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NFL’s partnership with CDC on head injuries is straight out of big tobacco’s playbook

New England Patriots tight end Rob Gronkowski
David Butler II-USA TODAY Sports
New England Patriots tight end Rob Gronkowski is hit by Jacksonville Jaguars strong safety Barry Church during the second quarter in the AFC Championship Game. Gronkowski has been cleared to play in the Super Bowl.

Earlier this week, Dr. Brenda Fitzgerald resigned as director of the Centers for Disease Control and Prevention following a report in Politico that she had bought stock in tobacco, drug and food companies while leading the agency.

President Trump appointed Fitzgerald to the CDC post last July. At that time, many public health officials raised concerns about a government-corporate partnership Fitzgerald had struck with Coca-Cola to fund an anti-obesity campaign in Georgia during her tenure as that state’s health commissioner. Soft drinks are believed to be a major driver behind the current obesity epidemic, but the campaign focused more on exercise than on diet.

Health officials worried that Fitzgerald would continue to let corporate interests influence public health messages once she got to the CDC.

Such concerns regarding the CDC didn’t start with Fitzgerald’s tenure at the agency, however. Nor do they end now that she’s left. As I reported here in 2015, the CDC Foundation, a nonprofit organization created by Congress in the mid-1990s, takes money from companies with major stakes in decisions regarding health policy.

And that has raised some serious conflict-of-interest questions.

A timely question for Super Bowl weekend

In an article published earlier this week, Dr. Michael Joyce, a writer-producer for the Minnesota-based HealthNewsReview.org, raises a timely question this Super Bowl weekend about the influence on the CDC of one particular corporate entity: the National Football League.

Joyce points to a recent paper in Injury Prevention that looked at the NFL’s research and educational collaborations with the CDC. The authors of that paper concluded that rather than following the lead of such public-spirited outside groups as the Bill and Melinda Gates Foundation, the NFL is using its partnerships with the CDC to promote its own self-interests, much like the tobacco and pharmaceutical industries have done in the past.

“The league has a record of promoting unsound research, both to downplay the risks of brain trauma as well as to oversell the potential for making tackling safe,” write the papers authors, Kathleen Bachynski, a postdoctoral fellow in medical humanities and ethics at New York University’s School of Medicine, and Daniel Goldberg, a bioethicist at the University of Colorado. “It has sought to purchase credibility through its partnerships with respected institutions, using its work with public health agencies to defend itself in the public sphere and to advance the league’s preferred framing of sports-related [traumatic brain injuries].”

Important ommissions

As Bachynski and Goldberg discuss in their paper, the CDC’s website hosts a video featuring NFL Commissioner Roger Goodell. Bachynski gave this description of the video in a commentary she wrote for Stat:

[Goodell] spends much of the video promoting the NFL’s efforts to address brain trauma in sports. He discusses concussions in the context of a broad range of youth sports, without once mentioning that tackling is associated with particularly high risks of repetitive brain trauma.

Goodell further contends that NFL athletes “receive the most up-to-date medical information on all issues including concussions, and I believe they receive the best medical treatment in all of sports, and probably the world.” The video’s implication that the league prioritizes the health of its athletes will no doubt come as a surprise to former NFL players. The NFL has previously acknowledged that about 1 in 3 retired NFL players will go on to develop long-term cognitive problems at younger ages than the general population. The league also notoriously spent years denying the risks of brain trauma associated with tackle football, and has recently come under fire for promoting tackling programs based on questionable evidence.

Bachynski and Goldberg also reviewed an educational concussion poster and various fact sheets that the CDC has produced with funding from the NFL and other national sports governing bodies:

The CDC handouts focus on concussions, but they don’t mention that sub-concussive trauma can contribute to cumulative brain damage, even if player collisions don’t immediately cause symptoms. The fact sheets also ignore evidence that even the best player education or post-injury concussion management cannot prevent the inherent risks of repeated brain trauma associated with tackling. These omissions suggested that not only were the NFL and other league logos emblazoned on this CDC material, but the content of the fact sheets was influenced by the sports leagues’ perspectives.

Based on our research, it appears that the NFL is trying to gain credibility by working with respected public health agencies like the CDC and is using this work to promote its viewpoint that it is possible to prevent brain trauma in a full-body collision sport like football.

Diverting attention

As Dr. Sean Engel, a sports medicine physician at the University of Minnesota, points out to Joyce, we still have a lot to learn and understand about subconcussive trauma.

“Repetitive, subconcussive trauma is certainly a concern,” says Engle, “but there’s still no consensus on whether it leads to brain damage.”

“This research is relatively new by medical and scientific standards,” he adds. “We need more data. Until then you can sort of understand why the approach to athletes in collisions has become ‘when in doubt, get them out.’ That approach wasn’t around 10 to 15 years ago.”

Still, as Joyce asks, is the NFL trying to manufacturer doubt on this issue? “It’s certainly a strategy we’ve encountered before,” he notes, pointing to Coca-Cola’s attempts to divert the public’s attention from the role of soft drinks in obesity and other chronic diseases.

“Although it seems obvious,” writes Joyce, “remember what’s at play here:  When your product is proven to be harmful, how do you divert attention from those harms?”

“It’s a question worth pondering as over 100 million of us watch the Super Bowl this weekend,” he adds. “The NFL makes billions (over $13 billion in 2015) in revenue. It’s not hard to enjoy the athleticism of these talented athletes. What may be harder is admitting the oxymoron that it’s a ‘violent game.’ That the NFL’s response to this has been inadequate and inconsistent. When it comes to public opinion regarding head injuries, the NFL has a lot at stake.”

FMI: You can read Joyce’s article at HealthNewsReview.org. Bachynski and Goldberg’s paper in Injury Prevention is behind a paywall, but you can read Bachynski’s commentary on the findings at Stat.

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