Authors: Mark Fainaru-Wada
On May 19, 2009, McKee, Perl, and Nowinski got together for breakfast in Manhattan before the meeting, not far from the NFL’s Park Avenue offices.
McKee was nervous but excited. She wasn’t thinking about the future of football or even how the sport might need to change. She had important scientific information to pass along, and she hoped the NFL would take her seriously. Perl was expecting a straightforward academic presentation, like the hundreds he had participated in over the years, the audience respectful and curious.
“I didn’t appreciate the political implications, okay?” he later said dryly. “That’s the best way to describe it.”
As they entered the lobby of
NFL headquarters, McKee found herself in awe. It was cheesehead heaven. After being cleared through security, McKee, Perl, and Nowinski rode the elevator up to NFL Central, the inner sanctum, where America’s richest and most popular sport was run. McKee saw the gleaming Lombardi Trophy, given to the winner of the Super Bowl; a trove of Green Bay Packers memorabilia; the legendary Jim Brown’s old jersey. There was a waiting room with lined green turf that looked like it had been ripped from a stadium floor. There was no mistaking where they were. Even Perl, a casual fan, was impressed.
The trio was ushered into a huge board room with a lacquered table surrounded by plush chairs. Perl thought it was the fanciest conference room he had ever seen. There was high-tech equipment suitable for any type of presentation. As some two dozen participants took their seats, McKee noticed that she was one of just two women in the room; the other turned out to be an NFL lawyer. Along with the MTBI committee, there were a few other invited guests, including Peter Davies, the tau expert who to the league’s chagrin had validated Omalu’s work; John Mann, a Columbia University neuroscientist and psychiatrist who
specialized in suicide research; and Colonel Michael Jaffee, the national director of the Defense and Veterans Brain Injury Center, which was seeking to collaborate with the NFL. One of the lawyers present specialized in class-action litigation, the visitors later learned. Nowinski believed the lawyers were present “to figure out what the researchers had and what to be prepared for down the road” in the event of a lawsuit. “They were clearly thinking about it already,” he said.
McKee had prepared a PowerPoint presentation, but she also brought along a box of lantern slides with 4-inch by 5-inch slivers of brain the doctors could hold up to the light. She started with those, passing around the brains, and it immediately became clear that this was not going to be the academic discussion she and Perl had anticipated. Members of the MTBI committee seized on the absence of visible bruising to question how football-related head trauma could have caused the disease. If there was no contusion, there was no trauma. Of course, that was the point: Almost all the brains, from Webster’s on, had looked normal from the outside. This wasn’t a disease caused by a single blow or even a few. The brain was deteriorating from the inside as a result of repetitive, consistent pounding.
McKee turned to the slides. She pointed out the brown splotches representing neurofibrillary tangles of tau protein that had suffocated the cells. This always had been the most powerful evidence. The tangles were indisputable signs of disease, and there was little or no beta-amyloid, which meant it wasn’t Alzheimer’s. And these were relatively young men with one common trait: All had played football for years. To McKee and Perl, the experts, this suggested dementia pugilistica, the boxer’s disease, now found in football players. Members of the committee again challenged her. Some wanted to know why the tangles weren’t closer to the surface of the brain, where the trauma had occurred. It was a reasonable enough question, but it had an edge. To many in the room, Casson seemed especially combative. His questions were along the lines of “How can you possibly think that? How is that possible?”
“Casson interrupted the most,” said Colonel Jaffee. “He was the most challenging and at times mocking. These were pretty compelling neuropathological findings, and so I guess to outright deny there could
be a relationship, I didn’t think that was really making an honest assessment of the evidence.”
It was turning into Chicago all over again. Only now it was two years later, two years in which the NFL supposedly had made major changes in the way it addressed concussions. Hank Feuer, the Colts’ physician and a charter member of the MTBI committee, said he was sitting directly across from McKee. He later said, “I honestly don’t think we were any different with her than we were with anybody else. If we, for some reason, came across as being disrespectful, then I would say that everybody else we interviewed over the 15 years must have felt the same way.” But as the meeting continued, the invited guests found themselves increasingly uncomfortable with the line of questioning. All had participated in sharp scientific debate. This was qualitatively different, they felt. McKee felt like it was more of an inquisition than a legitimate inquiry.
