[Fresh Ink] Offensive PLay: How different are dogfighting and football?

[Richard Menec]

(after this, you won't look at American "foot"ball in quite the same way 
again)

http://www.newyorker.com/reporting/2009/10/19/091019fa_fact_gladwell?printable=true#ixzz0b5x0jq5S

The New Yorker     October 19, 2009

ANNALS OF MEDICINE

OFFENSIVE PLAY

How different are dogfighting and football?

by Malcolm Gladwell

An offensive lineman can't do his job without "using his head," one veteran 
says, but neuropathologists examining the brains of ex-N.F.L. players have 
found trauma-related degeneration.

One evening in August, Kyle Turley was at a bar in Nashville with his wife 
and some friends. It was one of the countless little places in the city that 
play live music. He'd ordered a beer, but was just sipping it, because he 
was driving home. He had eaten an hour and a half earlier. Suddenly, he felt 
a sensation of heat. He was light-headed, and began to sweat. He had been 
having episodes like that with increasing frequency during the past 
year-headaches, nausea. One month, he had vertigo every day, bouts in which 
he felt as if he were stuck to a wall. But this was worse. He asked his wife 
if he could sit on her stool for a moment. The warmup band was still 
playing, and he remembers saying, "I'm just going to take a nap right here 
until the next band comes on." Then he was lying on the floor, and someone 
was standing over him. "The guy was freaking out," Turley recalled. "He was 
saying, 'Damn, man, I couldn't find a pulse,' and my wife said, 'No, no. You 
were breathing.' I'm, like, 'What? What?' "

They picked him up. "We went out in the parking lot, and I just lost it," 
Turley went on. "I started puking everywhere. I couldn't stop. I got in the 
car, still puking. My wife, she was really scared, because I had never 
passed out like that before, and I started becoming really paranoid. I went 
into a panic. We get to the emergency room. I started to lose control. My 
limbs were shaking, and I couldn't speak. I was conscious, but I couldn't 
speak the words I wanted to say."

Turley is six feet five. He is thirty-four years old, with a square jaw and 
blue eyes. For nine years, before he retired, in 2007, he was an offensive 
lineman in the National Football League. He knew all the stories about 
former football players. Mike Webster, the longtime Pittsburgh Steeler and 
one of the greatest players in N.F.L. history, ended his life a recluse, 
sleeping on the floor of the Pittsburgh Amtrak station. Another former 
Pittsburgh Steeler, Terry Long, drifted into chaos and killed himself four 
years ago by drinking antifreeze. Andre Waters, a former defensive back for 
the Philadelphia Eagles, sank into depression and pleaded with his 
girlfriend-"I need help, somebody help me"-before shooting himself in the 
head. There were men with aching knees and backs and hands, from all those 
years of playing football. But their real problem was with their heads, the 
one part of their body that got hit over and over again.

"Lately, I've tried to break it down," Turley said. "I remember, every 
season, multiple occasions where I'd hit someone so hard that my eyes went 
cross-eyed, and they wouldn't come uncrossed for a full series of plays. You 
are just out there, trying to hit the guy in the middle, because there are 
three of them. You don't remember much. There are the cases where you hit a 
guy and you'd get into a collision where everything goes off. You're dazed. 
And there are the others where you are involved in a big, long drive. You 
start on your own five-yard line, and drive all the way down the 
field-fifteen, eighteen plays in a row sometimes. Every play: collision, 
collision, collision. By the time you get to the other end of the field, you're 
seeing spots. You feel like you are going to black out. Literally, these 
white explosions-boom, boom,boom-lights getting dimmer and brighter, dimmer 
and brighter.

"Then, there was the time when I got knocked unconscious. That was in St. 
Louis, in 2003. My wife said that I was out a minute or two on the field. 
But I was gone for about four hours after that. It was the last play of the 
third quarter. We were playing the Packers. I got hit in the back of the 
head. I saw it on film a little while afterward. I was running downfield, 
made a block on a guy. We fell to the ground. A guy was chasing the play, a 
little guy, a defensive back, and he jumped over me as I was coming up, and 
he kneed me right in the back of the head. Boom!

"They sat me down on the bench. I remember Marshall Faulk coming up and 
joking with me, because he knew that I was messed up. That's what happens in 
the N.F.L: 'Oooh. You got effed up. Oooh.' The trainer came up to me and 
said, 'Kyle, let's take you to the locker room.' I remember looking up at a 
clock, and there was only a minute and a half left in the game-and I had no 
idea that much time had elapsed. I showered and took all my gear off. I was 
sitting at my locker. I don't remember anything. When I came back, after 
being hospitalized, the guys were joking with me because Georgia 
 Frontiere"-then the team's owner-"came in the locker room, and they said I 
was butt-ass naked and I gave her a big hug. They were dying laughing, and I 
was, like, 'Are you serious? I did that?'

