
But I do believe that this Congress, this body does have a
role in making sure that the people who play this game on the
professional level all the way down to the peewee football
level are doing so safely.
Mr. Coble. I thank you, Mr. Smith.
Mr. Smith. Thank you.
Mr. Coble. Dr. Weir, as your second study proceeds, what
other research would you like to see performed to help better
understand why, if at all, football head injuries cause long-
term neurological impairments in the players affected?
Mr. Weir. As best I understand it, the study under way,
under the direction of Dr. Ira Casson, should shed interesting
light on the progression of head injury cases.
I think it is actually of great importance to compare
college athletes and professional athletes to those who did not
participate, to look at the risks at each of those levels
independently. That will probably require a larger study than
that one is.
I know there have been some criticisms of that study
because it is being conducted directly under the auspices of
the league. I think that could perhaps be addressed by an
independent monitoring board that could come in and review
those protocols, perhaps offer some advice on it.
It would be a shame if that research ended up having no
value because it was simply not considered credible. I suspect
it will have great value. And that is the kind of study we
need, is long-term follow-up of people, where we know what
happened to them and we follow them afterward.
Mr. Coble. Thank you, Dr. Weir.
Mr. Chairman, I see the red light has illuminated, so I
yield back. And I thank the panel again.
Mr. Conyers. Thank you, sir.
The Chair recognizes the distinguished gentlewoman from
Houston, Texas, Sheila Jackson Lee.
Ms. Jackson Lee. Thank you very much, Mr. Chairman. And I
thank you and the Ranking Member for this brilliant hearing.
Actually, I would like to acknowledge, Roger, that both you
and DeMaurice make a very good pair. And I think you should
look at yourselves as part of the 21st-century NFL.
I wanted to make mention, as I begin my questioning, of a
meeting that I had this morning with NFL Hall of Famer Jim
Brown. And we talked about the value of the NFL, the value of
the players, particularly today. We talked about the raging
violence among our communities and young men.
DeMaurice, you know you have been with me, and we have
addressed this question. We have acknowledged the fact that the
NFL is respected and admired. The young men that are a part of
this great family that you have can be wonderful role models.
And, of course, Mr. Brown is aware of the dire need of
mentorship and manhood training. He is in the room today.
And we talked about the idea that I shared with the
Attorney General recently that tracks Mr. Brown's program, but
it is to build a partnership with the NFL and our government on
this whole question of violence and, in particular, young
African American men, young men, to create a new revolution in
mentoring, to have NFL players out across America in these
schools and addressing the question of manhood and how do you
be, in essence, a manned-up man but also a compassionate,
caring person that does not take up the gun.
Our young people admire all of you. And I want to, myself,
pay tribute to Jim Brown, who stayed, so that I could thank him
for his genius on the idea of reaching out to young people.
And I am going to, frankly, ask a very quick question to
Mr. Goodell. Would you work with us to implement a program that
I would like to start with the DOJ and others on this question
of violence among our young people?
Mr. Goodell. Congresswoman, yes, we would. As I said
earlier in the testimony, we believe that we set the standard
on the NFL level, that our players do, both on and off the
field. I have spoken to Mr. Brown about the work that he is
doing, and I encourage it. And we would welcome the
Ms. Jackson Lee. Well, I would look forward to it. And I do
full disclosure that this separates from the questioning, but
this would be something in addition to what you traditionally
do, and I do appreciate the fact.
Mr. Smith, would we be able to work with you on this issue?
Mr. Smith. Absolutely. And you know that I am always happy
to work with the Attorney General and to work with you, as we
have done in the past. We have challenged our players to not
only be good players but to be good men in their communities.
So we would love to partner with you.
Ms. Jackson Lee. This would be not an existing program, but
we are talking about a whole new approach.
Mr. Smith. Absolutely.
Ms. Jackson Lee. And so I look forward to that issue.
And this leads me to why I am here questioning today,
because I want these young men to have completely vibrant lives
into their middle ages and into their older ages.
I thank Jim Brown for staying in the room. And we
acknowledge and thank you for sharing your great leadership.
Thank you so very much.
Mr. Brown. Thank you very much.
Ms. Jackson Lee. My questioning is in his name, but also in
the name of Earl Campbell, my champion, my Tyler Rose, among
many others that have come out of the great colleges in Texas.
And let me just continue to say, keep on coming.
But I do believe it is important--and my colleague made a
very important point: We do not do this in anger. We do not do
this in the need to undermine an organization that, frankly,
there are many who will say you are America's pastime. The
great interest of who bought the St. Louis Rams was not about
trying to deny capitalism; it was to have you have the right
image, the right attitude. That is why some of us expressed our
opposition to who might be buying the Rams.
So I would simply say to you, these are my questions, Mr.
Goodell in particular. How does a former NFL player qualify for
the league's pension plan and disability benefit plan?
It is my understanding that a football player does not
qualify for the pension plan until they have played for four
seasons. However, the average span of a NFL career is 3.6
years. Considering these figures, it appears that the
substantial amount of players are not eligible for the benefits
that the league does offer.
Does the disability benefits plan operate under the same
framework? So, is it not that they have to play 4 years, sir?
Mr. Goodell. It is 3 years.
Ms. Jackson Lee. They have to play 3 years.
And they only stay for about 3.6. So we can imagine--Mr.
Smith, would you imagine that there could be injuries prior to
Mr. Smith. There are. There are people who do suffer those
injuries. There are people who suffer significant injuries
prior to their third year, second game.
Ms. Jackson Lee. So, in actuality, this legislation, as we
look at it, and the idea of the antitrust exemption which many
of us are looking to consider as to whether or not that is a
way of helping the NFL, are you suggesting that this kind of
effort is very important to saving lives and saving future
quality of life?
Mr. Smith. I think anything that we can do to take a look
at all of the information, to make reasoned decisions based
upon that information so that we can aid more players who play
this game, I think any step in that direction is positive.
Ms. Jackson Lee. Ms. Culverhouse, could you just tell me
again what you saw when NFL players had to fill out forms that
had been so damaged? Could you just tell us again?
I, frankly, believe this is like the robust public option:
sick people who need help.
Could you just give us that detail again, please?
Ms. Culverhouse. Yes. You can imagine--I have suffered a
concussion. I actually had a brain shear and could not access
words for 2 years. Now, that was one concussion. You can
imagine players who have sustained repeated concussions. They
are now in their late 40's or 50's.
And you look at reams of paperwork. The print is so small,
I have trouble with my glasses. They look at it, and they say,
``Gay, I don't remember what year, what game, what date. I
don't remember that.'' And then they look at all of it, and
they say, ``Is it worth it? What am I going to get? What am I
going to get at the end of all of this?'' And they would much
rather go home, take a pain pill, and lay on the sofa.
It is daunting. And there are no advocates to help them
fill this paperwork out. It is almost as though, if you have
the intelligence to jump through those hoops, you are not
Ms. Jackson Lee. Mr. Chairman, as I see the red light, let
me just simply say this, Mr. Chairman. We are the help in this
room. We are not the punishers, but we are the helpers.
And, frankly, if we do need this extra hammer, which sounds
negative, sounds punitive, I believe these young men and I
believe the NFL for what it has become to America warrants the
involvement of this congressional body, warrants a review,
whether it is legislation before us, whether it is a question
of the antitrust issue.
Mr. Goodell, we are friends, but we must save lives. And
these young people have so much to give America, that we must
do that now.
Mr. Chairman, I count myself as part of a friend of this
great sport. I am from Texas, and, boy, are we wedded to you.
But we want our young people to be able to live in a good
quality of life, come back after the NFL, and share their
stories, fighting against youth violence. And I look forward to
being in touch with both of your offices on this issue.
Mr. Chairman, you have been very kind. Thank you. I yield
back to you.
Mr. Conyers. Thank you.
The Chair recognizes the distinguished gentleman from
California, Dan Lungren.
Mr. Lungren. Thank you very much, Mr. Chairman.
And let's not fool ourselves, football is controlled
violence. That is the nature of the game.
You don't have to play in the NFL to get hurt. I have five
knee surgeries, a new hip and everything, and I didn't even
play varsity at Notre Dame, for goodness sakes. But the
question is, is the violence controlled?
Teddy Roosevelt saved the game of football at the beginning
of the last century, when things such as the flying wedge were
allowed and players died. And the question was whether they
were going to outlaw this game in the United States. And Teddy
Roosevelt brought the leaders of universities to Washington,
D.C., without legislation and said, ``Get your act together.''
So we don't always have to have legislation here. And I think
this hearing does serve a very, very good purpose.
I would like to just concentrate on two things. One is
education, and the other is on-the-field enforcement.
Players have a responsibility to be educated and to do the
right thing. And we had a quarterback for the Redskins not too
many years ago who head-butted a wall before a game and gave
himself a concussion. We see players head-butting one another
in celebration today. That is just nuts.
There is peer pressure that needs to be utilized, with
information that the commissioner's office and the owners and
the Players Association can give to--I mean, it is not macho to
be head-butting one another before the game, for goodness
So, education is extremely important based on scientific
information. I have no doubt about that.
But part of that is this: And in a briefing we had with the
NFL a little bit earlier, a couple days ago, I asked, do you
have any control over your commentators? And the answer I got
was ``no.'' But do you educate your commentators so that they
don't make stupid statements about some of the plays on the
field that will encourage that kind of conduct, maybe not by
the players in the NFL, but by the kids watching?
So I would hope education would be an important part of
whatever you do, both the players and the commissioner's office
and the owners.
The other thing is on-the-field enforcement. We have had
changes in rules. I am old enough to remember Jack Tatum. I am
old enough to remember the cover story of Sports Illustrated
where he was called ``the assassin'' and when he talked about
trying to hit a player hard enough in the head that he hoped
that he would drool as he was lying there on the field. And
nobody really spoke out against that, in those days. That was
considered, if not the norm, that was the bar that you wanted
to achieve. And I know we have gone in a different direction
since then, but we need to go even further.
Tim Tebow, probably the most famous college football player
there is today, suffered a major concussion evidently--it sure
looked like it--and he was playing the next week. I don't think
that met Merrill Hoge's standard of 7 days. I wonder what the
story is there. I know there were doctors that were involved,
And I attended a game at my alma mater just 2 weeks ago,
and I saw a head hunter on the field that tore a helmet off a
player, and he was left dazed. No penalty. The next week, that
team played in the LA Coliseum; that same player did the same
thing to a guy, I think, from it was either Oregon or Oregon
State. No penalty. No penalty. He tore his helmet off. He is
the second guy hitting him 2 weeks in a row. No penalty. And
what the Pac 10 has just done is suspended the official for not
calling a penalty. No penalty on the player.
Now, I realize that is college, not pro. But I would say,
without talking about that particular instance, Mr. Martin,
what message would that send to the team or to the players if,
2 weeks in a row--and I will take it away from that particular
circumstance--but, 2 weeks in a row, a player did something
which really went after a defenseless player and no call is
made on that player 2 weeks in a row? What message does that
deliver to the team and to the players?
Mr. Martin. Well, first of all, from my humble opinion--and
thank you for the question, sir--I think it sends the wrong
message, not only from the player himself, but also the
coaching staff and the institution which they both represent.
And I know that the safeguards, at least from a structured
point of view in the NFL, those situations would not happen.
But I think that there has to be a point where the player,
themselves, through education, I which I think is vitally
important, has to realize it is incumbent upon him to conduct
himself as part of that organization.
And that is why I am proudly old-school and proudly one of
those that are from the yesterdays period of the NFL, because I
have taken my responsibility of giving back to the community
and my obligation to my teammates very seriously. And I think
that is one of the reasons that I now head this post. And I
would like to see more of that self-conscientiousness happen
throughout all the sports.
Mr. Lungren. Mr. Goodell, I just have to say that, when
that play has been shown, the ones that I referred to, the
commentators almost always say, ``And this person will be a
first-round draft choice of the NFL because he is the kind of
guy they are looking for.''
I just want to tell you, I know it is not your
responsibility, but that message seeps down to kids. And kids
see that. And these are their heroes. And if that message gets
out, that that is allowed on the playing field, frankly, you
will have more assassins out there, and you will have more kids
And I don't think we can stand to allow that to occur with
the knowledge we now have gained from the medical community,
which we just didn't have before, just did not have before.
So I am taking in good faith what you have said, what Mr.
Smith has said, what the doctors have said here. I mean, I
truly hope you are taking this more seriously. Because the
tragedy of the NFL players that have suffered dementia is a
tragedy--or any player who has--but I am thinking about the
kids coming up. And I hope that you folks are genuine in what
you are telling us here today.
Mr. Conyers. Thanks, Dan Lungren.
We have two Judiciary suspension bills on the floor right
now, which requires that we declare a recess, lunch, et cetera.
And we will resume after a series of votes as early as we can,
which will be probably 45 minutes to an hour.
The Committee stands in recess.
Mr. Conyers. The Committee will come to order. The Chair
recognizes Bill Delahunt, the distinguished gentleman from
Massachusetts, to continue in the discussion.
Mr. Delahunt. I had made some notes and now I am fumbling
for them. This has been a very informative hearing. Do we
have--I thought I saw Dr. Cantu. Is he still with us? I take it
he has left. Well, maybe somebody on the panel can answer this
question. It is a medical question, I presume. The term CTE, in
what I have read, has--the information from the research done
has come from--as a result of autopsies. Is there a technology
now that exists that allows for the diagnosis or determination
of CTE in a young male that is alive? I don't see anyone that
knows the answer to the question.
Mr. Goodell. I am not qualified.
Dr. Tucker. Everybody is looking at me. I am not a
neurosurgeon or a neuropathologist. So Dr. McKee, Dr. Maroon,
Dr. Morgenlander will be able to answer that better. The quick
answer from my perspective as a team physician is no. It is
not--it is not easy or simple to make a diagnosis of CTE from
an imaging study right now. Now, certainly there are MRI
changes associated with dementia related diseases. But
specifically to the question you ask, my answer would be no,
but I would defer to the----
Mr. Delahunt. Right. I understand there is a second panel.
But the purpose of the question I tell you what concerns me is
obviously the league itself is the standard in terms of where
young people--this hearing is not just about the NFL, by the
way. It goes beyond that. I think there was testimony earlier,
I forget from whom, that there are some 3 million participants
in youth football today, presumably that excludes the universe
of young men that are playing in college and even playing at
the high school level.
So what we have at risk here aren't just players in the
NFL, but thousands, hundreds of thousands of young males
participating in football in this country, probably the most
popular sport because of the popularity of the NFL. And I guess
my question is, if there were to be a technology that could
serve as--there was a diagnostic test to determine whether CTE
was present in young people as they were playing the sport, it
would serve as an early warning of a potential problem and
inform those personnel who are coaches, who are athletic
directors, that this young man should not be participating in a
sport where there is the potential for a concussion.
And if that diagnostic tool does not exist, it might be
incumbent on Congress working with the Administration to
examine the feasibility providing funding through NIH or
through some other appropriate relevant agency to do some real
serious work to develop that so that we don't have young people
out there playing when they shouldn't be playing and where I
think as parents they could feel much more comfortable, because
obviously the stories that have been related to the Committee
by this panel are truly heart-wrenching. And as a parent, and
your testimony, Ms. Culverhouse, was very poignant in your
concern and affection for your players, that I am sure you
consider as part of your extended family.
Multiplying your feelings times literally thousands, tens
of thousands or hundreds of thousands of, sets of parents
really demands an answer about this issue. It is not just about
the NFL. The NFL is here today because this Committee has
antitrust jurisdiction. But it is an issue that really I think,
working together, needs to be responded to. But that was--that
was my main question. And why don't I conclude with that and
Mr. Conyers. This will be gone in further in the second
panel. The distinguished gentleman from Iowa, the Ranking
Member of immigration, Steve King.
Mr. King. Thank you, Mr. Chairman. I want to thank the
witnesses for your testimony today. And one of the things that
came out of it for me was to be in the same room with George
Martin and Willie Wood and Jim Brown. To see them all on the
same field together, I didn't think I would ever actually see
that. So I appreciate that. And I want to remind the folks here
that just as I watched on Saturday night an Iowa-Michigan State
game, there were two injuries that resulted in players being
carried off the field and they were both helmet to helmet
contact. So it comes in a particularly timely fashion. However,
as I listen to the Members of this Committee discuss this and
we have covered a lot of the territory, I note that Sheila
Jackson Lee said that she is concerned that owners need the
right image and her opposition to who might be buying the St.
Louis Rams or her reason for that is owners that might not have
the right image.
She wasn't any more specific than that, but we know who she
is talking about, and that is Rush Limbaugh. But I would ask
Commissioner Goodell this question: Your position on owners
having the right image--and I would direct it to your statement
on the 13th of October where you said I think it is divisive
comments are not what the NFL is all about. I would not want to
see those kinds of comments from people who are in responsible
positions within the NFL, no, absolutely not. Now, I take you
as a man of your word, but I would point out that you have a
couple of owners that have performed lyrics in songs that are
far more offensive. In fact, I don't think anything that Rush
Limbaugh said was offensive. But with Fergie and with JLo, they
have between the two of them alleged that the CIA are
terrorists and liars. They promoted sexual abuse of women.
They have used the N word, verbal pornography, recreational
drug use, et cetera and they are owners of the Dolphins. And it
is also ironic that Fergie was approved as an owner on the very
day that you made your statement against Rush Limbaugh. And I
would point out for the Committee the statement that Rush
Limbaugh made is this, that seems to be the one that survives
the criticism. And that is, I think what we have had here is a
little social concern in the NFL. The media has been very
desirous that a Black quarterback do well. They are interested
in Black coaches and Black quarterbacks doing well. McNabb got
a lot of credit for the performance of the team that he really
didn't deserve, closed quote. Now, I have scoured this quote to
try to find something that can be implied as racism on the part
of Rush Limbaugh and I cannot find it.
There is an implication of racism on the part of the media.
That is the only quote that seems to survive the scrutiny of
Chase checking back original sources in at least nine quotes
that were alleged to Rush Limbaugh. And by the way, of those,
eight are complete fabrications, they are not based on
anything, they are not a misquote, they are not a distortion.
They are complete fabrication. And the one that remains stands
true and shines the light against the media, not against Rush
So if you are concerned about this, Mr. Goodell, then I
would ask you are you prepared to level the same charges
against Fergie and JLo or are you prepared to apologize to Rush
Mr. Goodell. Let me try to take this in a couple of
different directions. First off, my comments at the annual
meeting were directed about specific comments he made about
Donovan McNabb. And I made the point--and I will make it again
here today--that the NFL is about bringing people together, it
is about unity and that we do not move toward divisive actions.
And, in fact, our teams, I think, have demonstrated that both
on and off the field. Nothing brings a team and a community
together better than the NFL.
Mr. King. Mr. Goodell, were you considering those other
quotes that I referenced when you made your statement or were
you considering the one that was true, the one that I have read
to you and the one that doesn't shine a negative light on Rush
Limbaugh but on the media?
Mr. Goodell. I am not shedding any kind of light on Rush
Limbaugh here. I am not an expert on all of his quotes and I
would try to reinforce something to you I said at the time. He
was not even under active consideration as an NFL owner. This
is--I stated this several times before, that we had not started
a process to review ownership groups. They had not even
determined to sell the St. Louis Rams. And it is something----
Mr. King. You were speaking directly of Rush Limbaugh. You
said the comments that Rush made specifically about Donovan I
disagree with very strongly.
Mr. Goodell. I do. Because I think Donovan McNabb is an
outstanding young man. He is an outstanding quarterback and it
has nothing to do with the color of his skin.
Mr. King. I will just close with this. Here are Rush
Limbaugh's--his position. And after 20 years on the radio,
there is nothing there that would undermine this. He says my
racial views? Do you mean my belief in a colorblind society
where every individual is treated as a precious human being
without regard to his race. And I will close with that, Mr.
Goodell. And I would ask you to go back and take a look at the
owners of the Dolphins and the language that is in the public
venue, the songs that they have recorded, review those lyrics
and I will provide some of those lyrics to you. And I will ask
you to come back and respond to that question after the hearing
as to whether you will put the same scrutiny on those owners
who have really shined a negative light on the NFL as opposed
to somebody that the NFL apparently just doesn't agree with his
politics. I yield back.
Mr. Conyers. The Chair now turns to the gentleman from New
York, Mr. Weiner--oh. We will defer, we will hold our Member--
our only Member whose athletic prowess was recently displayed
just a few days ago. But I will now turn to Mr. Steve Cohen.
Who is a Subcommittee Chairman and the gentleman from Memphis,
Tennessee is recognized.
Mr. Cohen. Thank you, Mr. Chairman. And I thank the
gentleman from New York. The game Monday night, that was here
in the D.C. area, that, there was a running back for the
Eagles, Brian Westbrook that was injured. He, as I understand
it, had a grade 3 concussion, which is the max grade. The coach
has reportedly said that he is ``counting on Westbrook to be
back on the field Sunday against the Giants.'' From what I
hear, that doesn't necessarily sound like he is looking out for
the most careful approach to Mr. Westbrook's concussion. Mr.
Goodell, do you think that Coach Reid's comments were
appropriate that ``he is counting on him,'' which sounds like
he is putting a burden on him to rise to the occasion of play
after he has had a concussion just 6 days later?
Mr. Goodell. As you say, I have not seen the quote, but I
know Coach Reid. He has heard me repeatedly say these are
medical decision, they must be made by medical professionals.
My presumption would be that he has gotten medical advice of
how he has responded to the injury and that he is continuing to
be under very strict and very careful medical attention, and
the doctors have given him the indication that he should be
able to play.
Mr. Cohen. Let me ask you this, because Dr. Culverhouse
made clear that the doctors are the teams' doctors. They are
counting on him. They have got to get 3 yards. It is third and
goal, and he is the guy. Well, when he is 60 years old, he
might not have felt that it was good to be there on third and
goal. Shouldn't there be some independent doctor that makes a
decision when you are going to play, or possibly play, 6 days
after a grade 3 concussion?
Mr. Goodell. Well, I would offer to you that I believe our
doctors did not work for the coaches. In many cases, in most
cases do not actually work for the team. They work for other
institutions, highly respected well, known medical
institutions. They are doing this as part of their either
representation of that institution. Or they are doing this
because this is in addition to their other private practice.
Mr. Cohen. I am sure they do and they have got a
Hippocratic oath, and all that stuff. But nevertheless,
somebody signs the check and chooses among all those fine firms
who they are going to pick. And still--just like Cesar's wife
in the be beyond reproach, and also to be sure the player is
being looked after, don't you think it would be nice to have an
independent panel in these circumstances where there is a
player looking to play within 6 days or 7 days or some limit?
Mr. Goodell. I would say as long as it is made by medical
professionals, I would support it.
Mr. Cohen. Medical professionals kind of, probably, okayed
Muhammad Ali to fight Larry Holmes, which was a serious
mistake. He did it for the money. There are medical
professionals that send the boxer in the ring and send the
football player on the field and they have--I just think you
have to look after the players.
Dr. Culverhouse is to be commended. She obviously--I read
about her last name on The Times on the Web. She has a great
love for her players. Dr. Culverhouse, what do you think? Do
you think a player like that should be sent into action with a
Ms. Culverhouse. Absolutely not. Thank you. Absolutely, 100
percent not, no. There is no way. I have suffered a concussion,
I have watched my players suffer concussions, I have talked to
my players about their concussions and there is no way that
that player should be back on the field within 7 days of that
kind of stage 3 hit, there is absolutely no way.
Mr. Cohen. Do you think there could be a system where there
could be a 3-member group of physicians, or just some
independent doctor, that could be created that the AMA would
work with here, or some neuro----
Ms. Culverhouse. Absolutely. That is what I had mentioned
earlier. I think that if you have an independent neurologist
and you only really need one per game because they would work
for both teams as independent evaluator. But these players--we
grew up with Marcus Welby. We trusted our doctors. Even when
they said something, we didn't want to hear, we trusted Dr.
Welby. These players go into the NFL and they trust their
college doc, they trust their team doc. And then all of a
sudden, their team doc is shooting them up in the locker room
before they go out to play so that they can make the score, so
that they can block. And then at half-time they are putting
cuffs around their arm to IV them for the fluid loss. Cuffs are
not best medical practice for IV'ing a player. The player is
not being looked after by Dr. Marcus Welby. He is being looked
after by a coach's ally whose goal is to get the player back on
the field and make that score.
Mr. Cohen. Barbaro has better independent advisor, did.
Ms. Culverhouse. Yeah, I liked that horse.
Mr. Cohen. Yeah, I did too. And there was--okay, Mr.
Chairman, if I could ask one last question. Doctor, where are
the other owners? Are there other owners that have the same
feelings that you about their players, and have spoken out on
Ms. Culverhouse. Not to my knowledge. I am a rebel with a
cause. Not to my knowledge. You have to understand also that
Mr. Goodell works alternate the pleasure of the owners, so
actually he is representing here every owner in the NFL because
if he was not saying what they wanted him to say, he would be
Mr. Cohen. Thank you, Mr. Chairman.
Mr. Conyers. The Chair is pleased to recognize Judge Louie
Gohmert of Texas.
Mr. Gohmert. Thank you, Mr. Chairman. And I do appreciate
all the witnesses being here, your patience with us
particularly. And, Mr. Smith, congratulations on being
executive director of the NFL players. I know something about
your background. And I understood one of the benefits that was
deemed to have someone with your prestige from Patton Boggs
that does some lobbying, was the contacts that you had had with
Congress. Was there something in mind that you had and have
that Congress might do to help the NFL?
Mr. Smith. The NFL players?
Mr. Gohmert. The NFL player--you don't want to help the
NFL, you just want to help the players? Because I took it you
would want to help the whole NFL?
Mr. Smith. I think it is right to look at both the NFL and
the players. I think that holding this hearing today is both in
this instance and historically one of this great body's major
roles, to shine not only the light that comes from asking tough
questions of people who are brought before this Committee, but
also serving in your role to bring it--to bring it out to the
public in general. So I think when Congress asks tough
questions, when we are asked to come forward and present
information, I think that is a good thing for the National
Football League. I know it is a good thing for the players of
the National Football League.
Mr. Gohmert. When I say NFL as an outsider, I always think
of the players, everybody, owners, managers, coaches, all of
that within the NFL. That is what somebody like me sees when we
see the NFL. So it is nice when you work better together than
Congress does. But, Dr. Culverhouse, I really appreciate your
compassion for the players and all. I am curious, do you see
Congress needing to do something to step in and start telling
owners and players in the NFL what they need to do?
Ms. Culverhouse. Absolutely. You are the only body that can
tell the NFL what to do.
Mr. Gohmert. I see. Well--okay. What if we decide we don't
want you as an owner anymore? I mean that kind of thing.
Ms. Culverhouse. Fine with me. Get somebody honest,
straightforward, who cares about the players in there instead.
Mr. Gohmert. What we find here in Washington is that it
just seems to depend on who is in office. Currently we know for
example, from the insurance industry that when the White House
or leaders in Congress get upset with an industry and threaten
them and say we may yank your antitrust exemption, that they
are willing to retaliate and do something like that. So there
is a message there. Some of us think it is important to make
sure that everybody plays fair and there is a level playing
field and then make sure that in the case of the NFL you have
got the players and the owners who have a level playing field
on which to meet and work things out for the benefit of the
entire NFL. But when Congress steps in, it seems like
invariably we don't make things better, we create more
Look at our track record. And in fact--in view of the way
things have gone here lately, it seems like perhaps the
solution that some here in Congress might come up with to fix
the NFL would to be give people more choices, give them a
Federal-public option. We know Green Bay has a city option, but
give them a public option where we start having government
teams because I think if we truly had some government run
teams, that perhaps Tampa Bay, St. Louis, Tennessee would not
be undefeated. They would have some wins under their belt if we
had some government teams right now. So they would have
somebody they could beat up on. But that is my concern. And Mr.
Goodell. That is my concern. So often when we come in and weigh
in to an issue, sometimes we muck it up even worse.
Ms. Culverhouse. You know, I have more trust in you than
Mr. Gohmert. You haven't been in Congress obviously.
Ms. Culverhouse. Hope springs eternal in my world.
Mr. Gohmert. It springs eternal in mine and that is why I
am still here. But I still think the role of government is not
to be a player, but to be a referee and make sure that
everybody is playing fairly and that is the only time that we
should step in, but if we get too involved in the intricacies
of any industry--ask the car dealers. Good grief. So I have
just dealt with so many people that said if I had known what
you were going to do with our knee by the time it got to the
floor and got voted on, I would never have asked Congress to do
anything. So please keep that in mind when you ask for
anything, it may come out as something you never dreamed that
makes things worse. But I appreciate all of your patience. I
appreciate the pleasure that you have brought to so many. We do
want to make sure that people stay as healthy as possible in
such a tough game. Thank you very much.
Mr. Conyers. Thank you, Judge Gohmert. The Chair recognizes
Linda Sanchez of California----
Ms. Sanchez. I believe Mr. Weiner is ahead of me in line.
Mr. Conyers. Two interceptions, plenty of respect. What are
you talking about? I am very delighted to recognize the
starring player representing the Congress, Mr. Weiner from New
Mr. Weiner. Thank you, Mr. Chairman. I want to recognize
someone who lived up to his storied family name, Tom Rooney
from Florida, who played a remarkable job at tight end and,
from time to time, did that thankless of all jobs, offensive
line, who did a great job in the game as well. I want to thank
you, Mr. Chairman and Ms. Sanchez. I just want to establish for
the record, Commissioner, who is Dr. Irv Casson?
Mr. Goodell. I believe you mean Ira Casson?
Mr. Weiner. Do I mean Ira? Ira Casson.
Mr. Goodell. Yes. He is a doctor that serves on our MTBI
committee as co-chair.
Mr. Weiner. Isn't it a fact that the Committee asked for
his presence here today and he is an employee of yours, is that
fair to say? Do you sign some element of his paycheck?
Mr. Goodell. He is not an employee of the NFL.
Mr. Weiner. Does he represent you?
Mr. Goodell. He represents the MTBI committee as co-chair.
Mr. Weiner. We asked him to participate in this hearing. He
was unavailable and we asked for your help in having him appear
here. Can you just clarify the record, did you ask him to be
here and he said no?
Mr. Goodell. I did not get involved in that, no.
Mr. Weiner. If you could, while I am asking my question,
members of your staff can find that out. I also--I think the
record should show beyond any work of any Member of Congress,
even you, Mr. Chairman, you, Ms. Sanchez, Alan Schwarz of The
Times has been driving this issue with some of the reporting
and we probably wouldn't even be here today if it were not for
some of the stories that he has written both at the college
level and the pro level about this problem. In a recent expose
that he published, frankly went into the questions of
credibility about the study that the league is currently
And basically three points of contention emerge from his
reporting. And the first is the notion that any of the NFL
supported and funded research would lack a basic level of
independence. That some of the statements that have been made
on behalf of the NFL put a cloud over whatever research might
A second concern that was raised by experts not associated
with this debate but associated with just research is the
relative paucity of subjects that are being studied for the
purpose of trying to clear some of the dust around this issue
and get down to the brass tacks which is what every Member of
the Committee has testified what they would like to do.
And third has been the role of this Dr. Casson who has
taken some rather high profile positions, pooh-poohing some of
the research that has been done and basically driving a fairly
hard line that in fact the saying, going as far as to say, to
question and being a little dismissive of the notion that
multiple concussions actually do lead to problems later on in
life. Wouldn't it be, for the purpose of this conversation,
getting back onto a more even keel where is not seen. We had a
member of the NFL staff refer to the research that had come--
that reinforced dementia links as phantom. Bad use of language.
I think everyone would agree that shouldn't have been language
that was used.
But let me give you the context of that quote to give you a
sense of why I think this debate is not going in the right
direction. ``I say phantom says this''--says Joe Brown, NFL
spokesman, ``because we have not seen this analysis in our
office. If it was done, it was obviously written for the NFL
players union on self-promotional lobbying purposes in
anticipation of next week's congressional hearing.'' That is
this one. Putting aside that lines have been drawn here, for
the purpose of really allowing the public to have confidence in
the end product and given that this has been characterized as a
political issue between the players and the league and given
that there are experts who can give sound advice on this,
wouldn't it be perhaps most wise to put the breaks on the study
that is going on, the ADA plan that has raised so many
questions about its impartiality, whether it has enough
subject, whether or not the people supervising it have not
already formed opinions, and say let us try to error on the
side of absolute impartiality by saying, let us try to find
somebody separate and apart from this whole debate, but someone
who is good at this kind of stuff, that both sides of the
debate at this table and all sides of the debate in public can
take a look at that information and say we have absolute
confidence in because for those of us for whom this--this is a
worker safety issue for a lot of us.
I mean, putting aside whether or not we like your product,
and I do, this is a worker safety thing, no different than if
someone was coming off the assembly line at a production plant
and 20 years later they all had--they all had arthritis in
their right knee. We would look at it the exact same way, I
So if you can give me the answer to that question, about
why it might not just be better for your own purposes to say
let's take this out of the existing structure, where so many
questions have been raised about it, and do something truly
independent, stop this where it is, something truly
independent, something that the league, Congress, everyone
agrees is independent, and start from scratch to try to get
Mr. Goodell. Well, the answer to your question is that we
want you to have confidence in the studies. That is one of the
reasons, for the 15 years that we have been involved in this
issue, we have published every piece of data that we have ever
done. We have published it publicly, we have given it to
medical journals, and it is part of peer review.