Mann, the Columbia suicide expert, had never met McKee, but he found her research compelling. It was obvious to him that she had found a serious brain disease in these players. After she was finished, Mann presented his own research, at one point describing data that showed how people who had had mild head injuries as children or adolescents were at an increased risk for suicidal behavior. Mann sought to connect his results to the cases McKee had presented.
Casson tossed up his hand and interrupted. “It would be impossible to link a disease like CTE to suicide,” he asserted.
That wasn’t true, said Mann: “It’s not just possible, it’s entirely plausible based on what I’ve seen from Ann McKee.”
At one point, it was suggested to McKee that really, wasn’t CTE just a “misdiagnosed case of frontotemporal dementia,” a disease of the brain’s frontal lobe? To which she replied: “Well, I was on the NIH committee that defined frontotemporal dementia’s diagnostic criteria, so, no.”
Perl studied the room. He, McKee, and Davies were the only experts in tau and neurodegenerative disease. He came to believe that no one else at the table truly understood the science. Or wanted to understand it. Casson and his colleagues—Viano and Pellman in particular—were most focused on proving that the cause of whatever they were seeing was
not
football. Perl described it as a “kind of unsophisticated denial. Now, admittedly it’s not their field, okay? But we’re the experts. Between Ann
and myself, you had at that point maybe 50 years cumulative of looking at brains day in and day out.” Perl did notice that McKee’s message seemed to be sinking in with some of the other team doctors, particularly those who didn’t have a background in the brain, such as the orthopedists and emergency room physicians.
They weren’t saying anything, but what Perl saw on their faces said, “Holy shit!”
McKee had experienced heated debate before. Scientists in the Alzheimer’s community weren’t shy about attacking their colleagues. But this was different, she thought. It was almost personal.
“I felt that they were in a very serious state of denial,” she said. “I felt like they weren’t really listening. That’s honestly what I thought. That’s how it felt, like they had their heads in the sand. They didn’t want to see it, so they didn’t see it.”
McKee also couldn’t help noticing the preponderance of testosterone in the room. She was surrounded by men. She already worked in a field dominated by men, and she was familiar with the look they were throwing her way. It said to her: “Is that girl saying something? Could we get a doctor in here, please? Could we get someone in here who actually knows what they’re talking about?”
Casson, Viano, and Pellman—the triumvirate that had run the NFL’s concussion committee for years—bombarded McKee and Perl with alternative theories: steroids, nutritional supplements, high blood pressure, diabetes. On and on they went until finally McKee threw up her hands.
“You are delusional,” she told the NFL’s men.
Jaffee, the military doctor, had a sense of déjà vu. He had faced similar denials from Pentagon doctors who still couldn’t accept the idea that concussive blasts in the field might contribute to mental health problems such as post-traumatic stress.
“There were certainly questions unanswered: Why everyone who played doesn’t have this? What factors lead to it?” he said. “Those would be questions I have, as opposed to questioning if there is any relationship.”
The two-hour meeting ended cordially, with McKee and the others receiving thanks from the MTBI committee but no promises for follow-up. As Mann prepared to leave, Casson told him how surprised
he was that Mann had asserted that there was a relationship between head trauma and suicide. Mann couldn’t tell whether Casson was genuinely curious or dismissive. “My reaction was, if he believes it, they’ll be in touch pretty fast,” he said.
Mann never heard from Casson or anyone from the MTBI committee again.
Out on Park Avenue, McKee, Nowinski, and Perl reflected for a few minutes, shocked by what they had just experienced. McKee was relieved it was over. It was clear to her that “we hadn’t made a dent in anybody’s opinion.”
She couldn’t wait to
call her brother Chuck back in Wisconsin. He had to hear this not just because he was a doctor but because he was a sideline physician and a former football star. As McKee recounted the meeting, Chuck grew more and more angry that his sister had been attacked by those know-nothing doctors. Soon he and McKee were feeding off each other, blasting the league:
You wouldn’t fucking believe these guys. These guys are such assholes
.
