Book Review: League of Denial

Publication Details:
League of Denial The NFL, Concussions, and the Battle for Truth
Mark Fainaru-Wada and Steve Fainaru
© 2013
Crown Archetype
ISBN 978-07704-3754-1


 “Is football killing its players?”

“Do we really want to know?”

Brothers Mark Fainaru-Wada and Mark Fainaru ask these questions in the prologue of League of Denial (p. 8). It would be easy, and lazy, to read the book as a simple, “What did they know and when did they know it” story. League of Denial should be considered much more than merely an exposé of the National Football League’s response, or lack thereof, to the multiplying cases of brain damage of former football players.  It could reasonably be titled Nation in Denial. Football kills its players.


League is divided into three parts mirroring stages in the development of the NFL’s growing concussion epidemic. Part One, “Discovery,” lays down the foundation for how the problem came to light. Chapters 1, 3, and 5 focus on the rise, fall, and untimely death of one man: Pittsburgh Steeler Hall of Fame Center, Mike Webster. Mike Webster rarely missed a game during his 17 year NFL career. He died paranoid and penniless, barely able to string two thoughts together. Chapters 2, 4, and 6 detail concussions suffered by players in 1990s. The intent of the juxtaposition is clear: we should expect many more Mike Websters.

In between episodes of Mike Webster’s life, the reader is introduced to players Merril Hodge, AL Toon, Steve Young, Troy Aikman, and one of the first NFL insiders to sound the alarm about concussions: player agent, Leigh Steinberg.  Seeing clients like Aikman and Steve Young suffer the debilitating effects of concussions drove him into action. In the mid 1990’s he began holding seminars on concussions and brain damage. By 2001 a study of over 2,500 living football players led researchers to one conclusion, “Football causes brain damage” (p. 117).

If part 1 detailed the beginning of sorrows, part 2, “Denial,” marks the entrance into great tribulation. The NFL’s Mild Traumatic Brain Injury committee is the focus of chapter 7. The committee was chaired by Elliot Pellman. Pellman was a rheumatologist who took some generous creative liberties when writing his résumé: lying about his education and job experience (p. 127). As team physician for the New York Jets he once sent tight end Kyle Brady back into a game on the next offensive series after being knocked unconscious. He would do the same with other players (p. 129-30).

Over the next several years the MTBI would publish a series of 16 papers on concussions in the journal Neurosurgery: a journal under the editorial control of New York Giants medical consultant Michael Apuzzo. The first three papers provided valuable scientific information. It was determined that the heads of NFL players were struck with blows that measured between 70 to 126 g forces. That is equivalent to being hit in the head by a 10-pound canon ball traveling 30 m.p.h. Earlier studies had demonstrated that the collision of two NFL linemen produced up to six times the energy as the firing of a .357 caliber bullet (p. 73).

The MTBI committee’s fourth paper asserted that football players were essentially impervious to brain damage (p. 145-6). In the peer review process, the paper was rejected by multiple readers and by the section editor of the journal. Michael Apuzzo, the general editor and New York Giants medical consultant, published it anyway. The remainder of the papers would repeat the same themes: there was no proof football led to brain damage; football players recovered quickly from concussions; suffering one concussion does not increase the risk for successive concussions; etc. Dr. Robert Cantu, the section editor for Neurosurgery wrote the NFL’s claims were “at odds with virtually all published guidelines and consensus statements on managing concussions” (p. 147).

Chapter 8 is the in depth introduction to Dr. Bennet Omalu. Omalu is the man credited with discovering the forensic proof that football causes brain damage. Omalu was on duty the Saturday Mike Webster’s corpse was wheeled into the Allegheny County coroner’s office. When Omalu removed the brain and initially examined it, he was somewhat disappointed: it appeared perfectly normal. On a whim he decided to have it “fixed:” chemically hardened and preserved for further study. Several months later, a scalpel and a microscope leveled one of the biggest hit the NFL would ever see.

Omalu discovered that Webster’s brain had a massive build-up of tau protein. As tau grows it strangles the brain’s neurons. This kind of Tau buildup had never been seen in someone as young as the 50 year old Webster. Omalu sought out confirmation of his findings from two more-experienced colleagues. Steve DeKosky, chairman of the University of Pittsburgh Medical College’s Department of Neurology stated, “I knew it was going to change everything, but quite frankly, it was so controversial that I just thought it’s going to take a long time before this is accepted” (p. 163).

The difficulty of that journey was made clear in 2004 when the NFL’s MTBI committee published its 5th paper in Neurosurgery. According to paper number 5, no NFL player had ever suffered brain damage (p. 167). This claim was made despite the fact the NFL retirement committee had awarded medical benefits for brain damage to Mike Webster and at least 8 other former players (p. 169).