So I think when you talk about Dr. Casson and others, we
don't control those doctors. They are medical professionals,
they are scientists, they do this for a living. They look at
these issues independently. They draw conclusions. We have
Mr. Weiner. Let me stop you. Are you confident of that
today as we sit here, that Dr. Casson is an independent viewer
of this, given some of the statements he has made? I mean, do
you believe that?
Mr. Goodell. Independent of what? Independent of my views?
Mr. Weiner. No, independent of a position here. It seems to
me that he arrives at this debate with certain notions. I mean
look, the NFL has said research has not shown any connection to
long-term problems in NFL players. I mean obviously that is--I
mean today I doubt you would say that multiple concussions
don't create long-term problems today knowing what you do now.
The question is the confidence in this report has been
I mean, you read Mr. Schwarz's reporting. He went around
and called academics and physicians, and they asked him a
couple of questions, and they said in these important areas
already today before a single bit of--I shouldn't say that--at
this early stage of the research there are already so many
questions, why continue going down this path? Why not try to
address the structural problems in the research, you know, that
we don't have the classic garbage in, garbage out. I mean not
to be too harsh and not to question anyone. Just the appearance
is clearly that this research is stacked and is lacking in
credibility. And it is also clear that the parties involved
have developed--I mean I think you would agree with this--have
developed a sense of loggerheads about this issue that I don't
think serve most of the public. I mean most members of the
public are not partisans for the players or for the union. We
basically want to try to get this policy right and try to make
sure that people are protected. So wouldn't it be better to
start, get a fresh start with a fresh report?
Mr. Goodell. Well, we want Congress, we want the medical
community, we want everyone involved to have confidence in the
work that is being done, and that is why we have medical
professionals involved. That is why we put it up for peer
review and why they choose that. If this Committee believes
there are ways in which we can improve that by making it more
independent in some fashion, I would be happy to work with the
Committee to do that. We want you to have confidence in the
work that we are doing.
We have led the way. Many people have taken our research
and used it, including, it was mentioned earlier this morning,
the Department of Defense. We have met with them and shared our
Mr. Weiner. Well, I appreciate your willingness to assess
this as we go along. And did you find out an answer to the
question whether a member of your staff made any effort to
secure Dr. Casson for this Committee?
Mr. Goodell. I am just reading this to you as I get it. Our
office was not asked to help get Dr. Casson to testify.
Mr. Weiner. Thank you.
Mr. Conyers. Thank you very much. I am pleased to recognize
Judge Ted Poe of Texas.
Mr. Poe. Thank you, Mr. Chairman. I want to thank all of
you all for being here all day and your testimony. As the
Chairman mentioned, I am from Texas. And when you talk about
football, we believe we are the best, you know. And I have two
favorite college teams, University of Texas and anybody that
plays Oklahoma. My brother-in-law played for the New York
Giants for 5 years. Everybody plays football, wants to, I
think. My son started at 9 years of age and went all the way
through college, played college ball, never missed a football
So football, as all of you all know, is something that we
do. And this report and your testimony about this report is I
think important for us to be aware of injuries that can occur.
But I am really not clear as to what Congress ought to be doing
involved in professional football. I mean if Congress gets
involved, it would seem to me it would be the end of football
as we know it. We would all be playing touch football out there
on these football fields, whether it is pros or college or high
school or peewee league.
People know when you play football there is a chance that
you are going to get hurt. Parents know that, players know
that, and all of you all know it better than anybody.
My question really is what do you want Congress to do about
the information that all of you all have testified about and
the report? What is it you want us to do?
Commissioner, I will start with you on this end if you
Mr. Goodell. Congressman, as I stated in my opening
remarks, we are not waiting to see where the medical research
goes. We are taking steps now to improve our game, prevent
injuries, make sure when injuries do occur that they are
treated properly, conservatively, and safely, and that we are
caring for our athletes. We have to do a better job of that. We
must continue to push this research.
I think the exposure and the issue that is raising this is
a public issue, a public health issue. And the debate that goes
on within the medical community is healthy because it does put
on a spotlight to something that can affect millions of people.
Alzheimer's itself is projected to be affecting over a hundred
million people in the very foreseeable future on a global
This is a significant issue. So we want to be part of the
solution. We want to be able to share our data, share our
information, and continue to make progress in this area that
will affect thousands of people that are not playing football,
that are playing other sports, or may not even be involved with
sports. So if our data can be helpful to that, we would like to
be part of that.
Mr. Poe. Well, I understand what you have said. And the
research has been passed on to not only other sports, but to
health professionals as well, the research that has been done.
But that doesn't really answer my question. What do you want
Congress to do? Do you want more research funds from Congress
to the private sector?
Mr. Goodell. No, with all due respect, I was asked to come
here. So I am not asking Congress to do anything.
Mr. Poe. Well, that might be a first. But let's just go on
down the row if we have got time. Mr. Smith, thank you.
Mr. Smith. Yes, sir. I think two things. One, I think
Congress should ensure or seek to ensure that there is the
disclosure of the aggregate medical data that is being
collected on NFL players. I think that is one. And number two,
to take up your point earlier, I think it is Congress's role to
make sure that the business playing field or the other playing
fields that businesses engage in is fair, is equal.
So when Congress assures itself that it has done everything
it can do in order to protect the safety of the people who play
this game on the professional level, on the college level, on
the youth level, I think that is Congress serving its role.
Mr. Poe. All right. Thank you. I am about out of time. I
will just let anybody else weigh in on the last minute that I
have. Anybody else want to weigh in on that?
Ms. Culverhouse. I would like you to help me keep my
grandson from being damaged.
Mr. Poe. And how would you expect Congress to do that?
Ms. Culverhouse. I think Congress is very creative. I
believe in Congress. I believe in the United States. Don't get
me started on that. But I believe you have power that others of
us don't, and that is why we elect you to this office.
As a constituent with six grandchildren, I am asking you to
please help the youth of our day now and the future football
players of tomorrow to stay safe. Call it an OSHA deal, call it
anything you want, but they go from being our youth in America
to our employees. And we have, I believe, as Americans an
obligation to make this a safer sport.
Mr. Poe. I appreciate that.
Last comment. Mr. Chairman, as I mentioned, you are not the
only person with grandchildren. I have got seven and a half and
four kids, and I think it is a parent's role to at the very
early age to take care of the safety of their children. I
certainly don't think the Federal Government has a role to
intervene in that. But Congress may have a role in making sure
that there may be some funds for research and development. But
getting involved in the everyday operation of an NFL football
team, Congress is not qualified to do that. Maybe we should
stick to what we know best.
With that, thank you, Mr. Chairman. I will yield back the
remaining portion of my time.
Mr. Weiner. What is that? What do we do best?
Mr. Poe. We discuss things, debate.
Mr. Conyers. The Chair is pleased now to recognize our
former Subcommittee Chair, Linda Sanchez of California.
Ms. Sanchez. Thank you, Mr. Chairman. I want to start by
making a comment first on some of the testimony before I move
on to the questions that I have. And I want to start with
something that Mr. Goodell said.
You were quick to mention some improvements that the league
has made in the last 2 years to try to minimize some of the red
tape and some of the hurdles for NFL retirees who are applying
for disability benefits, and I just wanted to point out to the
skeptics on this dais that the changes that the league made
were very much in keeping with some of the suggestions that
came out of the Subcommittee's hearing on this very issue in
June of 2007, which is about 2 years ago. So for those of you
that think that Congress is ineffective, I think the
congressional scrutiny might have had a little something to do
with some of those positive changes.
Now before I get to my questioning, I want to first show a
brief clip that is courtesy of HBO's Real Sports.
Ms. Sanchez. Okay. And Mr. Goodell, you are about to be
handed a copy of a pamphlet that I believe is currently
distributed to NFL players. And I would ask you to please read
the highlighted portion of the pamphlet. And if I may ask
unanimous consent to also enter it into the record, Mr.
Mr. Conyers. Certainly. Without objection it will be.
[The information referred to follows:]
Ms. Sanchez. Mr. Goodell?
Mr. Goodell. Yes, I read it.
Ms. Sanchez. Yes, please. Where it starts, ``If I have had
more than one concussion''----
Mr. Goodell. Yes.
Ms. Sanchez. Can you read that out loud, please?
Mr. Goodell. Oh, I am sorry. ``Current research with
Ms. Sanchez. Pardon me, can you back up and read the
question and then the answer that is in the pamphlet?
Mr. Goodell. ``If I have had more than one concussion, am I
at increased risks for another injury? Answer: Current research
with professional athletes has not shown that having more than
one or two concussions leads to permanent problems if each
injury is managed properly. It is important to understand that
there is no magic number for how many concussions is too
Ms. Sanchez. Okay. Thank you. Now, the question that I have
for you is, I am a little concerned, and I hear the concern
expressed by some of the witnesses on the panel today, that the
NFL sort of has this kind of blanket denial or minimizing of
the fact that there may be this, you know, link. And it sort of
reminds me of the tobacco companies pre-1990's when they kept
saying no, there is no link between smoking and damage to your
health or ill health effects. And they were forced to admit
that that was incorrect through a spate of litigation in the
1990's. And my question to you is wouldn't the league be better
off legally, and wouldn't high school and college football
players be better off, if instead of trying to minimize this
issue, the league took the opposite perspective and said, look,
even if there is a risk, however minuscule, that there may be
this link, so we really need to jump on top of it and make kids
and parents aware of this so that there isn't this sort of
sense that the NFL is really just slow walking the issue to
death by saying, well, we have been studying the issue for 15
years, we are going to maybe study it another 15 more years,
when there is already non-NFL paid for research that suggests
that there is this very high correlation with cognitive
impairment? Don't you think the league, you know, would be
better off legally, and that our youth might be a little bit
better off in terms of knowledge, if you guys just embraced
that there is research that suggests this and admitted to it?
Mr. Goodell. Well, Congresswoman, I do believe that we have
embraced the research, the medical study of this issue. As you
Ms. Sanchez. You are talking about one study, and that is
the NFL's study. You are not talking about the independent
studies that have been conducted by other researchers. Am I
correct in stating that?
Mr. Goodell. I am not sure of your question.
Ms. Sanchez. There are other studies, research in dementia
and CTE that show that there is a link. But again the league
seems to downplay that and say, well, you know, we are
conducting our own study and, you know, when we have that study
completed then we will know.
Mr. Goodell. No, I think what we are doing is because we
have to a large extent driven this issue by making sure that we
have medical professionals studying this issue. I am not a
Ms. Sanchez. I understand that. And I understand that Dr.
Ira Casson is, who unfortunately is not here to testify today,
because there are a number of really great questions I would
have loved to have asked him. And I would think that, as the
person who is spearheading the research and the one who is
individually examining the players who will participate in the
study, I think it would have been really important for him to
be here today. And I hope that in the future--maybe you didn't
get asked to have him here today--but I think in the future it
would be really appreciated by the Congress if you could ask
him to come so that we could put specific medical questions to
him. Because you know, without him here I am not going to get
medical answers out of you, and that is very clear to me.
But I just want to briefly go through one of the big issues
with respect to the research that is currently underway by the
NFL. There are other professionals who have looked at the
methodology. And some of the concerns have been already raised,
but I just want to kind of go through them again. One of the
criticisms of the study is that the statistical comparison is
going to be between professional football players and people
who played football in college. That is sort of like comparing
two-pack-a-day smokers with one-pack-a-day smokers to see what
the differences are, instead of two-pack-a-day smokers with the
general population to see whether there is an increased risk of
the activity that they are participating in to their health. So
that has been an issue that I think merits your going back and
talking to the doctors who are conducting this study about
trying to tweak in the study.
The second thing that really troubles me is that the
subjects are sort of self-selected. You sent out phone calls
and letters and asked for people to participate. Well, homeless
people don't typically have addresses where you can send
letters. And people with cognitive impairment, some of the
effects of which are slurred speech, trouble focusing, memory
loss, physical incapacity, they are going to be unlikely to
really respond to a phone call or to a letter or to physically,
many of the worst cases, be able to travel to New York to be
examined by Dr. Casson. So I think you guys need to go back and
rethink how you are selecting the participants in this so-
called unbiased study.
And third, and this is probably the most troubling, as was
exhibited by the clip, it appears that Dr. Casson, who is the
only one again who is going to be examining these former
players, has already made up a determination of what the
conclusion of the study is going to be.
So my question is why are you even going through, you know,
the charade of presenting the final analysis of going through
this study if the determination, in my opinion, has already
been made by Dr. Casson and, you know, is denied in the
pamphlet that they hand out to NFL players?
Mr. Goodell. Well, first let me say I do not, and I think
you stated that he is the only one examining these patients and
the findings. That is not correct.
Ms. Sanchez. He is not controlling the examinations or the
Mr. Goodell. I would not say he is controlling that at all,
Ms. Sanchez. He is participating in it, though.
Mr. Goodell. I do not know if he is participating in the
examinations. I can find that out.
Ms. Sanchez. And he has been a consultant to the NFL, is
Mr. Goodell. He has been on our MTBI committee for several
Ms. Sanchez. And some of the people who are participating
in this study have other conflicts of interest. You know, one
of the committee members on the concussion committee owns the
company that makes and markets, mainly through its use by most
of the NFL teams, the neuropsychological test that is used in
the study. Isn't that true?
Mr. Goodell. I don't know the answer to that question, but
I will find out for you.
Ms. Sanchez. Okay. I am just concerned because there are
several people that are part of this study that are NFL-
related, either being paid by the NFL as consultants or actual
employees of the payroll.
Mr. Goodell. Well, Congresswoman, I go back to something
that I stated early on in my opening remarks. We had a medical
conference in 2007. And you are correct to your point about the
last hearing we had here was very helpful. And I will submit
for the record about 20 changes that we made that are
significant to our player benefits. And I will submit that. And
so we do acknowledge that and we appreciate that. But I have
also been Commissioner for 3 years. So I want to make sure that
that is clear. You are also raising a very important point. I
don't control the doctors' output. The doctors that we have
involved with this, I do not judge whether they have a
particular view going in or going out. This is a collective
group that are tremendous professionals, that have studied this
and other issues on a scientific basis, and this is part of
medical debate. And I think it is clear today there is a
significant medical debate about the impact, what that impact
is, and at what point. As I say, we are trying to move past the
medical debate on one level, which is control, what we can
control and try to bring solutions.
Ms. Sanchez. My suggestion would be, and my time has
expired, but my suggestion would be that instead of having NFL-
connected consultants and doctors, that perhaps the true
findings of a truly unbiased study would be better conducted by
people who have not been on the payroll or not been retained by
the NFL in any capacity.
And with that, I will thank the Chairman for his patience
and yield back.
Mr. Conyers. Thank you very much. Tom Rooney, of recent
amateur football fame, is now recognized, the gentleman from
Mr. Rooney. Thank you, Mr. Chairman. And I want to thank
Representative Weiner for recognizing the people on the line of
scrimmage who are allowing you to be heroic in getting the
defensive game ball. I am going to recuse myself from asking
questions specifically of the panel, though I do want to thank
you all for being here and for your testimony today.
I, like the Commissioner, played college football at
Washington & Jefferson, and also on the other side of the
table, although I see that he is gone now, I was roommates with
Merrill Hoge for a year or so. I certainly empathize with both
sides of this debate, although like some of my colleagues, I am
not really sure what our role in Congress should be in getting
involved with the National Football League.
You know, football is a very violent game. And certainly as
one who played it and suffered concussions myself, I can say
that those that choose to play football, those that involve
themselves with the sport fully understand that.
I will take the liberty, briefly, to say and to question
the statement that was made earlier that pro football teams
don't care about their players beyond scoring touchdowns. I
hope that is not true. I hope that that isn't what was meant.
And in fact I know that is not true. Beyond this hearing, but
at least this hearing, I would say, Mr. Chairman, raises the
serious issues of safety and head injuries, and that is a good
thing. And I am confident that the NFL and the players union
will continue to work together to make sure that they are doing
everything that they can to improve the league and improve
player safety for years to come.
I yield back. Thank you, Mr. Chairman.
Mr. Conyers. Thank you very much, Mr. Rooney. And I thank
Commissioner Goodell, in response to a question from the
gentleman from New York, Mr. Weiner, you indicated that the
Committee never requested that Dr. Ira Casson testify. I
understand that you would like to clarify that response.
Mr. Goodell. I was handed a note to respond to the
Congressman. And I have just been handed another note which I
will read to you as I see it: ``Tell them you will check
further to get back to them in writing tomorrow. So I have not
Mr. Conyers. Okay. This record will be open for a while
afterwards, so you can submit any----
Mr. Goodell. I will check with our staff further.
Mr. Conyers. Well, I want to thank this panel. This has
been surprisingly well-attended. The views are various. But I
think there are some things that we can come to an agreement on
about the serious nature of these injuries and the fact that
there is still more that can be done about them. And for that
reason, I am in your debt.
I am sorry that we took so long to complete this first
panel. I thank you very much, and you are now excused, or
invited to stay and hear the second panel. Thank you very much.
Now, our final panel is Bernie Parrish; Dr. Joel
Morgenlander, neurology at Duke University; Dr. Julian Bailes,
Chairman, Department of Neurosurgery, West Virginia School of
Medicine; Dr. Joseph Maroon, Vice Chair, Department of
Neurosurgery, University of Pittsburgh; Dr. Ann McKee,
Associate Professor, Neurology and Pathology, Boston
University; Mr. Christopher Nowinski, Co-Director, Center for
the Study of Traumatic Encephalopathy; Dr. Eleanor Perfetto,
wife of Ralph Wenzel, former NFL player; Dick Benson, high
school football safety advocate. And we will be starting off
with--and Mr. Tiki Barber, retired NFL player.
Because of time constraints involving Dr. Perfetto, we are
going to invite her to testify first. She is the wife of the
former San Diego Chargers lineman Ralph Wenzel, and currently
serves as the Senior Director in the Pfizer Evidence-Based
Strategies Group. She is the caregiver for her husband, who has
early onset Alzheimer's, and has been awarded the Advocacy
Leadership Award by the New York City chapter of the
Alzheimer's Association. Welcome to our second panel. And I am
delighted, Dr. Perfetto, for you to begin our discussion.
TESTIMONY OF ELEANOR M. PERFETTO, Ph.D., M.S., WIFE OF RALPH
WENZEL, FORMER NFL PLAYER
Ms. Perfetto. Thank you, Mr. Chairman. Chairman Conyers and
Committee Members, thank you for inviting me to speak today. My
name is Dr. Eleanor Perfetto, and I am a pharmacist with a----
Mr. Conyers. Pardon me, pull the mike up closer.
Ms. Perfetto. I am a pharmacist with a Ph.D. Degree in
public health, concentrating in health policy and epidemiology,
and I am employed by Pfizer. I tell you that because I wear two
hats today, predominantly as a wife and caregiver, but also one
as a health researcher.
The topic of this hearing is very important to me, and it
has been for almost 15 years. I want to tell you about my
personal experience and provide suggestions about urgent
actions that need to be taken by the NFL to help disabled
retired players, current players, and children involved in
My husband, Ralph Wenzel, played as an offensive guard in
the NFL for 7 seasons, retiring in 1974. In 1995, over 20 years
after retiring from the NFL, my husband began having vague
disconnected symptoms, depression, uneasiness, anxiety, losing
things. Today we recognize those symptoms as resulting from
CTE. In the years following Ralph suffered obvious memory loss
and confusion. And in the fall of 1999, 10 years ago, at the
age of 56, Ralph was diagnosed with mild cognitive impairment,
which progressed to severe dementia. In the last 10 years,
Ralph has lost his ability to work, drive, play golf, read,
cook, and enjoy a glass of wine. He can no longer dress, bathe,
or feed himself. He lost his sense of humor, he lost his
personality, and he lost his dignity. He lost it all.
Almost 3 years ago, I had to place Ralph in an assisted
living facility for dementia patients, and he resides there
today. Frankly, my husband no longer has a life, and he
certainly does not have a life that he would want for himself.
And he does not have a life that he and I would want for anyone
In almost 15 years since our ordeal began, we have been
through many ups and downs. You have a spouse who becomes
aloof, disconnected, irresponsible, who may be hostile and you
don't know why. The diagnosis is frightening, but it is also a
relief. You finally understand why these things are happening.
It is not you, it is not him, it is an illness.
I cared for Ralph at home for over 7 years and I learned:
Living wills, power of attorney, guardianship, Social Security,
home care, adult medical daycare, psychiatric admissions, long-
term care, et cetera, et cetera. These experiences are similar
to those of anyone caring for someone with dementia, but there
are some nuances when caring for an NFL player.
I also learned that our current infrastructure is based on
providing services for your grandmother, not for a very large
man. The staff at these facilities are afraid. They are
intimidated. I had to buy a full-size bed for my husband
because these facilities provide a twin bed that was much too
small for him. My husband was lucky in one way. He has a wife
who is educated, who works in health care. She is the one who
filled out all the forms. She has a good job with a company
that offers excellent health care benefits, and she also
happens to be one very pushy broad. So Ralph has fared well
because he has had a very strong advocate.
But there are many out there in the situation that Ralph
and I have been in over the last 15 years, and they need help.
I speak with family members regularly, and I help them find
doctors and other services. Often I simply just talk to
distraught women and help them get through it. They turn to me
because they have no place to go and they are finding their way
the way I did years ago.
So what are my asks today? What do I want to see come out
of this? I have four. The first is that the NFL must stop its
denial of the relationship between brain trauma and brain
disease and become a proactive leader that it should be. The
evidence is there. The denial is disrespectful of the players
and the families that are suffering, and it endangers current
players and children.
Second, the NFL must do more to protect current players and
children so they are not faced with this travesty later in
life. The NFL is in a prime position to educate on and advocate
for prevention, and it is a moral imperative.
My third ask is that the NFL go beyond the 88 Plan, which
assists players diagnosed with dementia. Players and families
suffer for many years before the diagnosis comes. The NFL must
educate and find players with early signs and symptoms to
provide support so their families can better manage the ordeal
before them. This is not an academic exercise. This is
something that the NFL should be doing for all of the players,
not a handful or a group of players that participate in a
study. For former players like Mike Webster, the diagnosis came
Lastly, I mentioned earlier that I wear a second hat as a
researcher. My fourth ask is that you examine carefully the
studies put before you. Some will tell you these studies should
be disregarded or that they have been misreported or that they
have been exaggerated. I encourage you to talk with third-party
experts about the quality of these studies. There are different
kinds of bias. There is the bias of an opinion. Of course I
have a bias with my husband being where he is today. I have a
bias about the studies. The NFL has its bias about the studies.
But there is also other kinds of methodological bias, and I
encourage you to listen to experts about those kinds of things
and to listen to the experts about the issues of statistical
And I provided more details about this and examples in my
written testimony. I know that you are not doctors and I know
that you are not scientists, but I know and I have the
confidence that you are able to understand clear information
that is provided to you in these studies, especially with the
assistance of third-party methodologists who can make all of
this very clear, and I thank you for letting me be here today.
[The prepared statement of Ms. Perfetto follows:]
Prepared Statement of Eleanor M. Perfetto
Mr. Conyers. We are grateful to you for your presentation
and some relation of your experience, your very personal
experience. The four asks we are going to take into careful
consideration. And so I am going to excuse you now, because I
know of your previous commitment. But thank you very much for
joining us this afternoon.
We now turn to the former running back for the New York
Giants, Tiki Barber, who set virtually every career offensive
record for the Giants. And being voted three times NFL Pro
Bowl, all time records with the Giants for a number of things.
And we are lucky to get this perspective, because here is a
person that retired at a relatively young age, and he is now a
correspondent for the Today Show.
Welcome, Mr. Barber.
TESTIMONY OF TIKI BARBER, RETIRED NFL PLAYER
Mr. Barber. Thank you, Chairman. I appreciate you being
here. I appreciate being here. Mr. Goodell, it is good to see
you as well.
It is a privilege and an honor, and also a little bit of
source of entertainment to hear some of the tangential
conversations surrounding our discussion on brain injury. I
have one ask of this Committee, and I will be brief. And I will
get to it shortly.
I played football for 10 years. I had exactly two
concussions, both of which I came back from in the same game. I
was not affected. As you mentioned, I retired really for a
quality of life decision, so that I didn't lose my knees, I
didn't lose my cognitive abilities, and I could live a
My other hat that I wear, as you mentioned, is with the
``Today Show'' and ``NBC News.'' And a story that I have been
working on recently involves new helmet technology and the
troubles that high school kids have with concussions. In the
course of our research and our studies, we met with Vin
Ferrara, who is here. He is the creator of a new helmet called
a Xenith. But what he told me most that troubled me about high
school athletics is that less than half of high school teams
have access to an athletic trainer. Now, you can all understand
why that can be dangerous.
In the National Football League, as much as you hear the
anecdotal evidence, you hear the bile that comes from people
who think that the NFL is not addressing this issue. At the end
of the day, it is a player's choice. When we get injured, when
we break our arms, when we break our fingers, when we pull our
hamstrings, when we get concussions, ultimately the doctors
give us advice, but it is our choice to go back into the
football game. At a high school level, it is not so much so
because they do not have the advice.
My ask of you is that you find a way to mandate that every
high school athletic program has access to medical doctors who
can diagnose, understand, and treat concussions so that kids
who are trying to emulate and be like me and be like the
current players in the National Football League know the
dangers of playing the sport that we all love.
I thank you for your time.
Mr. Conyers. That is a very important aspect that sort of
blends into our next witness, Dick Benson, who as a result of
the tragedy in his family has a Texas law named after his son.
And it goes to the same point that has been raised, the
hundreds of teenagers who have been seriously injured, some
killed, because of their lack of information about concussions.
Welcome, Mr. Benson, to our hearing. And you may proceed.
TESTIMONY OF DICK BENSON, HIGH SCHOOL FOOTBALL SAFETY ADVOCATE
Mr. Benson. Thank you, Mr. Chairman, and Members of the
Committee for the honor to testify in front of you. I have a
short story to tell about the untimely death of my 17-year-old
son, excuse me, who died of a head injury he received in a
football game. And this football team had trainers and had
doctors and is an elite private school. It had generally the
access to the best of everything, but it wasn't effectively
employed. We had a team doctor, for example, but as is common
in Texas and maybe in the rest of the country, the team doctor
was an orthopedic surgeon. And for all I know, he may have been
the best orthopedic surgeon in Austin. But he admitted later
under oath that he didn't know how to diagnose a concussion,
and yet he was a team doctor of our team.
These kids die of head, neck, heart, heat, and asthma-
related injuries. That is what kills them. They don't die of
orthopedic injuries. Now, if orthopedic doctors want to be team
doctors, if it is a franchise that is commercially or morally
valuable to them, I think that is great. I simply ask that they
get the training in emergency sports medicine that will enable
them to be qualified to handle these kind of injuries.
Additionally, our law, called Will's Bill, after my son,
requires that the coaches, the trainers, the sponsors of any
competitive activity in public schools in Texas get that
training. That includes band directors. And the reason we have
band directors is you know we have 105 and 100-degree days in
Texas in August when the band is working out, and we have had
heat-related injuries on the part of band members. So those
band directors need to have the same kind of training for heat-
I think most importantly, what we have asked for, and
frankly I am sorry to say that the most uncertain I am about
the legal compliance, is the training for the kids. You know,
we have a concept in our society called informed consent. And I
don't think anybody can make the argument that a 16 or 17-year-
old kid, no matter how intelligent or no matter how emotionally
mature, can give informed consent unless he has gotten the
information. And we require that in Will's Bill. And I am not
completely sure it is being delivered.
The gentleman on my left, Mr. Nowinski, has written an
outstanding book about the issues of concussion and head injury
called Head Games. I refer it to all of you. And I challenge
you to read it and not come back with a moral sense of the
necessity for action.
Now, there has been some earlier objection that maybe the
Congress shouldn't be making these rules, maybe the NFL and the
players union shouldn't be making those rules--or should make
them for themselves. Who speaks for the 2 million young people
who benefit or suffer from those rules? Nobody in that setup. I
think you should make some rules because you can. And if you
don't want to, I would like to see your list of who you think
is going to step in.
Getting Will's Bill passed in Texas was very difficult. It
took 4 years. It took two professional lobbyists. It took lots
of money. It took lots of phone calls. It received virtually no
public opposition and received massive private opposition from
that huge slice of Texas culture that is concerned with
football. I don't know if you know or not, but in small town
Texas, and I would include some pretty affluent suburbs of big
towns in this particular definition, the most important man is
the football coach. And if you are running for public office in
Texas on a statewide basis, you make it your business to try to
get every football coach you can to be an endorser of your
campaign because they have so much to say about the future of
So football is part of Texas culture. And I must say, based
on my observation beyond that, it is a cult as well. And like
most Americans, you know, we all love not to be told what to
do. Simultaneously, we love to tell other people what to do.
And I am sure that describes me as well as it does the football
But finally, we made some progress frankly because we made
a breakthrough with a male coach who was the head of the girls'
coaches association in Texas. And he came in and he persuaded
the boys' football coaches, and they persuaded our public
entity, the University Interscholastic League that is
responsible for all of this, and we finally achieved it, and we
had broad bipartisan support, and it was signed by the
Republican Governor of Texas, Governor Rick Perry, in 2007.
So my one request is don't let it happen again, please.
[The prepared statement of Mr. Benson follows:]
Prepared Statement of Dick Benson
Mr. Conyers. Thank you very, very much, Mr. Benson.
Chris Nowinski is the former World Wrestling Entertainment
professional wrestler who turned his background as a Harvard
football star into one of the most entertaining and probably
hated characters on television. He debuted on the World
Wrestling Entertainment flagship program in 2002, when he was
named newcomer of the year, and was the youngest male hard core
champion in history before his career was ended by a 2003
concussion. And he began a quest to better understand his
condition. And his relentless effort has resulted in a lot of
educational work. And he specializes in commercial strategy and
licensing. And if I am not mistaken, he has also published a
book on the subject.
We are very pleased to have you here, Mr. Nowinski.
TESTIMONY OF CHRISTOPHER NOWINSKI, CO-DIRECTOR, CENTER FOR THE
STUDY OF TRAUMATIC ENCEPHALOPATHY, BOSTON UNIVERSITY SCHOOL OF
Mr. Nowinski. Thank you. Mr. Chairman, Ranking Member
Smith, and Members of the Committee, thank you for the
invitation to testify today on an issue that has become my
My name is Chris Nowinski, and I am a Co-Director of the
Center for the Study of Traumatic Encephalopathy at Boston
University School of Medicine, and also Co-Founder, President
and CEO of the nonprofit Sports Legacy Institute, which is
dedicated to solving the sports concussion crisis, as well as a
member of the board of directors of the Brain Injury
Association of America. But when it comes to my personal
identity, I will always see myself as a former Harvard football
player. And I hope to provide a unique perspective as a former
player, current brain trauma researcher, and post-concussion
When I learned I was following Merrill Hoge, whose story he
shared with me for my book Head Games, I realized that you
don't need to hear my personal story. You only need to know
that I also lost my career as a professional wrestler with
World Wrestling Entertainment and then lost the next 5 years of
my life to post-concussion syndrome all because I ignorantly
tried to push through concussions.
After the damage was done, I was lucky enough to find Dr.
Robert Cantu. He taught me for the first time that repetitive
brain trauma can lead to cumulative damage. Second, he told me
that had I rested any of the concussions I had received, I
would have limited that damage. But it seemed very strange to
me that I was a 24-year-old with a Harvard degree and over 11
years of brain trauma under my belt, and I had no idea the risk
I was taking or how to protect myself. When I began asking
around with the men I played with, I learned that no one had
told them either. And that is when, 6 years ago, I decided to
dedicate my life to this issue. But while 6 years ago I had a
notion that something was wrong with football and other contact
sports, now when led to the diagnosis of CTE by Dr. McKee and
others, and the diseased and battered brains of ex-football
players, combined with the lack of awareness of the
consequences of brain trauma, I am certain that radical
measures are needed for football to continue safely.
CTE is an ugly disease that slowly kills brain cells and
connections. I don't know if I have CTE inside my head right
now because today we cannot diagnose it while someone is alive.
But it doesn't matter if I know, because we cannot treat it and
we cannot cure it. Today we can only prevent it.
But to do this, we have to dig deep and find the will.
Because this Friday night in towns across America you can be
sure we are creating it. This Friday night over a million kids
will take to the football field, one in eight boys in America.
One in eight boys plays football at the high school level. And
thousands will suffer concussions.
One, a fictional boy we will call Mike, will take a hit to
the head number 1,000 this season. But this one will make him
feel stunned and confused. And he will see double and forget
where he is for a few moments. He will begin walking toward the
wrong sideline, a clear indication he is concussed. And his
coach, who is a good guy, but was never trained on the dangers
of concussions, will see it and think, oh, he just got a little
dinged. The referee will notice, but he won't know if it is his
place to say something. Sometimes an athletic trainer might
notice, but Mike's high school is one of the 58 percent without
one. So Mike won't know to say something because Mike's brain
isn't functioning correctly. So a teammate will grab Mike by
the jersey and pull him back into the huddle. Mike's parents
will notice from the stands, but they don't understand. All 10
other guys in the huddle will see that Mike's concussed, but
that happens all the time. So instead of calling time out, they
just keep telling him the play over and over when he forgets
while walking to the line of scrimmage. The teammates don't
know that by playing, Mike is exposing himself to further brain
damage or sudden death from second impact syndrome. After a few
more plays, Mike appears better, although he has a raging
headache he doesn't tell anyone about. The concussion is never
What happens to Mike? I don't know. He might be fine or he
might be laying the groundwork for CTE, or next week he might
get another concussion, and if that doesn't kill him, the post-
concussion syndrome might be so bad that he can't focus in
class, his grades slip, and he becomes unmotivated, and his
promising life becomes permanently derailed. While the
discussion of the concussion crisis has primarily been focused
on the professional game, the focus needs to be on youth
As we now think of how to solve this crisis, remember that
95 percent of the players are under the age of 18 and under the
age of consent, as Mr. Benson said. So the idea that we know
what we are getting into is erroneous. The fact is we aren't
even giving these kids a chance to protect themselves. In fact,
for most kids, the only source of this information would be the
great work that is coming out of the New York Times, because
there is no formal education for kids.
