Walter Koroshetz needed some advice. It was September of 2014, and Koroshetz, the director of the National Institute for Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), was looking for donors to participate in the Sports Health Research Program (SHRP), a program intended to address brain trauma in sports.
Founded two years earlier with a $30 million pledge from the National Football League, SHRP would essentially use the Foundation of the National Institutes of Health (FNIH), a nonprofit entity, to funnel money from interested private donors through the NIH to promising areas of brain research. Concussions, hits to the head, and neurodegenerative diseases such as chronic traumatic encephalopathy (CTE) had become an area of major concern for both the military and contact sports—so much so that the NIH and the NFL had expressed a desire in SHRP's initial press release to recruit additional financial partners.
However, talks with and solicitations of the National Football League Players' Association, the National Collegiate Athletic Association, FIFA, the National Hockey League, and the Department of Defense hadn't produced additional pledges. So Koroshetz emailed Ellen Sigal, founder of Friends of Cancer Research, who had seen success in raising funds for public-private partnerships in cancer research.
"Somewhat surprisingly," Koroshetz wrote to Sigal in an email chain, "we haven't been able to recruit other partners."
He then wrote something that the rest of the world suspected but didn't know for sure at the time: "NFL not a real partner. Their agenda doesn't match ours."
"Walter, this does not surprise me at all," Sigal replied. "They are real thugs who have a very low bar for anything but making money and creating violence. They were just doing this for the PR value."
Koroshetz replied, "Agree. But we did get $30 million for TBI research. And we have funded very interesting projects. So NIH won this one."
Flash forward to 2016, and neither the NIH nor the NFL looks like a winner. Last year, their partnership blew up in spectacular public fashion when an ESPN report revealed that the league backed out of funding a seven-year, $16 million study of CTE, the neurodegenerative disease at the core of football's brain trauma crisis. A congressional investigation ensued, producing a 91-page report accusing the NFL of "improperly attempt[ing] to influence the grant selection process at NIH"—an allegation the league vigorously denied.
How could an arrangement so seemingly beneficial to both sides turn so sour? And why? Seeking answers, I filed a Freedom of Information Act request with the Department of Health and Human Services, asking for records related to the NIH-NFL partnership. In return, I received almost 3,000 pages of email correspondence, meeting notes, and supporting documents. I read through every page—twice. And what I learned, above all, is that there was a fundamental misunderstanding between the two sides about how much input the NFL would have.
The league believed it had a seat at the table to express concerns and provide input into specific research funding decisions. The NIH thought otherwise.
Koroshetz and several other staffers for the NIH declined to comment for this article. Sigal did not respond to several requests for comment. However, reviewing the documents reveals that the partnership was never just about working toward a better scientific understanding of brain trauma, something both sides publicly claimed.
In a June 2012 email that was written before the agreement was even in place, Koroshetz wrote that the NFL wanted to be involved to "to improve their public image." Was that the case? Probably. Documents show the league had been pushing for an agreement by certain arbitrary deadlines, the better to announce it during major television events like the Super Bowl or the first Monday Night Football game of the year.
Then there's the dust-up that occurred over a press release for a White House visit on May 29, 2014. The NFL believed they had the right to provide edits to the White House's statement, which FNIH denied.
The problem with the statement, from the NFL's perspective, was that the league's name didn't come first.
"We were under the impression that our approval was needed before going forward," wrote one of the NFL's publicists. "It is important to us that the name of our organization leads the statement. It may seem like a small thing, but to us, it's not."
An exasperated NIH communications staffer wrote in an email to a colleague, "Bottom line is White House highlight is because of NIH staff hard work and they deserve a thank you and not a f&$@ you. We could have rolled with this alone and we tried to be magnanimous."
The NIH had a very good reason to work with the NFL, despite the league's checkered history of funding and producing dubious, self-serving concussion science. Since 2003, the agency's budget has fallen 22 percent, adjusted for inflation. This shortfall has created a highly competitive environment for research funding, where more scientists than ever are vying for fewer dollars.
For a while, the NIH-NFL partnership worked, thanks to some gentle politicking from Koroshetz and his colleagues. The agency received a pledge for $30 million from the league, funding six studies that could have a significant effect on our understanding of traumatic brain injury. A spokesman for the NFL released a statement to VICE Sports emphasizing that the league has also funded two $6 million grants "to studies of the long-term changes that occur in the brain after a head injury or multiple concussions."
