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.

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