Documentary: For years, NFL ignored concussion evidence

• PBS will premiere a Frontline documentary%2C League of Denial%2C on Tuesday night
• Two ESPN reporters co-wrote the film and a book%2C examining the NFL%27s past handling of concussions
• Film says doctor who first diagnosed concussion damage in deceased player came under attack from NFL

Although the NFL admitted no guilt when it agreed in August to pay more than $765 million to settle concussion-related suits by about 4,500 former players, the issue is not going away for American pro sports' preeminent league.

On Tuesday night (9 p.m., ET), the PBS television series Frontline airs a two-hour investigation: League of Denial: The NFL's Concussion Crisis. The much-anticipated film airs after ESPN, which had agreed to partner with Frontline on the project, pulled out shortly before the concussion settlement was announced. ESPN, a major broadcaster of NFL games, denied the decision came after pressure from the league. The film rolls on with substantial reporting by ESPN journalists.

The 2002 death of center Mike Webster of the Pittsburgh Steelers at age 50 is the cornerstone of the documentary, a tipoff delivered in opening scenes of molten steel and blast furnaces. The Hall of Famer was the first former NFL player diagnosed through autopsy with the brain disease known as chronic traumatic encephalopathy, or CTE.

Webster and other CTE cases were cited in the lawsuits, but because the ex-NFL players opted not to go to trial, the case never got to the stage of what the NFL knew and when it knew it. Frontline makes the case that, beginning in the late 1990s, the NFL ignored mounting evidence about long-term dangers of concussions and tried to refute emerging science with questionable research of its own.

The Pittsburgh doctor who diagnosed Webster says the NFL tried to "squash" him and later helped block him from examining the brain of former NFL star Junior Seau, who committed suicide in 2012. Another researcher says she encountered a dismissive attitude – and sexism – when she made a presentation to a male-dominated NFL committee in 2009.

The NFL has implemented an array of player safety policies over the past four years, including no return to play on the same day a concussion is diagnosed, stricter rules covering hits to the head (including fines and suspensions of players) and putting athletic trainers in the press box to alert the sideline of potential concussions. This season, a league directive added "independent" neurological consultants on the sideline during games.

In the settlement, which is subject to court approval, the NFL agreed to compensation and medical benefits for former players, as well as funding for research. Independent of the suits, the league this year launched a $60 million "Head Health Initiative" to encourage research into diagnosis, treatment and prevention of concussions.

In response to League of Denial, the NFL issued a statement from Jeff Miller, senior vice president of health and safety policy, who said that for more than two decades the league has been a "leader in addressing the issue of head injuries in a serious way." Miller cites investments in research, changes in rules and this year's national launch of "Heads Up Football," a youth safety program administered by NFL-supported USA Football.

"By any standard, the NFL has made a profound commitment to the health and safety of its players that can be seen in every aspect of the game, and the results have been both meaningful and measurable," Miller wrote.

Steve Fainaru and his brother, fellow ESPN investigative reporter Mark Fainaru-Wada, who co-wrote the documentary and a book (also being released Tuesday), paint a different picture of how the NFL handled the issue in previous years.

"The league just knocked it down time after time," Steve Fainaru, a 2008 Pulitzer Prize winner for reporting on the Iraq war, told USA Today Sports. "At the very least, the league should have known that it was a far more nuanced picture than they were presenting to the players and the public and that there were very serious warnings from credible scientists.''

Mark Fainaru-Wada pointed out contradictions in the league's actions: At the same time the league's former Mild Traumatic Brain Injury (MTBI) Committee was denying a link between concussions and long-term effects, the league's retirement board was awarding disability compensation to players such as Webster following doctors' assessment of their mental conditions.

"You had this weird dynamic of two separate (NFL) committees … one sending a message that concussions were essentially not a problem and the other acknowledging that football had caused brain damage in several players," said Fainaru-Wada, who also broke the BALCO steroid scandal.

NFL disputes findings

Mike Webster played with the Steelers (1974-1988) and Kansas City Chiefs (1989-1990), winning four Super Bowls with Pittsburgh in his Hall of Fame career. But the physical toll was high for the offensive lineman. "For Mike Webster, the head hits just kept on coming for 17 years," says Frontline narrator Will Lyman.

The documentary details Webster's descent into confusion, depression and dementia, the end of his marriage, his living out of a pickup truck and his inability to sleep. His former wife, Pam, tells how he took a knife and slashed all his football pictures.

Webster died on Sept. 24, 2002.

"The news that day would start a chain of events that would threaten to forever change the way America sees the game of football,'' the narrator says.

Frontline shows a photo of Webster's body on a table at the coroner's office in Pittsburgh . Bennet Omalu, the forensic neuropathologist who did the autopsy, said death was due to heart disease, but he also wanted to examine Webster's brain.

Omalu said his examination found evidence of CTE, a degenerative condition that previously been associated with boxers. Omalu was the first to report a case in an NFL player and in 2005 he published his findings in the journal Neurosurgery.