Just as noteworthy, however, is what the NFL didn't fund: the much-publicized seven-year, $16 million CTE study led by Boston University researcher Robert Stern. Ultimately, the controversy over Stern's study occupied six months of NIH officials' time, and also slowed down the scientific process.
In its statement to VICE Sports, the NFL quoted a second congressional investigation launched by a GOP committee on the issue , which found, essentially, the exact opposite as the first congressional committee: "There is no evidence to suggest that the NFL would not have funded the study if so requested by NIH and FNIH." The NFL also referred to a statement released by FNIH, which said, "The NFL was willing to contribute to the Boston University CTE study headed by Dr. Stern. The NIH made the decision to fund this study in its entirety."
From the beginning, Koroshetz and his colleagues considered the study "a critically important project." In June of 2015, Koroshetz went into more detail during an email discussion with FNIH officials: "The real take home point is that this study will in all likelihood set the standard for diagnosis of CTE in living people with NFL level exposures. And of course NIH is going to fund it with or without NFL support."
It's easy to imagine the profound effect such a study could have on football. Currently, CTE can only be diagnosed posthumously by examining brain tissue under a microscope. A reliable method of identifying the disease in the living would allow researchers to determine just how prevalent it is among athletes at all levels of the game.
Perhaps unsurprisingly, the NFL expressed objections to the Stern study. Initiating the league's complaints was Elliot Pellman, the controversial head of the NFL's previous concussion committee, which disbanded in 2010 due to widespread criticism from the independent medical community for publishing discredited research claiming that concussions were not serious injuries and that concussed NFL players could return to play in the same game.
Pellman, who has since retired from the league, also was a New York Jets team doctor, a personal physician to former commissioner Paul Tagliabue, and one of the NFL medical officials who pushed back against neuropathologist Bennet Omalu's groundbreaking discovery of CTE in the brain of deceased Pittsburgh Steelers center Mike Webster in 2002.
In June 2015, Pellman emailed the league's point of contact at the FNIH, expressing concerns about Stern's involvement with the study. He sent the email from Florence, Italy, where he was vacationing at the time.
Pellman's correspondence with the NIH is particularly curious given that he was no longer an official liaison to the agency, having been replaced six months prior by the NFL's senior vice-president for health and safety, Jeff Miller. It's also interesting to note that the league's newly appointed medical advisor, Betsy Nabel, was not the one to express the NFL's concerns, but rather was looped in later. When asked about this, a NFL spokesperson said, "Dr. Pellman replied to the email because they emailed him." However, there is no evidence Pellman is referencing a previous email or conversation, and his email is the first in the thread released to VICE Sports.
Emails sent by Pellman, Nabel, and Miller raised the following issues about the study, each of which was dismissed by the NIH as unfounded:
1. The study's principal investigator, Dr. Robert Stern, filed an affidavit in a class action concussion lawsuit brought by former players against the NFL, which the league perceived as evidence that Stern was biased against it. A review by Dr. Patrick Bellgowan, a program director at NINDS, found no cause for concern. In August of 2015, he wrote to colleagues that "Dr Stern is simply expressing his opinion [in the affidavit] that CTE includes psychosomatic symptoms which I find difficult to link to confirmation bias [something NFL doctors accused him of]."
The NFL's proposed settlement of the lawsuit included cash payments for players suffering from symptoms of cognitive impairment associated with CTE; Stern's affidavit mostly pointed out that his research on former players diagnosed with the disease indicated that it also was linked to mood and behavior disorders, which were not covered by the deal.
In a particularly ironic passage, Bellgowan added that, if anything, Stern's opinion worked in the NFL's favor, so claims of bias were particularly bizarre. Robert Finkelstein, another director at NINDS, agreed "100 percent with what you've said below."
2. The NFL was concerned that other members of the study co-authored other papers with Stern's Boston University group, which the league perceived as a conflict of interest. In a June 2015 email, Nabel attached "a pdf I received through the NFL" which demonstrated some of their concerns. The PDF contained the first page of several academic papers, with the names of members of the BU group and other members of the proposed study underlined to demonstrate their co-authorship.