"They cleared me for practice that Thursday. I probably shouldn't have. I 
don't know what damage I did from that, because my head was really hurting. 
But when you're coming off an injury you're frustrated. I wanted to play the 
next game. I was just so mad that this happened to me that I'm overdoing it. 
I was just going after guys in practice. I was really trying to use my head 
more, because I was so frustrated, and the coaches on the sidelines are, 
like, 'Yeah. We're going to win this game. He's going to lead the team.' 
That's football. You're told either that you're hurt or that you're injured. 
There is no middle ground. If you are hurt, you can play. If you are 
injured, you can't, and the line is whether you can walk and if you can put 
on a helmet and pads."

Turley said that he loved playing football so much that he would do it all 
again. Then he began talking about what he had gone through in the past 
year. The thing that scared him most about that night at the bar was that it 
felt exactly like the time he was knocked unconscious. "It was identical," 
he said. "It was my worst episode ever."

In August of 2007, one of the highest-paid players in professional football, 
the quarterback Michael Vick, pleaded guilty to involvement in a dogfighting 
ring. The police raided one of his properties, a farm outside Richmond, 
Virginia, and found the bodies of dead dogs buried on the premises, along 
with evidence that some of the animals there had been tortured and 
electrocuted. Vick was suspended from football. He was sentenced to 
twenty-three months in prison. The dogs on his farm were seized by the 
court, and the most damaged were sent to an animal sanctuary in Utah for 
rehabilitation. When Vick applied for reinstatement to the National Football 
League, this summer, he was asked to undergo psychiatric testing. He then 
met with the commissioner of the league, Roger Goodell, for four and a half 
hours, so that Goodell could be sure that he was genuinely remorseful.

"I probably considered every alternative that I could think of," Goodell 
told reporters, when he finally allowed Vick back into the league. "I 
reached out to an awful lot of people to get their views-not only on what 
was right for the young man but also what was right for our society and the 
N.F.L."

Goodell's job entails dealing with players who have used drugs, driven drunk 
and killed people, fired handguns in night clubs, and consorted with thugs 
and accused murderers. But he clearly felt what many Americans felt as 
well-that dogfighting was a moral offense of a different order.

Here is a description of a dogfight given by the sociologists Rhonda Evans 
and Craig Forsyth in "The Social Milieu of Dogmen and Dogfights," an article 
they published some years ago in the journal Deviant Behavior. The fight 
took place in Louisiana between a local dog, Black, owned by a man named 
L.G., and Snow, whose owner, Rick, had come from Arizona:

The handlers release their dogs and Snow and Black lunge at one another. 
Snow rears up and overpowers Black, but Black manages to come back with a 
quick locking of the jaws on Snow's neck. The crowd is cheering wildly and 
yelling out bets. Once a dog gets a lock on the other, they will hold on 
with all their might. The dogs flail back and forth and all the while Black 
maintains her hold.

In a dogfight, whenever one of the dogs "turns"-makes a submissive gesture 
with its head-the two animals are separated and taken back to their corners. 
Each dog, in alternation, then "scratches"-is released to charge at its 
opponent. After that first break, it is Snow's turn to scratch. She races 
toward Black:

Snow goes straight for the throat and grabs hold with her razor-sharp teeth. 
Almost immediately, blood flows from Black's throat. Despite a serious 
injury to the throat, Black manages to continue fighting back. They are 
relentless, each battling the other and neither willing to accept defeat. 
This fighting continues for an hour. [Finally, the referee] gives the third 
and final pit call. It is Black's turn to scratch and she is severely 
wounded. Black manages to crawl across the pit to meet her opponent. Snow 
attacks Black and she is too weak to fight back. L.G. realizes that this is 
it for Black and calls the fight. Snow is declared the winner.

Afterward, Snow's owner collects his winnings; L.G. carries Black from the 
ring. "Her back legs are broken and blood is gushing from her throat," Evans 
and Forsyth write. "A shot rings out barely heard over the noise in the 
barn. Black's body is wrapped up and carried by her owner to his vehicle."

It's the shot ringing out that seals the case against dogfighting. L.G. 
willingly submitted his dog to a contest that culminated in her suffering 
and destruction. And why? For the entertainment of an audience and the 
chance of a payday. In the nineteenth century, dogfighting was widely 
accepted by the American public. But we no longer find that kind of 
transaction morally acceptable in a sport. "I was not aware of dogfighting 
and the terrible things that happen around dogfighting," Goodell said, 
explaining why he responded so sternly in the Vick case. One wonders 
whether, had he spent as much time talking to Kyle Turley as he did to 
Michael Vick, he'd start to have similar doubts about his own sport.

