Welcome to the Concussion Industrial Complex

A public desperate for an answer to football's concussion crisis has become easy prey for the profiteers selling them snake oil.

by Jack Moore
Nov 17 2014, 1:20pm

Photo by Jeremy Brevard/USA TODAY Sports

It looks like Wall-E's EVE in a football jersey, and it's the solution to your high school football team's concussion problem. It goes by VGo—the name of the "robotic telepresence solutions" company behind the technology—and allows trainers on the sideline to remotely contact neurologists or other brain specialists. For schools who either can't afford or simply can't find an on-site brain specialist for their games, VGo offers a solution. Currently, the football robot is still in testing at Dartmouth, but VGo's YouTube page shows the generic version of the product in action:

The fear of concussions and other brain trauma resulting from football has parents across the country questioning whether or not they should allow their children to play the sport. But for many, giving up football is entirely out of the question. Those people want a solution, and American business is more than happy to offer one.

The Concussion Industrial Complex is here.

VGo the concussion robot is merely the most imaginative product to emerge from a burgeoning new industry. There are concussion caps—gel caps for underneath the helmet, padded shells for the outside. There's the concussion mouthguard, the concussion sports drink, the concussion powder, concussion sensors, and concussion programs. People want to hear their kids will be safe playing football. Men like Dr. Harry Keradisis, a.k.a "The Brain Doctor," are here to sell them the answer they want. His product is XLNTbrain Sport™, "the first complete concussion management program without the cost of having a neurologist on payroll."

"Concussions," Dr. Keradisis said in a press release, "don't have to kill contact sports."

What Dr. Keradisis says is true, if you want it to be. Problem is, none of these products or efforts address the fact that concussions still occur despite the best helmet technology. They don't address the fact that subconcussive blows can be just as dangerous as the most calamitous hits. Each product sells itself as a solution, but none leaves football in an appreciably different place than before. Instead, under the guise of safety, they offer false hope to people desperately searching for it.

Photo by Matt Cashore/USA TODAY Sports

"If 10 percent of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football."

According to an NFL doctor quoted in the book League of Denial, this was the implication of Dr. Bennet Omalu's discovery of the neurodegenerative disease chronic traumatic encephalopathy (CTE) in professional football players during the 2000s. Since then, a wave of evidence that football players of all ages and levels are both risking and suffering brain damage has spooked the public, prompting LeBron James to say his sons won't play football and leaving the sport's governing bodies managing a slow-motion crisis.

According to a Wall Street Journal story, football participation by children ages 6-8 declined 5.4 percent from 2008 through 2012. At the Pop Warner level, the decline has been even more precipitous—a 9.5 percent participation drop from 2009 through 2012. Dr. Robert Cantu, a neurosurgeon and prominent concussion expert at Boston University, has been among the voices calling for a ban on tackle football for athletes below the age of 14. Cantu's perspective is far from the majority, but such ideas were unfathomable even five years ago.

Tony Strickland, a member of Pop Warner's Medical Advisory Committee, told Outside the Lines in November 2013 the participation decline was "in part because of the description of individual cases and the information out there about the incidence of CTE." Junior Seau's suicide—and the confirmation of CTE in his brain—as well as the release of League of Denial were high-profile events that kept concussions in the headlines. "If I'm a parent," Strickland said, "anybody hearing this information, in the absence of other science, would be foolish not to be cautious."

Men like Bob Ferguson, owner of SkullTec, are the ones providing the "other science" Strickland makes reference to. The SkullTec "Advanced Gel Sports Cap" showed "25 percent reduction of impact, which is huge by anybody's standards," Ferguson says in a 2013 YouTube video describing the product. Ferguson shows off his gel cap's stopping power by placing his hand inside the SkullTec gel and bashing it twice with a brick with no apparent damage. "We're actually trying to reduce the impact," Ferguson says, "which, in our opinion as SkullTec company, that's where all concussions start from, impact."

SkullTec isn't alone. The Brain Pad mouthguard claimed its unique design "creates new brain safety space!" and "Reduces Risk of Concussions! From Lower Jaw Impacts." The Guardian cap "brings a soft-shell layer to the outside of the decades old hard-shell football helmets and reduces the impact the head takes in a hit up to 33%." NeuroSafe, at one point sponsored by the one and only Tom Brady, calls itself "a patent-pending NeuroProtective drink that protects your brain from the consequences of sports-related traumatic brain injury, like concussions." Sensors like the Brain Sentry Hit Counter provide "an opportunity to monitor and limit exposure to head impacts."

Reporting last year on "The Booming Business of Concussions," Darren Heitner of Forbes spoke to an industry insider who attended a recent conference with some 200 companies looking to make a splash in the concussion industry. Heitner's article came as the NFL filed a motion to dismiss over 100 concussion lawsuits from former players—part of an ongoing legal battle that has only fueled the industry's fire.

"[The litigation] has caused a wonderful thing to happen," Phil Jones, president of Dynavision, told Heitner. "$100 million of funds have been delivered to do research to get ahead of the game. The strength of the concussion business is that the NFL is the penultimate sports organization in North America, and they are not going to just fold the tent and not play football any more. The really good news is that it has caused a revenue industry to form." Dr. Kevin Walter, director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin, told USA Today this May, "A lot of us say the concussion-reducing helmet is the Holy Grail. If you can actually find medical proof that your protective equipment reduces the risk, holy cow. Everyone will be buying that helmet."

About that sort of equipment: In 2012, the National Federation of State High School Associations (NFHS) first allowed the use of padded helmet shells, including the aforementioned Guardian as well as ProCap and Shockstrip. The latter two immediately sent out press releases touting the NFHS decision as an endorsement of their products. Shockstrip's included the headline, "First Time Ever NFHS Permits Use of External Helmet Device That Reduces Concussions On the Playing Field."

