Malcolm Gladwell Compares Dog Fighting and Football

By John Ballard

With customary attention to detail Gladwell puts football head injuries under a microscope and drives home his points by weaving his findings together with a subject guaranteed to get attention: dog fighting. Michael Vick, of course, is the lynchpin, but once he has the reader's attention Malcolm Gladwell forces the reader to look at the brutal realities of football without averting his eyes until he gets the point.

I printed the article to have something to read today during my twelve-hour shift as a senior caregiver. Here are some parts that caught my attention.

In 2003, a seventy-two-year-old patient at the Veterans Hospital in Bedford, Massachusetts, died, fifteen years after receiving a diagnosis of dementia. Patients in the hospital�s dementia ward are routinely autopsied, as part of the V.A.�s research efforts, so the man�s brain was removed and �fixed� in a formaldehyde solution. A laboratory technician placed a large slab of the man�s cerebral tissue on a microtome�essentially, a sophisticated meat slicer�and, working along the coronal plane, cut off dozens of fifty-micron shavings, less than a hairbreadth thick. The shavings were then immunostained�bathed in a special reagent that would mark the presence of abnormal proteins with a bright, telltale red or brown stain on the surface of the tissue. Afterward, each slice was smoothed out and placed on a slide.

The stained tissue of Alzheimer�s patients typically shows the two trademarks of the disease�distinctive patterns of the proteins beta-amyloid and tau. Beta-amyloid is thought to lay the groundwork for dementia. Tau marks the critical second stage of the disease: it�s the protein that steadily builds up in brain cells, shutting them down and ultimately killing them. An immunostain of an Alzheimer�s patient looks, under the microscope, as if the tissue had been hit with a shotgun blast: the red and brown marks, corresponding to amyloid and tau, dot the entire surface. But this patient�s brain was different. There was damage only to specific surface regions of his brain, and the stains for amyloid came back negative. �This was all tau,� Ann McKee, who runs the hospital�s neuropathology laboratory, said. �There was not even a whiff of amyloid. And it was the most extraordinary damage. It was one of those cases that really took you aback.� The patient may have been in an Alzheimer�s facility, and may have looked and acted as if he had Alzheimer�s. But McKee realized that he had a different condition, called chronic traumatic encephalopathy (C.T.E.), which is a progressive neurological disorder found in people who have suffered some kind of brain trauma. C.T.E. has many of the same manifestations as Alzheimer�s: it begins with behavioral and personality changes, followed by disinhibition and irritability, before moving on to dementia. And C.T.E. appears later in life as well, because it takes a long time for the initial trauma to give rise to nerve-cell breakdown and death. But C.T.E. isn�t the result of an endogenous disease. It�s the result of injury. The patient, it turned out, had been a boxer in his youth. He had suffered from dementia for fifteen years because, decades earlier, he�d been hit too many times in the head.

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The other major researcher looking at athletes and C.T.E. is the neuropathologist Bennet Omalu. He diagnosed the first known case of C.T.E. in an ex-N.F.L. player back in September of 2002, when he autopsied the former Pittsburgh Steelers center Mike Webster. He also found C.T.E. in the former Philadelphia Eagles defensive back Andre Waters, and in the former Steelers linemen Terry Long and Justin Strzelczyk, the latter of whom was killed when he drove the wrong way down a freeway and crashed his car, at ninety miles per hour, into a tank truck. Omalu has only once failed to find C.T.E. in a professional football player, and that was a twenty-four-year-old running back who had played in the N.F.L. for only two years.

�There is something wrong with this group as a cohort,� Omalu says. �They forget things. They have slurred speech. I have had an N.F.L. player come up to me at a funeral and tell me he can�t find his way home. I have wives who call me and say, �My husband was a very good man. Now he drinks all the time. I don�t know why his behavior changed.� I have wives call me and say, �My husband was a nice guy. Now he�s getting abusive.� I had someone call me and say, �My husband went back to law school after football and became a lawyer. Now he can�t do his job. People are suing him.� �

McKee and Omalu are trying to make sense of the cases they�ve seen so far....

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...In 1905, President Theodore Roosevelt called an emergency summit at the White House, alarmed, as the historian John Sayle Watterson writes, �that the brutality of the prize ring had invaded college football and might end up destroying it.� Columbia University dropped the sport entirely. A professor at the University of Chicago called it a �boy-killing, man-mutilating, money-making, education-prostituting, gladiatorial sport.� In December of 1905, the presidents of twelve prominent colleges met in New York and came within one vote of abolishing the game. But the main objection at the time was to a style of play�densely and dangerously packed offensive strategies�that, it turns out, could be largely corrected with rule changes, like the legalization of the forward pass and the doubling of the first-down distance from five yards to ten. Today, when we consider subtler and more insidious forms of injury, it�s far from clear whether the problem is the style of play or the play itself.

Take the experience of a young defensive lineman for the University of North Carolina football team, who suffered two concussions during the 2004 season. His case is one of a number studied by Kevin Guskiewicz, who runs the university�s Sports Concussion Research Program. For the past five seasons, Guskiewicz and his team have tracked every one of the football team�s practices and games using a system called HITS, in which six sensors are placed inside the helmet of every player on the field, measuring the force and location of every blow he receives to the head. Using the HITS data, Guskiewicz was able to reconstruct precisely what happened each time the player was injured.