In 2003, a seventy-two-year-old patient at the Veterans Hospital in Bedford, 
Massachusetts, died, fifteen years after receiving a diagnosis of dementia. 
Patients in the hospital's dementia ward are routinely autopsied, as part of 
the V.A.'s research efforts, so the man's brain was removed and "fixed" in a 
formaldehyde solution. A laboratory technician placed a large slab of the 
man's cerebral tissue on a microtome-essentially, a sophisticated meat 
slicer-and, working along the coronal plane, cut off dozens of fifty-micron 
shavings, less than a hairbreadth thick. The shavings were then 
immunostained-bathed in a special reagent that would mark the presence of 
abnormal proteins with a bright, telltale red or brown stain on the surface 
of the tissue. Afterward, each slice was smoothed out and placed on a slide.

The stained tissue of Alzheimer's patients typically shows the two 
trademarks of the disease-distinctive patterns of the proteins beta-amyloid 
and tau. Beta-amyloid is thought to lay the groundwork for dementia. Tau 
marks the critical second stage of the disease: it's the protein that 
steadily builds up in brain cells, shutting them down and ultimately killing 
them. An immunostain of an Alzheimer's patient looks, under the microscope, 
as if the tissue had been hit with a shotgun blast: the red and brown marks, 
corresponding to amyloid and tau, dot the entire surface. But this patient's 
brain was different. There was damage only to specific surface regions of 
his brain, and the stains for amyloid came back negative. "This was all 
 tau," Ann McKee, who runs the hospital's neuropathology laboratory, said. 
"There was not even a whiff of amyloid. And it was the most extraordinary 
damage. It was one of those cases that really took you aback." The patient 
may have been in an Alzheimer's facility, and may have looked and acted as 
if he had Alzheimer's. But McKee realized that he had a different condition, 
called chronic traumatic encephalopathy (C.T.E.), which is a progressive 
neurological disorder found in people who have suffered some kind of brain 
trauma. C.T.E. has many of the same manifestations as Alzheimer's: it begins 
with behavioral and personality changes, followed by disinhibition and 
irritability, before moving on to dementia. And C.T.E. appears later in life 
as well, because it takes a long time for the initial trauma to give rise to 
nerve-cell breakdown and death. But C.T.E. isn't the result of an endogenous 
disease. It's the result of injury. The patient, it turned out, had been a 
boxer in his youth. He had suffered from dementia for fifteen years because, 
decades earlier, he'd been hit too many times in the head.

McKee's laboratory does the neuropathology work for both the giant 
Framingham heart study, which has been running since 1948, and Boston 
University's New England Centenarian Study, which analyzes the brains of 
people who are unusually long-lived. "I'm looking at brains constantly," 
McKee said. "Then I ran across another one. I saw it and said, 'Wow, it 
looks just like the last case.' This time, there was no known history of 
boxing. But then I called the family, and heard that the guy had been a 
boxer in his twenties." You can't see tau except in an autopsy, and you can't 
see it in an autopsy unless you do a very particular kind of screen. So now 
that McKee had seen two cases, in short order, she began to wonder: how many 
people who we assume have Alzheimer's-a condition of mysterious origin-are 
actually victims of preventable brain trauma?

McKee linked up with an activist named Chris Nowinski, a former college 
football player and professional wrestler who runs a group called the Sports 
Legacy Institute, in Boston. In his football and wrestling careers, Nowinski 
suffered six concussions (that he can remember), the last of which had such 
severe side effects that he has become a full-time crusader against brain 
injuries in sports. Nowinski told McKee that he would help her track down 
more brains of ex-athletes. Whenever he read an obituary of someone who had 
played in a contact sport, he'd call up the family and try to persuade them 
to send the player's brain to Bedford. Usually, they said no. Sometimes they 
said yes. The first brain McKee received was from a man in his mid-forties 
who had played as a linebacker in the N.F.L. for ten years. He accidentally 
shot himself while cleaning a gun. He had at least three concussions in 
college, and eight in the pros. In the years before his death, he'd had 
memory lapses, and had become more volatile. McKee immunostained samples of 
his brain tissue, and saw big splotches of tau all over the frontal and 
temporal lobes. If he hadn't had the accident, he would almost certainly 
have ended up in a dementia ward.

Nowinski found her another ex-football player. McKee saw the same thing. She 
has now examined the brains of sixteen ex-athletes, most of them ex-football 
players. Some had long careers and some played only in college. Some died of 
dementia. Some died of unrelated causes. Some were old. Some were young. 
Most were linemen or linebackers, although there was one wide receiver. In 
one case, a man who had been a linebacker for sixteen years, you could see, 
without the aid of magnification, that there was trouble: there was a shiny 
tan layer of scar tissue, right on the surface of the frontal lobe, where 
the brain had repeatedly slammed into the skull. It was the kind of scar you'd 
get only if you used your head as a battering ram. You could also see that 
some of the openings in the brain were larger than you'd expect, as if the 
surrounding tissue had died and shrunk away. In other cases, everything 
seemed entirely normal until you looked under the microscope and saw the 
brown ribbons of tau. But all sixteen of the ex-athlete brains that McKee 
had examined-those of the two boxers, plus the ones that Nowinski had found 
for her-had something in common: every one had abnormal tau.