So when I think of the immense scope of the problem, I am
reminded that football has not always been played as it is
today. In 1905, the game was so dangerous that President
Theodore Roosevelt summoned leaders to Washington for a summit
on how to make the game safer. He threatened to take action in
the absence of significant reform, and he got it.
Today it is important to realize that football has evolved
into something it was never intended to be. I believe the CTE
research has shown us that it is time for a new change, and
maybe even a new committee like Roosevelt's. Except this time I
think it is a committee to save football, because we cannot in
good conscience allow this scenario to continue.
If we agree that the game is broken and needs to be fixed,
we can develop a solution, and that solution may be easier than
we think. Today the members of the Sports Legacy Institute,
including doctors and ex-NFL players, posted a 10-point plan on
how to save football at our Web site at sportslegacy.org, which
I would like to enter into the record.
Mr. Conyers. Without objection, it will be.
[The information referred to follows:]
Mr. Nowinski. Thank you.
The document highlights 10 different proposals to create a
safer game. And everything is on the table, from rule changes
to mandatory education. The first proposal, to reevaluate how
we practice, could cut the number of blows to the head in half.
Imagine if we only allowed hitting 1 day a week. The plan as a
whole could easily eliminate 75 percent of brain trauma and
concussions without fundamentally changing football. It is
simply a question of leadership.
So much of this crisis has mirrored big tobacco and the
link between smoking and lung cancer. And I ask you if you were
able to create all the smoking laws and awareness we have today
back in the 1950's when the first conclusive pathological
research was done linking smoking to lung cancer, would you
save those millions of people who smoked without understanding
As you listen to Dr. McKee next describe these diseased and
battered brains of former football players, think of it as if
you are hearing the first cases of pathologically described
lung cancer from smoking. But in this case remember that the
choice these men made to play football was made when they were
just children. And then think about what you are willing to do
to ensure this doesn't happen to future generations. Although
there has been progress, the NFL has not been eager to take
this on. So maybe it is time for another committee, a committee
to save football. Let's not let this opportunity pass us by.
[The prepared statement of Mr. Nowinski follows:]
Prepared Statement of Christopher Nowinski
Mr. Conyers. Thanks, Mr. Nowinski.
Mr. Benson. I am sorry, Mr. Chairman, but I forgot, I have
a paper written by Vin Ferrara, who invented the Xenith
football helmet technology. He is the CEO. It is a very well
considered, carefully thought out paper, much like the one that
Mr. Nowinski is talking about. And with your permission, I
would like to introduce it into evidence.
Mr. Conyers. We would be happy to accept that paper, and
Mr. Benson. Thank you, sir.
[The information referred to follows:]
Mr. Conyers. Dr. Ann McKee has a lot of experience, medical
experience. She was Assistant Professor of Nuclear Pathology at
Harvard Medical School, and then became Associate Professor of
Neurology at Boston University School of Medicine, has served
as the Director of the Neuropathology Corps of Boston
University. She has conducted groundbreaking research on CTE.
She is the chief neuropathologist at Framingham Heart Study.
She also has the same title for the Boston-based Veterans
Administration Medical Centers and for the Sports Legacy
Institute. And we are so pleased that you could join us this
TESTIMONY OF ANN C. McKEE, M.D., ASSOCIATE PROFESSOR, NEUROLOGY
AND PATHOLOGY, BOSTON UNIVERSITY SCHOOL OF MEDICINE
Dr. McKee. Well, thank you, Mr. Chairman and Members of the
Committee. It is a pleasure to be here. And I am glad to speak
on an issue that I think is extremely important.
My name is Dr. Ann McKee, and I am an Associate Professor
of Neurology and Pathology at Boston University Medical School.
I received my medical degree in 1979, and I am board certified
in both neurology and neuropathology.
I come at this issue with a slightly different perspective.
I examine the brains of individuals after death. And for the
past 23 years, I have examined the brains of thousands of
people, brains from people from all walks of life, and from
individuals who lived to be well over the age of 100.
Through Chris Nowinski's efforts in early 2008, I had my
first opportunity to examine the brain of a retired
professional football player. It was the brain of John
Grimsley, a former linebacker for the Houston Oilers, who had
died of an accidental gunshot wound while cleaning his gun at
the age of 45. According to his wife, he was concussed three
times during his college career and eight times during his NFL
John began showing changes in his behavior and cognitive
decline at the age of 40. He developed difficulties in short-
term memory, attention, concentration, organization, planning,
problem solving, judgment, and ability to juggle more than one
task at a time. He would ask the same questions repeatedly over
the course of the day, and would ask to rent a movie that he
had already seen. He had trouble assembling his tax records,
shopping alone, and understanding television. He developed a
shorter and shorter fuse, and would become angry and verbally
aggressive over seemingly trivial issues.
When I looked at his brain on postmortem examination, I
found a massive buildup of tau protein as neurofibrillary
tangles. The neurofibrillary tangles were distributed in a
unique pattern, a pattern not found in any other
neurodegenerative condition except chronic traumatic
encephalopathy, or CTE. In CTE, tau protein builds up in the
individual nerve cells, preventing them from making normal
connections with other nerve cells, and eventually killing the
cells. In this man's brain there were massive numbers of NFTs,
so many that you could see the abnormalities on the glass
slides without the use of a microscope, as you can see in the
middle panels of the figure that is being presented. There is
tremendous accumulation of tau protein that appears as a brown
pigment. All the brown pigment you see is abnormal. And please
compare what you see in the middle panel, John Grimsley's
brain, to the brain of a normal man on the left, where you see
absolutely no brown pigment.
All these slides are prepared and stained in the identical
way and there is no brown pigment visible in the normal
individual, whereas the brain of this 45-year-old husband and
father at the prime of his life showed profound changes of CTE.
In John's brain, there were striking changes in regions of the
brain that controlled personality and behavior, such as the
frontal lobes. There were extreme changes in areas controlling
rage behavior and impulsivity, such as the amygdala. And there
were severe changes in areas that are also responsible for
memory, such as the hippocampus.
I remind that you in a normal 45-year-old, absolutely none
of these changes would be found. In fact, you wouldn't find
these changes in a normal 65-year-old, 85-year-old, or 110-
The next five brains that I examined from former NFL
football players all showed the same distinctive changes of
chronic traumatic encephalopathy, including the brain of Thomas
McHale, a former Tampa Bay Buccaneer.
The seventh brain of a former NFL player I analyzed was
that of Louis Creekmur, a former offensive lineman for the
Detroit Lions and an eight-time Pro Bowler. Louis Creekmur
played 10 seasons for the Lions and was famous for suffering at
least 13 broken noses and 16 concussions. Beginning at the age
of 58, he began to show increasing cognitive and behavioral
difficulties that included memory loss, problems with attention
and organization, and outbursts of anger and aggression.
Mr. Creekmur was a member of the NFL's Plan 88. He died
from complications of dementia at the age of 82. The brain of
Mr. Creekmur showed extensive damage. There were widespread
NFTs throughout his brain in the unique pattern that is found
in CTE. There was no evidence of Alzheimer's disease or any
other neurodegenerative disorder. The findings indicated that
if Mr. Creekmur had not sustained repetitive head trauma during
the play of football, he would be alive and well today enjoying
his family and grandchildren.
I also have examined the brain of a high school player who
suffered several concussions and died at the age of 18. Now,
the brain from an 18-year-old man should be perfect. There
should be no abnormalities anywhere. But in the brain of this
young man at the age of 18, there were already spots of extreme
damage and you could see the areas of damage, looking at the
slides again, just with your naked eye as you see in the top
panel in the red boxes. Those are areas of extreme damage found
in an 18-year-old high school football player.
These are changes--the earliest changes of CTE, had he
lived longer he certainly would have developed the same full
blown CTE we have found in college and professional football
I have now examined the brains of seven former NFL players
and four college players, and I have found the profound changes
of CTE in all of them. I have also found the earliest changes
of CTE in a high school football player.
I realize this is only a handful of cases. So what can you
say about that? What can you say about only 11 cases? Well,
what I can say is for the past 23 years I have looked at
literally thousands of brains, from individuals of all walks of
life, of all ages, and I have only seen this unique pattern of
change with this severity in individuals with a history of
repetitive head trauma, and that has included football as well
None of my colleagues has ever seen a case of CTE without a
history of head trauma, and there has been no documented case
of CTE in the medical literature that did not occur without
head trauma. The changes that we have seen today are
dramatically not normal. There is no way that these pathologic
changes represent a variation in normal that we would find
under a bell-shaped curve. We have found these changes in every
professional football player's brain that has come into the
CSTE laboratory, and I have never seen this elsewhere in 20-
plus years of examining brains. I have had colleagues of mine
from other institutions, including leading pathologists from
Harvard and Mount Sinai, independently examine these brains and
they have come up with the same diagnosis, which is CTE.
I know that the argument is often made that there are
hundreds of thousands of former football players, including
professional players, that have no signs of cognitive decline
or memory loss or personality change. But what I don't
understand is why we are expecting that exposure to repetitive
head trauma will cause disease in 100 percent of the
individuals that suffer this trauma. Do we expect 100 percent
of cigarette smokers to develop lung cancer? Do we expect 100
percent of children who play with matches or even with
chainsaws to get hurt. No. Even if the percentage of affected
individuals is 20 percent, or 10 percent or 5 percent, there
are still thousands of kids and adults out there right now
playing football at all levels who will eventually come down
with this devastating and debilitating disorder. And as a
doctor and as a mother, I think this calls for immediate
action. We need to take radical steps to change the way
football is played and we need to change this today.
[The prepared statement of Dr. McKee follows:]
Prepared Statement of Ann C. McKee
Mr. Conyers. Thank you so much for your testimony.
Dr. McKee. Thank you. And I just want to introduce also a
paper that we have written for your consideration.
Mr. Conyers. We will accept it into the record.
[The information referred to follows:]
Mr. Conyers. Dr. Joseph Maroon, board certified Clinical
Professor of Neurological Surgery, the University of Pittsburgh
Medical Center, Vice Chairman of the Department and the Heindl
Scholar in neuroscience. He has clinical and research
interests. He has worked with neuropsychologist Mark Lovell,
and with him they have developed the first computerized system
to determine concussion severity and the timing for return to
contact sports. It is now the standard of care for concussion
management in the football league, the hockey league, Major
League Baseball, NASCAR and is used in over 2,500 colleges and
high schools in the United States.
He has been team neurosurgeon to the Pittsburgh Steelers
for 20 years and honored by neurosurgical societies around the
world, and has been honored in more than one Hall of Fame in
We are delighted and honored you would be with us today,
Dr. Maroon. You are invited to proceed.
TESTIMONY OF JOSEPH MAROON, M.D., VICE CHAIR, DEPARTMENT OF
NEUROSURGERY, UNIVERSITY OF PITTSBURGH
Dr. Maroon. Thank you very much, sir. I am here first as a
neurosurgeon from the University of Pittsburgh Medical Center,
with a career-long interest in preventing head and neck
injuries in sports, and in particular football. I am also here
as a former collegiate football player myself. I went to
Indiana University on a football scholarship, which was good
and bad. I went there and had a concussion like Mr. Nowinski, a
very significant concussion that erased about 2 to 3 weeks from
my mind but it also forced me to quit football and apply to
medical school. So I probably wouldn't be here if it weren't
for that concussion.
Thirdly, I am here as a team neurosurgeon for the
Pittsburgh Steelers, and I have been very, very honored and
pleased to work with three Super Bowl coaches, Coach Charles
Noll, Coach Bill Cowher and Coach Mike Tomlin, and I must say
at no time in my 25 years of professional career with that
sports organization have I ever felt any pressure, any coercion
or any suggestion that I should modify my diagnostic or
decision making for any particular individual.
I must challenge Dr. Culverhouse in that regard in
suggesting or intimating that most college or most professional
team doctors are in the pocket of the team owners or compromise
their own scientific and their own medical integrity for the
team. I don't think that is the case now. In days gone by, it
may have--there may have been some of that. But at the present
time, I would strongly dispute that.
In addition, I was challenged once by Coach Chuck Noll in
1990 when I told him that his starting quarterback could not go
back to play against the Dallas Cowboys the next week because
he had a concussion. And he asked me why can't he? I said well,
the guidelines say such and such. He said who wrote the
guidelines. And then basically he said look, Maroon, if you
want me to keep an athlete out of football, I want objective
data that you can show me indicating that there is something
wrong with his cognitive ability.
It was at that point that I called Mark Lovell, a
neuropsychologist. And we went into the medical literature and
we designed a test subsequently called impact which measures
concentration, the ability to focus and memory and also
reaction time to 1/100ths of a second. Dan Rooney and Coach
Noll then allowed us to do the whole Pittsburgh football team,
and subsequently there have been over 75 papers written
validating the test and confirming that it is a neurocognitive
test that is baselined--the athletes are baselined before the
season and, if there is a concussion, retested to assess
cognitive functions, which is an extremely important aspect
that all of the panelists have spoken to at this point.
And fourthly, I am here on behalf or as part of the MTBI
committee of the NFL. So I am here to tell you four things.
Number one, concussions are serious problems. I know personally
and they have the potential for long-term neurological damage.
At the University of Pittsburgh, we see 150 athletes a week. I
am going to say that again. 150 athletes a week with post-
concussion syndrome. This is a very serious entity and one that
we must work to prevent.
I am here also to tell you that prevention is essential.
Hippocrates, the Father of Medicine, said that the first
responsibility of a physician is to prevent illness. If that be
impossible, to cure it. Unfortunately, we don't have any cures,
as Mr. Nowinski said and Ann McKee, for this entity of post-
Third, I am here to tell you that from my experience, the
NFL is a model in concussion management. The things they are
doing, and I will go into that in just a second, are exactly
what should be passed on to youth football. Merril Hoge this
morning, who I will say I personally, after evaluating Merril
after his concussions, advised him to quit football based on
his neurocognitive tests and his examination. I suggested,
Merril, this is not good for your brain. And fortunately he
listened. But as he said, there are 3 million youth athletes.
There is 1.1 million high school athletes. There is 50,000
college athletes. All of these need to have the same
protective, preventive measures in place that are used for our
And I would go farther than that and say that what
Congressman Pascrell said this morning about our troops in
Afghanistan and Iraq, they should have the same benefits as our
NFL quarterbacks in terms of when they should return to combat.
Finally, what is the NFL doing? You have heard of the NFL
committee that was formed 15 years ago. So they have not had
their head in the sand. There has not been denial about the
effects of concussion. They have published many papers and done
research. They have also educated the players, the coaches, and
the trainers on the significance of concussion, the long-term
effects of concussion, and the dangers of concussion. That is
Number two, they have instituted mandatory neurocognitive
testing. They have instituted strict return to play guidelines.
They have penalties and fines for hits to the head and there is
a whistleblower program. If any player feels that he is being
coerced to going back prematurely following a concussion, he
can call a hotline and immediately have assistance in this.
And fourth, there is continued research going on. I was so
pleased today when the Commissioner stated that he is now--that
the NFL is going to make a joint effort to participate in the
CTE programs that are looking at this in terms of the research
So I think in summary, I commend you, Mr. Chairman, and
your Committee for bringing everyone together today in this
meeting and also putting the national spotlight on this problem
so that it can have a positive effect on the millions of kids
who aren't playing professional football.
[The prepared statement of Mr. Maroon follows:]
Prepared Statement of Joseph Maroon
Mr. Conyers. We are indebted to you. And we look forward to
our discussion as soon as we finish up with Dr. Julian Bailes,
Chairman of the University of West Virginia Medical School's
Department of Neurosurgery. During his career, he was a
finalist in the National Association of Emergency Medical
Physicians' Cerebral Resuscitation Program Competition and has
been awarded the West Virginia School of Medicine Dean's
Excellence Award for his work there. He has received research
grants that nearly reach $27 million in amount and has
investigated head injuries in numerous football players, has
publications, several that are mentioned here that will be put
in the record.
Thank you, Dr. Bailes, for joining us. We appreciate your
TESTIMONY OF JULIAN BAILES, M.D., CHAIRMAN, DEPARTMENT OF
NEUROSURGERY, WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE
Dr. Bailes. Good afternoon, Chairman Conyers and Ranking
Member Smith and Members of the Committee, And I appreciate
being able to meet with you.
My background is as a former player for 10 years, a
sideline physician at the NFL or NCAA Division I level for the
last 20 years, a neurosurgeon who runs the neurological service
of a busy Level I trauma center, and as a laboratory researcher
using models of concussion. I am also the father of five
children, and I will say up front that I think football is the
greatest sport in America and it is the one that I love the
I have worked extensively at the Brain Injury Research
Institute with Dr. Bennet Omalu, the neuropathologist who first
discovered CTE in the former Hall of Famer, Mike Webster, in
My current position, as you said, is Professor and Chairman
at West Virginia University Department of Neurosurgery. In
2000, Frank Woschitz, who was the Executive Director of the
NFLPA retired players, asked me to set up a center to study the
health of retired players, which we did. We put it at the
University of North Carolina Chapel Hill. I remain the Medical
Director, Kevin Guskiewicz is the Center Director. And we
looked at all sorts of health issues of retired players. We
found expected incidence of heart problems and aches and pains
and spinal problems and arthritis. But what surprised us way
back then was out of this big funnel of data came the issue
that these guys were cognitively impaired, the mental problems
they were having. And that was way more than we expected or
that you would expect for the population age-matched controls.
The only risk factor we found for them having CTE--we analyzed
all of their past medical history--was three or more
concussions and if they had had three or more concussions
during their career, they had a five times increased chance of
having been diagnosed with cognitive impairment. Cognitive
impairment is not good, because within a decade the vast
majority of those people go on to being diagnosed as having
We published that 4 years ago. So that has been out there.
Two years ago we published a second study that said once again
if you have three or more concussions you had a triple
incidence of having depression diagnosed when you were retired.
So both of these, cognitive impairment and depression,
obviously are not good.
We continue our work there. We in fact have a study
currently of retired players with great detail, the MRI scans,
the neuropsychological testing and others, and we expect that
study to be completed next spring.
We were in 2000 and we remain today the only entity, the
only center that was ever envisioned to study the health of
players once they retire. With special standing methods used
for detecting Alzheimer's disease, Dr. Omalu and I have gone on
to examine the brains of 17 modern contact sport athletes.
As you can see from the slide, a normal brain on the left
and on the right, a slide of the first case of CTE, the great
Steeler center, Mike Webster, who played 17 years, you can see
the brown spots, similar to what was shown before with--
representing dead neurons, this tau protein, it is in a way
sort of like sludge which clogs up the brain cell, the neuron.
It can't clear it. It is portions of this dead protein in the
brain cells and their connections. In every case, where similar
behavioral or psychological problems, such as personality
changes, memory loss, business and personal failures,
depression and suicide, we found extensive areas of tauopathy,
which is the abnormal collection of tau protein.
Many continue to say we are going to keep studying this, we
are going to keep after it. However, it is my scientific and
medical opinion that we now have enough indisputable research
from examination of the brains of dead players to the lives of
retired players that confirms the reality of CTE. Unless
changes occur, further injuries will happen in professional
football players, all the way down to all levels of play.
And we heard today a lot about a lot of changes that have
been made and are going to be made, and I think that is great.
I believe also that the velocity of the head impacts today
in football are one of the biggest differences. The velocity of
the hits and the hits to the head are a big, big part of the
I also think there is an emerging concept of subconcussive
injuries. In other words, all of our energy and all of our work
has been toward the diagnosing the player who had concussion.
What about the players--and we have autopsied several linemen,
none of them who had a history of concussion--who had extensive
tau protein deposition and all died with a clinical syndrome of
CTE, behavioral and psychological problems. So I think that
subconcussive blows, undiagnosed concussions is more a problem
than previously appreciated.
I would like to conclude by saying that obviously
concussion is a complex issue. In response to Dr. Culverhouse's
comments, I will tell you that 20 years at the NFL level with
the Rooney family and the Steelers and Coach Chuck Noll and
Coach Bill Cowher and 10 years at the NCA Division Level I
level, I never had one occasion of a coach or anyone else
trying to influence my medical decision. So I respectfully
disagree. I don't really think that is where the problem lies.
I think the problem lies in maybe improving rules, always
trying to improve helmets and realizing about velocity. I am
here today to try to keep the game alive by making it safer.
Thank you again for allowing me to speak, and I will be
glad to answer any questions.
[The prepared statement of Dr. Bailes follows:]
Prepared Statement of Julian Bailes
Mr. Conyers. We appreciate your conclusions and your
analysis. You bring a lot of experience here.
Dr. Joel Morgenlander, from Duke University, Professor of
Neurology, runs the Clinical Neurology Service at Duke and is
Medical Director of the Neuroscience Clinical Service Unit at
Duke Hospital, and he is also connected with the committee that
works with the National Football League on this same subject.
We welcome you, and we appreciate your patience with us. It
has been a long day. But I think it has been more than
worthwhile, I can say on behalf of the Members of the
Committee, for all of you to give us this very invaluable time.
TESTIMONY OF JOEL MORGENLANDER, M.D., PROFESSOR OF NEUROLOGY,
DUKE UNIVERSITY MEDICAL CENTER
Dr. Morgenlander. Thank you, Chairman Conyers, Members of
I was contacted 3 years ago by Dr. Tom Mayer, the Medical
Director of the NFL Players Association. I was asked to
consider joining the Mild Traumatic Brain Injury Committee of
the NFL. At that time, Dr. Elliott Pellman was the Chair of the
MTBI Committee. I was very clear with Dr. Pellman from the
beginning that I was interested in helping with the committee's
work on player safety as long as I was convinced the committee
was going to take my ideas and concerns seriously. I am a
neurologist and to my way of thinking, all concussions are to
be avoided. I wanted Dr. Pellman to understand my vantage
The MTBI Committee is compromised of team physicians,
trainers, an engineer, a statistician, neurosurgeons, a
neuroradiologist, a neuropsychologist, neurologist, and NFL and
NFLPA representatives. I feel it is important for the Members
of the Judiciary Committee to hear that in my 3 years that I
participated in this work, I feel that all of my ideas and
those of other committee members have been heard and discussed
The support for our work goes past the MTBI Committee to
the Commissioner's office. I have been privy to no hidden
agenda during my work with the MTBI Committee. Those that I
have worked with are focused on player safety. Our hope is that
lessons learned will help with injuries beyond the realm of
professional football, but the NFL players are a central
The issues of the MTBI Committee's work include injury
prevention, player and medical personnel education, return to
play decisions, and evaluations of late effects of concussion.
During the years I have been on the committee, we have
communicated directly with players and families about the
symptoms of concussion to try and facilitate understanding on
We have held several conferences with leaders in the field
of head injury and sports concussion, including the Department
of Defense, to share ideas and better understand opportunities
for future research. With the Commissioner's support, we
instituted a rule to not return any player with loss of
consciousness to the same game. Each team is now required to
have a neuropsychology consultant and baseline cognitive
testing for each player.
We continue to work with manufacturers of helmets and other
equipment on improvements targeted at player safety. We have
much more to do, but I believe we are making a difference. As
physicians, we strive to use the highest level of medical
evidence when making evaluation and treatment recommendations.
Unfortunately, in my opinion, the area of sports concussion
is behind in many areas in neurology in the amount of
prospective data on injury and recovery. Retrospective data is
never as reliable as prospective results and associations do
not prove causation. Therefore, at this time it is not possible
to specifically determine the long-term risks of a single or
For the return of play decision, it is recommended that the
player be asymptomatic both at rest and with exercise. As you
have heard, the medical evaluation rests partly on the player's
report. NFL team concussion data has shown that over the past
several years, more players with concussion are not returning
to play on the same day.
Our committee has worked with team physicians and trainers
to update our concussion report forms for the purposes of
improving data collection and looking for clinical keys to
player outcomes. Members of the MTBI Committee are concerned
about reports of pathologic brain findings in retired NFL
players and other athletes as well as nonathletes who have
sustained multiple head injuries.
The syndrome term, chronic traumatic encephalopathy, or
CTE, as you have heard, appears to be pathologically different
from other neurodegenerative diseases. In my conversations with
the NFL players, it has become clear to me that nearly all of
them have had concussions at some point in their careers. This
includes concussions occurring during high school, college, and
If the majority of players sustain concussions during their
career, then why are only certain players affected with CTE?
The majority of players lead cognitively normal lives after
football. So what is different about these subjects that
predisposed them to additional risk? We know that from
Alzheimer's disease literature, genetics factors interact with
environmental factors to advance cognitive decline in some
patients. We do not know the effects of other medical factors,
including illness and exposures that might have an impact on
this repeated head injury.
We now hear reports of high school and college athletes
with pathologic changes of the brain consistent with CTE. Might
there be a particular age at injury that predisposes the player
to these late effects?
All of these questions are very important and need to be
sorted out in order to determine the actual risk of brain
injury from contact sports for those who choose to participate.
In one attempt to get more information, the MTBI Committee
and the NFL have sponsored the retired players study you have
been talking about. This study is an attempt to gain more
information about middle aged retired players, comparing
players with different NFL career duration. We are including
past medical history and player examinations with state-of-the-
art Magnetic Resonance Imaging studies, genetic screening and
neuropsychological testing. These tests have normative data by
age to compare to.
Neuroradiology and neuropsychology consultants, independent
of the MTBI Committee, have been involved in this study both
from design data analysis and will be involved in the
publication. We hope data from this study will add further
information concerning the risk to players and help improve
future player evaluation and testing. I personally feel that
this neuropathologic work you have been hearing about is
important and know that those involved plan to continue.
Players with no history of cognitive complaints are
currently being recruited as controls and that will be
important. Future prospective studies following a cohort of
young players may be particularly helpful. These studies should
include medical and concussion histories, neuropsychological
evaluations and neuroimaging studies. Many researchers are
interested in these areas concerning sports concussion and more
precise information should be forthcoming.
I hope that my testimony has been helpful to the Committee,
and I will be happy to answer any questions you may have.
[The prepared statement of Dr. Morgenlander follows:]
Prepared Statement of Joel Morgenlander
Mr. Conyers. It has been very helpful. All of your
testimonies have left us with a whole new and important
perspective. And, Mr. Dick Benson, I would like you to think
along with me about two considerations that leave me to discuss
with everybody here.
The first is what Dr. Maroon described so eloquently is
very important, except for the fact that many of, if not most
of, the high school, middle school kids that are in football
don't have the kind of people around with the talent and
medical expertise to accomplish the excellent kind of results
that he has reported. Pro football--well, I am assuming pro
football does, but I don't even do that with any sincere degree
of certainty. But I know when you go down and when you get out
into the little leaguers where they don't have an orthopedic
surgeon who doesn't know concussion if it hit him in the face.
They don't have anybody. They don't have any--they don't even
have a doctor of any kind. They trained--they trained parents
at the school about--they give them a few things about health.
So there is one problem, isn't it? And I want you to talk
with me about it. But I want to get the other one out so that
we can all talk about this together.
The other question is that I find that I have had a little
experience listening. I am disturbed that Dr. Gay Culverhouse
seems to be the only one that sees something that many people
have commented critically on. Now, is it that she doesn't have
any experience about football or she is not--well, to put it in
a more colloquial way, Mr. Barber, what is your problem? Where
does she--how does she get so distraught about something that
nobody else can put a finger on?
What does that tell the Chairman of this Committee? Well,
one thing it could tell me, Mr. Benson, is that she may be on
to something that nobody else wants to break the news to all of
us Federal legislators, and I want to now yield to Mr. Benson
and Mr. Nowinski to help me feel better as this thing comes to
an end. Maybe we can rationalize this away a little bit better.
Mr. Benson. Mr. Chairman, it is obviously true that the
younger players and younger leagues don't have adequate medical
care, and I would argue that is mostly true through high school
in Texas, because until the passage of Will's Bill there is no
requirement that the team doctors, whether they are an
orthopedist, a psychiatrist, a dentist or whatever willing
volunteer, actually catch up and learn the technology of the
injuries that are potentially catastrophic. That is what we are
The purpose of Will's Bill was to try to cut back and deal
with and treat catastrophic injuries, those that cause death,
permanent or long-term disability. I personally--I am not
enthusiastic about very young football leagues. I think maybe
it is a lot of fun for the kids when you turn a blind eye to
the potential cost and you turn a blind eye to the fact that
they are more susceptible to concussion and less likely to
report it and, as I understand it, experience the conditions
longer. I don't like that. I wouldn't let my children engage in
that league, not anymore.
Mr. Nowinski. Thank you for the question, Mr. Chairman. I
will answer the second one first in terms of Dr. Culverhouse.
I do believe the stories that Dr. Maroon--I think he is a
great guy and I am guessing the Steelers have been fine for a
while. But I will tell you that I know of plenty of stories of
guys who have been mistreated and a lot of those guys coming
forward and telling their stories has created the awareness
that we have.
I will give you one example, is Ted Johnson. Ted Johnson is
a middle linebacker for the Patriots for 10 years. A few years
ago he got a concussion in a preseason game, 2 days later
showed up to practice, had not seen a doctor, should not have
been able to practice. And in the middle--when he had--in the
middle of practice, he had a noncontact jersey on and an
assistant came up and said put this full-contact jersey on and
Coach Belichick wants you back in the game. No medical person
intervened. They allowed him to go back into the practice. He
took another concussion on the next play and that pretty much
derailed his career, derailed his life. He retired from
concussions and he is not the same guy he was.
That was a very obvious example of mismanaged medicine.
Kyle Turley, if he was here today, just retired last year
in the Pro Bowl, has been telling stories left and right of
times when he was mistreated by the teams he played for, had a
bad concussion, locked in a room and left there unchecked for
My best friend and roommate from college, Isaiah
Kacyvenski, played 8 years in the league. Team to team is very
different. He was with the Seahawks at first and couldn't speak
well enough for how well they did it. Went to other teams and
spoke of a time he got concussed, was on the sidelines and they
had a neural expert but he was up in the sky box. The other
doctor tried to examine him. He couldn't smell the smelling
salts. He couldn't see straight and they were trying to tell
him to go back in. And it wasn't until the neuro guy got all
the way down from 10 floors above and said that is crazy, you
can't put him back in.
So there are definitely holes in the system, and the
players would be happy to tell you themselves, and most of them
are on the record with it.
In terms of the youth issue, I think you are absolutely
right. There is something very strange about not telling the
kids or the coaches about one of the most common injuries they
can get in football and the most serious one. The idea that we
are willing to put a helmet on a kid and tell him to run into
his friends a thousand times every fall but not tell him to
look out for this, not tell him how to look out for concussions
or tell him how to take care of it and not tell the only adult
there, the coach how to do it, and not providing medical staff
seems to me to be a mistake.
Mr. Conyers. Before I turn to Bob Goodlatte, could any of
you weigh in on my final two questions? Anybody else have a
thought about this? Please make me feel better as we bring this
hearing to an end.
Dr. Maroon. I think in the past, as I think Bob Cantu this
morning, one of the speakers this morning said, that his
management of concussions and the management of injuries in the
last 5 to 10 years is clearly different from the way we managed
injuries before. And I think that I am--in terms of the
comments of Dr. Culverhouse, I think that clearly in the 1970's
and the 1980's and the 1960's, the culture was very different.
And what I am seeing now is a major culture change and a
culture shift in the appreciation of the players as well as the
administrating physicians and trainers in the handling of
Clearly there have been errors in the past in judgment. But
I think as Chris said, there are holes in the system. But it is
our responsibility to try to patch those holes as quickly as
possible for the benefit of the athletes.
Mr. Conyers. Bob Goodlatte.
Mr. Goodlatte. Thank you, Mr. Chairman. Mr. Chairman, I
want to thank you for holding this hearing. This is not an
ordinary topic for the Judiciary Committee to cover, but it has
certainly been a very enlightening one for all of us who have
participated, and I must say that it is my hope that those
people who are able to view this on the streaming, on the
Internet, or perhaps this will be rebroadcast on C-SPAN, that
if there are just some parents who see this and hear this they
will be better informed, either to be better informed about
decisions made by their children, whether or not they play
football, but also more importantly many of them are going to
decide to play football and they can advocate for better
conditions under which they do play.
I have the greatest concern for those young people.
Obviously I am concerned about anybody who sustains the kind of
concussions that we have talked about here today and the life
impairing injuries that they could sustain.
Mr. Benson, I think you have done it the right way in
getting that passed through the Texas legislature. I am very
concerned about this, but I have to say that given the
considerations of the Commerce Clause of the U.S. Constitution,
it would be difficult, I think, for the Congress to extend the
long arm of the Federal Government down to high school football
games and be able to enact the kind of regulations that you and
Mr. Hoge and Mr. Barber and others have referred to here. But
the awareness that you brought that we have been able to
facilitate here I think is a good thing.
And I would like to ask, Mr. Barber, who I am delighted is
here. He has excited a lot of fans in my hometown of Roanoke,
Virginia, playing for Cave Spring High School and subsequently
for the University of Virginia and then of course the New York
Giants. And I would like to ask Dr. Maroon as a team physician,
and maybe Dr. Bailes as well.
This problem at the NFL level, you have a multi-billion
dollar industry, players with multi-million dollar contracts,
fans that pay hundreds of dollars for a ticket to see the game
in person or watch it on TV in the hundreds of millions and we
all know what an ad goes for for 30 seconds on the Super Bowl.
