NFL & CTE: Super Bowl Distraction or Dangerous Downplaying of Brain Disease?

As 125 million Americans prepare to watch the Super Bowl on Sunday, the NFL and NFL Players Association (NFLPA) may hope viewers focus on the athleticism and excitement of the game, rather than the long-term neurological consequences for the players. But for those who have witnessed the devastating effects of chronic traumatic encephalopathy (CTE), the spectacle is a stark reminder of a growing public health crisis.

The link between repetitive head impacts and CTE is no longer a matter of debate. In March 2016, Jeff Miller, the NFL’s senior vice president for health and safety, acknowledged “certainly” a link between football-related head trauma and CTE, marking the first time a senior league official conceded the connection. This admission came during a roundtable discussion on concussions convened by the U.S. House of Representatives’ Committee on Energy, and Commerce. However, the understanding of CTE and its causes continues to evolve, and recent research has sparked controversy regarding the factors contributing to its development and the interpretation of suicide rates among former players.

My personal experience underscores the gravity of this issue. My husband, Ralph Wenzel, played in the NFL for seven seasons. He began experiencing memory lapses and cognitive problems at just 54 years old, and was diagnosed with early signs of dementia by 56. He entered memory care at 63, and an autopsy later confirmed he had CTE. His case, sadly, is not unique. More than 90% of the 376 former NFL players’ brains studied at Boston University have been identified as having CTE, a degenerative brain disease strongly associated with dementia.

For years, the NFL has faced accusations of suppressing awareness of CTE, employing tactics reminiscent of those used by the tobacco industry to downplay the harms of smoking. This history casts a shadow over recent research, particularly a study from Harvard’s Football Players Health Study (FPHS) examining suicide rates among NFL players. The study, which has received funding from the NFLPA since 2014, reported a 2.6-fold increase in suicide rates when comparing the periods 1979-2010 and 2011-2019. However, the study’s authors suggest that increased “awareness” of CTE may be partly to blame – implying that former players might choose suicide because they fear having CTE, rather than as a consequence of the disease itself.

As a researcher with a background in public health, I find this interpretation deeply problematic. The study’s methodology raises significant concerns. The authors identified 66 suicides over 40 years, a relatively small number that limits statistical power. The choice of 2011 as a cut-point year appears arbitrary. When using 2010 or 2012 as the dividing year, the increase in suicide rates is not statistically significant, suggesting the 2011 finding may be a random occurrence. The initial surge in CTE awareness began around 2007 with reporting in the New York Times, well before the period emphasized in the study.

The researchers employed numerous statistical comparisons, increasing the risk of false-positive findings. A proper correction for multiple comparisons would likely have eliminated the statistical significance of their results. The study failed to adequately account for other potential contributing factors to suicide, such as imprisonment, accusations of violent crimes, financial distress, or marital problems. The researchers also did not measure CTE “awareness” directly, nor did they consider broader societal trends, such as the doubling of gun manufacturing in the U.S. Since 2011, and the established association between firearm access and suicide, particularly among individuals with traumatic brain injury – a condition nearly universal among NFL players.

The focus on “awareness” as a potential driver of suicide distracts from the fundamental issue: CTE itself. The disease is a significant health crisis for NFL players, and hundreds have died from dementia in the past decade. Rather than attempting to deflect blame, resources should be directed towards developing methods for diagnosing CTE before death and, finding treatments to prevent or slow its progression. The FPHS’s use of player funds to promote a narrative that minimizes the impact of CTE is, frankly, unacceptable.

This isn’t the first time the FPHS has been accused of downplaying the severity of CTE. The current research appears to be part of a pattern of attempting to shift the focus away from the league’s responsibility for the long-term health of its players. The goal seems to be to allow fans to enjoy the Super Bowl without confronting the uncomfortable reality of CTE.

Suicide is a tragedy, and prevention efforts are crucial. However, those efforts must be grounded in scientific rigor and a commitment to addressing the underlying causes, not in research that obscures the truth. Let’s embrace awareness as an opportunity for change, not treat it as a risk factor. The NFLPA needs to prioritize the well-being of its members and ensure that research funding is used to advance our understanding of CTE and protect the health of current and former players.