Transcripts For CSPAN Traumatic Brain Injuries 20171126 : vi

Thank you all for being here today. Our judiciaryk Committee Ranking member chairman condors because he was the chairman because chairman when we were in the majority. I can refer to you as chairman, but not myself. Thank you chairman for joining us to examine the longterm impacts of repetitive brain trauma, in particular trauma associated with Contact Sports. I look forward to engaging in dialogue about this issue. Playersek, football take the field and engage in a contact and engage in a contact sport they enjoy playing but may be harmful to their health in the future. There are a lot of concerning questions that we will discuss today. At the very least athletes and their families need to know they are being informed about the health risk and the risks associated with Contact Sports are being mitigated to the greatest extent possible. With more and more research coming out, the evidence is becoming clearer and clearer, the effects of repeated head trauma, even those received during ones youth, can accumulate and cause serious and devastating conditions and these conditions can stem from injuries once considered minor known as sub sorry subconcussive hits. Boston University Researchers led by dr. Ann mckee, dr. Bob stern and Chris Nowinski said they have a marketedly increase of mood disorders like depression and this research has found language between head impacts and c. T. E. , a degenerative brain disease. These researchers examined the brains of 111 deceased National Football League Players whose families chose to donate their brains and 110 of the deceased players suffered from c. T. E. During their lifetimes. Im pleased were joined by all three of these researchers who are conducting critically important research. Their research must be considered by athletic associations and others, including congress, as we look for Real Solutions to this devastating disease and i thank them for their invaluable contribution to this area and look forward to hearing more today. Beyond this research, there are a number of Unanswered Questions about what risk factors make individuals more susceptible to these debilitating conditions. We need to understand what happens to the brain when its hit and how this triggers neurological effects and whether its possible to diagnosis c. T. E. During life and what treatment should be offered for those struggling with cognitive issues to the cumulative brain trauma. And while theres research that needs to be done, that should not be an excuse for inaction. What is not in dispute is the connection between head trauma and football and degenerative diseases like c. T. E. A number of our panelists today played professional football or have Family Members who did. Id like to welcome former nfl player, harry carson, mike adamle. Were joined by mr. Adamles wife, kim adamle, and dr. Eleanor perfetto, who is the widow of ralph wenzel. They have witnessed firsthand the exposure to the longterm impact. They can speak to the challenges they live with and witnessed as a result of this trauma, and they can also speak to the concerns of the future and whether they believe they will be adequately supported by the nfl or other organizations as they face future challenges. I would also like to mention that we invited the nfl to attend, but they declined. The science has raised enough red flags about the dangers of repetitive head trauma that its incumbent to those who organize Contact Sports to make the game as safe as possible. That commitment must come from all levels of play, including the highest level of football. Since the nfl recognizes the link they need to commit to supporting independent research, meaningfully reducing the risks and supporting players suffering from the effects of longterm brain injury. So this forum is critically important. Its unfortunate, however, this discussion is not being conducted in a formal congressional hearing. Despite our repeated requests for a series of hearings on this subject last year, the republican majority agreed to one hearing during last congress on concussions in youth sports and thats simply not enough. But im hopeful todays forum will help us build momentum for further action and discussion. I thank you, again, to all our witnesses for your contributions and for being here for this important discussion on traumatic brain injuries in athletics. I hope we can all continue to Work Together to find the best ways to address the significant Public Health issue. Im not going to mention my colleagues by name, because they are each going to be part of this forum and discussion. But i do want to say looking at the people that are up here, my colleagues that are up here really many of them have played a major role in dealing with shoes, so i appreciate the fact they are here today. Let me call on Ranking Member i call him chairman of the Judiciary Committee, congressman conyers, for an opening statement. Thank you for letting us use your room as well. Mr. Conyers youll get the bill. [laughter] mr. Conyers top of the morning, everybody. What a pleasure it is to be here with our energy and commerce Ranking Member Frank Pallone and all my colleagues in sponsoring this event. Its an important event, and its taken a little while to get there and we got a long way to go. Todays forum brings together some of the nations leading experts from the medical research and athletic communities to review the causes, effects and treatments of concussions and other head trauma. In particular, the forum examines what is known about brain injuries, what gaps exist in scientific literature and what is being done to address those gaps. The following year, the Judiciary Committee it will also feature firsthand accounts from individuals who suffered from subconcussive trauma or have witnessed its longterm effects on their loved ones. And thats why we have eight people this is a very unusual forum and im glad of it. When i was chairman of the Judiciary Committee, we held a hearing in 2009 on football head injuries, which was prompted by the mounting Scientific Evidence connecting head injuries in football and cognitive problems later on in life. During that hearing, the National Football league refused to acknowledge a connection between head injuries on the football field and the Subsequent Development of brain diseases. The following year, the Judiciary Committee held a hearing in detroit, michigan, followed by forums in houston and new york city as part of our ongoing commitment to calling attention to this problem and examining ways to prevent head injuries in youth, high school and in College Football as well. And this brings us to todays forum where our medical panelists will discuss their recently published studies examining the brains of 111 deceased National Football League Players, which found that an astounding 110 of them had chronic traumatic encephalopathy, also known as c. T. E. For short. Although Scientific Evidence clearly links head injuries in football to cognitive problems later in life, between 1. 6 million and 3. 8 million sports and related sports and recreationalrelated concussions occur each year, according to the center for Disease Control. The extent of injury is particularly problematic for our youth, as most brains are not fully developed until 25 years of age. As a result, a concussion is more dangerous for youth than it is for an adult. So i hope the panelists today will provide guidance on how we can better protect all athletes, especially our Young Athletes. And i would be remiss if i did not briefly comment concerning the president of the United States recent series of statements concerning our nations professional Football Players. At his rally in alabama on september 22 he mocked the National Football leagues efforts to prevent brain injuries, declaring two guys, just really beautiful tackle, boom. 15 yards. The referee goes on television, his wife so proud of him. Theyre ruining the game. Theyre ruining the game. End of quotation. The president of the United States then went on to use the power of his and Vice President s bully pulpit and twitter feeds to rail against the right of private citizens to express their views and right to protest as guaranteed by, of course, the first amendments free speech protection. Ironically, President Trump has not uttered a single word about the actual underlying issue. The glaring disparities in how africanamericans are dealt with under our criminal Justice System and their treatment by Law Enforcement officers which have often had deadly consequences. These are problems, by the way, which have gotten worse, not better, in my view under the Trump Administration and