I’m writing this after watching former NFL quarterbacks Boomer Esiason and Dan Marino talk on TV about the upcoming Super Bowl 50. My ambivalence is palpable.
Normally, I would be excited about the game. I was friends with Carolina Panthers Head Coach Ron Rivera back in college.The game is being hosted by my local metropolis. I’m friendly with the team CEO and I’m glad to see Jed York’s triumph in bringing the game here to the San Francisco Bay Area. There’s also a 39-year-old quarterback in the big game, proving that life in Silicon Valley doesn’t have to end at 27. Not to mention that the Super Bowl affords us the world’s greatest display of tattoo art, notwithstanding what the NBA’s Chris Anderson and JR Smith have to offer.
But as I watch these guys talk football, all I can wonder is which one is the next CTE ticking time bomb? Which one took just a few too many hits to the head and is thus headed for a miserable last 5-10 years of life, filled with pain, memory loss, emotional problems, suicidal thinking, violence and heartache.
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If you haven’t heard of it, CTE is short for Chronic Traumatic Encephalopathy. This condition’s telltale sign is a buildup of tau, an abnormal protein that destroys brain cells in areas that control memory, emotions and other functions. And it appears to be the proximal cause of a shocking number of cases of brain damage and death among pro athletes and even younger ones.
In any given year, there are about 1,700 NFL players. Research has suggested that as many as 96% of former players tested have shown signs of CTE. I’m no math genius, but that’s almost all of them. There are over 1 million high school football players and over 90,000 college football players. That’s a lot of potential brain damage.
Frank Gifford in his good days
The list of football players whose lives have been ruined by CTE reads like the Hall of Fame roster: Stabler, Seau, Gifford, Dorsett, Marshall. These men and so many others are among the 4,500-plus plaintiffs in a class-action lawsuit filed against the NFL for failing to protect them, and worse, concealing, that there is a link between playing football and brain damage. As part of the settlement reached in August, the NFL did not admit to wrongdoing, according to an ESPN story. Dead? No, they’re just resting! Headaches? Nah, they’re pining for the fjords! It’s unconscionable. I can’t imagine how many more players might have participated in this lawsuit if they weren’t dead already. Many players are are still too young to know they should be involved…yet.
The rising tide of awareness around the CTE phenomenon has all but ruined football for me. It’s hard to say that because I am a huge sports fanatic. Pro, college, baseball, basketball, football, soccer–it’s all good. As a kid, the TV in my home was all sports all the time. I was one of those daughters who embraced it, along with my sister. Sadly, she has grown up to be a Yankees fan. It breaks my heart. Go Giants!
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But after hearing about the endless parade of football players whose life has been destroyed by continual head injury, which is most prevalent and studied in football, it pains me to watch. I’ve become someone who loves the sport, hates the game. And when I think about what kids are doing to themselves by playing football and other sports during their teen and pre-teen years, the healthcare person in me wants to cry. We used to think that football players would have high healthcare costs later in life due to arthritis and orthopedic breakdowns. The CTE crisis makes me think that they should hope to be so lucky.
Parents are getting the message. In a recent survey by PRRI, 31% of people said they would not allow their young sons to play football, up from 22% with that view one year ago. The sport is becoming populated more and more with kids from less advantaged families. They are willing to bet that the potential for getting a better life through college athletic scholarships or a chance at the NFL may outweigh the grim alternatives. But either way may turn out to be grim, it appears.
Normal brain on the left, Advanced CTE on the right
Something different clearly needs to be done to better protect athletes from head injuries. For what it’s worth, football is not the only culprit. The risk is just as bad or nearly as bad in soccer, basketball volleyball, even cheerleading! On a per capita basis, girls actually experience more concussions than boys. But there are more athletes who play football and there are many who make a career of it, amplifying the head impact. The average pro football player takes over 1,000 blows to the head every single season. Your job may be tough, but you’re probably not getting knocked on the head 3 times a day. By the time a child athlete has made it through college, it is likely that he or she has sustained numerous concussions during their brain’s formative years.
Yes, we can adopt rules against contact tackles in practice or against throwing your cheerleaders in the air above a hard gym floor. All this must happen. But with pressure to play from coaches and drive to play from athletes, there has been too little activity to mitigate risk, particularly in youth sports.