Here's one example:
Koroshetz asked Bellgowan to look into these assertions. A few days later, Bellgowan reported back: "So here is what my search has found. I think the case that there were conflict of interest based on publication records is really weak. None of the reviewers have ever been on a paper with Robert Stern. None of the papers were data papers all [sic] were either consensus papers, reviews or commentaries."
It's also worth noting that, for many of the papers, some of the other co-authors were researchers the NFL has funded in other studies.
3. The NFL believed Stern and his co-investigators could unduly influence the outcome of the study. It's worth pointing out, as Bellgowan immediately did when the issue first arose, that the study would be a "large group of multi-site collaborators" subject to the NIH's rigorous peer-review process. Aside from BU, the study would include investigators from:
- Brigham and Women's Hospital
- Harvard Medical School
- Cleveland Clinic Lou Ruvo Center for Brain Health
- Mayo Clinic Arizona and Banner Alzheimer's Institute
- NYU Langone Medical Center and New York University School of Medicine
- VA Puget Sound and University of Washington
- Molecular NeuroImaging
- Neuroinformatics Research Group and Central Neuroimaging Data Archive at Washington University School of Medicine
In short, the idea that Stern could or would tilt the study to fit his alleged personal bias appears patently ridiculous on its face.
Although its contract with the FNIH and NIH stipulated that the NFL couldn't choose which studies were funded by its $30 million donation—a fact NIH officials reminded the league of several times during this period—the NFL did have a nuclear option. Thanks to the same contract, the league had the right to terminate the agreement completely with 30 days' notice for any reason, although the six studies approved in 2013 would still have to paid out.
In effect, the NFL could choose not to fund the study, but only if they wanted to suffer the PR consequences of canceling the partnership. This gave the league no cards to play, and the NIH knew it.
As late as December 2, 2015—just 20 days before the ESPN report made this whole issue public—the NIH Executive Committee was committed to making the NFL pay for the study, whether the league liked it or not. Francis Collins, the director of NIH, wrote to Koroshetz that he "discussed the NFL situation with the [executive committee] yesterday—and there was unanimous sentiment for following the peer review process and having the NFL funds go to Boston U. That's what NFL signed up for—no restrictions."
Collins went on to note, somewhat cheekily, that in a recent 60 Minutes interview, NFL commissioner Roger Goodell emphasized, "We want the facts. We think the facts will help us develop better solutions. And that's why we're advancing medical research." Oddly enough, Goodell also name-checked Boston University: "That's why we're funding directly to Boston University on some of this research."
Because of FOIA officials' heavy redactions, it's unclear from the documents what changed after that. But four days later, Collins emailed Koroshetz again: "We went over this complex situation again. [Redacted] But I need to discuss this again with the NIH Exec Comm and we won't be able to meet until the week of December 14 … so let's hold tight for now."
By December 17, the NIH had decided to fund Stern's study itself, as opposed to using some of the NFL's $30 million. A talking points list for Koroshetz's interview with ESPN reporter Steve Fainaru included questions such as "Why is NFL not funding this work?" and "Why is NIH/NINDS funding this work?"
Why did the deal turn sour? Only the NIH and the NFL know the exact reasons. But from the released documents, the congressional investigations, and ESPN's reporting, it appears that the NFL wanted to steer its donations away from Stern for reasons that didn't pass the NIH's scientific smell test. In a larger sense, the entire episode illustrates an underlying and ongoing problem with the league giving money to brain trauma research. Like other industries funding scientific work that could place their core product in a negative light and damage their bottom line, the NFL has as much interest in looking good as it does in finding out the truth.
In fairness to the league, it's possible that the NFL believed its concerns about Stern were completely legitimate. If that's the case, though, it's almost worse: How could the league's top medical people—with the exception of Nabel, who repeatedly emphasized she was simply passing along the message and was "remaining neutral"—not see what the NIH, a congressional inquiry, and reporters saw? How could they believe there was a conflict of interest at play other than their own?
Five days after Koroshetz received his talking points, ESPN published their report, "NFL backs away from funding BU brain study; NIH to fund it instead." In response, NFL spokesman Brian McCarthy tweeted:
ESPN story is not accurate. NFL did not pull any funding. NIH makes its own decisions.
— Brian McCarthy (@NFLprguy) December 22, 2015
The NINDS PR person forwarded the tweet to Koroshetz, who replied, "NIH makes its [sic] own decisions--is correct."
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