Sessions Department of justice. Now, todays forum allows to return to the actual facts and evidence and consider how we can best protect Football Players at all levels in an incredibly violent sport. I thank all the panelists and the members for being here today, and i turn it back to mr. Pallone, my colleague and friend. Mr. Pallone thank you, chairman. Thank you so much for your comments and, again, for having letting us have a place to have this forum today. I wanted to introduce the panelists, but normally members of congress get to make Opening Statements when they come to these forums and we are not doing that today because they all agreed not to in order for us to get to the panelist. Let me at least introduce everybody up here, if i could. First on my left is jan schakowsky, shes a member of the energy and commerce committee. Shes from chicago. Shes probably done more on this issue than any other member. I have to be honest. Shes just been very concerned about this whole issue of concussion in sports and been out front on it from the beginning. To her left is mr. Mcnerney from california, also a member of the energy and commerce committee. And then to my right is steve cohen who is from memphis, outspoken on so many issues. I call you the investigative congressman. And then we have david cicilline. Both are members of the energy Judiciary Committee and david is the cochair of our message or we call it democratic policy group. And he plays a major role in getting our many and developing our policy. So on our panel, we have today dr. Ann mckey, i guess im going from my left. Director of the c. T. E. Center at Boston University. We have dr. Robert stern whos director of Clinical Research for the Boston University c. T. E. Center. Then we have dr. Chris nowinski who is cofounder of the Concussion Legacy Foundation and cofounder of the Boston University c. T. E. Center. Then we have harry carson who is a member of the pro football hall of fame and linebacker for the super bowl xxi new york giants who served as team captain of the giants for 10 seasons. You probably figure hes my favorite. [laughter] deandre levy who is starting linebacker for the Detroit Lions from 2009 to 2015. And then we have mike adamle who is a record setting fullback for northwestern and played for the chiefs, the jets and the bears before entering into a 40plus career in broadcasting during which he worked for all of the major networks. And then we have his wife, kim adamle, who has supported mike throughout his struggles with dementia and shes an Educational Consultant and School Psychology teacher with three decades of experience conducting cognitive assessments. And then last is dr. Eleanor perfetto, who is senior Vice President of Strategic Initiatives for the National Health council. And she was the caregiver for her spouse, ralph wenzel, prior to his death due to c. T. E. So, thank you all. You are all such experts and personal knowledge of what were dealing with today. I was going to start i would like to have two people start, and that is dr. Ann mckee first. If you would make a statement. Dr. Mckee yes, thank you, Ranking Member pallone, Ranking Member conyers and distinguished members of the committees. This is a great honor and a great pleasure to be here, and i am going to try to summarize the the work that weve done on c. T. E. As well as discuss two of our recent papers, and then dr. Stern will discuss his research and his recent paper. So the first question is, what is c. T. E. . C. T. E. , or chronic traumatic encephalopathy, is a progressive neurodegenerative disease found in athletes and military veterans with a history of repetitive head trauma, including concussions and asymptomatic subconcussive hits to the head. C. T. E. Is increasingly recognized as a potential risk for athletes participating in Contact Sports, such as american football, but also soccer, boxing, and ice hockey. Military veterans who are exposed to explosive blasts are also at risk for c. T. E. C. T. E. Is characterized by the buildup of an abnormal protein called tao in nerve cells and nerve cells processes in a unique pattern in the brain. C. T. E. Gradually interferes with normal brain functioning and may lead to changes in behavior, such as impulsivity and violence, changes in mood such as depression and hopelessness, and cognitive changes, such as memory loss and cognitive decline. At the current time, c. T. E. Can only be diagnosed after death by examination of the brain, and there are no known treatments for the disorder. Also unknown at this time is the exact prevalence of c. T. E. In amateur and professional and contact sport athletes as well as military veterans. Given that millions of contact sport athletes and military Service Members are exposed to repetitive head trauma every year, c. T. E. Has become a major Public Health concern. Over the last nine years, there have been many advances in our understanding of c. T. E. My colleagues at v. A. Boston Health Care System, Boston University and the Concussion Legacy Foundation developed the largest brain bank in the world in 2008 to study the longterm effects of exposure to repetitive head trauma and c. T. E. The v. A. Brain bank has brains and spinal chords of 450 athletes, military veterans who experienced head trauma. We diagnosed c. T. E. In over 280 individuals and published the clinical and pathological features of over 70 of the confirmed cases reported worldwide since c. T. E. Was first identified in 1928 by Harrison Martland and named chronic traumatic encephalopathy by Mcdonald Critchley in 1949. We reported the first case of c. T. E. In High School Football, College Football, soccer, boxing, baseball, ice hockey, mixed martial arts. The youngest and the first series of c. T. E. In military veterans of the iraq and afghanistan conflicts. We published original articles on the relationship between c. T. E. And the development of motor neuron disease, or a. L. S. We analyzed the roles of other proteins in c. T. E. , including beta alkaloid. We begun to investigate how the protein spreads from one nerve cell to another to result in widespread disease. In 2013 we defined the pathological features for the of c. T. E. And developed a staging scheme to assess pathological severity. We now know there is a unique pathological hallmark of c. T. E. There is a hallmark tao lesion that does not exist in a normal brain or any other nerve degenerative disease such as alzheimers disease. This hallmark c. T. E. Lesion allows for the precise pathological diagnosis of c. T. E. This unique lesion of c. T. E. Is present in small areas of the brain in the beginning of the disease and it becomes widespread and distributed throughout the brain in advanced disease. Two consensus panels of expert pathologists sponsored by the National Institute of neurological disease and stroke and National Institute of bio medical and bioimaging defined this lesion as a patho lesion. Research by biomedical engineers have also suggested the reason tao is distributed in this unique pattern, these are the brain regions subjected to the greatest stress and physical strain during head impact trauma. Data from our studies also indicate the severity of c. T. E. Pathology increases with the links of a Committee Ranking<\/a> member chairman condors because he was the chairman because chairman when we were in the majority. I can refer to you as chairman, but not myself. Thank you chairman for joining us to examine the longterm impacts of repetitive brain trauma, in particular trauma associated with Contact Sports<\/a>. I look forward to engaging in dialogue about this issue. Playersek, football take the field and engage in a contact and engage in a contact sport they enjoy playing but may be harmful to their health in the future. There are a lot of concerning questions that we will discuss today. At the very least athletes and their families need to know they are being informed about the health risk and the risks associated with Contact Sports<\/a> are being mitigated to the greatest extent possible. With more and more research coming out, the evidence is becoming clearer and clearer, the effects of repeated head trauma, even those received during ones youth, can accumulate and cause serious and devastating conditions and these conditions can stem from injuries once considered minor known as sub sorry subconcussive hits. Boston University Researchers<\/a> led by dr. Ann mckee, dr. Bob stern and Chris Nowinski<\/a> said they have a marketedly increase of mood disorders like depression and this research has found language between head impacts and c. T. E. , a degenerative brain disease. These researchers examined the brains of 111 deceased National