“I just want to live a long, healthy life,” said 24-year-old Chris Borland in announcing his retirement from the NFL on Monday. The San Francisco 49ers linebacker, who had signed a nearly $3 million contract and seemed on the verge of an all-pro career, quit football because he was concerned about its effect on his brain. “I don’t want to have any neurological diseases or die younger than I would otherwise,” he explained.
Borland’s surprising, early exit from the league has been taken as a sign that players are getting wise to the dangers of their game. We’re told the sport itself is now at risk. “Borland’s decision-making process is what represents the fundamental danger to the NFL,” wrote Will Leitch in Sports on Earth. “The problem is that more Borlands are coming.”
Columnists and commentators who have long lamented the problem of concussions—some giving up on watching football altogether—now have their most convincing convert. Borland says his journey began when he started reading League of Denial, an expose of the NFL’s policies on head injuries. He read the book in secret, he told its authors, Steve Fainaru and Mark Fainaru-Wada. Now he’s ready to send a message to the league: “Inevitably this action makes a pretty profound statement. … Health is more important than a career in football.”
Borland’s action certainly makes a statement, but let’s not assume—as so many have already—that it’s profound. His retirement comes less than a week after that of his teammate Patrick Willis—a 30-year-old, 7-time Pro Bowl linebacker and defensive captain who was in the middle of a $50 million contract. Both men elected to quit their jobs and relinquish millions of dollars in salary rather than put themselves at risk of future injuries. Both worried about their long-term health. Yet Borland’s announcement has been deemed a major blow to football, “a moment that feels much bigger than him alone.” Willis’ has mostly been ignored. Why?
Borland is six years younger, and seemingly in tip-top shape; Willis has suffered from repeated ailments, and fears his performance has already been degraded. But what really separates these two men, at least in the public mind, is the nature of their fears. Borland worries that he might hurt his brain; Willis wants to protect his feet. The space between those body parts has been enough to put one man’s story on the front page of the New York Times, while the other has been buried in some wire copy.
Willis had good reason to be concerned about his feet. They’re special: “I don’t know what it is about these feet, but they got y’all saying, ‘Wow,’ ” he said during a tearful press conference last week. “Lord made my feet like the feet of a deer.” Wills worries that his hooves have already lost some “Wow,” and he’s concerned about what might happen if he gives them more abuse: “Honestly, I pay attention to guys when they finish playing,” he told reporters. “Walking around and they ain’t got no hip, and they can’t play a pickup basketball game or they can barely walk, or their fingers are all like this.” Willis held up his hand, contorted like a claw. “It’s because he played those few extra years.”
Like Borland, Willis traded off the gains of playing football at the highest level for a chance at better health. Yet we’re not inclined to see his decision as being one that “should worry the NFL.” It’s simply not as important or significant as the one that Borland made, since it’s not about his brain.
That distinction between a player’s brain and body reflects a systematic bias in how we think about the NFL. We know that football players hurt themselves in lots of ways, and that they may suffer from these injuries for all the years that follow. But we assume that one source of disability matters more than any other. A damaged foot, a damaged knee, a damaged spine, a damaged shoulder: These seem like inconveniences. A damaged brain? That’s a different thing entirely—an insult to the soul, an affront to personhood, a life-destroying tragedy. The body can be broken in 200 places, but we tend to think a broken mind is sui generis. The risk of encephalopathy stands alone.
This is not a medical fact; it’s a matter of opinion. Consider that more than 40 percent of NFL retirees report arthritis before they reach the age of 60, a rate that’s more than triple that of other men. Another survey found that four-fifths suffered from “moderate to severe pain,” again more than triple the baseline rate in the general population.
What about the risks of head injury? Borland says that he’s afraid of “dying young,” but the data show that former NFL players reach older ages than the rest of us, on average. According to the best available study of football’s effects on mortality, 54 players end up living longer lives for every one that dies of ALS or Alzheimer’s. (In absolute terms, a full career of playing football might have added 0.13 percentage points to Borland’s risk of death from ALS.) Like Borland, we’ve all heard dramatic stories of wounded athletes who kill themselves, but in truth NFL retirees commit suicide less often than age-matched controls. And many of the grim statistics that so often get repeated (e.g., “1 in 3 former football players experience accelerated cognitive decline”) turn out to be specious, exaggerated, or speculative.
It’s not that head trauma doesn’t pose a real danger to NFL athletes. Football adds to players’ risk of neurodegenerative disease and early-onset dementia, and can indeed be a source of tragic incapacity and early death. These same hits to the head can also be a source of mild cognitive impairments and long-term inconvenience. But their effects on a former player’s health may not be any worse than those that come from injuries to his back or limbs or hands and feet.
Imagine two middle-aged men, identical in every way except for the nature of their ailments:
“Chris” has a moderate traumatic brain injury, as a result of the years he spent being knocked in the head on the football field. He suffers from frequent headaches, memory problems, difficulty concentrating, and dizziness. He’s often anxious and moody.
“Patrick” has moderate musculoskeletal problems, as a result of the years he spent being battered on the football field. He has pain and deformity in most joints, causing difficulty moving around, getting up and down, and using his hands for lifting and carrying. He often feels fatigue.
Which of these men has paid the steeper price for playing football? Perhaps some readers would rather be in Patrick’s shoes, since for all his chronic pain at least he hasn’t lost his mind. But others might feel differently, and if we’d really like to know whether it’s better to be Chris or Patrick, then we ought to look not at our own preferences, but at survey data.
