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A Piece of My Mind
September 27, 2016

It’s Time to Change the Rules

Author Affiliations
  • 1Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
  • 2Morgan Stanley, Los Gatos, California
JAMA. 2016;316(12):1260-1261. doi:10.1001/jama.2016.8184

We observe football in the United States with mixed emotions. As fans, we enjoy watching the skills, excitement, and drama that make football one of this country’s favorite spectator sports. However, as an emergency physician and former team doctor (P.S.A.), and a former collegiate player and high school coach (W.H.W.), we cringe. Football is an inherently violent sport definitively associated with repetitive traumatic brain injury (TBI). In the elite professional football leagues, aggressive and powerful athletes conquer their opponents by hitting them hard and often. Many of these players profess to feel badly when a competitor is knocked out of a game, but their celebrations belie this as a heartfelt emotion. Some coaches frequently encourage youth football players, beginning in grade school, to collide with harmful impact force. These young players develop attitudes and behaviors that contribute to their possibly being injured at every level of the sport. The evolving consensus is that unless there is a way to reduce the number of TBIs caused by the sport, football will remain a threat to the brains and health futures of the players, including impaired cognitive function and reasoning, memory loss, emotional depression, and other sequelae that profoundly erode quality of life. It is worth noting that three decades ago, the medical profession and society intensely debated the sport of boxing and brain damage, during which discussion US football was also emphatically noted to be violent.1 Today, the number of participants who play football renders it a colossally greater cause of significant injuries than boxing to participants. In its current configuration, football imposes an epidemic of TBI on its players.

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