The other major researcher looking at athletes and C.T.E. is the 
neuropathologist Bennet Omalu. He diagnosed the first known case of C.T.E. 
in an ex-N.F.L. player back in September of 2002, when he autopsied the 
former Pittsburgh Steelers center Mike Webster. He also found C.T.E. in the 
former Philadelphia Eagles defensive back Andre Waters, and in the former 
Steelers linemen Terry Long and Justin Strzelczyk, the latter of whom was 
killed when he drove the wrong way down a freeway and crashed his car, at 
ninety miles per hour, into a tank truck. Omalu has only once failed to find 
C.T.E. in a professional football player, and that was a 
twenty-four-year-old running back who had played in the N.F.L. for only two 
years.

"There is something wrong with this group as a cohort," Omalu says. "They 
forget things. They have slurred speech. I have had an N.F.L. player come up 
to me at a funeral and tell me he can't find his way home. I have wives who 
call me and say, 'My husband was a very good man. Now he drinks all the 
time. I don't know why his behavior changed.' I have wives call me and say, 
'My husband was a nice guy. Now he's getting abusive.' I had someone call me 
and say, 'My husband went back to law school after football and became a 
lawyer. Now he can't do his job. People are suing him.' "

McKee and Omalu are trying to make sense of the cases they've seen so far. 
At least some of the players are thought to have used steroids, which has 
led to the suggestion that brain injury might in some way be enhanced by 
drug use. Many of the players also share a genetic risk factor for 
neurodegenerative diseases, so perhaps deposits of tau are the result of 
brain trauma coupled with the weakened ability of the brain to repair 
itself. McKee says that she will need to see at least fifty cases before she 
can draw any firm conclusions. In the meantime, late last month the 
University of Michigan's Institute for Social Research released the findings 
of an N.F.L.-funded phone survey of just over a thousand randomly selected 
retired N.F.L. players-all of whom had played in the league for at least 
three seasons. Self-reported studies are notoriously unreliable instruments, 
but, even so, the results were alarming. Of those players who were older 
than fifty, 6.1 per cent reported that they had received a diagnosis of 
"dementia, Alzheimer's disease, or other memory-related disease." That's 
five times higher than the national average for that age group. For players 
between the ages of thirty and forty-nine, the reported rate was nineteen 
times the national average. (The N.F.L. has distributed five million dollars 
to former players with dementia.)

"A long time ago, someone suggested that the [C.T.E. rate] in boxers was 
twenty per cent," McKee told me. "I think it's probably higher than that 
among boxers, and I also suspect that it's going to end up being higher than 
that among football players as well. Why? Because every brain I've seen has 
this. To get this number in a sample this small is really unusual, and the 
findings are so far out of the norm. I only can say that because I have 
looked at thousands of brains for a long time. This isn't something that you 
just see. I did the same exact thing for all the individuals from the 
Framingham heart study. We study them until they die. I run these exact same 
proteins, make these same slides-and we never see this."

McKee's laboratory occupies a warren of rooms, in what looks like an old 
officers' quarters on the V.A. campus. In one of the rooms, there is an 
enormous refrigerator, filled with brains packed away in hundreds of plastic 
containers. Nearby is a tray with small piles of brain slices. They look 
just like the ginger shavings that come with an order of sushi. Now McKee 
went to the room next to her office, sat down behind a microscope, and 
inserted one of the immunostained slides under the lens.

"This is Tom McHale," she said. "He started out playing for Cornell. Then he 
went to Tampa Bay. He was the man who died of substance abuse at the age of 
forty-five. I only got fragments of the brain. But it's just showing huge 
accumulations of tau for a forty-five-year-old-ridiculously abnormal."

She placed another slide under the microscope. "This individual was 
forty-nine years old. A football player. Cognitively intact. He never had 
any rage behavior. He had the distinctive abnormalities. Look at the 
hypothalamus." It was dark with tau. She put another slide in. "This guy was 
in his mid-sixties," she said. "He died of an unrelated medical condition. 
His name is Walter Hilgenberg. Look at the hippocampus. It's wall-to-wall 
tangles. Even in a bad case of Alzheimer's, you don't see that." The brown 
pigment of the tau stain ran around the edge of the tissue sample in a 
thick, dark band. "It's like a big river."

McKee got up and walked across the corridor, back to her office. "There's 
one last thing," she said. She pulled out a large photographic blowup of a 
brain-tissue sample. "This is a kid. I'm not allowed to talk about how he 
died. He was a good student. This is his brain. He's eighteen years old. He 
played football. He'd been playing football for a couple of years." She 
pointed to a series of dark spots on the image, where the stain had marked 
the presence of something abnormal. "He's got all this tau. This is frontal 
and this is insular. Very close to insular. Those same vulnerable regions." 
This was a teen-ager, and already his brain showed the kind of decay that is 
usually associated with old age. "This is completely inappropriate," she 
said. "You don't see tau like this in an eighteen-year-old. You don't see 
tau like this in afifty-year-old."

