Over the last two decades or so, CTE – short for chronic traumatic encephalopathy – has become almost synonymous with the National Football League.
The media’s role in the relationship between the football and concussions and other brain injuries is the subject of a new book called CTE, Media, and the NFL: Framing a Public Health Crisis as a Football Epidemic.
The book is written by University of South Florida Zimmerman School of Advertising and Mass Communications faculty members Travis Bell and Janelle Applequist and the University of South Carolina's Christian Dotson-Pierson.
When they started looking at the issue, the authors saw parallels between the NFL's response to criticism of how it handled CTE and its players and two previous public health issues: how tobacco companies dealt with research on the health effects of cigarettes and how people reacted to the AIDS epidemic in the 1980s.
“We used those two instances to look at the ways in which these responses then not only add to the public health discourse surrounding issues as this, but then actually help people to understand what those conditions are,” said Applequist.
“When AIDS first came out, there was a ton of misinformation about what could cause AIDS, and we saw a lot of stigmatization associated with that, in the same way that we now are seeing with the way that CTE has been reported.”
“There's some misinformation, some missing information. And so we were really focused on looking forward, how could that impact the public health perception of a diagnosis such as that,” she added.
“I think we would argue that the media is doing a bit of a disservice at this point, because we're still in the infancy of describing what chronic traumatic encephalopathy is and who can be affected by it.”
There’s also the matter of the business relationship between the media and the NFL.
For example, in 2013, ESPN producers Mark Fainaru-Wada and Steve Fainaru wrote a book about the NFL and traumatic brain injury called The League of Denial.
However, when it came time to produce a documentary with PBS and Frontline, ESPN dropped out, saying it didn't have enough editorial control. Others disagreed, saying the network faced pressure from the NFL as a business partner.
“ESPN is one of the broadcast entities who provides billions of dollars to the NFL, so it was not surprising that they removed themselves from that editorial stuff that was happening in 2013,” said Bell. “I think if that film were to come out now, ESPN might be more willing to participate at least a little bit because the NFL has publicly acknowledged a connection.”
Bell said newspapers, particularly the New York Times, were instead able to take advantage of their independence from the NFL and conduct deeper investigations of the issue. But they had, and still have, a similar conflict that broadcast media face – consumer demand for football-related news.
“I find it interesting that how did media try to grapple with this, in reporting this potentially deadly outcome from playing this sport, yet still wanting to make sure that it's in every day's newspaper about who won, who lost, what's the fantasy sports implications, all of these sports things that newspapers and media in general still thrive on,” he said. “So how much are they actually willing to push that boundary while also supporting the cause of making sure that it still is a huge part of what they do as a media source?”
That brings up the simple, yet undeniable fact: despite some fluctuating fan interest, Americans still love the NFL.
“We are cognizant of the fact that football is synonymous with America. It is such a cultural experience, and one that we both appreciate and participate in,” said Applequist. “At the same time, it's also important to be conscious, critical consumers of that industry, because there's still a responsibility that the NFL has to its players, but also to its fans in terms of how it's responding to some of these criticisms that it's been receiving.”
“The NFL, its responses over time have been really interesting to look at from a public relations perspective, how they kind of at first hid behind the science that was out there about CTE. And then they're at the point now of finally accepting it, but the question is, ‘Then what do you do about it in order to protect your players?” she said.
“And in terms of the culture of football, I think we're not arguing that this should go away – although some of the medical researchers on CTE would certainly argue that, but there has to be proper protocols put in place in order to protect the players. And that extends beyond the NFL, that extends to college football to high school football, particularly youth football, because their brains are so underdeveloped, they're at the highest risk of developing something like this.”
Bell adds that this risk forces participants at all levels, both coaches and players, to face difficult questions.
“I think that's why it's so fascinating to think about how willing people are to step away from the game because of potential brain injuries,” he said. “How willing are people to actually quit playing, or how willing are coaches to say, ‘This player looks like he's got something wrong with his head, we need to stop, bring him out.’
“Don't go with the mentality of ‘You got to push through, you got to push through.’ That's the notion that's embedded in American sport culture in general, and I think … that's an important takeaway is that one more thing about how media frame this, it's a football epidemic.”
Bell said there are some differences with the way the media covers this subject versus other controversies, such as players’ on-field demonstrations to raise awareness of racial issues.
“I think (that’s) because CTE is so connected to the on-field performance. But there still is this desire to separate sports and politics, the medicalization part, I think they're more willing to grapple with some,” he said. “I think the political tensions that are embedded in sport now are still very much taboo, the media will still discuss it and will still report on it. But I don't think it has the long-term hold that the idea of reporting on brain injuries have because of its direct connection to on-field performance versus ancillary things that are going on.”
And both authors think that, when it comes to CTE and other brain injuries, the media needs to look beyond the football field.
“CTE is not a diagnosis that is going to discriminate. Two populations that I don't think we were expecting would be veterans that have been in combat and experienced some jarring of the body and also victims of domestic violence that have sustained repeated physical abuse,” said Applequist.
“I think if media is willing to not only talk about it and self-reflect on what role do they play in this process, and then making sure that the reporting is actually done with due diligence to ensure that anyone who is at risk is in the conversation,” added Bell. “So, if there's a greater prevalence of concussions between female soccer players and men's soccer players, if females are at greater risk, why is that not talked about?”
“You don't think of cheerleading as a violent sport, but the number of cheerleaders who are dropped on the ground daily, in practices and events is a pretty prominent risk of hitting someone's head on a hard surface and creating brain injuries,” he said. “So, I think taking away from this book, that this is not a gendered thing. It's not a football thing. It is a repeated head trauma thing.”