League of Denial (28 page)

After a while, the Dissenters threw in the towel. If any assertion could be published unchallenged as peer-reviewed science in
Neurosurgery
, they reasoned, what was the point of peer reviewing the studies? “Quite frankly, people like Kevin and myself just quit reviewing these papers,” said Cantu. “We just said, ‘These are poorly written, you can’t use this data to make the claims they’re making, and we won’t even bother to write comments anymore because it’s just so flawed and so bad. We won’t be a part of this.’ ”

“We were like, ‘I’m outta here,’ ” said Guskiewicz. When Apuzzo sent him papers to review, Guskiewicz refused. Soon Apuzzo stopped asking. Cantu said Apuzzo’s solution to the peer review uprising was not
to shut down the NFL’s research but to find other reviewers who were willing to chime in.

Lovell continued to argue that he was on the outside of this unruly debate and that except for the three papers that had his name on them, he barely paid attention to the literature the MTBI committee was churning out every month. “I probably only read five of the papers,” Lovell said. “Other than that I had absolutely nothing to do with the papers.” That argument avoided one important fact: As a body of work, the papers were an expression of NFL dogma. Over and over, they repeated the same essential themes, making it nearly impossible to disassociate oneself from the overall message. Lovell was a coauthor on NFL Papers 3, 6, and 12; all asserted that NFL players didn’t get brain damage from playing football and/or seemed to have superhuman qualities that limited their susceptibility to concussions. Paper Number 12 included the observation: “In our opinion, it is unlikely that athletes who rise to the level of the NFL are
concussion prone.”

“That’s just kind of a stupid statement,” Lovell said when it was read back to him. “What do you mean by ‘concussion prone’? What does that mean? I didn’t write it, but it’s stupid either way.”

“Well, your name’s on it,” it was pointed out.

“No, no, no,” he said. “I mean, is my name on that sentence?”

The researchers associated with the NFL’s work would all take a hit to their reputations, but Lovell in many ways had the farthest to fall. By the time he arrived on the committee, he had spent years helping athletes understand the seriousness of head trauma. He had helped bring concrete measurements to an injury that team trainers and doctors had only guessed at. Now Lovell found himself accused of carrying water for the NFL. Whether Lovell was a passive or an active participant in this stunning transformation was subject to interpretation. Lovell argued that he was merely swept up in the politics of the committee but played a very minor role. “I’m not a, you know, NFL company man,” he said. “Do I regret some of the things that were said that had my name on it? Yes. Would I say them again? No.” But others portrayed Lovell as a scientist caught in a web of conflicts that proved too lucrative, seductive, or both for him to disengage, if in fact he wanted to.

Lovell had come a long way. Back in 1993, when he and Maroon had
come up with the idea to measure the Steelers’ brain functions, Lovell had started with just pencil and paper and 27 reluctant subjects. He had since refined that test and developed it for the computer. With financial backing from UPMC, the test was now being mass-marketed under the brand name ImPACT. Many brain scientists didn’t consider ImPACT much different from the alphabet soup of neuropsych tests that were out there, such as ANAM, which was used by the Army, and NEPSY, which was designed for kids. But ImPACT, through its association with the NFL, had come to be known as the football concussion test, an impression that Maroon, Lovell, and Collins constantly encouraged.

By the mid-2000s, ImPACT had taken off. When the company was founded, Lovell’s overlapping roles didn’t draw much attention. But as the torrent of NFL papers continued, many researchers saw an obvious conflict. Lovell was overseeing the NFL Neuropsychology Program at the same time he was pushing ImPACT to NFL teams. The league’s research helped him promote his company. Paper Number 12 read almost like an advertisement: “Many studies using the ImPACT have indicated that it is reliable and valid.” Lovell’s financial stake was disclosed in small print at the end of the paper. Soon, nearly every NFL team was using ImPACT. So was most of the NHL, which adopted mandatory neuropsychological testing in 1997. As concerns about concussions grew, the association with the NFL proved a gold mine for the company’s marketers, who turned ImPACT into a Kleenex-like synonym for concussion assessment. Micky Collins, Lovell’s brash protégé, became an ambassador and indefatigable marketer, hitting the road to promote both the research and the test behind it. “I’ve given a thousand lectures, two thousand lectures,” he said, emphasizing that his primary focus was on concussion awareness and management. “I mean, I’ve been spending time away from my family because of it, educating and really promoting the data.” By the end of the decade, with the national hysteria over traumatic head injuries peaking, over 90 percent of the high school trainers who used computerized testing to assess concussions were using ImPACT, according to the company. The test, which sold in kits for $350 to $750, had been translated into 17 languages.

