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.

6 replies »

  1. 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.

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  3. 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 of sporting careers to be ruined for the false positives.

    Add in the trial lawyers, brain MRIs (findings are often not clear cut), raucous fans, dreamy players, pushy coaches…and you’ve got an ugly cocktail where damned if you are wrong and damned if you are wrong.

    I don’t envy these doctors. Rather it be you than I.

  4. 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, offering reassurance to listeners, specifically parents like me, that it is safe for kids to play football. To this end, he said (paraphrasing, here): there is no evidence that youth football results in head injuries with long-term consequences and that because the players are smaller, there is less to worry about. I submit that: a) there is no evidence of any kind about sports-related head injuries in kids and their long-term impact because we do not systematically gather and report data about it; b) there is a huge difference between Maroon’s statement and asserting that playing youth football is [relatively] safe in terms of head injuries because longitudinal analysis of players shows it to be so; and, c) his understanding of physics is wrong. While the players are smaller and moving more slowly than their mature counterparts, they also have immature bodies that are less able to absorb and dissipate impacts, adjusted for body mass. Yet, here is the chief physician for one of the NFL’s revered teams (one I’ve been a fan of for over 40 years) essentially blowing off parents’ concerns.

    My son, age 10, plays NFL-sponsored flag football and is a student of karate. It fascinates me that his karate senseis reinforce that in practicing karate a shot to the head is NEVER allowed, even in tournament conditions. It is grounds for immediate disqualification. In flag, all contact in incidental, but many kids playing flag (including mine) want to move up to full contact youth football. He and I are already talking about the differences between the sports and the fact that the NFL is a money machine interested mostly in making more money and that there is likely more unknown than known about head injuries and football.

  5. Remembering McMahon from his playing days, I find this one a bit hard to swallow. Keep in mind that we didn’t know very much about these drugs back then – there was a sense that medicine was allowing athletes to rewrite what was possible. Painkillers came first. Then steroids. We’re only now dealing with the long-term public health consequences of both.