The Football Dilemma

St. Augustine High School football, New Orleans, Louisiana

No sport inspires the passions and loyalties of Americans more than football. From September through December, Friday night lights dominate the American landscape, when the local high school football teams suit up to play their cross-county rivals. In hard-luck towns across America, high school football provides a unity of purpose, a place where the glory days of old are re-lived by aging men with aching bodies, and the struggles of everyday life are temporarily set aside to enjoy the youthful athleticism of young men who provide hope of a glorious future. Black or white, liberal or conservative, Christian or atheist, nothing brings people of diverse backgrounds together, or promotes community unity better, than football. From the forgotten towns of rural America to neglected inner-city housing projects, the local football field is where the American Dream comes true.

Like many young American boys then and now, football was the sport that most competed with my love of baseball and basketball. Every fall, starting in grade school and throughout my high school years, I looked forward to watching football on Saturday and Sunday afternoons. My friends and I played flag football games in the backyard and on the school fields of my youth. We played Strat-O-Matic Football in the basements and family rooms of our childhood homes (see “Strat-O-Matic Memories: The Football Years”). I looked up to the star football players who walked around town with varsity jackets on their backs and pretty cheerleaders by their sides.

The popularity of football is why high schools across the country devote disproportionately large percentages of their limited capital and operating budgets to sustain high-end football programs, even in poor communities that cannot afford a full-time librarian or consistently underperform academically. Although the child poverty rate in Valdosta, Georgia, exceeds 33%, and although 84% of school-aged children in the district are considered economically disadvantaged, the school district recently spent $15 million on a new 83,000-square foot indoor training facility that includes a 100-yard turf field, offense/defense meeting rooms, and an expanded kitchen. Similar examples can be found in every state and region of the country. From small, economically-depressed towns in western Pennsylvania, to poorly funded, working-class communities throughout rural Texas, under-resourced communities pour money into their local high school football programs as if they are non-negotiable budget priorities.

The financial priorities of the nation’s colleges and universities are even more out of whack. A successful football program at a Division I school requires hundreds of millions of dollars to pay for and maintain an 80,000-seat stadium, first-class practice fields, indoor gyms, and locker room facilities. The head football coaches at top-ranked Division I schools earn salaries in excess of $5 million to $10 million per year. At many state universities, a head football coach is the highest paid public employee in their state. Even some relatively small universities pay their head football coaches over $1 million per year, funding their programs through mandatory (and excessively high) student fees and university budget subsidies.

Football in America is big business. Last year, the NFL recorded $23 billion in revenues. Its commissioner is paid $64 million per year. Each NFL team’s salary cap exceeds $300 million (for player salaries), and the legalization of sports gambling has brought billions of more dollars into the NFL. Team valuations have more than doubled in ten years, and even poorly performing teams are valued at close to $10 billion. Every Sunday (and Monday and Thursday), the NFL commands the nation’s attention on five major networks (ABC, CBS, ESPN, NBC, FOX). College football fills the airwaves on Saturdays. The most elite college players now earn hundreds of thousands, and in some cases, millions of dollars for use of their name, image, and likeness. The games are played in major cathedrals before capacity crowds.

The young men who play the game are adored and uplifted and treated as special people … until they can no longer perform. And then they are forgotten.

A recent study published in the British Medical Journal and reported extensively over the past two weeks has forced me to consider some uncomfortable truths, about American society’s love affair with football, and with my own admiration and draw to the sport. The study shows that the risk of developing chronic traumatic encephalopathy (CTE), a form of brain damage caused by repeated jolts to the head, is far more prevalent than originally imagined.

CTE is associated with the accumulation of thousands of small, sub-concussive hits, not necessarily recognizable concussions. These hits start as early as pee-wee football and accumulate as players progress through high school and college ball. By the time the small group of elite players reach the NFL, many if not most of them have likely already experienced some significant, long-term damage. The brutal physicality of football, the hundreds of violent hits and tackles, the rattling of the brain that occurs on most plays, the incredible speed and size and strength of the players who bring such talent and zeal and beauty to the sport, all contribute to what we are now learning about the medical data.

The study examined 338 brains donated by players’ families between 2008 and 2021 (out of a total of 1,721 players who died), and found that 93% were diagnosed with CTE. To account for selection bias, as most families who donated their loved ones’ brains likely suspected something was wrong, researchers narrowed the study to the 878 players who died between 2016 and 2021. That sample included 235 donated brains, of which 91.5% were diagnosed with CTE. After looking at demographic data and other information from death certificates of all NFL players who died in that time frame, they found that not less than 25% of the players had CTE. Because only a small percentage of the dead players’ brains were autopsied, and because an autopsy is the only way to detect CTE, the 25% figure is the absolute floor, or the lowest possible minimum of CTE prevalence, and assumes that every player whose brain was not autopsied was perfectly healthy, which is extremely unlikely. Medical experts believe the actual rate of CTE could be as high as 97.7%, and is most likely somewhere between the high and low figures.

The symptoms of the disease are devastating. They include memory loss, confusion, uncharacteristic mood swings, increases in erratic and impulsive behavior. It has been found in very young men, including several high-profile former NFL players who committed suicide, suffered debilitating cases of cognitive impairment, and in a few cases committed violent crimes.