Collins, like Lovell, went to great lengths to try to distance himself from the NFL committee. Within minutes of sitting down for an
interview in Pittsburgh, he declared: “First of all let’s make this on the record: I wasn’t involved in any of the NFL research, none. I just want to make sure you’re clear on that. I’m not on any papers. I’m not on an NFL committee. I’ve never been on an NFL committee.”

That was technically true. Collins had never had a direct role with the committee. But after a while it became hard, if not impossible, to figure out where the NFL ended and ImPACT began. A case in point was Pellman’s pet project: the concussion-resistant superhelmet. After the early tests involving the crash-test dummies, the idea had been forgotten, buried under the avalanche of disputed research the NFL was cranking out. But the idea was very much alive. After the first biomechanical studies, Riddell, the NFL’s official helmet maker, got to work designing the concussion-resistant helmet, which was based on specs that had come out of the NFL’s research.
For $500,000, Riddell even hired the Ottawa biomechanics firm, Biokinetics, that had performed the crash-test studies for the league.

Early on, the helmet project suffered a setback. In November 2000, Biokinetics sent
a confidential report to Riddell warning that no football helmet—no matter how new and improved—could prevent concussions. That assessment confirmed what researchers such as Cantu and others had believed all along and essentially torpedoed Pellman’s grand vision. The report, unearthed years later by
Frontline
’s Sabrina Shankman, went so far as to state that even if Riddell created a helmet that surpassed industry safety standards, there was still a 95 percent likelihood that a player would sustain a concussion from a strong enough blow. “No helmet can prevent a concussion.
Full stop,” Chris Withnall, the Biokinetics senior engineer who wrote the report, told Shankman.

Riddell built the helmet anyway, with Withnall’s name on the patent. The company called it, ambitiously, the Revolution. Its principal defining features were flaps that extended over the lower jaw and additional protection around the ear hole. The NFL’s video reconstructions had found that most concussions resulted from blows to the face mask, jaw, and side of the head. The Revolution’s main selling point was that its design was based on research aimed at reducing concussions.

But how could Riddell make that claim after Biokinetics had privately warned that no helmet could prevent concussions? The answer
came in summer 2002, a few months after the Revolution was released. Collins got together with Thad Ide, Riddell’s senior vice president for research and development. “For the record, I don’t know who approached whom,” said Collins. Together, they came up with an idea for a research project involving ImPACT, Riddell, and the University of Pittsburgh Medical Center. “Both Thad and I reciprocally thought it was a really good idea to do a study,” Collins said. “Riddell was coming out with this new helmet technology. I’m not an engineer. All I know is that we could create a methodology that could study it.”

The idea was to compare high school football players, some wearing the Revolution and others wearing their old helmets. The study would use ImPACT to determine recovery time after a concussion was diagnosed.
Riddell provided the helmets and paid $75,000 to UPMC to subsidize the salaries of Lovell and Collins while they worked on the study.

The potential for conflict was obvious. Lovell was a member of the NFL’s influential concussion committee. He was on record as saying the creation of a concussion-resistant helmet was “a fantasy,” yet he had taken money from the NFL’s official helmet maker to produce a study examining whether its new helmet reduced concussions.

Collins, who led the study, suggested that he was motivated in part by the need to bring in research dollars to justify his position at UPMC. “I needed money to fund my salary,” he said. “I was going to get my ass fired, you know? So I’m looking for any kind of funding to do this research. Any struggling academic is looking for that. So that was part of it.” He said he understood that Riddell probably was shopping for research that would support its claim that the Revolution reduced concussions. “I’m not an idiot; I know Riddell wanted the results to look good, okay?” he said. “I mean, obviously. I understand that. But I am one of the leading experts in concussion; I’ve done as much research as anyone. I can be trusted as an academic to do a good research project.”

