Athletes' Health and Mental Health in Jeoparty

LIST OF HEALTH-RELATED ESSAYS ON THIS WEB-PAGE

Mental Health Month 2024: Mental Health of Athletes Tends To Be Ignored or Marginalized
Many NFL Players Gamble with Their Brains, While Owners Become Increasingly Wealthy
Is Ten Too Young to Fast Track Promising Athletes: Of Course It Is.
Are Guardian Caps Another NFL Brain Damage Defection?
The Djokovic Fiasco: What Really Happened Reveals An Underlying Covid Chaos, In Tennis and Other Major Spectator Sports
Spectator Sports in the Coronavirus Era: Generating Revenues During a Public Health Emergency
Why Elite Pitchers Are Accumulating More Arm Injuries, While Throwing Fewer Innings in Fewer Games
So Much More Needs to be Done to Achieve Mental Health in American Spectator Sports
Epilogue to The Athlete's Dilemma: Sacrificing Health for Wealth and Fame
Aaron Hernandez: Limits of CTE in the Courtroom Marijuana for Elite Athletes
The Carnage Undermining American Football Performance Enhancements: Legal, Illicit, and Illegal Health-Related Pathologies in American Sports

MENTAL HEALTH OF ATHLETES TENDS TO BE IGNORED OR MARGINALIZED:
So Much More Should Be Done
By John Weston Parry, J.D.

May is mental health awareness month in the United States. What tends to be downplayed are the many athletes challenged by mental health and emotional well-being issues. Some of those concerns are directly linked to the sports these athletes participate in; others are ones that anyone might experience. The burden of sports is to address much better the mental health needs of their athletes, both while they are competing and afterwards. Although certain sports have improved somewhat in this regard, so much more should be done for them, especially after those athletes are no longer able to compete.

Athletes face a variety of mental health challenges, some which are not readily apparent. Too often the organizations governing sports as well as teams, especially at the professional, major collegiate, and Olympic levels, contribute to their athletes’ mental health concerns by focusing only on generating revenues and building wealth at the expense of everything else that should be important. Mental health neglect and even abuse in spectator sports continues to be widespread as documented in my book The Burden of Sports: How and Why Athletes Struggle with Mental Health (Rowman & Littlefield, 2024).

The reasons for these struggles are complex and varied. Each of the book’s eleven chapters addresses a different set of mental health-related issues confronting American sports and the athletes in those sports.

The Single-Minded Pursuit of Spectator Sports Rewards
Elite athletes, spectator sports organizations, and teams too often pursue spectator sports rewards, especially revenue generation and wealth building, with a single-mindedness that can become almost obsessive. For elite athletes and athletes aspiring to be elite this brand of obsessiveness is different than for most other people.

Those differences encompass: (1) the extreme pressures on athletes to try to pursue and achieve some form of athletic perfection; (2) the magnitude of the rewards bestowed on them when they are successful; and (3) the stress, pain, and anxiety they experience should they fail to meet their own expectations or those imposed on them by others. No wonder sports psychology has become such a thriving business.

As British sports scholar P. David Howe has explained,
the acceptance of risks—including mental impairment, emotional trauma, and pain—is an “inevitable consequence of professional, Olympic, and collegiate participation in sport.”

Stated another way, elite athletes tend to view health from a narrow prism of attaining fitness and pain endurance that are necessary to perform at or near peak levels for as long as possible. That type of risk-taking can be inseparable from doing whatever is possible to be a good or great athlete.

The American Legal System Unreasonably and Unfairly Favors Sports Organizations
Much of this mental health ignorance, neglect, and abuse that athletes experience is downplayed or marginalized because the American legal system unfairly favors, and gives broad discretion to, spectator sports organizations and enterprises. This is a circumstance that has existed in the U.S. for nearly 150 years. Such legal favoritism began in the second half of the nineteenth century, when professional baseball formed the National and American leagues in order to operate as a cartel.

Each baseball player became bound to one team unless he was traded or released by the team’s owner. When the Sherman Antitrust Act was enacted in 1890, it was not enforced against leagues and professional teams. In 1922, the U.S. Supreme Court gave its approval to this labor-stultifying arrangement by creating the legal fiction that Major League Baseball did not engage in interstate commerce. Thus, MLB was not covered by our antitrust laws.

For years, this shielding of professional leagues and teams from antitrust enforcement and other laws has been extended to collegiate teams under the NCCA’s umbrella. Perhaps the worst example, of this type of legal favoritism, however, has been the special congressional charter extended to the United States Olympic and Paralympic Committee (USOPC) that in no small way contributed to the rampant sexual and emotional abuse of American female Olympic athletes and those girls aspiring to be Olympians.

Similarly, laissez faire enforcement of the most important federal and state antidiscrimination laws for people with disabilities in professional, collegiate, and Olympic sports has led to many instances in which athletes or former athletes with mental health and emotional challenges have had few, if any, legal remedies available when they have been discriminated against or denied adequate care and treatment.

Sportswashing and Other Spectator Sports Propaganda Tools
Propaganda, especially sportswashing, has been a prominent component of spectator sports going back as far as the ancient Olympics. Myths about building a better world through spectator sports have been propagated since the end of the nineteenth century, beginning with large expenditures of public funds necessary to establish and perpetuate the modern Olympic movement. Perhaps the most disturbing myths have surrounded those many star and superstar athletes who, despite their moral foibles, have been packaged as exemplary role models.

Sports propaganda and sportswashing have been used for a variety of other purposes as well. They include:

preparing immature boys and men [and now girls and women] for war and celebrating the virtues of military service;
proselytizing Christianity and Christian values;
promoting the illusion that big-time college athletics are amateur competitions between student-athletes;
creating the impression that sports entities embrace racial justice, even as they have continued to create obstacles to racial progress;
justifying or marginalizing misogyny, homophobia, and ableism;
persuading parents that tackle football is a reasonably safe and healthy activity for children and adolescents;
obscuring and covering up widespread doping by athletes in professional, Olympic, and college sports; and
persuading or manipulating large metropolitan area into spending limited public funds for extravagant stadiums and arenas for extremely wealthy corporations and sports entrepreneurs.

Moreover, major sports organizations and businesses routinely use propaganda to sportswash away their misdeeds and transgressions. With respect to mental health issues, these enterprises routinely marginalize or ignore the mental health challenges of their athletes and former athletes. The NFL in particular, as well as the NHL and other spectator sports, continue to sportswash the dangers of brain injuries to their athletes.

Mental Health Concerns That Athletes, Like Everyone Else, May Experience
Many of the mental health challenges that athletes face in American spectator sports are like those that anyone might experience. What can make them worse, however, are locker room behaviors and team bonding influences and experiences, which can work to exacerbate mental health-related stigmas, stereotypes, and discrimination.

Inculcation of dysfunctional attitudes towards mental health challenges typically begins at a relatively young age, when immature and impressionable athletes with talent are often plucked away for special leagues and competitions reserved for those perceived to be the best. From then on, at every step of the process to become an elite athlete, these dysfunctional mental health attitudes tend to be reinforced and exacerbated.

The disconnect between athletic fitness and mental health widens as the rewards and benefits of participating in those sports increase. This skewed reality applies not only to the athletes themselves, but, perhaps more so, to the individuals who are there to supposedly nurture and train them. Sports cultures, particularly involving male athletes, can be kryptonite to mental health and emotional well-being.

Once these athletes reach a point where their athletic careers appear to be over or greatly diminished, mental health care and treatment tends to be reduced, if it was provided for at all, or disappears entirely, leaving it up to the athletes to fend for themselves. Like anyone else, and sometimes more so, athletes are subject to a variety of mental health issues related to: personality; sexuality and gender; hazing and bullying; sexual misconduct; the need to self-medicate; eating disorders; depression; suicide; anxiety; stress; and sleep disorders.

Sports-Related “YIPS,” Stress, Anxiety, and Depression
On top of all the mental health conditions athletes may face, which are similar to those experienced by any American, there are a whole set of sports-specific mental disorders that athletes experience, depending on what sport they compete in. These types of sports-related, mental health challenges tend to generate more sympathy and empathy within the sports world.

To a certain extent, sports-related stress and performance-related anxiety are experienced by almost every elite athlete or athlete aspiring to be elite. This is why so many elite athletes today have direct access to sports psychologist or just have them on retainer whenever the need arises. Sports psychology has become a booming business because sports anxieties, including the yips, can disrupt or even end athletic careers and disrupt their lives.

When sadness, stress, and anxiety become overwhelming, an athlete’s ability to perform can be badly compromised, sometimes permanently. Team and sports organization officials, coaches, and trainers often compound these mental health challenges. Many of the worst mental health stereotypes and prejudices are still expressed and acted upon in sports. The threshold question tends to be whether an athlete’s mental conditions will prevent him or her from competing up to normal standards.

Too often those athletes with mental health challenges, who cannot perform adequately, are labelled as “malingers” or “malcontents,” especially if those challenges do not resolve quickly or are allowed to fester behind a veil of secrecy and silence. Furthermore, once they retire, with few exceptions, the mental health care and treatment of former players, even there conditions are sports-related, will be left to them to pay for and deal with or, assuming they even exist, provided for inadequately in their mental health-deprived pension plans.

Evolving COVID Risks: Known, Suspected, and Unknown
The COVID pandemics have created a constellation of mental health challenges for athletes. Most of the worst outcomes occurred at the onset of the first pandemic before vaccines were available; certain challenges continue to exist today. Although major spectator sports in America and internationally have survived COVID, there have been complications, competitive disruptions, bad behaviors, and much uncertainty.

A certain amount of chaos has existed as well when athletes and coaches have come down with the disease, have refused to be vaccinated, or have lied about their vaccination status. Too often the mechanisms sports organizations have had in place to protect the health and welfare of their athletes and people close to those athletes have not been followed. Furthermore, local state, and national jurisdictional differences as to which public health protocols and mandates should be obeyed and enforced has created additional confusion and disruptions.

No major spectator sport has escaped COVID-related problems, especially early on in the pandemics. Most troubling, has been the uncertainties surrounding long-term COVID symptoms, both in identifying athletes with those symptoms and treating them successfully. These longer-term effects include fatigue, shortness of breath, cardiovascular problems, as well as cognitive and mental dysfunctions.

The New York Times, based on information from the Centers for Disease Control and Prevention and the World Health Organization, described these mental health effects as “brain fog, pain, … depression, anxiety, … and sleep disturbances.” This is because COVID can travel to, and wreak havoc with, any part of the human body, including the brain. Any severe symptoms will negatively affect those athletes’ abilities to perform, athletically.

CTE, Other Brain Damage, and Related Erratic Behaviors
One of the most reported upon mental health risks in sports is brain damage, especially from chronic traumatic encephalopathy (CTE). This cluster of problems not only involves damage to athletes’ menta. health generally. It also concerns the many aberrant or erratic behaviors linked to those diagnosed with these severe or repetitive brain injuries, often years after the damaging blows have occurred—or in the case of CTE only after they die.

CTE is thought to appear in four progressively worse stages. By stage two athletes experience depression, explosive moods, and memory loss. By stage four athletes with full-blown CTE are overwhelmed by what Medical Net describes as “profound memory loss,” “language deficits,” and “psychotic” mood disorders. The longer athletes compete in violent contact sports, the greater the likelihood they will develop CTE.

Ground zero for such symptoms, not surprisingly, has been football, America’s most popular spectator sport. NFL and collegiate players, who began participating in football as youngsters, are particularly at risk. The collective force of all repetitive blows to the brain can be devastating as the sad stories of many former NFL players have confirmed. Yet, for years, the NFL has engaged in patterns of deception, deflection, and marginalization to obscure these well-known risks to their players.

The NHL has not been not much better. The impact of brain damage on boxers, though, has been far more transparent, if no less devastating. Early on, it was simply assumed that punch drunk boxers had assumed the risks of brain damage by engaging in this extremely violent sport.

Damage to the brains of athletes and the bad behaviors that often accompany such damage remains a major mental health concern. The number of reported brain damage cases in sports keeps rising. Yet, much of the media still tends to buy into the sportswashed claims that major U.S. contact sports enterprises are seriously committed to protecting their athletes from CTE and other forms of brain damage.

Substance Abuse and Dependency
Like many Americans, athletes can suffer from substance abuse and dependency. In spectator sports, though, this dependency is ramped up by: the pressure on athletes to perform; the use of powerful medications to deal with pain and injuries; the misuse of performance-enhancing drugs (PEDs); as well as the use of recreational drugs. Often athletes’ substance abuse occurs along with other mental disorders. These combinations of symptoms are classified as co-occurring disorders.

Dependency due to withdrawal symptoms makes it more difficult for affected athletes to substantially reduce or quit abusing these substances. The more they imbibe, the more tolerance they have for those substances.

The image of athletes swallowing a handful of pain relievers, sometimes with alcohol, is part of the macho folklore surrounding male athletes in a number of contact sports, especially football and hockey. What can happen to athletes who are misusing drugs to deal with pain and nagging injuries resembles a car with mechanical problems that continues to be driven. Eventually the car requires costly repairs or simply breaks down and can never function properly again.

Abuse of popular performance-enhancing drugs, such as steroids and methamphetamines, can produce harmful, long-term side effects as well. These effects include rage, paranoia, convulsions, hallucinations, and compulsive and repetitive behaviors.
While prosecutions of elite athletes using or those providing these substances is rare, abuse and overuse can shorten athletes’ professional careers and place their personal lives in jeopardy. Locker rooms and other sports-related environments, along with the pressures to compete at a high level, may cause, exacerbate, perpetuate, nurture, and/or facilitate alcohol abuse and drug dependency.

The Mental Health and Emotional Well Being of Female Athletes
The overall record of America’s most popular spectator sports in dealing with the mental health and emotional well-being of marginalized athletes in their sport has been much worse than the neglect, ignorance, and abuse displayed by those sports in failing to address the mental health needs of their athletes generally. Discrimination based on gender and gender identity has been common.

The largest population of marginalized athletes are females. They experience some degree of misogyny and discrimination virtually all the time. Additionally, their special problems related to pregnancy, postpartum depression, menstrual disorders, and motherhood are challenges that are not commonly shared by their male counterparts and are not dealt with very sympathetically, much less empathetically.

Furthermore, female athletes are far more likely to experience mental and emotional traumas due to the bad behaviors of trusted men in their sports. Such abuses have been particularly common in Olympic sports, like gymnastics, under the umbrellas of the USOPC and NCAA. In response, Congress continues to allow those major organizations to police themselves.

Female athletes consistently report substantially greater mental health challenges than their male counterparts do. Nevertheless, their struggles have received far less empirical and psychological study than the mental health issues male athletes experience. Worse, sexual, emotional, and physical abuse of female athletes continues to be regularly revealed in a broad array of women’s spectator sports. With only a few exceptions, the people most responsible for such abuses have been men. Nonetheless, most of these sports continue to be dominated by male leaders.

LGB Athletes and Sports Homophobia
No segment of the athlete population has experienced more discrimination and marginalization in our most popular spectator sports than those who are part of the lesbian, gay, and bisexual (LGB) community, except intersex and transgender athletes. Homophobia is the most ingrained and widespread pathology in the athletic world.

This is not that surprising. For years even the American Psychiatric Association inappropriately listed homosexuality as a mental disorder. The close connection between homophobia and the undermining of the emotional well-being of LGB athletes should be crystal clear. This massive prejudice also has had devastating consequences on those young male athletes, who have been sexually abused by trusted men, because homophobia works to prevent such abuse from being revealed and properly investigated.

Although elite athletes are more receptive to having teammates who are queer than in the past, homophobia continues to be an important issue in major profession team sports for men. A majority of queer athletes never feel comfortable revealing their status publicly, and if they do, it is at the end of their careers or after they retire from competition. Being outed as queer can have devastating emotional and financial consequences on these athletes, especially if they are male. Female athletes and soccer players appear to be more receptive to having queer teammates.

Homophobia remains a pervasive part of American spectator sports. Those attitudes are changing slowly. Thus, the mental health and emotional well-being of queer athletes continues to be jeopardized.

Intersex and Trans Athletes
Within the LGBTQ+ communities of athletes, no segment has endured more abuse, prejudice, and discrimination than intersex and transgender athletes. Such gender-based injustices occur mainly because men have—or are presumed to have—certain natural athletic advantages over women, while it is men who mostly define what those masculine advantages are and how they should be addressed.

The term “intersex” refers to people who naturally have atypical sex characteristics for their assigned gender at birth that do not fit comfortably into what society views as being masculine or feminine. Transgender means people whose assigned gender at birth does not conform with their internal sense of what their gender identity really is or should be. Society and sports organizations place the mental health and emotional well-being of both of these groups of athletes at extreme risk.

It was almost unheard of until recently for a person identifying as male to be disqualified from or severely limited in a sport because he was presumed to have overly feminine characteristics. Yet, with the enactment of certain regressive state laws that prohibit all transgender athletes from participating or severely limiting their participation in youth and scholastic sports, even that boundary has been crossed.

Much of the discrimination and abuse that intersex and transgender athletes face is based on male-driven definitions of what unfair competitive advantage should mean and how it should be enforced. Thus, who should be allowed to compete as female athletes tends to be determined in disturbing ways.

In an open society, the principle should be that any athlete already competing as a female should be presumed to be female, unless there is strong evidence to the contrary, based on multiple, unambiguous scientific measures. There is little definitive scientific evidence, however, beyond the opinions of experts hired by sports authorities, that can conclusively establish whether an athlete is not female enough to be allowed to compete, especially when it is based on testosterone readings alone.

Conclusion
More and more athletes are coming forward with stories about their struggles with mental health and emotional well-being while participating in our most popular spectator sports. The litany of neglect, abuse, and ignorance that sports organizations and teams exhibit towards athletes with mental health and emotional well-being concerns continues to be alarming.
While there are many ways to improve that status quo, the most promising would seem to be to increase the influence of female leaders in sports. Despite the incremental progress that has been seen recently in talking about the mental health and emotional well-being of athletes in America’s male-dominated spectator sports, there remains a wide gap between the words and meaningful actions.

BEHIND THE CURTAIN AT THE TAYLOR SWIFT/LAS VEGAS SUPER BOWL EXTRAVAGANZA
Many NFL Players Gamble with Their Brains, While Owners Become Increasingly Wealthy
John Weston Parry, J.D.

Behind the curtain at the Taylor Swift/Las Vegas Super Bowl extravaganza, which became the most watched American television program in history, many NFL players, like former players before them, gamble with their brains, while their owners become increasingly wealthy. The NFL is a money-making, marketing machine that is strategically structured to neglect brain health of its players and former players, who are over 50 percent Black.

Today’s players must realize they are risking their cognitive health both now and in the future for levels of fame and fortune only some of them actually achieve. Yet, they cannot seem to help themselves, except perhaps when they insist that they only play flag football in the Pro Bowl Games and, apparently the 2028 Los Angeles Olympics.

Each year, during the week between the NFL’s conference title games and the Super Bowl, one or more of the newspapers and other media outlets, which all benefit from the popularity of NFL football, briefly turn their attentions to the brain mayhem that the NFL’s brand of tackle football inflicts on its players. This year two of the best, most searing critiques appeared in The Washington Post written by Pulitzer Prize winning journalist William Hobson and Pulitzer finalist Sally Jenkins, respectively.
Brain damage in the NFL, college football, and elsewhere is a major focus of the chapter entitled “CTE, Other Brain Damage, and Related Behaviors” in my new book, The Burden of Sports: How and Why Athletes Struggle with Mental Health (Rowman & Littlefield, 2024), as well as several chapters in my previous book, The Athletes Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, 2017). According to my research, the NFL’s CTE and brain damage problem is far more complex and significantly worse than even what either of these excellent Post writers suggest.

What the Washington Post Found and Hobson and Jenkins Concluded

Hobson’s exhaustive investigation of the “Broken Promises of NFL’s `Landmark’ Settlement” with its former players may well garner him another Pulitzer Prize or at least a nomination. He examined in detail the experiences of former NFL athletes, who tried to opt into the billion-dollar-plus NFL settlement agreement, but apparently were denied benefits because the plan administrators required that the mandated diagnoses by medical specialists of the otherwise eligible former football players apply unorthodox, legalistic, and medically suspect criteria for documenting the presence of football-related dementias and other cognitive disorders.

The NFL’s callus sleight of hand has resulted in at least 70 former players—those whose medical diagnoses the Post could verify—being denied benefits, even though their examining physicians had diagnosed them with dementias. Of that group, 14 former players who have died since their claims were rejected, received post-mortem diagnoses that they their brains had been impaired by Chronic Traumatic Encephalopathy (CTE). Unfortunately, given the accepted medical protocols in this country, currently CTE can only be properly diagnosed once a subject has died.

The total number of former players improperly denied benefits probably is much larger than the Post’s verified examples indicate. Records the Post reviewed from the court, which is overseeing the 2017 settlement, show of the nearly 2,000 dementia claims referred to that judicial tribunal about 55% (1100) were denied, 300 of which were based on diagnoses by doctors used by the administrators of that settlement agreement. The Post calculates, based on the “average cost of approvals” for each covered claimant, those denials probably saved the NFL from shelling out more than $700 million in additional benefits.

The substantial discrepancy between what is considered a proper medical diagnosis of dementias compared with the plan’s far more stringent and legalistic criteria is known as a legal fiction. Black’s Law Dictionary defines that term as a working “assumption that something is true even though it may be untrue.” This particular legal fiction was agreed to by lawyers on both sides in order to reach an agreement about how to administer the settlement.

As discussed below, that agreement appears to compensate each law firm or lawyer involved in the litigation, far more so than each average individual claimant. Fewer than half of those claimants have received benefits, and most former players do not qualify under the strict terms of the settlement agreement.

According to Judge Brody, who heard and decided the case and now oversees the agreement with the help of a special master, there is a clause stating that every 10 years of the 65-year agreement NFL lawyers and lawyers representing the former players must meet to consider whether the dementia definition should be changed. For such a change to happen, however, both parties to the settlement must agree to any revisions. It is extremely doubtful that NFL owners would ever consent to any revised formula that would cost them more money, unless they were getting something back in the collective bargaining process with the NFL Players Association (NFLPA) in return that was more valuable.

Sally Jenkins deliciously describes the plight of players who develop “concussion-related cognitive problems” and then try “to seek medical recompense from the league” as facing “a slow walk to a swindle.” Current players are not even part of the settlement agreement. In addition, unless things unexpectedly change, current players will have to pursue limited relief under the unfriendly mental health benefits found in the league’s pension plan for its former players. Jenkins reported that even under the terms of the settlement agreement, former players must have four separate cognitive impairments “under two different [medical] protocols” to even “receive a qualifying diagnosis,” which is a threshold step necessary to receive any award.

NFL Commissioner Goodell, who in theory is supposed to look out for the players’ welfare, is beholden to the owners’ positions instead. In a 2022 court document, Goodell disingenuously compared the “`risks… [of] playing football and other sports’” with the “`risks… [of] walking down the street.’” Given the league’s attitude about brain damage to its players, Jenkins can only think of two unlikely ways to try to compel these NFL owners, who remain “gluttons for public assistance,” to compensate their players for football-related brain damage.

One would be to somehow convince those in the media, who make up a majority of the voting members of the Pro Football Hall of Fame, to refuse to admit any more ego-driven NFL owners “until the concussion settlement has been reopened and the terms reformed.” The second would be for members of Congress, who should have been overseeing the NFL all along, to convene another “hearing on the NFL’s attitudes and practices.”

Jenkins says the hearing’s purpose should be for Congress to ascertain whether the league has been involved in “an effort to improperly suppress medical findings [about players and former players] and to make the owners provide “lifetime health coverage for players.” She compares NFL team ownership with owning a coal mine. The “price” of ownership of either business—both of which receive substantial public subsidies—should be “a lifetime of compensation for those who are permanently disabled,” whether it is from “coal dust” or brain injuries. Congress, for its part, however, has been extremely reluctant to discuss, much less take, needed steps to better protect NFL players.

NFL Brain Damage Problems Are Extremely Complicated, As Are Existing Remedies

What happens to players and former players who have or develop cognitive impairments due to preparing for and playing football in the NFL now depends on a number of factors, including some that have little to do with medical need. The threshold issue is whether they are covered by the NFL Concussion Settlement and/or the NFL’s Pension Plan. Neither option guarantees good care and for many athletes little or no care. Both options are designed to limit the financial liability of the NFL or the NFL and the NFL Players Association (NFLPA) together.

Terms of the Settlement Agreement as Reported at WWW.NFLConcussionSettlement.com
As reported on the website for claimants, their lawyers, and administrators of the settlement—this grand agreement—despite the more than a billion dollars that already has been committed to brain injury compensation, mostly in lump-sum payments—is worth only a fraction of the total cost of the brain damage that has been wreaked upon NFL players over the years. Most former and existing players, who have been or will be diagnosed with serious brain injuries and cognitive decline during their careers, are not covered, or not covered in full, by the language of that agreement, which is cluttered with exclusions and limitations.