So there are lots of resources available to address this.
Is the risk reduced by that or is it just as great because
while you have more equipment and better physicians on the
ground, you also have stronger, faster, more aggressive--I
mean, you are playing at the very top of this game. And is that
more likely to result in those kinds of concussions? Or is the
risk greater for high school and college teams that don't have
those same resources, obviously especially at the high school
level, and are faced with making a different set of decisions?
Is the problem the same or is it different at the high school
level and at the professional level?
Mr. Barber. I appreciate the question, Mr. Goodlatte, and I
will answer this in two ways. I think on the high school level
the danger is because of ill-fitting helmets. It is a lot of
hand-me-down things that aren't specifically structured for a
young athlete's head. It is whatever is in the bin. In the NFL,
things get a little bit better because they are custom made.
We have to remember that helmets were originally made to
prevent skull fractures. We used to play with leather helmets.
But when people started hitting each other very hard skulls
were cracking, and so the original designs of helmets were not
to protect us from concussions. It was to prevent our brains
from cracking open.
I think on a more important issue, it is about people, it
is about the individuals who play the games. And what I mean by
that is from a very young age, if you are an athlete, a star
athlete, you are ushered along, you are fed meals, you are
taken care of medically, so that when you get to the point in
college and high school, you almost don't know how to think for
yourself, and so the empowerment of individuals to know their
own bodies, to be able to make their own decisions I think is
the most paramount thing that we need to focus on.
As I mentioned earlier, when you get a concussion, as I did
in 1997, and you break your arm as I did in 2000, and
ultimately decided to play in both cases, it was my informed
decision to do so with the input from my doctors, with the
input from my training staff, with the input from my coaches. I
felt like I was capable of doing it because I was informed.
A lot of athletes are not informed because they just listen
to what is told them. If there is one thing that I could change
and empower and inform fellow athletes, it is to learn
yourself. Don't trust what everybody else tells you. Learn it
Mr. Goodlatte. Thank you. Dr. Maroon.
Dr. Maroon. Thank you. That was an excellent question, sir,
from a couple of different viewpoints. You started with the
financial aspect of it and relative to high schools versus the
professional team, and Tiki had a very excellent point that the
testing requirements up until recently have been to prevent the
fatal head injuries and the penetrating experiences through the
skull and the head to protect the outer shell. Recently, the
NFL has and presently, actually ongoing, is evaluating five
different helmet manufacturers and their helmets. In other
words, in the past, if you go to the equipment manager of the
Pittsburgh Steelers, the various companies will come in and
make assertions that my helmet is better than this helmet, is
better than that helmet, and can reduce concussions by X
percentage with no good data out there to substantiate that. So
what the NFL has done, they invited all helmet manufacturers to
submit models of their helmets for 23 separate individual tests
that have evolved from the video analysis done by--on the
research that has been ongoing with the NFL, and these helmets
are being tested now for their ability to prevent the
subconcussive blows and the concussions. Not necessarily fatal
injury, but what are we doing to prevent subconcussive blows in
Well, we really are making progress in that area. And very
many concepts--Dr. Bailes mentioned that--the formula of force
is equal to mass times acceleration. In the NFL and in college
and high school, we have massive--big masses, as you know, 300,
350-pound individuals going at a very fast speed, high
velocity. Mass times velocity equals force. So there is much
But if you ask what is acceleration, it is the delta, the
change in velocity over time. So if you are driving home on the
Washington Parkway and you come to a bifurcation in the road,
instead of hitting the coffin corner with no--with a concrete
embankment, you know the Highway Department now has telescopic
compressible water filled cushions that absorb the velocity. It
takes longer, the time is increased, thus reducing the velocity
and reducing the force.
So this kind of new helmet technology that is evolving is
actually here. The problem of cost is definitely a significant
one. These helmets are in the range of $300 a piece. The older
helmets, which still 40 to 50 percent of NFL players use, are
in the 160 to $180 range. So cost is a factor and how to bring
that down at the high school level, I don't know.
Mr. Goodlatte. Dr. Bailes.
Dr. Bailes. Yes, briefly. I think one way to look at it is
the high schools and the lower levels of play have less
everything. They have less education, they have less medical
advice and attention, they have less numbers of athletic
trainers, less good headgear, for instance. So I think they
just have a lot less. They also have a brain that is probably
more vulnerable at the younger age.
Now, the NFL, the issue there, you asked about that, is I
believe they have much bigger and much faster players, as we
have said. And they also have a much higher velocity of impact.
Secondly, they have accrued more years of exposure. So I think
that also is another factor.
So I think both at the highest levels and the lower levels,
I think you have different factors at play.
Mr. Goodlatte. The Chairman has indicated we are probably
not going to do another round of questions. This is an
excellent panel and he has given me leave to ask one more
question. And I would like too direct it to Mr. Nowinski and
A lot of discussion, both from Members here and from some
of the Members of the panel, analogizing the problem with head
injuries in football to cigarette smoking and cancer. Obviously
one big difference is that if you asked almost anybody on this
panel on either side of the aisle, we would tell somebody who
was considering smoking don't do it, period. End of discussion.
Avoid all of the risks that are entailed therein.
On the other hand, I think if you asked most Members of
this panel whether or not we should tell everybody not to play
football, there would be maybe a much stronger on the other
side saying, no, we are not going to tell people not to play
So given your concerns and what you have said, are you
advocating, Mr. Nowinski, that people not play football? Where
do you come down in trying to address this problem? Because
obviously based upon what the two doctors said and what Mr.
Barber said, the resources just aren't there to make this sport
as safe as you or I would like to make it be for high school
students, and yet it is something very popular not only with
the players, but obviously with the large populations in almost
every community in America.
Mr. Nowinski. I thank you for your question. I would like
to begin by actually addressing your last question. There is
another piece of data. In terms of the difference between high
school and pro sports, there was a study that came out of the
University of Illinois this summer that showed that the average
force of the head of a high school player was actually higher
per collision than a college player, who is 24 Gs to 22, with a
theory being the high school players have weaker necks and they
use their helmets more because they need to. They are not as
strong. So the problem is really at the lower level.
So the question being should people be playing. The problem
I had when I got in the situation I was in as a pro wrestler,
and then as an adult, was I didn't know. I never had a choice
in my outcome. So the fact that I had to deal with 5 years of
headaches and depression and short-term memory problems and
couldn't go back to work to any job for a couple of years, I
was very frustrated by the fact that I didn't know any better
and I could have prevented it.
So I think that goal number one is to make sure that every
parent who signs up their kid to play football understands the
risk. And I think goal number two is to make sure that
everybody who plays understands the risk and also understands
how to minimize it.
I do not want to see football go away. I still enjoy going
back to Harvard football games every Saturday and rooting to
beat Yale, which we always do now, which is great. And I don't
want to--I don't want to see it go away. So what I do want to
see, though, is this radical change, this whole idea of this
10-point plan. I don't think--if we are committed to assessing
everything, putting everything on the table, saying look, these
guys, these 11 brains we have looked at, the brains Dr. Bailes
and this group have looked at, these are the canaries in the
coal mine. This is showing that the game has evolved into
something we didn't understand. It is nobody's fault, but it is
something it shouldn't be. And if we don't put everything on
the table and say let us change it, then I don't know--if the
commitment doesn't show, then I don't know what to tell
parents. I think they have to make up their own minds. But I
want to see it changed first.
Mr. Goodlatte. Dr. McKee.
Dr. McKee. I would agree with everything Mr. Nowinski has
said. I do believe that the game can be changed. I too, believe
it or not, am a huge football fan. But I think it can be
changed. And I don't play football, so I wouldn't be able to
elucidate all the different ways we would minimize the injury
during the play of the game. But Chris has come up with a 10-
point plan--reducing contact during practicing, reducing
scrimmage. All those things I think we need to do and I think
we need to do them immediately.
Football is an American sport. Everyone loves it. I
certainly would never want to ban football. But I think we can
play it smarter. There is a lot of risks associated with
football and they may be very great for the young player. We
maybe need to reconsider when kids start playing football and
we need to consider what kind of support we are going to allow
for the football to be played. I mean, do certain things have
to be in place for football to take place at the high school
level? And maybe that does mean that we can't play football
unless there are resources there to support it adequately.
And then in the case of the pro player, I think that of
course football can go on but we need to adequately inform the
players about their risks. We haven't banned cigarette smoking.
People smoke. People make that choice. But they need to make an
informed decision. They need to understand the risks and it
needs to be out there if they want to pay attention to what
those risks are.
Mr. Goodlatte. I agree with your analysis, and I hope that
we can make progress in finding ways to make football as safe
as possible but still keep this very popular national pastime.
Mr. Chairman, thank you again. I have to say that I think
that in terms of education, this has been a great hearing. I
still feel that the Congress should not inject itself into the
negotiations between the NFL and the NFL players. And I think
that as this pertains to improving the safety of football, we
can promote research and we can promote education. I think some
of the tough decisions that have been advocated for have been
made at the State and local level just because of how our
system of government works.
Thank you very much for holding this hearing.
Mr. Conyers. Thanks for those two excellent questions.
Mr. Delahunt. Thank you, Mr. Chairman. And I want to
acknowledge the great work that is happening at the university
in my hometown, Boston University. Professor Cantu, Chris is
here and Professor--Dr. Ann McKee. I had posed a question to
the first panel and no one had an answer. But I think the point
that Bob Goodlatte made--or I think you made actually, Dr.
McKee, that goes to the issue of the individual or in the case
of those who have not attained majority, their parents should
be well informed. And from my very cursory reading of the
reality that often times indicia of problems occur decades
later, is there--and it would appear that the protein, tau,
is--as was shown on the slides earlier--is a red flag, and that
seems to be indisputable.
Is there a tool that can measure CTE while an individual is
alive, or is this always done in the course of an autopsy?
Dr. McKee. Well, no. Right now we have no way to diagnose
CTE during life. And, you know, it has been a huge battle, I
think, for us to even recognize that CTE is an issue. We have
had to wait until these players died and they had a postmortem
diagnosis to recognize the condition.
Mr. Delahunt. It would appear, however, according to what
seems to be more than a consensus, almost a unanimous opinion,
that CTE is indicative, is without doubt a factor that, if we
had awareness of, could be a prognosticator in terms of what
would happen, particularly to young people who were
participating in football later in life.
Dr. McKee. Oh, I think there is just tremendous things that
we need to learn. And we can actually learn them first from
these autopsied individuals. We have learned where the disease
affects the brain the most. We didn't know that 2, 3 years ago.
Believe it or not, there has been an explosion of knowledge
just concerning this disorder. And----
Mr. Delahunt. I don't have too much time. Is there research
being done now----
Dr. McKee. Yes.
Mr. Delahunt [continuing]. That would provide a diagnostic
tool so that, if I happen to have sons and I was concerned,
that I could refer them to your shop or some hospital to inform
me as to whether there may be a future risk involved?
Dr. McKee. Well, what we are doing is setting up
longitudinal studies of players, and we are looking for that
way to diagnose it during life. We are going to take what we
have learned from it at postmortem exam and apply it to people
that are living. We don't have that technique yet. We----
Mr. Delahunt. Is there enough funding available?
Dr. McKee. No, we always need more funding. We have just
the beginnings of funding.
Mr. Delahunt. Well, what I think we have is an epidemic.
And I dare say that, just given the autopsies that have been
performed on deceased NFL players--I mean, how many players at
any given time are in the National Football League? I mean, it
is minuscule when compared to the universe of 5 million
participants any given year in football.
And we hear that, you know, in terms of people in high
school, obviously they don't have the same physical capacities
and strengths that someone would in college or someone would in
There could very well be--I am going to put this out as a
premise and welcome comment--there very well could be much of
our concerns about depression, about Alzheimer's, about the
whole array of injuries or symptoms associated with the
functioning of the brain could be as a result of, I think the
term is post-concussion syndrome. Am I in the ballpark, or am I
Dr. McKee. No, I think you are absolutely in the ballpark.
The point I think that I am hearing from you is that CTE could
be playing a much bigger role than we presently realize and
that CTE may be responsible for the depression we are seeing in
these retired players, may be responsible for the cognitive
impairments in the retired players, but may also play a role in
society at large.
Mr. Delahunt. Exactly.
Dr. McKee. There are lots of people that have suffered head
injuries; they have lots of memory disorders and psychological
problems. We have no--this is really an untapped concern that I
am sure our knowledge needs to expand dramatically in to.
And then don't forget the soldiers.
Mr. Delahunt. Right.
Dr. McKee. I get calls and e-mails from soldiers every day
talking about memory concerns, how they had an IED.
So this has huge legs, and we are just scratching the
Mr. Delahunt. I would suggest, Mr. Chairman, that there
should be a real sense of urgency about the kind of funding
that would be appropriate and necessary to deal with this.
Because, on the other end, the costs that are associated with
depression, with memory loss, with dementia, with Alzheimer's
are costing society far more than the funding that would
hopefully result in a diagnostic tool for us to have the kind
of informed patient or informed parents to make a decision.
And, with that, if anyone else wants to comment. Chris, do
you want to comment?
Mr. Nowinski. I think you are absolutely right. You know,
we have a longitudinal study now of 175 athletes that are going
to donate their brains to us when they die. And most of them
come out to us because they have this constellation of
symptoms, but they have never been diagnosed. Most of the
brains we looked at that had dementia were originally diagnosed
as Alzheimer's brains. So a significant percent of Alzheimer's
patients are actually CTE patients; we just don't know what
And, if you want to look at outside research, look at the
head injury rate in the prison population. You wonder what
maybe turned these people bad. I will give you one example, my
former colleague at WWE, Chris Benoit, who killed his wife,
killed his son, killed himself. He had a very severe case of
this disease at 40 years old. So this is much bigger than we
Mr. Conyers. Thank you for your line of inquiry, Mr.
Mr. Benson. I would like to add a brief comment to what Mr.
Nowinski said. When we are talking about disorders that cause
cognitive disorders, we are not just talking about Alzheimer's,
or maybe we are not even talking about lower SAT scores. We are
talking about fundamental problems like emotional control and
impulse control that can show up as huge distractions and
disorders throughout life.
And every year there is some kind of extravagant behavior
on the part of football players in one age group or another,
and I am forced to wonder what is the true cause of that
behavior. Could they have had impulse control loss due to a
Mr. Conyers. Uh-huh.
Sheila Jackson Lee, Texas.
Ms. Jackson Lee. Thank you, gentlemen and lady, very much.
We are in and out because there are overlapping hearings and
meetings. But I can't express, articulate, I think, at the
level of importance that this hearing, I believe, is for the
Congress but also for the American people.
I disagree with my colleague, and I do believe that labor
negotiations are vibrant and vital. And I think they are what
they should be: adversaries or maybe even people who agree with
each other working out responsible rights for both management
But, as I have listened to the witnesses and listened to
Mr. Benson, who hails from my home State, and I know from which
he speaks--no politician sets up an event on Friday night
football unless you are sitting in the stadium watching Friday
night football in Texas. And so I know how intimately this
whole game is for those who live in many places and certainly
But, as I listen to you, I don't see any way to handle this
holistically unless it rises to the level of the national game.
It is a national game. It is America's pastime. It raises to
the level of a congressional response, as I said, not in a
punitive manner, but in a collaborative manner, in a manner
that says, ``We want the sport to last. We want there to be
more boys playing.'' And, of course, we have girls football, I
understand. But we want more people playing and more people
So, Mr. Barber, let me thank you for the good times you
have given to a lot of folk who have watched you play. But let
me just ask this question. I am going to give rapid-fire
questions if I can get rapid-fire answers.
Do you think the structure of the NFL contracts are
contributory to players shielding their injury and symptoms?
And is there anything we can do to change that culture?
And I am going fast because I am going to Mr. Benson and
Mr. Barber. I will answer that question. Thank you for that
question, Ms. Jackson Lee.
I think a lot of it comes down to pride. I know when I was
playing and I would get hurt, I didn't want to come out of the
game because I hated seeing someone else do my job. I never
thought about the economic benefits of playing. I think my
contracts weren't incentivized based on playing time, yardage,
et cetera. But, for me, it was a sense of pride, because I
loved doing my job.
Ms. Jackson Lee. Can we balance that pride with ways of--
and you are right, I was going to refer to playing time and
incentives to keep people in, but you are saying pride.
Mr. Barber. I think how you balance that is with education.
If you give players--and I mentioned this with Mr. Goodlatte,
as well--if you give players the knowledge of their injuries
and the potential dangers of their injuries and have them take
control of it, as opposed to relying solely on doctors' inputs
or trainers' inputs or coaches' inputs, they are much more
likely to make the correct decision should they get a
Ms. Jackson Lee. But we need to help support them in that
by educating trainers and coaches so that they don't get the
evil eye when they do decide to come out because they do have
Mr. Barber. Of course.
Ms. Jackson Lee. And I know the evil eye is there.
Mr. Benson, let me offer to you my sympathy, and try to get
just an understanding. You said something very important, that
we need to--Mr. Chairman, I am hoping that this testimony that
we have heard might be on the Judiciary Committee Web site, and
indicate to parents across America, spend some time reading the
outstanding testimony that this panel has given.
Mr. Benson, your bill in particular--and I had many of
these cases in my own congressional district. In fact, one
summer it looked as if we had one or two or three or four of
those kinds of incidents on the field. People were dehydrated,
et cetera. You believe that we should include the high school
playing of football, is that not correct?
Mr. Benson. Could you ask it again? I am sorry. I didn't
quite hear you.
Ms. Jackson Lee. You believe we should include high school
football, as well, in our assessment of improving safety and
ensuring safety on the field?
Mr. Benson. Absolutely. And the summer you are referring to
may have been the summer my own son died. Seven players died
Ms. Jackson Lee. And so, your ``Will's Bill'' in Texas
deals with that kind of inattention and requires more attention
to these young men?
Mr. Benson. Absolutely.
Ms. Jackson Lee. I want to get a copy of the bill.
I want to go to Mr. Nowinski because he fascinated me with
referring to that shocking incident that everyone was just
saying why. Tell us about the wrestler that no one could
explain what was going on. You have documented evidence that
that was a CTE victim?
Mr. Nowinski. I worked on that case with Dr. Bailes and Dr.
Omalu. It was summer of 2007. Chris wrestled for 23 years and
was known as a guy who wouldn't take a day off. He was a very
physical wrestler. He once confided to me about a year before
the incident, when I was working on my book, that he had had
more concussions than he could count. And he actually seemed
very interested in my work, so I think he knew something was
wrong with him.
In talking to wrestlers who knew him in the last year, he
stopped calling wrestling matches beforehand because he
couldn't remember. He started acting very emotionally bizarre.
He was keeping a very strange journal. And then the incident
happened, he killed everyone over a couple of days.
The media jumped on ``it was a steroid incident.'' And we
knew that, from what he told me and what I had known with these
other cases with Andre Waters and with Terry Long both
committing suicide, I thought otherwise. We looked at his
brain, and it was actually, at that time, it was the most
damaged brain. It was more damaged than Waters and Webster and
those guys. It was very severely damaged.
Ms. Jackson Lee. So you were able to look at Chris's brain?
Mr. Nowinski. Yes.
Ms. Jackson Lee. And found the evidence of CTE.
Mr. Nowinski. Yes.
Ms. Jackson Lee. So if we take both of these--the
wrestlers, as I understand it--correct me--don't wear helmets.
And I have listened to, I think, Dr. Bailes--I am sorry, I am
looking at--the testimony as I came into the room, talking
about the new technology. Which I don't understand, if we can
land people flying into space, as I am an advocate of, we can
do better on technology.
But do you wear helmets wrestling?
Mr. Nowinski. No.
Ms. Jackson Lee. So how would we intervene if we took the
Mr. Nowinski. Dr. Maroon and I were talking about that,
because he is the new medical chair for the WWE. And it is
actually much easier, because since pro wrestling is fake, the
contact is always accidental. It is just a question of risk
management and education of our guys.
Ms. Jackson Lee. All right. So what we have overall is, in
essence, a curable entity. It may mean that we look at the NFL
in terms of legislation or some intervention that, again, is
not punitive but is helpful. And then we look at the high
school football--you made a very important point, weaker necks
in high school students, using the helmets.
And I guess the last point is to go on to Tiki Barber's
point, and I think you made it too. What is this about being in
a circle and you know you have a concussion or you think you
have one but just go on and play? How do we break that for your
age, for the high school and the college players?
Mr. Nowinski. Yeah, I would echo Tiki; it is education. It
is always going to be hard yourself to self-diagnose and take
yourself out, not only because of pride, but also because you
just had a brain injury and you aren't thinking straight.
Ms. Jackson Lee. Right.
Mr. Nowinski. But if every one of your teammates knows, by
you staying in the game, you could really end up messed up,
those guys like you, they are your friends--there are many
incidents now in the last probably only year or 2 where players
will tell the coach, ``Get him out of there. There is something
wrong. Get him evaluated.'' So if everybody knows, if the
coaches know and the players know and the parents know, this
stuff would not happen.
Ms. Jackson Lee. And then we work on the other side with
getting the technology investment to make a helmet that is
befitting of a Nation who travels into space and has an
international space station.
Mr. Nowinski. Absolutely.
Ms. Jackson Lee. Wouldn't that work?
Mr. Nowinski. Big improvements in the helmet.
Ms. Jackson Lee. Mr. Chairman, let me thank you for
allowing the line of questioning. I think I was able to listen
to the statements or the testimony from the neurologists that
this is something that we cannot overlook, and we can find ways
of solving it.
I hope the education, however, is for the whole structure.
Because players being educated--and parents be frightened and
intimidated, ``I don't want my son to be the one on the bench
and miss these opportunities, and my coach and trainers don't
understand.'' So I think the whole--it has to be an
infrastructure change if we are going to get the best results.
Thank you. I yield back.
Mr. Conyers. Thank you.
Maxine Waters, you are now the person that will end our
discussion that has gone on so long. We thank you.
Ms. Waters. Thank you very much, Mr. Chairman, for your
patience. Thank you for your interest in this subject. And this
is not the first hearing you have held basically focusing
somewhat on the NFL but focusing on various aspects of the
problems with football and the NFL in particular. And today
this focuses on brain injury.
I would like to first thank--aside from thanking you,
secondly I would like to thank Mr. Dick Benson. I thank you for
coming to this Committee to relive the pain and trauma of your
child's death. That is not easy, and I understand that. And I
certainly respect you for coming here and sharing with us today
what happened to your child. Thank you very, very much.
I thank all of the other persons who have come today on
both of the panels.
I did not have an opportunity to hear it all because, as
Ms. Jackson Lee said, we are between Committees. But I did hear
part of Dr. Gay Culverhouse, former president, Tampa Bay
Buccaneers. Thank you so very much, not only for actually
stepping way outside of the box and telling it like it is, but
hearing it come from a woman is just so pleasing, to know that
not only were you president of Tampa Bay, Dr. Culverhouse, but
that you dare to say what a lot of others don't dare to say.
We had a lot of people in here today who were protecting
the NFL and a lot of people here today on the payroll of the
NFL and hoping that somehow they will look good enough to maybe
get a pay raise because they came here and performed for them
today. As you know, I don't take a back seat on these issues.
Now, I respect everything that is being done to try and
prevent these head injuries. And I have heard everything that
everybody has said about what we know, what we don't know,
about how we should do a better job of educating and advising.
And I have heard what was said about helmets and, I guess,
other kinds of equipment, et cetera, et cetera, et cetera.
But, in the final analysis, if you play football, in
particular, and other sports, some other sports, there are
going to be head injuries. There will be head injuries. I am
told that simply by the movement of the brain inside the head
that you are going to have people who are going to end up with
And the reason that I come in here today is not so much
that I need to be told that the study is correct or maybe it is
not so correct. I mean, I have common sense, as most of us
have, and we know that hard hits and people hitting their heads
will do something; you are not going to be the same.
And we do know that there are people who have had
concussions, football players, who were sent back out on the
field. My husband was a football player. He told me about the
times that people were knocked out and they were put back. And,
in the day, it certainly happened perhaps more than it happens
now. So I am concerned about the children, the football
players, et cetera.
But for the NFL that is $8 billion strong, I am concerned
about what they are going to do to compensate these players and
their families after it is known that they have dementia or
that they have received these serious injuries and they have to
end up fighting--I mean fighting with the NFL to try and get
some support for their families.
I have not been involved with the brain injuries, but I
have been involved with trying to assist other football players
who happened to be friends of ours, two of whom have died, who
fought with the NFL for support.
Today, as we sit here and talk, the NFL is in negotiations.
And I asked if, in fact, they were entertaining anything in
those bargaining sessions about head injuries. Of course I
didn't get an answer, because it is not happening.
And so, Mr. Chairman, while, in fact, I know that you
wanted to take a look at the study today and to learn exactly
what is going on that will be helpful in preventing these
injuries and what can be done to prevent them and all of that,
we must keep our eye on the ball, and we must understand that
the NFL has an antitrust exemption and that that is big. I
mean, that is huge. And if we ever want to get them to do the
right thing, we have to have them know and understand that we
are going after that antitrust exemption.
They cannot continue to enjoy making the money that they
are making and not being willing to compensate these injured
players and their families, who are dying on the street and
dying in alleys, broke, with dementia. And they are not the
stars that they were when they played when they are in those
And so I am committed to the proposition that we have the
authority, we have the authority, to take away that exemption.
And that is what we need to start down the road to do, in order
to get some compensation for injuries that are going to
continue to happen no matter what anybody says.
I yield back the balance of my time.
Mr. Conyers. Thank you so much.
I am going to insert The New York Times article by Alan
Schwarz in today's The New York Times, ``N.F.L. Players with
Head Injuries Find a Voice.''
[The information referred to follows:]
Mr. Conyers. And I can't thank all of the witnesses enough.
Without objection, we will have 5 days for Members to
submit additional testimony. We will also have 5 days for other
witnesses to submit any materials or additional comments to
their own statements.
And I will submit a statement received from Brent Boyd, a
retired NFL player who suffers from cognitive problems
resulting from football head injuries.
[The information referred to follows:]
Mr. Conyers. I thank Mr. Goodlatte and Ms. Waters for their
tenacity and staying power.
And this hearing is adjourned. Thank you.
[Whereupon, at 5:08 p.m., the Committee was adjourned.]
LEGAL ISSUES RELATING TO
FOOTBALL HEAD INJURIES (PART II)
MONDAY, JANUARY 4, 2010
House of Representatives,
Committee on the Judiciary,
The Committee met, pursuant to notice, at 1:02 p.m., in
Room 1460, Wayne State University, 540 East Canfield Street,
Gordon H. Scott Hall, Detroit, Michigan, the Honorable John
Conyers, Jr. (Chairman of the Committee) presiding.
Present: Representatives Conyers, Sanchez, and Cohen.
Mr. Conyers. Well, good afternoon. Since the room has
quieted down, let's begin the hearing. I welcome everybody and
thank you all for coming. This hearing's being held at Wayne
State University Medical School where we've been before on
other related subjects of healthcare. One I remember most was
with the late Senator Ted Kennedy and the Dean of the Congress,
Michigan Congressman John Dingle, and myself. We had a
wonderful evening, and it's memorable in many respects because
that was the last time that Ted Kennedy graced us with his
The medical school was created in 1868 before the rest of
the university, and it has been the focal point for brain
injuries and related matter since 1939. We are very pleased
that the dean and her staff, vice-president, and others have
been with us today. So many of you here are distinguished, and
the subject matter is one that interests us all.
You might want to know that on October 28 in Washington,
D.C., this Committee held a hearing on that subject, the same
subject that brings us here today, closed-head injuries in
football, but the subject of concussions and related matters in
general in Washington, and so this constitutes the second
hearing, and we're pleased that all of you are here.
We're particularly excited by the fact that there are so
many people with particular expertise, not just testifying but
many here that may not testify, and I just wanted to note that
we have wide receiver Herman Moore; Greg Landry, quarterback of
some fame; Ron Kramer, tight end, Horace King, fullback, Tom
Lewoski (ph.) Fullback, Ron Rice, safety, among others that are
Mr. Thrower. Jim Thrower.
Mr. Conyers. Jim.
Mr. Thrower. Thrower.
Mr. Conyers. Jim Thrower is here.
Gallery Member. Defensive back line.
Mr. Conyers. So--and there are others, other players here
that their names will be sent up to me as we go along.
[The prepared statement of Mr. Conyers follows:]
Prepared Statement of the the Honorable John Conyers, Jr., a
Representative in Congress from the State of Michigan, and Chairman,
Committee on the Judiciary
Mr. Conyers. We'd like to start out with Ms. Linda Sanchez
who wants to make a few opening remarks. She's a distinguished
attorney who I remember campaigning for when she came to the
Congress in the Los Angeles area. She started off being
remembered as the first Member to join her twin sister in the
Congress, as well, Loretta Sanchez, and we were very pleased
that we could get her on the Committee on the Judiciary. She
was at our--well, she was holding hearings in 2007 on this
subject, and we're delighted that she left the snowy, cold
frigid areas of Los Angeles to be with us today, so I'm very
pleased to welcome her, and the only thing we're sorry about,
she didn't bring her little boy, who I claim some extended
jurisdiction over, and I'm so glad that you're here, and I'm
going to put my statement in the record, and ask you to begin
the discussion. Welcome to Detroit and to the medical school.
Ms. Sanchez. Thank you, Chairman, and I just want to make
one quick, minor correction. My sister Loretta is not my twin,
she's 9 years my senior, and that's very important for me to
get out there, and I'm particularly pleased to be in your
hometown of Detroit for what I consider to be a very important
field hearing, and I think the importance of this hearing is
underscored by the number of witnesses who have come today to
testify and by the fact that I left 80-degree weather in
Southern California to be here, myself, this afternoon.
But as everybody here probably knows, the issues of
concussions in professional and amateur sports is a very
serious one that deserves scrutiny, and while the NFL is moving
toward the playoffs, and the NCAA is concluding its bowl games,
it's important to note that we're not addressing this
particular issue simply because it's relevant only to football.
We're here today because this is a worker safety issue, and it
impacts athletes of every level in many different sports.
I'm pleased that since this Committee's October hearing,
the NFL has taken a number of serious steps to try to help
address this issue of concussions, but I can't help but
wondering would the NFL have been as proactive if Congress
hadn't taken an interest in the issue and scheduled the
hearings in the first place. So I think that our role up here
is a very important one because I think we can be a catalyst
for change even though there are skeptics who simply deny that
Congress is effective at doing anything in particular.
There are increasing studies and a body of evidence that
show that there is a significant risk to individuals who suffer
repeated head trauma, whether it's in the NFL, in professional
boxing, or even high school sports, and while there are those
here today who will argue against the validity of some of these
studies, there appears to be a preponderance of evidence that a
number of professional athletes who suffer repeated head trauma
experience physical and mental decline earlier than the general
population at large, and it would seem to me--and I stated this
to Commissioner Goodell at the last hearing that we held that
it would be better for the NFL and the NFLPA to be proactive in
alerting its players to the risks that they face, and it's my
hope that in the discussion that we have here today, the NFL
and the NFLPA will make continued improvements in educating
players on the dangers they face by playing with a concussion,
treating those athletes appropriately who do have concussions,
and removing the stigma that pressures players to play through
the injury, and one of the most recent quotes that was heard on
November 29th, 2009, was an interview during the pregame show
before the Steelers' matchup with the Ravens when somebody
said, basically, that he had been dinged up and got right back
into the game and that, you know, just because somebody's
having headaches, pretty much the quote is, you know, they need
to suck it up and continue to play on, and the fact of the
matter is that sucking it up and continuing to play on may mean
very serious and grave consequences down the line.
Many witnesses that we have had before the Committee have
testified about how the NFL, like it or not, influences the
lower levels of football, and the actions that they take or the
actions that they choose to ignore to take have significant
impact on players at lower levels. The NFL, quite frankly, has
vast resources available to its disposal to educate coaches and
players and medical personnel on the proper way to handle a
concussed player, and if they have all these resources
available to them and are not addressing the problem, imagine
how can we expect every high school or college to be able to
properly treat a concussed player if that proper action isn't
being taken at the very top levels of the sport?
I believe one of the most important things that can come
from this hearing is the strong need for those who are coaching
younger athletes to recognize the damage that repeated head
trauma can have on developing brains, in particular, and I look
forward to the testimony of our witnesses who will talk about
the steps that are being taken to educate athletes on the--at
the high school, college, and lower levels to see what further
steps we can take to ensure that we are protecting these kids
at all level of play.
Mr. Chairman, as I noted above, the last Committee hearing
resulted in many positive steps being taken, and I'm pleased
that this Committee's continuing to focus on this issue, and I
hope that the outcome of this hearing is similarly positive,
and I thank you for my time, and I yield back.
Mr. Conyers. Thank you very much, Linda Sanchez, younger
sister of Loretta by 9 years. I don't know why I made that
I'm now pleased to recognize Subcommittee Chair Steve
Cohen, Memphis, Tennessee, who has some familiarity with
football, not as a player but as a fan, and a very good friend
of mine. I was--remembered him for many years as a State
senator from Tennessee before he began his congressional
career. He is currently the Chair of the Commercial and
Administrative Law Subcommittee, and we worked very closely
together on many civil rights issues, civil liberties issues,
and we work on copyright, patent, and other matters that come
before what many regard as one of the most significant
Committees in the Congress. Welcome, Chairman Steve Cohen.