McKee is a longtime football fan. She is from Wisconsin. She had two 
statuettes of Brett Favre, the former Green Bay Packers quarterback, on her 
bookshelf. On the wall was a picture of a robust young man. It was McKee's 
son-nineteen years old, six feet three. If he had a chance to join the 
N.F.L., I asked her, what would she advise him? "I'd say, 'Don't. Not if you 
want to have a life after football.' "

At the core of the C.T.E. research is a critical question: is the kind of 
injury being uncovered by McKee and Omalu incidental to the game of football 
or inherent in it? Part of what makes dogfighting so repulsive is the 
understanding that violence and injury cannot be removed from the sport. It's 
a feature of the sport that dogs almost always get hurt. Something like 
stock-car racing, by contrast, is dangerous, but not unavoidably so.

In 2000 and 2001, four drivers in Nascar's élite Sprint Cup Series were 
killed in crashes, including the legendary Dale Earnhardt. In response, 
Nascar mandated stronger seats, better seat belts and harnesses, and 
ignition kill switches, and completed the installation of expensive new 
barriers on the walls of its racetracks, which can absorb the force of a 
crash much better than concrete. The result is that, in the past eight 
years, no one has died in Nascar's three national racing series. Stock-car 
fans are sometimes caricatured as bloodthirsty, eagerly awaiting the next 
spectacular crash. But there is little blood these days in Nascar crashes. 
Last year, at Texas Motor Speedway, Michael McDowell hit an oil slick, 
slammed head first into the wall at a hundred and eighty miles per hour, 
flipped over and over, leaving much of his car in pieces on the track, and, 
when the vehicle finally came to a stop, crawled out of the wreckage and 
walked away. He raced again the next day. So what is football? Is it 
dogfighting or is it stock-car racing?

Football faced a version of this question a hundred years ago, after a 
series of ugly incidents. In 1905, President Theodore Roosevelt called an 
emergency summit at the White House, alarmed, as the historian John Sayle 
Watterson writes, "that the brutality of the prize ring had invaded college 
football and might end up destroying it." Columbia University dropped the 
sport entirely. A professor at the University of Chicago called it a 
"boy-killing, man-mutilating, money-making, education-prostituting, 
gladiatorial sport." In December of 1905, the presidents of twelve prominent 
colleges met in New York and came within one vote of abolishing the game. 
But the main objection at the time was to a style of play-densely and 
dangerously packed offensive strategies-that, it turns out, could be largely 
corrected with rule changes, like the legalization of the forward pass and 
the doubling of the first-down distance from five yards to ten. Today, when 
we consider subtler and more insidious forms of injury, it's far from clear 
whether the problem is the style of play or the play itself.

Take the experience of a young defensive lineman for the University of North 
Carolina football team, who suffered two concussions during the 2004 season. 
His case is one of a number studied by Kevin Guskiewicz, who runs the 
university's Sports Concussion Research Program. For the past five seasons, 
Guskiewicz and his team have tracked every one of the football team's 
practices and games using a system called HITS, in which six sensors are 
placed inside the helmet of every player on the field, measuring the force 
and location of every blow he receives to the head. Using the HITSdata, 
Guskiewicz was able to reconstruct precisely what happened each time the 
player was injured.

"The first concussion was during preseason. The team was doing two-a-days," 
he said, referring to the habit of practicing in both the morning and the 
evening in the preseason. "It was August 9th, 9:55 A.M. He has an 80-g hit 
to the front of his head. About ten minutes later, he has a 98-g 
acceleration to the front of his head." To put those numbers in perspective, 
Guskiewicz explained, if you drove your car into a wall at twenty-five miles 
per hour and you weren't wearing your seat belt, the force of your head 
hitting the windshield would be around 100 gs: in effect, the player had two 
car accidents that morning. He survived both without incident. "In the 
evening session, he experiences this 64-g hit to the same spot, the front of 
the head. Still not reporting anything. And then this happens." On his 
laptop, Guskiewicz ran the video from the practice session. It was a simple 
drill: the lineman squaring off against an offensive player who wore the 
number 76. The other player ran toward the lineman and brushed past him, 
while delivering a glancing blow to the defender's helmet. "Seventy-six does 
a little quick elbow. It's 63 gs, the lowest of the four, but he sustains a 
concussion."

"The second injury was nine weeks later," Guskiewicz continued. "He's now 
recovered from the initial injury. It's a game out in Utah. In warmups, he 
takes a 76-g blow to the front of his head. Then, on the very first play of 
the game, on kickoff, he gets popped in the earhole. It's a 102-g impact. He's 
part of the wedge." He pointed to the screen, where the player was blocking 
on a kickoff: "Right here." The player stumbled toward the sideline. "His 
symptoms were significantly worse than the first injury." Two days later, 
during an evaluation in Guskiewicz's clinic, he had to have a towel put over 
his head because he couldn't stand the light. He also had difficulty staying 
awake. He was sidelined for sixteen days.