In response, the then-chairman and other members of the NFL's former Mild Traumatic Brain Injury (MTBI) Committee wrote a letter to the journal saying Omalu's findings were based on a "complete misunderstanding of the relevant medical literature" and that there was "inadequate clinical evidence that the subject had a chronic neurological condition."

"They insinuated I was not practicing medicine. I was practicing voodoo … voodoo," the Nigerian-born Omalu tells Frontline.

Omalu added: "CTE has dragged me into the politics of science, the politics of the NFL. You can't go against the NFL. They'll squash you."

After former San Diego Charger Seau's death, Omalu was invited to participate in the autopsy. He said he had an understanding with Seau's son, Tyler, that he would be allowed to examine the brain. The documentary reports that access was denied after the NFL informed the son that "Omalu's research is bad and that his ethics are bad."

"I got a long email about it," Tyler Seau says in the film.

The Frontline report also says that in 2000 the NFL retirement board said in a letter to Webster's attorney, Bob Fitzsimmons, acknowledging that Webster had been declared totally disabled as a "result of head injuries he suffered as a football player with the Pittsburgh Steelers and Kansas City Chiefs." The finding were based on reports from five doctors, including a neurologist hired by the NFL board.

Mark Fainaru-Wada says the letter is "sort of the proverbial smoking gun," an admission that the NFL was not making publicly at the time.

Frontline also challenges a series of research papers published by the NFL's MTBI committee from 2003 to 2009.

In 2004, a league study had found "no evidence of worsening injury or chronic cumulative effects" from multiple concussions.

In a study published in 2005, the committee said players whose concussion symptoms go away while a game is in progress can return "safely" to that game. It noted the "possibility" that the same might apply to high school and college players.

In May 2009, Ann McKee made a presentation before the MTBI committee at NFL headquarters in New York. A professor of neurology and pathology at Boston University and co-director of BU's Center for the Study of Traumatic Encephalopath, McKee told Frontline the committee was not receptive.

"They were convinced it was wrong, and I felt that they were in a very serious state of denial," she said.

McKee also sensed a gender issue. "Sexism is a big part of my life, and getting in that room with a bunch f males who thought that they knew all the answers, more sexism. It was like, 'Oh, the girl talked. Now we can get back to some serious business.'"

Neurosurgeon Henry Feuer, a member of the committee at the time, tells Frontline: "I don't know why she feels that way. … I don't know where she's coming from."

Unknowns remain

Frontline and McKee acknowledge there are unknowns about CTE.

In 2012, the Boston University Center for the Study of Traumatic Encephalopathy reported it had examined the brain of 50 deceased football players that had evidence of CTE: 33 from the NFL, one from the Canadian league, one semi pro, nine college and six high schools players.

Yet after an international conference in 2012 in Switzerland, a consensus statement said that CTE represents a condition "with an unknown incidence in athletic populations." It also said "that a cause and effect relationship has not as yet been determined between CTE and concussions or exposure to contact sports." It recommended that interpretation of cause should "proceed cautiously."

Michael Collins, director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, addressed the uncertainty about CTE in an interview last summer with USA Today Sports. UPMC is the sports medicine provider of the Steelers.

"There's no proof at this point in time determining that concussion is an isolative favor in causing CTE. There are so many other factors that have yet to be controlled for," said Collins. " … We haven't looked at a bunch of control brains to see if that occurs in the normal population. We don't know if factors such as steroid use or alcohol use (play a role). … I think people generally think that concussion has been confirmed to cause this problem, when in fact the science hasn't proven that."

But McKee says she believes additional data will show a strong relationship between concussions and CTE. "I think it's going to be a shockingly high percentage," she says. "I'm really wondering where this stops. I'm really wondering on some level if every single football player doesn't have this."

Frontline says the shift in NFL policies about concussions was stepped up after Goodell, who replaced Paul Tagliabue in 2006, was called in October 2009 to testify before Congress about concussions and long-term effects. Goodell said in his testimony that the league was committed to player safety but that "the medical experts should be the ones to continue that debate."

U.S. Rep Linda T. Sanchez (D-Calif.) responded, "The NFL sort of reminds me of the tobacco companies pre-'90s."

A month later, the NFL announced it was "strengthening and expanding" its concussion committee. In early 2010, the MTBI committee was replaced – with new leadership – by the Head, Neck and Spine Committee with new leadership.

"In the short term, we can already see that football is changing," says Steve Fainaru. " … The NFL is certainly trying to get its arms around the problem.''

Studies and lawsuits aside, what's the prognosis for the long-term future of football?

"The core issue around this is what is the incidence of brain damage associated with football?" Steve Fainaru told USA Today Sports. "Some people, like Ann McKee, will tell you that she thinks it's going to be a shockingly high percentage of players. Other people feel we don't know.

"It's going to be a while before we know what the prevalence is, and I think that's going to have a real impact in determining how many people end up playing and how far the league has to go to try to protect the players."

Harry Carson, a former linebacker with the New York Giants who is in the Pro Football Hall of Fame, sums up the problem during the documentary.

"The human body was not created or built to play football," he says. "You're going to have some brain trauma."

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