Lovell, Maroon, and Riddell’s Ide were listed as coauthors. Although this paper would be published in
Neurosurgery
, the study was not technically part of the NFL series.

Not surprisingly, the study concluded that wearing the Revolution helmet reduced the “relative risk” of concussion by 31 percent and the “absolute risk” by 2.3 percent. The change in helmet design that grew
out of the NFL’s research, Collins and his colleagues wrote, “appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players.”

Riddell rushed out a press release:

Later, a UPMC spokeswoman provided e-mails that she said showed how the university had tried to prevent Riddell from misrepresenting and exploiting the research. The e-mails included Riddell’s press release with proposed corrections. Riddell made a few changes, including striking the sentence, “There is now proof that one football helmet provides better protection against concussions.” But most of the press release, including the banner headline, stood.

Cantu was still the section editor at
Neurosurgery
when the Riddell-funded Revolution study came across the transom. It seemed that his worst fears had been realized. Years earlier, Pellman had announced to the world that the NFL planned to create a concussion-resistant superhelmet. And now here was the result: a helmet that couldn’t prevent concussions any more than any other helmet, created with the NFL’s stamp of approval and peer-reviewed research that was funded and even coauthored by the company that planned to sell it to kids.

Cantu attached
a blistering commentary to the study, suggesting that it failed to pass the “sniff test” and writing: “This article, in my opinion, suffers from a serious, if not fatal, methodological flaw.”

That flaw was that the new Riddell helmets had been compared with random older models of indeterminate age.

Collins conceded that the varying ages of the helmets was “a major flaw” that skewed the results.

Years later, when asked about Cantu’s criticism, Collins launched into a tirade that was very much of its time. “For him to criticize this study is a bunch of fucking bullshit,” Collins said. “The flaws in this study were outlined. Everything was fair and balanced in that paper. And Cantu, he was part of the editorial staff! If he didn’t want to publish it, why was it published? I have no problem with Bob wanting to reject the paper. There were serious flaws with the study, okay? I understand that. But when I picked up the paper for the first time and read the comments, I was like, ‘Holy shit. Bob is ripping the shit out of me.’ I’m like, ‘Are you kidding me? Didn’t pass the sniff test?’ ”

Micky Collins was a headstrong young researcher who once had admired Cantu as a giant in the field. “I was a young kid, and I respected the shit out of Bob Cantu,” he said. But tests like ImPACT, which revealed an endless variety of concussions, had made Cantu’s grading scales obsolete, Collins thought. “And guess what Bob did? Bob defended them until he looked like an idiot,” said Collins. “Basically it was like an ugly death.”

For his part, Cantu was still the King of Concussions. He had spent more time studying the injury than any researcher in the country. His voice carried a lot of weight.

But there was a larger issue beyond the debate over the Revolution helmet and the conflicts of interest and the competition between an older researcher and a younger researcher.

Collins, whether he acknowledged it or not, had aligned himself with the NFL, like Lovell, his mentor.

Cantu was a Dissenter.

That epic battle was building.

Not long after Omalu and Co. submitted their paper on Mike Webster to
Neurosurgery
, two things became clear. One was that the widely held view in some circles that
Neurosurgery
had been converted into a house organ of the NFL—the Official Journal of No NFL Concussions—was not entirely true.
Apuzzo continued to rubber-stamp the NFL’s research despite the mounting protests that it was flawed and self-serving. But now, in February 2005, he
agreed to publish Omalu’s paper as well. The publication of the Webster study set up competing narratives in the same medical journal: One said NFL players didn’t get brain damage from football, and the other said they did. This development seemed to
support Cantu’s theory that Apuzzo more than anything was interested in topics that “sizzled” and boosted his readership. Whether Apuzzo had totally thought this through was unclear. The Webster paper would prove so hot that it ended up scorching almost everything it touched, especially the NFL.