NFL Concussion Hearings in Congress – Moving Past the Need for Perfect Proof of Brain Damage


Posted on 5th January 2010 by Gordon Johnson in Uncategorized


The issue of concussion awareness seems to have hit critical mass with yesterday’s hearings by Congress in Michigan. The hearings included a panel of former players and medical professionals on the issue of concussion in sport. For a thorough story on the hearings, see the New York Times story: Lawmakers Grill Doctor for His Views on Concussions. See I will discuss in this blog some of the news highlights of that hearing and in the coming blogs will dig into the topic in more depth, from the documents on file from the U.S. House of Representatives website.

Once again Ira. R. Casson, M.D. was at the center of the controversy because of his claimed denial of evidence that NFL concussions cause permanent brain damage. As the debate on this issue has been heated in the media over the last few months, his statements made the most headlines. Frankly, they fit more into the non-denial, denial category and are not terribly significant. The NY Time article did see the forest for the trees. It began:
Although the most theatrical moments of a House Judiciary Committee hearing on football brain injuries on Monday involved the grilling of a former NFL. doctor, most of the testimony centered on the application of recently strengthened professional rules to amateur levels, from youth leagues to college programs.
With respect to Casson’s testimony, one Congressman, Steve Cohen a Democrat from Tennessee called out Dr. Casson, who recently resigned as a co-chairman of the NFL.’s committee on concussions, “for continuing to discredit mounting evidence linking professional football with cognitive decline and decrying what he called “the politicization” of science.”

It is certainly a misstatement to say that Casson claims that the scientific evidence has been discredited. What Casson has said is that the studies clearly “proving” that concussion cause permanent brain damage in “NFL” players are flawed. Casson’s point seems to be an academic one with respect to methodological flaws in the studies that have been done.

Casson’s written statement, submitted before his testimony contained these statements:

The conclusion that I have reached as a result of these analyses is that there is at present not enough valid, reliable or objective scientific evidence to prove that head impacts from professional football are the cause of chronic brain damage. Association does not prove causation.

I certainly agree that some retired NFL players have abnormal tau pathology in their brains. However the cause of this pathology is still uncertain. Head trauma may be playing a role, but even if it is, we do not know if the significant head trauma occurs in childhood, adolescence or at a later time in life. The presence of tau pathology in the brain of an 18 year old high school athlete and some middle aged men who had played high school and college football but never played in NFL certainly suggest that head trauma in adolescence may be an important factor. (Bold facing added.)

The ridiculous part of Casson’s argument is that he is also saying that not all relevant concussions that happen to football players happen while they are in the NFL. The point is that all football, not just NFL football leads to brain damage. For Casson to defend the NFL because football players could have injured their brains before their professional career began is absurd. What is needed is reform in the way in which all concussions are diagnosed and treated, not just those that happen in the NFL or in football.

But these hearings are not about criticizing the NFL for not doing something sooner. The NFL has made significant change this year, even to the point that one of the big controversies of the fall was players criticizing team officials for not allowing players to return to the game. As pointed out in the NY Times story, the NFL has changed its concussion policy since the first round of these hearings in October. House Democrat John Conyers Jr. of Michigan, gets kudos here for his work.

I do agree with Dr. Casson that more research needs to be done, but that research needs to be far broader than his focus on “tau pathology”. Understanding and treating concussion is not about finding the objective scientific proof of the pathology, but of understanding the inherently subjective nature of a disability that involves a total synergistic change in the way in which the brain and emotions work. In the days ahead, I will focus on the more substantive aspects of the testimony at this weeks hearings.