To add insult to injury, the NFL and its owners, as part of the settlement agreement, were permitted to continue to “deny that they did anything wrong.” That loophole was included, despite overwhelming evidence recounted in the Athletes Dilemma and elsewhere that for many years the NFL made official statements and took actions intended to deceive and mislead their players and the public about the dangers from concussions and other brain traumas associated with playing football.

The Four Subclasses of Covered Claimants
Under the settlement agreement only some former players, who had retired “prior to July 7, 2014,” were covered and no players since then. Covered former players were divided into two subclasses:

those who were not diagnosed with a qualifying condition or “Death with CTE” before July 7, 2014; and
those who were either (a) diagnosed with a qualifying condition before July 7, 2014 or (b) diagnosed with a qualifying condition “prior to [their] death or who died prior to July 7, 2014 and [also] [had] received a diagnosis of Death with CTE.”

The agreement also included two additional subclasses of claimants, each with legal ties to the eligible former NFL football players. As they were defined in the settlement, each of these derivative claimant classes raised different legal concerns for eligible former players.

The first derivative subclass arose or arises, if covered former NFL players have been adjudicated as “legally incapacitated or incompetent.” Their authorized, court-ordered guardian or representative is empowered to make claims on that former player’s behalf.

Most people with significant cognitive impairments that limit their decision-making abilities, however, are never adjudicated as such, nor should they be. Even well-intentioned guardianships or conservatorships inevitably strictly limit the civil liberties of the subjects of these judicially-imposed remedies. Hence the Brittainy Spears outrage.

Thus, it is reasonable to conclude a substantial, but unknown, number of settlement-eligible former NFL players were not, or may not be, able to do what is necessary to pursue their claims effectively. That would include important threshold steps such as retaining a competent attorney, making a “timely” claim, and doing what is necessary to be properly diagnosed under the complicated terms of the settlement.

The second derivative subclass encompassed “[s]pouses, parents, dependent children, or any other persons who properly under applicable state law [may] assert the right [to make a claim] independently by reason of their relationship with a living or deceased Retired NFL Football Player.” Such claims, though, if they proved successful, reduce the proceeds that the eligible former NFL player would be entitled to receive. Should a conflict arise as to whether this type of derivative claim was or is warranted, such a dispute might lead to expensive litigation between the former player and the derivative claimant.

Settlement Exclusions and Limitations
In order to receive an award, in addition to proving that they are part of an eligible subclass, claimants must be able to successfully navigate numerous exclusions and limitations. No matter how severe a brain injury the former player experienced while playing or practicing in the NFL or one of its affiliate leagues, their potential awards could or will be reduced by the following exclusions or limitations.

To begin with, all potential claimants were required to abide by an onerous and complicated settlement schedule. Until it was finally approved, a date which could not be determined at the time of the original settlement, none of the potential claimants could even register to apply to receive an award. Yet, if they wanted to opt out of the settlement and pursue potential remedies independently, they had to do so by October 14, 2014. Ultimately, settlement registration did not open until more than two years later on January 7. 2017; then closed after only seven months on August 7, 2017.

Eligible former NFL football players, who failed to register in a timely manner, were automatically excluded from receiving benefits, except in two narrowly worded circumstances: (a) if a judicial body had appointed a representative claimant for that potential recipient, the representative would have 180 days from the time of the appointment to register; or (b) if the eligible football player could show “good cause” for needing such an extension—which subject to possible review by the Special Master overseeing the settlement—appears to have been left up to the discretion of the “claims administrator.” It is important to reemphasize that both Post writers criticized the benefits claims administrator for consistently limiting the frequency and value of successful claims.

One obvious “good cause” would seem to be if the claimant, due to his mental impairment, was in the process of having a representative plaintiff appointed for him. Another would seem to be the inability of an eligible former player, due to cognitive decline and the absence of legal representation, to fully understand the complicated settlement requirements. But how either of those situations should be assessed is still going to be based on the claims’ administrator’s discretion.

A second limiting provision reduces benefits for eligible former players who were not fully vested, based on the number of “eligible” seasons they had played or practiced in the NFL or one of its affiliated leagues. In order to be fully vested, an NFL athlete had to have played or practiced for more than 4.5 seasons prior to July 7, 2014.

For eligible former players who played or practiced 4.5 seasons or less, benefits were to be reduced by 10% initially; then 10% more for each half-season they did not play or practice, until their amount of eligible time was under .5 seasons. Then there would be an additional 7.5 % reduction. making the total reduction a whopping 97.5% of their potential benefits.

Third, awards could be further reduced by 75% if the former player involved experienced either a “medically diagnosed stroke” or “severe traumatic brain injury” that occurred before he had received a “Qualifying Diagnosis.”

The lone exception would be if “the retired player (or his Representative Claimant) [failed to] show by clear and convincing evidence” that his injury or condition “[was] not related to the Qualifying Diagnosis.” The use of such a high evidentiary standard was unusual. The clear and convincing evidence standard normally is reserved for civil legal matters impinging upon fundamental liberties. A preponderance of the evidence standard is used in most civil matters like this.

Fourth, any award would be further reduced if the retired NFL player had failed to receive a qualifying diagnosis before he turned 45. Only athletes who were under 45 at the time of the settlement in 2014 were entitled to full awards. For ALS that would be $5 million, followed in value by: death with CTE ($4 million); Parkinson’s and Alzheimer’s ($3.5 million); a Level 2 cognitive impairment ($3 million); and a Level 2.5 cognitive impairment ($1.5 million).

Any such awards would be increasingly reduced in five-year increments should they receive a qualifying diagnosis when they were 45 or older. Those former NFL players who received or will receive a qualifying diagnosis when they are 80 or older would be entitled to receive only a tiny fraction of the value of the greatest possible award.

Fifth, all the settlement awards are subject to inflation. While such “an award may be increased up to 2.5% per year” for inflation, there does not appear to be a formal mechanism for determining when such adjustments should be made and how to calculate that percentage. Regardless, in those years in which inflation exceeds 2.5%—and so far, that has occurred in most years since the settlement was finalized—the real value of the claimants’ awards will be reduced by inflation.

Sixth, the settlement discriminated against Black former players by creating diagnostic criteria that was more rigorous for them than for white players. It was not until 2022 that those discriminatory racial diagnostic criteria were dropped.

The good news about the settlement is that claimants’ attorneys’ fees, set at $112.5 million, were to be paid without reducing individual awards to claimants. The one exception was fees claimants might have paid out initially in order to retain their attorneys. Also, as alluded to earlier, all settlement benefits were to be “completely independent of any [other] benefits that have been created by or between the NFL and the NFL Players Association.”

Former NFL Player Pension and Health Care Benefits
Much like the settlement agreement, health care and related benefits retired players are able to receive through the collective bargaining process between the NFL and the NFLPA have plenty of exclusions and gaps in coverage. Those deficiencies have made it difficult for brain-damaged players to receive the long-term care they need, if they were not one of the lucky few who were appropriately compensated as a result of the settlement.

Until recently, the NFL’s disability plan, run in conjunction with the NFLPA, did not even cover dementia because incredibly it was not viewed as a risk associated with playing football. Awards based on any football-related brain disorders were rarely approved in the past, as compared to physical conditions and injuries, which were more commonplace. Even with those covered cognitive conditions, however, they had to have been diagnosed as having developed no later than 15 years after the players had retired.

Thus, conditions that took longer to manifest, like those caused by CTE and other forms of brain damage, were excluded.
The league itself, until more recently, did not even mention, much less acknowledge, the prevalence of brain damage to its athletes. Even in the settlement, the NFL and the owners insisted upon the right to say they were not responsible for causing any brain damage, even though they were agreeing to pay out much more than a billion dollars to brain-injured former players. The NFL appears to have implicitly presumed that players should be responsible for paying for their own long-term mental health care. Even now the mental health care for many former players, who do not qualify for coverage under the settlement, has been, and continues, to be intentionally subpar.

Only Vested Former Players Qualify for Full or Partial Pension Benefits
The NFL’s pension plan is limited to retired players who are either vested based on a complicated, multi-pronged, date-based formula for calculating what are termed “credited seasons” or “by satisfying special rules.” Those who do not vest, do not qualify for benefits, which has been the story for many and perhaps most players since the average NFL player career is only a little bit over three years.

If a former player has at least one credited season after 1992, he needs only two more to be vested. If a former player has a least one credited season after 1973, but none after 1992, he needs three more credited season to vest. If a former player has five credited seasons in any time period, he also vests. In addition, any former player, who while still active, qualified for “total and permanent” disability benefits, he is vested as well, regardless of the number of credited seasons he accumulated.

The “special rules,” which provide lesser benefits, apply to former players who: (1) entered the league before 2012, were employed in the NFL after March 31, 1976, and had “at least 10 years of service”; (2) were employed in the NFL after 1988 and “have at least four years of service, at least one of which occurred after [1988] … and was a year of service [in which the player] did not earn a credited season”; (3) were employed after 1992 “and have at least three years of service, at least one of which occurred after [1992] and was a year of service in which [the player] did not earn a credited season”; or (4) the player earned “four credited seasons, none of which was after the 1973 season, and [he] was alive on June 1, 1998.” Former players who “first entered the league in 2012 or later, must earn at least five years of service to become [vested].”

Retired players qualifying under the special rules are ineligible to receive benefits based on credited seasons. However, if they were otherwise employed by the NFL as a coach or some other position after they retired, that service would count towards their eligibility as long as the non-active player employment “immediately precedes or immediately follows, without interruption, [their] employment as an active player.”

Problems with the Mental Health Care for Current Players
Mental health care for current players has its problems as well. Two well-publicized examples illustrate the nature of these problems. First, is the continuing deliberate abuse of painkillers in the NFL, which was first exposed nationally in a 2013 Post investigative piece by Sally Jenkins and Rick Maese.

As is detailed in The Burden of Sports, though, “beyond the prosecution of a San Diego team physician in a US Department of Justice probe of illegal prescriptions written by team doctors during the Obama administration, the NFL… [has] largely escaped serious government scrutiny” for pain-killer drug abuses. In addition, any “civil remedies [taken against NFL teams and team physicians] have been few and far between.”

Former Miami Dolphins All-Pro cornerback Byron Jones, upon retiring recently with “crippling injuries,” warned “young players” coming into the league:
`DO NOT take the pills they give you. DO NOT take the injections they give you. If you absolutely must, consult an outside doctor [first]…’”

A second example involved the multiple head traumas Tua Tagovailoa suffered in 2022, which revealed how problematic the NFL’s concussion protocols still appeared to be five years after the settlement agreement had been finalized. The Burden of Sports describes the Tagovailoa fiasco as “a perfect storm of incompetence and neglect” in which “the flaws in the NFL’s concussion protocols were put on full display in three nationally televised football games.”

The first incident occurred in a September contest when the star Miami Dolphins quarterback “could be clearly seen staggering to even walk off the field after he was slammed to ground helmet first.” A “’neurotrauma consultant’ hired by the league” examined Tagovailoa. Even though the quarterback displayed signs of what other brain experts later identified as “`gross motor instability,’” he still was allowed to return to play the rest of that game.

Four days later, Tagovailoa was starting at quarterback for the Dolphins in a Thursday night contest. His injury in the previous game was being described by the quarterback and his team as a “`hyperextended’ back, not a concussion or brain trauma that would have required him to be placed on the injured list.” During that second game, Tagovailoa “was tackled hard, and once again his helmet struck the ground violently. The quarterback “lay motionless” in a position that neuroscientists later identified “as an involuntary response triggered by some sort of brain trauma.”

The NFL, in conjunction with the NFLPA, investigated and agreed, in the future, players who display ataxia, “narrowly defined as “’abnormality or balance/stability, motor coordination or dysfunctional speech,” should be sidelined immediately. Twenty-four days later, Tagovailoa was able to resume his quarterbacking “duties.” He performed well initially, but in later games it appeared as if his “performance level [had] dropped.”

In a late December game, the Dolphins quarterback fell awkwardly striking the back of his helmet on the ground. Nevertheless, “he was allowed to continue to play” because he did not display obvious signs of ataxia. He was held out of the Dolphin’s last regular season game and the team’s only playoff game, however, suggesting that in the prior game he had suffered another brain trauma.

In light of all the bad publicity the Tagovailoa incidents generated for the NFL, but speaking more generally, “the NFL chief medical officer pontificated, ‘I can tell you there’s been a sea change over the decade in the willingness and the understanding of players to speak out about their symptoms.’ The obvious implication was that it is the players’ responsibility to protect themselves, not the league’s….”

The NFL and the NFLPA followed that up by issuing a joint statement, which contended that in late December game, the proper concussion protocols had been followed. The implication was that under those protocols the Dolphins and the league was not required to remove Tagovailoa from the game, even though he would be unable to play in the next two contests, including one which was a critical playoff game.

Conclusion

The mental health care and treatment for former and current players, who have sustained brain traumas since the settlement agreement was reached, continues to be undermined by NFL-inspired neglect, deceptions, and misleading statements. There are two major systemic reasons why these types of failures have occurred and will continue to occur, unless the NFL’s mental health care systems are reformed for both current and retired players.

The first and most important concern is that the NFL operates as a business, even though it is treated by Congress, state legislatures, and the courts more like a charitable enterprise. In this protected, laissez faire business environment, NFL owners are pretty much free to prioritize their wealth-building and generation of revenue streams over the safety and welfare of their players. Even today, when it is clear that tackle football results in brain-damage, the NFL and its teams work to hide the full scope of that damage to their athletes and to marginalize the moral obligation they have to protect and care for their current and former employees, who are playing this violent sport.

The second major concern is that current and former players’ interests with respect to the need for mental health care provided by the league its teams are not aligned. Current players, represented by the NFLPA, are far more focused on salaries and benefits now, as compared to future benefits for themselves, much less for former NFL players, who are not even allowed to be members of—and thus have no voice in—the NFLPA.

Given the revenue-sharing model upon which the NFL’s collective bargaining process is based, current players generally favor receiving more of those revenues now and less benefits later once their NFL careers are over. Those priorities might seem shortsighted, and they certainly are from a mental health perspective, but, tragically, they still reflect what most Americans would choose if they had to decide between immediate rewards and future mental health benefits.

IS TEN TOO YOUNG TO FAST TRACK PROMISING ATHLETES?
Of Course, It Is
By John Weston Parry, J.D.*

Is the physical, mental, and emotional health and well-being of gifted young athletes put at risk when their parents allow them to be fast tracked into one sport when they barely have reached the age of adolescence? The answer should be obvious to any parent, but clearly is not for many. It may not even be obvious to sports reporters, who should be aware of all the bad things that can, and do, happen to these athletic prodigies later in their lives.
The Washington Post posed the question in a headline on the front page of its venerated sports section whether age 10 is “too soon” to “fast track” a young athlete with Olympic aspirations? Then, in a sub-headline, the Post added that the very young athlete’s aspirations “seem realistic.”

The well-researched and written story by Sam Jane about Elise Pridgeon, a 10-year-old track star, was filled with red flags. A blind spot surrounding our gifted young athletes is produced, in large part, by a perceptual fallacy. It essentially boils down to talented kid athletes, and those in charge of them, believing the aspiration of becoming a sports star justifies risk-filled means in trying to attain this highly unlikely outcome. In young Elise’s situation, the belief begins with the undeniable fact that she ran faster than any other girl of her age group at the USA Track & Field National Junior Olympic Championships at 100 meters, 200 meters, and 400 meters.

The Physical Advantages of a Prepubescent Athletic Prodigy Examined

Elise’s athletic feat is truly extraordinary and appears to be suggestive of possible Olympic medals in her future, until one dives deeper into the circumstances surrounding her victories. It is important to understand almost every star athlete has some athletic gift or gifts very few if any athletes share, or share to a much lesser degree.
Serena Williams’ power combined with speed and coordination, Tom Brady’s jet fighter pilot ability to quickly process everything that was going on in front and around him on a football field, and Simone Biles extraordinary ability to control her body while in flight, are all examples of these special gifts. Nonetheless, even with supreme athletes, their gifts can be temporarily interrupted or permanently derailed by physical, mental, or emotional disturbances, or life changes.

Very young, extremely talented athletes have athletic gifts that are likely to change as they mature, especially during puberty. For most, their advantages will be less than what they used to be, when compared to other talented athletes their own age. At the same time, many kids who did not appear to be athletic standouts before their bodies matured become better or, in a few cases, great athletes after puberty.

As Sam Jane aptly describes, Elise at “5-foot-5 … towered over the rest of the competition.” Her height reportedly made other parents of athletes at the national track and field meet express the sentiment: “She couldn’t be 10-years-old.” Elise is so tall that her mother “carries around her birth certificate, just in case.”

At age ten, Elise is taller and thus has a much longer stride than her competitors. That unique athletic advantage, which now separates Elise from almost every other female athlete her age is highly unlikely to continue to the extent it constitutes a unique advantage now. Physical maturity following puberty will tend to neutralize some or much of the impact of Elise’s physical gift.
Furthermore, when young athletes engage in only one, or mostly one, sport for much of the calendar year, they risk chronic or permanent injuries and related physical impairments from repetitive strains on the body parts their primary sport stresses as they pursue athletic perfection. The more time these young athletes spend participating in their sport, the more likely they will have serious physical problems that will diminish their ability to play any sport later on, much less their chosen sport. This appears to be especially true for female athletes.

Mental and Emotional Well-Being of Prepubescent Athletes

In addition, parents should be deeply concerned about the mental and emotional effects on young athletes who specialize in one sport at a very early age. Athletic trainer Tamara McLeod, a leading expert on how to help kids properly specialize in a sport, nevertheless describes specialization as being: “`almost a rat race… that if you’re not engaging in this off season programming, then your child might be left behind.’”

Elise’s father worries that “[t]rack and field is one of those sports where there’s so much pressure at times that if you don’t moderate it as a parent, it becomes too much for the athlete.” As the Technical University of Kaiserlautern in Germany found, after conducting a detailed study, the best junior athletes do not become the best young adult athletes. “Young athletes who specialize in a sport quickly get ahead of their peers, but then those peers eventually catch up.” Ultimately, as Jeff Kovan, Michigan State University’s Director of Sports Medicine, warns: “there’s a line many [young athletes] cross that becomes detrimental to their health and well-being.”

Yet, what is “too much” specialization and training lie in the eye of the beholder, which usually becomes an agreement or accommodation reached between the parents and the child-athlete. Typically, the more success a child-athlete achieves, the more likely that this already difficult to discern danger line will be crossed in pursuit of rewards associated with the increasingly more difficult to achieve high school, collegiate, and professional success—hence the “rat race” analogy.

Unfortunately, rat race is a more vivid, but less transparent and accurate, way of warning about the mental and emotional stresses that can lead, depending on the sport, to burnout, anxiety, use of performance-enhancing drugs, substance abuse, brain damage, and/or other mental health problems and disorders.

In Elise’s situation early warning signs have emerged. Even though her parents are trying to minimize the impact of her running schedule on Elise’s life, it seems forced. They say she only races “every other weekend,” and “incorporates month-long breaks into her training schedule.” Yet, she is only ten years old! And, of course, there are likely to be exceptions when key events are held.
Reportedly, “her parents knew” when Elise was 5 that “she was ready for serious training.” However, there is little mention of her academic education, other than the fact that she supposedly “watches the `Today’ show every morning” with her mother and “[p]re-algebra is giving her trouble.” No mention is made of her going to school, of having school friends, or how she is progressing in her other subjects. Presumably, like many other talented child-athletes, Elise is being home-schooled. Unfortunately, there is no meaningful outside supervision or educational requirements for home-school kids to meet in Maryland, or most other jurisdictions.

By comparison, Elise already has a personal track coach and trainer. He intends to incrementally increase “the amount of weight training [Elise] does” as she gets older—and presumably the amount of running she does as well. Elise envisions herself as being a runner in high school and college, which “will lead to a potential Olympic bid.”
Hopefully, plans will be in place if her aspirations do not work out, which, based on the experiences of other very young and talented athletes seems likely. At the moment, though, being a serious student does not appear to be a priority. Trouble with pre-algebra, for example, is viewed as “a little problem that seems to hold her behind,” not academically, but in keeping up with her busy training schedule.

Conclusion

Based on anecdotal evidence from athletes themselves and stories of the overwhelming majority of young athletes who never achieve the elite success they are seeking, as well as the opinions of many experts, it seems undeniable that many more young athletes will be harmed physically, mentally, and/or emotionally by over-specialization and over-training, than will benefit from that experience. The athletic landscape is littered with the broken dreams and broken minds and bodies of the vast majority of athletes who fail to become elite, as well as many of those athletes who achieve elite success, at least for a while.
Potential rewards may be stupendous for kids who actually reach their pinnacle of athletic productivity. However, the risks to those athletes’ physical, mental, and emotional health and well-being are significant, and much greater than they need to be. For elite athletes and those aspiring to be elite, the athletic rat race is something like playing the lottery in a Shirley Jackson kind of way, where even the relatively few apparent winners can turn out to be big time losers.

*John Weston Parry, is is the author of numerous books, including The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, 2017) and a forthcoming book entitled The Burden of Sports: How and Why Athletes Struggle with Mental Health (Rowman & Littlefield, Feb. 2024).

Are Guardian Helmet Caps Another NFL Brain Damage Deflection?
John Weston Parry

The NFL’s messaging was crystal clear. Among those position players, mostly linemen, who were mandated to wear the odd-looking and reportedly clumsy feeling Guardian helmet caps during most of the preseason, concussions dropped more than 50 percent from the year before. The sportwashed implications of that message was evident as well. This new helmet should: (1) greatly ease concerns about football players being brain damaged; and (2) boost the impression that team owners are looking out for the welfare of their players. “The performance of the cap exceeded our expectations,” gushed Jeff Miller, the NFL’s executive vice president of communications, public affairs and policy, the position once held by Commissioner Roger Goodell, during the height of the league’s CTE scandal.

If the NFL’s concussion manipulations of the past are any guide, however, this announcement deserves to be scrutinized carefully to ascertain whether it is another sportswashed deflection, if not an outright deception. To begin with, as Miller conceded, concerns remain about the sizing and awkward fit of the pillow-like casing, which, for those watching, appears to make the heads of players wearing those elongated caps move like bobble head dolls. As Pittsburgh Steelers defensive tackle Cameron Yeyward complained, “[w]hen you go to tackle, it almost feels like there’s a pillow on your head.” Worse than that, after Philadelphia Eagles tackle Jordan Mailata sustained a preseason concussion, he lamented: “The hat’s fake news. It doesn’t stop anything.”

Nonetheless, no one who has viewed these awkward looking protective shells on top of the supposedly already buttressed NFL helmets cannot help but come away with the impression that the Guardian Cap is being rolled out as a concerted effort by the league to vastly improve perceptions about player safety. Who doesn’t want 50 percent less concussions? Moreover, in terms of repeated sub-concussive impacts over a football career, which the science has concluded is far more dangerous, the NFL self-reports that these caps reduce the severity of each collision between two players wearing them by no less than 20 percent. Wow!

Before we applaud the NFL—or take seriously the football media’s congratulations of the NFL—for finding the Holy Grail of football-related brain damage protections, though, it might be wise to more closely consider three basic elements of this narrative. First, what do these results actually mean when scrutinized from a more scientific perspective? Not much. Second, should we trust the NFL as being a reliable source for information about NFL player safety? Only at the players’ peril.

And finally, will the NFL players union, which has been unwilling to agree that Covid vaccines should be mandated for its members, be willing to agree that players should be forced to wear pillow caps on their heads? Doubtful.

This recent NFL safety outreach campaign appears to be another effort by the league to kick the CTE controversy down the road, until it becomes obvious that the current version of the Guardian helmet cap is a no go. Even if it proved to be every bit as protective as advertised, the helmet cap still would only be a modest, albeit a significant, improvement in brain safety, especially since the collision forces of players continue to increase as athletes grow bigger, become stronger, and run faster.

What Do These Very Preliminary Results Mean Scientifically?

Even though the information about the over 50 percent reduction in concussions was disseminated by the NFL, as if that figure was based on reliable empirical findings, this so-called publicity exercise—stunt?—was far from a rigorous scientific study. To begin with, the NFL chose a period of time that for some reason ended with the second preseason game, rather than including all three games, which would have been more meaningful.

One can surmise that because no players are being compelled to use the pillow caps in the regular season, the NFL and the players union must have agreed that there needed to be a transition game where no one had to wear the odd-looking cap. According to the NFL, 200 players wore the helmet once the mandate was lifted, but even that figure does not identify how many of those guinea pigs were cut before the regular season began and how many continue to wear them now. There seems to be no evidence whatsoever that players are using the helmet in the regular season in significant numbers, if at all.

More importantly, in terms of the reliability of the NFL’s preliminary results, the basis for those findings represents two small and variable samplings. Reportedly, there were 23 concussions involving players last year, who played the designated helmet cap positions during an equivalent period, and only 11 such concussions were reported this year. That variation may not even be statistically significant, especially when one factors into the calculation that NFL teams, which have a vested interest in promoting the purported safety advances of the league, are the ones responsible for reporting how many concussions there were on their respective teams during those two periods of time, approximately a year apart.