However, a simple reading of the NFHS' accompanying press release reveals no endorsement of any sort. To the contrary, it states, "To this point, the NFHS, like the other football rule-makers and the Consumer Products Safety Commission, has not been able to form a definitive conclusion as to whether a number of such products are, on balance, beneficial or detrimental." Not only does the NFHS back off from endorsing such products, it leaves open the possibility these products are actually making things worse. "Questions arise from time to time," the NFHS wrote "as to whether a given product may, rather than diminishing the incidence of injuries, in fact enhance it."

Now, before accessing the Guardian caps website, the user is forced to check a box indicating they have read a warning message, which states: "No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests." Another warning on the site, under bright yellow text reading "Hey Man, read this before you use it!" informs a potential customer, "We make Guardian to reduce some of the impact, but that doesn't make you concussion proof."

Screenshot taken 11/16 from the Guardian's website

NOCSAE, the National Operating Committee on Standards for Athletic Equipment, agreed with the NFHS's ruling on helmet caps in a 2012 release and extended its caution to non-helmet products. "Any device or supplement promoted as being able to prevent, diagnose, or cure a concussion must be supported by scientific data and peer-reviewed research linking mouth guards, head bands, supplements or other specialty products to a reduction in concussion risk or severity. For companies to suggest otherwise misleads athletes, parents and coaches into a dangerous false sense of protection against concussion."

This is a classic example of the "Peltzman Effect," something our very own Dr. Kerasidis noted in a post at Psychology Today this June. Simply put, the Peltzman Effect refers to the idea that a safety measure can make a person overly reckless. In fact, one of the major reasons it has taken so long for concussions to become they issue they are now is because of belief in the safety of the constantly evolving football helmet. As Dr. Julian Bailes said in the League of Denial documentary, "we didn't really relate that in a modern sport like football, in a helmeted sport, that it could lead to [CTE]."

Over the past two years, disclaimers like those found on the Guardian website have become commonplace across the concussion industrial complex. The Brain Pad mouthguard company reached a settlement with the Federal Trade Commission (FTC) in 2012 barring the company from "making unsupported claims that their mouthguards reduce the risk of concussions from lower jaw impacts, reduce the risk of concussions generally, or have been clinically proven to do either." Similarly, in 2013, the FTC sent a letter to Riddell concluding a study in the Journal of Neurosurgery "did not prove that Revolution varsity football helmets reduce concussions or the risk of concussions by 31 percent," a claim that vaulted the Revolution to the top of the helmet market in previous years. Riddell escaped sanction, however, because it had "discontinued use of the 31% claim." According to League of Denial, the FTC sent similar warnings to the creators of 18 other concussion products.

SkullTec's website contains a disclaimer on its FAQ page stating, in part, "I understand and agree that Skulltec LLC, makes NO expressed or implied impressions that this product will reduce, stop and or limit the possibility of any concussion and /or related impact or activity injury." Shock Doctor mouthguards note in a brochure, "There is not yet any independent research confirming that mouthguards prevent concussions."

These disclaimers typically combine dense legalese language and awkward placement in the literature or on the website in question. And even the disclaimers often continue to drill in the consumer's head that the product "reduces impact," or, as the Shock Doctor literature puts it, "medical and dental experts agree that mouthguards most certainly help protect against a serious blow becoming a concussion." Even as the salesmen admit their products are not panaceas or one-shot cures, they continue to send the message to parents and athletes, "This is good, solid protection."

Dr. Walter sees a clear comparison in the American marketplace. "It's kind of like (dietary) supplement companies. They're not coming out and saying, 'We prevent concussions.' But they phrase it in a way that consumers think that." It's an apt metaphor. The dietary supplement industry draws in consumers through a near-universal desire to lose weight and be skinny without the work of diet and exercise. The concussion industrial complex similarly realizes football is a way of life for many Americans, and that for many, one reassuring sentence is enough to put them right back in the stands or on the field.

The best example of this attitude comes from Jeffrey Kutcher, associate professor of neurology at the University of Michigan, who testified about the issue to the Senate Commerce Committee in 2011. When asked about misleading claims like Riddell's 31 percent concussion reduction technology, Kutcher said, "Well, I can see that, and I do see that every week in my clinic. I see patients coming in with their parents saying they want to buy the new helmet: 'This is the concussion helmet. What do you think about it? That is a very real conversation I have all the time."

In October, Tom Cutinella, a 16-year-old varsity high school player from Long Island died hours after suffering a head injury in an on-field collision. Steve Cohen, superintendent of the Shoreham-Wading River school district, said the injury was a "freak accident," but more importantly, he noted it "was the result of a typical football play." Cutinella became the third high school football player to die in a span of just four days. He is now one of seven players to die from injuries directly related to football in 2014 and one of 15 in the past two years. The official causes of death in several of the 2014 cases have not been confirmed, but of the eight deaths in 2013, six were the result of head or brain injuries and two were the result of neck injuries according to data from the Annual Survey of Football Injury Research.

This, in the end, is the failure of the concussion industrial complex. No gel helmet, no outer shell, no mouthguard or sports drink or helmet sensor or fancy robot is going to change what makes a "typical football play." The impacts could be reduced. The game may look or feel safer. But it will still be completely defined by bodies thrusting themselves into collisions. "If you really wanted to prevent the vast majority of injuries in football, you could do that if you took away tackling," Dawn Comstock of the university of Colorado's Colorado School of Public Health said. And it's a great solution.

"But then," Comstock reminds us. "It wouldn't be football any more." The concussion issue isn't going anywhere any time soon, as both litigation and bodies continue to pile up. But as long as football is football, people will continue to look for ways to, if not solve it, at least put it out of sight and out of mind. And American business will be right there waiting to profit.