Football<\/a> League Players<\/a> whose families chose to donate their brains and 110 of the deceased players suffered from c. T. E. During their lifetimes. Im pleased were joined by all three of these researchers who are conducting critically important research. Their research must be considered by athletic associations and others, including congress, as we look for Real Solutions<\/a> to this devastating disease and i thank them for their invaluable contribution to this area and look forward to hearing more today. Beyond this research, there are a number of Unanswered Questions<\/a> about what risk factors make individuals more susceptible to these debilitating conditions. We need to understand what happens to the brain when its hit and how this triggers neurological effects and whether its possible to diagnosis c. T. E. During life and what treatment should be offered for those struggling with cognitive issues to the cumulative brain trauma. And while theres research that needs to be done, that should not be an excuse for inaction. What is not in dispute is the connection between head trauma and football and degenerative diseases like c. T. E. A number of our panelists today played professional football or have Family Member<\/a>s who did. Id like to welcome former nfl player, harry carson, mike adamle. Were joined by mr. Adamles wife, kim adamle, and dr. Eleanor perfetto, who is the widow of ralph wenzel. They have witnessed firsthand the exposure to the longterm impact. They can speak to the challenges they live with and witnessed as a result of this trauma, and they can also speak to the concerns of the future and whether they believe they will be adequately supported by the nfl or other organizations as they face future challenges. I would also like to mention that we invited the nfl to attend, but they declined. The science has raised enough red flags about the dangers of repetitive head trauma that its incumbent to those who organize Contact Sports<\/a> to make the game as safe as possible. That commitment must come from all levels of play, including the highest level of football. Since the nfl recognizes the link they need to commit to supporting independent research, meaningfully reducing the risks and supporting players suffering from the effects of longterm brain injury. So this forum is critically important. Its unfortunate, however, this discussion is not being conducted in a formal congressional hearing. Despite our repeated requests for a series of hearings on this subject last year, the republican majority agreed to one hearing during last congress on concussions in youth sports and thats simply not enough. But im hopeful todays forum will help us build momentum for further action and discussion. I thank you, again, to all our witnesses for your contributions and for being here for this important discussion on traumatic brain injuries in athletics. I hope we can all continue to Work Together<\/a> to find the best ways to address the significant Public Health<\/a> issue. Im not going to mention my colleagues by name, because they are each going to be part of this forum and discussion. But i do want to say looking at the people that are up here, my colleagues that are up here really many of them have played a major role in dealing with shoes, so i appreciate the fact they are here today. Let me call on Ranking Member<\/a> i call him chairman of the Judiciary Committee<\/a>, congressman conyers, for an opening statement. Thank you for letting us use your room as well. Mr. Conyers youll get the bill. [laughter] mr. Conyers top of the morning, everybody. What a pleasure it is to be here with our energy and commerce Ranking Member<\/a> Frank Pallone<\/a> and all my colleagues in sponsoring this event. Its an important event, and its taken a little while to get there and we got a long way to go. Todays forum brings together some of the nations leading experts from the medical research and athletic communities to review the causes, effects and treatments of concussions and other head trauma. In particular, the forum examines what is known about brain injuries, what gaps exist in scientific literature and what is being done to address those gaps. The following year, the Judiciary Committee<\/a> it will also feature firsthand accounts from individuals who suffered from subconcussive trauma or have witnessed its longterm effects on their loved ones. And thats why we have eight people this is a very unusual forum and im glad of it. When i was chairman of the Judiciary Committee<\/a>, we held a hearing in 2009 on football head injuries, which was prompted by the mounting Scientific Evidence<\/a> connecting head injuries in football and cognitive problems later on in life. During that hearing, the National Football<\/a> league refused to acknowledge a connection between head injuries on the football field and the Subsequent Development<\/a> of brain diseases. The following year, the Judiciary Committee<\/a> held a hearing in detroit, michigan, followed by forums in houston and new york city as part of our ongoing commitment to calling attention to this problem and examining ways to prevent head injuries in youth, high school and in College Football<\/a> as well. And this brings us to todays forum where our medical panelists will discuss their recently published studies examining the brains of 111 deceased National Football<\/a> League Players<\/a>, which found that an astounding 110 of them had chronic traumatic encephalopathy, also known as c. T. E. For short. Although Scientific Evidence<\/a> clearly links head injuries in football to cognitive problems later in life, between 1. 6 million and 3. 8 million sports and related sports and recreationalrelated concussions occur each year, according to the center for Disease Control<\/a>. The extent of injury is particularly problematic for our youth, as most brains are not fully developed until 25 years of age. As a result, a concussion is more dangerous for youth than it is for an adult. So i hope the panelists today will provide guidance on how we can better protect all athletes, especially our Young Athletes<\/a>. And i would be remiss if i did not briefly comment concerning the president of the United States<\/a> recent series of statements concerning our nations professional Football Players<\/a>. At his rally in alabama on september 22 he mocked the National Football<\/a> leagues efforts to prevent brain injuries, declaring two guys, just really beautiful tackle, boom. 15 yards. The referee goes on television, his wife so proud of him. Theyre ruining the game. Theyre ruining the game. End of quotation. The president of the United States<\/a> then went on to use the power of his and Vice President<\/a> s bully pulpit and twitter feeds to rail against the right of private citizens to express their views and right to protest as guaranteed by, of course, the first amendments free speech protection. Ironically, President Trump<\/a> has not uttered a single word about the actual underlying issue. The glaring disparities in how africanamericans are dealt with under our criminal Justice System<\/a> and their treatment by Law Enforcement<\/a> officers which have often had deadly consequences. These are problems, by the way, which have gotten worse, not better, in my view under the Trump Administration<\/a> and Sessions Department<\/a> of justice. Now, todays forum allows to return to the actual facts and evidence and consider how we can best protect Football Players<\/a> at all levels in an incredibly violent sport. I thank all the panelists and the members for being here today, and i turn it back to mr. Pallone, my colleague and friend. Mr. Pallone thank you, chairman. Thank you so much for your comments and, again, for having letting us have a place to have this forum today. I wanted to introduce the panelists, but normally members of congress get to make Opening Statements<\/a> when they come to these forums and we are not doing that today because they all agreed not to in order for us to get to the panelist. Let me at least introduce everybody up here, if i could. First on my left is jan schakowsky, shes a member of the energy and commerce committee. Shes from chicago. Shes probably done more on this issue than any other member. I have to be honest. Shes just been very concerned about this whole issue of concussion in sports and been out front on it from the beginning. To her left is mr. Mcnerney from california, also a member of the energy and commerce committee. And then to my right is steve cohen who is from memphis, outspoken on so many issues. I call you the investigative congressman. And then we have david cicilline. Both are members of the energy Judiciary Committee<\/a> and