The US National Football League (NFL) recently paid US$765 million to settle a lawsuit with former players who claimed repeated head injuries and concussions while playing the sport led to brain degenerative diseases.
The impact of “collision sports” has recently been getting attention in Australia as well and the settlement has interesting implications for local football codes.
Despite its small population, Australia sustains four different professional football codes, three of which have been described as “collision sports” - Australian Rules Football (AFL), rugby league, and rugby union.
In the United States, the NFL overshadows all other professional sports in terms of revenue, average attendance and television ratings. But the recent history of American football has been plagued by controversy about the effects of repeated concussions and head injuries.
The US case
In 2012, a class action lawsuit against the NFL was filed on behalf of more than 4,500 former players. You can read the full complaint here.
Among the most serious allegations made in the “concussion lawsuit” were that:
- the NFL hid and misrepresented evidence about the long-term neurological effects of football-related head injuries;
- the NFL was aware of the neurological risks of playing football but deliberately failed to warn players; and
- the NFL funded a “falsified body of scientific research” that was conducted by its concussion advisory committee with the intention of raising doubts about independent evidence of the long-term effects of head injuries.
After failing to have the lawsuit dismissed, the NFL agreed to settle the case for US$765 million. This may sound like a lot of money but it’s less than 10% of the NFL’s annual revenue of more than US$9 billion.
An easy settlement
The NFL lawyers probably considered it to be a good price for reducing the cost of fighting the case and risking a much larger payout.
It also means the NFL avoided a forensic examination of its alleged deception. And it achieved these benefits without admitting liability or “that plaintiffs’ injuries were caused by football”.
The players also had good reasons to settle. The payout means players with “cognitive injuries” (which are yet to be defined) will be able to access compensation (US$675 million) and obtain money for medical examinations (US$75 million) sooner than if the case had continued.
If it had proceeded to a jury trial, the players may have received more money but they could also have lost, and received nothing.
One major weakness of the settlement is the small amount allocated to research and the lack of information on how the independence of any such work will be assured.
Well-designed, independent, and credible research is essential to resolve uncertainty about the seriousness and prevalence of the type of brain damage claimed to be produced by repeated concussions and head injuries.
At present, we only have several dozen postmortem examinations reporting evidence of trauma-related brain degeneration in some former American footballers - called chronic traumatic encephalopathy, or CTE. Indeed, the condition is currently only diagnosed after death.
The most recent consensus statement about such injuries by the 4th International Conference on Concussion in Sport held in Zurich, November 2012 stated that:
a cause and effect relationship has not as yet been demonstrated between CTE and concussions or exposure to contact sports.
Medical officers from the Australian AFL and NRL have downplayed the implications of these US case studies for their sports. In 2012, for instance, the director of the AFL Medical Officers Association Hugh Seward said:
We’ve got no evidence to suggest that the condition we’re seeing in America from multiple head knocks is akin to what we see in Australian football. We have no evidence that CTE is an issue, and the long-term brain damage that they’re talking about in America may not exist in Australia.
And an NRL doctor has said:
I think that we need to be pretty careful how we interpret the Boston stuff [CTE case studies from Boston University]. The aim of their game is to actually crash into each other with their heads, so potentially players are being concussed. We don’t have any such thing in our game.
But, so far, there have been no studies of former players from Australian football codes, even though they have some of the highest rates of concussion in any team sports worldwide.
The meagre US$10 million allocated by the NFL settlement for research has a limited capacity to shine a brighter scientific light on:
- the precise nature of CTE and how to diagnose it while players are still alive;
- the risk factors for its occurrence; and
- the prevalence of the condition and other related conditions among football players.
This is crucial information for all contact sports, not just American football.
It may be timely for Australian football codes to consider ways of facilitating research into CTE and other long-term effects of repeated concussion. But this work needs to be truly independent of the codes if it is to avoid criticism about conflicts of interest on the part of those conducting the research.