In addition, there appears to be considerable inconsistency in how games are called in terms of penalties from game to game, much less between seasons, especially when relevant rule changes are announced or updated. The only given seems to be that NFL referees are supposed to change how they interpret the rules and issue penalties based on instructions from the league office, which often are not publicized. Thus, comparing those two seasons is more like comparing apples and oranges. It is conceivable, given the NFL’s embarrassing history, that there could have been a special behind the scenes effort made to protect players from collisions involving their heads in the preseason this year as compared to the year before, simply to make the new helmet look more promising.

It will take quite a few more years and a far more structured empirical study, comparing players who use the pillow caps with those who do not, to reliably determine whether the newfangled helmet, or a version there of, provides statistically significant protections for the players. It seems odd at least, and perhaps suspicious, that none of the players in skill positions, who also tend to be involved in the most violent collisions, were included in this initial experiment.

Wide receivers, running backs, return and special team specialists were basically excluded from the league’s reported statistics, and they are the heart of the offensive-minded NFL. Quarterbacks already receive greatly enhanced protections because they are viewed as too valuable to sacrifice, even in order to satisfy the entertainment values of the fans and football media. One can only imagine the delight of personal injury lawyers at being able to exploit the legal opportunities for them that such a gross safety disparity between football positions would provide, if the helmet is implemented in the way it has been rolled out so far in the preliminary experimental stage.

The NFL’s Legacy of CTE Deflection, Deception, and Lies

For decades, the NFL did everything possible to cover up the dangers of brain damage to its players. Now the league is earnestly asking the American public to believe it is sincerely committed to protecting the safety of players’ brains when it assesses, in house, rather than with a rigorous scientific study, the efficacy of its new helmet configuration that the NFL hopes will substantially reduce negative effects of concussions and repeated sub-concussive impacts on athletes’ cognitive and mental health.

Unfortunately, Charles Schultz is no longer around to present us with a parody of Lucy holding a football in place while Charlie Brown prepares to kickoff, in the context of the NFL’s past failures to protect its players health and safety. Those disturbing efforts, which were aptly described by sports journalists at the time as involving deflections, deceptions, lies, and a combination of all three, went on for decades. A summary of a few of those more recent outrages makes the point that the NFL should not be trusted.
Junior Seau committed suicide in 2012 during one of his reported bouts with the effects of CTE. In 2015, when Seau was to be inducted into the NFL Hall of Fame posthumously, his daughter, who Seau had designated to speak on his behalf, was denied that opportunity. The NFL apparently did not want deceased players’ CTE symptoms to be referenced, much less emphasized, during those ceremonies.

Thus, in 2010, once it became obvious that there might be a string of NFL players who had died in tragic ways related to CTE being inducted into the Hall of Fame, a remarkable rule was instituted barring anyone, but the player himself, from speaking, which of course dead people cannot do. The NFL, citing that rule, declined to honor Seau’s predeath request by making an exception. As David Baker, a past Hall of Fame president explained: “Our mission is to honor the heroes of the game… We’re going to celebrate his life, not the death and other issues.”

Similarly, the NFL successfully sportswashed Jovan Belcher’s CTE-infused murder-suicide in 2012. The New York Times summarized what had happened this way: “With his coach looking on, a Kansas City Chief’s linebacker shot and killed himself outside the team’s practice facility …less than an hour after he killed his girlfriend…,” who also was the mother of his baby daughter. As the Times television critic Richard Sandomir observed later, “sports… has become adept at a type of cleansing more commonly associated with authoritarian governments.” Jovan Belcher, like many other star athletes with suspected CTE, was “`airbrushed from the highlights.”

Despite the league’s best efforts to hide these CTE dangers, the NFL eventually had to agree to a billion dollar plus brain damage settlement with former players, rather than litigate the matter in court, and likely lose. The NFL did this in part so it would not have to publicly admit any wrongdoing.

Afterwards, though, because the league continued to act in bad faith, the NFL had to agree to another settlement in October 2021 with African American former players, who had been denied full coverage and benefits from the original brain damage settlement, due to racial profiling. NFL representatives had been assuming that those players were more likely to be cognitively disadvantaged due to their racial identity, as compared to other players. Applying that skewed logic, the football-related brain impairments to African American former players were deemed to be less damaging, and thus less deserving of compensation. This type of racial discrimination was particularly offensive, since a majority of players in the NFL are Black.

Given this shameful history that directly involved the NFL’s chief publicist at the time, Roger Goodell, which appears to have played a big role in his becoming the Commissioner after Paul Tagliabue was cast aside, does not inspire much confidence in the objectivity or sincerity of the league when it comes to matters involving the brain health of its players.

How Will the Player’s and Their Union Deal with the Guardian Helmets?

It is usually difficult to accurately predict human behaviors. In this case, however, the signs are not good of there being universal, much less widespread, player acceptance of these pillow caps, which cannot possibly improve game performances and appear to the athletes to be a significant impediment. If the league and the union cannot get players to agree on mandated and strictly enforced Covid public health protocols, including vaccines, it seems highly unlikely that these clumsy looking, and playing, skull protections will be a big hit.

It is extremely telling that the NFL felt compelled to conduct its initial experiment with a helmet cap mandate in such a limited way. Only offensive and defensive linemen and linebackers were included, while the even more highly paid, more nimble skill positions were given a pass. This was true, even though it is with these skill players that the most violent head impacts seem to occur. Furthermore, the experiment was only conducted in the preseason and did not include the final preseason game.

There are two reasons that can explain why this preliminary experiment was conducted in the way it was, neither of which auger well for eventual acceptance of a pillow cap mandate by the NFL players and their union. First, it could have just been a matter of position privilege. The more valued players, quarterbacks, wide receivers, and running backs have more clout, particularly in the media, and the NFL figured it would be easier to force the lunch pail, player crowed to comply.

Second, and more likely, the clumsiness of these protective pillow caps would appear to be more pronounced on those players who need to move their bodies the quickest and fastest without feeling like bobble head dolls. If that is actually what happened, the helmet caps may only be approved for some of position players, not all. If such a scenario were to unfold going forward, in which only some of the players, mostly linemen, would be forced to use the helmet cap, the resistance by those players undoubtedly would be huge, and the league’s potential brain damage liability would also increase.

Even if it turns out that the helmet caps substantially improve player safety, and at this point that is a big if, player resistance and lawyers may make the matter moot, unless the helmet is redesigned to not only effectively protect, but to minimally interfere with player performance and cater to player vanity. The current version of the Guardian helmet looks more like something designed for clown college, than for NFL studs.

The DJOKOVIC FIASCO
What Really Happened Reveals Underlying Covid Chaos, In Tennis and Other Major Spectator Sports
John Weston Parry

I love to watch Novak Djokovic play tennis. By most reasonable performance measures, he is the greatest player of all-time (GOAT). He also is a highly intelligent leader of the professional tennis establishment, who is fluent in several languages, witty, and often charming. Djokovic rose to tennis stardom in a war-torn Serbia, which helps explain why his motivation to be the best is unparalleled, even compared to his more beloved superstar contemporaries, Roger Federer and Raphael Nadal.

Djokovic’s obsession to prevail athletically has earned him 20 grand slams and more masters victories than anyone in history, but it also has been counterproductive to his tennis legacy and his quest to become as popular as those other two all-time great champions. For all his athletic accomplishments and intelligence, a number of times in his career, Djokovic has proven to be his own worst enemy. He has frittered away multiple opportunities to win grand slams that define tennis greatness. He should have solidified his GOAT status several years ago.

Djokovic continues to sabotage his opportunities to win grand slams in which he would be the favorite. Unless he adapts to the realities of Covid by getting vaccinated, he will likely spurn more such opportunities. Unlike the redeemed John McEnroe, who tempered his tennis bad behaviors with a sensitivity for the common good, too often Djokovic perceives the world through a mirror in which there is only a reflection of himself asking—to paraphrase the Evil Queen in Snow White— “Who is the greatest of them all?”

That said, blame for this Australian Covid tennis fiasco extends well-beyond Djokovic. The Association of Tennis Professionals (ATP), the Australian Open, and Australian politicians all contributed to the chaotic patchwork of Covid rules and protocols. Without their missteps and shared incompetence, there would have been little or no controversy.
Australian tennis and public health authorities practically invited Djokovic to violate the public good and remain unvaccinated by granting him a special visa to play in the Australian Open; then the nation’s Immigration Minister, with the Prime Minister’s blessing, used his discretion to suddenly withdrew permission. This was done, as The New York Times reported “to make an example out of [Djokovic],” when it became politically beneficial to do so.

One can only imagine the public outcry in the United States if President Biden had barred Djokovic from playing at the 2021 U.S. Open, or, for that matter, barred any unvaccinated athletes from participating in any major American sporting event. It is so easy for much of the American media to demonize Djokovic; then excuse or look the other way as a number of high-profile American athletes do the same thing.

In addition, that sudden reversal in policy meant it was too late for Djokovic to become vaccinated in time to play in this grand slam event that he has won on nine different occasions. We will never know whether he would have complied, if he had been given a “get vaccinated” ultimatum, although, it is quite possible, he will be faced with that decision in order to play the French Open, where he, and not Nadal, is the reigning champion. Furthermore, if the Prime Minister wants to be really nasty, it appears as if his government can ban Djokovic from playing in Australia for the next two Opens as well, by strictly enforcing its deportation policy to prohibit the tennis super star from traveling to Australia for the next three years.

Djokovic’s Skewed View of the World

Even compared to Federer and Nadal, both of whom are supreme competitors, Djokovic appears to be in a class by himself when it comes to obsessively bringing every advantage onto the tennis court. Like Serena Williams in the women’s game, though, Djokovic does not always deal with the pressure on himself constructively, even though it has pushed him to be the best tennis player ever.

Federer and Nadal found ways to cope. As a young man, Federer let his temper burst out of control in a John McEnroe sort of way. Federer’s father threatened to stop him from playing if he did not change his behavior. Federer evolved into a perfect gentleman on and off the court and beloved by corporate sponsors and millions around the world.
Nadal is obsessed with winning as well. When he is on the top of his game, he fights for every single point and expects to win them all. He channels his compulsions with ritualistic, repetitive behaviors that on the court look a bit strange. Those behaviors do little harm, except to delay his matches and occasionally cause him to receive time warnings and, once in a blue moon, lose a point—not multiple grand slams.

Djokovic appears to hold it all in stoically, until he eventually reacts in self-destructive ways. At the height of his career, in 2017 after having won four grand slams in a row, his game and focus mysteriously dissipated. Publicly, his distress was tied to a reported elbow issue, which, for a long time, he tried to treat with various natural remedies, until he eventually agreed to have surgery.

However, much more than that was going on. Djokovic inexplicably split up with his long-time training team. He retained Andre Agassi who later admitted he could not motivate Djokovic to play inspired tennis. Djokovic attributed his malaise to unidentified personal problems, which John McEnroe compared to the problems Tiger Woods had experienced in his pursuit of greatness.
In February 2018, Djokovic finally had surgery. Afterwards he said he “cried for two or three days… I felt like a failure.” He then added, “I believe that our bodies are self-healing mechanisms…. [Y]ou never know how your body will react to very aggressive medical treatment.”

Midway through 2018, Djokovic returned to form after reuniting with his training team, He won Wimbledon and then the U.S. Open. By postponing his surgery for so long, however, he had lost the opportunity to compete at or near his best in six straight majors.

In 2020, after having won the Australian Open and doing well at the French and Wimbledon, Djokovic went into the U.S. Open as a clear favorite. Wimbledon had been canceled due to the pandemic and the French had been rescheduled for later that fall. In a fourth-round U.S. Open match, he became frustrated with himself after losing a point. Like almost every tennis player has done at some point, he impulsively struck the ball in no particular direction. When it hit a lineswoman, he was defaulted for acting recklessly. Djokovic’s misbehavior cost him another opportunity for a grand slam he was expected to win.

Djokovic’s most recent bout with self-destruction began well before the 2022 Australian Open. His subsequent views about being vaccinated were placed in context by his extreme reluctance to undergo elbow surgery, along with his feelings of failure in having done so. In April of 2020 he confirmed on Facebook that he was concerned about what being vaccinated for Covid might do to his tennis fitness.

Yet, Djokovic, like so many Americans, did not appear to have similar, much less proportional, concerns about what Covid itself might do to his health. In June, during a series of exhibition matches that he helped arrange in the Balkans, Djokovic and several other tennis players contracted Covid. It turned out that even masking and social distancing had not been required. Like a number of athletes, he apparently thinks his physical conditioning will protect him from the virus, while the vaccine might affect his body in unforeseen ways.

The fact that he could place people near him in jeopardy and encourage many others not to be vaccinated did not seem all that important to him. As Sally Jenkins wrote in The Washington Post, ultimately Djokovic’s obsessive “hunt for stand-alone greatness… [i]s downright anti-social.”

Given that mind-set, Djokovic felt no compunction about trying to find a way to obtain a visa to enter Australia without being fully vaccinated, which the country’s travel rules for visitors requires, unless they qualify for a specified exemption. To him, avoiding vaccination was a tennis strategy like his extreme fitness and flexibility regimes. Get the visa and win his 21nd grand slam for a place, by himself, in tennis history.

Instead, he opened the door for Nadal, his arch rival, to get there first with a much easier route to the finals than if Djokovic had never been approved to play and thus given the number 1 seed, which, at the last moment, had to be filled by a qualifier. Nadal is now the second highest ranked player in that half of the draw. Two of the remaining best players, #2 Medvedev and #4 Tsitsipas, are in the other half.

The Professional Tennis Establishment and the Australian Government

Tennis Australis governs what happens at professional tournaments in Australia. The Open is by far the most important tennis event, which generates substantial revenues for Melbourne and Sidney, the two metropolitan areas that alternatively host the two-week tournament. This year the Open is being played in Melbourne, which is in Victoria.

Therefore, it should not have been surprising to the sports world that the Victoria health department granted Djokovic’s medical exemption. Such favoritism is just another example of sportswashing in which governments give special leeway to sports enterprises and their athletes, especially super stars. That deference occurs frequently in Australia, which normally is a sports happy nation.

For Tennis Australia and the health department of Victoria it was a matter of money, privilege, and pretense. As a nine-time champion, Djokovic, along with a few other players and support staff, was certified as deserving a medical exemption, reportedly because he was likely immune after having contracted Covid a second time in December.

The approval process appeared to be rigorous. Victoria’s public health officials established two medical panels to review each successful application. The first panel ruled on whether the applicant had met Australia’s medical exemption criteria based on his or her submission. That panel supposedly did not know the applicant’s identity, although one would imagine it might have been difficult for Djokovic’s application not to have provided strong hints of his identity.

Then the applications of the players who that panel qualified, preliminarily, were examined by a second panel. The grounds for receiving a temporary medical exemption vary and are subject to medical confidentiality. However, the one Djokovic apparently relied on, according to his own lawyers, was proof based on a PCR test that he had contracted Covid in December, which permitted him to defer being vaccinated for six months.

Tennis Australia, the Victoria health department, and both medical panels concluded Djokovic properly met the exemption criteria. Thus, it was presumed that his temporary visa to play in the Open would be approved, even though he had not been vaccinated. By the time the super star appeared at customs for entry into Australia, though, public outrage had exploded about his being allowed into the country even though he was refusing to be vaccinated. Craig Tiley, the CEO of Tennis Australia, insisted that Djokovic had satisfied the Australian exemption guidelines, so “there has been no special favour…, no special opportunity granted to Novak.”

However, the special approval process for Djokovic—and other tennis-affiliated applicants— even though it appeared to comply with Australian guidelines. became a political hot potato for Prime Minister Scott Morrison and his government. The public outrage in Australia was overwhelming because most Australians were under some of the most rigid Covid restrictions in the world, and they were pissed off.

In a series of ad hoc decisions that did not follow normal immigration guidelines, Djokovic’s exemption was revoked and, ultimately, he was deported. Djokovic was stopped by immigration officials as soon as he tried to enter the country. They disallowed his previously agreed upon medical exemption. Djokovic then was placed in a jail-like immigration detention facility while he appealed.

On procedural grounds, a judge ruled for the tennis player and, indirectly, Tennis Australia. Nevertheless, Australia’s Immigration Minister Alex Hawke exercised his official discretion to reject Djokovic’s visa, claiming it would not be in the public interest to allow a medical exemption in this particular case.

The same judge heard Djokovic’s second appeal. The question before the court was not whether Djokovic should be deported based on the merits of his application, but rather whether Hawke had exercised his discretion in a rational manner. According to The New York Times, what convinced the court that the decision had been rational was the mere possibility that Djokovic’s presence at the Open “might influence others to resist vaccination or defy public health orders.”

The week-long back and forth ordeal gave everyone involved in this international scandal a black eye. It all could have been avoided if the professional tennis establishment had instituted a transparent vaccine mandate for all its players. Unfortunately, as happened for years with testing for performance-enhancing substances, the International Tennis Federation, the Association of Tennis Professionals, and the Women’s Tennis Association have been reluctant to hold their players accountable.

In part, this may be because Djokovic exercises a great deal of influence among the male players who still dominate professional tennis. Instead, Covid policies have been left up to the tournaments themselves to determine, based largely on requirements in the jurisdiction in which the tournament is being held. As a result, professional tennis has a broad array of Covid protocols to deal with, which has created considerable chaos.

Conclusion

This type of Covid chaos is being played out in virtually every major global and American spectator sport, albeit in not so dramatic a fashion as the Djokovic affair. With the Beijing Winter Olympics being just around the corner, though, this type of drama may escalate precipitously since China has even more draconian and arbitrary Covid rules than Australia.

The problem that all of these global spectator sports have encountered is a lack of uniformity in the health-related Covid rules and protocols being required. Traditionally, sports enterprises have established certain rules that govern their sport. National, state, and local governments usually defer to those rules and to the entities enforcing those rules, except in extreme circumstances.

The most prominent American examples are Major League Baseball’s exemption from America’s anti-trust laws. The NCAA has skirted those same laws for years by convincing courts to accept a legal fiction about athletes at big time college athletic programs competing as student-athlete amateurs. With Covid rules and protocols, however, this deference has been turned on its head.

Sports enterprises, especially leagues with player unions, have refused to impose strict vaccine mandates for athletes and have been lax about masking and social distancing. The good of the sport is sacrificed for the selfish beliefs and preferences of a minority of elite athletes who refuse to comply with sound public health policies. Furthermore, because these sports have rules and protocols in place that lack uniformity, are in flux, and are poorly monitored and enforced, local, state, and national jurisdictions have little reason to defer to these enterprises in Covid-related matters affecting those sports.

Major spectator sports, all of which depend on their athletes, coaches, trainers, broadcasters, and other people to be able to travel freely from jurisdiction to jurisdiction, are caught in this morass of different rules that apply in different jurisdictions. This is especially disruptive if the sport— which all of them seem to do—allow some or all of their athletes to violate basic public health protocols.

A solution to this mess is pretty simple, if not easy to achieve: mandate athletes and everyone else affiliated with a sport be fully vaccinated, which would include receiving all CDC recommended boosters. Put in place a truly transparent process—not like the one used for performance-enhancing substances—to ensure that this vaccination mandate is followed by every athlete. That should satisfy requirements in most American and international jurisdictions. If not, ask the remaining jurisdictions for a certain amount of latitude to allow the sport to enforce its own Covid rules, as long as doing so does not clearly jeopardize public health. This may not solve every Covid problem that these sports have now, but it should provide a pathway to eliminate or greatly narrow many of these challenges

SPECTATOR SPORTS in the CORONAVIRUS ERA: GENERATING REVENUES DURING a PUBLIC HEALTH EMERGENCY
By John Weston Parry

Overview

It took considerable nudging but, for the most part, with two important exceptions—the National Football League (NFL) and thoroughbred horseracing—spectator sports have done the right thing, so far, in protecting America’s public health by closing up shop for the immediate future.

The danger, however, is the underlying attitude—often pushed by the President and many of his followers—on making the commitment to support social distancing as temporary as possible, based on unrealistic or even reckless aspirations. There is a powerful incentive to get these sports rolling again, along with the rest of the U.S. economy, even before critical coronavirus control measures have been put in place and prevalence rates have declined sufficiently to adequately extinguish the looming threat to our nation. Extinguishing this threat is particularly important for large, densely populated metropolitan areas where major athletic events typically are held.

Those who control these spectator sport enterprises—extremely wealthy, mostly white men who have access to the very best medical care—appear eager to get back to some replica of normalcy as quickly as the optics and their athletes will allow. It reminds me of the scene in Jaws when the police chief closes the beaches in the face of an imminent shark attack, and the mayor of the town consoles the business owners with his assurance that the closure is very temporary. The beaches, he promised, would reopen in a day or two. Anyone who read the book or saw the movie knows how well that worked out.

Similarly, anyone who viewed the images of people crushed together at Disney theme parks, churches, or Florida beaches while the pandemic already was escalating or listened to the President’s repeated assurances that there were relatively few reported covid-19 cases in the U.S.—due in large part to the fact the nation was uniquely unprepared to test for the virus—should understand that profit motives and public health concerns will be competing for primacy throughout this lengthy ordeal. Nowhere is that battle likely to be more palpable than with many of the spectator sports Americans most like to watch. The wild card is likely to be the athletes, who stand to benefit economically by getting back to their lucrative athletic careers, but whose health—and the health of their loved ones—will be endangered if sports open for business before its safe to do so.

The signs of resistance to common sense public health measures in the spectator sports world have been many already. Numerous horse tracks throughout America continued to operate without spectators, placing the jockeys, trainers, and other track employees at risk. The International Olympic Committee (IOC) and the NFL repeatedly opined that the virus would not disrupt their training preparation and athletic events. The Tokyo Summer Olympics and the beginning of the NFL season would proceed, these enterprises promised time and time again. Their assurances sent a dangerous faith-based message, which also was gaining momentum in the White House.

While it is fine to hope for the best if it is grounded in scientific reality, faith-based assurances are reckless if they ignore and marginalize clear and present dangers, including that:

the U.S. still does not have adequate testing capabilities—on a per capita basis we trail every other wealthy nation, even Italy and Spain where the virus has been devastating;
the geometric increase in new cases will not crest for weeks;
the time required to get the virus under control is highly uncertain, especially given the lack of effective treatments and the divided political climate in this nation over what social distancing measures should be implemented or continued, if any; and
the time required to develop and produce an effective vaccine for the entire U.S. population is at least a year away, and may be much longer than that, if it can be achieved at all.

As The Washington Post’s Barry Svrluga opined in the context of the Olympics, but his words apply to the NFL and other sports as well: “You know what’s counterproductive? Forcefully claiming… [that these sports] will be contested on schedule and unhindered in a world that is in complete and utter crisis.” While speculative fears can be toxic if they are overblown, a realistic appreciation of the public health challenges ahead is absolutely essential if: we are to make substantial progress fighting this easily spread, but difficult to treat, disease; and then not lose all the gains we have made by trying to go back to normal too soon.

In order to properly plan for and overcome this unique health crisis, scientists and public health experts should be allowed to guide our actions at the expense of relatively short-term economic considerations, including the fiscal health of American spectator sports. If we do not get this pandemic under control, there may well be hundreds of thousands of deaths and a long-term economic catastrophe, which is likely to have a particularly damaging impact on all of these sports enterprises. Strict social distancing, absent any effective vaccine and adequate testing, is absolutely required in order to have a relatively speedy recovery, which the most optimistic public health projections calculate as being months away.

It is increasingly unlikely that there will be live spectator sports in the U.S., except apparently horse racing, until local communities and states—and perhaps the federal government—along with the athletes, believe that the pandemic is under control, meaning social distancing is no longer necessary and effective testing protocols are in place nationwide to stem a new wave of coronavirus cases. Unfortunately, there already appears to be a dangerous gap between those perceptions, which President Trump and his supporters have tried to manipulate, and what is reasonably safe and prudent to do. As Thomas Boswell wrote in the Washington Post, “our job right now is to minimize casualties, and canceling sports events is a basic element.”

What has happened to date with regard to how major spectator sports have acted recently and are likely to act in the future is more than unsettling, although for the most part the athletes, with the exception of NFL players, have ultimately pushed their sports in the right direction. Nevertheless, these major spectator sports enterprises continue to operate as if they are entitled to unilaterally make these critical business decisions that directly affect the public health of all Americans.

Continuing to allow major sports enterprises to respond to the coronavirus pandemic as if they should be the ultimate decision-makers for their sports is a very risky path to follow. Typically these individuals—predominantly white males—will be motivated to maximize their wealth, and the fame that is necessary to accumulate wealth, at the expense of the health and safety of fans, the general public, and sometimes even their athletes, coaches, and other employees. [See John Weston Parry, The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, 2017]. The decisions that these enterprises have made, or tried to make already, underscore the potential conflicts going forward.

Deciding Whether or Not to Hold Spectator Sporting Events

In dealing with the coronavirus pandemic in the U.S., major spectator sports—including our professional leagues, Olympic organizations, major college athletic programs, NASCAR, the PGA, professional tennis, and horse racing—basically have considered four options: (a) ignore the virus and continue to provide entertainment to live audiences; (b) hold the events, but without spectators in attendance; (c) postpone the events; or (d) cancel the events altogether. Each of these alternatives has been embraced by one or more major spectator sports enterprise.

