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Fifteen years before the National Football League (NFL) was established, the Chicago Tribune published the headline “Football’s Death Harvest” in November, 1905. The story led with a telegram to President Theodore Roosevelt that read more like a military briefing than a report about teenage boys as young as 15 dying for sport. “The 1905 football season practically closed today with two dead on the field of battle. Today’s fatalities bring the total of slain to nineteen, and the injured (record only being made of accidents out of the ordinary) to 137.”
Phrases like “the bloody shambles of football” and “ gridiron battles” are not subtle, but neither are the dangers of playing football—something we’ve seemingly known since the early 20th century. And even before that Chicago Tribune article, Roosevelt knew something had to give. In October the same year, Roosevelt had to call a meeting of coaches from Yale, Princeton, and Harvard to figure out how to save the sport from abolition by saving players from being obliterated. The last hundred or so years have seen a flurry of change in the sport, many aimed at making one of America’s great pastimes safer to play. But according to a recent study, it seems like that might all be for naught. Making football safe would mean taking the hits out all together, which according to James Castle, MD, a neurologist at Rush University Medical Center, simply isn’t realistic.
“It’s just baked into the game,” he said. “It would be like taking the flour out of bread.”
But that hasn’t stopped many from trying. The safety remedy Roosevelt’s experts landed on was, in part, the forward pass. The best and brightest minds in football believed that throwing the ball downfield for another player to catch would neutralize the sport’s brutality. On top of that, they banned some dangerous formations, created a neutral zone, and doubled the first-down distance to 10 yards. The changes helped, reducing football deaths the following season.
More changes came later, like making helmets and pads mandatory in the 1940s and ‘50s, or banning dangerous moves like the spear tackle in 1976. Still, football has remained deadly. Regardless of innovations in helmets, studies show they do not sufficiently protect against concussions. Certain helmet innovations can even give players a false sense of security, leading them to hit each other harder. Concussion protocols, like most of these interventions, are better than nothing. But research continues to show that football is downright dangerous.
A study published in August in the BMJ found that out of the 338 former NFL players who died and donated their brains to science, 315 met the diagnostic requirements for Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease that is rare in non-athletes. When adjusted for the total number of NFL player deaths during the 2008 to 2021 period, researchers estimate the rate of CTE to be anywhere between 24.5% and 97.7%.
Castle, who was not involved with the study, suspects that the prevalence is really on the high end of that estimation. To Castle, a former college football player, over 300 families donating their loved ones’ brains says a lot about the sport’s impact. “It’s not a normal thing to have somebody in your family die, and then you have their brain shipped off,” he explains.
CTE is caused by repeated head injuries that lead to progressive death of nerve cells in the brain. Symptoms like memory loss, impulsive behavior, aggression, and suicidal thoughts can get worse over time. According to Castle, there is often an acute awareness when people are going through the early stages of this CTE that “they have a major problem and they’re in full panic mode, feeling like they’re losing their mind.” Adding far more than insult to injury, there is no test or way to definitively know if someone has CTE until after death, through a brain autopsy.
Although CTE is often compared to Alzheimer’s, Castle finds that to be a misrepresentation of what CTE patients endure. He points to the correlation between suicide and CTE as evidence of a unique suffering.
To reduce the elevated CTE risk football players face, physician and lead author of the BMJ study, Daniel Daneshvar, MD, PhD, recommends cutting back on hitting during practices.
“We know that nearly 70% of head impacts are occurring in practice,” Daneshvar, an associate professor at Harvard Medical School, said in a statement. “So without changing a single minute of game time at any of those levels, we can be substantially reducing the cumulative head impact burden that these individuals are experiencing throughout their lives.”
Unfortunately, Castle thinks this reform is just another version of the forward pass; the problem just keeps getting thrown downfield, in hopes someone will handle it later.
To be fair, the NFL’s 2011 collective bargaining agreement limited the number of contact practices during the season, and the Ivy League banned full-contact tackling during practices. Castle is skeptical that no-contact practices could be implemented at the college level in total. Because of Name, Image, and Likeness (NIL) opportunities and revenue sharing, college athletes can make comparable money to some NFL players, and sometimes more. That is why a number of professional football players took legal action to return to playing at a university level, where players are only getting bigger, stronger, and faster, Castle warns. Consequently, “I think the problem’s just gonna get worse.”