The July 2005 edition of Neurosurgery published Omalu’s findings from the Mike Webster autopsy. Omalu had decided to apply the label chronic traumatic encephalopathy (CTE) to the ailment. Over the course of the following several years, former NFL players Terry Long and Andre Waters would commit suicide. They had exhibited some of the same disturbing behaviors as Mike Webster. Omalu examined their brains and saw the same tell-tale signs of CTE.

The remainder of part 2 is the story of entrenchment, accusation, and denial. Omalu, with the aid of others was able to study more brains. More doctors- even doctors hired by the NFL confirmed Omalu’s findings. In 2007 the NFL established the “88 Plan” to provide up to $88,000 per year to players suffering from dementia, Alzheimer’s, amyotrophic lateral sclerosis (ALS), or Parkinson’s (p. 214-215). Yet the league continued to deny the link between football and brain damage. When asked about the rationale for the plan, league spokesman Greg Aiello simply stated that those ailments were common among the elderly.

In September of 2007 the Senate Committee on Commerce, Science and Transportation held a hearing on the NFL retirement system. Former NFL player Dave Duerson was vocal in his support of the league and his denial that football caused brain damage. Four years later Duerson’s name was added to an ever increasing roster of former NFL players who committed suicide by shooting themselves in the chest.

Part three, “Reckoning,” brings the debate and denial to the current year. Dave Duerson’s dying wish was that his brain be given to the “brain bank.” He too was found to have CTE. Despite a litany of doctors, deaths, studies, and players, the NFL continued to deny playing football caused brain damage. In 2009, the League’s 16th paper asserted football causes “no or minimal brain injury” (p. 276).

Even after the NFL donated $1 million dollars to Boston University and $30 million to the National Institutes of health, league commissioner Roger Goodell testified before congress in 2009 that the medical community was uncertain of the connection between football and brain injury. When league spokesman Greg Aiello was asked about the donation to BU, he replied, “It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems” (p. 284). This was the first and last time that anyone from the NFL acknowledged any connection between football and brain damage.

In 2013 the league settled a lawsuit brought by 6,000 former players for $765 million plus legal expenses (an estimated additional $200 million). That total represents less than 10% of one year’s revenue for the league. Ray Easterling, the lead plaintiff, committed suicide 8 months after the case was filed. He had CTE.

At the 2013 rookie symposium Cleveland Browns team doctor Mark Schickendantz told incoming NFL players, “Right now, we’re learning a little bit more about long-term brain damage. No direct cause and effect has been established yet” (p. 350).

Post game analysis

League of Denial tells a sickening story. As the medical community becomes increasingly certain that the game of football causes brain damage, the NFL desperately spins. With its mouth the league says the game is safe. With its wallet it has paid over one billion dollars to keep former players quiet.

Should you read League of Denial? First, the Christian reader should be advised that the book contains pervasive swearing. It is not on every page, but when it appears it is often in torrents. Because of the pervasive swearing, I cannot recommend the book to Christian readers. I would plead with you to watch the PBS Frontline special of the same name. It was produced in conjunction with the authors of the book and has most of the salient points without the foul language.

Of all the questions in the book, the most pungent is perhaps the last, “With so many alternatives, how can we let our children, our loved ones, ourselves, play a game that may destroy the essence of who we are? How can we enjoy it as entertainment?” (p. 339). This is asked by men from a scientific-humanist perspective. How much more should Christians confront this question?

We are made in the image of God. Is it right for Christians to take pleasure in an activity that does irreparable violence to God’s image? Is it demonstrating love for one’s neighbor to watch, to applaud, to cheer him as he loses 20, 30, 40 years of his life? Since seeing the Frontline report and reading the book, I have given up football entirely. Like so many of the doctors in the book, I can only wonder why it took me so long to see what was right in front of me.

Grant Horner’s Bible Reading Plan Revised

Grant Horner’s Bible reading plan takes the reader through 10 different sections of the Bible one chapter at a time. The profit of reading 10 chapters of the Bible per day should be evident to any Christian. Or, it should be. Reading 10 chapters a day, though, can be something of a challenge. The plan has at least two built-in features that offer some aid: first, you are reading in different parts of Scripture every day; 2)the reading sections are all different lengths, meaning you will never read the same thing twice. A secondary aid for those who like to read through the Bible every year is that Horner’s plan is not tied to a calender. You can start any time and in the back of your mind is always the knowledge that if you miss a day or two, or a section or two, you are still going to get through the Bible. Here is the plan laid out by Horner (the number following each section refers to the amount of chapters):

Gospels 89
Pentateuch 187
Rom.-Col, Hebrews 78
1 Thess-Phil, James-Rev 65
Job, Eccl, Song 62
Psalms 150
Proverbs 31
Joshua-Esther 249
Isaiah-Malachi 250
Acts 28

This is the plan I used in 2011 for my Bible reading. And I returned to it again this year with slight modification.

