Concussion Protocol: Is Football Worth the Risk?

Fortunately for me and the others gathered at the Katz home, we enjoyed a fabulous, Cuisinicity.com meal for the Big Game. No surprise there; my wife is the culinary genius behind the site.

Thank goodness for the wonderful dinner, because the game itself was rather disappointing. There was, I trust my fellow spectators will agree, an unusual bumper crop of penalties, some egregiously bad calls by the referees, some truly strange mistakes by players and a disquieting bounty of poor sportsmanship into the bargain. Congratulations to the Broncos and Peyton just the same, but seriously, weird game.

Alas, it also featured an announcement all fans of the game should now know is a reason for a collective wince: concussion protocol. Corey Brown, of the Carolina Panthers, left the game after a head injury, underwent neurological evaluation and was found to have a concussion.

I trust everyone now knows the ominous implications of that kind of injury if repeated periodically over the course of a career. The media attention to Chronic Traumatic Encephalopathy, or CTE, is considerable and rising. The movie "Concussion," starring Will Smith, raises the profile further. I highly recommend the movie if you haven't seen it, by the way. It is very well done, and beautifully acted, and entertaining even as it educates.

I have no particular expertise in CTE beyond any doctor's basic understanding of it, and others have said plenty already. If you are interested, as every football fan should be, and certainly as every parent of a child inclined to play football must be, the relevant information is readily available. I will take the opportunity to make a different point, about the cultural malleability of "normal," and thus, "acceptable."

While I have no claim to the football-fan hall of fame, I like the game as much as the next guy. I am wondering more and more, though, if my entertainment is worth the price the players are paying.

Football is part of our culture, and thus normal. We might thus think that if it has occasional consequences, those, too, are normal. That may make them seem acceptable. But that's the real danger here: complacency. We can perhaps only see it looking across cultures, rather than from corner to corner within the box that is our own.

Consider, for instance, the Gladiatorial Games of Roman times. Those were, infamously, contests to the death, whether between people, or people and wild, half-starved animals. The only vague approximations of any such barbaric entertainment in the modern world are, so far as I know, bull fighting, and the generally illegal contests between fighting dogs or roosters. There is no longer any mainstream interest in watching bloody death for entertainment.

But that's simply because sensibilities and culture have evolved. The Romans were people just like us. Their society, too, was made up of mothers and fathers, aunts and uncles. They, too, knew love and compassion. But they cheered while watching young men, literally, kill one another. In their culture, it was normal, and thus acceptable; but I trust we agree history has reached a different verdict.

I happen to be a fan of both the late Heath Ledger, and Paul Bettany, and was thus predisposed to love the movie "A Knight's Tale." I'm no movie critic -- I can't say whether or not it's a great movie -- I can only say I like it.

The movie is especially noteworthy for how it handles anachronism. More than once, it features period elements, like music, and then transitions them to the modern analog, such as a rousing rendition of "The Boys Are Back in Town" by Thin Lizzy. More memorable still is a scene at a dance. Heath Ledger's character is dancing with his love interest in the stylized manner of medieval folk dance. The music then transitions to the late, great David Bowie -- "Golden Years," to be exact -- and the dancing keeps pace, morphing into what one would expect, more or less, in any given club on any given Saturday.

The director, I think, was telling us something important: The old-fashioned music and dance of medieval times would not have felt old-fashioned then. It was, simply, the music and dance of its day. It was normal. Showing medieval folk dancing to a modern audience says: this was an old-fashioned party. The director substituted "current" music and dance to show us how it felt to the participants. It was current and normal then, and no matter how it feels to us now, that's how it would have felt to them.

That's relevant to football. We are not willing to entertain ourselves by watching young men bash one another's heads in with maces, as the Romans did. But we do entertain ourselves as young men bash their helmeted heads into one another repeatedly over a span of years, with all-too-often calamitous consequences.

Our gridiron heroes are latter-day gladiators. And their house -- the house of football -- inspires almost religious devotion in our culture. But that may be only because it is part of our culture. Imagine if football did not yet exist, and we were thinking of introducing it, and knew about CTE from the start. Would we add such a game and such a liability to our cultural entertainments?

The one-time editor of the Journal of the American Medical Association, and later Medscape, Dr. George Lundberg, reflected along similar lines in the New York Times recently. He discusses cultural evolution over a much shorter period than the Middle Ages to now, noting a marked change in his personal -- and our societal -- enthusiasm for the brutalities of boxing. Both the sport and its following have changed dramatically in recent years, and he conjectures that football is in that same queue.

My principal mission here is to point out the inevitability of culturally induced blindness to the unacceptable elements of what is currently normal. We live in a time of epidemic obesity and its complications in our children, yet continue to market multicolored marshmallows to them as "part of a complete breakfast." This is absurd, and history will judge us accordingly, but it's normal now -- and so we overlook the hypocrisy. Cultures around the world justify practices as heinous as female genital mutilation. What passes for "normal" is self-defining, and to some extent, self-perpetuating.

Until, that is, we evolve beyond it. Looking back, what was normal yesterday often proves repulsive and contemptible today.

We speak routinely about "thinking outside the box," but when the box is culture, that is much easier said than done. Everything we know is inside the box, as are we. The contents of the box at any given time are normal.

History turns the years into a ladder. Out of the box we all climb, into a bigger box presumably, as we gain the perspective of altitude, and roll our eyes at the mess we've left behind.

I love watching football. The Romans presumably loved their gladiatorial games. Both are normal in context. That doesn't guarantee that either is right.

For the sake of today's players, and our sons inclined to take their places, I hope we reform the game of football sooner than later. It's a great game, but not when paid for with brains scrambled, and lives cut short.

In general, we need to recognize how readily we follow the gospel of any given culture telling us what's normal. We need to recognize that normal is simply what we do now, and that it isn't necessarily right. Perhaps the true measure of cultural enlightenment is how ably we judge ourselves in real time as history is sure to do in the fullness of time.

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the director of Yale University's Yale-Griffin Prevention Research Center, which he founded in 1998, and current president of the American College of Lifestyle Medicine. He earned his Bachelor of Arts from Dartmouth College in 1984, his medical degree from the Albert Einstein College of Medicine in 1988 and his master's degree in public health from the Yale University School of Public Health in 1993. He completed sequential residency training in internal medicine and preventive medicine/public health. He is a two-time diplomate of the American Board of Internal Medicine and a board-certified specialist in preventive medicine/public health. He holds two honorary doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters and 15 books, including multiple editions of leading textbooks in both preventive medicine and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.