david is the cochair of our message or we call it democratic policy group. And he plays a major role in getting our many and developing our policy. So on our panel, we have today dr. Ann mckey, i guess im going from my left. Director of the c. T. E. Center at Boston University<\/a>. We have dr. Robert stern whos director of Clinical Research<\/a> for the Boston University<\/a> c. T. E. Center. Then we have dr. Chris nowinski who is cofounder of the Concussion Legacy Foundation<\/a> and cofounder of the Boston University<\/a> c. T. E. Center. Then we have harry carson who is a member of the pro football hall of fame and linebacker for the super bowl xxi new york giants who served as team captain of the giants for 10 seasons. You probably figure hes my favorite. [laughter] deandre levy who is starting linebacker for the Detroit Lions<\/a> from 2009 to 2015. And then we have mike adamle who is a record setting fullback for northwestern and played for the chiefs, the jets and the bears before entering into a 40plus career in broadcasting during which he worked for all of the major networks. And then we have his wife, kim adamle, who has supported mike throughout his struggles with dementia and shes an Educational Consultant<\/a> and School Psychology<\/a> teacher with three decades of experience conducting cognitive assessments. And then last is dr. Eleanor perfetto, who is senior Vice President<\/a> of Strategic Initiatives<\/a> for the National Health<\/a> council. And she was the caregiver for her spouse, ralph wenzel, prior to his death due to c. T. E. So, thank you all. You are all such experts and personal knowledge of what were dealing with today. I was going to start i would like to have two people start, and that is dr. Ann mckee first. If you would make a statement. Dr. Mckee yes, thank you, Ranking Member<\/a> pallone, Ranking Member<\/a> conyers and distinguished members of the committees. This is a great honor and a great pleasure to be here, and i am going to try to summarize the the work that weve done on c. T. E. As well as discuss two of our recent papers, and then dr. Stern will discuss his research and his recent paper. So the first question is, what is c. T. E. . C. T. E. , or chronic traumatic encephalopathy, is a progressive neurodegenerative disease found in athletes and military veterans with a history of repetitive head trauma, including concussions and asymptomatic subconcussive hits to the head. C. T. E. Is increasingly recognized as a potential risk for athletes participating in Contact Sports<\/a>, such as american football, but also soccer, boxing, and ice hockey. Military veterans who are exposed to explosive blasts are also at risk for c. T. E. C. T. E. Is characterized by the buildup of an abnormal protein called tao in nerve cells and nerve cells processes in a unique pattern in the brain. C. T. E. Gradually interferes with normal brain functioning and may lead to changes in behavior, such as impulsivity and violence, changes in mood such as depression and hopelessness, and cognitive changes, such as memory loss and cognitive decline. At the current time, c. T. E. Can only be diagnosed after death by examination of the brain, and there are no known treatments for the disorder. Also unknown at this time is the exact prevalence of c. T. E. In amateur and professional and contact sport athletes as well as military veterans. Given that millions of contact sport athletes and military Service Members<\/a> are exposed to repetitive head trauma every year, c. T. E. Has become a major Public Health<\/a> concern. Over the last nine years, there have been many advances in our understanding of c. T. E. My colleagues at v. A. Boston Health Care System<\/a>, Boston University<\/a> and the Concussion Legacy Foundation<\/a> developed the largest brain bank in the world in 2008 to study the longterm effects of exposure to repetitive head trauma and c. T. E. The v. A. Brain bank has brains and spinal chords of 450 athletes, military veterans who experienced head trauma. We diagnosed c. T. E. In over 280 individuals and published the clinical and pathological features of over 70 of the confirmed cases reported worldwide since c. T. E. Was first identified in 1928 by Harrison Martland<\/a> and named chronic traumatic encephalopathy by Mcdonald Critchley<\/a> in 1949. We reported the first case of c. T. E. In High School Football<\/a>, College Football<\/a>, soccer, boxing, baseball, ice hockey, mixed martial arts. The youngest and the first series of c. T. E. In military veterans of the iraq and afghanistan conflicts. We published original articles on the relationship between c. T. E. And the development of motor neuron disease, or a. L. S. We analyzed the roles of other proteins in c. T. E. , including beta alkaloid. We begun to investigate how the protein spreads from one nerve cell to another to result in widespread disease. In 2013 we defined the pathological features for the of c. T. E. And developed a staging scheme to assess pathological severity. We now know there is a unique pathological hallmark of c. T. E. There is a hallmark tao lesion that does not exist in a normal brain or any other nerve degenerative disease such as alzheimers disease. This hallmark c. T. E. Lesion allows for the precise pathological diagnosis of c. T. E. This unique lesion of c. T. E. Is present in small areas of the brain in the beginning of the disease and it becomes widespread and distributed throughout the brain in advanced disease. Two consensus panels of expert pathologists sponsored by the National Institute<\/a> of neurological disease and stroke and National Institute<\/a> of bio medical and bioimaging defined this lesion as a patho lesion. Research by biomedical engineers have also suggested the reason tao is distributed in this unique pattern, these are the brain regions subjected to the greatest stress and physical strain during head impact trauma. Data from our studies also indicate the severity of c. T. E. Pathology increases with the links of a Football Player<\/a> career or the number of years between starting to play and retirement from the sport. Recently we reported the largest and most methodologically case series of individuals with c. T. E. Ever published in the journal jamma. The methods used in this study were superior to all previously published case series on c. T. E. , a panel of four pathologists used the defined criteria to make the diagnosis of c. T. E. Without any knowledge of the clinical history and the clinical case description was standardized, comprehensive, and performed blinded to the pathology and reviewed by a panel of clinicians. Not only did this jamma study more than double the size of any previous case series, all the participants were exposed to a relatively similar type of head trauma experienced during the play of football. The case series included 202 american Football Players<\/a> at all levels of play. Excuse me. I am missing something. At all levels of play, whose brains were donated for research. The study found that 177 or 87 of the brain donors were were diagnosed with c. T. E. Using the strictly defined criteria. This included three of 14 high school players. High school only players, three of 14, 21 . 48 of 53 College Football<\/a> players or 91 . And 110 of 111 nfl players, or 99 . The study also found that nearly all former nfl players had severe c. T. E. And in players with either mild or severe c. T. E. , behavioral, mood and cognitive problems were frequent. Dementia was common among those players with severe c. T. E. So what is the prevalence of c. T. E. In the general population . The jamma study was not a population study and could not be used to determine how common c. T. E. Is in the general population. It was also not representative of all living Football Players<\/a>, as most of the subjects in the study played football for long periods of time at high levels. However, the jamma study does tell us beyond any reasonable doubt that football that people who play football for many years develop c. T. E. Much more often than people who do not. Now, what does the jamma Study Indicate<\/a> about the prevalence of c. T. E. . The critical question is the denominator for the study. The denominator is not the approximately 20 million former Football Players<\/a> in the general population or 177 out of 20 million. The denominator for the jamma study is the number of individuals who played football and died during the same study period. We dont know that number for former high school and college players, but allen schwartz, formerly of the New York Times<\/a>, has provided the number of former nfl players who died during the study period and that number is 1,300. So even if one makes the highly improbable assumption that all of the former nfl players whose brains were donated to our brain bank during the study period whose brains were not donated to our brain bank were negative for c. T. E. , the minimum prevalence among former nfl players would be 10 . 