In 2012, a Harvard professor of global health named Joshua Salomon published a paper with scores of colleagues from around the world on the relative importance of several hundred different medical conditions. Salomon presented the subjects of his study with pairs of descriptions like the one above and asked a question: Person A has the following symptoms and Person B has a different set; which one would you say is in better health? Then Salomon aggregated those judgments, and used them to infer the relative importance of each condition for a person’s perceived health.
The Harvard-based team reached out to more than 30,000 people in 167 different countries, for the largest-ever study of its kind. To Salomon’s surprise, he found that ratings were more or less the same from one place to another.
So how does this relate to football? Salomon’s study included a handful of conditions that tend to show up among former NFL players, including traumatic brain injury, musculoskeletal disorders, dementia, and chronic pain. In fact, the symptoms listed in the “Chris” and “Patrick” examples above are drawn almost verbatim from the Harvard survey. When Salomon compared these two conditions he found that people rated Patrick’s musculoskeletal problems as being somewhat worse than Chris’s traumatic brain injury.
That’s just one example. In general, when you compare traumatic brain injuries and dementia to joint problems and chronic pain, the weights tend to be about the same. Severe traumatic brain injury (unable to think clearly; needs help with eating, walking, and going to the bathroom; etc.) and severe musculoskeletal problems (severe, constant pain; extreme fatigue; sadness; etc.) are seen as being similarly debilitating, while having mild dementia (problems with memory, concentration and making plans) is rated as slightly less unhealthy than suffering from mild, chronic pain (difficulty turning the head, holding arms up, etc.).
Even Salomon and his colleagues were surprised by their results. They assumed that cognitive impairments would be deemed more debilitating than physical ones, but the data came out the other way: “People are much more likely to say that a physical problem produces a greater loss of health than a mental one,” he told me. That tendency wasn’t limited to lower-income populations, either, where physical impairments might be more detrimental to a person’s livelihood.
What explains these surprising findings? It could be the framing of the question. Salomon’s study asked people to judge the effects of these conditions on a person’s “health.” That’s different, he says, from judging their effects on a person’s “welfare,” or judging which condition would be “preferable” to have. It could be that the word health itself sets people up to focus on physical factors rather than mental ones. For that reason, Salomon warns against making too much of these comparisons.
Still, there’s another possibility, and one that also makes a lot of sense. What if Salomon and his colleagues were surprised by their results because they happen to be a bunch of egghead scientists? For someone who spends all day at his computer, a brain injury would surely seem more debilitating than early-onset arthritis. “As academics, perhaps we put undue importance on mental impairments,” says Salomon.
The same goes for those in the media who see an injury to Chris Borland’s brain as being more important than an injury to Patrick Willis’s feet. But according to 30,000 people around the world, a life spent in chronic pain and unable to walk might indeed be worse than a life spent with fuzzy memories and difficulty concentrating. For them, the message that Willis sent—that his physical health is more important than playing in the NFL—would be as profound as Borland’s, if not more so.
Editors might argue that the newness of concussion science makes it a better subject for newspapers. (We already knew that players suffer from twisted spines and stiffened joints, so why bother to discuss them?) While it may be true that novelty makes head trauma more interesting to readers, that doesn’t mean it’s necessarily more important to football players or the NFL than a busted foot or broken hands.
The media bias for the brain (and against the body) has never been more clear than it was this week. We’ve heard how Borland weighed the pros and cons of his career, and then made a choice to quit, “as rational people might be prone to do.” He used his brain—the very organ that was so much at risk—to weigh the evidence and make “a rational, self-preserving decision.” It’s a story that gets right to what we think is most crucial to our being: A clear mind and the capacity to reason.
Of course it’s not clear at all that Borland will end up in better health, having forgone a mountain of salubrious greenbacks in order to protect his noggin. His decision may have been rational and forward-thinking, but it may also be incorrect. Willis, for his part, has a different intuition about the risks and rewards of playing in a violent sport. “Be a man, hit me up high,” he said after a 2013 loss to Seattle, in which a low (but legal) block broke the ankle of his teammate Ian Williams. “Hit like rams. You don’t see a ram going and cutting another ram’s legs. They hit head to head, pad to pad,” he continued, in a soliloquy that surely made some cringe. With low blocks, he finished, “you’re not talking about a concussion and being out for two weeks. You’re talking about being down for the rest of the season.”
For the “enlightened” football fan this comment reveals everything that’s wrong with football. Willis invokes a dangerous machismo—be a man! be a ram! be a half-man, half-ram hybrid!—that ignores the risks of head trauma. When he says that concussions aren’t anything compared to broken ankles, we assume that he’s naive, or not conversant in the latest scientific data. We take it as a given that he isn’t thinking of his future.
But that’s not true at all—Willis is neither crazy nor misinformed. He’s a guy who thought the risk of damage to his body was greater than the risk of damage to his mind. That’s rational and it might be true. More than that, it reflects his values, and the weights that he assigns to different kinds of health.
If anything, Willis’ decision to retire sends a more unexpected and important message to the NFL: Even if you don’t care too much about concussions, and even if you think that men should bang their heads like rams, then you might still decide that football is too dangerous. You might still decide to quit, or you might still pull your children from their Pop Warner team. It doesn’t matter if it’s a danger to our bodies or our minds; either way, football might not be worth the risk.