When 125 million Americans watch the Super Bowl on Sunday, the NFL and NFL Players Association (NFLPA) don’t want them thinking about the brain disease chronic traumatic encephalopathy. When fans see an exciting big hit, thinking about how the players might not know their own family members in 30 years ruins the fun.
But I have personally seen the results of those hits 30 years later. My husband, Ralph Wenzel, played in the NFL for seven seasons. At just 54 years old, he was having memory lapses and cognitive problems. By 56, he was diagnosed with early signs of dementia, and by 63 he was in memory care. An autopsy confirmed chronic traumatic encephalopathy (CTE).
We know his CTE was caused by the years of repetitive head impacts he endured during his football career. So, you can probably understand why Super Bowl week is challenging for me. Watching sports organizations minimize the existence and consequences of CTE is even more difficult.
Since CTE was first diagnosed in an NFL player in 2005, the industry has been accused of using Big Tobacco-like tactics to suppress CTE awareness. It seems to persist today.
A recent study from Harvard’s Football Players Health Study (FPHS), which has received tens of millions of dollars in funding from the NFLPA since 2014, claims NFL player suicide rates increased 2.6-fold when comparing two periods, 1979-2010 versus 2011-2019. The authors suggest that increased “awareness” of CTE from “highly publicized research articles” may be partly to blame — implying former players might choose suicide because they fear having CTE, rather than due to the life consequences resulting from CTE.
I follow the research on CTE. Because of my training in public health research, I balance study quality, findings, and funding source. I noted significant methodological issues in the study that I believe make the findings and conclusions flawed. I am baffled by what appears to be an attempt to manufacture a narrative and equally concerned about potential motivations behind it.
The details are buried in the study’s supplement. The authors identified 66 suicides among NFL players over 40 years. While every suicide is devastating, this is a small number statistically, which creates analytical limitations. For example, when the authors used 2010 or 2012 as the cut-point year, there is no significant increase in suicide rate, which suggests 2011 could be a random finding. As someone very engaged in early advocacy on CTE, I believe increased awareness began around 2007 with the New York Times series, quickly followed by TV news coverage and documentaries, which wouldn’t be counted as “research articles.”
The many comparisons the researchers tested show a torturous pathway to a significant finding. When NFL players were their own control group, comparing suicide from 1979-2010 to 2011-2019, the difference is not significant.
So, the researchers compared NFL players to Major League Baseball (MLB) players, finding suicide rates were not significantly different. Only after pooling MLB with NBA players, a comparison group they’d never used before, did they find a statistically significant result for the 2011 cut point.
The researchers clearly conducted multiple comparisons, which is widely known to increase the probability of false-positive findings. Had FPHS properly corrected for the many multiple comparisons, the findings most likely would have lost statistical significance.
They also failed to measure the CTE “awareness” they blame, or consider more obvious factors related to the suicide, such as actual players imprisoned for murder or accused of murder while in prison, or murder-suicides. They did not consider severe financial distress and/or marital distress, or anything specific to real circumstances. I suspect murder-suicides were not caused by “awareness” of CTE.
Broader societal factors were also ignored. U.S. gun manufacturing — a proxy for gun availability — doubled since 2011. The Department of Veterans Affairs has shown that access to firearms is associated with suicide, particularly for those with traumatic brain injury. Nearly 100% of NFL players have a history of traumatic brain injury.
CTE is the most significant health crisis facing NFL players. More than 90% of the 376 former NFL players’ brains studied were identified as having this degenerative disease, which is strongly associated with dementia. Hundreds of former players have died from dementia in just the past decade.
Yet FPHS is spending players’ money to try to blame “awareness” of CTE for suicides — rather than addressing CTE itself.
If the authors had simply reported the statistical finding of a rise in suicides and concluded it is likely related to CTE but hard to say because of the limitations, I wouldn’t be pushing back. That would be plausible.
Instead, they push this narrative to blame CTE awareness and other medical factors, and it’s not the first time they have done it.
Is it so everyone can watch the Super Bowl without thinking about CTE, without talking about CTE? I can’t say. But we must talk about it. We must raise awareness.
As a scientist, I am disgusted. As an NFL widow who witnessed unimaginable suffering, I am furious.
The NFLPA needs to get its house in order. These kinds of studies bring us no closer to diagnosing (before death) or treating CTE, or helping families navigate life with CTE, including suicide prevention. Instead, the funds are being used to produce a narrative that diverts attention from a major public health issue and discourages the press from covering it.
Suicide is tragic, and prevention is essential — but not through research that distracts from the real risks facing NFL players and young athletes. Let’s treat awareness as an opportunity, not a risk factor.
Eleanor M. Perfetto, Ph.D., M.S., is professor emeritus at the University of Maryland. She holds bachelor’s and master’s degrees in pharmacy from the University of Rhode Island and a doctorate in public health from the University of North Carolina at Chapel Hill. She was a plaintiff in a class-action lawsuit against the NFL on concussions and CTE.