10 is the minimum percentage it could possibly be, and it would be reasonable to assume that the actual percentage is much higher. The question then becomes if a minimum of 10 of nfl players develop a devastating and progressive, untreatable disease as a result of playing football at the professional level, is that an acceptable risk . I think the answer to that is no. Theres also the issue of selection bias in the jamma study. In this study, as in all of our Peer Reviewed<\/a> published original articles, we were careful to acknowledge there is selection bias. That is most of the Football Players<\/a> brains were donated by families who suspected their loved ones had symptoms of c. T. E. It is important to emphasize that the brain bank team never asked the family about clinical symptoms before donation. The only question that is asked is whether or not the loved one was exposed to head trauma. However, we recognized that if a family suspects something is wrong with a loved one or if a loved one died from suicide or accidental death, the familys much more likely to pursue brain donation. Yet, remember, brain donor families are not skilled medical professionals. They have no Laboratory Tests<\/a> to make a diagnosis of c. T. E. So despite their humble limitations, the donor families had diagnostic accuracy rate of 87 for c. T. E. In the jamma study. 87 is a diagnostic accuracy rate that would be impressive, even for a Tertiary Center<\/a> focused on degenerative disease with all of the stateoftheart medical devices. Selection bias is a factor for donors for all sorts of brain banks, including at the b. U. Alzheimers brain bank. Fewer than 5 of those brain donors have been diagnosed with c. T. E. So these critical caveats and the fact weve been able to amass 177 instances of c. T. E. In Football Players<\/a> over a brief eightyear period is an indication that c. T. E. Is not rare. C. T. E. May be underrecognized, but it is certainly not rare. In addition, we found c. T. E. , even very severe c. T. E. , in individuals who only played football at the College Level<\/a>, and thats a cause for us all to be concerned. Our work on the neuropathological examination of brain donors has also led to advances in understanding the and the diagnosis of c. T. E. Advances that are beginning to lead to the identification of what we call novel biomarkers to detect c. T. E. In living people, and we hope will also lead to new treatments for people suffering from c. T. E. The unique perivascular lesion is associated with a robust and persistent inflammation. Our studies show there is a significant increase in brain inflammation after exposure to football, and this inflammation increases further as c. T. E. Develops and becomes progressively more severe. In september, 2017, my colleagues and i reported in the journal plus one that inflammatory ccl 11 was in former college and professional Football Players<\/a> compared to nonathletes with alzheimers disease and nonathlete controls. We also took postmortem samples of cerebral spinal fluid from individuals with c. T. E. Controls and alzheimers disease and found the levels of ccl11 in the c. F. F. Were similar were normal in the controls of alzheimers disease but elevated in c. T. E. Again, suggesting that ccl11 might in the c. F. F. Might be able to assist in the detection of c. T. E. During life. These findings represent the early steps towards identifying c. T. E. In living people and offer mechinistic insights. We need to evaluate this study to see if ccl11 can be found in living individuals and whether the levels can predict the severity of the disease in living individuals. C. T. E. Is a risk for Football Players<\/a>, especially Football Players<\/a> who play a long time at a high level. C. T. E. Is a risk for all contact sport athletes, military veterans and any individual who experiences repetitive head trauma, including concussions and subconcussions. We have made major advances at our understanding of c. T. E. Over the past nine years. To further accelerate Critical Knowledge<\/a> and the prevalence of c. T. E. , the prevention of c. T. E. , the risk of exposure, the genetics of c. T. E. , the diagnosis of c. T. E. And effective treatment for c. T. E. We will need Additional Research<\/a> funding. C. T. E. Needs to be recognized as an alzheimersrelated neuro degeneration and part of the National Research<\/a> action plan. If we understand what goes wrong in the brain in c. T. E. And leads to the buildup of the abnormal protein and feeds the deposition of other neurodegenerative proteins after head trauma, we will make enormous progress in the fight against all neurodegenerative diseases including alzheimers disease and other neuro degeneration. If we are truly concerned about the brain and Mental Health<\/a> of future generations of americans, including military service personnel, we will commit to Additional Research<\/a> for funding for c. T. E. Thank you. Mr. Pallone thank you, dr. Mckee. Let me also mention that we have been joined by congresswoman Sheila Jackson<\/a> lee from texas. Thank you for being with us. Just so you know what we will do is well hear next dr. Bob stern. The rest of the panelists have agreed not to make Opening Statements<\/a> so we can go right to questions and so thats what we will do that after dr. Stern. Thank you for being here. Dr. Stern good morning, Ranking Member<\/a> pallone, Ranking Member<\/a> conyers and distinguished members of the committees. It is indeed a great honor to participate in this forum today. Since 2008, my research has focused on the longterm consequences of repetitive brain trauma in athletes, including this neurodegenerative disease, c. T. E. As you heard from dr. Mckee, at this time c. T. E. Can only be diagnosed after death through postmortem examination. Several important questions about c. T. E. Remain unanswered. Such as, how common is it . Why does one person get it and another person does not . And how can we differentiate c. T. E. From other similar diseases and conditions with similar symptoms . To answer all these and other really important questions, the ability to diagnosis c. T. E. During life is the critical next step. Our group at Boston University<\/a> and other scientists from around the country are actively conducting research to develop methods to accurately diagnosis c. T. E. During life. Im honored to be the lead investigator of a 16 million, sevenyear longitudinal, multicenter investigation funded by the National Institute<\/a> of Neurological Disorders<\/a> and stroke. That study brings together a network of approximately 50 investigators from around the country from 10 Major Research<\/a> institutions. The study referred to as the diagnosis c. T. E. Research project is aimed at developing methods of diagnosing c. T. E. During life, and were studying several hundred former professional Football Players<\/a>, former College Football<\/a> players and men of the same age who never had any exposure to these repetitive hits or brain trauma. All of these folks undergo extensive testing over a threeday period at one of our four sites around the country and then return three years later for a followup evaluation. We are developing, refining and testing a variety of potential biological tests for c. T. E. , including new experimental pet scans that allow us to actually see the buildup of that abnormal tao protein in the brain during life as well as advanced m. R. I. Scans, spinal fluid measures and new blood tests that may be able to detect the disease even before the symptoms begin. Im confident that we will have an accurate method or methods to detect and diagnosis c. T. E. During life within the next five years. However, we cannot wait for the availability of these tests to begin to examine who may be at greatest risk for this devastating disease. Previous Research Shows<\/a> that the brain undergoes key periods of development and maturation during childhood and several brain structures and functions of the brain reach their Peak Development<\/a> during the period leading up to age 12 in boys. Therefore, our group has conducted a series of Research Studies<\/a> to examine if there may be a period of vulnerability during which exposure to repeated subconcussive trauma through the routine play of tackle football may result in later life neurological be a normality. Three of these Peer Reviewed<\/a> studies involved former nfl players between the ages of 