Mr. Cohen. Thank you, Mr. Chairman Conyers. I first would
like to ask Mrs. Sanchez to--somewhat unfortunately, I want to
correct you. You obviously did not read the Pasadena Star News
in November 1965 when I caught the last pass in the Black Hawks
Mr. Conyers. You know, I did miss that. I don't know how I
could have missed that.
Mr. Cohen. It was the only game my parents ever came to
witness, and it was the only game in which I was able to have a
pass thrown to me and I caught it. But it's a pleasure to be
here with you, and it's an honor to serve in the United States
Congress. This is my second term, and I'm fortunate to be on
the Judiciary Committee that I think is so important because
it's the basics--the base of America, what it is, basic rights,
bill of rights, and values, and due process, and equal
protection, and nobody does more to protect these than Chairman
Conyers. He is legendary and a stalwart and a voice of
conscience of the United States Congress, and so I'm fortunate
to serve on this Committee with you and to return to Detroit.
The last time I was here in Detroit was when the GMAC Bowl
was playing and DeAngelo Williams who gave Memphis our wholly
particularly outstanding year during this century led us to
victory over Akron. I did not, like Ms. Sanchez, leave 80-
degree weather to come here, but I did leave Elvis at the donut
This hearing is most important, and some people would
question the idea of Congress having hearings on issues like
this because, as Ms. Sanchez has properly cited, the NFL has
changed its policies, and that's important, and the NCAA has
some changes in store, as well. They have had a committee
recommend some changes on concussions and how to deal with
them, unlike the way they deal with them in Lubbock, Texas, you
should be sent to the neurosurgeon, not to the shed, and that
is shameful what apparently went on there.
But in college and in lesser-level, younger football
activities, young people are potentially endangering their
future cognitive abilities and ability to enjoy life. Nobody,
particularly the very, very, very involved sports fan from
childhood wants to see anything happen to this wonderful sport,
that is--rivals baseball or maybe has surpassed baseball as
But nevertheless, the players who we revere, and as I
mentioned earlier, as a child, Les Bingamen was my favorite, I
guess because he was just so big and he stood out on the
screen, but I liked Les Bingamen, and I remember Gale Larry
(sic) punted in ``Night Train'' Lane, who was the defensive
back, and all the great lines back then, and Ollie Matson was
my hero, and to think that these players may have suffered some
type of permanent brain injury and there is plenty of data that
gives any person, at least a reasonable cause to believe that
there is the potential of brain--permanent brain injury from
the concussions that are received on the field.
This is a violent sport, and with the increase in--well,
Joe Donellini started it, but the weightlifting, and I don't
know who else started the rest of what made everybody so big
and so strong, but you've got a lot of violence out there
directed at different players and head-on collisions, and when
people have concussions, there's damage.
We know it from boxing, I talked to Dr. Casson earlier, and
we know boxing has that damage by Harold Ford Patterson
suffered from it, Muhammad Ali suffers from it, and we
shouldn't put our athletes who are our heros, in many cases, in
this type of harm's way if we can protect them by seeing that
the medical attention they receive is independent, that it is
cautionary, and that the helmets are the best that can be--and
other equipment is the best to protect them from injuries, we
need to do that.
This Committee and the hearings we've had have made a
difference, I think, in the NFL on this issue, and I appreciate
the NFL and Mr. Goodell for taking the positions they've done
since. There are other things we can do with the committee and
bring the attention of America to different problems, and I
don't want to divert much but the NBA's one-and-done rule is
the situation where the ownership uses the players for a year
and takes away the earning capacity for a year from players who
could be making money in the short earning capacity they have
because the owners have a vested interest, and Commissioner
Stern was honest about it, he said we do this for the good of
the team, for the good of the league, not for the good of the
players, and in this situation in football, I think
Commissioner Goodell has shown some interest in the players,
but, nevertheless, there's some, maybe, concern of some
lawsuits or what do we know and when did we know it, and that
should be secondary to the health of the NFL players and the
college players, and the kiddie league players and the high
school players, which we all need to be concerned about.
We ask motorcycle, in most states, riders to have helmets
and most folks to wear seat belts because we know that they
could be injured, and while we don't want to have touch
football, we want to have equipment that at least gives, you
know, utmost scientific research and development to protect the
players from serious injuries.
I look forward to the testimony. I've read much about the
different studies in the past, the work at UNC and the
University of Michigan and EU, and I look forward to the
testimony, and as a fan of the NFL and a fan of athletes, I
want to see the athletes come first. I think the owners owe it
to them, and I think the owners have not looked after the
players as they should have in the past.
Mr. Chairman, I thank you for the opportunity to be with
you to be in the great city of Detroit--that is, as Motown, as
we have stats that share Ben Hooks and Kenneth Whalum with our
cities of Memphis and Detroit, and that has a great NFL
football team--a great NFL football history. Thank you, Mr.
Mr. Conyers. Your qualification has been duly noted, and
most of us agree with it. We have a distinguished panel, and
other Members will be able to submit their statements--other
material can be submitted by all of the panelists here. We have
Vin Ferrara, founder of Xenith, L.L.C., Harvard graduate; David
Halstead, Technical Director of Southern Impact Research
Center; we have Dan Arment, President of Riddell, Dr. Ira
Casson, neurologist at the Long Island Medical Center; Dr.
Bennet Omalu; we have Lem Barney, three-time conference star,
quite an impressive record; Scott Hallenbeck, who led USA
Football, the governing body of America's favorite sport on
youth and amateur levels since the year 2005; Bob Colgate, the
Assistant Director of the National Federation of State High
School Associations; Dr. David Klossner, Associate Director of
Education Services, the National Collegiate Athletic
Association; Dr. Joseph Maroon, Certified Clinical Professor of
Neurological Surgery, the University of Pittsburgh Medical
Center; and DeMaurice Smith, Executive Director of the National
Football Players Association, who received his degree from
University--Cedarville University of Ohio. He began his career
in the U.S. Attorney's office for the District of Columbia,
responsible for national security issues, earned numerous
honors throughout his career, and in March 2009 was elected
executive director of the NFLPA.
One of his biggest challenges is negotiating with the NFL
owners who opted out of the current collective bargaining
agreement and also feeling the rift between union--the union
and its retired players. He recently announced the creation of
a committee within his organization to examine concussions and
their effects on sports.
We're delighted to have all of the witnesses here. Their
statements will be reproduced in the record, and we want to
begin the discussion with them, and of course, we start off
with Attorney DeMaurice Smith. Welcome to these hearings.
TESTIMONY OF DeMAURICE SMITH, EXECUTIVE DIRECTOR, NFL PLAYERS
Mr. Smith. Thank you, Chairman. It's a pleasure to be back
in front of the Judiciary Committee and also to be in this
great state and this great city. I'd also like to say good
afternoon to Congresswoman Sanchez, Congressman Conyers, and
Congressman Cohen. I have to apologize for my voice. Everybody
here will have to suffer through this as my family continues
to. They're very happy that I'm not at home today.
Mr. Conyers. Pull the mike a little closer, please.
Mr. Smith. It's not going to make it sound any better but--
Good afternoon. As I've testified before, I represent
players, both current and former of the National Football
League. Please accept our deepest gratitude for shining the
national spotlight on the issue of concussions and brain trauma
in football. To answer your question, Congresswoman Sanchez,
you did make a difference. Congress made a difference. By
shining its spotlight and its attention on this issue, you have
achieved a significant amount of change in a few short weeks.
I'm happy to talk about a number of the changes that the
National Football League has instituted, as well as a number of
programs and changes that the players have taken over the last
several weeks. In conjunction with this Committee, we have made
strides each and every day to make this game safer for those
who play football on a professional level, for those who play
in college, and for the many players who play in youth sports.
During the next few minutes, I'd just like to outline a
couple of the steps that we mentioned during our--my last
testimony to give you an update of where we are and where we
hope to be. During the October 28th hearing, we agreed to do
the following and have provided you with written testimony on
our status and our progress.
First: We promised to objectively and honestly embrace all
of the studies related to the issue of traumatic brain injury
and to create a roadmap to prevent significant and serious
injury for football players going forward. In May of this year,
the players of the National Football League formed its own
players' concussion committee. That committee was designed to
do one thing: To get the answer right. That committee, I am
proud to say, was not formed by the executive director. It was
formed by a player of the National Football League, Sean Morey,
who was a special-teamer with the Arizona Cardinals, met with
me in the executive committee, and he was committed to do one
thing, to get the answer right. He challenged each and every
player on that executive committee to get the answer right.
We proudly formed that committee, and many of the people
who are on the panel today, including Dr. Omalu, Dr. Nowinski,
have agreed to serve on that committee. We will strive to do
one simple thing, to get the answer right.
Second: To verify the scientific relevancy of the ongoing
studies regarding current and former players. In an attempt to
verify the scientific relevancy of the current and previous
studies, we have asked, and we, indeed, encourage the National
Football League to release to the players any and all
communications regarding studies surrounding head injuries in
football so that both of our organizations can be working with
the same information and can build upon the valuable research.
Third: We have renewed our request, as we have pointed out
to your staff, renewed the request for the NFL to provide the
injury data and the aggregate injury data that they collect
from every player in the National Football League from 2006 to
2008. We believe that that data would not only serve to improve
and enhance the ongoing studies, but also, it would serve to--
serve as a platform for new studies, not only in the area of
head injury, but also in the area of joint rehabilitation,
effects of the aging, and a myriad of other ailments that not
only plague professional football players and retired players,
but also players on every level.
We have committed ourselves to improving the 88 plan. The
NFL Players Association called upon the NFL, and I'm glad that
they responded, to accept new applicants for the 88 plan in the
NCAP year. I am proud to say that they have agreed to do so.
And lastly, we believe that the National Football League
and the players in this game owe an obligation not only to
those who have played this game, but to those who will play
this game in the future. You are right, the National Football
League is the standard bearer. If we set the standard, others
will follow. As Executive Director of the Players Association,
my primary goal is to serve the players who have played this
game and those who will play this game.
It is an honor for me to commend people like Sean Morey and
Kevin Mawae for forming the Players Concussion Committee. I
look forward to working with Dr. Tom Mayer and others on the
committee as we move forward to get the answer right to help
prevent these injuries where we can and to treat those injuries
where they occur.
Ladies and gentlemen of not only the panel but----
(Whereupon the lights in the auditorium went out at 1:33
Mr. Smith. You know, normally, I have that effect on----
(Whereupon the lights came back on at 1:33 p.m.)
Mr. Smith. Oh. Chairman Conyers, Congresswoman Sanchez, and
Congressman Cohen, on behalf of the players of the National
Football League and the retired players, I promise to do one
thing, to get this answer right, to come before you on each and
every opportunity when you have questions, and to serve the men
and the families of this great game. Thank you.
[The prepared statement of Mr. Smith follows:]
Prepared Statement of DeMaurice Smith
Mr. Conyers. Thank you very much. I think you're doing a
Mr. Smith. Thank you.
Mr. Conyers. The light went out just as a signal that you
were approaching near the end of our allotted time, a very
We know that you may have to leave early, so please take
our leave whenever you feel it appropriate.
Mr. Smith. Thank you.
Mr. Conyers. Welcome, Dr. Joseph Maroon, a neurological
surgery professor at University of Pittsburgh Medical Center.
In 1999, along with Joe Montana, Kareem Abdul-Jabbar, you were
inducted into the Lou Holtz Ohio Valley Hall of Fame for your
athletics, for your accomplishments and contributions to sports
and medicine. We're very pleased to have you here, and we note
that along with another neuropsychologist, Mark Lovell, Dr.
Mark Lovell, you developed the Immediate Postconcussion
Assessment and Cognitive Testing, the first computerized system
to deal with some of the problems that bring us here this
afternoon. We welcome you to the hearings.
TESTIMONY OF JOSEPH C. MAROON, M.D., PROFESSOR AND VICE-
CHAIRMAN, DEPARTMENT OF NEUROSURGERY, UNIVERSITY OF PITTSBURGH
Dr. Maroon. It's my great pleasure, Mr. Chairman, thank you
very much, and also Congressman Cohen and Congressman Sanchez,
I deeply appreciate your preliminary comments, specifically
speaking to be proactive and a catalyst for change, and I'm
going to address those issues later on in my discussion, but I
want to bring up, first, the fact that the MTBI Committee, the
Traumatic Brain Injury Committee of the NFL, was formed in 1994
after traumatic brain injuries to Al Toon for the New York Jets
and Merril Hoge for the Pittsburgh Steelers and also the
Chicago Bears, these gentlemen were both forced to retire
because of their head injuries in 1994.
It was at this time that Commissioner Tagliabue
commissioned the formation of the MTBI committee with the
express purpose of supporting independent, scientific research
to further the understanding of the causes, diagnosis,
treatment, and prevention of concussion as well as investigate
helmet standards and the long-term effects of concussion. That
was the mission statement in '94.
In this past October, I presented to you what was being
done from '94 to the present time relative to management of
concussions, and there were five things. Number one, I outlined
for you the educational efforts on behalf of the NFL with the
players, the coaches, the trainers, informing them of the
potential dangers of concussion. They also instituted
neurocognitive testing as a mandatory test, which I think
speaks for itself. There were stricter return-to-play
guidelines and, also, penalties and fines for head hits, as
well as a hotline for any individual in the NFL who feels he is
being coerced into playing can call the hotline and make it
known that this is inappropriate. Perhaps, that might have
helped in Texas, Congressman.
Regardless, I'm here today to show you and to illustrate
for you the additional steps that have been taken since our
last meeting relative to protection of players and, also, the
catalyst for change that the NFL hopes to be in the recent--
recent (sic) future. Number one, besides the criteria for
return to play that I outlined, being asymptomatic and normal
neurological examination and without symptoms on exertion, the
NFL Players Association with Mr. Smith and Commissioner Goodell
have formulated an independent neurological consultant as being
mandatory for the NFL teams. These are to be mutually approved
by the NFL Players Association and the NFL.
Number two, it's a two-way street. The NFL is doing a
considerable amount to initiate changes and educate the
players, but there's also a player responsibility in this, and
that is to report when they have concussions. And yes, I know
the motivating factors against that having participated in
football at the collegiate level, myself, and the fact that
concussions are difficult to diagnose, but we must make an
effort on the players to let the physicians and the team
personnel know when a concussion has occurred so that it can,
indeed, be addressed appropriately.
Third, aware that the NFL is, indeed, now the model for
concussion management in the United States, they're speaking to
Congressman Sanchez's dictum that with this awareness, with the
fact that it is a model of concussion management, how do we get
it to the 1.1 million high school kids in the United States and
the 3 million youth sport participants in the United States?
And to that end, recently in December, in conjunction with
the CDC, the NFL is working on public service announcements
that will be shown during the playoff games, as well as during
the regular season emphasizing to parents, coaches at the youth
league, and also the players, themselves, that concussions at
any level is a significant major problem.
Number four, because of the importance of head injuries in
the NFL, the commissioner is now strengthening and expanding
the membership of the MTBI committee, and the national search
is underway at the present time in the recruitment of a new
chairman and/or cochairman to continue the work of the
committee in a very, very unbiased, independent fashion.
Number six, in terms of equipment safety, in response to
the equipment managers who have complained that many different
equipment manufacturers come to them complaining that they all
say that their helmets reduce concussions by X percent or that
percent, the equipment managers wanted objective data just like
the impact test is an objective instrument when an athlete can
return to play, and the NFL, together with the NFLPA, is
working with engineers to grade, to look at, to evaluate
various helmets for their protective effect.
When I first started in sports medicine 20, 25 years ago
with the Pittsburgh Steelers, the incidence of concussions was
1 in 5 individuals. Every five players had a concussion during
the season. That incidence is now into 1 in 20 because of the
rules changes, the improvement in equipment, etcetera.
And then finally, working with John Madden as a special
adviser to the commissioner, we're looking at ways to cut down
on the head impacts, not only during the game with fines and
penalties, but also during practice, and in summary, then, the
NFL committee has long recognized the long-term effects of
I think the goal at the present time matches your goals.
That is, to make the game safer, to address the needs of
retired players, and also to set the right example for players,
coaches, and trainers at all levels, and not just for football.
It's said that in science, many, many scientific innovations
proceed through three stages. The first is confusion when a new
idea is introduced. The second is controversy, which we are all
familiar with, and then the four--the third is consensus, and I
think with the help of your Committee, the spotlight that Mr.
Smith emphasized you're shining on this problem, we are at a
point, in my opinion after 25 years in this, of consensus.
[The prepared statement of Dr. Maroon follows:]
Prepared Statement of Joseph C. Maroon
Mr. Conyers. Thank you very much, Doctor. David Klossner is
a doctor, but he's a Ph.D., and he is the associate director of
education services with the National Collegiate Athletic
Association with primary duties on health and safety aspects.
He's also a Liaison to the Committee on Competitive Safeguards
and Medical Aspects of Sports. He has a distinguished previous
career at DePaul, then at Bloomington, Indiana University prior
to completing his Doctorate in Philosophy from Ohio University.
Welcome this afternoon, sir.
TESTIMONY OF DAVID KLOSSNER, DIRECTOR,
HEALTH AND SAFETY, NCAA
Mr. Klossner. Thank you, Chairman Conyers, Congresswoman
Sanchez, and Congressman Cohen, and other distinguished guests
in attendance. On behalf of the National Collegiate Athletic
Association, thank you for inviting me to appear before you
today to discuss the NCAA's multifaceted approach in
preventing, identifying, and treating mild traumatic brain
injuries and concussions. I've been with the NCAA for 7 years.
I, as mentioned by Congressman Conyers, I served as liaison to
the NCAA's Membership Committee on Competitive Safeguards and
Medical Aspects of Sports, the committee charged with providing
leadership on health and safety recommendations to more than
1300 conferences, colleges, and universities that are members
of the association.
I appreciate the opportunity to respond to your request for
information on a critical medical issue at the core of student
athlete well-being. The NCAA and its membership have devoted
significant resources to study, educate, and enforce various
health and safety standards, including those in the area of
football related mild traumatic brain injury.
Chairman Conyers, you'll be interested in learning that
since we provided you with the response in October, the NCAA
has taken additional steps to further ensure student athlete
well-being, and I'll respond--expand upon those in a moment.
The NCAA's health and safety recommendations and policies are
addressed through the collaborative efforts of national office
staff, governance committees, sport playing rules committees,
sport issues committees, and external associations for our 23
Since 1976, the NCAA has warned against using the head as a
weapon in football and other contact sports, and for the past
15 years, the NCAA has provided member institutions with
specific recommendations regarding concussion management in its
sport medicine handbook. In the sport of football, the NCAA
football rules committee has made changes over the past 5 years
to further protect players against sustaining concussions.
As part of its ongoing review of concussions, the NCAA
committee on Competitive Safeguards and Medical Aspects of
Sports met on December 13th through the 15th, 2009, to discuss
the most recent developments in athletic related brain injury
and concussion. The committee reviewed the NCAA injury
surveillance data, current policies of the National Federation
of State High School Associations, the National Athletic
Trainers Association, and the National Football League, and
discussed findings of a recent expert conference related to
concussions conducted in Zurich, Switzerland.
During its meeting, the committee also consulted with
authorities who recommended possible courses of action. As an
outcome of this ongoing evaluation of concussions in all 23
NCAA sports, the committee determined that a common playing
rule is necessary to provide an emphasis on the significance of
head injuries, their prevalence, and the importance to refer
for appropriate medical care. This action is also accompanied
by a Concussion in Collegiate Sports Summit that will be held
in 2010 to review NCAA policies for medical management of
concussions and prevention strategies appropriate to the
collegiate environment and the NCAA membership at large.
In addition, the committee will lead a collaborative
educational initiative for coaches, officials, and student
athletes. The proposed playing rules subject to review by the
NCAA Playing Rules Oversight Panel as early as mid-January 2010
would mandate removing from competition and practice a student
athlete who exhibits signs, symptoms, or behaviors consistent
with a concussion. The proposed concussion rules enforce the
fundamental principle that the medical care and return-to-play
decisions for concussions are best handled at the local level
as with any other medical conditions.
Pending consideration of the rule change, the committee
also revised its guideline in the NCAA Sports Medicine
Handbook, advising member institutions on responses to
concussion injuries and procedures for returning student
athletes to competition or practice. The NCAA will produce a
video by fall 2010 to further educate student athletes about
the dangers of concussions and approve awareness of the issues
among coaches and game officials.
The NCAA sponsored Concussion in Collegiate Sports Summit
will also provide an opportunity to explore emerging trends in
medical management of concussions. On behalf of the NCAA and
its more than 400,000 student athletes, I would like to thank
Chairman Conyers for his leadership on this important matter.
Mild traumatic brain injuries have and continue to be a
significant concern to the NCAA and its membership. The NCAA's
long-standing and ongoing commitment to the health and safety
of its student athletes is reflected in the comprehensive
approach taken to address concerns in this specific injury.
We look forward to the continued work with medical
professionals and athletics personnel as we continue to search
for new and effective tools to prevent, identify, and treat
mild traumatic brain injuries. Thank you.
[The prepared statement of Mr. Klossner follows:]
Prepared Statement of David Klossner
Mr. Conyers. Thanks, Dr. Klossner.
Representing the National Federation of State High School
Associations is Bob Colgate, Assistant Director from
Indianapolis, Indiana, has a broad set of responsibilities
because, as I understand it, your jurisdiction covers all male
sports, female sports, football, wrestling, track and field,
golf, football, of course, and probably others.
He served as Liaison to the Federation's Sports Medicine
Advisory Committee, Wrestling Rules Committee, Football Rules
Committee, and the Sports Medicine Advisory Committee. We're
pleased that you could be with us today. Welcome.
TESTIMONY OF BOB COLGATE, ASSISTANT DIRECTOR, NATIONAL
FEDERATION OF STATE HIGH SCHOOL ASSOCIATIONS
Mr. Colgate. Thank you, Chairman Conyers and distinguished
Members of the Judiciary Committee for the opportunity to
testify today on this important issue. I am an Assistant
Director of the National Federation of State High School
Associations, the NFHS. In my work for the NFHS, I serve as the
editor and national rules interpreter for sports and football,
wrestling, and staff liaison for our NFHS Sports Medicine
Before further discussing head injuries, let me provide
some context on the role of the NFHS within the high school
community. The NFHS based in Indianapolis, Indiana, is the
national leadership organization for high school athletics and
performing arts programs in speech, debate, theater, and music.
Since 1920, the NFHS has worked with its member state
associations on the development of education based
interscholastic sports and fine arts activities.
The NFHS sets direction for the future by building
awareness and support, improving participation, establishing
consistent standards and rules for competition, and helping
those oversee high school sports and activities. The NFHS
writes voluntary playing rules for 17 sports for boys and girls
at the high school level. Through our 51-member state
associations, the NFHS reaches more than 19,000 high schools
and 11 million participants in activities, in high school
activities programs, including more than 7.5 million in high
school sports. The NFHS conducts national meetings, produces
publications for high school coaches, officials, athletic
directors, and serves as the national information resource for
interscholastic athletics and activities.
One of our critical functions is to obtain and disseminate
health and safety related information. The NFHS Sports Medicine
Advisory Committee, SMAC, is one facet of the federation that
addresses medical issues relevant to interscholastic athletics,
including concussions and concussion management. The membership
of the Sports Medicine Advisory Committee includes a number of
highly represented physicians and other healthcare providers
from around the country.
The SMAC makes recommendations to the NFHS staff and
membership about programs and services to the NFHS. The SMAC
regularly reviews the latest medical evidence regarding sports
related concussions in high school athletes. The past decade
has witnessed significant changes in the management of sports
related concussions as new research findings have been
As a result, the SMAC has worked with the Centers For
Disease Control, CDC, to disseminate concussion management
information from the CDC to our Nation's high schools. They've
updated the concussion section of our sports medicine handbook
and has issued a new NFHS brochure on suggested guidelines for
management of concussions in sports. The NFHS has made
concussion management a point of emphasis in rule books in
recent years. For example, in all rule books for the coming
academic year, the NFHS provides that any athlete who exhibits
signs, symptoms, or behaviors consistent with a concussion,
such as loss of consciousness, headache, dizziness, confusion,
or balance problems shall be immediately removed from the
contest and shall not return to play until cleared by an
appropriate healthcare professional.
The key concussion related issue for the NFHS is to help
high school coaches identify the signs and symptoms of
concussions so they can direct injured athletes to appropriate
healthcare professionals. We can help coaches with concussion
recognition. Toward that end, we have extensively circulated
printed and online educational materials. Our mission is to
continue this important educational process.
In summary, with more than seven and a half million
participants in high school sports, minimizing the risk of
injury has been and remains one of the chief tasks of our NFHS
rules committees. The NFHS Sports Medicine Handbook has a six-
page section on dealing with concussions. The third edition of
this handbook was distributed to virtually every high school in
the country during the 2008-9 school year. The SMAC was also
involved with producing the brochure I mentioned entitled
Suggested Guidelines For Management of Concussion In Sports.
The issue of concussions is a serious one, and our various
medical and sport professionals and experts have been reviewing
the subject for a number of years and will continue to monitor
developments, but we cannot mandate the adoption of specific
treatment protocols at the local level. We continue to provide
up-to-date resources to assist NFHS member state associations
and high schools in developing policies that are in the best
interests of the participants.
Minimizing the risk of injury for high school student
athletes has been a foremost priority of the NFHS rules writing
process and we'll continue to champion the task in years to
come. We would be happy to continue our assistance to the
Chairman and Members of the Committee on this issue. I look
forward to answering any questions and providing any additional
information you require. Thank you.
[The prepared statement of Mr. Colgate follows:]
Prepared Statement of Bob Colgate
Mr. Conyers. Thank you, Mr. Colgate.
Scott Hallenbeck has led USA Football, the national
governing body on this sport at the youth and amateur levels
since 2005. He covers all aspects, football development,
communications, corporate partnerships, membership programs,
and the organization has built senior and junior national teams
for international competition, produced industry leading
resources to further strengthen coaching and officiating within
America's football system, established a half-million-dollar-
per-year equipment and grant program, kicked off a
groundbreaking volunteer youth coach background check program
to ensure that we get as much positive football experience as
A couple years ago they established coaching, officiating,
and commission membership programs, including the certified
coaching education program which conducts 40 full-day youth
football coaching schools in more than 30 states. He's done a
great deal of work in this area, and he's President of the Pan
American Federation of Sports. Mr. Hallenbeck, we're pleased
that you're with us today.
TESTIMONY OF SCOTT HALLENBECK,
EXECUTIVE DIRECTOR OF USA FOOTBALL
Mr. Hallenbeck. Thank you very much. Thank you, Chairman
Conyers, Congresswoman Sanchez, and Congressman Cohen for
having me here today. Three million American youngsters, aged 6
to 14, and some 500,000 adult volunteers comprise youth
football, making it one of our country's most popular youth
sports. USA Football is the sports national governing body in
youth and amateur levels. We're an independent nonprofit with
members in all 50 states and the District of Columbia.
Our members are youth football coaches, players, league
commissioners, and game officials. We lead the sports
development and serve the youth football community. A critical
part of that leadership is the health and safety information we
provide, including our work with the CDC on concussion
USA Football has worked with the CDC for more than 2 years
to share concussion awareness information throughout youth
football, and we will do so with even greater emphasis in 2010.
I'd like to briefly share some background with you on youth
Youth football has likely never been stronger or more
popular than it is right now. Like most all youth sports, it is
dependent upon committed volunteers. The amount of time that
they have to learn how to teach this game's fundamentals and
techniques is limited. Youth football is fragmented.
Conservatively, 80 percent of leagues are independent and
With such variance in structure, football and every youth
sport needs clear, concise safety standards so that volunteers
can comprehend the critical information like concussion
awareness. This is what we're doing for football in partnership
with the CDC and others. We encourage youth sports leagues, not
only those pertaining to football, to adopt our CDC-approved
concussion awareness and management policy which is found in my
Succinctly stated, this covers educating athletes and
parents about concussion, informing coaches, parents and
athletes of concussion signs and symptoms, and what to do if a
concussion is even suspected. When in doubt, sit them out is a
CDC approved guideline that we stress. Just as important is an
athlete who endures a concussion can only return to play after
an appropriate healthcare professional clears his or her
return. In some, returning to play must be a medical decision.
This information is prominently posted on our website,
usafootball.com, and will be distributed to tens of thousands
of coaches during 85 training events in 27 states and through
our membership programs. Our events, online education programs,
and resources for coaches provide a strong knowledge base. No
physical activity is injury proof, but having coaches who know
how to teach tackling and blocking fundamentals would likely
lessen the chance of injury.
More than 26,000 youth coaches have completed our primary
online coaching course since May of 2008. By this coming April,
this eleven-chapter course will be bolstered with new chapters
on concussion awareness, athlete hydration, and even equipment
failure. Every chapter is followed by a quiz strengthening
comprehension, and that's the critical point, strengthening
comprehension. To successfully complete the course, a coach
must be reach a cumulative quiz score of 80 percent.
USA Football's commitment to keeping the sport safe is also
demonstrated through our equipment grant program. From this
past November through February of this year alone, we will
award a million dollars' worth of new helmets and other
football equipment to more than 800 youth and high school
programs in 44 states based on need and merit.
Concussion related legislation in youth sports exists. A
coalition of Washington State health providers and the CDC
helped pass a State law there this past May that mirrors much
of our suggested policy for youth leagues. The American College
of Sports Medicine has joined forces with that Washington
coalition to pass similar laws at State or Federal levels. USA
Football supports such legislation, and we hope that other
sports national governing bodies will join us. All youth sports
need to recognize the seriousness of concussions and the need
for further education among our coaches, the administrators,
game officials, athletes and parents.
I thank you, and I'd be happy to answer any questions at
[The prepared statement of Mr. Hallenbeck follows:]
Prepared Statement of Scott Hallenbeck
Mr. Conyers. Thanks, Mr. Hallenbeck.
Lem Barney, welcome.
Mr. Barney. Thank you.
Mr. Conyers. We've got so many stats on you.
Mr. Barney. Don't call them all.
Mr. Conyers. I'll just put--don't worry, I won't.
Mr. Barney. Love you, too.
Mr. Conyers. I'll put them all in the record. You've been
named all NFL in '68 and '69, all NFC in '72-'75, you are--have
been a double/triple threat, kickoff return, punt return,
interception, tailback. We'll let the record speak for itself.
We're glad that you're with us today, and we welcome any
reflections that you have on this important subject.
TESTIMONY OF LEMUEL BARNEY,
DETROIT LIONS HALL OF FAME PLAYER
Mr. Barney. Thank you very much for this great opportunity,
Representative Conyers, to Chairperson Sanchez, and to Chairman
Cohen, and to other members of the House Judiciary Committee,
to the panel, to my former teammates that's in attendance, and
to all the attendees, I am Lem Barney, and prior to becoming a
minister, I played professional football for the Detroit Lions
for 11 seasons and was inducted into the Professional Football
Hall of Fame in 1992. I began playing football in 1959 at
Sturgis Junior in San Bernadino, California. After playing high
school football in Gulfport, Mississippi, I attended Jackson
State University where I was three times all-SWAC player.
I thank you again for inviting me to testify at this
hearing. I also want to thank the Committee for bringing
awareness to the important issue of brain injuries in
professional football. When I played in the sixties and the
seventies, we did not have the same level of awareness that we
do now. And we would not--and I repeat--we should not repeat
the mistakes of the past. I played football for a total of 20
years, and concussions have always been a part of the game.
I've had several concussions myself. The first concussion
that I remember was the result of a knee from Rufus Mays of the
Cincinnati Bengals, six-nine, 285, a knee to the earhole of my
helmet while playing the game. I was out on the field for 20
minutes before moving to the sideline and later returning to
The next concussion that I recall was the result of me
becoming privy to the high-knee action that made Gale Sayers
the running back that we all know today, and the final
concussion that I remember was from Robert Newhouse of the
Dallas Cowboys, known for his powerful running style. In each
incident, I returned to play immediately.
Sure, there was examination done by the trainer or the team
physician on the sideline, and there were general questions I
asked of players that experienced concussions, questions like
``How many fingers am I holding up,'' and ``What day of the
week is it,'' but in reality, the ultimate decision to return
to the game rested on the desire of the player and sometimes
Hindsight tells us that we should not have returned to play
based on those factors alone. New research into the effects of
these injuries tell us that returning to play may not have been
in our best interests and more than likely made us more
susceptible to further injury. Back then, as I'm sure the case
for some players now, guys just wanted to play the game. I have
witnessed guys return to the game and seeing firsthand how they
reacted to their injury. Players would exhibit signs of
wooziness and imbalance but still in some instances be allowed
to retake the field.
As I said before, hindsight tells us that those players
would have probably been better off not returning. Thankfully,
the decision is moving closer to the hands of an independent
third party. The committee of the National Football League
Players Association should be applauded for raising the public
awareness of this issue, and in particularly, I want to note
that the Players Association's new Player Concussions Committee
will ensure the future of generations of players and provide
with them the knowledge to make the best possible decision.
I am delighted and encouraged to see players taking the
initiative and exerting control over their personal welfare. I
would also like to commend the NFL on the league's new policy
to restrict the return of players who have experienced
concussions and other brain injuries. Football is a great
sport, and was--I repeat--was one of my favorite passions. But
no sport should endanger the lives of its participants. This
holds true for all levels of football from pee wees to
I have never coached a game of football, but I have played
the game on every level, including seven Pro Bowl appearances.
On the way to becoming a member of the National Football League
Hall of Fame, since my playing days, I've noticed continual
improvements in the equipment used by players on the fields.