When we think about football, we worry about the dangers posed by the heat 
and the fury of competition. Yet theHITS data suggest that practice-the 
routine part of the sport-can be as dangerous as the games themselves. We 
also tend to focus on the dramatic helmet-to-helmet hits that signal an 
aggressive and reckless style of play. Those kinds of hits can be policed. 
But what sidelined the U.N.C. player, the first time around, was an 
accidental and seemingly innocuous elbow, and none of the blows he suffered 
that day would have been flagged by a referee as illegal. Most important, 
though, is what Guskiewicz found when he reviewed all the data for the 
lineman on that first day in training camp. He didn't just suffer those four 
big blows. He was hit in the head thirty-one times that day. What seems to 
have caused his concussion, in other words, was his cumulative exposure. And 
why was the second concussion-in the game at Utah-so much more serious than 
the first? It's not because that hit to the side of the head was especially 
dramatic; it was that it came after the 76-g blow in warmup, which, in turn, 
followed the concussion in August, which was itself the consequence of the 
thirty prior hits that day, and the hits the day before that, and the day 
before that, and on and on, perhaps back to his high-school playing days.

This is a crucial point. Much of the attention in the football world, in the 
past few years, has been on concussions-on diagnosing, managing, and 
preventing them-and on figuring out how many concussions a player can have 
before he should call it quits. But a football player's real issue isn't 
simply with repetitive concussive trauma. It is, as the concussion 
specialist Robert Cantu argues, with repetitive subconcussive trauma. It's 
not just the handful of big hits that matter. It's lots of little hits, too.

That's why, Cantu says, so many of the ex-players who have been given a 
diagnosis of C.T.E. were linemen: line play lends itself to lots of little 
hits. The HITS data suggest that, in an average football season, a lineman 
could get struck in the head a thousand times, which means that a ten-year 
N.F.L. veteran, when you bring in his college and high-school playing days, 
could well have been hit in the head eighteen thousand times: that's 
thousands of jarring blows that shake the brain from front to back and side 
to side, stretching and weakening and tearing the connections among nerve 
cells, and making the brain increasingly vulnerable to long-term damage. 
People with C.T.E., Cantu says, "aren't necessarily people with a high, 
recognized concussion history. But they are individuals who collided heads 
on every play-repetitively doing this, year after year, under levels that 
were tolerable for them to continue to play."

But if C.T.E. is really about lots of little hits, what can be done about 
it? Turley says that it's impossible for an offensive lineman to do his job 
without "using his head." The position calls for the player to begin in a 
crouch and then collide with the opposing lineman when the ball is snapped. 
Helmet-to-helmet contact is inevitable. Nowinski, who played football for 
Harvard, says that "proper" tackling technique is supposed to involve a 
player driving into his opponent with his shoulder. "The problem," he says, 
"is that, if you're a defender and you're trying to tackle someone and you 
decide to pick a side, you're giving the other guy a way to go-and people 
will start running around you." Would better helmets help? Perhaps. And 
there have been better models introduced that absorb more of the shock from 
a hit. But, Nowinski says, the better helmets have become-and the more 
invulnerable they have made the player seem-the more athletes have been 
inclined to play recklessly.

"People love technological solutions," Nowinski went on. "When I give 
speeches, the first question is always: 'What about these new helmets I hear 
about?' What most people don't realize is that we are decades, if not 
forever, from having a helmet that would fix the problem. I mean, you have 
two men running into each other at full speed and you think a little bit of 
plastic and padding could absorb that 150 gs of force?"

At one point, while he was discussing his research, Guskiewicz showed a 
videotape from a 1997 college football game between Arizona and Oregon. In 
one sequence, a player from Oregon viciously tackles an Arizona player, 
bringing his head up onto the opposing player's chin and sending his helmet 
flying with the force of the blow. To look at it, you'd think that the 
Arizona player would be knocked unconscious. Instead, he bounces back up. 
"This guy does not sustain a concussion," Guskiewicz said. "He has a lip 
laceration. Lower lip, that's it. Now, same game, twenty minutes later." He 
showed a clip of an Arizona defensive back making a dramatic tackle. He 
jumps up, and, as he does so, a teammate of his chest-bumps him in 
celebration. The defensive back falls and hits his head on the ground. "That's 
a Grade 2 concussion," Guskiewicz said. "It's the fall to the ground, 
combined with the bounce off the turf."

The force of the first hit was infinitely greater than the second. But the 
difference is that the first player saw that he was about to be hit and 
tensed his neck, which limited the sharp back-and-forth jolt of the head 
that sends the brain crashing against the sides of the skull. In essence, he 
was being hit not in the head but in the head, neck, and torso-an area with 
an effective mass three times greater. In the second case, the player didn't 
see the hit coming. His head took the full force of the blow all by itself. 
That's why he suffered a concussion. But how do you insure, in a game like 
football, that a player is never taken by surprise?

