The NFL’s Conflicted Relationship With Doctors

NFL injuryToo often doctors, trainers and other health care professionals who work for professional sports teams are accountable only to their teams and, especially, team owners. To keep their jobs they have to keep coaches, general managers, fans and billionaire investors happy.

This situation has created an intolerable ethical mess in which athletes’ health is too often their lowest priority. It is time to fix that.

Concussions are giving professional football, hockey and other sports a huge headache these days. The implication is that the NFL, NHL and their doctors long knew that “getting your bell rung” was bad for an athlete’s brain but said nothing.

Now a group of former NFL players are suing the league claiming that they were given powerful painkillers and anti-inflammatory drugs to keep them on the field. They say no one ever warned them about the long-term dangers of addiction, horrible side-effects or playing injured while drugged to withstand pain.

The eight plaintiffs, led by 1985 Superbowl champions Richard Dent, Jim McMahon and Keith Van Horne, say the league “recklessly and negligently created and maintained a culture of drug misuse, substituting players’ health for profit.”

Team doctors and trainers “were handing out drugs like it was Halloween candy,” says the group’s attorney Steve Silverman. Among the drugs said to be given freely were Toradol, Percocet, Vicodin, Ambien, Prednisone and Lidocaine. The eight players estimate they were given “hundreds, if not thousands” of pills through the course of their careers.

None of this comes as a surprise to sports fans, especially those of a certain age, who remember the NFL, NHL, MLB, NASCAR, FIFA, pro cycling and NBA of the ’70s, ’80s and ’90s when doctors and trainers kept athletes going at any cost with any pill, salve, injection, bandage, device or inhaler they could get their hands on.

“Just win, baby” was the guiding ethical principle of the era and doctors and trainers put aside their oaths and codes to make sure stars played, their team won, the fans were happy and the owners renewed their contracts for another season.

Whether the NFL players win this current lawsuit or not, it reveals something very wrong about how health care is organized in pro sports and probably in many amateur sports as well. What should be a sports doctor’s first priority? The health of the athlete.

Even athletes cannot be expected to protect themselves. Young athletes believe themselves to be invulnerable. Athletes who want to win will use anything offered to get an edge.

Someone whose starting role often depends on playing hurt and who gets nothing but flack from fans and coaches if he does not play due to injury — much less risk of injury — needs doctors and trainers to stand up for his health. No one else will. They need doctors and trainers who are competent, fair, objective and insulated from the team’s obsession with winning.

Guess what? There are another group of people in sports who have to be seen and act as fair and objective, who have to be insulated from the pressures brought by coaches and owners and whose competency must be assured by their peers, not by fans: referees.

Umpires, linesmen, and referees can only act in these roles if they are paid by the league, not teams, if they report to a head official, not a coach, and if they are assessed each year by their peers not by owners.

Trainers and doctors ought to be employed in pro sports using the same model. They should be selected for their competence not because they care for the owner’s wife or brother-in-law. They should work for the league and not a particular team. They should report to a head medical official who evaluates their performance every year and uses that evaluation to promote or fire them. And they should have one mission and one mission only according to which they are judged — protecting and maintaining player health.

Sports carry risks and dangers. But doctors and trainers should try to minimize them. In the past, if the current NFL lawsuit is on target, they didn’t. They won’t in the future unless the way health care delivery in sports is delivered is radically changed.

Arthur Caplan, Ph.D. is head of the Division of Bioethics at New York University Langone Medical Center.This post originally appeared in NBC News Online.

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Peter1John RokieSaurabh JhaVik Khannajohn irvine Recent comment authors
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Can’t feel sorry for NFL (National Felons League) players. Grown men with big paychecks out to hurt the other guy and over paid, over recognized for their “contribution” to society. Large, aggressive, egomaniacal bullies.

Now in their poorly prepared for retirement they’re just looking for someone else to blame.

John Rokie

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Saurabh Jha
Saurabh Jha

The old agency problem rears its ugly head again. You can get the league, even the tax payer, not the team to appoint the physician. But then someone will complain that there is no continuity of care, and doctors lack the personal touch with the player. Health of the player should be sovereign concern. Yes. But… Sometimes health and illness are clear cut. Often they are not. So the physician must decide whether to err on the side of “you can play, you’ll probably be ok” or “headache, you need a brain MRI and no playing for this season.” Lot… Read more »

Vik Khanna

Art: I completely agree that the model of medical protection for athletes at the pro level is broken, and I think there is a lot to recommend your model of the league as employer. As a dad, however, I have a different concern and that is the downstream communication by the league about head injuries in kids who play football. These kids are both the pipeline of future players and consumers, and I think that the league is intentionally disingenuous in its representations. Consider, this example: last year, Dr. Joe Maroon, the Steelers’ physician was on a sports talk show,… Read more »


Great model to think about. It’s always important to consider who hands out the paychecks.