I have two issues with Horner’s original plan. The Old Testament readings have a major flaw: the imbalance between the Job-Song and the Prophets groupings. Job and Ecclesiastes are great books and can’t be read enough. But look at the size imbalance between those two sections and consider the implications. Is reading Song of Solomon four times for every time you read one of the Prophets really that profitable? How many times does the New Testament refer to Song of Solomon, and how many times to the prophets?

In the New Testament readings, there is just some tinkering. It is hard to know what to do with the epistles. You would like to keep all of Paul’s together and all of the generals together, but this results in an imbalance of 87 chapters for the Pauline Epistles and 56 for the General Epistles. It loses some of the balance Horner’s plan provides. So I like the balance of Horner’s groupings, but I am not too fond of having Hebrews read in a group with Paul. I also think Colossians and Philemon should be in the same reading group.

The basis for my Old Testament revision is theological- I think Horner’s original is faulty. The basis for my New Testament revision is practical – I think Horner’s plan is okay, but could be better.

Here is what I came up with:

Gospels 89
Pentateuch 187
Rom-2 Thess, Philemon (read immediately after Colossians) 74
1 Tim-Titus, Hebrews-Rev 69
Job, Eccl, Song, The Twelve (Minor Prophets) 129
Psalms 150
Proverbs 31
Joshua-Esther 249
Isaiah-Daniel 135
Acts 28

For the Old Testament portion, this plan will have you reading each of the prophets twice in one year except once. (And reading Job, Eccl., and Song twice instead of four-five times.) The New Testament portion keeps the balance (actually improves it a bit) while keeping all of the General Epistles together. It still breaks up Paul,but at least does it in a more natural way: keeping all  of the “church” epistles and “pastoral” epistles together.

A more radical New Testament reorganization would be:

Luke-Acts         (52)
John, 1-3 John, Revelation      (50)
Matt, Mark, Hebrews, James, 1, 2 Peter, Jude (71)
Pauline Epistles (87)

While more radical, it is also much more “logical.” While there are advantages to Reading Acts every month, there is something to be said for a little more balance in the New Testament.

Dear Christian Mom, Should you let your son play football?

Dr. Ann McKee is a neuropathologist. She studies brains of dead people looking for diseases. She has studied the brains of 46 football players. 45 of those brains had Chronic traumatic encephalopathy. “Individuals with CTE may show symptoms of dementia, such as memory loss, aggression, confusion and depression, which generally appear years or many decades after the trauma.”

One might say, “Well there are several thousand former professional football players, so 45 out of several thousand is a pretty small percentage.” But that is the wrong way to process the information. Dr. McKee. and others like her, can only study the brains of dead players. The number you need to focus on is 45 out of 46: nearly 98%.

Suppose you are at the grocery store in front of the bananas. There are several thousand of them. The produce clerk tells you that they have tested 46 bananas and found that 45 of them are poisoned with arsenic. What do you do? Do you focus on the fact that only 2% of the bananas are poisoned? Or do you focus on the fact that 98% of the tested bananas are poisoned? Do you buy any bananas?

Believers are instructed in to do all things “to the glory of God.” Man, as the crown of God’s creation, is made in God’s image. There is a lot of discussion about what exactly that means, but pretty much everyone agrees that the rationality of man is included in the equation. Is it to God’s glory to allow your child to participate in an activity that will rob him of his ability to think and relate to others? Is it to God’s glory to allow your child to participate in an activity that will cause him to lose his memory and to despair of living? Is it to God’s glory to allow your child to participate in an activity that inflicts this damage upon others?

Is God glorified in any activity that causes a man to lose his mind?

Christians in the League of Denial

I watched the “League of Denial” Frontline last week and I am now working my through the book. My impressions from it, “Culture makes us oblivious to the obvious.” It is striking to read about how surprised neuropathologists were at their surprise to the brain damage caused by the game of football.

So I have had a similar experience, but without the microscopes. Hmm, maybe it is not a very Christian thing to watch men fight to lose 20-30 years of their life.

We live in a culture of violence, excess, and immediate gratification. So activities, like football, which manifest those qualities are embraced with no introspection, with no dissent. To speak against it is to be a fool or ninny.