Helmets used in my days were little more than a thin plastic
layer with a small donut shaped piece of foam rubber at the
And I've brought these two helmets, Pro Bowl helmets, as an
example for you to examine today for yourself. Today's helmet
is much more protecting for the players enduring the games and
competition. I recognize that in today's game, the athletes are
bigger, stronger, faster, and in some cases more intelligent.
As a result of the hits, they are harder and the impact from
each hit is greater. With much research into the way to protect
the players, we can continue to enjoy this game for years to
Thank you again for your hard work on this issue and
inviting me to be here at this hearing. I'll look forward to
answering any questions that you may have. Thank you very much.
[The prepared statement of Mr. Barney follows:]
Prepared Statement of Lemuel Barney
Mr. Conyers. Thank you very much, Lem Barney.
Our next witness is Dr. Bennet Omalu who discovered and
named chronic traumatic encephalopathy in American football,
and not only among football players but wrestlers, as well. His
first case of CTE in a football player was Mike Webster, the
Pittsburgh Steelers Hall of Famer who died in 2002. His first
case of CTE in a wrestler was Chris Benoit, a World Wrestling
Entertainment Champion who died in the year 2007.
Dr. Omalu has also identified CTE in an 18-year-old high
school player who died in 2006 10 days after following
concussions sustained while he was playing football. He's
examined the largest number of brains of deceased professional
and amateur athletes with CTE in the United States. His book
Play Hard, Die Young, Football Dementia, Depression and Death,
he's published extensively in the medical literature field. He
has four board certifications, a Master's in Public Health and
Epidemiology, a Master's in Business Administration, a visiting
professor at the Blanchette Rockefeller Neurosciences
Institute, a Co-Director of Brain Injury Research Institute, an
Associate Clinical Professor of Pathology at the University of
California - Davis, and Chief Medical Examiner with San Joaquin
Valley County in California.
We're delighted to have you, sir, with us today, and we
welcome you for your testimony.
TESTIMONY OF BENNET I. OMALU, M.D., CO-DIRECTOR, BRAIN INJURY
RESEARCH INSTITUTE, WEST VIRGINIA UNIVERSITY
Dr. Omalu. Thank you, Chairman Conyers, and good afternoon,
everybody. Good afternoon, Chairman Conyers, Congresswoman
Sanchez, and Congressman Cohen.
I discovered the first eight cases of footballer's dementia
in football players between 2002 and 2008. My first case was
Pittsburgh Steelers Hall of Famer, Mike Webster, whose life
after retirement was marred by progressive symptoms of
permanent brain damage. Surprisingly, his brain at autopsy
appeared normal by naked-eye examination.
I performed extensive tissue analysis which revealed a
unique type of dementia. As you can see from the following
slides, a microscopic image on the right is Mike Webster's
brain. You can see the brown blotches which indicate brain
damage. That was his brain appeared normal, even on CT scan and
The image on the left is that of a normal brain. This
instigated my definition of a new disease in football players
which I called chronic traumatic encephalopathy, CTE for short.
Since Mike Webster, my colleague and I, Dr. Julian Bailes, have
examined over 20 brains of amateur and professional contact
sports athletes at the Brain Injury Research Institute, West
Virginia University School of Medicine. We have identified CTE
in many football players, including an 18-year-old high school
We have also identified CTE in two WWE wrestlers. I have
identified CTE changes in the brain of a Vietnam War veteran
diagnosed with lingering posttraumatic stress disorder which,
hopefully, should be published soon in the Stars and Stripes. I
have examined thousands of brains of sufferers of all types of
brain injuries, including brains of high school students,
football players who died from brain injury sustained while
The current focus has primarily been on concussions and has
remained on concussions, while we are not recognizing
subconcussions. A concussion may present one end of the
spectrum of mild traumatic brain injury; however,
subconcussions or blows to the head which may not manifest with
incapacitating symptoms are equally as important as
concussions. For every one documented concussion, there may be
tens to hundreds of subconcussions. Thousands of subconcussions
without any documented concussion can equally result in
permanent brain damage and dementia in football players and
other individuals at risk for brain injury such as members of
the Armed Forces.
We must also consider the neuropathology of traumatic brain
injury while developing management protocols for concussions.
Concussions result in the accumulation of certain types of
proteins in the brain. For example, amyloid precursor protein,
APP for short. APP begins to accumulate noticeably in brain
cells and their fibers about one to 3 hours following a
concussion. APP disappears from the brain after about 3 months
following a a concussion.
While a concussed player may be symptom free, several weeks
after sustaining a concussion, APP accumulation in the brain
will tell us that a concussed player's brain cells may not have
recovered after several weeks. Would 1 week, 2 weeks, or even
several weeks be sufficient postinjury intervals for the
concussed player to return to play and prevent permanent brain
The human brain becomes fully developed at the age of 18,
injury to the developing brain of a child is more likely to
result in more serious adverse outcomes than a developed adult
brain. The brain cells of children who play football are more
vulnerable to subconcussions and concussions. A child who plays
football can be precluded from obtaining the full capacity of
his cognitive and intellectual functioning as an adult. How can
we translate and apply this piece of information to the
administration and management of football in children?
Rules changes may mitigate the prevalence of subconcussions
and concussions. Unfortunately, it seems less likely that
impacts to the head may be completely avoided in the game of
football. The ultimate focus, therefore, should be on the
development of biomarkers and the identification of drugs which
will prevent and cure CTE and other sequelae of subconcussions
We have identified proteins which accumulate in the brains
of CTE sufferers. We also have noted proteins, which accumulate
in the brain following subconcussions and concussions. There
are existing drugs which we know can prevent the accumulations
of these abnormal proteins. If we can prevent the formation and
accumulation of these abnormal proteins, there is a high
scientific probability that we can cure CTE and other sequelae
of subconcussions and concussions.
We should focus on developing a battery of biomarkers in
clinical pathology for subconcussions, concussions, and CTE.
Decades ago, we did not have biomarkers which were specific for
heart attacks in clinical pathology. Today, fortunately, we
have a specific diagnostic marker for heart attacks called
Troponin-I. There is no reason why a similar model cannot be
developed for the diagnosis and treatment of subconcussions,
concussions, and CTE in football players.
Thank you for allowing me to speak with you, and I'm very
happy and excited to be here today.
[The prepared statement of Dr. Omalu follows:]
Prepared Statement of Bennet I. Omalu
Mr. Conyers. Thank you very much, Dr. Omalu.
We now welcome Dr. Ira Casson, a neurologist at the Long
Island Jewish Medical Center, Former Co-Chairman of the
National Football Leagues' Mild Traumatic Brain Injury
Committee. He's a graduate of the New York University Medical
School, and finished his residency there at the same place in
1979. We're delighted that you can be with us, sir.
TESTIMONY OF IRA R. CASSON, M.D., FORMER CO-CHAIRMAN, NFL MILD
TRAUMATIC BRAIN INJURY COMMITTEE
Dr. Casson. Thank you. I want to thank the Committee for
inviting me to participate in this hearing. I will directly
address the issue in question, namely, whether or not a career
in professional football causes long-term chronic brain damage.
The media has consistently misrepresented my position. My
position is that there is not enough valid, reliable, or
objective scientific evidence at present to determine whether
or not repeat head impacts in professional football result in
long-term brain damage. Many have misunderstood my caution in
jumping to conclusions without convincing scientific evidence
as a denial of a link between head impact and long-term
Since I understand the link in boxing, I've been acutely
sensitive to look into connections in football. I believe that
there is tau pathology in the brains of some retired
professional football players and that a number of retired NFL
players have neurological and behavioral, psychological
As a physician, I am very concerned about the possible
long-term implications of these findings for the health and
safety of NFL players. I sympathize with the players and the
families who are affected. As physicians and scientists, it
behoves us to critically evaluate the evidence before reaching
definitive conclusions. We must always remember the fundamental
principle of evidence that the presence of an association does
not establish causation.
When tau deposition in the brains of retired NFL players
was reported, the NFL MTBI committee examined the evidence in
great deal. We reviewed the relevant scientific literature. I
took the initiative on behalf of the MTBI committee to consult
with nationally known experts on tau pathology. Based upon
these rigorous scientific analyses and consultations, I believe
that there are a number of significant limitations and
inconsistencies in the reports of tau deposition. I have
detailed these in my written statement.
For example, tau pathology is not exclusive to head trauma.
Tau deposition is the predominant pathology in a number of
other neurologic diseases that have never been linked to
athletics or head trauma. Some of these diseases have genetic
causes, some have environmental toxic causes, and others are
still of unknown cause. The clinical picture of these other tau
diseases is also completely different than that that has been
reported in the cases by Dr. McKee and Dr. Omalu.
Since tau pathology has been reported in men who played
college football but never played professional football and
even an 18-year-old high school athlete, we must consider the
possibility that some event or events, possibly head trauma,
occurring in childhood or adolescence is an important causative
factor in its development. It is also very hard to imagine how
tau in the lower regions of the spinal cord could possibly be
related to head impacts.
I have also analyzed the three survey studies that
purportedly show a connection between professional football and
late onset dementia and depression. These types of survey
studies suffer from many inherent methodological limitations
that I have detailed in my written statement. I was the lead
author of a landmark paper on brain damage in modern boxers
that was published in JAMA in 1984. Despite harsh criticism
from the boxing community, I followed the evidence, and I
published the findings. Despite current harsh criticism from
the media and others, I will continue to follow the evidence.
My allegiance is to scientific truth.
Some have suggested that scientific evidence regarding the
question at hand is conclusive and that there's no need for
further research. I strongly disagree with that position. In
the present state, we have a tau pathology condition that can
only be diagnosed after death. When treatments aimed at curbing
tau deposition become available, how will physicians know
which, if any, football players might benefit from these
treatments while they are alive?
We need further scientific research to discover in vivo
means of diagnosing tau buildup. In the present state, many
assume that all football players with symptoms of depression or
dementia have these as a result of tau pathology. This ignores
all of the other conditions and diseases that are associated
with dementia and/or depression in the general population. Such
thinking does retired players a disservice by not considering
the possibility that their symptoms may be related to treatable
or otherwise manageable conditions rather than a condition
which will inexorably lead to deterioration.
At present, many assume that head injury is the only
possible cause of this tau deposition. If we ignore the
possibilities that genetic, environmental, or toxic factors may
play a role in the development of tau deposition, we may
overlook strategies that ultimately can prevent its occurrence.
I believe that studies like the NFL Retired Players Study are
the most effective way to investigate the possibility that
professional football causes chronic brain dysfunction.
The NFL Retired Players Study has been derailed by
unwarranted and inaccurate media and political attacks. I hope
that this important study will ultimately withstand this
hostile environment and continue on to completion. If that does
not occur, the wealth of clinical information that has already
been collected from the more than 40 subjects who've been
thoroughly evaluated should be reported in the medical
My primary goal has always been to advance the scientific
and medical knowledge of concussions, thereby improving the
health and safety of NFL players. Toward that end, I made a
number of recommendations for further scientific research in my
written statement. Thank you, and I'll be glad to answer any
[The prepared statement of Dr. Casson follows:]
Prepared Statement of Ira R. Casson
Mr. Conyers. Thank you very much, Dr. Casson.
Our next witness is the president of Riddell, Mr. Dan
Arment. He's a Colgate graduate, played for the Colgate Raiders
as an outside linebacker for 4 years, has served as vice-
president of national sales for a number of companies, and has
a broad consumer marketing experience.
He joined Bell Sports in 2001 as vice-president, has
previously served as Easton-Bell Sports Executive Vice-
President and General Manager. Mr. Arment, we welcome you here
TESTIMONY OF DAN ARMENT, ASSISTANT DIRECTOR, NATIONAL
FEDERATION OF STATE HIGH SCHOOL ASSOCIATIONS
Mr. Arment. Thank you, Mr. Chairman.
Mr. Conyers. Pull it closer.
Mr. Arment. Again, thank you, Mr. Chairman, and Members of
the Judiciary Committee for the opportunity to speak today.
For more than 70 years Riddell has passionately been at the
forefront of providing state-of-the-art helmet technology and
will continue to be in the future. That commitment is
demonstrated to Riddell's parent company, Easton-Bell Sports
where company researchers across all of its brands, Easton,
Bell, Giro, and Riddell are constantly collaborating on the
latest in head protection innovation. Riddell has significant
partnerships with the NFL, the NFLPA, USA Football and American
Youth Football. We have also collaborated with high-profile
athletes and equipment managers at all levels and the sports
medicine community to maintain the highest levels of helmet
technology and advancement.
I understand that some will suggest that there has been
little advancement made in football helmet technology. In fact,
with the Riddell Revolution, the first helmet designed with the
intent of reducing the risk of concussion, was introduced in
2002, it was the first major innovation in this direction for
football helmets in 25 years. We have independent, peer-
reviewed, published research in the medical journal
Neurosurgery, February of 2006, showing that the Revolution
reduces the risks of concussions by 31 percent when compared to
As the market leader, we have always felt we have an
obligation, not just as a business but in the public interest,
to collaborate where possible and maintain the highest standard
of innovation and research that has continued to stand the test
of time, scrutiny, and independent research for nearly anyone
with interest in the issue. Today, over one million high
school, college, and professional players have made the switch
from traditional helmets to the Revolution family of helmets.
The introductions of the Revolution Speed, Revolution IQ,
and its technology are additional examples of Riddell's
constant evaluation for potential new technologies in order to
advance our mission of making the most protective products in
the game, enhancing performance for players at all levels. That
is a track record of innovation and demonstrated commitment to
science and technology yet to be matched by any competitor.
Regarding Riddell's relationship with the NFL, my
counterpart, Mr. Ferrara, will imply that the NFL's current
testing process has been somehow biased due to its licensing
relationship with Riddell. We want to be very clear that any
such insinuation is without any merit, whatsoever. Riddell had
absolutely no role in the selection of the test facilities or
involvement in any way in the actual tests recently conducted
by the league. Riddell was made aware of the preliminary test
results on December 15th, as were all other manufacturers.
It is important to note that despite read Riddell's
licensing relationship with the NFL, players are not mandated
to wear Riddell helmets. Each player may work with their team's
equipment manager to choose their own helmet from any
manufacturer. As such, Riddell has worked closely with the NFL
and the NFL Players Association to provide education on the
various protection and performance features of our helmets.
We need our paid players to wear our product and will
receive any endorsements from players, staff or team. As such,
it should be noted that Riddell helmets are the helmet of
choice by approximately 80 percent of the league's players. We
will continue to work closely with the NFL and NFLPA to ensure
our innovation and technology provides the very best protection
possible and maintains their trust in our helmets.
Thank you very much for your time.
Mr. Conyers. Thank you very much, Mr. Arment.
Our next witness is David Halstead, technical director of
the Southern Impact Research Center responsible for the
technical and scientific actions of the A2LA Accredited Test
Lab, as well as overseeing the technical aspects of all
testing, consulting, and other services provided by SIRC staff.
He's an expert in the field of head injury and helmets.
We have a long bio here, but the development of new
machinery drew his attention to it, and he was hired to head of
Firefighters Equipment Manufacturers Protective Clothing
Division in New Jersey. He became involved with helmet projects
in that New Jersey company, and he's immersed himself in the
study of sports helmetry and head injury. He's also worked
closely with Dr. Hoshin at Wayne State University and has
become involved with several committees involved with head gear
and brain injury. We welcome you to these proceedings, Mr.
TESTIMONY OF P. DAVID HALSTEAD, TECHNICAL DIRECTOR, SOUTHERN
IMPACT RESEARCH CENTER
Mr. Halstead. Thank you, Mr. Chairman. Thank you, Members
of the Committee; I appreciate the opportunity to be here today
and address the Committee.
My name is Dave Halstead, and I teach at the University of
Tennessee. I also direct the university's sports and
biomechanics impact research laboratory. I am Technical
Director of the Southern Impact Research Center, which is an
independent accredited laboratory, and have a variety of
responsibilities with various helmet committees. I am chairman
of the American Society of Testing Committee For Headgear. I'm
also a Technical Adviser to the National Operating Committee
For Standards in Athletic Equipment. I'd like to tell you that
I'm not here representing either one of those groups today. The
testing that we did on behalf of the NFL is not ASTM testing,
and it is not NOC-SAE testing, nor were they involved in that
I have for about 25 years worked on trying to understand
brain injuries and how protective products might be used to
mitigate them. The most recent testing, which I guess I'd like
to discuss for the benefit of the Committee, it was based on
1990's data collected by the National Football League in which
they used film analysis to understand how players were
impacted, the velocities involved, and the impact locations
involved. That data was published back in the nineties, and
recently, helmet manufacturers made some claims about whether
their helmets worked better, and I think a very reasonable
question was asked and that question was asked do they work
So the NFL contacted me. I guess in the interests of full
disclosure, I should tell you that I have worked with the NFL
Players Association, I have worked for every helmet
manufacturer in the United States, if not in the world
probably. I don't think that makes me biased in any way. The
gentlemen on each side of me are helmet manufacturers, and I've
worked with both of them. In any case, the work in this case
involved one additional laboratory from Canada, myself, and
some guidance from Dr. David Viano who does, I believe, teach
here at Wayne State and who certainly has served with the NFL
in the past.
The job was really quite simple, and it was very complex if
you want to get into the details of testing, but the concept
was simple. Take old helmets off the field that were at least
10 years old, helmets that were being used when the original
NFL study was undertaken, and test them using the new test
method, new being developed quite specifically in the last 5
years, or so, called the linear impacter to deliver impacts to
the helmet in different locations at different speeds in
The whole idea of testing the old helmets was to compare
whether the new helmets performed better or worse or the same
as helmets that were in use when the NFL did its original
study, but that has not yet been formalized. As the test
laboratory, I'm only familiar with my data. The other test
laboratory and I have not shared data, but the standard
deviation or the difference, if you will, between one test
lab's results and the other seem to be very, very close.
I can tell you that the selection of the helmets, the
selection of the impact location is completely unbiased. The
data did show some very interesting things. The data will not
be released until March. I'm not here to discuss the details of
the data, but I can tell you that several helmets did, in fact,
perform better than the baseline 10-year-old helmets, some
helmets did not perform any better, and some did not perform as
With that said, I'm not sure how this data will be used,
and that is my biggest concern. I believe the data to be valid,
I believe it to be reliable, I believe it will lead to some
statistically relevant inclusions about how the helmets
performed. My concern is that the data would be used, perhaps,
I'm not sure that better performance on this test results
in a significant change in player protection. I do think
helmets that manage energy better are a good thing, but the
direct correlation between how they perform and how a player
may end up injured or not is still somewhat missing, and I
think that that link has to be connected.
Even more importantly, I'm afraid that the general
consensus of what's good for the NFL is good for the rest of
the playing world at all levels is probably not correct. I
think that as helmets get larger and heavier given the
materials in use today, we don't have any magic materials that
will do the same amount of work in less space, so given that
the helmets get larger and heavier, this may not be a concern
for a football player at the NFL level, but it is certainly a
concern for my 9 year old, and just because the NFL decides to
use a certain helmet or use a certain protocol to help
determine which helmets should be on the field, which I can
certainly get behind, having that trickle down and
automatically become well, the NFL uses it, it must be the best
one, and you're not using it, I think that's a real big concern
that could hurt the sport.
So how the data is used and how the data is disseminated is
yet to be determined; I'm not part of that. It's a concern I
have that the validity of the data, however, I have no doubt
about. It does accurately reflect how these helmets perform in
that test scenario, and I'd be glad to answer any questions if
they should arise.
[The prepared statement of Mr. Halstead follows:]
Prepared Statement of P. David Halstead
Mr. Conyers. Thank you for your testimony.
Our final witness in this panel is Vincent Ferrara, founder
of Xenith Company that develops helmet technology and sells
helmets. He, himself, was a football player at Harvard
undergrad. He received his M.D. From Harvard, and then an
M.B.A. From Columbia. We're happy to have you here on the
TESTIMONY OF VINCENT R. FERRARA, FOUNDER AND CEO, XENITH,
Dr. Ferrara. Thank you, sir. Good afternoon, my name is Vin
Ferrara. I'm the founder and CEO of Xenith, manufacturer of the
X1 football helmet.
After playing quarterback at Harvard and graduating from
the medical and business schools at Columbia University, I
founded Xenith in 2004 with the goal of addressing the
concussion issue for a blend of innovation and education. I've
experienced concussions myself, and I know players who have
been debilitated by them. I have four young children who play
sports in which concussion is a risk. I feel I understand this
problem and I certainly care about solving it.
At the last Congressional hearing, it was revealed that the
NFL's Concussion Committee was performing yet more research,
this time on helmet testing. The reaction to this testing from
leading experts has included phrases like, ``terrible stuff,''
``very bad,'' and ``should never happen.'' I will try and
explain this reaction.
First and foremost, Riddell is the official helmet of the
NFL. For the past 20 years, this deal, which was just renewed
in August just before the helmet testing started, has
overwhelmingly steered players into Riddell helmets based on
financially driven quotas and royalty famous to the league.
This deal also mandates that the logos of non-Riddell helmets
be covered up or pried off.
Given this conflict of interest and given the league's
track record on concussion research, the very concept of the
NFL performing independent helmet testing is inconceivable. The
NFL's testing protocol, which I would argue is highly unusual
and nonreproducible, is based upon a minute number of extreme,
illegal, open field, helmet-to-helmet impacts that should never
have happened in the first place and should be a thing of the
The league's preferred testing apparatus called the linear
impactor, which you saw in the video before, is not an official
standard, has no uniform basis for construction, and was
created using Riddell helmets in one of the labs doing the
testing with the lead technician listed as an inventor on
Riddell patents. We're going to see the testing here.
Thus, these tests and products or products designed to
mimic them, are linked in a biased way, much of the same way a
test for, quote/unquote, intelligence would be biased in favor
of those used to design it or those who are similar. Regardless
of its results, this test would not provide any meaningful
information on intelligence, and the NFL's test will not
provide any meaningful information on the risk--on reducing the
risk of concussion.
In fact, the measures taken in this testing are some of the
same measures that Dr. David Viano, who just resigned as Co-
Chairman of the NFL's Concussion Committee, yet, is still
running the testing, suggest should be abolished in a 2003
conference publication. The existing standard organization,
NOCSAE, for which David Halstead serves as technical director,
explicitly forbids numerical comparisons because the numbers
don't correlate to any particular injury risk. Simply put, a
crash test dummy cannot tell you it has blurry vision, chronic
headaches, or can't remember the play.
Designing for a test is not difficult, it has been done for
decades. The lab tests and player feedback are often not in
sync. We have, at times, deliberately made choices in
opposition to machine data based on player feedback. Our
approach is to address the potential damage of repeated impacts
which Dr. Omalu spoke of, while offering comparable protection
at the rare extreme.
We're confident in our product, and while we will always
seek improvements, we don't plan on changing our helmet based
on the NFL's tests. However, NFL equipment manufacturers will
make and some have already made critical safety decisions based
on words that at worst, are biased, and at best, don't mean
anything. These decisions will trickle down to the college,
high school, and youth levels. Do the individuals responsible
for this testing or those in the NFL who failed to stop it
actually want to incur the potential liability associated with
I would like the Committee to note that we have offered to
the NFL Players Association as many helmets as needed at no
charge to do player-based comparisons of helmet features, which
would yield useful information. This is something I don't
believe any other helmet manufacturer has done. But the NFL has
shown no interest in this. And by the NFL, I mean Dr. Elliott
Pellman, longtime Chairman of the NFL's Concussion Committee,
lead author on the NFL's concussion research publications. Dr.
Pellman maintains the role as, essentially, the league's
singular voice on player safety and actually stated to a group
of helmet manufacturers that gathering player data was,
``difficult to do, and we need to do something quickly.''
I believe that when things are done quickly, there's a high
likelihood they will be done wrong. I believe the NFL should
not be in the business of concussion research or helmet testing
and should not have an official helmet. I believe that the
concussion issue can be addressed through a blend of innovation
I sincerely appreciate the invitation of Chairman Conyers
and the House Judiciary Committee. This story is not just about
football helmets. What protects football players today may
protect soldiers and first responders tomorrow, or it may yield
better innovations in the future. This story is ultimately
about innovation and the government's role in fostering it in
an effort to advance the safety of activity and health of your
constituents. Thank you for the opportunity to share this
[The prepared statement of Dr. Ferrara follows:]
Prepared Statement of Vincent R. Ferrara
Mr. Conyers. Thank you very much, Doctor, and to all of our
panelists, we're indebted to you all. There are some questions
that we would like to put to some of you. If Linda Sanchez is
sufficiently recovered, I'll recognize her for questions.
Ms. Sanchez. I will do my best, Mr. Chairman.
I have a lot of questions for many of you, so I'm going to
try and get through these as quickly as I can, and I'm going to
start with Dr.--is it pronounced Maroon like the color?
Dr. Maroon. Yes.
Ms. Sanchez. Yeah, it's Maroon, and I don't mean to
necessarily pick on you, but I was struck by a portion of your
testimony, and I'm going to read from the written testimony,
you stated, and I wanted to follow up: ``Our committee--''
meaning the MTI committee ``--together with the NFL has long
recognized that concussions can lead to long-term health
issues, especially if they are not properly managed,'' and I
would dispute that sentence that it's been ``long recognized''
because it seems to me that the NFL has literally been dragging
its feet on this issue until the last couple of years when it
came under increased scrutiny.
And this is why I say that: The committee and even the
name, itself, mild traumatic brain injury, suggests a
downplaying of the dangers. I would assert that there's nothing
mild about traumatic brain injury, but I'm a layperson and not
a doctor, and that may be a specific medical term. But the
committee was comprised in 1994, specifically, you stated, due
to concussions from several players that ended their careers.
And yet, as early as 2005, there was paper published in
Neuropsychology saying that it might be okay, it might be safe
for high school players who've had a concussion to go back into
the game, and it took until 2009 for the NFL to impose the new
rules that if you get a concussion in the game you don't go
back in to that same game. That's about 16 years in my
estimation, 15 years, at least, give or take.
Why do you think it took that long for the NFL to bring
about these rule changes, or am I just, you know, being crazy,
that 15 years is a short amount of time?
Dr. Maroon. Well, I wouldn't suggest that you're being
crazy, and I think it's a very good question, but I think
there's been a considerable debate over the period of time just
what constitutes a concussion, and there have been many
different specialists who debate what is a mild concussion and
what is a severe concussion. For instance, I'm sure you have a
child, I believe.
Ms. Sanchez. A 7-month-old.
Dr. Maroon. And if you had your child wake up this morning
with a temperature of 99 or 99.1, I think you would agree that
that's a fever.
Ms. Sanchez. Correct.
Dr. Maroon. If your child woke up with a temperature of
105, I think you'd be considered--you would be much more
Ms. Sanchez. I would likely be more alarmed.
Dr. Maroon. Right. So if you hit your head getting out of
your car and you bump it on the jam of your--the frame of your
automobile, and you're stunned, and you may see a few spots in
front of your eyes, that would be considered a concussion. If
you're run over by a PAT bus and are laying unconscious on the
pavement, you also have a concussion. So there's all gradations
of concussion, and it has been recognized by, in fact, here at
Wayne State University, much of the pioneer work in concussions
have been done by Dr. Gurdjian and others in the sixties and
seventies that traumatic episodes to the head results in
injury. I mean it's a--it's----
Ms. Sanchez. I can accept that there are gradations of
Dr. Maroon. There are gradations of concussions.
Ms. Sanchez. I can totally accept that.
Dr. Maroon. So----
Ms. Sanchez. But in a high-impact sport like football----
Dr. Maroon. Yes.
Ms. Sanchez [continuing]. When somebody has a concussion--
Dr. Maroon. Yes.
Ms. Sanchez [continuing]. And we heard from Mr. Barney, he
was out on the field for 21 minutes, then taken to the
sidelines and later returned to the same game.
Dr. Maroon. That was in the 1970's.
Ms. Sanchez. I understand that, that was very early on, but
I'm saying since 1994, players have been returning to the same
game with concussions until the NFL just a couple months ago
changed the rules and said you can no longer return to that--
why did it take 15 years.
Dr. Maroon. And again, I'm telling you that they're still--
in 1997, the American College of--the American Academy of
Neurology published guidelines saying that if an athlete
completely recovers, asymptomatic in terms of no headache,
nausea, or vomiting, is able to perform aerobic activity on the
sidelines without--without complaints, has no amnesia,
confusion, if it's within 15 minutes, they can return to the
game safely. So this is the American Academy of Neurology's
guidelines in 1997.
So when the paper in Neuro--in Neurosurgery was published
by Dr. Pellman and others saying that a significant percentage
of athletes had gone back into the game, they had all recovered
completely. We now recognize the papers that have been
published in '05 by Dr. Omalu and in '06 by Dr. Omalu, it lead
immediately to '07 where the NFL convened a committee and a
meeting in Chicago and invited the Players' Association, the
athletes, the trainers, and the team physicians and said hey,
this--yeah, you're right, just like you're saying, it's a
problem, what can we do about it?
Ms. Sanchez. So let me get this correct. The same research
that Dr. Omalu, which gets discounted or was discounted
recently as not being scientifically valid enough for some
members of the MTBI committee is the same research you're now
saying that helped lead to the rules change----
Dr. Maroon. I'm saying----
Ms. Sanchez [continuing]. About not allowing players to go
back into the game.
Dr. Maroon. Two case reports in the literature don't make a
major shift in the thinking of medicine. I mean you can't say
that--you can't--yes, it's an observation, it's an important
observation, but does it happen in every situation that an
athlete who has a head injury is going to be demented.
Ms. Sanchez. I understand that, but if the MTBI committee
in 1994 was charged with studying this issue and trying to
prevent it, I just find it completely interesting that on the
one hand Dr. Omalu's study has been pooh-poohed to some extent,
and it's not scientific enough and, you know, but on the other
hand, what you're saying oh, well, it led us to rethink that
maybe it wouldn't be a good idea to let players--I mean to me,
the whole point is--was or was not one of the charges of the
MTBI committee to study to see what the effects were and how to
prevent them and what the best course of----
Dr. Maroon. Congresswoman--I'm sorry.
Ms. Sanchez. No, that's my question.
Dr. Maroon. No, I deeply respect your questions, but you're
discounting over 20 publications published in peer reviewed
journals over the course of 1994 to 2008 discussing the
problems with concussion, how to prevent them, helmet design,
now there's still controversy as to helmet design, as we've
just heard here within the last 10 minutes, so----
Ms. Sanchez. I understand, but my question was not about
Dr. Maroon. In 1997, the NFL commissioned the biogenetics
laboratory to look at helmet design and ask the question funded
by the NFL with no helmet manufacturer involved what can we do
to design the helmets in a better way to protect the athletes
so that I--I kind of dispute your position that nothing has
been done since 1994.
Ms. Sanchez. Very little has been done--and I'm not
talking--take away the helmet and the equipment testing. It
seems to me that if the MTBI committee was specifically
convened as a result of concussions which took some great
players out of the game, that the singular focus should have
been on the health and welfare of the players in terms of the
effects and how to--how to assess what the treatment would be
for that or what the best course of action would be after a
player has suffered a concussion. That's just my opinion, and
you may disagree with it, and you're entitled to do that. It's
a question I would love to ask you, but I'm going to ask Dr.
Casson--is it pronounced CASS-in or is it CASE-in?
Dr. Casson. CASS-in.
Ms. Sanchez. Casson, thank you. Do you agree with Dr.
Omalu's statement, and I'm quoting directly from his written
testimony, it was also in his oral testimony, that the concept
of permanent brain damage and dementia following repeated blows
to the head is a very well established and generally accepted
principle in medicine; would you agree with that statement.
Dr. Casson. There's a lot more you have to say about yes, I
agree, or no, I don't agree. Are you talking about in boxing?
Yes, it's rel----
Ms. Sanchez. No, no, no, it's not sports specific, it's not
even specific to sports. It's generally speaking, and I'll
repeat the quote, ``The concept of permanent brain damage and
dementia following repeated blows to the head--'' could be
blows of any kind, could be a blunt object, it could be, you
know, blows from multiple car crashes, perhaps, ``--is a very
well established and generally accepted principle in
Dr. Casson. First of all, let me say this. You don't
determine scientific or medical truth by popular vote. You
don't determine it by consensus. You determine it by evidence.
Ms. Sanchez. I understand that, and I understand that I'm
not a doctor, but I'm just asking if you accept a statement
that Dr. Omalu has said is generally accepted in principle.
Dr. Casson. No, there are specifics you need to know but
before you say that. You can't just generalize like that. It is
accepted in the sport of boxing. It's accepted in a few other
circumstances. It's not necessarily generally accepted in all
the football players. Now, have there been a few cases that
maybe it's true? Yes. But we need more evidence. Just because
there's an association does not prove causation.
Ms. Sanchez. So would you disagree that if somebody were
repeatedly hit in the head with a blunt object that there
likely would not be permanent brain damage and/or dementia that
would be associated with that.
Dr. Casson. I'm a physician. I've been treating patients
like this for my entire career. I trained at Bellevue where I
have the primary responsibility for the care of hundreds, if
not thousands, of head injury victims of all severities during
my residency program. I have a great deal of clinical
experience in this field. You cannot generalize. Every case is
Ms. Sanchez. Okay. All right. I can't get you to agree on
something that I think most laymen, probably most physicians
would agree to that, if somebody suffers repeated blows to the
head, there is going to be some kind of brain damage.
Dr. Casson. You said dementia.
Ms. Sanchez. Or dementia even.
Dr. Casson. Well, dementia is a specific type of brain
damage. The specific clinical----
Ms. Sanchez. Well, pardon me, pardon me, I said permanent
brain damage and/or dementia.
Dr. Casson. We can disagree.