Unfortunately, how these decisions were made, and continue to be made, should raise red flags. While horse racing has been the only major spectator sport in America continuing to hold sporting events—albeit without spectators—what will happen next in all our major sports is a fluid situation. Market forces have been at work unduly influencing the public health calculus as to when and how these sports events should resume, as well as how this nation has failed to adequately respond to the crisis.

For the athletes who, apart from the major sports enterprise entrepreneurs, tend to exert the most influence on spectator sports, the difference between their performing in front of a live audience or performing in empty arena’s and stadiums, is marginal from a personal health standpoint. Both options pose heath risks to them and their loved ones. Steps can be taken to limit or even eliminate any interactions with fans or the sports media, or to have those interactions occur in controlled environments, which enforce social distancing protocols. The threat that cannot be controlled in either situation is risks posed to the athletes, coaches, training staffs, referees, and other employees when they are interacting with each other as part of the normal course of playing games and holding other athletic competitions.

For the athletes, in one important sense, the biggest potential difference between these two alternatives is how it will affect salaries, as well as endorsements and other commercial opportunities. That difference explains why many prominent athletes in the NBA, most notably Lebron James, reflexively objected to the idea of playing games without fans as a way to better protect public health. After it became clear, though, that at least one NBA player already had contracted the virus and had been playing while infected, followed by several other players, sentiments quickly coalesced around temporarily postponing the basketball season.

Many NBA players, not surprisingly, were more concerned with their own health and safety than the health and safety of the fans and public. Later James, trying to walk back the bad optics, cleverly quipped that because of the financially damaging fiasco involving China and the NBA over human rights, Kobe’s death, and the coronavirus, 2020 should have been canceled. Lebron did not meant that major parts of two basketball seasons should be canceled, which would cost him and many other NBA players a great deal of money and public exposure.

Not only the NBA, but Major League Baseball (MLB), the National Hockey League (NHL), Major League Soccer (MLS), and most international soccer matches have been postponed. In addition, major upcoming events in professional golf, tennis, and NASCAR have been canceled, along with the NCAA’s basketball tournaments, for both the women and the men. The latter cancellation was permanent, but the other major spectator sports like the President initially expressed confidence that they could resume their schedules in April. That seemed like a pipe dream, given the geometric pace at which the coronavirus was spreading across the U.S. It also created the perception that America’s most popular sports would be resuming very soon and people could forget about enduring the hardships posed by social distancing, which too many Americans had been doing already.

Except for horse racing, no major spectator sport has embraced the option of holding their athletic events in empty stadiums and arenas, at least not yet. The reason these other sports have not followed horse racing’s reckless gamble seems self-evident: the economics of doing so appeared to be unfavorable to those who profit most from these major sports enterprises, including the athletes. The economic calculus may change, however, if spectators are prohibited from attending sports events for many months to come.

An apparent exception is the NFL draft. It is scheduled to go on as planned in late April without a live audience or athletes in attendance, even though teams will not be able to perform physical exams on, or conduct in person interviews of, many draft prospects. The NFL draft is a lucrative television show that goes on for several days. It is not a sports competition among athletes.

Furthermore, the fans who attend the draft do not pay admission. Those spectators have been there primarily to help make the draft a must see viewing event for professional football fans. This year the draft will marketed to a captive audience, a substantial percentage of whom will be social distancing in their homes, especially us older folks who make up the core of the NFL’s audience.

Yet, a number of individuals employed by NFL teams involved in the draft process will be at risk and may not be eager to participate. According to ESPN, Commissioner Goodell responded to that possibility by sending a “leaguewide memo… [which] served as a warning to those around the league who criticize the league’s stance.” He emphasized that “`public discussion of issues relating to the Draft serves no useful purpose and is grounds for disciplinary action’” In other words, if a league employee, player, or owner expresses a safety concern he—or possibly she— will be fined or suspended.

More importantly, though, the NFL, America’s most popular spectator sport by far, has communicated its intention to go full speed ahead with the upcoming football season, including training, scrimmages, and preseason games, without instituting any special precautions. So far NFL players have eagerly embraced the league’s coronavirus plans. In fact they lobbied for the regular business of the NFL to proceed without delays. They wanted to be certain that free agency signings of player contracts would not be interrupted. As the Washington Post reported, most of the teams and their front offices would have preferred a postponement of free agency, but the players, represented by their union, wanted the schedule to be unaltered, as if there was no coronavirus public health threat in the U.S.

For much too long, the IOC, through its President Thomas Bach, refused to seriously consider postponing the 2020 Tokyo Summer Olympics, despite the spread of the virus and increasing calls by American and other Olympic athletes and the media that it be postponed. Part of the delay in doing the right thing was the history of the IOC. Since before the 1936 Berlin Summer Games, the IOC has insisted that the Olympic Games should go on no matter what else is happening in the rest of the world.

For weeks after the coronavirus became a global pandemic, the IOC did not even discuss postponing the Games with the athletes. When American Olympic athletes raised their fears and objections, the United States Olympic and Paralympic Committee (USOPC) deferred to the IOC. The USOPC was one of the last national Olympic committees in a country being devastated by the coronavirus to publicly convey concerns of its athletes.

Individual professional sports, especially golf and tennis, have cancelled major tournaments and probably will have to cancel many more. This includes the Player’s Tournament and the Master’s in golf, the French Open and Wimbledon in tennis, and the Indianapolis 500 in car racing, which have been postponed indefinitely or rescheduled many months in the future. Significantly both Wimbledon and the British Open in golf have not yet publicly finalized any changes to their schedules, although it is becoming increasingly likely they will have to do so very soon.

Practice, Training and Anti-Doping Protocols for American Athletes

A critical concern, especially for the athletes in these major spectator sports, is what will happen to their training preparations and the anti-doping testing protocols that are necessary for them to be able to compete at their best, avoid serious injuries, and not be at an unfair competitive disadvantage. The most publicized training and testing-related questions for American athletes during this pandemic have centered on Olympic sports. Before the Tokyo Games were finally postponed there was little or no guidance from the IOC and USOPC about these issues.

Yet, key pre-Olympic trials and competitions were being cancelled and others appeared certain to be dropped. These are events that often determine which athletes will be on the American team and help all the American athletes prepare for their Olympic competitions. And that was only part of the difficulties American Olympic athletes were facing as they tried unsuccessfully to properly prepare for the Games.

Olympic training centers had closed indefinitely, along with public and private gyms and training facilities that these athletes were supposed to use. The likelihood that these facilities would not be reopening soon was great. This meant many—and probably most— American Olympic athletes would be unable to compete at their expected standards and to do so safely.

Throughout this ordeal both the USOPC and IOC avoided discussing these issues with the people who knew best, the athletes and their coaches and trainers. These two organizations wanted the Tokyo Olympics to proceed on schedule without any interference from the outside world.

In the NFL where the athletes had been pushing for the schedule to remain unaltered so contracts could be signed, perceptions are likely to change as training camps approach. Already the league has directed its franchises to temporarily restrict access to team facilities. Only players receiving ongoing medical treatment, along with the trainers or physicians who are providing such care, as well as security and other key personnel are allowed in. Those closures are scheduled to be lifted, however, on April 8th, which is just before Easter—the date President Trump originally had proposed much of the nation should begin relaxing their social distancing measures in order to help jump start the economy.

In the NFL, because the teams play at least two unnecessary preseason games in order to generate more revenues for their owners, there is some wiggle room to get the training camps started late, but still begin the regular season on time in early September. That has happened in the past when labor issues forced a delay of the schedule.

Similar practice and training concerns will confront the NCAA in deciding when the major college football season should begin. That decision, however—for better or for worse—will be made by the super conferences and the schools in those conferences, unless federal or, more likely, state government authorities intervene.

With respect to the four major sports whose seasons began but have been interrupted, which include the NBA, MLB, NHL, and MLS, the training and preparation issue is a little different for them. All those leagues already have had their normal preseason training preparations, but their athletes have been largely inactive since the middle of March. Assuming they remain dormant for at least six weeks, and perhaps significantly longer than that, those athletes will require a period of time, weeks not days, to train and practice to restore themselves to something close to resembling regular season form. This is especially true for the NBA and NHL, which if they do resume their seasons may well decide to collapse their schedules and start their playoffs almost immediately after an abbreviated training and practice period.

MLB, which was a couple of weeks away from beginning its regular season, and plays the most games of any professional team sport, has considerable flexibility to build in the necessary practice and training time. Since MLS’s season is about the same length, but American professional soccer has far fewer games to play, their teams have even more flexibility in that regard. Nevertheless, there will be considerable pressure on both leagues to play regular season games as soon as possible because of financial and logistic complications of playing past October.

Finally, all these major spectator sports have some form of testing for illicit performance-enhancing substances. Most of them, except for horse racing, have adopted World Anti-Doping Agency protocols. Thus, the US Anti-Doping Agency’s warning, which was issued through its chief executive officer Travis Tygart, applies to all of these sports. “The Games should be postponed… “to ensure they don’t potentially become the dirtiest Games ever due to significant reduction of anti-doping efforts due to covid-19.”

In order for these sports to be relatively clean—or no less clean than they have been—there needs to be sufficient time to catch up with proper testing protocols. The New York Times reports that anti-doping efforts in sports have been “hobble[d].” Conversely, “[f]or athletes inclined to cheat…, the Covid-19 pandemic has presented as extraordinary opportunity. Enforcers for the time being are not going to knock on their doors demanding a urine or blood sample.”

Health and Safety of the Athletes

Economic incentives for the athletes and other individuals that control and most benefit from these spectator sports, tend to push against needed public health social distancing measures. What appears most likely to affect that dynamic is how the athletes perceive their health and safety risks when weighed against the money and fame they are likely to lose. If the talent refuses to perform, there will be no show.

The only American athletes who have taken a public stand against holding events in their sports so far, though, are our Olympians, but it took a long time to convince the USOPC to act on their behalf. Instead, the organization that has a congressional mandate to protect our Olympic athletes chose to embrace the IOC’s reckless assurances.

In horse racing where the jockeys, other track employees, and horses appear to be disposable assets, health and safety concerns have not been much of a priority. Generating gambling revenues is the primary motivation of that industry. So far the people in danger have not raised their concerns publicly. As for the horses, they cannot get the coronavirus, but many of them have been dying because performance-enhancing substances are being injected into their blood streams.

As noted earlier, NFL players have been more than eager to support the position that the league’s established business routines should proceed on schedule while player contracts were being signed. Unfortunately, the widespread and explosive physical contact that is required to play their sport would appear to make professional football players especially vulnerable to coronavirus transmissions. Unless the pandemic is under control when contact drills and scrimmages are supposed to begin in July, which looks increasingly unlikely, there is a substantial possibility—if not a probability—that the NFL players union will step in and argue that such contact is even more risky than brain damage. If so, contact drills, scrimmages, and preseason games might have to be pushed back for weeks or more. .

Similarly, it is becoming increasingly likely that the NBA, NHL, MLB, and MLS seasons will be pushed back much further than originally projected as well.

Athletes in all of these sports have shown themselves to be willing to take many health and safety risks in order to accumulate wealth and fame. The continuing dangers posed by covid-19 have been too much of a gamble so far. Once it seems as if those risks are subsiding however, the allure of salaries and endorsements may be too much to pass up, even if significant dangers remain. This will be even more likely to happen if the President is telling the American public that strict social distancing protocols are no longer needed.

Who Should Decide When Spectator Sports Will Resume?

Ultimately the most important coronavirus-related question is who should decide when and under what circumstances that these spectator sporting events Americans most like to watch should resume? In answering that question, it is important to understand that most of these major American spectator sports enterprises have made decisions in recent years, which have jeopardized the health, safety, and welfare of the public and/or their athletes. Even after public health experts warned of an unprecedented global pandemic many of these enterprises took a wait and see attitude, and some tried to ignore the public health implications, hoping the rising danger would magically dissipate.

Nowhere has the resistance to sound public health policies been more apparent than with the decision-making associated with the Tokyo Summer Olympic Games. The IOC and the USOPC, which reports to the IOC, have demonstrated leadership deficiencies, repeatedly. Each of these organizations is recently responsible for facilitating an Olympic scandal that ranks among the very worst in modern global sports history.

The IOC allowed a Russian state sponsored doping scheme to flourish for years without ever imposing meaningful sanctions. For more than two decades, the USOPC failed to protect or intercede when hundreds of female American athletes who were being sexually abused by their coaches, doctors, and other men associated with U.S. Olympic sports.

In light of their complicity in these abominations, the IOC and USOPC promised they were going to substantially improve. Nonetheless, poor leadership has continued to characterize the self-interested decisions both organizations have been made, respectively, about postponing the Summer Olympic Games and whether American athletes should participate, if no postponement occurred.

Thomas Bach the President of the IOC, after ignoring the public health threat for weeks, and in the face of widespread criticism, shockingly announced that his organization would wait, perhaps as long as four more weeks, before finally deciding whether or not to postpone the Summer Games. The USOPC, through its chief executive Sarah Highland, obsequiously congratulated the IOC for its “important step in providing clarity,” before contradicting herself by adding that the American “athlete community continues to face enormous ambiguity surrounding the 2020 Games in Tokyo.”

As Sally Jenkins of the Washington Post opined, the IOC and USOPC had a duty to the athletes and the public to “shut down the Games” immediately. Waiting to close them down continued to send the wrong message to Americans about the need for social distancing, and placed American athletes in potentially dangerous and emotionally painful situations if they continued to train based on the IOC’s reckless assertion that the Games should be held as scheduled.

The Washington Post reported that unlike the USOPC the Canadian Olympic Committee, followed by Australia and Germany, told the IOC in no uncertain terms that their athletes would not participate, if the Games were held this summer. In addition, various American Olympic athletes and affiliate organizations voiced their concerns, including USA Swimming, USA Track & Field, and USA Gymnastics. A few days later, the USOPC equivocated once again when it refused to bar American athletes from participating. Instead the USOPC said that based on the “polling 1,780 athletes,” it had become “more clear than ever that the path toward postponement is the most promising.”

The IOC continued to silently mull over its shrinking options in the face of mounting global criticism. A few days later, it reluctantly announced a postponement. Almost immediately the USOPC asked Congress for a $200 million bailout to help cushion the impact of the pandemic on its revenues. Three-quarters of the total request—all of which Congress denied—would have gone to the USOPC and its affiliate organizations directly. Remarkably only a quarter of those funds would have been used to assist the 2,500 or so American Olympic athletes who will be preparing for the Tokyo Games, which have been rescheduled for July 2021.

The NFL has had its own history of poor leadership. Like the IOC and USOPC, the NFL was directly responsible for one of the worst sports scandals ever. For decades, it deliberately covered-up brain damage to its athletes from concussions and repeated sub-concussive impacts. In addition, on numerous occasions the NFL has watched as its athletes, coaches, and even owners engage in sexual misconduct and domestic violence without taking proper steps to investigate these assaults and severely discipline the guilty perpetrators.

Since the coronavirus pandemic became a public health nightmare, the NFL has done almost nothing to protect its athletes, coaches, and other employees. Instead, NFL officials have continued to project the image of a league that expects to go ahead with its normal preseason training routines beginning in early July.

Already there are concerns whether NFL players will be allowed to use team facilities for their required off-season workouts and if so whether team trainers and other employees who staff those facilities will be compelled to show up. Team facilities were recently closed until April 8. Furthermore, the NFL Physicians Society has informed the league that their doctors will not give physical exams to the players during this pandemic.

The NCAA and its super conference schools will have similar, but also different, challenges with regard to preparing for the upcoming football season, as well as other fall sports. Even more so than the NFL, the NCAA has been hampered by its leadership problems. Among other things, this has led to FBI investigations for blatant recruiting violations and hundreds of young women, mostly college students, being victims of sexual assaults and domestic violence by athletes or other men associated with college sports, especially football, men’s basketball, and women’s gymnastics.

Given this leadership vacuum, it is unlikely the NCAA will take the necessary precautions to prevent super conference members from going ahead with the football season prematurely. At the same time, if students are not on campus because the pandemic has continued to present too much of a risk, it would be extremely difficult, although not impossible, for athletic departments to try to justify bringing athlete-students onto campus to play football, or any other fall college sport for that matter.

Other major American professional leagues will probably be making decisions about when to resume, or in the case of MLB to begin, their regular seasons before the NFL does. The leadership deficiencies in those popular sports—while not as pronounced as the NFL, NCAA, or USOPC—should not inspire confidence. Like the NFL, the NHL led by its Commissioner Gary Bettman, has covered up and marginalized brain damage to its athletes for many years. One mitigating factor, though, is that any decisions that the league makes about restarting will have to be acceptable to Canadian government authorities.

For decades MLB looked the other way while its players used performance enhancing substances. This problem persists today. In addition, MLB has had its own issues with domestic violence and sexual assaults. With regard to the coronavirus and deciding when the new season should begin, unrealistic optimism still seems to be prevalent. Tom Boswell believes the restart date could be as soon as mid-May. MLB Commissioner Rob Manfred has echoed this view. From a public health perspective that start appears to be extremely risky.

Nevertheless, as Jeff Passan of ESPN points out, safety concerns are likely to balanced against the economic reality that “[b]aseball stands to lose billions of dollars in revenue should it miss a significant amount of the season, prompting teams and players to unite in a desire to return as soon as safely as possible.” Inevitably, the money at stake will affect what they key parties perceive as being safe, not only in baseball but other spectator sports as well.

The NBA has become known for responsible leadership, at least as compared to other professional team sports, Under Adam Silver’s direction, the NBA was one of the first American spectator sports to suspend play indefinitely. According to USA Today, many other American sports enterprises followed the NBA’s lead.

Yet, the NBA also has demonstrated that it too will act irresponsibly if the stakes are high enough. For example, the league has strongly discouraged anyone associated with the NBA from commenting about human rights violations in China because the league does not want to offend its totalitarian leaders. Also, it was widely reported that NBA athletes were being given priority over other Americans in getting tested for the coronavirus at a time when tests were in very short supply.

Finally, horse racing has had one scandal after the other. It remains one of the few sports continues to hold events across many parts of the country, although without fans in attendance. Since mid-March, horse tracks have stopped racing in Maryland, New York, and California because the governors of those states have directed that these facilities be closed. In addition, the Kentucky Derby has been postponed until September and the Preakness and Belmont Stakes are likely to follow.

Conclusion

Major spectator sports enterprises continue to believe they should be making the final decisions about when it is supposedly safe for them to resume holding athletic events again. From a public health standpoint allowing this type of self-interested decision-making is likely to be dangerous. Short-term economic considerations and the lack of expertise will unduly bias how these organizations assess and calculate the health risks.

In a health emergency state and federal governments have certain prerogatives that do not normally exist. The American legal system has long recognized the importance of allowing governmental authorities, in consultation with health experts, to make public health decisions, which may reasonably impede the rights of individuals and corporations. That health emergency imperative becomes far more compelling with regard to assessments about the potential dangers of having major spectator sporting events in densely populated metropolitan areas where these competitions are likely to be held.

ELITE PITCHERS ARE ACCUMULATING MORE ARM INJURIES,
WHILE THROWING FEWER INNINGS IN FEWER GAMES
A Baseball Paradox Explained, But Not Solved©
John Weston Parry

In recent decades there has been a substantial increase in arm injuries for pitchers at every level of baseball competition, especially for elite players and players trying to become elite. At the same time, teams are using their starting pitchers for fewer and fewer innings. This has substantially reduced the number of outings in which pitchers go more than seven innings, much less complete a game. Pitchers, who throw between one and three innings, have become increasingly predominant.

In addition, analytics are dispelling the traditional bias that “starters” and “closers” are much more important than pitchers who throw during middle innings. Defensively, games are won by giving up fewer runs than one’s opponent and lost by giving up more tallies. Over a season, which innings in a game those runs occur is almost irrelevant in terms of the probabilities of winning or losing. Much more relevant, though, are individual match-ups, the number of outs, the number of runners in scoring positions, and how the behind-the-plate umpire calls the game.

On the surface this trend of expanding relief pitching and reducing the number of pitches that are thrown is likely to improve pitchers’ longevity. Moreover, to the new generation of baseball experts, this is the way to produce the best athletic results, analytically. Yet, there are a number of underlying paradoxes that suggest both the health of the athletes and the effectiveness of this approach, from a win-loss standpoint, may be far more complicated than analytics alone are able to accurately or completely reveal.

The Health Crisis for Pitchers

For a long time now elite baseball pitchers—and the many more trying to become elite—have been encouraged to risk their arms and their potential athletic careers by throwing much too hard and much too often, especially at a young age when their arms are most vulnerable. Making matters worse, young pitchers are not routinely well-instructed in the art of pitching without constantly relying on high velocities and other unnatural movements that create unsafe torques on their arms. Tommy John surgeries occur so often that they are callously marketed as preventive measures that are supposed to eventually make most pitchers better than new.

While there is more talk about what should be done to protect pitchers arms, the science is evolving and education is still lacking. Subjective guesswork and trying to cash in on unrealistic dreams predominate in youth baseball around the country. One popular recommendation, the further lowering of the pitching mound from 10 to 6 inches, has little to do with teaching better fundamentals or promoting health. It seems to be more of a propaganda and public relations tool.

MLB has a vested interest in creating the impression that trying to become a professional baseball pitcher is reasonably safe for most of the young athletes who try. Much like the NFL did in trying to obscure the much worse dangers of brain damage to its players MLB is using members of the medical establishment to help them in similar ways. MLB paid the American Sport Medicine Institute (ASMI), led by famed orthopedic surgeon, James Andrews, to assess the likely impact of lowering the mound on “arm safety.” The problem with this quick fix is that any reliable assessment of whether or not it will work requires empirical evidence—which can only be collected over time. In advance of such data, ASMI experts can only offer their MLB-funded opinions.

Even though lowering the mound another four inches—after lowering it five inches in 1969—inevitably will lessen the advantage pitchers have over hitters by initially reducing pitching velocity, this does not mean that either the accumulated stress on pitchers arms will be relieved or that pitchers—as they did after 1969—will not try to reestablish their dominance by increasing their velocities in equally unsafe ways. Based on what transpired the last time the pitching mound was lowered, it seems reasonable to presume that lowering it again, without making basic changes in the biomechanics of pitching, is not likely to reduce arm injuries and may even lead to an increase.

Until 2015 no comprehensive empirical data was even being collected to determine what actually causes arm injuries to pitchers. At least ASMI has been gathering this “baseline data,” but it is limited to pitchers once they have been drafted. This approach is something akin to doing a drug study, but only using white men as subjects. What is happening to the vast majority of young pitchers, who are not drafted, will remain uncertain.

The aim of this study is to reveal whether MLB prospects sustain arm injuries as a result of “velocity, innings pitched, previous injuries, mechanics, players' unique physiologies or a combination of factors.” This may be useful information to MLB teams in developing their pitching prospects, but will have much less relevance to the far greater number of pitchers who try to become MLB prospects, but fail or move on to something else.

More importantly, though, even if the results identify which factor or factors are most prominent in destroying pitching arms, as with football, there is an established culture resistant to change, no matter what the scientific and medical evidence reveals. That culture embraces the view that the harder a pitcher throws the better pitcher he will be and the more money and scholarships he will obtain. This attitude is consistent with what ASMI and others have already documented with regard to pitchers who are drafted and make it to the big leagues.

As baseball expert Tom Verducci documented in Sports Illustrated a few years ago, nearly 40 percent of the pitchers who were the “top 30 draft picks from 2010-2012...had Tommy John surgery before age 22.” David Shenin of the Washington Post described this as young pitchers tearing their arms to “shreds.” The typical major league pitcher, well-before he makes it to the big leagues, is exerting more pounds of biomechanical force on a regular basis by throwing than is required for the “normal human arm [to break] apart.”

The pressure on promising young pitchers to throw in unsafe ways is immense. Next to being an NFL quarterback, being an MLB pitcher may be the most prestigious athletic career in the U.S. As I pointed out in The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017), “[m]oderation and common sense, which could prevent many of these arm injuries to these prized athletes, tend to be jettisoned in the pursuit of scholarships, professional contracts, and personal glory.”

Today, there are national competitions, in addition to almost year-round baseball games and practices, which encourage young pitchers to throw as hard as they can to determine who has the greatest velocity. Starting with freshmen in high school, elite pitchers are ranked by the highest velocity they can register on a speed gun. Similarly, when youth baseball games are televised, there are always speed guns aimed on the young pitchers to let viewers know these kids’ maximum velocities.

The Art of Pitching

Almost every baseball expert and most coaches now understand the harm that is being done to pitchers’ arms, which is why there are pitch counts at every level of competition. Yet, that change has not solved the overall injury problem. In many ways it simply has created an illusion of progress in protecting pitchers’ arms. It seems reasonably clear that the danger has less to do with the number of pitches thrown in a game and more to do with arm stress over the course of longer seasons, not only in the pros, but especially in youth leagues, high school, and college.