40 and 69. We found that the former players who began playing tackle football prior to age 12 had significantly worse memory and other cognitive functioning as well as abnormal m. R. I. Findings. Compared to those who started to play at age 12 or older. The total number of years they played did not account for these findings. Rather, the earlier they started playing in childhood, the worse the problems in adulthood. But we also wanted to know if this age at first exposure to football was also important in the millions of people who only play football up through high school or up through college and didnt go on to play in the pros. In the recently published study, we found participation in tackle football before age 12 increased the odds for later life clinically elevated depression scores by threefold and increase the odds of having problems with behavioral regulation by twofold. These findings were independent of the total number of years the participants played football through their life or at what level they played through such as high school or college or the pros. In addition to the age of first exposure to tackle football, weve examined the relationship between the estimated total number of head impacts someone sustains playing football and later life problems. In the study published earlier this year, we found a strong dose response relationship between the estimated total number of head impacts, experienced through youth, high school and College Football<\/a>. And the risk for developing cognitive, mood and behavioral impairments later in life. In laymans terms, the more hits to the head a Football Player<\/a> received, the more likely they were to have impaired thinking skills as well as depression and behavioral regulation difficulties decades later. Now, its really important to note that participation in sports and athletics during childhood can have many important benefits, including the development of teamwork, selfconfidence and social skills, not to mention the tremendous Health Benefits<\/a> from exercise. Therefore, the goal should be to make sure that children can take advantage of all the benefits of Sports Participation<\/a> without the risk of brainrelated difficulties later in life. Thats a difficult balance and requires a combination of unbiased scientific information and just plain common sense. In closing, i want to thank you for your interest in addressing this important issue and for your continued commitment for protecting the health and safety of all athletes. I also want to express my gratitude toward congress in general for continued support of n. I. H. Funding but also to underscore the need for expanded funding for brain research. Thank you. Mr. Pallone thank you, dr. Stern. Let me explain that the rest of the panel are going to be answering questions and shouldnt hesitate if the question isnt directed to you and you want to answer, please, you know, indicate that youd like to. And in terms of our questions, its going to be the two of us as cochairs or whatever and then were going to go based on seniority with the rest of you, ok . What did you say . No, i said seniority, not civility, although you are [laughter] though civility is important as you often mention to me. Im sorry about that. Sorry, steve. Let me start out. In recent years weve seen sports teams and leagues recognizing the potential dangers of concussions by attempting to develop rules and protocol to make sports safer for participants. Approaches includes additional medical evaluation in a hard hit occurs or preventing headtohead tackles. This focus on concussions seems to obscure the more important issue. That is, theres a growing body of research that continuous subconcussive hits may contribute to longterm brain injury than periodic concussion and i think both dr. Mckee and dr. Stern have indicated that. Let me start out with them. Dr. Mckee, can you tell us what the evidence shows about the effect of subconcussive hits on the brain . Have subconcussive hits been linked to decreased cognitive functioning or changes in brain chemistry . Dr. Mckee so what we know from our postmortem studies is that 20 of the individuals who played football developed and developed c. T. E. Never had a reported concussion. What we found over and over, its the length of their playing career or their exposure to football and the many hits that occur on every play of the game. Its those response to the years of playing football that increased the risk for c. T. E. Others have shown this, too. They looked at High School Athletes<\/a> playing football, soccer, as well as ice hockey, and they find even in the absence of a concussion, those individuals, if you look at those individuals at the beginning of the playing season and then look at them at the end of the playing season, there will be changes in their white matter on sophisticated neuroimaging. There will be changes in their cognitive function and this provides evidence that its the lowlevel hits, the routine hits, especially that occur in football nearly on every play of the game, that lead to longterm changes and also increase the risk for c. T. E. Mr. Pallone well, thank you. Now let me and ask you, dr. Stern, i understand professional Football Players<\/a> can get 1,000 subconcussive hits in a single season of play. According to some estimates, players get hits hundreds of times even at the youth and high school level. Even if a Football Player<\/a> is never diagnosed with a concussion, why should we be concerned about this volume of subconcussive hits, either one of you, dr. Stern . Dr. Stern lets break it down to the youth level. There was a study published a little less than a year ago, not from our group, that looked at kids between ages 8 to 13 and they put gizmos inside their helmets to measure the number and severity of the hits that they got. All those kids also had m. R. I. Done before the season and after the season. They took out any kid who had a diagnosis concussion. Only looking at the routine play without anyone who had a concussion. What they found was that the total exposure to hits, the routine exposure to hit, the subconcussive trauma, was directly associated with changes to the white matter of the brain in just one season of play. Thats just the little kids. Theres been multiple other studies looking at high school students, College Students<\/a> after just one season of play, alterations in the structure of the brain, in the functioning of the brain, in the cognitive functioning. Thats just the immediate shortterm complications. As dr. Mckee has pointed out, later on in life, we see both in living players and also in the deceased players that dr. Mckee examines that theres this relationship between the total exposure to playing football and when we try to estimate the total number of hits between those number of hits they received throughout their life and even changes in blood tests of tao and changes in the m. R. I. And especially problems with thinking and memory. Mr. Pallone what about the connection between these subconcussive hits and c. T. E. . Either of you want to answer that . Dr. Mckee again, its the same. What were founding is dose response, best measured as number of playing years that the longer you play football the higher your risks for c. T. E. And the higher the severity of the c. T. E. Were working on this risk profile. Thats something that we think is immediately very important. In terms of developing some guidelines for length of play that might be safe and when you are heading into a more highrisk category. But were not there yet. Mr. Pallone i dont know if you can answer this. The concern, of course, is, you know, subconcussive versus concussions. In other words, how do they compare in terms of the risk in a sport like football . Can you answer that . Dr. Stern its really important to understand there isnt a very clear diagnosis of what a concussion is. The clinical diagnosis at this point. Theres no test that specifically says this person had has had a concussion. So theres this continuum of whats going on in the brain and in the brain cells that result in the symptoms that are associated with concussion that leads to the diagnosis. If you dont have those symptoms you cant be diagnosed with a concussion at this point, but that may still be doing something to those brain cells, whether temporarily or with enough of them one after another after another. It may lead to longterm consequences. Mr. Pallone then its possible somebody who never had a concussion but just played one season because of the number of subconcussive hits could actually have significant changes to their brain, i guess, huh . Dr. Stern you know, one season of play, im not that concerned