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Doug Robinson: Merril Hoge's book challenges the popular narrative regarding football and CTE

SALT LAKE CITY — Merril Hoge is taking a few hits from the media. He should have expected as much because his book “Brainwashed” challenges the popular narrative that football can lead to CTE — Chronic Traumatic Encephalopathy (degenerative brain disease widely believed to be associated with repeated blows to the head).

It might be easy to dismiss Hoge as a former NFL player and former ESPN analyst who is simply shilling for the game, but he’s got an expert to cover his backside. The book is co-authored by Dr. Peter Cummings, a forensic pathologist who has challenged the findings of Boston University, which has contributed to the anti-football movement and provided the research it is based on. BU is also Cummings’ employer, likely much to the school’s chagrin.

The complete title of their book tells the story — "Brainwashed / The Bad Science Behind CTE and the Plot to Destroy Football."

Hoge and Cummings believe BU’s research is faulty and misleading, and that while there is a correlation between football and CTE, there is no legitimate research that shows causation (there’s a big difference). Maybe they’re already too late; many have already made up their minds that football is the cause of CTE.

Hoge and Cummings say several reporters they contacted told them they would not read the book. Others made their opinions clear: “Merril Hoge Doesn’t Want You to Use Your Brain,” deadpanned Deadspin. “Don’t Be Brainwashed by New Book that Rejects Sound Football CTE,” said the Idaho Statesman, a newspaper based in Hoge’s home state. “Hoge’s ‘Brainwashed’ Is for Football Diehards, Not for Advancing Science on CTE,” said Forbes.

Hoge and Cummings are challenging a widely accepted premise. Maybe it’s just another target in an era when teeter-totters, merry-go-rounds and red rover have been banished from the playground because they’re considered too dangerous.

If anyone would seem willing to point the finger at football, it would be Hoge. His eight-year career (1987-94) as a running back for the Steelers and Bears ended suddenly — and, in hindsight, perhaps prematurely — after a couple of concussions. He sued the Chicago Bears' team doctor for failing to follow proper concussion protocol, which made him much more vulnerable for a second, more serious concussion; he won a half-million dollars.

Notwithstanding, over the years he became concerned about the backlash against football resulting from the concussion/CTE issue. Both he and Cummings have sons who play or did play football (Hoge’s son Beau was a quarterback/running back at BYU who also suffered concussions). They are dismayed by the decline of participation in the sport at the youth and high school levels as a result of what they consider faulty information.

“This (book) is for families, and for people struggling with the headlines,” says Hoge. “They need to take the time to find out the truth. Both Peter and I came to this opposed to it as concerned parents. I wanted to know the truth. I started calling around. Once I did, I found out how wrong the headlines are.” Besides collaborating with Cummings, Hoge says he interviewed about a dozen neurologists multiple times, observed an autopsy and even dissected a brain.

Most of the CTE backlash against football is a product of studies conducted by BU, namely one in which the brains of 110 out of 111 former NFL players were examined and determined to have CTE. The press ran wild with that announcement, but Hoge and Cummings state emphatically and repeatedly that the study was seriously flawed.

They argue, for one thing, there was no control group and the brains belonged to men already known to be symptomatic. As the Associated Press reported, “Many donors or their families contributed to the studies because the players had repeated concussions and symptoms before death.”

That’s like trying to determine what percentage of the population has cavities and studying only people who complained of toothaches.

Even the lead researcher and public face of BU’s CTE research, Dr. Ann McKee, noted, “There’s a tremendous selection bias,” acknowledging that many of the families donated brains because the former player manifested CTE symptoms. From this study, some linked CTE to depression and suicide among former players (Junior Seau, Dave Duerson, Aaron Hernandez, Andre Waters).

Hoge and Cummings argue that any legitimate study requires a control group — in this case, former players who had had no reported issues, for instance, or controlling for other factors such as use of steroids or other performance-enhancing drugs, family history, mental-health issues, body weight (which affects the brain) and so forth.

Cummings says another study conducted by the Mayo Clinic was similarly flawed. (Cummings says he could “publicly shred it.”)

“There’s a whole body of evidence out there that doesn’t support the narrative,” says Cummings. “People are reluctant to speak out. ... One of the most important points to make is what science papers are saying outside of BU that no one’s hearing about. There’s a lot of research screaming, ‘We don’t know anything.’ We still don’t understand what causes (CTE). It’s a constantly moving target. There are new papers coming out all the time.”

Says Hoge, “We are in an observation state now. We don’t know what causes CTE and we don’t know what CTE causes. If CTE is caused by repetitive head trauma, how do you explain the hundreds of cases of people who have the pattern of CTE who never played football or contact sports nor had a history of concussion or head trauma? How do you explain (finding) it in a 1-year-old and a 4-month-old? … There are thousands or even millions of former football players out there who don’t have CTE. If every bump on the head causes CTE, how can this be?!”

Hoge also wonders how NFL players can be so much healthier than the general population if they’re suffering from CTE. It is frequently reported that NFL players have a short life span — as low as 55 — but that’s erroneous. The New York Times cited a government study that reported NFL players’ life expectancy is actually a little longer than the general population, and NFL players also have lower death rates for cancer and heart disease.

"The War on Football," a book authored by Daniel Flynn, reported that a study of 3,000 retired NFL players by the National Institute for Occupational Health and Safety found that the suicide rate is “less than half the rate of other American men.” CNN cited a study by the University of Texas at Dallas that concluded that the arrest rate for NFL players is lower than that of American males between the ages of 20-39.

“Just in the last month we’ve had several former NFL players pass away in their 80s and 90s,” says Hoge. “No one from BU was there to study them, and they played in an era when football was more dangerous. If you could pick an era in which to play football, it would be now.”

One thing that’s grown out of the concussion/CTE scare is that the game has gotten smarter and safer. Better equipment. Better helmets. Better tackling technique. New rules. The elimination of certain drills and hits. Limits on padded practices and full-scale tackling drills. The development of concussion protocols and treatment.

“If you get a concussion, it doesn’t mean you’re going to get CTE,” says Cummings. “You’re probably not going to get it. There’s no relationship between concussions and the number or severity in the development of CTE.”

Hoge and Cummings say the sport has too much to offer youths — discipline, exercise, socialization, preparation, work ethic, sacrifice — for parents and media to steer them away from the field, especially if it’s because of bad information. If Hoge is to be believed, he’s so committed to this message that he’s willing to pay a price. He self-published the book, which means he had no publisher fronting the costs.

“I’m so far in the hole on this,” he says. “I’m hemorrhaging money. If we had been doing it for money, it would be the wrong thing.” (Cummings says he will receive no royalties.)

Hoge’s son Beau has had three concussions, the first one as a result of falling in the shower in 2015. He did not undergo treatment at the time and subsequently (and predictably) experienced two concussions in football. According to the Hoges, Beau recovered completely after undergoing therapy.

“The treatments and the ability to identify where the brain has been affected, and the targeted therapies — I can’t even tell you how exciting that is,” says Hoge. “It’s nice to know there are ways to treat it. You can repair and recover. There are two types of recovery plans — cardiovascular training and cognitive training exercises — that help strengthen the brain. My own son went through that in 10 days. You could see the light bulb go on; you could see the energy change. He’s never worried about having another one.”

So many advancements have been made in the treatment of concussions that Hoge believes that if he had suffered his concussions in today’s NFL he would have had a longer NFL career.

“I would have been playing again that (same) year,” he says.