Back in 1994, I died for a few seconds. It was my eighth season in the NFL. I was sitting on the training table in the Chicago Bears’ locker room when I went into cardiac arrest. The next thing I remember, I was lying in a bed in intensive care. A few weeks later, I was done with pro football. I had suffered two concussions in five weeks. Back then, nobody was talking about brain injuries in football. Sure, you got hit in the head, but every guy on the field had been getting hit in the head since he was eight years old, so it just wasn’t a big deal. Nobody used the word concussion. If you took a knock to the head, you “got your bell rung” or “saw stars.” My attitude was that I wore a helmet to keep from getting my brain turned to tapioca, so what was the big deal? We just didn’t know then what we know now about brain trauma and how to treat it. Yes, I did sue Dr. John Munsell, the team doctor for the Chicago Bears, for improperly managing my concussions and prematurely ending my career by clearing me to play over the phone when an in-person office exam (which should have been common sense) would have told him that I wasn’t ready. But this is not a book about blaming the NFL. It’s also not about defending the NFL. It’s already been well-documented that the NFL did a lot wrong in dealing with what happens when two powerful men smash their brains into their skulls at one hundred times the force of gravity. For years, the league had no input on how teams or trainers should care for head injuries. Teams came up with their own protocols, if they had any. The team owners, then-NFL chief medical officer Dr. Elliot Pellman, then-commissioner Paul Tagliabue, and others have to answer for that, and they have. The Steelers, my first team, were the pioneers in bringing neurology into football, largely thanks to the vision of team owner Mr. Dan Rooney and the skill of experts like Dr. Joe Maroon and Dr. Mark Lovell. The Steelers started doing cognitive testing with pencil and paper in 1991, and in 1997 they switched to computerized testing. That same year, the National Hockey League was the first major sports league to make neurocognitive testing mandatory. It took the NFL ten more years to get there. But after I left the NFL, I wasn’t concerned about all that. Instead, I worked for ESPN; raised my kids, Beau and Kori; got involved with USA Football; and survived open-heart surgery and a bout with cancer. I stayed involved with the league and consulted with Commissioner Roger Goodell from time to time, but mostly I lived my life. Then came the death of my ex-teammate Mike Webster in 2002. When Mike died and neuropathologist Dr. Bennett Omalu (the doctor Will Smith played in the movie Concussion) announced in 2005 that his brain showed signs of a severe case of the neurodegenerative disease chronic traumatic encephalopathy (CTE), the caution about football and brain trauma got dialed all the way up to exploitation.

HYSTERIA IS OUTRUNNING THE FACTS

Now you can barely pick up a newspaper, watch TV, or go online without finding another story about CTE. The average person on the street might not know what CTE stands for, but they’ve heard the letters and they’re convinced that playing football causes a terrible, insidious brain disease that’s threatening adults—and worse, children—with futures of depression, rage, memory loss, and suicide. The trouble is that hysteria is outrunning facts. In about thirteen years, we’ve gone from Mike Webster to NFL representatives (including yours truly) testifying before Congress in 2009–10 to the tragic suicide of Junior Seau to the 2015 release of Concussion. From there, we’ve seen Jeff Miller, the NFL’s senior vice president for health and safety, answer a question from US Representative Jan Schakowsky about whether a link between football and CTE had been established by saying, “The answer to that question is certainly yes.” We had the suicide of Aaron Hernandez, and to top it all off, the infamous New York Times story about 110 out of 111 brains from former NFL players testing positive for CTE. Underneath it all has been a steady drumbeat of scary research about football, CTE, ex-players suffering from memory loss and depression, and worst of all, youth football causing brain damage in kids. A lot of that research has been sloppy and poor, but if you’ve read the press coverage or seen Concussion, you’re probably worried. When adults read endless headlines telling them that football turns you into a vegetable, they don’t dig into the details. They pull their kids out of youth football, file lawsuits, and start calling football murder and child abuse. Because of the endless press based on bad research with no context, millions of people have reached the following conclusion (and God help you if you publicly contradict it):

Playing tackle football = CTE

Nobody questions the research that continually pours out of a few facilities—mostly Boston University’s Chronic Traumatic Encephalopathy Center (BU CTE Center). But they should because a lot of that science—especially the work coming from BU and some of the people associated with it—is flawed or incomplete. If you look at all the information skeptically (as too few journalists are), the real equation becomes more like this:

Head impacts + lots of other variables + time = Possible changes to the brain that might not ever affect a person’s quality of life