about. We dont know, though. We just dont know. But the combination of duration that someone plays, the number of hits they get while theyre playing, perhaps on the position they play, the age that they started, all those things come together. Were trying to figure out exactly what that magic combination is that leads to later life problems. Mr. Pallone your group recently published a study including study concluding participation in tackle football before age 12 greatly increased the risk of developing dont know whats going on. [static] is it me . Bad microphone somewhere. Mr. Pallone well try again. [no audio] [static] mr. Pallone so your group recently published a study including participation in tackle football before age 12 greatly increases the risk of developing cognitive issues later in life and in a separate study you found the more hits a player received whether through youth, high school or college the more likely that player was to struggle with mood and behavioral impairments later in life. Talk about how much of a concern these subconcussive hits are for particularly young Football Players<\/a> before age 12 or if either of you, the measures taken thus far well, let me just ask about the young people because thats my particular concern. Dr. Stern there are so many questions we dont have answers for at this point. Theres growing evidence, time after time papers are coming out suggesting that having your head hit over and over again as a child may have short term and possibly longterm consequences. I guess the point i would make is, does it make sense to have our kids be exposed to those type of hits . I take off my science hat and put on my parent hat and say we parents do a lot of things to protect our children. We do everything we can to keep them healthy, to have them stay away from injury, to reach their full potential and then we let them off at a Playing Field<\/a> at age 6, 7, 8, put on a big helmet with a facemask that makes them a bobblehead and say go at it, hit your head over and over and over again against your teammates, your opponents, the ground. At a time when we know the brain is going through this incredible development. Does that make sense if that brain is getting moved around, jolted around, that brain that really is the most precious organ in our body . Does it make sense as parents to do that . Regardless what the current scientific knowledge is, does it make sense . The thing is, we are getting more science. Were getting more understanding that it does have an impact later on. Mr. Pallone if i could ask you, dr. Mckee, last thing. Are there measures taken thus far by the nfl enough to reduce the risk due to these repetitive hits to the head . Dr. Mckee so the issue with the nfl, theres been a focus on concussion and concussion awareness and all those efforts are to be applauded. But the real issue with the nfl and College Level<\/a> football and youth football is the routine hits that occur on every play of the game to nearly every player on the field and thats that we havent seen much change in terms of the nfl. We need to really think about keeping contact fully out of practice. We need to reduce head hits by stylistic and Behavioral Changes<\/a> to the game. We actually need to start thinking about some very severe changes to the game so that the players wouldnt be having collisions and tackles on every play of the game. Thats the issue in football, collisions, tackles and subconcussive hits are an intrinsic part of the sport. In another sport its more random, but in football as well as boxing its intrinsic and thats what the nfl has not dealt with to date. Mr. Pallone thank you. Chairman conyers. Mr. Conyers thank you very much, chairman pallone. This is i want to get to a part of this and involve former linebacker deandre levy and get some of you players, explayers into this. You stated in a Detroit Free Press<\/a> letter that you believe that Football Players<\/a> are, quote, almost numb to the risk of c. T. E. Because its part of the job. I think we as players have to acknowledge it and talk about it in a real way and demand answers. Would you comment, please . Mr. Levy yeah. Well, let me say that was a conversation i had in the locker room i had with eight or nine guys. We the locker room is a loose environment. We joke a lot. We joke about memory. Issues we have with our memory like our partners at home telling us something three, four times. We all chime in and relate to that. Not one of the players knew about the links about any of the research were finding out that this could very well be something more than forgetfulness. I pulled a couple guys to the side and we talk about some of the emotional issues we have, some of the mood swings, some of the highs and lows that just come and go. I think a lot of times we use football as a kind of guard and maybe say, ok, this is just a part of this season, this is just a part of something this is normal. We think its normal because thats just i dont know. Thats just how we operate. Football is a different culture. It bothered me that not one player knew anything about the c. T. E. Research. We see the headlines, but unless were cued in and paying attention to it, i dont think a lot of guys will, you know, be able to link them. For a long time i was unable to link it. I had memory issues. I had times during the day, during the week where my mood just switches and i dont know why and i cant control it. I cant come out of a funk. Its like a fog over me. A lot of guys i think have the same issue but dont know how to link it. We dont talk about emotional issues for the most part in the locker room. A guy isnt going to come in and tell you hes feeling depressed or anxious or sad and doesnt know why. Mr. Conyers do you think that players are aware of the risk associated with playing football . Mr. Levy i think we are aware we will have bad shoulders, we will have bad backs, have bad knees. I think a lot of us know thats par for the course. Speaking for myself and playing professionally, high school, collegiate. I think for the longest a concussion for us was a headache. It was a headache if you can play through its gone. Once its gone its gone, you know. I think a lot of guys still have that mentality and still think about it. There is a good portion of guys that dont want to think about it because honestly its frightening to consider that, you know, when five, 10 years down the line when you are done playing you could be a completely different person, you could slowly decline or rapidly decline. I think when youre going out there pursuing your dream, trying to provide for your family, try to create some Financial Freedom<\/a> for your family, you dont want to go out there and be scared or timid and think about the longterm effects. I think a lot of guys will intangibly put it out. Mr. Conyers does anything occur to any of you about what needs to be done to raise the awareness of this issue . Mr. Carson i think that every parent should be fully informed with all of the information that has been disseminated through Boston University<\/a> or other sources. They should be informed as to what risks they are subjecting their kids to. Any Football Player<\/a> that you ask or anyone who has played football because im sort of a little different. I played football that i was never really a Football Player<\/a>. But i was never really a Football Player<\/a>. And so i always sort of looked at my life as something football is something very temporary. And the issues that are there or issues that start when youre young, parents should understand that theres a physical risk that you assume when you play. I think all of us understood the physical risk. But when we played, myself, mike, eleanors husband, when we played, there was no information on the neurological risk. And so that information is out there now. To understand if you sustain an injury to the brain you may never, ever be the same. As players, we knew that we could possibly down the road after playing have to have Knee Replacement<\/a> surgery or hip replacement or shoulder replacement surgery, but when you injure the brain you cant replace the brain. Youre dealing with issues of the brain and the brain is really the most complicated organ in the body, and you dont know whats going to happen, you know, once youre removed from playing the game, you are so far removed from whether its pop warner, whether its high school, whether its college or even the nfl, once youre removed from the game, who do you complain to . Theres nobody that you can complain to because your career is over and, you know, i prnlly i personally have had the opportunity to come in contact with people who are in their teens and