Ms. Sanchez. Okay. All right. Now, in your testimony,
you're very clear about talking about your past experience and
studying the effects of head trauma in boxers in which you
conclude that: ``Modern era retired boxers had signs of chronic
I'm interested in knowing how the repeated head trauma in
boxers is different from the head trauma that's suffered by
those in professional football or some other activity where
there's repeated blows to the head.
Dr. Casson. Okay. First of all, there have been studies
that have demonstrated that the head trauma in boxing has much
more rotational forces and accelerations compared to football
concussions which are more translational in nature, meaning
more straight lined rather than rotational. There have been
studies published that have documented that.
Another difference, secondly, boxers don't wear helmets,
football players do. Thirdly, boxers are subjected to constant
repetitive blows from the time they start boxing all through
their careers in sparring, in training, as well as in their
fights over very long periods of times, and sustained more
blows causing rotational forces in a career than football
players do, so there clearly are differences----
Ms. Sanchez. Those are the three major differences, would
be those three then.
Dr. Casson. Those are three differences.
Ms. Sanchez. Okay, all right.
Dr. Klossner, I'd like to ask you, you testified to the
steps the NCAA has been taking to treat concussions including
the fact that you're recommending that rules be put in place
for all sports. Is it your opinion that the effects of repeated
head trauma are consistent across sports, for example? Are the
concerns expressed by those who play--by a football player
getting a concussion and returning too soon to the game also
applicable, to, say, a women soccer player who might suffer a
concussion during the course of----
Mr. Klossner. Well, I'd have to defer the medical opinion
of what happens with a student athlete who----
Ms. Sanchez. But is it----
Mr. Klossner [continuing]. Receives a concussion but----
Ms. Sanchez [continuing]. Is the concern the same?
Mr. Klossner. The prevalence of concussion from what we
measure from the NCAA injury surveillance system notes
concussions occur across sports, yes.
Ms. Sanchez. But is the concern the same that the NCAA has
that if you're a football player who gets a concussion and is
thinking about returning to play, are you any less concerned
that it might be a, say, a woman soccer player who gets a
concussion during a game and might----
Mr. Klossner. Our guidelines apply to all student athletes
Ms. Sanchez. So it applies to every sport and every student
Mr. Klossner. That's correct.
Ms. Sanchez. Okay.
Dr. Casson, in going back to you, in your testimony, you
didn't state definitively whether you feel that repeated
concussions have a long-term health impact and I'm interested
in knowing, yes or no, in your opinion, do you repeated head
impacts, regardless of where or how they occur lead to long-
term brain damage?
Dr. Casson. That is not a yes-or-no question. Maybe in
Ms. Sanchez. Maybe, okay.
Dr. Casson. Yes, because you have to take each individual
case and the facts, that's what a physician does, that's what a
Ms. Sanchez. I understand that but--so repeated
concussions, if somebody has multiple concussions, regardless
of how they got the concussions, you couldn't say that you'd
feel confident to say that it would lead to brain damage.
Dr. Casson. It very well might. I'm not saying that having
concussions is good for you, it's not. It's bad for the brain
to have a concussion.
Ms. Sanchez. Well, that's the strongest statement I've
gotten you to make on concussions, you know, since you've been
Dr. Casson. No, it's really not. What I stated----
Ms. Sanchez. In my opinion, it is.
Dr. Casson. Well, in my opinion, there's not enough
scientific evidence to jump to the conclusions that many people
have done. I'm a scientist----
Ms. Sanchez. How many----
Dr. Casson.--I follow the evidence.
Ms. Sanchez. Okay, I'm not even going to ask the question I
was going to ask, I'm just going to ask you one last question.
You made a series of recommendations at the end of your
testimony for what you believe could be done to further the
study of the effects of concussions. In your time on the MTBI
committee, did you ever make these recommendations to the NFL.
Dr. Casson. Yes, we talked about trying to develop in vivo
methods to measure tau in the brain, that was done very
recently. We have an NFL Retired Players Study that's now on
hold, unfortunately, which was to--in-depth clinical
examinations of retired football players. We had talked about
and we do have, as part of that study, psychiatric/
psychological evaluations to some extent, we talked about at a
later date expanding that to do a more detailed psychological
and psychiatric evaluations.
One of the goals of the NFL Retired Players Study is to
determine the accurate incidence of brain dysfunction in
retired football players, so yes.
Ms. Sanchez. So those recommendations were made, but they
were very made very recently; is that what you're telling me.
Dr. Casson. No, the NFL Retired Players Study we began
formulating in 2003, so no, it was not made very recently. Now
the idea that comprehensive----
Ms. Sanchez. As compared with 1994, I would say that's----
Dr. Casson. Well, one of the reasons that I was asked to be
on the NFL Retired Player Committee was because of my expertise
with CTE of boxers. I know a lot about this field, I have
expertise in this field. When we started this committee, the
goal of the committee was to advance the scientific medical
knowledge of concussions and thereby improve the health and
safety of NFL players. That is the way you improve health and
safety, by advancing the science, and that's what we set out to
Now you can't start doing everything at once. We started
with biomechanical studies, we started with epidemiological
studies of concussion in the NFL. Then we moved on to studying
retired players. So you can't do everything at once. You have
to have a plan, and that was the plan, and that's what we were
Ms. Sanchez. Okay, one last question for you, Dr. Casson.
In January of 2005, you along with Dr. David Viano and three
other authors published an--I referenced it earlier in the
Journal of Neurosurgery a paper that said it might be safe for
high school football players who sustained concussions to
return to the game in which they were injured. Do you believe
today that it's okay for athletes in their teens whose brains
are still developing to return to play in the same game after
suffering a concussion?
Dr. Casson. I'm glad you asked me that question. In that
paper, we never suggested that it was okay for high school
players to return to play on the day of an injury. We had done
a scientific study analyzing the epidemiology of concussion in
the NFL. It was aimed at, the study, specifically in this
paper, the group of players who had returned to play on the
date of injury to see if they were any different than the
players who had not returned to play to see what happened to
them, to see how they--whether they had more concussions down
the road or had repeat concussions. We specifically stated in
this paper and every one of our epidemiological papers that
these studies were on NFL players, and the results applied only
to NFL players.
Now, in the discussion of a scientific paper, very often
what scientists will then do in discussing the data is raise
questions that, maybe, other people want to look at to try to
get other people to study the field, and what we suggested that
was that no one has studied this in high school players or
college players, and it might be interesting for someone to
look at it. That's what we said. We didn't say it was okay.
Ms. Sanchez. But you did say that it may be safe.
Dr. Casson. What we said--the idea was that they--we don't
have evidence. What we said was we need evidence.
Ms. Sanchez. But you never used the words that it may be
Dr. Casson. I may have used those words. Even if we said
may be, the operative word is may be.
Ms. Sanchez. I understand, but today do you hold that same
Dr. Casson. That wasn't my opinion. My opinion was----
Ms. Sanchez. Is your opinion today that it may be safe for
high school football players who've suffered a concussion to go
back into the same game? Your opinion----
Dr. Casson. Without evidence stating one way or the other,
you can't answer that question.
Ms. Sanchez. Okay. All right.
Dr. Casson. There's no evidence.
Ms. Sanchez. Okay. Back to Dr. Klossner. In your testimony,
you stated that student athletes rightfully assume that
precautions have been made to minimize the risk of injury. Can
you talk about what the NCAA does to educate student athletes
about the risk of concussions.
Mr. Klossner. From the NCAA's perspective, we have an NCAA
sports medicine handbook that has a guideline on concussions
that outlines the risks associated with concussions and return-
to-play concerns that is provided to all member institutions
that help educate their student athletes on the rules of
concussions in sports.
Member institutions have responsibility to educate their
student athletes. At the end of the day, they make the
decisions of what happens with their student athletes and how
they educate them on various topics related to their student
Ms. Sanchez. Is there any kind of release that students are
required to sign in order to participate in sports other than
saying that they understand the risks of concussions.
Mr. Klossner. Those, again, are what the individual
institutions decide on how they medically release or provide
Ms. Sanchez. In your knowledge, are there some institutions
that require that.
Mr. Klossner. Yes.
Ms. Sanchez. Okay, that's what I'm getting at.
Dr. Omalu, you have mentioned the risk of subconcussions.
Can you elaborate a little bit on the subconcussions and what
we can do to identify and treat their effects?
Dr. Omalu. Well, every day I examine the brains of human
beings, I've examined thousands of brains. The brain is made up
of about 80 percent water. God, in his infinite wisdom, did not
create a brain which floats freely in our skulls to receive
repeated impact. So any impact, no matter how similarly that it
could be that makes your brain accelerate/decelerate, the very
basic laws of physics in issue, acceleration/deceleration
causes disruption of the proteins which are floating in water,
and we see that with the evidence since the 1970's at the
Institute of Neurological Sciences in Scotland results in
damages to the brain cells and their fibers. When they examined
these brains, you see accumulations of abnormal proteins, at
least an hour from when the injury. And unfortunately, many
times this impact wouldn't present with incapacitating symptoms
to manifest with headaches that the individual would dismiss--
Ms. Sanchez. Right.
Dr. Omalu. But on the cellular level, there is extensive
damage which may be why we did not identify this disease early
enough. Because on CT scan, the brain would look normal. On
MRI, the brain would look normal, the symptoms--there are no
symptoms, but on a cellular level, a lot is going on.
You saw Mike Webster's brain. Mike Webster's brain looked
normal, and I repeat, looked normal, but Mike Webster's brain
on the cellular level and other brains I've looked at were
extensively, extensively damaged. Every impact to your head has
the capacity to result in damage, at least on a cellular level.
Ms. Sanchez. So would it be your opinion that repeated
impacts to the head would cause some kind of brain damage?
Dr. Omalu. Yes, this has been established since the early
20th century. In fact, Dr. Harrison Macklin (ph.), who was a
forensic pathologist in New York, New Jersey, just like me,
described dementia in 1928. Proteins will build up in the brain
as described by Dr. Alzheimer in 1918, and in 1969, Dr. Roberts
that was commissioned by the House of--House of Lords in
England published a paper and a position paper by the Royal
College of Medicine in England that repeated blows to the head,
no matter how similarly the knock was, has the capacity to
result in permanent brain damage, and in the journal Lancet in
1976, it was clearly stated that repeated blows to the head
could result--in boxers could result in damage, repeated blows
to the head in other activities, cellular and otherwise, can
also result in permanent brain damage.
The issue here we should not make the mistakes of the past
like Mr. Barney said. The issue here is not really the
concussions because the concussion is the extreme.
Ms. Sanchez. Right.
Dr. Omalu. It is the innocuous repeated blows, repeated
blows. In football, players are subjected sometimes to 200--or
to 120 g force. That is a lot of force, a lot of energy for a
brain that is 80 percent water.
Ms. Sanchez. So in your opinion, do you think that repeated
concussions, then, if concussions are the most extreme of the
brain disruptions that you're talking about in terms of even
minor blows to the head, do you feel confident in saying that
repeated concussions would lead to permanent brain damage?
Dr. Omalu. Yes, but Dr. Julian Bailes, my director at the
Injury Research Institute with some other authors, Dr.
Tuszkiewicz came up with the threshold of three, three
documented concussions increase your risk significantly. In my
practice, as a forensic pathologist, I have seen severe brain
damage from even one major concussion. Like Dr. Casson has
said, yes, there is a genetic variation, there are ameliorating
factors, there are accentuating factors, but the established
fact is that repeated blows to your head to a brain that floats
freely inside your skull to the brain that is made up of 80
percent water could result in permanent brain damage.
Ms. Sanchez. Thank you, Doctor, and last and final question
for you, what are your thoughts about the changes to the NFL
policy toward concussions that have occurred since our October
hearing on this issue.
Dr. Omalu. If you notice in my recent statement, my global
statement, I had--especially my recent statement, I had stated
we should not make the same mistakes of the past. We should
base guidelines, policies, and protocols on the science,
especially pathology. Neuropathologists since 19--1980, I
believe, papers were published by Dr. Graham, Dr. Geddes, and
Dr. Adams who are all Scottish men, that if you suffer a
concussion or a blow to your head, amyloid precursor protein,
this is a protein in very big protonated brain cells, would
accumulate from about 1 hour to 3 hours. These proteins do not
disappear in your brain until about 99 days; I would usually
say 3 months.
So if we have pathologic evidence since 1980 that tells us
the brain cells do not recover from a concussion till about 3
months, then the question leads now what is the basis,
scientific basis for the 2-week, 3-week, 4-week threshold for a
player to go back to play? And again, I would always advise the
absence of symptoms does not mean the brain has recovered from
Ms. Sanchez. Thank you.
Dr. Omalu. The neurological evidence confirms that,
neuropathological evidence confirms that.
Ms. Sanchez. Thank you, Dr. Omalu, I think your testimony
has been most instructive, and with that, I would yield back my
time to the Chairman.
Dr. Omalu. Thank you.
Mr. Conyers. Thank you very much. I'm pleased now to
recognize Steve Cohen, a distinguished Subcommittee Chairman on
the Committee of Judiciary.
Mr. Cohen. Thank you, Mr. Chairman, and not that it's
important at all, but I think I referred to the GMAC Bowl as
the Motor City Bowl. I'm in the city of the Motor City Bowl, I
have corrected it.
Dr. Maroon, Mississippi State, several weeks ago, Mr.
Dr. Maroon. Yes.
Mr. Cohen [continuing]. Of the NFL, spokesperson for the
NFL said that it's quite obvious from the medical research
that's been done that concussions can lead to long-term
problems. He said--I believe that is accurate. Are you familiar
with that quote from him.
Dr. Maroon. Yes.
Mr. Cohen. That--is that a conflict of what Dr. Casson has
told us that there is at present not valid, reliable, or
objective scientific evidence that prove that impacts from
professional football are--cause chronic brain damage, aren't
those kind of----
Dr. Maroon. No, I don't think they're incompatible at all.
I think what I heard Dr. Casson saying is that you have to
evaluate several factors, and going back to what Dr. Omalu
said, he said it has to be based on science, right? And as
the--I gave the example to Congresswoman Sanchez that if you
have a temperature of 99, you have a fever, if you have 106 and
you're in heat stroke in an ICU, you have fever. There's huge
variations in what a concussion is and the severity of the
concussion so that there are very, very minor bumps on the head
that I don't think lead to permanent dementia and
incapacitation, even if there are several of these.
One concussion, on the other hand, may, indeed, lead to
permanent brain damage. In our clinic at the University of
Pittsburgh, we see approximately 100 to 150 kids a week for
postconcussion syndrome evaluation. So when you ask me can head
injuries--can concussions lead to significant long-term
effects, there's no question that it can. But I guess going
back to Dr. Omalu's work, it has to be based on science, and he
says 2 months, 3 months, how do you base when an individual may
go back to play?
Well, going back to one of the comments of Congresswoman
Sanchez, initially, you mentioned the Pittsburgh Steelers and
the Bengals game in your introduction, and I think you were
referring to the quarterback of the Pittsburgh Steelers who was
not permitted to play in a very critical game because under
exertion, he developed headaches, and under the guidelines, we
know that the brain has not completely recovered.
Not guidelines, but the science has shown us that if you
remain symptomatic, you haven't recovered, and consequently,
the neurocognitive tests which assess the processing
information and processing power of the brain are--are
objective criteria that were evaluated beginning in 1990 when
Coach Knoll and Dan Rooney from the Pittsburgh Steelers told me
Maroon, I don't care what you know about or what you think
about a concussion, I want objective data.
And that's why Impact was formed because it gives you
objective data, so that I think they're not inconsistent, his--
his comments with the questions that were asked.
Ms. Sanchez. Will the gentleman yield.
Mr. Cohen. Yes.
Ms. Sanchez. And I appreciate that, I just want to make
this point. Dr. Omalu testified that a person can be
asymptomatic. In that instance, he was symptomatic because
under stress, there was a problem. Asymptomatic and not fully
recovered in the brain, and I just wanted to point out that
important distinction. I now will yield back.
Mr. Cohen. Thank you.
Let me ask you this. Dr. Casson--and I respect your study
and your concern here. You said that association does not prove
Dr. Casson. Yes, that's a principle of scientific evidence,
Mr. Cohen. But can't association--would not association
possibly be sufficient to give people cause for concern, alarm,
Dr. Casson. Yes, there is cause for concern, but I'm a
scientist, and I'm a physician. Scientists and physicians need
more than that.
Mr. Cohen. Right. And I understand what you're saying to
come to a conclusion in your field and in your beliefs and
studies, but when you have lives in the balance, don't you
think that maybe association should be sufficient to dictate
that there be a change in the practice to protect these lives?
I mean, you know, to err on the said of caution.
Dr. Casson. Well, in all my involvement on the MTBI
committee, we have always erred on the side of caution. In all
my years of clinical practice, I've always acted in the best--
for the best benefits of my patients by erring on the side of
caution. However, that is not the same as saying that the
science proves the point, that the science is there. It doesn't
prove that one thing causes the other.
Mr. Cohen. It may not prove it, and I'm not--you know and
Dr. Omalu have different opinions, and others may, too, but
there is sufficient proof, I believe, you would agree, that
there is an issue, there's at least probable cause or there's
reason to believe that there could be a problem, and so if you
err on the side of caution, shouldn't maybe you in your studies
or the NFL earlier had set some policy about players maybe not
staying in the game when they had a concussion or getting
better helmets or something to protect the players before that?
Dr. Casson. We did subsequently get the helmets back in the
Mr. Cohen. Crash helmets, let's go to concussions.
Dr. Casson. What we did was we studied the prevailing
practice in the NFL and scientific studies of what would happen
to these players, the epidemiology of the ones who had
concussion. We came up with a definition of concussion that was
extremely broad and was extremely all encompassing, so we
picked up all of the injuries that could get reported, even the
mildest of injuries of people who would be dizzy for a few
seconds, if they told the trainer, that would become a
concussion, so you had very mild events that were reported, and
we studied these, and we did epidemiologic studies, we studied
the data and analyzed what happened to these people, and based
upon these analyses, we then, once we had the science and the
evidence, made recommendations of how to proceed.
For example, at that time, the American Academy of
Neurology guidelines, which is still in force today, were that
a player who has a concussion, not even just a professional
player, any player who has a concussion and gets hit in the
head and has some symptoms, if the symptoms fully resolve in 15
minutes and there was no loss of consciousness, that player was
allowed to return to play without even seeing a doctor.
At the NFL level, no player was allowed to return to play
once it was reported, if they reported it, without being
cleared by a physician. So we were, in a sense, running a
system that was in opposition to what was a standard guideline
that everybody was following, and we found that guideline
wasn't really good enough, and nowadays, nobody believes in
Mr. Cohen. How many years did that study take place before
you came to that guideline.
Dr. Casson. Well, we didn't come to it--before we made the
Mr. Cohen. Yeah.
Dr. Casson. Well, we started doing the studies in the
nineties. It took us 6 years of data to collect, so from '97
through 2001, we collected the data, and then we took a year or
two to analyze the data and publish it. They were published, I
believe it was 2002, it might have been 2003, we began to
publish the data.
Mr. Cohen. And I don't disagree with your concern for
science, and with all, you know, deference to Jackson Brown
who--and that lives in the balance for a different
circumstances--the 10 years that it went on, there were a whole
lot of football players getting concussions, and while you were
doing, which is commendable, your study, and fine tuning your
research and coming down with exactly what you think, players
are getting hit and hit and hit and hit, shouldn't there have
been, maybe, some concern 10 years earlier that said let's err
on the side of caution, we know that, you know----
Dr. Casson. Of course there was----
Mr. Cohen [continuing]. Boxers get pummeled and football
players are getting pummeled.
Dr. Casson. Of course there was concern. The standard of
treatment in the NFL from the time the committee was founded
was that players would not--were not allowed to return to play
on the day of injury until they were asymptomatic with a fully
normal neurologic examination. That was a--what the NFL
physicians practiced, and that was a standard of care that was
probably better than the standard of care than anybody else in
any other sports league was using at the time.
Mr. Cohen. You suggested that possibly the reason for this
tau being developed in the players might be because of anabolic
steroids, the possibility, growth hormones, or other toxic
contaminants; is that correct.
Dr. Casson. That's certainly a possibility, yes.
Mr. Cohen. And I'm sure it may be a possibility. Who here--
and I don't know, y'all look so young, you excluded, you're my
age, the rest of you, when did they start using anabolic
steroids in football?
Mr. Barney, do you have an idea when they started doing
Mr. Barney. The first time me hearing of it was about '64-
Mr. Cohen. So it's been a long time.
Mr. Barney. Mm-hmm.
Mr. Cohen. Were there players that maybe were playing in
the fifties or early sixties and didn't go into the six--later
on who wouldn't have been exposed to anabolic steroids who
developed these problems, Dr. Omalu.
Dr. Omalu. Yes. The literature, especially in boxers. I
must emphasize that this again, from the United States,
literature outside--coming out of the United Kingdom and
Europe, even while I was a medical student in Nigeria,
establishes this causation, these associations of traumatic
brain injury, permanent brain damage in boxers, in other
sports, contacting sports, and in other activities involving
impacts to the head, even the so-called punch drunk wife
syndrome, a woman who has been beaten repeatedly by the
husband, the issue is repeated transference of kinetic energy
to the brain. That is 80 percent water that is bouncing around
in the skull.
And again, in forensic pathology and in law, there is what
we call the underlying cause and contributing factors. There is
no single disease, and I repeat, there is no single disease
that has only one exclusive cause. An example is diabetes.
Diabetes is caused by the lack of insulin. However, if you ever
obese, it increases your risk of suffering diabetes, but it
does not mean that obesity causes diabetes.
The same applies to chronic traumatic encephalopathy.
Underlying cause is not football, it may happen in the game of
football, but repeated impacts and transference of energy to
the brain. Could there be other contemporaneous or simultaneous
factors that would either aggravate the lethality of the
disease or ameliorate the lethality of the disease? Of course.
Could genetic predisposition be present? Of course. Like in
every other disease model.
Mr. Cohen. So what you're saying is that maybe--you're
saying a lot, but one of the things I'm trying to get at is
that prior to the use of anabolic steroids, which is, give or
take, somewhere in the middle sixties or whatever, there were
football players, the Leo Nominellies, or whatever in the
fifties who could have had some type of--or you know had some
Dr. Omalu. Yes, there were football players that manifest
that symptoms of the cases that I have done, yes.
Mr. Cohen. So it wouldn't have been anabolic steroids or
growth hormones because those were not factors for those
Dr. Omalu. Yes.
Mr. Cohen. And Dr. Casson, you say--and I find your study
interesting, ``It's important to also remember that some tau
deposition can also be seen in normal aging brains,'' well, I
mean sure it is. Take that case of boxers, I mean you're kind
of saying because people with normal aging brains can have tau,
then that says that this may not be the reason why football
players have it, with that theory, he could never say why
anybody has it because it's normal aging.
How many boxers have you studied in your career?
Dr. Casson. Well, my study that was published in JAMA had
Mr. Cohen. Seventeen boxers.
Dr. Casson. My study in the years up to that time and after
that study, close to a hundred.
Mr. Cohen. Haven't some of the studies on the football
players--have you not criticized them because they weren't
broad enough and enough participants, the data was too limited.
Dr. Casson. You're talking about the survey studies.
Mr. Cohen. Yes, sir.
Dr. Casson. The survey----
Mr. Cohen. The surveys were mail-ins, but aren't there some
scientific, like Dr. Omalu, some study on brains or BU's? Is
Dr. Casson. Well, there have been a lot of criticisms. I'm
not sure which criticism you're asking about. One of the
criticisms is that there are no contemporaneously obtained
objective medical data on anybody. There's no doctors' reports.
There's no postneurologic exams, there's no reports of
psychiatric exams in what's been published in the literature.
It all comes from talking to the family members afterwards.
I'm not minimizing what family members might say and the
suffering that they have gone through, but you need objective,
scientific, medical examinations and studies so you can try to
see if there's a clinical correlation between what you're
finding in the brain and the clinical picture of the subjects,
and that's not available.
Mr. Cohen. You and Dr. Viano have both resigned from the
concussion committee; is that correct.
Dr. Casson. Yes.
Mr. Cohen. What were the circumstances surrounding that,
and was this a voluntary resignation.
Dr. Casson. I can speak for me, okay? The topic of
concussions, as you well know, has recently become highly
politicized. Scientific considerations took a back seat to
political media and labor relations issue. Personal attacks
upon me were distracting from the central issue of my role on
the committee, which was to improve the health and safety of
Throughout my years on the committee, my main goal was to
advance the medical, scientific knowledge of concussions to
help improve the health and safety of the players. The
commissioner and I agreed that the best way to allow the
committee to continue to do that work was for me to resign, so,
hopefully, the distraction of me being there would help them
get back on being able to focus on the science.
Mr. Cohen. Well, you agree that the new NFL policy is wise;
do you not.
Dr. Casson. Which NFL policy are you talking about.
Mr. Cohen. This new one about you get out of the game if
you have a concussion, and you have to have an independent
doctor, etcetera, etcetera, etcetera, the one that came out, I
think, last month.
Dr. Casson. There are a number of different parts to that
Mr. Cohen. Which do you agree with.
Dr. Casson. Well, certainly, that certain players with
certain types of concussions should not be allowed to return to
the play on the day of the game.
Mr. Cohen. And which do you disagree with.
Dr. Casson. I don't necessarily disagree with any of the
policies; however, the idea that independent neurological
examinations by independent--``independent neurologists'' is
going to give you a better result than the evidence-based
experience that we know that NFL team doctors have been
exhibiting throughout the years--because we have studies
documenting the efficacy of their decisions--we don't know what
the results are going to be of these independent neurologic
We don't know if these independent neurologists have
expertise in head injury. We don't know if their opinions are
going to be valid and reliable and stand up to scrutiny. We do
know that the NFL team physicians' decisions have stood up to
scientific study because we've published those studies.
Mr. Cohen. I respect you as a doctor, I respect the
positions and the study you've done, and your work, and I'm
sure you're an outstanding physician, and I have no question
about that and as a researcher, but you condemn, somewhat,
which is my particular avocation--or vocation, excuse me--
politics, and you said that the politicization of this issue
has harmed the scientific study. But without the quote/unquote
politicization of this issue, none of these changes in policy
that you agree with would have taken place.
So isn't politicization a little bit more important, just
like erring on the side of caution and lives in the balance
rather than waiting for the ultimate perfect scientific data
and how many more football players might have brain damage? And
I would submit to you, sir, that these areas and the quote/
unquote politicization have caused the NFL to do the right
thing that they might not otherwise have done. And your
research at some point might get them to do the same thing, but
in the interim, there are players who are being used without
precautions that are in--that I think are advisable. And so,
you know, I'd just--I've got to question some of your research
here or some of your conclusions----
Dr. Casson. Let me just say in response to what you just
Mr. Cohen. Yes, sir.
Dr. Casson. I'm a scientist, I'm not a politician, I'm not
a labor negotiator, I'm not a media expert, so I can speak to
the science. I don't have the expertise to speak to those other
Mr. Cohen. But don't you think the science is leading us in
a certain direction? I mean you might not be able to put the
stamp there and say it's done, finished, Warren Commission,
case closed, but don't you think it's leading us somewhere, and
don't you think there's a point to where the evidence tilts?
There's a preponderance of the evidence, there's--you know,
chancery court's different than a criminal court, preponderance
of the evidence.
Dr. Casson. Preponderance of the evidence is a legal term.
Mr. Cohen. More likely than not, more likely than not.
Dr. Casson. I'm a scientist, I don't see enough evidence to
make that statement at this time.
Mr. Cohen. Well, as a scientist, don't you want to see like
guilt beyond a reasonable doubt? Aren't you looking for, like,
Dr. Casson. No, I'm looking for evidence.
Mr. Cohen. You're looking for what you can firmly say
without question. But you're talking about lives and brains.
Don't you think at some point you say let's put some changes in
here, let's do something because, obviously, we've got a
Dr. Casson. And certainly, as I said before, since the time
of the inception of the committee, we've been doing that, the
committee did that, and the characterization that the committee
was doing nothing, the characterization that the NFL physicians
were ignoring this problem and blatantly sending players back
in to play without concern for their health, I submit to you,
is completely incorrect, and we have scientific data to verify
that that's incorrect.
I think that the NFL MTBI committee has been
mischaracterized and has been given a bad, I don't know what
you want to say about it, has been given a lot of bad press and
a lot of bad things have been said about it because of
political media and labor concerns that really don't have
anything to do with the science and the real work of the
Mr. Cohen. Mr. Barney, let me ask you something back to
anabolic steroids. Whether or not they or hormone growth drugs
that folks are taking might have some effect on their brains,
does that not make football players bigger, stronger, and when
they hurl themselves at the opposite player a more dangerous
Do you need a mic? Thank you, sir.
Mr. Barney. Thank you, Dr. Omalu and Chairman Cohen, I have
no idea, in sincerity, about the anabolic steroids only other
than what I've read about them, what I've heard other players
talk about, it was something that was somewhat wiped out when I
got into the league. Not totally wiped out because of certain
ball players were crippled by it, but I never had a chance to
see it, don't know what it looks like, don't want to know what
it looks like, either, but understanding what it would do to
you, it was almost like an hallucination trip, and you thought
you were still bombed on the planet, that's what I heard one
ball player say.
Mr. Cohen. Thank you, sir. I've just--you know, I've
watched, and I just see it, and back to what Ms. Sanchez says,
it's hard to fathom when you watch the game, and I love it, I
mean they are so much larger, the players, and it's, you know,
linemen used to be in college, 210. Now, you know, they're 310
Mr. Barney. Yeah, they're 210 in middle school now.
Mr. Cohen. Yeah. It's just--I understand science, but it
doesn't--I don't think it really takes a scientist of the
nature of the caliber and the brilliance of Dr. Casson to tell
you that something's happening, and it necessarily good.
Mr. Barney. Absolutely.
Mr. Cohen. Yeah, I'm just kind of there. Let me ask you,
Mr. Ferrara, about the helmets. Do you think your helmet's a
good helmet, you're going to save some players some
Mr. Ferrara. Sir, I've spent the entire 15--last 15 or 16
years building up to this moment. I certainly wouldn't be in
business if I didn't feel like our helmet could do a better
Mr. Cohen. Mr. Halstead said that you shouldn't necessarily
take some example of a better helmet that weighs more in an NFL
standard and apply it to these lesser, I guess, college but you
were probably talking about high school, or something, kids,
but aren't the pro players bigger, stronger, more likely to
take anabolic steroids, and a more dangerous ball player than
you might have in a pee wee league.
I thought some of my political opponents were here.
Mr. Cohen. But pro football's a different caliber and more
violent, so shouldn't--that helmet there wouldn't necessarily
be the helmet you want to have used in high school because of
the potential damage.
Mr. Ferrara. It's very important to point out what you
actually want a helmet to do. What causes brain injury is
actually sudden movement of the head. So we're talking about
impact. It's really important to understand that it's the
motion that results from the impact that would cause the
damage. And all things being equal, more sudden movement means
So what you want a helmet to do is actually minimize how
suddenly the head moves. In order to do that, it actually needs
to adapt to impacts in different energies and different
directions. What happens in the NFL, and it is quite extreme,
and the NFL's testing protocol is based upon the most extreme
events and the most extreme circumstances. Designing for the
extreme will lead to worse performance in normal circumstances,
and while I'm in Detroit, if I can use an automotive analogy.
What you really want the helmet to do is apply the brakes
to whatever's being impacted. If the government were to come
along and say we're setting a new standard for automotive
brakes and those brakes need to stop a Mack truck travelling 70
miles an hour in 50 feet, you can imagine the brakes that would
be needed to do that would be incredibly massive and powerful.
If you put those brakes on a Honda Civic traveling 35 miles an
hour, that car would actually be undrivable. It, in fact, would
be dangerous. As soon as you touched the brakes, the driver
would jolt forward.
And that's what's happening to the brain when you use
extreme engineering. The head jolts to a stop, and the brain
jolts forward. So extreme events are not a good basis for
Mr. Cohen. Thank you, sir, and to be fair to Mr. Arment
here, you--I had a Riddell, I mean that was kind of standard in
1966 when I made that famous catch that you missed, Chairman
Conyers, but can even your helmet, which is kind of a standard,
can it be improved upon to protect the players.
Mr. Arment. Well, I think, you know, that with ongoing
research and ongoing partnerships and some of the information
that's coming out of the hearings today, clearly, helmets can
be improved, and we continue it at Easton-Bell Sports and
Riddell to really drive to what is the next level of
technology, what is the next improvement that we can make to,
you know, offer further protection and performance products for
our, you know, our athletes.
Mr. Cohen. Thank you. Mr. Klossner, let me ask you a
question. We had this situation at Texas Tech, and while Dr.
Maroon suggested, maybe, that some causation, it probably was
because player Adam James's father was an ESPN broadcaster
maybe why it got the attention it did, and protected him, and
maybe it wouldn't have happened. There's probably some other
schools where the same type of activity might have occurred
where some coach didn't like a player, thought maybe he was a
malingerer because he had a concussion and didn't want to
practice the next day, and at Texas Tech, the university has
Is this the conduct that the NCAA wants to leave to each
school to take care of, or should the NCAA react and control it
on a systemwide basis?
Mr. Klossner. I can't speculate on the alleged situation in
Texas. Our position is to do what is in the best interests for
our student athletes' well-being and continue to study the
issue, as we've done since 1976 and before. At the end of the
day, you know, student wellbeing is paramount. We provide
playing rules, we provide sports medicine handbook guidelines,
we provide videos on appropriate practices for our members to
utilize and to make the best decisions at the end of the day
that they can at the local level.