Elite players at every level tend to throw harder and with more torque applied to their arms than ever before and they pitch more months of the year. Since 2008, when MLB began using pitch-tracking, through 2017, the average four seam fastball has continued to increase from 91.8 to 93.6 miles per hour. The major remedies for the arm pathologies that have resulted include: strongly encouraging elite athletes to diversify by playing multiple sports that help relieve the stress on young pitchers’ arms; and teaching kids to pitch effectively by using an assortment of pitches and proper biomechanics.

            Pitching Less

Having kids play multiple sports used to be commonplace, especially in private schools. Today, it is much more of a rarity, even though many preparatory institutions still require most of their students to play a different sport each semester. For elite athletes in private schools, though, too many exceptions are granted out of a fear of losing these prized athletes to other programs that also can promise them instant fame.

In an ideal sports world athletic diversification would be the norm. This means in the off-season pitchers should play other sports that will not place stress on their arms or not play any sport at all. Playing quarterback, for example, is not be much of a benefit in terms of resting a pitcher’s arm, but playing fall soccer or competing in track, swimming, Esports, chess, drama, or the debating team would be.

Educating kids and their parents about the benefits of diversified athletics has been a major hurdle, especially when it involves elite athletes and athletes trying to become elite. Fred Bowen in his sports column for kids in the Washington Post gets the proper message across in many different ways. Unfortunately, the most powerful incentives—money and fame—rather than common sense pull young athletes and their parents towards the rewards of instant stardom.

By nurturing their arms, these young pitchers will increase the possibility that they will be able to play in college on scholarship and/or even have professional careers. More importantly, though, for the majority of athletes who do not fulfill those dreams, it is more likely that their bodies will be healthy and their career prospects better served.

            Pitching More Wisely

Since the educational message about the necessity of pitching less is failing to get through and, in recent years, one sport pitching wonders have been increasing—not decreasing—the more productive approach would seem to be to teach pitchers about the benefits of pitching more wisely, especially when they are young and their bodies are immature and more vulnerable. Pitching better involves more than improved biomechanics, however. That process should begin by learning about the elementary physics and perceptual psychology of pitching from the batters’ and pitchers’ points of view.

From the batters perspective, there are many elements that may cause them to miss the ball, in addition to extremely high velocity of a pitch. Surprise and illusion are two of the most important factors because they disrupt a batter’s anticipation and timing. Mastering a variety of pitches and being able to throw them at different speeds and locations creates a substantial advantage for a pitcher. Today, most MLB batters can consistently hit the ball hard if they know its velocity and that its location will be over the plate. Thus, if it is a choice between throwing extremely hard most of the time and learning how to throw a variety of pitches, with a few provisos, doing the latter will be better athletically and, in the process, avoid arm injuries.

Creating surprise and illusions for the batter are matters of physics and perception. A pitch can be a strike or a ball and, for the most part, MLB umpires are quite good at defining the strike zone, although learning about how specific umpires, leagues, and conferences call strikes can be quite beneficial. A pitch can be in any part of the strike zone, near the strike zone, or further away. Traditionally pitchers aimed for or near the strike zone on almost every pitch.

In recent years that has changed. As Ben Lindbergh explained for MLB.com, “MLB pitchers are avoiding the strike zone at record rates.” One reason is that while pitching velocities have increased, so has reliance on off-speed, change of pace, and breaking pitches that include “sliders, curves, changeups, and splitters.” These slower pitches with spin, however, are both harder to control and more likely to be hit by a batter when they fall inside the strike zone.

Another reason to avoid the plate, though, is enhanced pitching effectiveness. Tricking a batter to swing at a pitch outside the strike zone, especially if it is outside the batter’s hitting zone, creates a substantial pitching advantage. In today’s game where batters are rewarded most for home runs and extra base hits and try to make contact using awkward, but powerful, launch angles, batters strike out more frequently than in the past. They also are more likely to try to anticipate where the pitch will be, rather than perceive where it will be. In this hitting environment, batters are more likely to swing at bad pitches.

As science writer and baseball fan, Sarah Kaplan, explained in the Washington Post after familiarizing herself with the works of baseball scientists, there are two factors that affect how a batter responds to the classic curveball, which imparts the greatest amount of spin. As a matter of physics, a curveball when thrown at its optimum velocity, which is a leisurely 68 miles an hour, “can break up to 17.5 inches.”

Yet, that amount of downward movement is divided over the 60-foot space that separates the pitching mound from home plate. The actual curve, once it nears the plate, is at most about three inches. At the same time, to be effective, the batter needs to perceive the flight of the pitch almost from the time it leaves the pitcher’s hand. Thus, over that nearly 60 foot distance any break is going to appear to be much more pronounced. How much is a matter of informed conjecture rather than empirical knowledge. Nevertheless, given the difficulty most batters have hitting a well-thrown curve ball, that perceptual element appears to be substantial.

In a separate category are the more rare knuckle balls that deliberately impart very little spin, but appear to float slowly in unanticipated ways. Only a small percentage of pitchers master that pitch, but those who do have been surprisingly successful in the major leagues over the years. All of these off-speed pitches, however, combine unanticipated velocity with perceived changes in direction.

Fast or hard-thrown pitches include the traditional four seam fastball, sinkers, and cutters. They all put added strains on the arm when thrown at top velocities, but are highly effective, especially when they are used along with a variety of well-thrown slower pitches. Yet, MLB analytics reveal that since 2008 there has been a small, but steady decline of about 5% (67% to 62%) in the collective percentage of hard pitches being thrown and a corresponding rise in the use of off-speed pitches. This is not much of a change from the standpoint of promoting healthy pitching arms.

Still, it suggests that more professional pitchers and pitching coaches are appreciating the strategic benefits of using a different mix of fast and slower pitches. Ultimately, though, from a pitcher’s standpoint of being able to fool the batter most frequently, while avoiding extra base hits, the art of pitching can be practiced best by: (1) mastering different types of pitches; (2) being able to locate those pitches in all different areas on, around, or outside the strike zone; and (3) accumulating practical baseball knowledge and experience about the tendencies of individual batters and umpires. The benefits of these best practices apply whether a pitcher is a starter, reliever, or closer, though it would appear to be most beneficial for starting pitchers, who face batters more than once in a game.

Conclusion: Baseball Trends and Their Likely Affects on Young Pitchers Arms

One can feel confident that pitching most effectively by employing a wide variety of throws, speeds, and locations, rather than relying too much on fast balls also will better protect pitchers’ arms from injuries. Unfortunately, even if most young pitchers and their coaches become convinced of the wisdom of this approach, there still would be major problems to overcome.

First, what happens in the major and minor leagues, with respect to teaching elite athletes how to pitch effectively, is different in quality and scope than it is for youth baseball and high school. To begin with, the coaching they receive at these lower levels of competition tends to be variable and generally not nearly as good. In addition, a vast majority of relief pitchers and closers in the professional leagues are starters in high school and their youth leagues. They are likely to be star athletes with star expectations, not only from themselves, but those closest to them.

The allure of college scholarships and major league contracts tends to be magnetic, distracting, and too often corrupting. Trying to stand out as being the very best among talented athletes at one of the iconic positions in American male team sports, too often distorts common sense of the athlete and those people giving him advice. Nowhere is that distortion more apparent than with the extremely unhealthy obsession of so many talented high school and youth league pitchers to throw as hard as possible, almost every pitch.

In addition, this same allure of stardom encourages these elite young pitchers, or those trying to become elite, to supplement the traditional baseball season with almost year-round leagues, tournaments, appearances, and practice sessions. Again, this places more and more stress on young arms.

Second, the health benefits of protecting pitcher’s arms by throwing fewer high velocity pitches and many more that are off-speed with spins and other changes of direction have their own potential dangers. For young arms, the torque-related stress from throwing breaking balls, too violently or with other improper mechanics, can be as damaging as throwing extremely hard fastballs. Repeatedly throwing any of these stressful pitches can have harmful, and even devastating, biomechanical effects on arms and shoulders. In David Sheinin’s words, these stress-producing throws and poor mechanics can cause the muscles and tendons to be “torn to shreds.”

Finally, the movement in the major and minor leagues towards decreasing the number of innings pitched creates a paradox. On the one hand, logic strongly suggests that throwing fewer pitches will better protect arms, especially for younger players. Using strict pitch counts and reducing reliance on starting pitchers is likely to increase, meaning the innings pitched over a season and thus a career will continue to decrease for starting professional pitchers, which is a good thing from a health perspective.

Unfortunately, elite pitchers and those trying to be elite, in youth and high school baseball are not going to benefit necessarily. They already are supposed to be on strict pitch counts, which too often are marginalized in the march to be noticed, because a league or an event does not strictly adhere to these guidelines, or because no systematic effort is made to count all the pitches each young pitcher throws in games, practices, and exhibitions each year.

Thus, while MLB and its minor leagues may be producing somewhat more healthy environments for their pitchers, that trend does not seem to be translating to elite pitchers in high schools and youth leagues. Furthermore, with various winter leagues, world competitions, and other extra-curricular professional opportunities in the American baseball off-season, many professional pitchers already are throwing throughout much of the calendar year with fewer and fewer opportunities for extended periods of rest that their arms need.

The bottom line is that as in almost every major spectator sport, when it comes to protecting the health and safety of athletes, wins, championships, money, and fame outweigh the effective management of risks. For pitchers this has translated into high prevalence rates of serious, and often permanent, arm injuries with little remediation in sight. Recent pitching trends appear to be a wash—at best—in promoting pitchers’ health and safety.

So Much More Needs To Be Done To Achieve Mental Health in American Spectator Sports©
   John Weston Parry

Introduction and Overview

A growing number of high profile professional athletes, including Olympic great Michael Phelps, 2012 Heisman Trophy winner Johnny Manziel, and Cleveland Cavaliers Kevin Love, have made small headlines recently by revealing their struggles with serious mental health conditions. The National Basketball Association (NBA), through its players union, is exploring ways to de-stigmatize mental health treatments for their players without breaching confidentiality. As Michele Roberts, the union’s executive director, cautions, “the devil is in the details.... [I]f a player is unable to perform because of his issues, that opens up a different discussion.” Indeed it does.

For teams, owners, and event organizers, money—and wins that produce revenues and fame—overwhelmingly outweigh mental health concerns. As Wayne Huizinga, who owned professional baseball, football, and hockey franchises in Florida, once explained: “Money is how [teams] keep score.” Mental health care and treatment in professional and major college sports continue to be viewed as a taboo, deliberately veiled in secrecy and rife with deceptions.

In The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017) I observed that:

[m]any of the worst stereotypes and prejudices in America’s most popular spectator sports involve mental impairments. An ironic twist has been added to this type of stigma and discrimination with revelations that concussions and subconcussive impacts to athletes playing those sports can cause severe mental disorders.

What happens to players and coaches if they have mental conditions largely depends upon their team’s economic analysis of the situation, rather than what is best for those individuals as patients, therapeutically. Team officials and coaches compound this bias with mental health ignorance and short-sightedness. The threshold question always seems to be whether the athlete’s impairment will prevent him—or her—from suiting up. Those who cannot perform adequately are commonly labeled malingers or malcontents, especially if their mental health issues do not resolve quickly.

Players who incur multiple physical or mental health impairments, which keep them out of the lineup for relatively long periods of time, are likely to be slighted and devalued as being injury-prone or, even worse, faking. This prejudice is especially intense when the inability to perform involves a mental disorder. The common term of derision is a “head case,” which is very difficult for any athlete to come back from. Teams tend to view mental health problems of athletes and coaches as team-wrecking character flaws, rather than as diseases and treatable impairments.

As a result, most players with serious mental health issues feel so stigmatized that they try to hide and disguise their conditions and treatment needs, which tend to make their situations much worse, especially if those athletes begin to self-medicate with drugs and alcohol. Ask Terry Bradshaw (former NFL quarterback), Vin Baker (former NBA player), Peter Harnisch (former MLB pitcher) or Shayne Corson (former NHL player) how isolated they felt when they were battling mental conditions during their professional careers.

There is a double standard in sports when the mental health needs of athletes and coaches are being considered. With most health problems teams make a concerted effort to treat the affected athletes promptly in order to get them ready to play as soon as possible. At the same time, players tend to be pushed to compete before they are fully healed, which may shorten their athletic careers and create life-long impairments, including drug addictions. Too often substance abuse problems originate with—or are made worse—by painkillers that teams help dispense with reckless abandon.

Players with serious mental health problems, however, not only are pushed to compete too soon, but face an additional agonizing dilemma. Who, if anyone, can they trust with information about their mental conditions? Typically, professional athletes and their teams just pretend there is something physically wrong with them, which inevitably aggravates their problems—frequently at the expense of their careers, and even their lives.

American spectator sports have a long way to go in protecting the mental health of their athletes and coaches. Leagues, athletic departments, and other sports enterprises create environments that unnecessarily harm the mental health of their athletes and coaches. Moreover, these organizations compound such problems by failing to provide adequate mental health care and treatment, not only after the athlete’s career is over, but also while he or she continues to compete.

Not all mental health issues in sports should be viewed similarly. Admittedly broad, but meaningful, dichotomy exists. In one category are mental conditions precipitated by extreme stress, anxiety, or trauma in training for and/or performing as an elite athlete. In the second category are mental disorders that have a primary genetic basis or can happen to anyone, although such conditions also are likely to be aggravated by the pressures of being an elite athlete. In either category, though, the mental disorders are aggravated and made much worse when they are combined with substance abuse problems.

Athletes Who Have Sports-Related Mental Disorders

Anxiety and Stress

Athletes with sports-related mental disorders seem to generate more empathy and sympathy within the sports world, than do athletes who have other types of mental conditions. Stress and anxiety in particular are normal reactions experienced by almost every elite athlete. This is a major reason why, increasingly, psychologists have elite athletes as clients. Nevertheless, unless the affected athletes can overcome or control those anxieties, so that they can perform at a professional level, sooner or later they will be expelled from their teams or their sports.

While debilitating stress and anxiety are found among many different types of athletes and coaches, there are certain spectator sports in which it occurs more frequently and intensely. They include baseball, golf, basketball, and other sports requiring exceptional touch and hand-eye coordination. In those sports the condition is often referred to as the “yips.” What were once routine sports maneuvers or motions become nearly impossible for the athlete to replicate consistently without making gross mistakes. Pitching and other types of throws in baseball, putting in golf, and shooting in basketball are the most prominent examples of routine sports functions that can go terribly wrong for days, weeks, months, years, or forever.

In professional baseball, former Washington Nationals pitcher, Aaron Barrett, was able to cure his yips and perform as a highly competent professional baseball player. He had the help of an understanding and insightful coach in the minor leagues, who devised throwing drills for Barrett to repeat, until his problem disappeared, incrementally. He was then able to successfully resume his professional career, until physical injuries slowed him down again.

St. Louis Cardinal’s pitcher, Rick Ankiel, on the other hand, was never able to overcome yips that first appeared in the 2000 postseason. By 2007, though, he finally had completed an extraordinary transition, becoming a major league outfielder. Throughout this ordeal, he apparently never received treatment for his psychological condition. In addition, until he wrote his memoir in 2017, the public reason for his sudden inability to pitch was always “unknown.”

In golf the yips are common to putting, especially for older professionals. For a number of years golfers would anchor their putters to their bodies in order to reduce unwanted movements that would disrupt the direction and speed of their putts. Even though—or perhaps because—the yips appear to be a natural part of the aging process for golfers, the Professional Golfers Association Tour recently outlawed the use of that anchoring technique, forcing a number of Tour players to change their putters and strokes.

Keegan Bradley, who won the 2011 PGA Championship, deals with extreme nervousness, which can compromise his club distance and accuracy, in a different way. He employs an awkward, repetitive routine to distract himself from his jitters, but unfortunately he has been the butt of unkind criticisms and taunts from the media and even a few by his fellow players. Nonetheless, he has had a successful golf career by almost any measure.

While rumors surfaced a few years ago that Roy Hibbert of the Indiana Pacers was experiencing the yips shooting the basketball, apparently the most prominent recent basketball example involves the Philadelphia 76ers number one pick in the 2017 NBA draft, Markelle Fultz. When he was drafted, Fultz was seen as someone who would soon develop into a star point guard, and quite possibly a superstar. As a college basketball marvel, all aspects of the game seemed to come easily to Fultz, especially scoring. His shooting accuracy was one of his most valuable skills.

During the summer preseason, though, his ability to shoot the basketball with a professional level of proficiency—much less like a star player in the making—suddenly vanished. The problem became so overwhelming the 76ers no longer used him in games. While there was no official confirmation that Fultz had the yips or some other psychological problem that prevented him from shooting accurately, there were tell-tale signs that he probably has some kind of mental disorder that was being hidden from the public.

To begin with, the team initially attributed his shooting distress to a physical cause. The New York Times reported that the 76ers claimed Fultz had sustained what was described as a “scapular imbalance” from a shoulder injury in the summer. Yet, his personal trainer dismissed that explanation as untrue. Furthermore, for a long time there was no significant improvement in his shooting, even though his supposed injury had more than enough time to heal. In many ways, it seemed similar to what former tennis champion, Novak Djokovic, has been experiencing for many months.

Second, Fultz’ demeanor during games, while he sat in street clothes, was concerning. Reportedly, he lacked the ability to express his emotions and kept his distance from the team. “He is like a ghost. He is there, but not there,” noted the Times, which suggested Fultz might be experiencing side effects from medications he was taking and/or was depressed. Whatever the explanation, he was not engaging with his teammates.

Then, a few days after the Times story ran, the team suddenly returned him to the lineup as a reserve without any explanation. The 76ers management continues to prohibit him from speaking about this issue with reporters. It appears to be the type of secrecy and deception that characterize mental health problems in sports more generally.

Brain Trauma Mental Conditions

While mental disorders due to repeated brain traumas typically present themselves in former athletes, years after they retire, CTE affects current players as well, especially in the NFL and hockey. The most notorious example, however, involved former New England Patriots Pro Bowl tight end Aaron Hernandez, who killed himself in prison after being convicted of murdering several people. His posthumous CTE diagnosis, coupled with his aberrant behaviors, convinced a number of behaviorists that he became suicidal and homicidal due to an undiagnosed mental disorder brought on by repeated brain traumas. In hindsight whether Hernandez became mentally ill due to his CTE is difficult to ascertain with any high degree of certainty.

Nevertheless, a growing number of football and hockey players, who developed CTE, were reportedly acting irrationally and bizarrely before they died. Mark Rypien recently revealed in the Washington Post that, due to repeated brain traumas in his football career he has experienced “depression, anxiety, addictions, poor choices, poor decisions, [and has] “attempted suicide.” Today, there is little doubt that contact sports can be a substantial contributing factor in mental disorders diagnosed in former, current, and deceased athletes. This is why, increasingly, players in those sports are deciding to retire early, a few even at the beginning of their professional careers.

NFL Hall of Fame player, Junior Seau, is one of the highest profile athletes to receive a posthumous CTE diagnosis after acting bizarrely and then killing himself. The NFL was so concerned about what had happened to Seau Commissioner Goodell refused to allow Seau’s daughter to speak at his hall of fame induction ceremony. The league feared she would attribute Seau’s death to football, which is what she and many others believed—and the evidence indicated. Without anything more, the presence of advanced CTE has become convincing proof that the deceased—whether or not he or she was an athlete—had a severe mental condition at the end of their lives.

Mental Health Conditions of Athletes Where Sports Are a Contributing Factor

Given that nearly 20 percent of U.S. residents experience a diagnosable mental disorder each year, it should not be surprising that a similar percentage of athletes do so as well. The difference is that the stigma of mental conditions in our favorite spectator sports is even greater than in American society more generally. In addition, there are unique pressures to becoming, and continuing to be, an elite athlete. Thus, the prognosis for recovery from a mental disorder can be worse, despite the independent economic resources that most of these athletes have at their disposals.

For this reason, even if sports are not the primary cause of a diagnosable mental disorder in an athlete, it often is a contributing factor. Four of the more disturbing examples, in which sports played a key role in the mental health problems experienced by professional athletes in recent years, occurred in NBA-controlled leagues and the NFL.

Chamique Holdsclaw and the WNBA

Chamique Holdsclaw was one of the very best women college basketball players ever. Throughout her mental health-shortened WNBA career, which began in 1999, she experienced severe bouts of depression, made worse by excessive alcohol consumption. Her first team, the Washington Mystics and her teammates did little to help the future Women’s Basketball Hall of Fame member because they mostly viewed her illness as a character flaw. Sally Jenkins of the Washington Post reported that Holdsclaw was variously “labeled… a quitter… an enigma… or a problem.”

When she went on an extended leave of absence during the 2004 summer season, neither she nor her team were willing to explain what was really happening to her. She had an unspecified medical condition. Nonetheless, as soon as Holdsclaw was traded that October, Mystic team officials were eager to reveal her condition to the media. They needed an excuse for why they had given up on one of the greatest players of all-time, who, from 2002 until she left Washington in 2004, averaged nearly 20 points and 10 rebounds a game.

Her trade to the Los Angeles Sparks seemed to work well at first, but her mental condition became much worse in 2006, her second season with the team. She swallowed the contents of a bottle of antidepressant medication and was committed to a mental health facility with what were described as delusions. Her career went downhill from there. Although she returned to the WNBA as a member of the Atlanta Dream, it was only as a role player. Holdsclaw retired in 2010.

Thereafter Holdsclaw was arrested for shooting a bullet into her ex-girlfriend’s car. She pleaded guilty, but in lieu of jail time, she received the intensive mental health treatment that she had needed when she was an active player. Holdsclaw became a mental health advocate after writing a book about her painful experiences.

Royce White and the NBA

Royce White was one of the most physically gifted athletes in the NBA’s 2012 draft. Yet, his draft value dropped significantly when he revealed his anxiety disorder, which manifested itself in an overwhelming fear of flying. Unlike most athletes with mental disorders, who scrupulously hide their conditions, White had decided that he would be candid and transparent, which is what most mental health practitioners recommend.

White’s situation was hardly unique in the sports world. Both Tony Kornheiser and John Madden, when they were doing live broadcasts of weekly network football games, were driven to game locations in luxurious buses to accommodate their fears of flying. Both networks understood that the respective talents of the two television personalities more than made up for the added expense of providing a workable solution to this relatively common anxiety disorder.

Unfortunately for White, professional athletes with mental conditions tend to be treated with far less empathy and therapeutic concern than sports media personalities. Although White was viewed by many as a top ten pick, on draft day he was selected 16th by the Houston Rockets. White was optimistic at first, but soon a serious rift emerged with the Rockets regarding the proper way to deal with his mental health issues, especially the provision of reasonable accommodations.

The Rockets, the NBA, and most of the professional basketball media reflexively presumed that the team’s front office retained the prerogative to make any decisions they pleased without any guidance from mental health experts. Thus, an unenlightened Rockets management refused to agree to formulate a plan to accommodate White’s special needs. Instead they decided they would address each disability-related issue when it arose–based largely on the economics of the situation.

White, mental health professionals, and disability experts—but not his team or the league—understood that proper planning was essential. It involved relatively complex issues, requiring mental health and accommodations expertise, which was readily available and not particularly expensive. Thus, White insisted upon receiving an accommodations plan, which the Rockets refused to develop much less implement.

Neither party budged from their positions. In the mental health-unfriendly sports world, however, White was generally regarded as having overstepped his bounds. Despite his obvious basketball skills and talent, he was sent to play in what is now called the NBA’s G League, but was then the D “developmental” league.

By the fall of 2013, White had been traded to Philadelphia and soon was waived out of the NBA for good. His professional basketball legacy was summed up by Bleacherreport as “the worst first-round pick ever.” Sadly, with a little help from the Rockets and the league, White could well have become a very productive player.

Jonathan Martin, Mental Health Bullying, and the NFL

Jonathan Martin’s tragic story contains a similar lack of empathy and shortsightedness about mental illness that was part of Royce White’s basketball demise, but with the added destructive ingredient of hazing and bullying, which are part of the NFL’s locker room culture. Like White, Martin was a high draft pick in 2012 and an All-American in his sport. Martin, however, majored in the Classics at Stanford. He also came from an educationally and economically privileged background. Thus, he was quite unlike most of the players in the NFL, except for the fact that he was an African American.

His perceived privilege combined with his susceptibility to depression made him a vulnerable target for sustained harassment by both his white and African-American teammates with the Miami Dolphins. While he was at Stanford, there were no reported fracases involving teammates or concerns about his mental stability. He was a well-respected, highly-functioning member of the team, and even beloved. Once he arrived in the NFL his football life changed.

Early in his second NFL season (October 2013), Martin left the Dolphins claiming he had been the victim of harassment and bullying from his offensive line mates, especially Richie Incognito, who in 2009 had been voted by his peers as the dirtiest player in football. Among other things, Incognito had sent Martin e-mails that were later described as racist and threatening violence against his teammate. Also Incognito and two other offensive linemen on the Dolphins, who were African Americans, repeatedly hazed and bullied Martin. This triggered a depressive episode, which led Martin to check himself into a hospital psychiatric ward.

Despite the fact that most NFL players are African Americans and Incognito is white and known for his excessive violence and dirty play on the field, almost no one associated with the Dolphins or NFL came to Martin’s defense, including the players on other teams. Instead, criticisms of Martin began to mount. Even publicly black players were divided. Some expressed hard to believe shock that this sort of bullying could happen in an NFL locker room; others were offended by Martin's lack of courage in dealing with his tormentors.

