The Real Danger: Steroids in Football…or Football Itself?

Q:  Do the lawsuits over brain injuries by NFL ex-players show football is more dangerous than we thought?

A:  Hundreds of former players nationwide have sued the National Football League (NFL), alleging it ignored the consequences of repeated traumatic head injuries in order to promote the sport.  They claim the league knew as early as the 1920’s of the potential for concussions to harm players but allegedly did “everything in its power to hide the issue and mislead players concerning the risks…”  The NFL denies failing to protect its players, and the cases are now pending in the Philadelphia federal court.

Playing football is dangerous.  In 2005, the Pittsburgh Tribune-Review analyzed four years of NFL injury data, interviewed over 200 players, coaches and managers, and reviewed thousands of pages of medical research, finding that in the 2000 – 2003 seasons players sustained 6,558 injuries and over half the athletes are hurt annually (a whopping 68% in 2003-04). Some say it’s the danger element in football – or boxing or mixed martial arts – that makes for the excitement.

Head trauma is a significant risk. A “concussion” (from the Latin word meaning to violently shake) is diagnosed when the traumatic impact causes a change in mental state or impaired functioning.  In the past, coaches often downplayed concussions by calling them “dings” or “bell ringers” and expected the player to “shake it off” and get back on the field.

But a concussion causes the brain to slosh around inside the skull like a yolk inside an eggshell, and the long-term effects of repetitive concussions can be devastating.  Problems can develop over months, years, or decades after the last concussion, and can include tremors, speech problems, confusion, impaired judgment, paranoia, poor impulse control, aggression, depression, memory loss and, eventually, even dementia.  The name for this degenerative condition is Chronic Traumatic Encephalopathy (CTE).  The brains of deceased athletes with CTE show a marked build-up of an abnormal protein called Tau.  Neuropathologists at the Sports Legacy Institute(SLI) believe that CTE affects many more athletes than previously thought.

So, given the grave dangers presented to athletes who play by the rules, is it reasonable to direct so much attention to the dangers presented to those who break the rules by using performance-enhancing drugs?  Are steroids more dangerous than football itself?  Norm Fost, MD, the pediatrician, medical ethicist and steroid expert who appeared in “Bigger, Stronger, Faster*” (BSF*), thinks not.

Dr. Fost points out that both BSF* and an objective exposé on HBO’s Real Sports could confirm only a handful of athlete deaths plausibly attributed to anabolic steroids. “By contrast, there are over 100 deaths attributed to playing football, by the rules, and numerous other cases of serious permanent disability such as spinal cord injuries,” he says.  “And there’s the mounting evidence that repeated concussions cause serious brain damage. Many of those injuries could have been avoided with rule changes that either wouldn’t alter the nature of the game (e.g., reducing the number of full contact practices); or changes that alter the game minimally (e.g., the recent NFL enforcement against helmet to helmet hits); or changes that would alter the game a lot (e.g., making the rule for roughing the passer the same as roughing the kicker). But all of these changes would more effectively protect the players than the current anti-doping policies.” Of course, a less violent game might also be a less watchable … and less profitable one.

As for the potential effect of steroids to increase injury risk, Dr. Fost dismisses the argument. “Players were plenty big, strong and fast long before the steroid era; recall Teddy Roosevelt’s anti-football campaign.  And the NFL presumably is a steroid free league today; I don’t notice any decline in lean body mass.”

An ironic twist: the very first case investigated at SLI was the 2007 double murder and suicide of former WWE wrestler Chris Benoit.  The post-mortem examination of Benoit’s brain showed the marked build-up of Tau characteristic of CTE.  Although the tragedy was misrepresented by the mainstream media as a sure case of steroid-induced rage, Benoit’s brain suggests that CTE was a primary contributing factor to his behavior.

So, are all the resources invested in steroid testing really about safety?  Or is it a distraction that allows contact sports federations to claim they’re protecting players … without making the hard rules changes that would actually do so?

© Rick Collins, 2012.  All rights reserved.  For informational purposes only, not to be construed as legal or medical advice.  Reprinted with permission from Muscular Development magazine.