From a proposed rules standpoint, we are making changes as
far as putting it in the hands of the officials to remove
student athletes who exhibit signs of concussions and that the
individuals are then assessed by medical professionals,
particularly, a physician, and even though that may be
happening on some campuses, as you note, it may not be
happening on all campuses. So we think that the proposal rule,
one, highlights the prevalence and importance of concussion but
also sends a signal that these individual student athletes need
to be evaluated appropriately and have appropriate return-to-
play standards in place.
Mr. Cohen. All right, my final question is kind of to Dr.
Maroon and maybe Mr. Halstead on this helmet issue. You said
your study is not going to be finished or released until
March--or I think it was March. I would think it would be--if
it's not complete, I understand that, but at that time--and
will the NFL--is the NFL willing to share all prior
communications and research regarding helmet safety, testing,
Dr. Maroon. I, quite frankly, Congressman, I'm not sure
what the NFL's intention is to do with the data. I'm aware that
the testing was carried out at the request of the equipment
managers to somehow bring--to obtain objective data so that the
individuals relative to each team would have some better idea
on how to obtain the specific helmets that might be most
At the present time, we know that this--that up to 40
percent, for instance, of the athletes on the Pittsburgh
Steelers team are wearing older model helmets that, in my
opinion, could be upgraded, but for various reasons, they're
not wearing the newer helmets, and I think that there needs to
be some nudging in that regard. How the NFL proposes to do that
and what data and how it's going to be released, I don't know.
Mr. Cohen. Mr. Halstead.
Mr. Halstead. Yes. My understanding is that the data will
be released in March. I'm not exactly sure how it will be used.
It is my understanding that the intent is as Dr. Maroon opined,
many football players are wearing much older technologies. The
data thus far shows, that I've seen at least, it is still being
analyzed by an independent analysis team, as I understand it,
but the data does show that some new helmets do attenuate
energy in those tests much better. Some, not so much. So I
think it will be interesting data.
Again, I'm concerned about how it gets used. I think that
the concept of players being able to make and equipment men
being able to help them make better decisions because of how a
helmet performs on this test is a possibility. I think that
taking the data quite literally and saying well, this helmet
performed 20 percent better than our old helmet, maybe it
reduces the risk of injury 20 percent, that would be absolutely
So I have some real concerns about how it's used, and we
are talking about energies and accelerations to the head, and
I've heard a hundred g's mentioned by Dr. Omalu, and you know,
I'm not a politician, and I don't understand, maybe, a lot of
these debates, but Congressman Sanchez, you sneezed a while
ago, and that was a head acceleration. I don't know that you're
brain damaged, and I don't know that you'll be demented----
Ms. Sanchez. Others will argue with you about that.
Mr. Halstead. Right, I don't know that you'll suffer
dementia later, that really is the issue here is how, without
being able to see into the brain, do you know that the impact's
been one of a sufficient magnitude to cause the concern? I
think that's why things have moved slowly, and I'm not
defending anybody, I don't belong to any of these MTBI
committees and don't know, but I do know from studying helmets
for a long time somebody's got to give me the target, and
that's somewhat related to the input energies.
And helmet manufacturers have looked at this testing and
have said we can do better, so the NFL has extended to them an
opportunity to submit additional helmets for testing. They may
do better. But whether or not they, you know, actually work
better in the field to reduce or limit concussions, I think
remains to be seen, but I have a hard time arguing with a
helmet that manages more energy than some other helmet.
Mr. Cohen. Thank you. And if either of the two helmet
manufacturers' representatives want to comment, you don't have
to, but if you wanted to, I'd like to give you the opportunity.
Mr. Ferrara. I feel it is important to take note of what
Dr. Maroon, who I would consider a good ally, pointed out that
it appears there's a stated corporate goal on the NFL's part to
move players into modern helmets. A corporate goal is not a
scientific study. The idea of creating an older helmet profile
is highly unusual.
Some of the helmets were literally taken out of locker
rooms, apparently. Some of them were taken off of the shelves.
Given that helmets other than ours consist of multiple
components with unknown histories, no date stamps, that get
shuffled year after year in the reconditioning process, these
helmets would be entirely unreproducible. It would be as if you
walked out on the street right now and you grabbed a dozen
people who appeared to be older, whatever that meant to you,
and you took measures of their health and said this is the
profile of an older person, we're now going to test younger
people versus older people to see who's healthier. It simply
doesn't make sense. It's not credible science.
Mr. Cohen. Thank you, sir.
Mr. Halstead. May I give a response.
Mr. Cohen. Surely, go ahead, sir.
Mr. Halstead. Yes. The old helmets consisted of Pro R 2s
and VSR 4s, some of which I actually went and got off the
field, and I have a pretty good idea of what they looked like,
but Dr. Ferrara is correct, it's my assessment of what they
However, we were able to get from Schutt Sports
Manufacturing two 10-year-old Pro R 2 helmets that had been
never been put into play, and we were able to get from Riddell
at least two for each lab. The VSR 4 helmets had never been put
into play. So we had a pretty good idea of those constructions.
Whether they were hermitically sealed and somehow stored for
all those years is another question, but we did have unused
helmets, and we had used helmets, and their performance on the
test was statistically so close so as to render the argument
that Dr. Ferrara just made kind of inert.
Mr. Arment. My comments would center around--I want to go
back to my comments before where I said clearly, there is
opportunities to improve helmets, and a brought range of
research and debate and--is important to the topic. Our
commitment at Riddell is to ensure that we continue to put the
best technology on the field and that we use science and
independent research to verify that those helmets are, indeed,
as good as we say they are.
And that is our commitment, and I think that, you know, is
evidenced by the history of our helmets and the peer reviewed
research that we have, and that's a commitment that we're going
to maintain and continue to follow through with all of our
Mr. Cohen. Thank you. Doctor.
Dr. Omalu. Can I make a comment as a physician and also as
a forensic pathologist. We've been talking about scientific
evidence, scientific testing, but I must warn that medicine is
not an absolute science. We cannot make absolute derivations
from a laboratory simulation what happens in the human body.
Findings like what they're talking about, statistical
significance, if you change your end point, epidemiology is not
an absolute science. There are multiple factors involved. The
end point, the outcome, the cause will be different if you
change your limits or if you change your study definition.
And as a physician, you cannot base the plight of the
player on a single published paper or on a single study
formula. Again, the guideline as a physician who's sworn to the
Hippocratic Oath should be the players, themselves. The focus
should be the players, and again, like the law recognizes,
generally accepted principles and common knowledge should try
and guide our decisions and the decision making in concussions,
not laboratory simulations and corporate derivations. Medicine
is not an absolute science like mathematics or physics.
The human body cannot be simply reduced to an index or just
a number, and this is what the Hippocratic Oath is all about.
We must always have that behind our minds while we're
discussing these issues.
Mr. Cohen. Thank you, sir. One last issue on the helmet
issue, the issue's been raised, I guess, by this testimony
about the NFL's endorsement, long-term endorsement with
Riddell. I guess it's the helmet of the NFL or something like
Mr. Arment. It's the official helmet of the NFL.
Mr. Cohen. Official. Does that create a conflict of
interest, Mr. Halstead, for anybody when you get into helmet
tests? I mean you got the helmet of the NFL, this is the helmet
that protects the brains of the NFL players which, in essence,
you know, some of these owners might not belive that they are
the NFL, it's not the owners, they get a big share, it's like I
won, and they didn't do anything, they just bought the team.
It's the players who are the NFL. And so the helmet's
protecting their brains. Shouldn't be there some reason to
believe that maybe there shouldn't be an endorsement so there
might not be some proclivity to favor one helmet over another,
whether it's Mr. Ferrara's or Mr. Arment's and just have the
Mr. Halstead. Sure, I'll give you my personal opinion. I'm
not a marketing person. When I see these things, I think of
them as marketing decisions. Frankly, I--my personal
experience, which is somewhat limited with the league, is I've
had players and equipment managers and trainers and physicians
call me and say I've got So-and-So's been injured, you know,
what helmet should I put him in? And I don't have an answer for
that because I don't have any data to support that any helmet's
better than any other at preventing the next injury. The real
issue is not hitting your head again, and that goes back to
return-to-play guidelines and things that are beyond my ilk.
Mr. Cohen. But you said your study shows that some helmets
didn't do any good, and some did a lot of good, and some did a
little bit of good, you got a number----
Mr. Halstead. No, I think that's a mischaracterization.
What I said is that in these impacts, the study did show that
some newer helmets managed energy significantly better.
Mr. Cohen. Right.
Mr. Halstead. And some did not, which is kind of surprising
because the real difference between new helmets and old helmets
is how much standoff there is and how much distance there is
from the outside of the skull to the inside of the shell, and
as helmets get larger, they're able to manage more energy.
Whether that makes a better helmet for certain levels of play
is very, very questionable.
To specifically answer your question, I think any kind of
an indication or any emphasis that would have a player choose
one product over another just because of the name that's on
their product, probably not a good plan.
Mr. Cohen. Yeah, and I guess, you know, you pay the NFL, is
Mr. Arment. We have a licensing agreement with the NFL.
Mr. Cohen. How much is that? How much does that generate a
Mr. Arment. Our licensing agreement generates--it's about a
15 percent royalty rate.
Mr. Cohen. And what's that come to in dollars.
Mr. Arment. It's off of our consumer products business, so
historically, it's been, you know, less than a million dollars.
Mr. Cohen. Just, you know, I understand that it's good for
you, and it would be good for Mr. Ferrara if he could be it,
but it just seems like Delta being--or Planters being the
peanut of Delta, or Coke being the beverage of Delta is
different than the helmet. Nobody's going to get hurt too much
with the peanuts and the Coke.
Mr. Arment. Yeah, you know, I would hope to come back to
the fact that it is player choice and every manufacturer has
complete access, the same access that Riddell has, and we have
worked very, very hard with the NFL and with the NFLPA to
educate the players on the differences between--and the
features and benefits of our helmets.
I think the, you know, business relationship between the
NFL and Riddell is completely separate from the on-field
choices that were made. If that wasn't the case, we would have
a hundred percent, and we have an 80 percent number.
Mr. Cohen. I appreciate your testimony, I appreciate your
product, and I thank the Chairman for his having the Committee
and this outstanding panel he's put together, and I yield back
the remainder of my time.
Mr. Conyers. Thank you so much.
Mr. Hallenbeck, would you like to have the second to last
word in this hearing before the panel?
Mr. Hallenbeck. Thank you, Chairman. I guess as I sit here,
I look at it from the view of probably all your constituents,
the mom, the dad, you know, worrying about our sons and
daughters playing the sport, and what I said in my statement
and testimony, which I think is absolutely critical in all of
this, a lot of healthy debate, if you will, but in the end, if
we don't come to a solution that is clear, concise, and simple
application so that the moms and dads and the kids can
understand it, we've all done something terribly wrong.
So I guess the important statement here is, you know, we
need to make sure we can boil this down and people can
understand it. It's my job then to get it out in the hands of
these parents and players, and so forth. So I think there's
clearly been some very positive action taking place in the last
3 months, and I know there's been work done before that in my
own organization. We've been meeting with the American College
of Sports Medicine and a lot of other groups to try to make
some positive strides in this area, and--but certainly in the
last 3 months, there's been a sea change, and so I credit all
of the parties involved, including, certainly, this Committee,
the NFL Player Association, and so forth, and it's been said
already what happens at that level absolutely trickles down.
And so it's for my sole view of, you know, focused on youth
football and amateur football, I just hope all of us focus on
the fact that we've got to get to the point where we can offer
some real credible, concise, clear protocols that we can get
out and help these young players understand what the details
are around this and ultimately how to return to play safely.
Thank you very much.
Mr. Conyers. You're welcome. And Bob Colgate, high school,
you have the last word on this panel.
Mr. Colgate. Thank you, Chairman Conyers. I'd have the same
comments Mr. Hallenbeck brought forth. You know, I know we're
talking about football, but from our perspective of writing the
playing rules for 17 sports and dealing with 7.5 million young
men and woman participating in high school sports across the
country, concussions goes across all areas. And so we've got to
look at it from that perspective.
We're very, very interested in the ongoing discussions that
this committee has, also, the research, and also the equipment.
It plays a part, not only in football, but in all of our
sports. So any assistance that we can get to work with our
19,000 high schools across the country would be of benefit.
Mr. Conyers. You're more than welcome. I thank all the
panelists. There are eight other witnesses, doctors, former
players, trainers, Luther Campbell, and others. We will now
take a short break and eight other witnesses will resume, and I
thank you for your patience.
Mr. Conyers. We welcome our second and final panel, and I'd
like to just make a point of order that the second panel is not
inferior to the first panel. This is not some kind of ranking.
It was just that we couldn't get all 18 of you all up on the
same panel at the same time. We're happy to have Bernie
Parrish, former Cleveland Browns pick and choice for many
years; Luther Campbell, the much sought after professional
trainer of athletes in the country who is particularly occupied
in the Metro Detroit area and has trained athletes in both
football, basketball, and boxing; George Martin who was 14
years with the New York Giants, we're delighted that he's with
us; the founder of the Vince Lombardi Foundation, Robert
Schmidt, and we're delighted that he is here; Kyle Turley spent
9 years with the New Orleans Saints, the St. Louis Rams, Kansas
City Chiefs, an NFL All Pro; Chris Nowinski, best known as the
Former World Wrestling Entertainment Professional Wrestler who
turned his background as an all-ivy Harvard football player
into one of the most prominent figures on television these days
and nights; Dr. Jeffrey Kutcher, a hockey player since
childhood, who developed an interest in sports neurology at the
University of Michigan is with us, and our first presenter will
be Dr. Randall Benson.
He's the only fellowship trained behavioral neurologist at
the Detroit Medical Center. He's been on both DMC and Wayne
State University since 2001, an active member of the teaching
faculty, and has a very distinguished background in clinical
and research in traumatic brain injury and now fully engaged in
studying both impact and nonimpact head injuries, seeking to
understand the biomechanical mechanisms, treatment, and
prevention of injuries.
We're delighted that Linda Sanchez, who I hope you don't
have to find out how difficult it was for her to get here
today, in route, we deeply welcome her dedication for the work
that all of us love, and Steve Cohen, from Memphis, Tennessee,
is a valued friend of ours, as well, who's contribution is very
I would invite all of you in this final part of our
discussion to add any comments that you would feel ought to be
in this very extensive record that will be reproduced and
studied and examined by people from all professional walks, as
well as from the sports industry, itself, to make comments
about anything you may have heard in the--during the discussion
of the first panel or anything that came up in the first panel
that you would like to have a comment made about that.
This out of the way, I'd like to invite Dr. Randall Benson
to begin our discussion. Welcome, sir.
TESTIMONY OF RANDALL R. BENSON, M.D., ASSISTANT PROFESSOR OF
NEUROLOGY, WAYNE STATE UNIVERSITY
Dr. Benson. Thank you very much, Chairman Conyers, Mr.
Cohen, Ms. Sanchez. It's, indeed, a pleasure to have the
opportunity to speak to you today on something that is so
important. In fact, like most of us, I'm a lover of football. I
moved to Pittsburgh in 1969, and left to go to St. Louis in
'78. And so I was indoctrinated in the Steeler tradition, one
might call it a religion almost, and I just had the pleasure of
meeting Mike Richter's son, Garrett, out in the hall, and I
asked him who he plays for, and he said he didn't play, and my
jaw dropped, and then he explained to me that he had a knee
injury, but I trust that his head is fine.
So I actually wear two distinctively different hats, and
I'm going to speak to you from both perspectives. On the one
hand, I--I treat TBI and have done so since 2001. On the other
hand, I spent some time being nurtured in Boston first at
Boston University where Chris Nowinski has ties, and then at
Mass. General where I get into the imaging and also trained in
behavioral neurology, and so I think it was only a matter of
time before I came to head trauma; although, I came to it kind
of in a backwards fashion, looking at stroke and working on
something called functional MRI at Mass. General.
So since my arrival at Wayne State in 2001, my research
emphasis has greatly shifted to the application of what one
might call functional MRI methods to traumatic brain injury.
This was in large part driven by cross-campus strengths in TBI
at Wayne. Wayne State University, as has been mentioned, has a
long and illustrious history of biomechanics, head trauma
research beginning in the forties with Gurdjian and Lissner's
studies using cadaver brains, which led to the Wayne State
Concussion Tolerance Curve which continues to be the foundation
for most currently accepted head injury indices.
Over the last three decades, Dr. Albert King has been
leading the biomechanics and bioengineering department here at
Wayne State and continues the tradition of excellent
biomechanics research. In particular, he has developed some of
the vast three-dimensional mathematical models of the brain's
response to impact and blast forces which have resulted in
improvements of automobile cabin safety and, also, football
helmet design he's taken a look at.
I'd like to introduce Dr. King, who I must say I'm
disappointed that he's not on the panel. Dr. King?
On the medical side, hospitals at the Detroit Medical
Center are world leaders in the acute and rehabilitation stages
of TBI respectively and have had continued NIH research
support. My clinic is comprised largely of patients with brain
disorders, the majority of which are dementia evaluations and
traumatic brain injury cases. In a given week, I'll see as many
as three to four new patients with TBI and an equal number of
memory disorder cases.
What I'd like to do now is very quickly share some
observations from my 8 years of evaluating TBI, and I think
they're germane to sports related concussions, as well. Now,
the vast majority of my TBI cases I will get neuropsychological
testing and advanced MRI imaging or MNR imaging on. The first
observation is that people with TBI are frequently
misdiagnosed, often by multiple physicians.
The second is the most frequent diagnostic category given
is psychiatric, anxiety, depression, conversion disorder.
Number three, two neuropsychologists studying the same
patient may differ considerably regarding the existence of TBI,
and I think that's really important that neuropsychology is not
an exact science.
Number four, TBI symptoms overlap considerably with those
of primary psychiatric disorders, and some researchers believe
that it's actually a continuum, that posttraumatic stress
disorder may, indeed, be a very mild form of TBI.
Number five, without the ability to see the brain injury
with imaging, there is no completely objective way to determine
what is TBI and what is something else, for example,
posttraumatic stress, conversion disorder, malingering.
Number six, people with brain injuries seem to vary
considerably in severity of symptoms and in recovery in the
face of similar falls, crashes, etcetera. This may speak to
population differences in resistance to injury or effectiveness
of neuro recovery mechanisms, and it's in agreement with Mickey
Collins from the University of Pittsburgh who found large
differences in recovery from single concussion, and this work
was presented at the North American Brain Injury Society annual
meeting just a few months ago in Texas.
Finally, advanced MR imaging techniques, I believe,
including susceptibility weighted imaging, diffusion tensor
imaging, and something called MR spectroscopy are able to
reveal brain injuries where CT scans and conventional MRI
appear normal. Sports related TBI or concussion is not
different from sports related TBI, except that the severity is
usually mild, but repetitive concussions are the rule in sports
which have an increasingly poor prognosis.
So I'm involved in several ongoing research studies
involving TBI which have in common the application of newer
imaging methods but which differ by severity, time frame to
imaging, funding status, specifics of scanning sequences, and
mechanisms of injury. Each of these imaging studies is done at
the MR research center at Wayne State University under the
directorship of a Ph.D. Physicist, by the name of Mark Haacke.
He's internationally recognized for his achievements in
vascular susceptibility mapping which are very relevant to
concussive brain injury.
For example, one study looks at acute, mild TBI or
concussion. We scan these people right out of the emergency
room. A second study looks at more severe TBI when medically
stabilized. Another study has been going on for 15 years
supported by NIH, but an imaging component was added to this.
We have more recently studied former NFL players in two
capacities, the first sponsored by the NFL is an imaging study
using imaging methods prescribed by our group with imaging
performed at a clinical imaging facility, ProHealth, in New
Images are then sent by CD Rom to us for analysis. To date,
we've received and analyzed 41 scans sending reports back to
Drs. Casson and Viano in New York. Of course, we know that this
is on hold now. My role is as a consultant on both image
quality and data analysis and reporting. This study projected
to scan more than twice this number and, thus, is incomplete at
this juncture. The second study is a pilot imaging study of
former NFL players withstanding an analysis performed in
Detroit. To date, we've enrolled eight subjects, and I'm going
to present some very preliminary data on--on some of these
former NFL players.
I'd like now to review some of the imaging methods we've
developed and applied to TBI. The unabashed emphasis of our
work is the image traumatic axonal injury, also known as
diffuse axonal injury, which I'm sure this panel is aware of,
this panel and the committee, which is responsible for the bulk
of chronic cognitive deficit following TBI. In addition, the
most devastating consequence of repetitive TBI, chronic
traumatic encephalopathy, is thought to be the result of
diffusion axonal injury, possibly caused by a series of
concussions before full recovery occurs from the prior
This weekend I had the opportunity to e-mail Dr. McKee
repeatedly in preparation for my testimony, and she gave me the
go ahead to quote her. Specifically, there's a hypothesis that
she supports that phosphorylated tau, which we've heard
something about, within damaged axons is toxic to these
neurons, and in fact, Dr. Omalu mentions that amyloid--the
precursor protein may be the catalyst for triggering the tau
protein deposition, which is, as we understand, cytotoxic and
may underlie CTE.
Electrophysiologic data from an EEG, known as the event
related potentials, indicate that even after symptoms have
abated from sports concussion, the brain has not normalized,
and again, Dr. Omalu mentions 99 days, all right? So certainly,
it raises the question of whether people should be returning to
activity before that 3-month period. This suggests that
clinical symptoms are not a reliable indicator of recovery and
that to rely on symptoms exclusively to guide your turn is to
put the athlete at risk.
Okay. So now I'd like to show you a movie. Actually, this
is a movie that was--it was made from a series of MRI images,
okay, with a volunteer moving his head back and forth inside
the MRI. And if we could cycle that a few times, what I want
the attendees to appreciate is that this is sub-injury
threshold movement, and I think what you can appreciate--now
the matrix was something that was superimposed over the brain--
is a movement of the brain, itself, within the cranial cavity,
And again, this is a person like you or me simply moving
their head back and forth repeatedly. This work was done by Dr.
Phil Bailey, who has his own neurotrauma lab at Washington
University. I also have a similar image that was obtained by
Dr. Van Wedeen at Mass. General Hospital and looks very, very
similar. So again, the notion that you can sneeze and cause
brain injury may be a little bit farfetched, but it's not
farfetched to think that there is brain movement occurring with
relatively moderate head movement.
Okay. Okay, next slide? Okay. So I don't know that you
can--I don't know if we can turn the lights down, but I think
that would maybe help with visualizing some of these images. So
the first image type that I want to tell you about that we now
have plenty of experience with is something called
susceptibility weighted imaging.
In 2004, we had the opportunity to scan an 11-year-old boy
whose vehicle skidded off a mountain while his parents were
driving in the mountains of Colorado, and his parents both died
in the crash, he survived. He came to us in a coma. His family
was originally from Michigan, and we scanned him with these new
techniques, and what I'd like to point out--I don't know if you
have a pointer, I'm not even sure it's necessary--the image on
the left is a standard conventional MRI, a so-called T1
The image on the right is a susceptibility weighted image
developed by Dr. Haacke, and what I want you to appreciate are
the multiple black holes in that image. I trust that you can
see those. And those are microhemorrhages. Those are an
indicator of what we call diffuse axonal injury. He--he has
gone on to come out of his coma. He is by no means normal, he's
quite impaired, and--and I think the imaging, certainly the way
we do it, gave us some indication of what his prognosis was.
Next? Okay. Another example, even more striking, I think,
this is not a TBI case, this is a condition known as cerebral
amyloid angiopathy. So it has that word ``amyloid'' in there,
and there is a relationship. You tend to see this in older
individuals, frequently with Alzheimer's disease, and again,
appreciate the absence of holes in the standard clinical T1
image and the plethora of hemorrhages, and the pathologists, I
believe they did biopsy her. The imaging was done postbiopsy.
The pathologist told me that there was an excellent correlation
between the imaging and the pathology.
Now, it's also true that individuals can have more mild
injuries, as we know. This--this patient was involved in--in a
motor vehicle accident. We scanned her 3 days post her
accident. Her Glasgow Coma Score was 13, which is classified as
mild, and again, you see the hemorrhages which are apparent in
the frontal lobe on the SWICN but not the conventional image.
Okay. Another mild case, this time, not diffuse axonal
injury but a bruise or a contusion in her frontal lobe. This
was an employee at Wayne State who slipped and fell and hit her
head on an iron--an iron bar of some sort and went back to work
but wasn't right, and eventually, she took an early retirement
because cognitively, she never did recover back to her prior
Okay. Now, we move on to really what I think is the most
sensitive technique in looking at diffuse axonal injury, and
this is called diffusion tensor imaging. Panel A shows you
schematically what a normal axon looks like. B shows you
changes that occur early after stretch trauma or other kind of
deformation, and then C is the end stage. And the reason I'm
showing you the change in shape is that this is what allows us
to image and to identify axonal injury, all right? So C is the
late stage. You see the so-called retraction ball? Okay.
What we did is we looked at 20 patients with trauma that
came through our doors, and we looked at 14 normals, and we
plotted the distribution of an index which I won't bore you
with, it's called fractional anisotropy, or FA, and what we
find is that there's clear separation between the trauma cases
and the control cases, and furthermore, because of good
correlation between the severity of the injury and what we find
in the imaging, and we've gone on to refine this--can you back
up one slide--and we now do a regional analysis. Well, we can
now look at the injury in standard atlas defined regions rather
than just looking at the global brain. Next?
Okay. And we also compared each individual brain to 50
normal brains, and we did a statistical analysis, and this
allows us now to identify specific voxels, specific pixels, if
you will, that are showing an abnormality in this diffusion in
these. Okay? So now, this puts it altogether. This is a
comparison for a single subject on a single slice showing the
SWI with microhemorrhages and BTI with axonal injury, and
something called MR spectroscopy, which is a way to look at the
biochemistry, and they're all showing us abnormalities in the
lighting on it.
All right, in the first NFL case, we actually had the
opportunity to scan both in New York and at Wayne State, and
this allowed us, in a sense, to calibrate the imaging that was
done in New York for the NFL, and what I want to show you is
that there's striking similarity between the findings. The left
column is the Wayne State image of the three select slices. The
middle column was obtained in New York, and then the third
column is the average of the two, all right? Clearly, this
former NFL player has an axonal injury, I would say, based on
my experience, that he does.
Next slide, and the last slide. Thank you for indulging me.
This person is a 36-year-old, 11-year vet of the NFL, he's a
fullback. He retired 3 years ago. Now, interestingly, I went
back and looked at his questionnaire, he has by his report over
50 episodes of hits that rendered him blind for about a minute.
He said that he needed help to get back to the huddle. He
states he has no visual impairment now. The one area of
abnormality he has in the area called the splenium of the
corpus callosum, and that, of course, that contains crossing
fibers from the two visual cortices of the brain.
And so what I would suggest and my opinion is that if we're
going to get to the bottom of the issues, we need to do a large
scale imaging study, not just imaging. We know about the
individual variability. We need to look at ApoE. We need to
look at many factors, but we need to do a cross-sectional
study. We also then, possibly contemporaneously, need to look
prospect--we need to follow NFL players throughout their
career, charting concussions in order to identify the
predictors of cognitive deficit and, in particular, CTE. Thank
you for allowing me to testify.
[The statements of Dr. Benson follows:]
Prepared Statement of Randall R. Benson
Mr. Conyers. Thank you very much, Dr. Benson.
Dr. Jeffrey Kutcher comes from a bit different point of
view, a hockey player since childhood, but at the same
developed an interest in sports neurology at the University of
Michigan and then served his neurology residency after
graduating from Tulane Medical School. Since then, he's been on
the University of Michigan staff as director of Michigan
NeuroSport, an academic and clinical program focused on
improving the neurological care of athletes. His interests
focus on sports injury and the management of neurological
diseases in the athlete. Particular areas of research include
concussion, migraine headache, and sleep disorders.
We welcome you and await your testimony, Dr. Kutcher.
TESTIMONY OF JEFFREY KUTCHER, M.D., DIRECTOR, MICHIGAN
Dr. Kutcher. Thank you, Chairman Conyers, Congressman
Cohen, Congresswoman Sanchez, thank you for giving me the
opportunity to speak today. As you mentioned, I'm a neurologist
at the University of Michigan where I am both Chief of
Inpatient Neurological Services, as well as the Director of
Michigan NeuroSport. You mentioned it is a comprehensive
academic program of sports neurology. We care for athletes of
all levels from youth sports to professional leagues. We
conduct research on concussion, provide education to healthcare
providers and the community about concussion, as well.
I'm also the team neurologist for the University of
Michigan, Eastern Michigan University athletic programs, and
through these roles, I conduct preseason baseline testing,
diagnose and manage concussion on the sidelines, and follow
patients after concussion in the training rooms and in my
clinic. I'm also honored to be the Chair of the American
Academy of Neurology's Section on Sports Neurology, which was
founded in 2009 with the express purpose of improving
neurological care of athletes at all levels, through education,
advocacy, and research.
I should also note that I recently accepted an invitation
from the National Football League to serve on their concussion
committee as it's being reformed. I look forward to working
with the group to help ensure the safety of the sport.
With that in mind, however, I'm encouraged that today's
hearing goes beyond the scope of the NFL. While professional
contact sport athletes may have a longer period of exposure,
they represent only a small fraction of those at risk. With my
time, I'd like to address three particular points.
First, concussion is a complicated injury. We've heard some
testimony today to that effect. The brain is complicated in
dynamic. We know from other brain disorders that there is a
tremendous amount of variability between individuals. When a
mechanical force is applied, we do not expect one brain to
react the same as another.
To understand the short-term and long-term effects of
concussion, we must first understand how concussion varies
between individuals, what risk factors lead to worse outcomes,
and how much risk can be attributed to genetic versus
environmental factors. To accomplish this, I urge researchers
to focus on these specific questions and more importantly,
funding agencies to help provide the support needed to find the
My second point is that because of the brain's complexity
and the degree of individual variation, concussion management
does not lend itself well to the use of protocols, clinical
protocols. It is an injury that is best managed on a case-by-
case basis by people with neurological expertise and experience
Such a large portion of concussion management involves
determining when an athlete is back to their neurological
baseline, it is extremely helpful if the physician has personal
preinjury knowledge of that athlete, including their cognitive
abilities and personality. This makes the team physician and
athletic training staff a central component of any
comprehensive concussion program.
At both the University of Michigan and Eastern Michigan
Universities, we use our own surveillance data to determine
which sports to enroll in our concussion-monitoring programs.
Sports like football, wrestling, and ice hockey are some
obvious choices, but we have also found the need to include
many other sports at our schools, including water polo, field
hockey, cheerleading, and diving, among others.
When each athlete enters our program as a new student
athlete, we take a careful concussion history, we want to know
what happened to them in the past before they came to us, as
well as a detailed review of other diagnoses or family history
that may be relevant to their concussion risk, such as
dementing illnesses and headache disorders. We consider the
acquisition of preinjury baseline data to be essential in
conducting an evaluation that includes a neurological
examination, neurocognitive testing, and a sideline concussion
assessment tool in the preseason.
When a concussion is suspected, the student athlete
undergoes an immediate clinical evaluation by the onsite
certified athletic trainer and/or the team physician if they
are present. The team physician then follows the patient
closely until that concussion has resolved. Return-to-play
decisions are not entertained until the student athlete is
completely free of symptoms, has a normal examination, and has
progressed through a graded exercise challenge program that we
Computerized neurocognitive testing is used as an extension
of our physical examination, rather than a decision tool unto
itself. Return-to-play decisions, as well as retirement
decisions, are made with careful consideration of each
athlete's history, as well as looking for certain red flags, a
few of which are any change in their baseline function that we
can tell on objective testing or through school work or more
personal stories from their family members, escalating severity
of symptoms in subsequent injuries, or if they're getting
concussions too easily. We very carefully take a history of
what caused each concussion, so we know what their threshold
is, in other words.
However, with little published clinical data to help make
these decisions, there is very little that we can point to and
say this is when it's safe to go back. The key to making these
programs work is the involvement of an experienced and
knowledgeable medical staff. Relying on protocols is, in my
opinion, potentially dangerous, clinical protocols, as they
assume that conclussions are similar enough to each other to
fit a predetermined paradigm.
The final point I'll make is that realizing that proper
concussion management requires resources that are not available
to the vast majority of high schools in the country and many
colleges, we must address a larger public health need. To that
end, the American Academy of Neurology has recently undergone a
process of creating new practice perimeter guidelines. Dr.
Casson in the first half was talking about the '97 American
Academy Guidelines with the one-two-three business, that is
being revisited and we'll be coming up with new guidelines, we
started that process a couple of months ago.
To accomplish that, we have assembled a panel of experts
from the fields of neurology, neurosurgery, sports medicine,
athletic training, emergency medicine, rehabilitation medicine
and neuropsychology, being careful to choose members who are
without a commercial conflict of interest. The sports neurology
section of the academy is promoting awareness of concussion
among primary caregivers and general neurologists, working to
increase the number of neurologists specializing in sports
neurology and developing the educational tools necessary to
provide optimal care. We also feel that a central component of
athlete safety is to increase the number of certified athletic
trainers that are at all contact sport competitions and
As evidenced by this hearing today, the management of
concussion is evolving, and I'm glad to see that it is. I'm
also honored to be part of the effort, grateful to be working
with colleagues of such talent and focus, and I'm confident
that together as a group, we'll be able to do what's best for
athletes at all levels. Thank you.
[The prepared statement of Dr. Kutcher follows:]
Prepared Statement of Jeffrey Kutcher