In addition, no players supported Martin's decision to leave the hostile Dolphins’ team environment, which had been causing him such psychic pain. In the NFL and throughout much of the media, Martin was widely viewed as weak and having let his teammates down by running away. The Dolphins General Manager expressed this widely held sentiment when he said Martin should have “`punch[ed]'” Incognito.

Subsequently, an NFL commissioned report documented how Incognito and two of his African American teammates, Michael Pouncey and John Jerry, had harassed and bullied Martin. That included making fun of Martin's mental illness and calling him out as being gay, which, like being mentally ill, is rarely tolerated in NFL locker rooms.

Yet, while all three of his tormentors—after relatively short suspensions—would continue to have productive NFL careers, Martin’s career and later his life would be permanently derailed by the stigma that he faced. William Rhoden of the New York Times captured the prevailing sentiment when he advised Martin to stay away from the game for at least a year “to sort through … [the]complex emotional issues that have been aggravated not eased, by the culture of a brutal sport.” Rhoden then reiterated the view that Martin should have “retaliate[d],” rather than leaving to seek the mental health care he badly needed. Not only Rhoden, but also others in the media suggested that Martin should seriously consider never returning to the NFL because it was unlikely that the culture would ever change enough to accommodate Martin’s emotional needs. Sadly that proved to be correct.

As a result, Martin’s career was never the same. He signed with the San Francisco Forty Niners, but never started again. In 2015 he left the NFL for good, posting messages on social media acknowledging that he was suffering from depression and had tried to kill himself several times. In March 2018, he hit rock bottom when he was arrested and charged with making criminal threats against his NFL tormentors and certain other athletes in his past. He used Instagram to send those people an image of a shotgun and ammunition accompanied by a post which read: “When you’re a bully victim & a coward, your options are suicide, or revenge.”

Martin was sent to a mental health facility for treatment pending his trial. Hopefully, in lieu of jail time he will receive the extended care he needs—and local authorities will at least try to bill the NFL.

Erik Ainge and the NFL

Mental illness, substance abuse, and the pressures of professional sports can combine to have a devastating impact on athletes. This is especially true for NFL quarterbacks, from whom so much is expected. Recently, Johnny Manziel revealed he had bipolar disorder. He did this in order to explain his aberrant behaviors as a member of the Cleveland Browns.

Despite all the money that the Browns had invested in his success, Manziel was unceremonious dumped from that team and the league in 2016, largely because he had failed to perform on the field. Thus, in hopes of receiving another chance to play in the NFL, Manziel became one of a number of professional athletes willing to publicly acknowledge that he is being treated for a mental illness.

While it is too early to see how this works out for Manziel, there is another former NFL quarterback who had similar mental health issues, whose football career could not be salvaged: former New York Jets backup, Erik Ainge—the nephew of Boston Celtics General Manager, Danny Ainge. Ainge entered the NFL with a long history of addictions and undiagnosed bipolar disorder.

When Ainge was only 12, he began self-medicating his undiagnosed disorder, first with alcohol and later with cocaine and heroin. In 2007, his senior year at the University of Tennessee, he also developed an addiction to the painkillers football players often take in large quantities. This only made his mental condition worse and his behaviors more erratic and self-destructive. It also led to several rehabilitation stints while in college.

Despite readily available information that Ainge had serious mental health issues, when he came to his first training camp in 2008, Jets management and the NFL’s security force were remarkably oblivious to Ainge’s plight. In the NFL, like other professional leagues, what a player does on the field is much more important than anything else. Athletes who cannot suit up or perform competently are quickly forgotten, especially if there is no apparent physical injury that can explain any absences or poor performances.

That November, two months into his pro career, the NFL suspended Ainge four games—not for his life-threatening substance abuse—but rather taking steroids to enhance his performance. Unfortunately for him, professional teams—particularly in the NFL—generally view mental disorders as something that athletes need to handle themselves. Thus, no treatment and supports systems were set up to help Ainge cope with his mental health problems. Early in 2009, though, life became so desperate for Ainge that he entered a drug detoxification center and was compelled to tell Jets management. During that stay he was finally diagnosed with bipolar disorder.

Upon his release from detoxification, Ainge kept away from drugs for a while, but, at the same time, he was not taking medications for his bipolar disorder. Instead he turned to alcohol again. Almost every night he was driving drunk or over the legally permitted limit. Since he was not being monitored, nobody associated with the Jets or the league tried to stop him. Ainge had turned to alcohol because, as a chronic abuser, the NFL was now testing him for drugs several times a week.

In July 2010 just before training camp was to begin, Ainge relapsed, this time on hard drugs. As part of his rehabilitation, he was given medication to treat his bipolar disorder. Although he was still under contract, in June 2011 the Jets compelled Ainge to retire. Both parties pretended that the quarterback was leaving the game because of physical injuries he had endured.

Once he was out of the NFL and relieved of the pressures to succeed as a quarterback, Ainge began turning his life around. Although initially he was arrested for driving while drunk, for several years now he has been the host of a popular local Tennessee sports radio show. He also married and has a son and daughter.

Conclusion

Fans and the sports media tend to view athletes and coaches as being overpaid and pampered. When it comes to mental health, however, competing in professional and major college sports can be dangerous occupations. As compared to the long-term health risks from physical injuries, mental health risks are even greater. In large part this is due to widespread overuse of painkillers, the stress and anxiety of competing, and brain traumas and related mental conditions that concussions and subconcussive impacts can cause.

Given these high risks with life-altering consequences, those who operate and profit from spectator sports should have a special obligation to provide comprehensive short- and long-term mental health care and treatment for their athletes and coaches. Unfortunately, what leagues, teams, and other sports organizations choose to provide remains woefully inadequate.

Epilogue to The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame ©
By John Weston Parry

The disturbing trends in health care for athletes in our most popular spectator sports are well-established, but changing slowly. What tends to be lost or marginalized in the very necessary discussions about brain injuries to football players are the other physical and mental impairments that result, not only from football, but most of the other popular spectator sports.

Brain trauma occupies the epicenter of sports injury and impairment explosion. Other conditions, however, including drug abuse and addictions, are even more widespread in the sports world, and sometimes equally devastating. Making matters worse, pain and treating pain with powerful drugs, especially opiods, are commonly embraced in sports. Unfortunately, dulling the pain tends to mask serious physical and mental conditions that become more severe over time.

Yet, there is no comprehensive plan to help elite athletes limit the number of injuries and impairments that they must deal with, or to treat them later in life for their special long-term health care needs. It is presumed they will have enough money to pay for decent care and the sense to get the necessary treatment. Many former athletes, though, live on the margins of poverty, despair or addiction, often accelerated by their sports-related impairments and disabilities.

The list of health risks is daunting, as are the consequences later in life of accepting or embracing those risks. Something as seemingly straightforward and frequent as surgery for a torn tendon or ligament in a key joint, such as a shoulder, hip, knee, or ankle, for example, has a reasonable likelihood of leading to arthritis in as little as ten years, no matter what age the injuries occurred. Severe knee injuries in particular have become increasingly prevalent, especially as more and more girls have been playing soccer, basketball, baseball, hockey, and other sports that place stress on their vulnerable knees. Knee and hip replacements for baby boomers are now viewed as just part of growing older, while ankle replacements are no longer rare. Because shoulder replacements are not yet possible, severe injuries to that joint tend to have worse long-term outcomes, including the overuse of drugs and alcohol to deal with the arthritis and pain.

Eliminating contact sports for kids, except perhaps football, is hardly an option. Most people would agree that children should be engaged in at least one sport—or physical activity such as dancing—when they are growing up. This tends to be a good experience in terms of instilling life values and physical fitness into their lives. Daily physical education used to be part of every public and private school curriculum. In more recent years, however, limited physical education has become somewhat of a joke, rather than a serious academic experience. Today, physical education is not readily embraced in the sports world.

That is unfortunate because parents and guardians of children, who want their kids to have the benefits of being involved in sports, cannot depend on physical education classes and school supervised competitions to meet those needs. Typically, their children need to sign up to participate in, or at least try out for, various youth leagues, very few of which are operated by trained educators. It is in these programs where the health risks tend to multiply, especially in those ethically-challenged leagues dedicated to producing—or otherwise catering—to elite athletes or wannabes for profit or under-the-table payouts and benefits.

As detailed in The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017), there are many different ways that athletes unnecessarily or recklessly risk their health in sports. There is a catalogue of destructive impulses and practices. The more time that athletes devote to competitive sports—especially if they focus on only one sport—the more likely they will sustain long-term physical and mental impairments, which includes drug abuse and addictions. These health risks are accelerated—particularly in male-dominated sports—by four well-ingrained, but counter-productive, behaviors:

playing with painful injuries through the use of powerful drugs;
using health-threatening substances to enhance athletic performances;
engaging in overly-aggressive play, including—all too often—a willingness to deliberately injure one’s opponents; and
sacrificing health for money, fame, and recognition.

Using Drugs to Play Without Pain

Underlying many of the health-related problems in our favorite spectator sports, especially those mostly played by males, is a macho ethos that celebrates and rewards the ability of athletes to overcome pain that would typically incapacitate non-athletes. This is problematic in three ways. First, unrelenting pain is nature’s warning to human beings that they should stop engaging in whatever activity is causing them physical distress. Otherwise, they are placing their well-being at risk by engaging in those activities.

Second, generally drugs that kill or substantially reduce pain in order for athletes to continue to compete are masking the symptoms of those injuries, but not treating the injuries themselves. Hence, athletes tend to have many “nagging” injuries when they compete that never really heal, at least not until they have time to rest their bodies in the off-season, and sometimes never. Third, unless athletes rely on over-the-counter medications, the drugs they do take tend to be opiods or other similar powerful substances that have addictive properties. Furthermore, even over-the-counter analgesics have their risks, especially if taken in higher then recommended dosages or before or after consuming alcohol, which is common. The image of athletes swallowing a handful of pain relievers is part of this macho folklore.

What happens to an athlete is somewhat analogous to driving a car with mechanical problems, until it breaks down and can no longer function properly. Sometimes the vehicle can never be driven again. Usually it requires costly repairs, but rarely is it made as good as it once was. Similarly, playing in—or with—pain is likely to shorten athletes’ careers and create long-term health problems in their sports after-lives. Treatment is almost never as effective as preventive maintenance and care.

Despite strong evidence that playing with pain is an unhealthy practice, athletes are taught, beginning at a relatively young age, that to be successful they must learn how to manage their pain either through sheer willpower or more typically artificial means. Coaches, trainers, teammates, team doctors, and even parents reinforce this message in many different ways. The short-term athletic contributions of the athletes are valued much more than their long-term health and well-being. Brain damage is the most powerful illustration of the consequences of the play with pain and injury syndrome, but it is only one of many serious physical or mental conditions that can result.

Performance-Enhancing Substances

The use of performance-enhancing measures has become an essential ingredient of competing better in sports. Elite athletes in particular will do almost anything to get an edge on their opponents, or conversely not to be at a disadvantage. Thus, the most common complaint about the use of performance-enhancing substances in sports is that the many athletes who are using them gain an unfair competitive advantage by cheating.

Almost everything that has been done in order to address this problem is based on a punitive model that employs various tests and other indicators—often subjective—to try to ascertain whether cheating has occurred. By any objective measure those indicators are unreliable, producing too many false positives (athletes who are not taking such substances but are accused of doing so) and far too many false negatives (athletes who are taking such substances but never test positive conclusively).

As a result, there are various cat and mouse games being played in every spectator sport in which cheaters learn how cheat better, while testers try to improve their results—or to make it appear that they are improving. At the same time, the cartels and other organizations that run these revenue-producing sports would rather not have too many of their athletes, especially stars and superstars, penalized. To make this happen implicit compromises appear to be in place in which most cheaters are never sanctioned to ensure the continued profitability of these businesses.

What makes the punitive approach to enforcement so frustrating is that it not only fails to substantially ameliorate the cheating problems, but it largely ignores the health of the athletes involved, which should be the overriding priority. On the other hand, by focusing on the health of the athletes, enforcement becomes far easier to manage. Assuming performance-enhancing substances are taken in quantities and ways that are not unhealthy, there is far less reason to prohibit them, as long as all the athletes in a sport have relatively equal access to the same performance-enhancing “resources.” Those substances can then become part of a group of approved performance-enhancing measures, which would include nutrition, training, equipment, and analytics.

In that environment, controlling the use of such unhealthy substances becomes more of a public health matter. The main objectives would be to determine which substances and in what amounts may jeopardize the health of athletes, warning athletes about the risks, and informing athletes which healthy alternatives exist that are equally effective as using banned substances. Education can be a powerful tool for healthy living.

Overly-Aggressive Play Including Deliberate Injuries

While football, hockey, soccer, basketball, NASCAR, and other sports—at least as played by men—clearly emphasize the rewards of over-aggressive play, including deliberate strategies to slow down and even incapacitate opponents, all contact sports, including baseball, pass down and teach morally questionable strategies to help competitors prevail over their opponents. In most of our spectator sports this violence occurs less than in the past, but overly aggressive play tends to be amped up in playoffs and big games. With football violent play remains so integral to the game that even the new rule changes only make a relatively small difference. “Bountygate” was only a few years ago. It, along with the lies and deceptions about concussions, allowed the world to see how pathological the game of football has become.

Yet, there is substantial resistance towards making our favorite spectator sports safer by reducing overly-aggressive play. Many players and fans still view violence in sports as necessary and entertaining. As with the ritual of playing while injured, deliberately hurting, and getting hurt by, opponents is part of what supposedly makes these “games” great, and so profitable. More importantly, American professional sports leagues and the major athletic conferences in college sports understand—or at least think they understand—the correlation between profitability and sports violence.

Thus, the individuals who referee and umpire games lack the inclination, instructions, tools, and leeway to call fouls as aggressively as needed to curb overly-aggressive play. There is this constant refrain that calling too many fouls ruins the game for the fans and players, so clear fouls are often ignored. Especially in decisive moments there is a tendency to just let the athletes play and to settle the competition on the field or the court without interference from the referees.

The problem is that athletes who break the rules are unjustly rewarded and those who obey them are placed at greater risk. This dynamic also changes the definition of what it means to be a good athlete. Those who do not cheat by deliberately breaking the rules —or do not cheat well—are less valuable, and thus tend to be less well-compensated. The incentives for safe play are all wrong. The most successful cheaters are excused and even embraced as winners.

Performance-Risk Rewards Undermine Health and Safety

Overly-aggressive play and deliberate injuries is a sword with two destructive edges. One involves the damage that is visited on opponents. Not so obvious, though, is the damage to the athletes that are overly-aggressive or violent. For them the risks of injuries increase because of the often dangerous techniques that are used to overwhelm or incapacitate their opponents, and the retaliation from those opponents.

As British sports scholar P. David Howe has written so persuasively, “the acceptance of risk [is] an inevitable consequence of professional participation in sport.” This principle also applies to collegiate athletics, the Olympics, and—most unfortunately—to youth sports, especially for young athletes trying to become elite. Nonetheless, overly-aggressive play is only one category of performance-risk rewards that undermine the health and safety of athletes. There are many others, including playing with pain, taking performance-enhancing drugs, and the mantra of pushing one’s body past the limits of physical endurance and safety.
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Too often athletes are encouraged and pushed on by their teams, handlers, supporters, and families, who are invested in the most positive athletic and financial outcomes possible. Unfortunately, there are relatively few words of caution, certainly as compared to the many prescriptions to go for broke, which is what the best athletes are supposed to do, regardless of the consequences. Potential scholarships to private high schools and colleges and usually unrealistic possibilities of lucrative careers as professionals, not to mention the pride and glory of being an elite athlete, are more than enough motivation for most of them to risk their physical and mental health. [From the Athlete’s Dilemma, Chapter 20, “Performance-Risk Rewards Undermine Health.”]

While there are countless examples of athletes in our favorite spectator sports—and those who are supposed to care for athletes—engaging in reckless behaviors and practices that undermine athletes’ health—several of which have already been discussed—there are four particularly compelling examples that help illustrate the scope of the problem. First, is the willingness of young athletes and their parents and guardians to accept or ignore the high risks of serious physical and mental injuries and impairments from playing tackle football. The persistent laissez-faire attitude towards these bodily dangers fits the legal definition of child neglect.

Second, baseball pitchers are encouraged to risk their arms and their potential athletic careers by throwing much too hard, much too often, especially at a young age when their bodies are most vulnerable. Making matters worse, young pitchers are rarely instructed in the art of pitching without having to resort to high velocity and unsafe torques on their arms. Tommy John surgeries occur so often they are now callously marketed as preventive measures that supposedly make many athletes’ arms better than new.

Third, is the unconscionable absence of proper health care and disability benefits for collegiate athletes, especially those who play in major sports programs that generate the largest revenue streams for their universities and colleges. When it comes to the health of its athletes, perhaps no organizational structure governing major sports is more irresponsible than the NCAA, its members, and the major athletic conferences. Despite burgeoning revenues generated from football, basketball, and other high profile sports, health care for college athletes remains an unforgivable mess.

Finally, in all major sports the failure to adequately address stigma and stereotypes, which negatively affect and often devastate athletes who have mental impairments compromises the health of too many athletes. Some of the worst stereotypes and prejudices in America’s favorite spectator sports involve mental conditions. Teams and other sports organizations continue to concoct elaborate ruses to hide the fact that their athletes have these conditions. One of the most damaging condemnations that any player can receive is being labeled a “head case.” As a result, mental disorders tend to be hidden and necessary mental health treatments are ignored or eschewed.

Conclusion

The benefits to elite athletes of performing well in our most popular spectator sports are readily apparent. It is around money, publicity, and fame where the tunnel vision of athletes, teams, management, owners, organizers, universities and colleges, and the [sports] cartels… are mostly united, even when largely selfish disputes arise about the sharing of revenues. [Too often these common] interests compromise the overall health of athletes in our most popular sports…

In this greedy environment, addictive painkillers, performance-enhancing drugs, and the underreporting, marginalizing, and even ignoring of potentially serious physical and mental impairments too often become substitutes for medically appropriate care for elite athletes… So much of what is done to keep [them] fit enough to participate in their sports is at cross-purposes with keeping [them] healthy in life…[T]he individuals and entities that are supposed to protect the athletes mostly look the other way to avoid responsibility as these destructive practices continue to occur…

This [sports] environment is especially damaging for younger athletes aspiring to be elite, who typically lack the maturity and insight to properly assess the dangers of unhealthy living and pathogenic behaviors. They are constantly being tempted by the immediate rewards that taking these risks can provide them with, including fame, college scholarships, Olympic medals, or pro careers. [From the Athlete’s Dilemma, “Conclusion.”]

ROLE OF FOOTBALL IN AARON HERNANDEZ’S TRAGIC
DEMISE: THE LIMITS OF CTE IN THE COURTROOM©
John Weston Parry

In discussing the many controversies that engulf psychiatric evidence and testimony, one of the few areas of agreement is that homicidal people often are suicidal as well. There is a strong psychiatric connection between those two deadly human impulses. In order to better understand which factors most contributed to the tragic demise of former New England Patriot’s troubled tight end, Aaron Hernandez, that connection, in the context of his playing lots of football and developing Chronic Traumatic Encephalopathy (CTE), are essential pieces of a complex puzzle. These triggers are not only important in projecting whether Hernandez could have been found criminally responsible for all the murders he may have committed, but, more importantly, whether the NFL is likely to be held civilly liable to Hernandez’s family, especially his young daughter. The place to begin this discussion is the role of football in Hernandez’s life.

The Role of Football in Hernandez’s Troubled Life

While a number of professional football players have died from suicide or extreme neglect of their own welfare, very few have committed murder, although sexual crimes and domestic violence have not been that uncommon. Before the Hernandez affair, the most notorious presumed murderer to have played in the NFL—unless one includes Hall of Fame inductee, Ray Lewis—was O.J. Simpson, who was acquitted of killing his ex-wife and a guest in her house, years after he had retired from the NFL. Even if one presumes Simpson was the killer, these were murders of passion, which did not appear to be related to his football past.

Remarkably what Hernandez did—and was investigated and indicted for doing—should be viewed as being even more disturbing and pathological than the accusations against Simpson. Also, Hernandez’s presumed transgressions were carried out while he was playing professional football. He became a highly valued New England Patriots’ employee, whose prodigious football talents in 2012 allowed him to sign what was then the second most valuable contract for a tight end in NFL history. Hernandez was still in his early twenties and just entering his football prime.

Nevertheless, his life had been filled with disturbing events and troubling warning signs, which appeared to have been marginalized or over-looked because of his football prowess. As long as a player performs extremely well on the football field—whether it is in youth leagues, high school, college or the pros—bad behaviors and bad influences are often discounted and ignored, and probably made progressively worse within a dysfunctional locker room culture. Hernandez, who was a football prodigy, learned early on that deliberately incapacitating an opponent, especially someone on a team one did not like, was not only socially acceptable, but praiseworthy. Making matters worse, his seemingly stable life apart from football disintegrated before he went to college.

Through much of his high school years in Bristol Connecticut—the home of ESPN—Hernandez’s experiences were thought to have been relatively normal for a football mega-star from a solid middle class background. Nonetheless, he apparently developed a number of gang friendships and associations that would become problematic later on. Furthermore, in 2006—his senior year in high school—Hernandez’s father and role model suddenly died after routine surgery. According to his mother, as reported in the Washington Post, it turned him “`very, very angry’”—or perhaps his anger just became more visible and intense. He left Connecticut in 2007 to become a high profile member of Urban Meyer’s highly-ranked University of Florida football team, which included quarterback Tim Tebow. The two players could not have been more different, at least not based on their outward behaviors.

As a freshman in Gainesville, Florida, Hernandez’s criminal associations emerged as a public problem. Towards the end of that September he became a “person of interest” in the fatal shootings of two men outside a local nightclub, after he was initially identified as the shooter. Apparently Hernandez and some teammates had been in an altercation with the victims in that club, but months later the case went cold for lack of evidence. Throughout his Gator career, though, coaches were concerned that he was hanging out with the wrong people. Also at some point he caused a minor stir by testing positive for marijuana. Hernandez said he had been using the drug to help him deal with the loss of his father.

The New England Patriots and the NFL

When Hernandez left the university after his junior year in 2010, with a national championship in hand, a number of NFL scouts reportedly voiced their concerns that he seemed to have gang ties, which he had developed in high school. Combined with the Gainesville murder suspicions and marijuana use, his draft stock plummeted from a potential first round selection, which would have reflected his football skills, to the end of the fourth round. In his own words, after his daughter was born in the late fall of 2012, “I can’t be young and reckless… no more.” But by then his moment of self-reflection was too little, too late.

The first documented incident involving Hernandez’s explosive personality came to light in February 2013. Hernandez had joined Alexander Bradley, a close Connecticut friend—who had been convicted of a drug felony—at a strip club during the off-season. That night Bradley lost an eye after he was shot in the head. Subsequently he would allege that Hernandez had been the shooter. Bradley chose not to implicate his friend with the police—in their circles that would be bad form—but several months later Bradley filed a civil suit for damages.

Fifteen months later Bradley was the key witness for the prosecution in Hernandez’s trial for double murder in a July 2012 drive-by shooting. Bradley testified that he was with Hernandez on the night of those murders. Bradley alleged that while they were in a nightclub, the tight end had become enraged after one of the murder victims accidentally bumped into Hernandez causing the player to spill his drink. Reportedly, when there was no apology, Hernandez exploded with anger and had to be escorted out of the club. According to the testimony, Hernandez waited in Bradley’s car for the two men to exit the club. When the victims came outside and got into a BMW, Hernandez instructed Bradley to drive next to them. Hernandez emptied his revolver into that BMW killing both men, wiped off the gun, and threw it away.

In June 2013, a year before his double murder trial, Hernandez was charged with killing his friend, Odin Lloyd, who was dating the sister of Hernandez’s fiance. Reportedly, the two friends had exchanged heated words at a Boston-area nightclub a couple of nights earlier because Lloyd had been talking out of school about the double homicide that Hernandez had been involved in. On the night of what allegedly turned out to be his third Massachusetts killing, prosecutors claimed that Hernandez was caught on surveillance tapes leaving his home with a gun. Also, that night Hernandez had told a witness that he was upset with someone he could no longer trust.

Hernandez summoned two boyhood friends from Connecticut to come to Boston immediately. When they arrived, Hernandez drove them to pick up Lloyd to “discuss” what his friend had said at the nightclub. A little after 3:00 a.m. Lloyd texted his sister that he was with the “NFL…Just so you know.” Not long thereafter Hernandez’s car was filmed on a surveillance video going into the remote industrial area where Lloyd’s body would be discovered.

Hernandez’s Life After Football

After learning about Hernandez’s murder indictment, the Patriots severed ties with their former star tight end, canceled the remainder of his contract, and tried to recover whatever was left of the bonus money they had paid him. Despite the fact that the NFL and the New England Patriots—like most NFL teams—employ security personnel to monitor players and coaches, up until that moment nothing about Hernandez's background, behavior, or public statements was deemed sufficient to place him under special scrutiny. He—with the league’s and team’s assistance—had established a persona in which he was well-liked by friends and teammates, loving to his family, and almost always smiling.