�The first concussion was during preseason. The team was doing two-a-days,� he said, referring to the habit of practicing in both the morning and the evening in the preseason. �It was August 9th, 9:55 A.M. He has an 80-g hit to the front of his head. About ten minutes later, he has a 98-g acceleration to the front of his head.� To put those numbers in perspective, Guskiewicz explained, if you drove your car into a wall at twenty-five miles per hour and you weren�t wearing your seat belt, the force of your head hitting the windshield would be around 100 gs: in effect, the player had two car accidents that morning. He survived both without incident. �In the evening session, he experiences this 64-g hit to the same spot, the front of the head. Still not reporting anything. And then this happens.� On his laptop, Guskiewicz ran the video from the practice session. It was a simple drill: the lineman squaring off against an offensive player who wore the number 76. The other player ran toward the lineman and brushed past him, while delivering a glancing blow to the defender�s helmet. �Seventy-six does a little quick elbow. It�s 63 gs, the lowest of the four, but he sustains a concussion.�

�The second injury was nine weeks later,� Guskiewicz continued. �He�s now recovered from the initial injury. It�s a game out in Utah. In warmups, he takes a 76-g blow to the front of his head. Then, on the very first play of the game, on kickoff, he gets popped in the earhole. It�s a 102-g impact. He�s part of the wedge.� He pointed to the screen, where the player was blocking on a kickoff: �Right here.� The player stumbled toward the sideline. �His symptoms were significantly worse than the first injury.� Two days later, during an evaluation in Guskiewicz�s clinic, he had to have a towel put over his head because he couldn�t stand the light. He also had difficulty staying awake. He was sidelined for sixteen days.

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...Much of the attention in the football world, in the past few years, has been on concussions�on diagnosing, managing, and preventing them�and on figuring out how many concussions a player can have before he should call it quits. But a football player�s real issue isn�t simply with repetitive concussive trauma. It is, as the concussion specialist Robert Cantu argues, with repetitive subconcussive trauma. It�s not just the handful of big hits that matter. It�s lots of little hits, too.

That�s why, Cantu says, so many of the ex-players who have been given a diagnosis of C.T.E. were linemen: line play lends itself to lots of little hits. The HITS data suggest that, in an average football season, a lineman could get struck in the head a thousand times, which means that a ten-year N.F.L. veteran, when you bring in his college and high-school playing days, could well have been hit in the head eighteen thousand times: that�s thousands of jarring blows that shake the brain from front to back and side to side, stretching and weakening and tearing the connections among nerve cells, and making the brain increasingly vulnerable to long-term damage. People with C.T.E., Cantu says, �aren�t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play�repetitively doing this, year after year, under levels that were tolerable for them to continue to play.�

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...In a fighting dog, the quality that is prized above all others is the willingness to persevere, even in the face of injury and pain. A dog that will not do that is labelled a �cur,� and abandoned. A dog that keeps charging at its opponent is said to possess �gameness,� and game dogs are revered.

In one way or another, plenty of organizations select for gameness. The Marine Corps does so, and so does medicine, when it puts young doctors through the exhausting rigors of residency. But those who select for gameness have a responsibility not to abuse that trust: if you have men in your charge who would jump off a cliff for you, you cannot march them to the edge of the cliff�and dogfighting fails this test. Gameness, Carl Semencic argues, in �The World of Fighting Dogs� (1984), is no more than a dog�s �desire to please an owner at any expense to itself.� The owners, Semencic goes on,

understand this desire to please on the part of the dog and capitalize on it. At any organized pit fight in which two dogs are really going at each other wholeheartedly, one can observe the owner of each dog changing his position at pit-side in order to be in sight of his dog at all times. The owner knows that seeing his master rooting him on will make a dog work all the harder to please its master.

This is why Michael Vick�s dogs weren�t euthanized. The betrayal of loyalty requires an act of social reparation.

Professional football players, too, are selected for gameness. When Kyle Turley was knocked unconscious, in that game against the Packers, he returned to practice four days later because, he said, �I didn�t want to miss a game.� Once, in the years when he was still playing, he woke up and fell into a wall as he got out of bed. �I start puking all over,� he recalled. �So I said to my wife, �Take me to practice.� I didn�t want to miss practice.� The same season that he was knocked unconscious, he began to have pain in his hips. He received three cortisone shots, and kept playing. At the end of the season, he discovered that he had a herniated disk. He underwent surgery, and four months later was back at training camp. �They put me in full-contact practice from day one,� he said. �After the first day, I knew I wasn�t right. They told me, �You�ve had the surgery. You�re fine. You should just fight through it.� It�s like you�re programmed. You�ve got to go without question�I�m a warrior. I can block that out of my mind. I go out, two days later. Full contact. Two-a-days. My back locks up again. I had re-herniated the same disk that got operated on four months ago, and bulged the disk above it.� As one of Turley�s old coaches once said, �He plays the game as it should be played, all out,� which is to say that he put the game above his own well-being.

Plenty more at the link.

This should be enough to either whet the reader's appetite or let him know to move on to something else.