Guskiewicz and his colleagues have come up with what they believe is a much 
better method of understanding concussion. They have done a full cognitive 
workup of the players on the U.N.C. team, so that they can track whatever 
effect might arise from the hits each player accumulates during his four 
years. U.N.C.'s new coach, Butch Davis, has sharply cut back on full-contact 
practices, reducing the toll on the players' heads. Guskiewicz says his data 
show that a disproportionate number of serious head impacts happen on 
kickoffs, so he wonders whether it might make sense, in theory, anyway, to 
dispense with them altogether. But, like everyone else who's worried about 
football, he still has no idea what the inherent risks of the game are. What 
if you did everything you could, and banned kickoffs and full-contact 
practices and used the most state-of-the-art techniques for diagnosing and 
treating concussion, and behaved as responsibly as Nascar has in the past 
several years-and players were still getting too many dangerous little hits 
to the head?

After the tape session, Guskiewicz and one of his colleagues, Jason Mihalik, 
went outside to watch the U.N.C. football team practice, a short walk down 
the hill from their office. Only when you see football at close range is it 
possible to understand the dimensions of the brain-injury problem. The 
players were huge-much larger than you imagine them being. They moved at 
astonishing speeds for people of that size, and, long before you saw them, 
you heard them: the sound of one two-hundred-and-fifty-pound man colliding 
with another echoed around the practice facility. Mihalik and Guskiewicz 
walked over to a small building, just off to the side of the field. On the 
floor was a laptop inside a black storage crate. Next to the computer was an 
antenna that received the signals from the sensors inside the players' 
helmets. Mihalik crouched down and began paging through the data. In one 
column, the HITS software listed the top hits of the practice up to that 
point, and every few moments the screen would refresh, reflecting the plays 
that had just been run on the field. Forty-five minutes into practice, the 
top eight head blows on the field measured 82 gs, 79 gs, 75 gs, 79 gs, 67 
gs, 60 gs, 57 gs, and 53 gs. One player, a running back, had received both 
the 79 gs and the 60 gs, as well as another hit, measuring 27.9 gs. This 
wasn't a full-contact practice. It was "shells." The players wore only 
helmets and shoulder pads, and still there were mini car crashes happening 
all over the field.

The most damaged, scarred, and belligerent of Michael Vick's dogs-the 
hardest cases-were sent to the Best Friends Animal Sanctuary, on a 
thirty-seven-hundred-acre spread in the canyons of southern Utah. They were 
housed in a specially modified octagon, a one-story, climate-controlled 
cottage, ringed by individual dog runs. The dogs were given a final walk at 
11 P.M. and woken up at 7 A.M., to introduce them to a routine. They were 
hand-fed. In the early months, the staff took turns sleeping in the 
octagon-sometimes in the middle, sometimes in a cot in one of the runs-so 
that someone would be with the dogs twenty-four hours a day. Twenty-two of 
Vick's pit bulls came to Best Friends in January of 2008, and all but five 
of them are still there.

Ray lunged at his handlers when he first came to Best Friends. He can't be 
with other dogs. Ellen lies on the ground and wants her stomach scratched, 
and when the caregivers slept in the octagon she licked them all night long. 
Her face is lopsided, as if it had been damaged from fighting. She can't be 
with other dogs, either. Georgia has a broken tail, and her legs and snout 
are covered with scars. She has no teeth. At some point, in her early life, 
they had been surgically removed. The court-ordered evaluation of the Vick 
dogs labelled Meryl, a medium-sized brown-and-white pit-bull mix, "human 
aggressive," meaning that she is never allowed to be taken out of the Best 
Friends facility. "She had a hard time meeting people-she would preëmpt 
anyone coming by charging and snapping at them," Ann Allums, one of the Best 
Friends dog trainers, said, as she walked around Meryl's octagon, on a 
recent fall day.

She opened the gate to Meryl's dog run and crouched down on the ground next 
to her. She hugged the dog, and began playfully wrestling with her, as Meryl's 
tail thumped happily. "She really doesn't mind new people," Allums said. 
"She's very happy and loving. I feel totally comfortable with her. I can 
grab and kiss her." She gave Meryl another hug. "I am building a 
relationship," she said. "She needed to see that when people were around bad 
things would not happen."

What happens at Best Friends represents, by any measure, an extravagant 
gesture. These are dogs that will never live a normal life. But the kind of 
crime embodied by dogfighting is so morally repellent that it demands an 
extravagant gesture in response. In a fighting dog, the quality that is 
prized above all others is the willingness to persevere, even in the face of 
injury and pain. A dog that will not do that is labelled a "cur," and 
abandoned. A dog that keeps charging at its opponent is said to possess 
"gameness," and game dogs are revered.