His persona was so well-received that, despite his troubled past and criminal associations, Hernandez received the Pop Warner Inspiration to Youth Award in early 2013. That was only months before he would be indicted for multiple murders that allegedly had been committed in 2012. Despite his persona, less than a week after Hernandez's first indictment, Sports Illustrated easily gathered more than enough information—much of which was in the public record—to publish a detailed expose about Hernandez’s disturbing past.

From that point on Hernandez’s life became a private hell. In September his two friends, who had joined him in “interrogating” Lloyd, were charged with being accessories to murder. In November when Hernandez was deposed in the civil suit for shooting Bradley, the former Patriots football player decided, on advice of counsel, to assert his Fifth Amendment right not to be compelled to testify because what he said might be incriminating. A month later, Lloyd’s family filed a wrongful death action against Hernandez.

In April of 2014, Hernandez’s two Connecticut friends were indicted for murder, instead of being just accessories. The next month Hernandez was formally charged with the homicides in the drive-by-shootings. A year later Hernandez was found guilty of Lloyd’s murder and received a life sentence without parole. Soon thereafter media outlets reported that Hernandez, despite his multi-million dollar annual contract—which included a $12.5 million signing bonus—had run out of money.

In August 2015, Bradley received immunity for any involvement in the Massachusetts double murders in exchange for testifying against Hernandez. That December Hernandez was placed in solitary confinement as punishment for possessing a potentially lethal shank. Later he was moved to a single cell in the general population where he would remain. In April 2017, defying most legal expectations, Hernandez was acquitted of both murders. Apparently Bradley’s involvement in the shootings, his criminal background, and his immunity plea made him an unbelievable witness, especially in a case involving a former New England Patriots star.

Hernandez’s Death and His CTE After-Life

Shockingly, Hernandez was found hanging in his cell five days later with a bed sheet tied around his neck. The official cause of death was suicide, based in large part on three notes he had left to loved ones and friends, which suggested—but did not actually say—he was planning to commit suicide. The lawyer, who had just represented him in his acquittal for the double murders, contended that Hernandez’s death appeared to be a homicide. That lawyer pointed out his former client seemed to be in good spirits, having been buoyed by the not guilty verdicts and the prospect of overturning his murder conviction on appeal.

Less than a month after his death, Hernandez’s conviction was overturned, but it was based on an unusual legal technicality, rather than his innocence. In Massachusetts if someone dies while they are appealing a crime, the conviction can be overturned on equity grounds because the deceased no longer has an opportunity to pursue an appeal. Such a ruling probably would have ended any further scrutiny of Hernandez’s conviction or his football life, except his family had submitted the former player’s brain for testing at Boston University’s CTE center.

Not unexpectedly neuro-scientists found that Hernandez, like almost every other NFL player whose brain has been tested, showed substantial signs of CTE when he died. The surprise was the extent of damage to the brain of a 27-year-old player. According to the New York Times, the CTE researchers reported that it was “`the most severe case they had ever seen in someone of Aaron’s age.”

Hernandez played several years of Pop Warner football before playing in high school. Recent studies have demonstrated that youth football substantially increases the incidence of cognitive impairments and mental disorders later in life, especially for those who go on to play in college and the NFL. While, so far, no other NFL player—who later would be diagnosed with CTE—has been convicted of murder, there are at least four deceased former players with CTE who committed suicide, as well as a number of others who became homeless or destitute and unable to care for themselves. Furthermore, the NFL apparently concluded that the causal association between football and brain-related diseases and mental disorders later in life was strong enough for the league to agree to a settlement with former players, which is now likely to exceed one billion dollars.

It is in this factual context that the key mental health law questions involving Hernandez’s retrospective criminal culpability and the NFL’s civil liability to Hernandez’s family should be assessed. Yet, as will become clear, what may seem to be obvious to the sports media and fans, regarding the presumed health impacts of CTE, become far more complex and problematic in a courtroom.

It Is Unlikely That An Insanity Plea Would Have Been Winnable

Insanity defenses are extremely difficult to win. The standards are unnecessarily complicated and combine legal and psychiatric principles in non-compatible ways. At the same time, most Americans view any insanity defense as being unjust to the victims of serious crimes. As I documented in my book Mental Disability, Violence, Future Dangerousness: Myths Behind the Presumption of Guilt (Rowman & Littlefield, October 2013), defendants with serious mental impairments are much more likely to receive harsher punishments and serve longer sentences than the majority of defendants who have no such conditions.

In Massachusetts, like many jurisdictions, defendants are not criminally responsible for their actions if, due to a mental disease or defect, they were, at the time of the crime, substantially unable to appreciate the criminality or wrongfulness of their conduct, or were substantially unable to conform that conduct to the requirements of the law. In short, they may be found not guilty by reason of insanity if, due to a mental impairment, they could not appreciate what they were doing was wrong or criminal, or they could not control their actions. Unlike most states, however, which place the insanity burden of proof on defendants, Massachusetts places the burden on the prosecution to prove that defendants are criminally responsible beyond a reasonable doubt.

Nevertheless, even in that jurisdiction, successful insanity defenses are rare. This underscores the difference between how the law is supposed to be implemented in theory and how it is actually implemented in a courtroom. There is a well-ingrained popular bias against mental status defenses of any kind. Even soldiers who have sustained post-traumatic stress disorder or other serious mental disturbances in combat are likely to fare poorly when they attempt to assert an insanity defense involving a dangerous felony.

The other major problem Hernandez would have had is establishing a chain of evidence that demonstrated his CTE was the primary reason he murdered his friend. There were too many possible intervening factors to overcome the implicit presumption that almost no one should be found legally insane. If he had used such a defense in the double murders, for which he was found innocent, Hernandez probably would have been found guilty. That would have been a bad trial strategy, regardless of the outcome.

While it is true that the prosecution in the Lloyd killing would have had to prove that Hernandez was criminally responsible for murder beyond a reasonable doubt, as a practical matter this would not be a difficult burden. Hernandez was an elite athlete performing in the NFL, was taking care of his family, was respected by friends and teammates, and there was no evidence that anyone who knew him well, much less a mental health professional, suspected he might have a severe mental disorder. In addition, Lloyd’s murder appeared to be calculated and deliberate, rather than impulsive or delusional.

Once the prosecution presented its case, which initially demonstrated that Hernandez was criminally responsible, it would be up to the defense to overcome that presumption with evidence that would convince the jury or judge that Hernandez was legally insane. Establishing that Hernandez had CTE would be the easy part. The prosecution might even concede that the former player had CTE. The fact that his CTE had progressed so far in a man of his young age would also be significant.

The problem, though, would be establishing that his CTE caused him to commit murder. To begin with, we do not even know, at least not based on empirical studies—and thus can only unreliably theorize—whether the more advanced type of CTE that Hernandez evidently had would substantially increase the incidence of severe mental impairments, and if so, to what extent. Thus, it would be difficult to prove that he had an impairment that would have “substantially” affected his behavior as the Massachusetts statute requires.

The defense’s case would be weakened further because the prosecution could argue that there were many factors unrelated to any supposed mental impairments that may have contributed to his criminal behaviors. For instance, playing football in a locker room culture known for intimidation, aggression, and violence may well have contributed to his willingness to commit murder. His associations with gang members and criminals undoubtedly contributed as well. Even his mother acknowledged that he became very angry in high school after his father died.

In a high profile case before a jury—which Hernandez would have been entitled to—with a highly competent defense team on his side, it is conceivable that the unexpected could happen. It certainly happened with respect to Hernandez being acquitted of the double murders he had been accused of. At the same time, a successful insanity defense, even in Massachusetts, would be an aberration, especially for a man who was viewed as being clearly violent.

Moreover, from a psychiatric perspective Hernandez’s case is weak because the connection between CTE and murder is remote. Even if it could be established convincingly that Hernandez had a serious mental impairment due to his CTE—which would require a difficult retrospective diagnosis to establish—the likelihood that his condition would lead to murder is low. There is little evidence, beyond the fact that he was a murderer, to prove that Hernandez was psychotic and operating under some delusion or compulsion to kill. As mentioned earlier, he was a wealthy, highly functioning elite athlete who had a family and was well-liked. Assuming he was mentally ill or cognitively impaired, which would be difficult to prove, there appears to be little or no evidence that it made him legally insane, and much evidence that it did not.

It Is Unlikely That Hernandez’s Family Will Prevail Against the NFL in Court

Civil liability in a wrongful death action in which the deceased committed suicide is difficult to prove, even though the standard is only a preponderance of the evidence—in other words more likely than not. In Hernandez’s family’s action there must be a strong enough chain of evidence to establish that his playing football in the NFL and his developing CTE as a result was the primary cause of his committing suicide. Logically, it is one thing to prove that the NFL is responsible for harming a substantial percentage of former and current players, but quite another to conclude that the league is legally responsible for Hernandez’s suicide. There is a substantial difference between being able to establish what has happened or is likely to happen to a group of people—all former NFL players—with regard to their developing mental impairments later in life, as compared to proving that Hernandez probably committed suicide because he had CTE. The latter will be nearly impossible to prove persuasively, given all the plausible intervening events and circumstances in Hernandez’s life, not to mention the legal power the NFL is likely to wield.

Suicides are difficult to anticipate or reliably explain because there are many reasons why someone might decide to commit suicide, most seemingly irrational, but others more understandable. In addition, there are a myriad of intervening environmental and social factors that can push someone towards or away from suicide. Moreover, the lawyer who is representing Hernandez’s family in its suit against the NFL initially claimed that his client was probably murdered.

In any event, suicide causation can be very difficult to establish and the questions surrounding Hernandez’s death will not make the family’s burden any easier. More importantly, the fact that Hernandez had CTE when he died does not mean that he had any mental impairment that caused him to commit suicide. As with the argument that the Hernandez’s CTE caused him to commit murder, the causal chain for suicide due to CTE is attenuated, in fact it is even more attenuated.

To begin with, the NFL can argue persuasively that there is no reliable way to establish which of Hernandez’s football experiences from youth football to the NFL, if any, was the primary cause of his CTE. Based on recent studies Hernandez could have been substantially damaged playing youth football, as well as in high school and/or college. After all his NFL career was relatively short compared to the rest of his football career.

Second, even if Hernandez’s family could get past the CTE causation dilemma, they still must prove that his CTE resulted in a mental impairment or impairments that precipitated his suicide. Based on the available evidence, there was no substantial indication, other than the presumed suicide itself, that he had such a condition or disorder, at least not before he was imprisoned and placed in solitary confinement. Solitary confinement, and then being place alone in a cell within the general population for many months thereafter, might have triggered a mental illness or worsened an underlying illness that he already had.

The available evidence supports three additional theories as well: he committed suicide in an ill-conceived belief that he would be benefiting his family, which is why one suicide note said the family would be rich; he became depressed with the thought of spending the rest of his life in prison separated from his family and friends; or he did not commit suicide and was murdered instead. In addition, there were indications that Hernandez might have been gay—including what he said in one of the suicide notes he penned. Under that theory, he became extremely disturbed because his sexual preference might become public knowledge—which would have been potentially devastating for his football reputation—and he continued to be separated from his secret lover.

On October 13th Hernandez's family dropped its suit against the NFL. Ken Belson's article in the New York Times identified two possible reasons why--in addition to the CTE causation problems. First, their lawyer may have been shopping for a better forum. Second, the lawyer may be concerned about the NFL's claim that the league's mega-settlement should provide it with immunity from suits by other former players.

Ultimately, the best hope for Hernandez’s family is that the NFL will choose to settle in order to avoid a trial that could prove embarrassing to the league. Unfortunately for the plaintiffs, agreeing to settle will also create bad optics for the NFL and might open the door for other lawsuits by former players who are not covered by NFL’s mega-settlement. Either way, though, the league’s reputation could take a hit, unless somehow the NFL can persuade the family to agree to a convincing narrative that a wrongful death settlement was reached in order to do the right thing for Hernandez’s little girl.

THE CARNAGE UNDERMINING AMERICAN FOOTBALL AND THE NFL’S ANEMIC RESPONSE: HOW SHOULD THE "GAME" BE CHANGED? ©
By John Weston Parry

Cortez Kennedy’s Unsuspicious Death

When the great Hall of Fame defensive tackle, Cortez Kennedy, passed away at age 48 police revealed that there had been nothing suspicious about his death. That preliminary conclusion could be taken in two ways, both of which would be supported by the available evidence. Nothing suspicious is what tends to be reported about anyone’s unexpected death when no foul play or suggestions of suicide are readily apparent.

A second narrative, though, encapsulates the irony that the premature death of an elite athlete, who had made his living playing professional football for 11 years, did not raise any suspicions. Losing twenty-five years of average life expectancy is not that unusual for linemen who “play” in the NFL. According to the New York Times, Kennedy apparently died alone survived by his mother, stepfather, and daughter, Courtney, who was his only child.

The former Seattle Seahawk perennial Pro Bowl selection “had been experiencing headaches over the past week, his stepfather… said in a telephone interview.” That symptom in a professional football player immediately suggests the possibility of an underlying health problem related to brain traumas. Assuming there will be a thorough autopsy, which would include looking for Chronic Traumatic Encephalopathy (CTE), other brain damage, and any medications or other drugs he might have been taking, it would hardly be a surprise to learn that football contributed to or was the primary cause of his death.

Yes, it also is quite possible that Kennedy died of so-called natural causes like heart failure or a stroke. In all likelihood, though, either of those outcomes would be due in part to his having played a position in professional football that demands gargantuan bodily dimensions, even for a once in a generation player who was lauded as being “nimble.” It has been known for a long time that former NFL linemen have much higher death rates than the general population—meaning, among other things, they tend to die prematurely—even though a majority of them, but certainly not all, are able to afford superior medical care. For those former players who are poor or otherwise unable to properly care for themselves, like Mike Webster for example, their odds of survival become far worse.

Unlike the deaths of Mike Webster, Junior Seau, and Aaron Hernandez, there were no initial hints of emotional or drug problems other than that Kennedy apparently lived alone. In 2015 a former NFL acquaintance, who is now a general manager, described Kennedy as someone “who had a lot of success, was able to protect what he earned… and has done well 15 years after his career [had] ended.” Yet, two years later the former linemen died by himself, before reaching fifty, after experiencing symptoms that are associated with brain traumas. His death may not have been viewed as suspicious, but it seems quite likely that it had certain tragic dimensions.

Aaron Hernandez: Murder and Suicide

Kennedy’s death comes on the heels of the more horrific reported suicide of former football player and convicted murderer Aaron Hernandez, who was a Pro Bowl caliber tight end for the New England Patriots—until he was arrested for conspiring to kill an associate. Unlike Kennedy, Hernandez’s death in prison seems to have been the inevitable conclusion to a violent football life riddled with personal demons. Like most other former NFL football players in recent times, whose lives have ended tragically, Hernandez’s family agreed to have neuro-scientists examine his brain to determine if he had CTE.

Based on his violent and erratic behaviors, which included murder and apparent suicide—and the fact that over 95% of the brains of former football players that have been tested so far have revealed the presence of CTE—the odds seem overwhelming that Hernandez’s brain will test positive as well. The questions that will be much more difficult to answer include: How much did any cognitive impairment Hernandez may have had contribute to his violent behaviors? How much of his violent behaviors were due to his being part of a dysfunctional football culture? And how much were those behaviors due to personality and mental health issues independent of football? Furthermore, did his violent propensities help make him an All Pro football player, and/or did playing football help to make him inordinately violent? It seems likely that a combination of factors contributed to his premature death.

Ultimately all these questions about Hernandez will not be answered completely or satisfactorily. We will never be certain, beyond conjecture and opinion, what was going on inside his head. We will only know what he did or was alleged to have done. Then we can try to explain his actions in the context of what we do know about: the most important people in his life, beginning with his parents and boyhood friends; and his noteworthy childhood experiences, especially related to playing football.

What seems apparent is that Hernandez’s death was much more similar to what happened to Mike Webster and Junior Seau, then to Kennedy. Webster and Seau killed themselves after experiencing emotional turmoil and other gross symptoms associated with severe cognitive impairments. It is likely that such symptoms were caused, or at least accelerated, by football-related brain traumas. Kennedy, by contrast, at least based on the preliminary evidence, probably died of so-called natural causes related, at least in part, to being a huge man playing football.

Tackle Football Is Inherently Dangerous

Each of these high profile deaths confirm what we already know: tackle football is a dangerous sport that carries with it substantially elevated health risks, both physical and mental in nature. One of the most widespread and serious, CTE, cannot be fully diagnosed or treated until after the player dies. As a result, it has become extremely difficult to view the sport as being appropriate for children. Like boxing or cage fighting, tackle football is hazardous to adults who choose to “play” this “sports.” Those risks increase significantly for children and even young adults whose brains, skulls and other body parts are still developmentally immature, making them especially vulnerable to harm.

Assuming Kennedy, like Hernandez, is tested for CTE, it will be a major surprise if it turns out that either of these great players did not have this invasive brain disease. It also suggests that it may be time to more closely examine the alleged psychological oddities that have been difficult to explain about OJ Simpson’s post-football behaviors. Even kids who only played youth or high school football for a few years have tested positive for CTE. Amongst deceased NFL players, however, virtually everyone (97%) who has been tested had this brain disease.

Nevertheless, football players continue to try to deny that they have been concussed or marginalize their symptoms, while the NFL and its teams continue to create circumstances that allow these career and life-threatening deceptions to occur or even conspire to facilitate pretenses to obscure the actual dangers. Many players have admitted hiding their concussion-like symptoms so they could continue to play football immediately. Many more have been silent about their deceptions. According to Washington Post columnist Sally Jenkins, “Pittsburgh Steelers quarterback Ben Roethlisberger is the rare exception who has pulled himself out of a game, but even he [has] admitted… `I haven’t reported things either.’” Justifiable caution often depends on the game situation and its perceived importance.

Players who sit out too often are disparaged and devalued by the label that they are injury prone or gutless, as if getting hurt in a sport that promotes deliberate injuries is a physical or personal weakness, as opposed to an expected consequence of participating in a recklessly violent activity. Yet, many players and coaches still espouse the benefits of violence in the NFL. Washington’s Josh Norman, has made himself the current poster boy for such sentiments, including a fondness for the good old days of criminal-like physical assaults by defensive backs on receivers. The sports media often revel in such stories of on-the-field violence.

Ultimately, notes Jenkins with her inimitable forthrightness, if professional football players “want to calculate the exchange rate between winning a game and how many neurons must be sacrificed to stay on the field that’s their choice.” But by doing so “they have signaled to 4 million high school and college football players that hiding symptoms is what the great ones do….” They also have signaled that on-the-field violence is something to be celebrated and admired. Chris Nowinski, who runs the Concussion Legacy Foundation, has observed that there is an “incredible lack of leadership among NFL players” with regard to reporting concussions and other obvious manifestations of brain traumas. The same may be said about players and coaches failing to condemn this brazen violence.

Similarly, there is a lack of leadership amongst politicians who dare not intervene to ameliorate such carnage for fear of offending football fans. These constituents either: do not care about the carnage, as long as the entertainment continues; or watch the sport, despite having misgivings about what is happening to the players. Admittedly there is a schism within the minds of those of us who love to watch football being played at its highest level of proficiency, yet are painfully aware of the human devastation that results.

Colloquial terms for this dichotomy are compartmentalizing and/or cognitive dissonance, but that tends to marginalize the extent of the social dysfunction. The schism is more akin to what is known, psychiatrically, as Dissociative Identity Disorder (split personality) in which the individual’s world is viewed through two or more separate frames of reference that have no apparent rational connection to each other. Fans who compartmentalize in this way are likely to continue to watch their teams play as long as the game remains compelling. At the same time, they may be relieved when their moral dilemma is extinguished because tackle football can no longer be sustained as a favorite American sport. Unless there are fundamental changes, eventually football, like boxing and cage fighting, will be marketed to a narrow slice of humanity and no longer played in youth leagues, most high schools, and many colleges.

Conclusion

Deflation of the game probably will take years to evolve, maybe decades, but there are substantial signs that diminution is well underway. For the first time NFL ratings are in decline; many established NFL stars are retiring early; more and more children are being encouraged to play other sports; and the best academic high schools have dropped—or soon will drop—football altogether. For most people, especially parents and educators, having children play football is not smart.

As is detailed in The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017), children are the “NFL’s Achilles heel.” Why should minors be allowed, much less encouraged, to play a sport that is known to carry such a high risk of permanent physical and mental impairments and drug addictions? At the same time, the stark reality that tackle football is becoming a sport played almost exclusively by those who are convinced that they have no better alternatives for escaping poverty and other hardships places a stain on the American way of life, much more so than offering a meaningful opportunity for advancement.

In the face of many indications of a sport in trouble, the NFL—like the NCAA, most high schools, most youth programs—has faced this football carnage by implementing a series of anemic safety measures, such as shortening overtimes by five minutes, reducing the number of kickoff returns and hits to the head somewhat, and limiting full contact drills. That is like deciding to make Russian roulette safer by placing four bullets in the gun chamber rather than five.

Fundamental changes should be made to the “game” of football, which will protect players in ways that reflect what is known medically and scientifically about the health risks. Not allowing minors to play tackle football and demanding that adults, who chose to participate in this dangerous sport, be fully informed about the risks are good places to begin. In addition, college and professional teams that derive substantial revenues from football should be obligated to set aside enough money to provide comprehensive health and disability insurance to all participating players. This should include care and treatment for any physical and mental impairments or drug addictions that may reasonably be associated with their having played football.

MARIJUANA FOR ELITE ATHLETES: IS IT THERAPY, A PED, A VICE, A Crime, OR ALL OF The ABOVE?©
By John Weston Parry

Overview

Whether professional leagues, the NCAA, and Olympic organizations doing business in the United States should punish their elite athletes for using marijuana is a complicated question. Currently the NHL is the only major American sports league that refuses to penalize its players for marijuana use, but many members of the National Football League Players Union hope that soon their league will do the same. In the meantime, the NFL's chief medical officer is recommending that both NFL and its players conduct research to determine whether marijuana would be an effective pain management tool. A primary obstacle to any movement towards decriminalization is the federal government, which continues to make marijuana possession illegal for any non-research purpose and is threatening to step up enforcement. In addition, there are deep schisms, both in the health community and public perceptions, about the positive and negative effects of marijuana.

So much marijuana misinformation has been disseminated over the years that it has been difficult to separate facts from beliefs, deceptions, and falsehoods. In addition, like sex and alcohol, the reality that marijuana is a pleasurable experience for millions of Americans, including many minors, has unreasonably inflamed feelings about using the drug for any purpose. Opinions about marijuana consumption have spanned the spectrum from godly warnings about personal and societal doom to its being a mystical and magical elixir that can make people better musicians, poets, lovers, and athletes.

Furthermore, even the scientific and medical communities are torn over the drug’s benefits and risks, sometimes for self-serving reasons. In a recent article about the drug’s potential benefits, a doctor, who makes an unknown portion of his living certifying his patients as being eligible to receive medical marijuana, told the New York Times that: “I really think medical marijuana is the drug of the future…We’re going to find out that it does a lot of [positive] things we already think it can do.”

Another doctor, though, who has a close relationship with the International Olympic Committee’s (IOC) anti-doping efforts told ESPN that “[m]arijuana is an illegal drug… and the most illicit substance in the United States….[which] has no performance-enhancing potential.” He said it also is “associated with motivational problems including apathy, impaired judgment, loss of ambition and an inability to carry out long-term plans.” Furthermore, “chronic” users may develop a “tolerance” that creates “a tendency to increase the amount of marijuana used.”

This stark dichotomy in medical opinions is unlikely to be resolved soon. Current arguments favoring marijuana’s decriminalization seem to gravitate towards two ideas: its negative side effects do not appear to be as bad as existing alternatives, especially the use of alcohol or pain-relieving narcotics; and freedom of choice, except for minors and adults while they are driving motor vehicles.

For elite athletes there are at least two factors that may appear to distinguish their particular situations from those of the general public: (1) a need to control pain safely, since many spectator sports—most notably football and hockey, but many others as well—produce a high volume of chronic injuries; and (2) a desire to significantly enhance athletic performances, which seems to be more a matter of hope than a provable reality.

Marijuana for Pain Relief

Elite athletes using marijuana to control pain from their injuries is not that much different from members of the general public using it to relieve various pains associated with chronic medical ailments. The difference has more to do with how that pain originates. Overall, though, arguments on behalf of allowing marijuana use do not appear to be any more compelling for athletes than other Americans with chronic pain. In fact, for football and hockey players and other athletes, who choose to participate in sports in which skills to deliberately injure one’s opponents are taught and promoted (See, The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017), their chronic pain might be viewed as deserving less sympathy.

A major problem with using marijuana as a pain-relieving agent—both for athletes and the general public—is the scarcity of empirical data and other scientific and medical evidence supporting its benefits when weighed against the risks. The accumulated evidence in its favor is based mostly on subjective anecdotes and conjectures, which too often are propped up by medical opinions paid for by those who stand to benefit from its decriminalization. There continues to be a legitimate scientific debate whether marijuana does an effective job of relieving pain, either generally or for any specific disease or condition.

