As the American National Football League (NFL) continues to struggle with the health risks posed by concussions, a new HealthDay/Harris Poll finds that vast majorities of Americans say football teams need to do more to protect their players from head injuries.
The poll reveals that the public is now widely aware of the often-debilitating and sometimes deadly health problems facing many current and retired professional players -- a controversy that's the focus of a new Will Smith movie, Concussion, which premieres Christmas Day.
"There's definitely an increase in concern for players at all levels," said Dr. Sharief Taraman, a pediatric neurologist at Children's Hospital of Orange County, California.
"Although it started with NFL players having these tragic outcomes, it's trickled down to even the paediatric level."
The poll findings also suggest that the more a person knows about the concussion crisis, the more likely he or she wants to see action taken to protect players, Taraman added.
Read: Measuring footballers' risk of concussion
According to the poll, both the general public and pro football fans in particular say football teams at all levels - from the pros to youth leagues - should:
- Require players who suffer a head injury to take a set amount of time off from playing to recover (83 percent for the public, including 88 percent for football fans and 76 percent for non-fans).
- Use a standardised test to determine if and when injured players can return to the field (82 percent for the general public; 88 percent for football fans and 74 percent for non-fans).
Americans also think that aggressive tackles that can lead to head injuries should be restricted in youth football (79 percent for the general public; 84 percent for football fans and 72 percent for non-fans).
A smaller majority also supports limiting aggressive tackles in pro football - about three out of every five people, across the board.
The NFL instituted rules in 2010 designed to limit head injuries, but the public is generally skeptical about whether those rules are working, the poll found.
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These include more stringent return-to-play rules, prohibiting a player from launching himself off the ground and using his
helmet to strike a player in a defenseless posture in the head or neck, and all players who suffered a head blow must be seen by a neurologist.
Only 44 percent feel the new rules have been effective. However, football fans are more likely than non-fans to say the new rules are working - 57 percent versus 26 percent.
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Incentives to ignore the rules are a problem
People may be skeptical because there are incentives at all levels of the NFL - from players to coaches to team owners - to not strictly enforce these rules, suggested Dr. Stephen Rice, director of the Jersey Shore Sports Medicine Center at the Jersey Shore University Medical Center in Neptune, N.J.
Players want to stay on the field to keep their jobs, coaches need to keep strong players on the field to chalk up wins and protect their jobs, and owners want their teams to win - and to make money, Rice said.
"Maybe people think it's not being enforced well," Rice said.
"All the coaches are supposed to have learned this information, and athletic trainers and doctors are supposed to know it and practice it. It should be enforced, but we can do a better job and we should do a better job."
In a statement, the National Football League said: "The NFL has made numerous changes to the game to enhance the health and safety of players at all levels of football.
These include nearly 40 rule changes in the last decade, strict concussion protocols, and better training and sideline medical care. We are seeing measurable results, including a 34 percent decrease in concussions in NFL games since the 2012 season.
"Additionally, we are funding independent scientific and medical research and the development of better protective equipment to advance further progress. The game continues to change, and the safety of our players remains our highest priority," the statement said.
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Brains of some ex-players show Alzheimer's-like signs
The concussion controversy in football traces back to at least 2002.
That's the year Pittsburgh forensic pathologist Dr. Bennet Omalu decided on the spur of the moment to autopsy the brain of "Iron Mike" Webster, a star center for the Pittsburgh Steelers who died at age 50 after years of dementia had left him penniless and intermittently homeless.
Omalu discovered that Webster's brain was riddled with large clumps of tau protein, which generally is considered a hallmark of Alzheimer's disease. Omalu - who's portrayed by Smith in the new movie - published his findings in the journal Neurosurgery in 2005.
Omalu's research served as the spark for the concussion crisis in football. Since his initial discovery involving Webster, a stream of personal tragedies and research has further tied football at many levels - not just the pro level - to concussions and potential brain damage.
Read: Did repeated concussions cause Joost van der Westhuizen's MND?
In perhaps the most shocking example, All-Pro linebacker Steve Baul "Junior" Seau took his own life in 2012 at age 43, shooting himself in the chest to preserve his brain for research that later showed it had sustained the same sort of damage as Webster's.
Earlier this year, NFL standout rookie linebacker Chris Borland quit the game after suffering two diagnosed concussions, specifically citing his fear of brain injury as his reason for ending a promising career.
A month later, a federal district court judge gave final approval to a lawsuit brought against the NFL by more than 5,000 former players, some of whom accused the league of downplaying the dangers of repeated concussions. The settlement provides payments of up to $5 million per player for those suffering from severe neurological disorders.
Also this year, NFL legend and Hall of Famer Mike Ditka said he wouldn't want his child to play football.
"I wouldn't. And my whole life was football," Ditka said on the HBO show Real Sports with Bryant Gumbel. "I think the risk is worse than the reward. I really do."
But, the HealthDay/Harris Poll also found that Americans think football players know the score when it comes to the threat of concussions and brain injury, and participate at their own risk.
About 83 percent of the public - and nine in 10 football fans - agree that the risks of playing football are widely known, and that players have accepted those risks.
When poll participants were asked who should be held at least somewhat responsible for football players' well-being on the field:
- 81 percent point to the players themselves.
- 71 percent point to the coaches.
- 62 percent say team owners.
- 56 percent cite the sport's governing body.
- 43 percent say schools.
"Despite obvious public concern over these types of injuries, there is also a prevailing sentiment that players know what they're getting into and are responsible for their own well-being, over and above any other party," said Larry Shannon-Missal, managing editor at The Harris Poll.
A huge majority of Americans believes that helmets should be changed to better protect players against concussions, including 86 percent of the general public and 92 percent of football fans.
But that opinion is based on a misconception, Rice said.
"Helmets have never, ever been able to prevent concussion," he said. "They're fabulous at preventing skull fractures and scalp lacerations, but they do not do anything that anyone has ever successfully measured to prevent concussions."
Watch the trailer for Concussion
Nigerian-born Dr Bennet Omalu (played by Will Smith) single handedly changed the way the National Football League (NFL) thinks about concussion, but his fight to get the NFL to do so was not easy. He fought denial, institutional racism and reams of red tape. For him, the movie will be a vindication, for others it should be a wake-up call.
The HealthDay/Harris Poll was conducted online within the United States between Nov. 23-25, 2015 among 2,096 adults aged 18 and older.
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