Some may argue this is what the men signed up for when they chose to play such a physically violent game that brought them a modicum of fame and money. But how many of the risks were told to the high school teens that were later so aggressively recruited to play at Division I colleges and universities?

For those of us who love to watch football, or who spend money on football tickets and merchandise, how do we come to terms with the knowledge that the high-speed hits, blocks, and tackles we love to watch causes the athletes’ brains to bounce against their skull, each time potentially inflicting little injuries? Or that, when these little injuries are repeated over and over again, the long-term consequences are dire and devastating?

Even by turning on the remote to watch the game are we not supporting what is a multi-billion-dollar industry that glorifies and promotes a game in which the players repeatedly do immense damage to their brains? Can we really say that the 20-year-old man who chooses to play professionally knows precisely the risks he is taking? What about the 13- and 14-year-old boys who are drawn to the glory of Friday night lights?

In the fall of 1973, as a 14-year-old about to start my freshman year in high school, and decades before we knew anything about CTE, I too was drawn to high school football. My mother, herself a high school athlete, was less enthusiastic about the idea. She worried that football was a dangerous sport that could result in serious injury. A few weeks before football practice started, mom quietly purchased a then bestselling paperback book called Meat on the Hoof: The Hidden World of Texas Football by Gary Shaw (St. Martin’s Press, 1972). Shaw played football for the University of Texas at Austin in the 1960s, and his book exposed the brutal realities of the UT football program under Coach Darrell Royal.

Mom handed me a copy of the book one afternoon and said, “You really need to read this.” I recall feeling a bit exasperated at the time, but became genuinely intrigued by the book as I absorbed its contents over the next several days. Shaw’s memoir described the poor medical care, punishing practices, and extreme psychological pressure the players endured. Players were put through practice drills intentionally designed to weed them out, through injury, severe hazing, and humiliation. Players who became injured, including Shaw, were treated as expendable inventory. Many lost their scholarships. The promises made by Coach Royal during recruiting sessions—that they would be looked after, receive a first-rate education, and be treated like family—suddenly vanished. Instead, as the title of the book implied, the athletes were treated like livestock ("meat on the hoof"), used, exploited, and then discarded when no longer useful.

But I was fourteen years old. From my vantage point, high school football was glorious, with marching bands and cheerleaders, pep rallies and stands filled with people on gameday. Football players were looked up to and treated like rock stars. Besides, I failed to see the connection between a football program at a big-time Texas university and the smalltime freshmen program at Hightstown High School.

So, I endured the twice-a-day practice sessions held during the peak summer heat, and learned to hit and tackle and block. The coaches tried their best to turn me into someone I was not, a physically aggressive, angry and ruthless person willing to inflict punishment on others. Throughout the season, the coaches yelled at, intimidated, and humiliated us, believing it motivated us to play harder, hit harder, tackle harder. Although as a tight end and occasional wide receiver, I led our underperforming team in scoring, I learned quickly that football was not for me. I played in fear of getting injured (not a good way to play football), hated playing defense, and held the coaches in disdain. When the start of my sophomore year came around, I opted out.

Yet I understand why so many young men are attracted to football. It is a beautiful game to watch and a fun and exciting sport to play. The adulation and adornment dished out to football players in many communities and schools is hard to ignore. And football offers an attractive avenue for young men in search of meaning and purpose in their lives. Football teaches discipline and a strong work ethic, teamwork and collaboration, leadership skills, and the perseverance and resilience needed to overcome challenges and handle setbacks. But too many young men play the game in the hopes of achieving college scholarships and NFL stardom and the big money attached to it. For some talented high school players, the fame, riches, and glory are there for the taking, or so it seems. For most, it turns out to be a mirage.

Is there any truth to the notion that football is so popular in the United States because it is such a violently physical sport full of risk? Or are we simply oblivious, or unthinking, in our support of what is admittedly an exciting, beautiful game? If it turns out that the rate of CTE among professional football players is as high as 97% (or even 40% or 50%) what are the ethical implications of school boards, college presidents, local media outlets, NFL owners, advertisers and sponsors, and the sports gambling industry supporting and promoting an industry that causes such harm to those who play it? And what about all of us who support the game by watching and rooting for young men as they entertain us in a way that will eventually cause many of them to suffer severe brain damage and disproportionately high cases of early dementia, ALS, Parkinson's disease, and worse?

I am genuinely conflicted by all of this because I continue to enjoy football for the exciting, dynamic, and thrilling sport that it is. I love that football brings people from all walks of life together. And I understand the socioeconomic and cultural factors that play a role in the high percentage of African American athletes who play and dominate football at its most competitive levels. The lure of football as an opportunity to open doors to a better life, to riches and fame, is compelling and difficult to resist, especially if you are poor and don’t perceive a bright future outside of football. But it is sad. Only a select few are good enough to make it, and even then, based on the medical data, it does not seem worth it.

It is not for me to tell anyone whether or not they should play football, or root for football, or support the game financially. But I hope that any young person considering playing the game today will take a long, hard look at the evidence and ask themselves, is the glory of Friday night lights really worth it?