We’ve Been Brainwashed

Look at all the science from unbiased sources and you start to see a different picture. Talk to doctors who aren’t invested in the football-CTE connection, and you find a lot of doubt—and a lot of caution about speaking out, which is a problem all by itself. I know because I’ve looked at the science and talked to the scientists who are scared to go on the record. I learned from people a lot smarter than me that the main culprit in CTE is a microscopic protein called tau. Tau is a protein that helps stabilize brain cells. When a nerve cell is injured or diseased, tau can accumulate in the cell. It does this by becoming hyperphosphorylated. That means it gets lots of phosphate groups attached to it, and it gets sticky. When cells filled with tau get sticky and clump together, they are called neurofibrillary tangles. Tau accumulations can be seen in a number of diseases and in aging. Tau goes through a series of stages as it gets sticky and starts to accumulate. At first, the cells are normal looking, with some small amount of granular or dot-like staining. Those cells are functioning normally with only minimal tau accumulations. As things progress, pretangles form—tiny strings of tau inside the cell. As the process continues, you see the classic neurofibrillary tangles, the mature form of tau accumulations. At the end of the process, the brain cell dies, and you’re left with ghost tangles outside the cells, where the cell used to be. Tau deposits can build up in the brain and, over time, can interfere with neurological function. Voilà! Cognitive decline. Tau accumulation is part of what causes diseases like Alzheimer’s. But you know what else can cause tau to form in the brain? Drug use, anabolic steroid use, obesity, chronic inflammation, and chronic stress. Mike Webster was rumored to be a steroid user. Yes, he absorbed incredible punishment on the line of scrimmage, but claiming that impacts to the head caused his problems is like standing in a downpour and blaming one particular cloud. The researchers at BU, led by Dr. Ann McKee (and aided by the Concussion Legacy Foundation), have built their notoriety and reputations on the idea that impact to the head leads to tau buildup and then to CTE. They seem to be suggesting it’s simple cause and effect, case closed. But did you know that other labs have looked at the brains of athletes who had dozens of concussions and found little or no tau? I’ll bet you also didn’t know that thousands of ex-football players—who’ve taken millions of hits to the head—have no symptoms of cognitive decline and are doing great into their seventies and older. They’re not falling apart or having suicidal thoughts. Nobody’s talking about that because there’s no fame or money in good news. And the news coverage is a part of this story. The press has used parental fear to sell papers and online ads and turn a few people into press darlings. At the same time, it has most Americans convinced that football causes CTE without them ever seeing the evidence. In these pages, I’ll turn the spotlight on the press, too. Here’s something else you might not know. For years, BU has also selected research cases that would support its theories, suppressed information that contradicts those theories, and published science that’s just plain terrible. That’s not just me saying that; it’s trained neuropathologists, neuropsychologists, and neurologists. In these pages, they’ll tell you what they think and what they know. I’m not glossing over reality. Taking hits to the head can cause damage, especially if the resulting brain trauma isn’t managed the right way. Some ex-players do have problems. There are some risks to playing football. But we’re acting as though the science is sewn up and we have all the answers when the truth is far from that.

Dr. Peter Cummings

Right now, you might be saying to yourself, “Merril, you’re not a doctor or a scientist. How did you figure all this out on your own?” Great question, and I have a simple answer: I didn’t. I had help from a guy who’s a neuropathologist, a football dad, a coach, and an absolute warrior for the truth: Dr. Peter Cummings. This book would not have been possible without him. Dr. Cummings is a skilled, careful scientist who’s not afraid to ask questions. But the most important thing you need to know is that he holds three board certifications in pathology and spends his time investigating injuries—particularly brain injuries. He’s performed more autopsies and cut more brains than my stomach would care to count. He’s also an associate professor at the Boston University School of Medicine (yes, the same BU that’s home to the CTE Center), where he not only teaches forensic sciences and anatomy but also runs a graduate-level course in experimental design. To me, that means two things: this guy knows about brain trauma, and he knows statistics. It was Dr. Cummings’s September 19, 2017, editorial on Yahoo! Sports that first made me aware of his interest in digging deeper into the evidence and hysteria surrounding CTE and let me know I wasn’t alone in my concerns. It was called “I’m a Brain Scientist and I Let My Son Play Football,” and this is part of what it said: When I saw that editorial, I thought three things. First, holy cow, this Cummings guy has a ton of guts. To speak out against the overwhelming consensus of your profession—even when that consensus is wrong and based on bad information—is tough, especially when you’re part of the faculty at BU, the organization spreading most of the bad information. Second, brain science is this guy’s profession, and if it took him three years of investigating to figure out that the science behind football and CTE was mostly garbage, what chance does the average person have? That’s why most readers, especially parents, stop reading at the scary headlines, pull their kids out of sports, and start signing petitions to ban tackle football in their city, county, or state. Third, I knew he and I had to work together to get the truth out. This book is the result.

