‘Concussion’ distorts the scope of traumatic brain injury

By Brad Segal 

I just watched the movie Concussion (2015) as an assignment for one of my bioethics courses. The movie is about a physician, Dr. Bennet Omalu, as he unravels the association between playing in NFL and an acquired neurodegenerative disease, a condition he calls, “chronic traumatic encephalopathy” (CTE). At one point Dr. Omalu tries to convince a prominent researcher that, despite suffering head traumas similar to those of football players, animals like the woodpecker have the means of avoiding CTE;

“The woodpecker’s tongue comes out the back of the mouth through the nostril and goes around the top of its head. Basically, it’s one big safety belt for the brain.” (source)

The tongue shoots out through the nostril? As a medical student, I found this trivial aside absolutely fascinating. But when I tried to learn more I quickly realized–to my dismay–that most experts would balk at this characterization. Woodpeckers don’t develop CTE for a variety of reasons, including; (1) smaller mass means less force from deceleration; (2) no head rotation during each peck as to decrease angular forces, and; (3) their skulls have a physiologic protective cushion. I won’t delve further into the weeds about where exactly the movie’s assertions depart from reality, but to put it generously, this crucial argument totally misrepresents the science.

The problem with all of this is that it’s tempting to watch Concussion and feel better informed about the controversies surrounding professional football and CTE. To be honest, I was mesmerized watching familiar events brought to life on screen, and it all seemed credible as it used the actual names of people involved. Movie reviews by Rolling Stone even suggest that it should be mandatory for football fans, and The New York Times remarks on how it, “sells a complex issue.” Sure, everyone knows Concussion is “for entertainment purposes only,” but can’t stories that are true also be entertaining? However, the seemingly-trivial inaccuracy about woodpeckers was a potent reminder that this film is not a documentary. Concussion should be viewed as it is–a major Hollywood blockbuster starring Will Smith and Alec Baldwin.

Hollywood has changed since the 1980’s when it featured tobacco products to encourage smoking, but emails leaked from the 2015 Sony hack revealed that studio executives had intentionally softened up Concussion’s critiques of the NFL and deleted “unflattering moments” to avoid antagonizing the NFL. The emails also showed that a consultant was hired to work with the NFL on the movie’s messaging. This sort of relationship with the NFL doesn’t exactly foster the environment for accurate and comprehensive film making.

Granted, this isn’t the first Hollywood flick based on real events to be criticized for not getting the facts right. For instance, in 2010 questions about hyperbole in The Social Network made headlines as well. But there’s a distinction to be made here—unlike Mark Zuckerberg’s fraternity experience, sports-related CTE carries tremendous implications for public health. The CDC estimates that 1.3 million Americans visit the emergency department for suspected traumatic brain injury annually. While Concussion focuses almost exclusively on mid-career professional football players (who amount to ~1,700 active players), it pays is little attention to paid to the alarming rate of head injuries among adolescents (Figure). An estimated 140,000 high school and college-aged individuals suffer a concussion annually. Long before the movie’s release there were cases of CTE in college and high school athletes who had no prior concussions. Concussion simply fails to inform the viewer about the scope of the problem, and it doesn’t try to explain that CTE is actually a problem not limited to the NFL.

CDC Data
Emergency Department (ED) visits for traumatic brain injury in the US. Adapted from Faul M, et al. “Traumatic brain injury in the United States.” Atlanta, GA: national Center for injury Prevention and Control, Centers for disease Control and Prevention (2010).

Society needs an open and well-informed discussion about traumatic brain injury among children and adolescents, not just professional athletes. From a moral perspective, an NFL player can arguably consent to heightened risk to their personal well-being in exchange for commensurate financial reward, but minors lack the capacity to consent to medical risks, and are not paid to play sports. The goal would be to find the right balance between the benefits of playing sports against the risks our society is willing to tolerate. Even in today’s political environment, compromise is not unreasonably idealistic. For instance, in 2015 the US Soccer Federation restricted headers for players age 11 to 13, and banned them altogether for players under the age of 10. Scientific facts, recent events, and conflicts-of-interest need to be common knowledge for this conversation to succeed within other sports as well.

Regrettably, a film about that is widely-seen but biased will only serve to polarize viewpoints and promote disinformation–setting back the public’s interest in preventing CTE among younger generations.

NOTE: This post reflects my own views only.  It does not necessarily represent the views of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School or the Football Players Health Study at Harvard University.

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