In one way or another, plenty of organizations select for gameness. The 
Marine Corps does so, and so does medicine, when it puts young doctors 
through the exhausting rigors of residency. But those who select for 
gameness have a responsibility not to abuse that trust: if you have men in 
your charge who would jump off a cliff for you, you cannot march them to the 
edge of the cliff-and dogfighting fails this test. Gameness, Carl Semencic 
argues, in "The World of Fighting Dogs" (1984), is no more than a dog's 
"desire to please an owner at any expense to itself." The owners, Semencic 
goes on,

    understand this desire to please on the part of the dog and capitalize 
on it. At any organized pit fight in which two dogs are really going at each 
other wholeheartedly, one can observe the owner of each dog changing his 
position at pit-side in order to be in sight of his dog at all times. The 
owner knows that seeing his master rooting him on will make a dog work all 
the harder to please its master.

This is why Michael Vick's dogs weren't euthanized. The betrayal of loyalty 
requires an act of social reparation.

Professional football players, too, are selected for gameness. When Kyle 
Turley was knocked unconscious, in that game against the Packers, he 
returned to practice four days later because, he said, "I didn't want to 
miss a game." Once, in the years when he was still playing, he woke up and 
fell into a wall as he got out of bed. "I start puking all over," he 
recalled. "So I said to my wife, 'Take me to practice.' I didn't want to 
miss practice." The same season that he was knocked unconscious, he began to 
have pain in his hips. He received three cortisone shots, and kept playing. 
At the end of the season, he discovered that he had a herniated disk. He 
underwent surgery, and four months later was back at training camp. "They 
put me in full-contact practice from day one," he said. "After the first 
day, I knew I wasn't right. They told me, 'You've had the surgery. You're 
fine. You should just fight through it.' It's like you're programmed. You've 
got to go without question-I'm a warrior. I can block that out of my mind. I 
go out, two days later. Full contact. Two-a-days. My back locks up again. I 
had re-herniated the same disk that got operated on four months ago, and 
bulged the disk above it." As one of Turley's old coaches once said, "He 
plays the game as it should be played, all out," which is to say that he put 
the game above his own well-being.

Turley says he was once in the training room after a game with a young 
linebacker who had suffered a vicious hit on a kickoff return. "We were in 
the cold tub, which is, like, forty-five degrees, and he starts passing out. 
In the cold tub. I don't know anyone who has ever passed out in the cold 
tub. That's supposed to wake you up. And I'm, like, slapping his face. 
'Richie! Wake up!' He said, 'What, what? I'm cool.' I said, 'You've got a 
concussion. You have to go to the hospital.' He said, 'You know, man, I'm 
fine.' " He wasn't fine, though. That moment in the cold tub represented a 
betrayal of trust. He had taken the hit on behalf of his team. He was then 
left to pass out in the cold tub, and to deal-ten and twenty years down the 
road-with the consequences. No amount of money or assurances about risk 
freely assumed can change the fact that, in this moment, an essential bond 
had been broken. What football must confront, in the end, is not just the 
problem of injuries or scientific findings. It is the fact that there is 
something profoundly awry in the relationship between the players and the 
game.

"Let's assume that Dr. Omalu and the others are right," Ira Casson, who 
co-chairs an N.F.L. committee on brain injury, said. "What should we be 
doing differently? We asked Dr. McKee this when she came down. And she was 
honest, and said, 'I don't know how to answer that.' No one has any 
suggestions-assuming that you aren't saying no more football, because, let's 
be honest, that's not going to happen." Casson began to talk about the 
research on the connection between C.T.E. and boxing. It had been known for 
eighty years. Boxers ran a twenty-per-cent risk of dementia. Yet boxers 
continue to box. Why? Because people still go to boxing matches.

"We certainly know from boxers that the incidence of C.T.E. is related to 
the length of your career," he went on. "So if you want to apply that to 
football-and I'm not saying it does apply-then you'd have to let people play 
six years and then stop. If it comes to that, maybe we'll have to think 
about that. On the other hand, nobody's willing to do this in boxing. Why 
would a boxer at the height of his career, six or seven years in, stop 
fighting, just when he's making million-dollar paydays?" He shrugged. "It's 
a violent game. I suppose if you want to you could play touch football or 
flag football. For me, as a Jewish kid from Long Island, I'd be just as 
happy if we did that. But I don't know if the fans would be happy with that. 
So what else do you do?"

Casson is right. There is nothing else to be done, not so long as fans stand 
and cheer. We are in love with football players, with their courage and 
grit, and nothing else-neither considerations of science nor those of 
morality-can compete with the destructive power of that love.

In "Dogmen and Dogfights," Evans and Forsyth write:

When one views a staged dog fight between pit bulls for the first time, the 
most macabre aspect of the event is that the only sounds you hear from these 
dogs are those of crunching bones and cartilage. The dogs rip and tear at 
each other; their blood, urine and saliva splatter the sides of the pit and 
clothes of the handlers. . . . The emotions of the dogs are conspicuous, but 
not so striking, even to themselves, are the passions of the owners of the 
dogs. Whether they hug a winner or in the rare case, destroy a dying loser, 
whether they walk away from the carcass or lay crying over it, their 
fondness for these fighters is manifest.

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