Why I Wrote This Book

I wrote Brainwashed because, while our knowledge of sports and CTE is at about a 2 on a 1–10 scale, we’re acting like it’s a 9. That’s having some dire consequences. For one, when I started this book, five states were talking about restricting or banning youth tackle football based on this sketchy, biased information. (California’s and Illinois’s bills are dead for now, but they will be back.) I’ve been involved with USA Football for years, and I love the sport, but I also know how valuable it is for kids. Football is one of the biggest sports in families with lower incomes. Take it away from those kids and what will they do? Our kids spend more time indoors today than ever, but football gives them a chance to get outside, exercise, learn skills and teamwork, and discover who they are. Pop Warner and other major programs have adopted stringent safety policies and equipment that make youth tackle football safer than ever. And some kids want to play tackle football. Is youth football safe? It’s a lot safer than sitting on the couch playing video games, eating sugar, and developing type 2 diabetes. If we’re going to restrict youth football, it had better be based on solid science, not biased BS. It also sickens me to see how CTE anxiety has spread among former athletes. Dr. Shannon Bauman, medical director of the clinic Concussion North in Barrie, Ontario, Canada, has said that she regularly sees athletes coming to her clinic months after getting concussed, terrified that they have CTE and are on a one-way trip to cognitive decline. Some pro athletes have even killed themselves because they were sure they had CTE; the terrible irony is that after autopsies, their families have found out that they didn’t have the disease. I wrote this book to set the record straight—to tell the whole story, not the half-truths you’ve been reading. Brainwashed fights back against the narrative that says football causes CTE, all ex-athletes have brain damage, and youth football should be banned. The truth is that much of the science is shoddy and misleading, and multiple parties have been getting on the bandwagon to make money, rationalize the deaths of loved ones, or get famous. The book attacks the pervasive myths about football and brain trauma in three sections:

• Myth #1: All NFL Players Are Falling Apart. This section looks at the reality of what’s happened to NFL players as related to brain trauma, including my journey from running back to media personality to CTE truther, the story of how ex-players are doing and how the ones with legitimate cognitive problems might be helped, and the important truth about ex-players and suicide. In this section, I’m not going to completely exonerate the NFL, but I’m not going to demonize it, either.
• Myth #2: CTE Is Settled Science, and Football Causes It. This section digs into the influence of BU and the fawning media coverage of its research, takes a closer look at the biased and poor science behind today’s “football = CTE” consensus, and presents a theory of CTE that better fits the evidence.
• Myth #3: Youth Football Is Child Abuse. This final section goes into the attacks on youth football based on CTE fears as well as the truth about the safety of the sport. We’ll talk to experts treating brain injury with therapies that actually reverse and prevent damage and look at cutting-edge safety and treatment methods that get players back on the field safely. We’ll rip to shreds once and for all the sloppy arguments behind both the assault on youth football and the irresponsible media coverage of it. And we’ll examine the real benefits of youth football—and the real threats to our kids’ health—and make an argument for why it should be protected.

I wrote this book because I want people to have good information so they can make informed decisions. I want everyone—athletes, parents, kids, everybody—to be as healthy as they can be. I’ve been through head trauma, cancer, and open-heart surgery, and the one major advantage I had over people my age in all those situations was my health. In all three situations, my doctors told me that being in great health helped me recover. Health can also prevent problems, even with the brain, and science backs that up, as you’ll see.

What is CTE?

I’m aware that people will label me a “CTE denier.” That’s what happens to anyone who questions the existing narrative, contradicts the so-called experts who dominate the news cycle, and tells the truth. I expect it. But I’m not a CTE denier. I’m a bad science denier. A lies denier. A hysteria denier. As I will repeat, I’m not saying it’s good to take repeated impacts to the head. It’s not. I’m not saying there aren’t former pro athletes who have psychological and neurological problems. There are. But science done right is a slow process. Because we favor information that confirms our biases, millions of doctors, athletes, parents, coaches, and journalists are making up their minds based on an incomplete picture painted by headlines that are far ahead of the science. That’s leading to conclusions that are harmful and wrong. It’s time we stopped calling people “deniers” and had an open, candid conversation about what’s true. So before we get rolling, let’s address the question I’ve heard from so many people: is CTE a real thing, and if it is, what is it? We know a lot less than the coverage would lead you to believe, so let’s talk about what we know and what we don’t:

• We know that mild traumatic brain injury—sometimes repeated injuries, sometimes just a single injury—can sometimes cause a pattern of tau proteins to accumulate in the brain. We call those tau patterns CTE.
• We also know that other factors, such drug abuse, smoking, obesity, and chronic inflammation, can also cause tau to accumulate in the brain. We don’t know yet how these other factors may play a role in the pattern of tau called CTE.
• We don’t know all the factors or conditions that lead to tau deposits in critical areas of the brain or why some people appear to be more or less susceptible. We also don’t know how tau deposits in the brain lead to clinical symptoms, such as mood, behavioral or cognitive disorders—or if CTE is involved at all—since those same symptoms are also associated with many other neurodegenerative diseases, including Alzheimer’s.

So yes, CTE is real, but that is all good evidence can tell us right now. In other words, at present, all that sound, conservative research can tell us is that CTE is an accumulation of tau in certain areas of the brain. Full stop. We’re not clear on what causes those accumulations, and we’re not clear on what effect, if any, they have on a person’s short-term or long-term neuropsychiatric health. This book is about setting the record straight and countering misinformation with facts. Laying all that out is a tall order for an ex-running back with no background in science. However, I have an MD in common sense, a PhD in football experience as a player, coach, and parent, and the professional judgment of Dr. Cummings and others. This is the mission of my life. It’s time to fight the misinformation, get to the truth, and take action. No more acting out of fear. No more brainwashing.

— Merril Hoge