The argument that it is safer than opiods represents a very low threshold, given that America is in the midst of what has been described as an opiod-abuse epidemic. Many well-credentialed pain relief specialists eschew extended use of any powerful drugs to deal with chronic pain. All prescription medications, including marijuana, have various addictive-like properties and their treatment efficacies are largely unknown—or if known support not using them for that purpose.

Ideally sports are supposed to embrace pure competitions between athletes where no one has an unfair advantage, except access to more money. Based on this often ignored Olympic ideal, however, there is a compelling argument to be made that elite athletes should not be encouraged to compete, if the pain they are experiencing does not allow them to perform at their best without having controlled substances in their blood streams to manage and mask that pain.

Many people involved with sports believe that therapeutic doses of over-the-counter or carefully prescribed pain relievers should be the standard for all athletes, not only in order to protect their health, but also to ensure fair competitions. Elite athletes might be sidelined longer after experiencing an injury without abusing powerful drugs, but their risk of re-injury and long-term impairments would be reduced, making those athletes healthier and more productive, while extending their athletic careers. The dysfunctional mantra that playing in pain or while injured is to be greatly admired [(See, Chapter 1: “Real Men Play Hurt,” in Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield June 2017)], should be resisted and overcome with education and athlete-embraced disincentives to limit such unhealthy practices.

A second major problem with allowing elite athletes to use marijuana to relieve pain would be its implementation, even assuming federal and state laws were changed sufficiently to permit that treatment alternative in our favorite spectator sports. There also appears to be very little, if any, medical justification for allowing the unhealthiest and most frequent type of marijuana use: smoking, as opposed to digesting or perhaps vaping it. Nor is there medical justification for allowing it in non-therapeutic forms or doses.

Thus, what should be permitted on medical grounds would appear to be therapeutic doses in forms that achieve therapeutic purposes, while removing its more pleasurable, addictive, and possible cancer-causing qualities. Does anyone seriously think, however, that the push for medical marijuana would continue to grow without the backing of commercial marijuana interests for whom non-therapeutic doses and the most easily accessible and pleasurable methods of imbibing are where the greatest profits reside?

Marijuana Use to Enhance Athletic Performances

For both elite athletes and members of the general public who want to use marijuana for non-therapeutic reasons, the most compelling arguments embrace: the libertarian notion of freedom of choice; the extremely negative social consequences of continuing to imprison mostly young people for possessing and selling relatively small amounts of marijuana; and the aforementioned argument that it is not as bad as existing alternatives, especially alcohol, opiods, and most other recreational drugs. Rationales for allowing elite athletes to use marijuana for non-therapeutic reasons focus on its potential for improving athletic performances. But are those supposed benefits mostly imagined? And what are the risks?

The anecdotal evidence indicates that there are three major reasons why elite athletes embrace marijuana, beyond providing them with a pleasurable high, or ameliorating chronic pain. Many athletes seem to believe marijuana use can: (1) reduce the time that is needed to recover from injuries; (2) enhance focus when engaging in repetitive tasks such as practice, working out, or long-distance athletic events; and/or (3) increase the ability to be strategically aggressive by reducing fear and anxiety. Nonetheless, such claims are supported by little medical or empirical evidence, and there are substantial questions about marijuana’s risks and efficacy for each of these purposes.

Reduces the Time Required to Recover From Injuries or Strenuous Work-Outs

Most of the evidence that marijuana can speed recovery from strenuous work-outs and injuries derives from the opinions of athletes and health care providers working with athletes. The presumed therapeutic effects might well be a placebo, like many of the substances athletes take with the small hope that it will boost their athletic performances, or out of fear that it might help their competitors. A few years ago Sports Illustrated reported that deer antler velvet had become the drug of choice for a significant number of elite athletes. Furthermore, health and nutrition companies have become rich marketing vitamins and additives for consumption by athletes—elite and not so elite—with promises that these untested substances help athletes perform better. [See, Chapter 5: “Performance-Enhancing Measures: The Good, Bad, and the Ugly,” in The Athlete’s Dilemma: Sacrificing Health for Wealth and Fame (Roman & Littlefield June 2017).]

Recently, a drug known as meldonium, which for years Russian soldiers and Eastern European athletes took to help them recover from strenuous physical effort without any apparent negative health effects, was banned as a performance-enhancing substance. If marijuana actually produces similar recovery effects, how could using it be condoned? According to the IOC, which greatly influences the World Anti-Doping Authority (WADA), marijuana has little or no performance-enhancing qualities. If anything it interferes with achieving peak athletic performance.

Thus, at the 2016 Rio Summer Olympics, while many athletes were banned from participating because they had used meldonium, athletes who used marijuana during the Olympics were given a pass. Admittedly, much of the intense scrutiny surrounding meldonium was caught up in the politics involving the Russian state-sponsored doping scandal. Nonetheless, those political considerations would not explain the official decision to ignore marijuana use, unless most of the so-called WADA experts had been of the opinion that doing so was not performance-enhancing in any significant way.

Enhances Focus and Concentration

For all those people who claim that marijuana increases the ability to focus on certain repetitive tasks, there appear to be many more individuals who have experienced the opposite effect: a substantial reduction in focus, often with a corresponding lack of judgment. Theoretically, such diametrically opposed experiences might be due to situational and environmental factors, as well as an individual’s psycho-neurological make-up. Unfortunately, there is very little scientific or medical evidence that would explain why these perceived differences occur, or if it is even real. One thing is clear, however, when it comes to driving, there is a broad public policy consensus that marijuana use tends to be a major distraction that causes drivers to engage in reckless behaviors resulting in many more accidents.

One might argue that the superior concentration necessary to become an elite athlete should make it more likely that athletes would be able to overcome the recklessness that marijuana seems to generate. Unfortunately, becoming an elite athlete, especially if you are a male, does not seem to reduce recklessness. In fact, if sexual offenses, domestic abuse, and other bad behaviors are any indication, there is good reason to believe that elite male athletes in many sports are no less reckless than other males there own age, and quite possibly more so.

Makes Athletes More Aggressive By Reducing Fear and Anxiety

Ironically, the argument that marijuana allows athletes to be more aggressive by reducing fear and anxiety would seem to support the contention its use promotes recklessness. A good working definition of recklessness is poor judgment associated with reduced inhibitions. Such uninhibited aggressiveness would not be a good thing when driving, dating, partying, or hooking up.

From a different perspective, though, this type of aggressiveness might enhance athletic performances in sports, while entertaining millions of fans. At the same time, that aggressiveness tends to place the health of athletes playing those sports at risk, especially in the NFL, NHL, MLB, and professional soccer, where there are many examples of players trying to deliberately injure their opponents to gain an advantage. Also, in high risk individual sports such as skiing and snowboarding elite performers, and aspiring young athletes who emulate them, already are willing to sacrifice their bodies in order to win competitions, medals and trophies. Does society really want to encourage such aggressiveness and risk taking by permitting those athletes to use marijuana for that purpose?

Conclusion

The most persuasive argument supporting marijuana use by elite athletes is freedom of choice. Marijuana is a vice that adults should be allowed to choose with certain limitations. Criminalizing its use—except for discrete penalties for giving it to minors or being under its influence while driving—causes far more social problems than it solves. At the same time, based on existing medical and scientific evidence, there are no compelling arguments that elite athletes should be treated differently than anyone else with regard to how marijuana is criminalized, decriminalized, or regulated.

Ultimately, until what we can document about marijuana changes substantially, professional leagues, the NCAA, and Olympic organizations—and those in government who are supposed to hold these sports organizations accountable—should apply the same standards to elite athletes as everyone else. There should be no specific penalties targeting athletes, and no special preferences either. What the NHL is doing by leaving it to governmental authorities to handle is a sound policy.

Performance Enhancements: Legal, Illicit, and Illegal©
By John Weston Parry

Ethics regarding performance enhancements in sports is becoming more complicated as technology and medical advances alter playing fields and athletic environments. Unfair competitive advantages in athletics may have nearly as much to do with access to financial, technological, and other valuable resources that other competitors do not have access to, or have less of, than with cheating or otherwise breaking the rules. Moreover, substances that have been banned because they have been perceived as being competitively advantageous or unlawful, like human growth hormones, meldonium, or marijuana, may have substantial health benefits when used appropriately.

Medicinal, Technological, and Financial Advantages

In almost every sport the equipment and technology has become better and more expensive, meaning that athletes with access to money can play their sports at a higher level of proficiency than in the past, minimize certain types of injuries, and shorten their recovery times. More importantly, the corporations that make, promote, and sell new equipment and technologies increase their profits each time they implement these advancements.

Protective gear for goalies, catchers, and football players, aluminum bats for baseball players, new clubs and balls for golfers, energy-producing running shoes, friction-reduced suits for swimmers and ice skaters, special gloves and shoes for football players, and space-age rackets and strings for tennis players, have fundamentally altered the athletic competitions in these sports, not always for the better. Some equipment provides superior protection for those who play contact sports, but most of these enhancements dramatically improve performance as measured by physical outputs.

In golf, for example, its hallowed traditions and the commercial benefits of promoting substantial equipment changes, often clash. Unlike altering the rules to accommodate a player with a disability, however, which in the case of Casey Martin was viewed as golf sacrilege (See the essay on the diversity page), making greater changes to boost profits is another matter.

Since the 1960’s when golf became a television favorite, radical changes have been permitted, which have made the clubs that golfers now use unrecognizable from the past. Remarkably, the most publicized equipment-related controversy in golf has focused on how some players held their newfangled long putters. Years after those putters were first introduced, the PGA passed a rule change to bar—starting in 2016—professional golfers from anchoring golf clubs against their bodies to minimize a psychological condition called the “yips,” which negatively affects putting accuracy, especially for older players.

For many people—but apparently not the one’s making the ultimate decision—this seemed to be an arbitrary way to re-establish tradition, which long ago had been forsaken in the name of better equipment and larger profits. Drivers with striking surfaces the size of softballs, composed of space-age materials, have made Jack Nicklaus’ and even Tiger Woods' prodigious drives of yesteryear look pedestrian. Utility clubs for almost every type of shot have made what is carried in a professional golfer’s bag almost as important as shot execution. The distinction between what is permitted and what is banned with respect to equipment changes is largely governed by money. Because there is minimal commercial advantage in allowing anchored putting to accommodate a problem related to a psychological condition or aging, tradition was deemed to be more important for the game than providing an accommodation for the minority who benefited from using this unorthodox putting stroke as a way to combat the yips.

In all of our favorite spectator sports scientific advances in data gathering, medicine, biology, and psychology have revolutionized training methods, treatments of injuries, and other important aspects of athletic competitions. The availability of relevant data, almost instantaneously through a variety of electronic gadgets, provides an immediate feedback loop in order to easily measure, analyze, and compare athletic progress and the success of various training methods. In addition, sports psychologists are now commonly employed to help athletes perform better under pressure and to more accurately visualize the mechanics of reproducing a perfect or near-perfect result. Fees for such psychological assistance can cost upward of $200 an hour or $10,000 a year.

Expensive special labs and training centers also have been established to help elite athletes improve their form and otherwise maximize their performance potentials. Some businesses focus on nutrition and diet, while others provide athletes with enhanced instruction, especially for the most prized, valued and lucrative positions in sports, such as pitchers and quarterbacks.

Similarly, many college players who hope to be drafted into the NFL now attend individualized training programs to improve their times and skills for workouts and drills required at the league’s Scouting Combine. This can be a relatively costly investment that only some of the most heralded or wealthy athletes can afford. They may not be better football players after having undergone such skills training, but are likely to be perceived as being better. Thus, they command a higher draft position and make more money.

Furthermore, various surgical procedures have allowed athletes to recover from what in the past would have been career-ending injuries. Tommy John elbow surgery has been so successful that many pitchers who have had this operation are convinced that their performance actually improved after sustaining their injuries. The concern is that because of the perceived improvements certain medical practitioners have been performing surgeries on pitchers with relatively healthy elbows. Unfortunately, unnecessary surgeries are no longer rare events in American society, for athletes or non-athletes alike.

Technological and medical advances continue to produce new performance enhancing substances, methods, and procedures that have minimum health risks, yet allow athletes to improve their performances or to recover from their injuries much sooner and better than in the past. If in addition, however, they are viewed as providing competitive advantages, no matter how slight or scientifically undocumented, these drugs and procedures may be banned or restrictively controlled in ways that interfere with health and proper healing.

Unfair Competitive Advantages and Other Forms of Cheating

The whole notion of cheating has been transformed in the post-modern world, especially as expressed in our most popular sports. Honesty is no longer expected or required, certainly not all the time. Individuals fudging their taxes, politicians reinventing the truth, and corporations exaggerating the benefits of their products and minimizing the risks are often perceived as expected distortions that should escape serious criticism, much less penalties or punishment. These offenses tend to be greeted with knowing smiles or embraced with a joke.

Deceptions have become commonplace in athletics as well. Phil Taylor explained in Sports Illustrated, that “[w]e have …such a tolerance for cheating in sports that simple rule-breaking doesn’t get more than a yawn….” Those teams and players who do not commit them are often criticized for being strategically deficient and not playing to win.

At the same time, too often the idea of a person’s word being his or her bond has been replaced with plausible deniability. As long as it cannot be proven, it did not really happen. And should there be substantial proof of a lie, smearing those who uncovered the truth or creating a bigger lie may be employed to try to deflect attention away from any bad publicity.

The problem in sports—as well as in the rest of society—is that these lies add up and undermine the moral fibers of our nation. Recidivist offenders and their apologists have lowered the bar for the expected behaviors in athletics. Today instead of requiring everyone to play by the rules and condemning all those who fail to meet that once unambiguous standard, we tend to select a relatively few scapegoats for particularly harsh treatments, while the the vast majority of the cheaters and their facilitators go unscathed.

In baseball, for example, Alex Rodriquez, Barry Bonds, and Roger Clemens became the designated pariahs, much like Lance Armstrong in cycling or Maria Sharapova in tennis. It is likely that their superlative athletic accomplishment will never be fully appreciated or recognized again, certainly not on a national stage. Yet, the evidence also strongly suggests that the use of performance enhancing drugs was—and continues to be—widespread in baseball and most of our other popular spectator sports.

Major League Baseball and its team owners were well aware of the problem, but chose to look the other way for as long as possible under the cover of plausible deniability. This self-serving approach for dealing with performance-enhancing substances--which in December 2016 resulted in former Commissioner Bud Selig being inducted into the Hall of Fame, despite his direct responsibility for baseball's tarnished legacy—appears to be prevalent throughout much of the sports world, including the NFL, NHL, NBA, Olympic sports, tennis, and golf.

To a large extent, at least from the points of view of most elite American athletes, what remains important is that everyone who competes with them is governed by the same rules and enforcement is even-handed. At the same time, in sports with referees, an athlete is now expected to do everything possible to stretch the rules short of blatant cheating. In refereed sports the athlete becomes part of a fraternity, which views referees as agents of the power structure. Pretending to have been fouled, for example, most notably in soccer--but many other sports as well—is acceptable and often commended as being smart athletically because those players who succeed at this ruse are viewed as cheating the referees, rather than their fellow athletes.

Taking banned substances is going to be condemned as cheating, but usually only if the athlete is caught. Because so many athletes do cheat in that way, however, it often is considered bad form to “rat” out a fellow athlete who is using banned substances, particularly if he or she is a teammate. That is something for the authorities to do.

Furthermore, athletes tend to view what should be banned differently than do the anti-doping authorities. Stimulants, for example, such as amphetamines in baseball or Adderall in football, have been viewed more as enhancements that every athlete can use relatively safely without creating an unfair competitive advantage. In addition, drugs that speed recovery from injuries may be performance-enhancing, but they also may be medically essential for effective healing. Also, marijuana remains a banned substance, even though it is the preferred method of dealing with pain for many athletes, as compared to using far more dangerous opiods.

Most athletes are well-aware of how various games should be played and competitions conducted. What they view as cheating often is substantially different than what fans, the media, and anti-doping authorities believe. Where there seems to be overwhelming agreement among the American media and our Olympic athletes, though, is that state-sponsored cheating should be punished more harshly than the more widespread free market variety, especially if the government authorities involved are the Chinese, or even worse the Russians.

Yet, for years the IOC and WADA allowed Russian government-orchestrated doping practices to continue without conducting a thorough investigation, much less levying sanctions against any Russian sports organizations or officials. Instead, the Russians were rewarded with the Sochi Winter Games. On the other hand, the United States has been blackballed from becoming a host Olympic nation since 2002 because the IOC thought it was entitled to a larger share of the American television revenues. Ultimately, though, both the IOC and WADA have been ineffective in curtailing sports doping globally because as the the New York Times observed in condemning the Russians, "[t]he culprit is the culture of winning at any cost," and that culture makes sports entertainment extremely valuable, both domestically and globally.

That long-standing conflict between enforcement and revenue generation revenues is manifesting itself once again. The USOC and U.S. anti-doping officials (USADA) are in direct conflict about the advisability of levying further sanctions against Russian athletes and the Russian Sports Ministry. The USOC, which is trying to obtain the Summer Olympics for Los Angeles in 2024, is actively discouraging Congressional involvement, arguing it should be handled by the IOC. USADA, on the other hand, is leading an orchestrated assault on state-sponsored doping before a House subcommittee presenting American athletes as the unfortunate victims of this type of cheating. (See, Part II, Chapters 5-11 and "Conclusion: Protecting Athletes' Health in Cartel-Governed Sports," in The Athlete's Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield, June 2017)

Health-Related Pathologies
In America’s Favorite Spectator Sports©
By John Weston Parry

Football is not the only American spectator sport that has spawned health-related public controversies and scandals involving its athletes. Similar health pathologies infect baseball, basketball, hockey, soccer, Olympic competitions, and tennis. Powerful, selfish, and sometimes corrupt organizations run our most popular spectator sports without meaningful oversight. These sport cartels include the National Football League (NFL), Major League Baseball (MLB), National Basketball Association (NBA), National Hockey League (NHL), Major League Soccer (MLS), the National Collegiate Athletic Association (NCAA), the Professional Golfers Association (PGA), the International Olympic Committee (IOC), the Fédération Internationale de Football Association (FIFA), International Association of Athletic Federations (IAAF), the International Tennis Federation (ITF), and the World Anti-Doping Agency (WADA).

Too often governments and politicians treat sports cartels as if they exist to serve the public interest, rather than to generate revenues, wealth, and fame for their owners, members, or organizers. As a result, almost no one is protecting the health of elite American athletes who participate in these sports—often recklessly and sometimes irresponsibly—for their own aspirations of wealth and fame. Nor do the cartels look out for the interests of younger athletes who are trying to become elite. Instead, these sports cartels and many of those individuals who run sports for elite young athletes perpetuate environments in which abuse, risk-taking and cheating is implicitly condoned, and even promoted and covered up. Thus, while there has been an extraordinary increase in the popularity and income generating capacities of these favored sports, it has come with a steep price for the athletes who "play" them, as well as local communities and the American public who pay for them.

Baseball, basketball, hockey, soccer, Olympic competitions, tennis, golf, lacrosse, wrestling and other professional and intercollegiate sports have had well-publicized health-related transgressions, controversies, and scandals. Football, however, has been the exemplar and preeminent culprit. More so than any other American sport, football—in the hands of the NFL and NCAA—promotes a culture of reckless and even intentional harm, domestic abuse, and other unhealthy attitudes and practices obscured by various forms of deceptions and denials. Former NFL Commissioner Paul Tagliabue still tries to rationalize his role in leading the NFL's cover up of brain injuries for 10 years as simply engaging in "some things... that were not positive." And in many ways he is more principled than his successor.

Unfortunately, the risk-taking, neglect, irresponsibility, recklessness, and cover ups extend to athletes in all of our most popular spectator sports. As Adam Kilgore wrote in the Washington Post , one of the primary reasons college athletes tried to unionize was to address "medical mistreatment from coaches or schools." Instead of providing money and extensive services to former college athletes, who have been brain-damaged competing in football and other sports, the NCAA provides "monitoring that may [or may not] be covered by their health insurance."

Making matters worse, there is little or no accountability when teams or athletic departments place the health of their athletes in jeopardy. For instance, Kilgore reported that no public reprimands, much less penalties, were meted out after three Oregon football players had to be hospitalized when "an arduous off-season team workout left them with... a condition that causes muscles to break down and the resultant fluid to leak into the bloodstream."

Both the NFL and NHL, like big tobacco, have dealt with health problems facing their athletes by either denying any danger exists or arguing that the science documenting those dangers is flawed or incomplete. The fact that so many former athletes in both those leagues have become incapacitated is viewed as far less important than protecting team owners from legal liability. As noted neuropathologist, Ann McKee, of Boston University stated in April 2017, by trying to manipulate, dispute, and misrepresent science these professional leagues are likely to "cause lasting damage to ongoing research on the long-term effects of repetitive trauma and on chronic traumatic encephalopathy."

What befalls so many elite American male, and increasingly female, athletes—and many, many more children and wannabes—can be a debilitating paradox. The overwhelming desire to do what is necessary to boost their performances leads athletes towards: constant pain, injuries, and reliance on illicit and potentially harmful drugs during their athletic careers; and poor physical and mental health, disability, addictions, and even premature death afterwards.

Too often these health-related pathologies are incorporated into an athlete’s path for success: playing with pain; using drugs to mask pain and speed recovery; relying on drugs and other risky medical interventions to enhance athletic performances; and enduring repeated concussions and other physical or mental impairments that have long-term and sometimes catastrophic health consequences. Furthermore, the treatments, rehabilitation, and disability benefits that these impaired athletes need to become whole again—or at least to improve—typically are inadequate or nonexistent once they leave or are jettisoned from their sports. Unless they have the independent means and self-awareness to obtain such services themselves they can find themselves in devastating predicaments, even leading to homelessness, suicide, and jail.

Many of the most unconscionable stories originate in professional football, where careers tend to be shorter and debilitating injuries more prevalent. At the same time, these human tragedies can befall American athletes who participate in most of our favorite spectator sports. The problem for many former elite athletes is that they lack the financial acuity, knowledge, and/or temperament to thrive economically without large pay days from their athletic accomplishments. Once their athletic careers come to a close or are substantially diminished, many are in trouble. This is especially problematic if they become addicted to painkillers, dementia sets in, or they otherwise become mentally or emotionally impaired, or even helpless.

Surprisingly, impoverishment is no idle possibility, even for the relatively few elite athletes who have successful professional careers. Despite greatly increased salaries, even star athletes can spend all or most of their assets indiscriminately leaving them with little or no savings. Unfortunately, sports stories of financial mismanagement by professional athletes continue to occur on a regular basis. Furthermore, the financial prospects of many elite or not so elite athletes, who never have professional careers or ones that are cut short by injuries or modest or waning talent, tend to be much worse, especially if they are not well-educated. Poverty and disability tend to be closely linked. These life challenges often feed off of each other in extremely unhealthy ways.

The toll on these athletes well-being can be enormous. Teams, leagues, and sports organizations typically push depleted athletes out the door. On the dark side of fame, caveat emptor, free market principles, good and bad fortune, and charity largely determine whether many former athletes live in relative or extravagant comfort or suffer the worst consequences of extreme pain, disability, dementia, substance abuse, and/or addictions. Colleges, universities, professional leagues, and Olympic organizations do very little to protect the health of athletes in their prime, or to help former athletes in need thereafter.

Most of these negative health outcomes are pathogenic in the sense that they involve destructive practices and behaviors, which are spread like an infectious disease among elite athletes, their teams, leagues, and sports organizations; and those youngsters who try to emulate elite athletes. Such dysfunctions breed in locker-rooms and other private places where athletes gather and transparency and dissent are strongly discouraged. Pathologies are allowed—and often facilitated—in large part, because sports leagues, organizations, and federations continue to be far more concerned with wealth and the wealth fame begets, than promoting or ensuring healthy lifestyles for their elite athletes.

In a similar vein, too often youth sports—especially those targeting potentially elite athletes—are being run by people whose primary objective is to find ways, both legal and illegal, to line their pockets. In this greedy, unregulated environment the health of young athletes tends to be an afterthought. The organizations that run football programs for children have largely ignored the dangers of concussions and other head traumas until just recently.

In January 2017 USA Football indicated that it would finally take actions to change the rules to make the game marginally safer for young athletes. Unfortunately, this may be too little too late, since the medical evidence strongly suggests that tackle football should be banned altogether, at least until high school, and over many years millions of children have been damaged already. As a result, Pop Warner Football is being sued, like the NFL and NCAA, by former young players who have been brain damaged. (See, Chapter 16: "Children Playing Football: The NFL's Achilles Heel," in The Athlete's Dilemma: Sacrificing Health for Wealth and Fame (Rowman & Littlefield June 2017.)

ATHLETES' HEALTH AND MENTAL HEALTH IN JEOPARDYAGONY IN THE SHADOWS OF VICTORY© ​

ATHLETES' HEALTH AND MENTAL HEALTH IN JEOPARDY

AGONY IN THE SHADOWS OF VICTORY©