“Mental corruption, I think, is what we were talking about,” Chuck McKee recalled. “That word never came up, that phrase never came up, but just that these people, what’s the quote, ‘A man will not believe something that his livelihood depends on his not believing.’ You know, that’s kind of what it’s about. These people could not believe that because it meant that they were marginalized. And that was so clear, that this was about their protecting their own stake in the NFL and their positions as medical advisers. And they didn’t give a damn about the data, and they didn’t give a damn about the players.”
The committee, of course, had already taken a public position on the matter in published papers and commentary. To acknowledge otherwise was to admit that the NFL’s men were wrong, incompetent, or both.
As their conversation ended, Chuck McKee had one last message for his baby sister: “Just hang in there, kid. You’re right and they’re wrong.”
By now, it was hard for the NFL to say it hadn’t been warned. McKee, of course, was just the latest authority to go directly to the league with her concerns. Over the previous decade, the roster of neuroscientists making the case that football led to higher rates of depression,
memory loss, dementia, and brain damage read like an all-star team of researchers: Barry Jordan, Kevin Guskiewicz, Julian Bailes, Bob Cantu, Bob Stern, Ron Hamilton, Steve DeKosky, Danny Perl, Bennet Omalu, Ann McKee. The warnings had come in the form of player surveys, research papers, autopsy studies, and innumerable public statements by experts and former players. Bailes and Guskiewicz had delivered the message personally to Goodell at the 2007 summit in Chicago. And now, two years later, McKee and Perl had brought the message to the NFL’s doorstep. Meanwhile, the number of dead football players with CTE continued to mount.
Jason Luckasevic didn’t know the half of it, but he still thought he had enough ammunition to sue the NFL.
The young Pittsburgh lawyer originally had been motivated by his desire to protect his friend Omalu back when Omalu was under attack by the league’s doctors. At the time, Luckasevic hadn’t had the slightest clue to what kind of case he might bring. But as he looked at the situation more closely, Luckasevic thought that what had happened to Omalu was part of a pattern that went back at least to the publication of the first NFL papers and possibly as far back as the formation of the MTBI committee in 1994. One of the more curious aspects of the concussion crisis was that almost everyone who ended up taking on the NFL
loved
the NFL. Luckasevic was no exception. He bled Steelers black and gold. Yet he came to see himself as an advocate for the players, many of whom simply wanted the league to acknowledge their suffering.
From a legal standpoint, what Luckasevic was considering was by any measure preposterous, the ultimate David and Goliath story. He was a small-time personal injury lawyer, an associate at the Pittsburgh firm of Goldberg, Persky & White. The NFL was, well, the NFL: a multibillion-dollar industry with a legal winning percentage that rivaled that of Lombardi’s Packers. A cursory glance at the NFL’s case history told Luckasevic that one major hurdle—among many major hurdles—was that
the league could fall back on the collective bargaining agreement with the players to argue that the claims didn’t belong in court. The contract specifically set up the Bert Bell/Pete Rozelle NFL Player Retirement Plan to deal with long-term health problems related to NFL combat. To the extent that the league might be liable, it was the individual
teams, not the league, that managed injuries. The league would argue that the players’ recourse was to appeal through the retirement plan or to bring workers’ compensation claims against their teams.
Luckasevic thought that couldn’t possibly be right. If the NFL had willfully denied or even concealed repeated warnings that football causes brain damage—and at that point there was no doubt in his mind that it had—that was a qualitatively different proposition. Luckasevic thought the collective bargaining agreement (CBA) couldn’t protect the league from claims of negligence and fraud. “For me, it became an issue that, look, this isn’t about a collective bargaining agreement,” he said. “This is about something that they owe the players—as basic as the ball is to the game. I mean, you can’t just hide from somebody that there’s something inherently dangerous in my sport that’s going to hurt you. You can’t just lie to people about your sport.” That became the core of Luckasevic’s case: The NFL had had ample warning that football causes brain damage, but the league’s response had been to deny that information and cover it up.