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110/111: Football, CTE and risk-taking

Malcolm Potts, professor of population and family planning | August 1, 2017

Human beings, like other animals, take risks because in some situations it pays off. We have evolved to value and perhaps even enjoy risk-taking.  My brother-in-law was a famous climber.  A mountain in Antarctica, “Clinch Peak,” honors his name.  Several of his close friends died in climbing accidents. In conversation Nick Clinch would admit that if there were no danger then mountaineering would lose its fascination. I have a daughter who went bungee jumping, a son who liked hang gliding, and a grandson who wants to follow his 2016 kayak trip across the English Channel with a paddle-board crossing this year.

We never will – never should – make all playgrounds risk-free, punish teenagers for stupid pranks, or cease admiring Alex Honnold because be climbed El Capitan in Yosemite in under four hours.

But what if next year 111 young men attempt to follow Alex Honnold up El Capitan and 110 fall and die, or suffer incapacitating injuries?  And what if the university sets aside several million dollars to subsidize the Cal El Capitan Club designed to encourage such risk-taking?  Alumni might say they are so impressed that they want to increase their donations. A TV sports channel might promises $1 million for every death they can broadcast “live.”

I’ve created this El Capitan parody of what is happening to college football to highlight two ethical limits on risk-taking.  First, some risks are so high that they should not be permitted. Second, the decision to undertake a modest risk should be a free-informed choice and risk-taking should not be encouraged by subsidies from public institutions.

I choose the 110 deaths among the 111 climbing El Capitan because that is what last week’s publication in the Journal of the American Medical Association (JAMA) demonstrates is the risk of an NFL player developing chronic traumatic encephalopathy (CTE). In some ways the JAMA study merely underscores what we already knew but it is proving a tipping point. In this week’s Wall Street Journal, sportswriter Jason Gay asks, “Could Football Ever End?”

After reading the JAMA article, Steelers’ quarterback Ben Roethlisberger – a man who loves football and is said to have earned $70 million – said, “If you want to mess with your brain, go ahead. I’m not going to. I love my family and my kids … I want to remember them when I am 70 years old.”

I recognize that CTE can only be diagnosed by a post-mortem examination of the brain. The JAMA study is probably biased towards those who showed symptoms of CTE before death, such as confusion, blinding headaches, depression, violent behavior and dementia. However, if we assume that all the other 1,200 NFL players who are still alive, or have chosen not to donate their brains, have no CTE (a highly unlikely assumption) then the new study still show a NFL player has about a one in 10 chance of dying a nasty, undignified, costly death – a death that is often as painful for the loved ones of the CTE sufferer as for the victim himself.

Do the NFL findings apply to college football? The JAMA study found 48 out of 53 former college football players (91%) whose brains were available for study had CTE. Not quite as terrible as among NFL players, but, I suggest, a compelling evidence of an unacceptable level of risk.

For some years I had the privilege of chairing the campus Committee for the Protection of Human Subjects (CPHS). We often spent time discussing relatively simple ethical questions. Nothing ever approached the gravity of discussing how a young person should make a choice about a risk with a high probability of causing increasingly incapacitating brain damage.  I can’t be sure how the CPHS might respond to the question – should the campus permit Cal football to continue? I suspect that they would emphasize that if it does continue then the campus has an ethical responsibility to ensure players are making a fully informed choice when they accept a highly significant risk of catastrophic damage over  the remainder of their lives.

I suggest that this fall, the Chancellor write each team member enclosing the JAMA article (JAMA. 2017;318(4);360-370.doi:10.101/jama.2017.8334) along with the  excellent New York Times coverage (July 27 pages A14 –A15) and the Wall Street Journal (July 31, page A 14). It might be useful to offer counseling from faculty expert in neurology and perhaps from former Cal players with early CTE.  It would be prudent to ask players who chose to continue to play football to sign a release form promising not to sue the university later in life for developing CTE.  At least one former player has opened such a case against the Regents.

My parody on Cal climbers falling splat off El Capitan is intended to raise another ethical challenge. If we agree, as I hope everyone will, that accepting the high probability of developing CTE should be an informed individual choice by each player then we need to ask, should the university continue to subsidize and encourage young men to take risks that many find unacceptable?

By 2016, UCB was $150 million in debt. Coach Sonny Dykes is paid $1.81 million a year (more than Governor Brown or UC President Napolitano) to teach men a game that is now proved to scramble their brains and cause decades of horrible suffering for many players.  UCB spent $475 million on the Simpson Center and upgrading the Memorial Stadium.  By the time the relevant loans are repaid with interest, we will have spent over $1 billion on football infrastructure.

On commonsense financial grounds, and on even more important ethical grounds, I suggest the campus ceases all subsidies to the football teams.  As the basic ethic should be informed choice, I suggest it would be reasonable to permit Dykes and the other coaches to volunteer to continue teaching football, but that it would be patently unethical for a public university to use its limited financial resources to continue promoting a behavior that scientific research has demonstrated causes progressive and irreversible brain damage.

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