Fortunately, healthcare innovators have a role to play in screening, diagnosis and patient education. Numerous companies and products are emerging that measure force against the head (in helmets, mouth guards). Others, such as ImPACT, provide cognitive and medical testing that is objective rather than based solely on the best guess of the trainer, or worse, the athlete who just wants to get back in the game.
The science of CTE is advancing. Researchers at UCLA are testing a new brain scan that uses a radioactive marker to identify the signs of CTE in the living. That’s great for the NFL, perhaps, but impractical for use on a widespread basis among young people playing football in high schools and colleges across the nation. We need faster and cheaper tools, though the UCLA efforts may lead us there. This should be a call to action for entrepreneurs.
Since researchers think they know the culprit—tau protein—this is also a great opportunity for the biotech community to develop a cure, or at least a method of limiting the progress of disease. Whatever biotech company comes up with this will have their name emblazoned on the door of every sports hall of fame.
This is also a rich opportunity for consumer education and engagement and training in self-care. We must teach young athletes and their parents about the cost of ignoring the danger of head trauma. This has to start in the Pee Wee leagues. We have to make it acceptable in sports to be perceived as a badass even when a player decides to take care of him/herself, and incentives to preserve one’s long term career rather than going back in the game to be “tough.” Chris Borland, a 24-year-old San Francisco 49er who had a successful rookie season playing linebacker, chose to retire, and forgo millions in future earnings, rather than take further head injury risk. He made that decision after doing his homework on the risk of CTE. It will be interesting to see if others follow suit as they become more informed.
Towards this end, a few health systems have sought to make a difference. Mayo Clinic has experimented with remote diagnostic tools on the sidelines. Dignity Health’s Barrows Neurological Institute has developed an extensive program, Brain Book, which is mandated for all high school athletes in Arizona (not just football players). The program requires regular youth athlete education and screening for concussions in an effort to make the seriousness of the issue real and tangible to kids and their parents. Under the direction of Dr. Javier Cardenas, who developed Brainbook, Barrows also offers telemedicine consultation where needed. This is particularly important since so many schools can’t afford sideline trainers or even coaches who truly understand the issues. The program has had tremendous success in increasing consumer (aka high school kid) awareness and now other states are considering it.
Dr. Javier Cardenas
I helped Dignity work on a growth plan for this program. While working on this project, I was particularly taken with a conversation I had with the lead trainer of a leading NFL team. He told me that the NFL is really worried that the concussion crisis will ultimately destroy football as parents refuse to expose their kids to the risks. “No high school football means no college football. No college football means no pro football,” I recall him saying. So if the sport is going to survive, much less thrive, we have to help the kids at the beginning of the funnel become aware and willingly engage in staying healthy for the long term.
As the crisis unfolds and the facts become clear, it seems to me that the football community (and that of other organized sports) should be more worried and a hell of a lot more proactive about finding the solutions that engage and reward athletes for being more aware and self-protective. We in healthcare are constantly harping about teaching consumers to question the status quo and their doctors by getting informed and speaking up. This is a great population with which to start. I hope other health systems join Dignity Health and Mayo in this mission. If you’re a healthcare organization worried about the future healthcare costs of high-risk consumers, this is a great target audience for your efforts.
Football’s best friends
Our sports heroes are falling fast and, as a fan, it’s terrible to watch the carnage in prime time, beer in hand. It’s getting harder and harder to cheer when I hear the crunch of helmet against helmet. We need more than a Hail Mary pass here. For the sake of our kids, America’s future adults, we need more action. The healthcare industry has a role to play in making sports safer and applying our scientific minds to the challenge of engagement, education, diagnosis and treatment of CTE and related conditions. Let’s help carry this ball.
Lisa Suennen is Managing Partner at Venture Valkyrie Consulting, which provides advisory services to venture capital firms and healthcare companies. Lisa was previously a founding partner at Psilos Group, a healthcare venture capital firm. Prior to that she was a successful healthcare entrepreneur. Lisa is a Board Member of Beyond Lucid Technologies and Pokitdok and the Dignity Health Foundation. She is on the advisory boards of Qualcomm Life, CHCF Innovation Fund, Accelevate, Inc., Health XL, and Sanofi’s Integrated Care Group. Lisa teaches healthcare venture capital at the U.C. Berkeley Haas School of Business. Lisa healthcare investing blog can be found at www.venturevalkyrie.com.
Photo: Getty Images (Ezra Shaw)