having neurological issues. Young people who played High School Ball<\/a> and now theyre in their 20s and theyre having neurological issues. Individuals who never even got to the nfl who are having neurological issues, having played the game, so the issue, while we focus on the nfl, is more widespread than anyone really knows. I think, again, every parent should know exactly what they are signing their kids up for. Last year, i have been a very vocal advocate for some of the players who have sustained traumatic brain injury and concussion so forth. Last year i petitioned the Surgeon General<\/a> and center for Disease Control<\/a> to do the same thing with football and Contact Sports<\/a> as they have done with cigarettes. That is put a warning on the consent form so that theyll know exactly what they are signing their kids up for. Mr. Conyers what might it say . Mr. Carson understand that your child or the participant could be subject to some kind of neurological injury that might affect them for the rest of their lives. Mr. Conyers let me ask my final question. What advice would any of you on this distinguished panel give to parents who may not be here today or may not be getting in on this hearing . Mr. Nowinski id like to start by answering your first question. Actually which was, what we need to do raise awareness of this. One of the more interesting things i have experienced doing this now for 14 years has been the fight against this information. When we had our first hearing in mr. Conyers to keep it from coming forward for us getting into it in the first place. Dr. Nowinski yes. In 2009, it was interesting when we had the original hearings on this issue how much the nfl fought this information. And their history that was laid out very clearly at that hearing of trying to dismiss and minimize the c. T. E. Research. Now were eight years later, hundreds of cases further into the research, and i was blown away by one of the only ways we had to get the right information out to the public is through the media or through forums like this. Families arent getting it through football. It shocks me we are so full into this any players dont know. Parents dont know. To pick on somebody, because they went on record on this. I was surprised in response to a study on youth football the way that pop warner thought this with dishonest statements. Not with truth, but with dishonest statements. Do you think it pop warner in response to the study went on the radio and said it is important for parents to know this research is not peerreviewed. It was. That is not a debatable thing. The medical director of pop warner, in response to the research, was quoted as saying, if i can find the right one, i dont think the real risk accrues until you play professional. There have been very few that have been discovered at the College Level<\/a> only. That was in response to a paper that was published 48 at of the first 53 College Football<\/a> players were positive for c. T. E. My concern and what i fight every day is still an advocate at heart. I rep that my phd in may. Let people make the right choice for themselves. To me, as the guy who played football in college, i am embarrassed that members of the Football Community<\/a> are actually giving people misinformation as they are trying to make the best choice for their child. Forink my mother legally making i think my mother frequently for make me wait until high school to play football. Giveis the advice i would to any parent. It is clear from the research that there is danger each additional year you play. I would love to hear thoughts of other panelists who played more and better football than i did, if there is any damage to playing as a young person as a Football Player<\/a>. As i am hearing as i am listening all of these hall of famers pain there is no advantage to playing football young. If you want to play, wait until high school. I think that is the best advice we can give parents today. Anybody else . Following up, i agree. I think you can develop your childs skills without football. If you love them and want them to play, you can develop those skills without putting on a helmet and shoulder pads. There are ways you can get the benefits of sports without the neurological damage. There is no benefit to putting on a home on a sevenyearold. If they maintain that interest and drive it would take to reap whenenefits of football, they are reintroduced, if they still have it, we can talk to them. The amount of work, hours and energy it takes to get a scholarship. If that is the first checkpoint in playing professionally, the energy, time and sheer work ethic it takes to get anything from it, you can put that somewhere else. It will not happen magically. Else and try to go that path. I was diagnosed with epilepsy. The reason i was diagnosed was i was on the air, doing a normal sports cast. The next thing i know, i felt this wave come over my body. The next thing was i went into my room and my shirt was dripping wet. Chicagoa neurologist in and he said he did this checkup work. , you have a lesion on your left temporal hemisphere. My opinion is that you got that from playing football. This was before cte. Linebackeran allpro. He played without a facemask and letter home. Loved the game ever since having players who played in the 80s and early 90s, we talked about getting knocked out and concussions. Diggers were the red badge of courage. Coaches loved the fact that we left over leapt over the pile of players trying to block us and hit receiver with our heads. We would slap each other the highfive. Coaches would hug you for doing this great thing. A lot of guys did not know what was going on. Ago,snt until two years when i went to the doctor for a epilepsy,eckup on the that he said we think we have that under control. We have also found out, looking exitever, m. R. I. s, the the epilepsy looks like it is going down. But we also think you have a lot of symptoms, and with cte. And i said, hey wait a minute. Youre not supposed to be with the find this until we are dead. I do not want to die right now. The real thingt the everyan feel the decline single day. Youre going around like this and then you drop down and as sharp as you work. Then you start to get scared. When you get scared, things happen. My wife, who knows about this. She has the credentials. This is something that nobody. As talked about i do not think any of us knew this would happen. I would like for her to talk, because families suffer the most from cte. Kim. Ahead, my wife tries to feed me kill two. It stinks. I put it in his smoothly. He doesnt know the difference. If i may speak for the thousands of families out there, i am part wives. Oup of women, nfl it is a Facebook Group<\/a> with approximately 2500 people. We are in the trenches. We are beginning to learn about cte, what it is, what does that mean . That we have been living it. Love,n, husbands that we have been demonstrating these bizarre behaviors and symptoms for 12 or 15 years and we havent known what was going on. Many of us experienced a great of major catastrophe, chaos and loss in our families. Statistically, the divorce rate for nfl players is 75 . In the general public it is Something Like<\/a> 51 . Youd be surprised at the number and manyvorced have reunited. Part of understanding what happened and understanding is the love wasnt gone. It was out of the fact that they need us. Theyre not able to live on their own. We have had to become, in the trenches in our family, denver to be theday, we have primary breadwinner, take care of our men. Then talk more about that and the actual brain. But how that translates into life is dramatic. We have handle the medical affairs, scheduling of appointments. The number of medications, alone. Youre handling the daytoday of taking care of the man and managing the medical system, insurances, disability, getting pensions in place. Then we have to know the law. Lawyers do not know what is going on with this case. The wives are doing their best to navigate the system, network, share what we know. Because everybody wants a part of this. Out of the thousand or so cases that have been filed, approximately 100 have been paid out. Often, much less than the original amount they were entitled to. Most of the money has been paid out has been to the attorneys. They have their money. There is a lot more involved in that. But the wives are the ones trying to navigate that system all of the steps that need to be taken, the documentation, battling attorneys, battling the nfl. And may have a diagnosis you have to get it over again. Or they find a little piece to disqualify them. , many of themloss lose their jobs, livelihood. 15 or 20 years of productivity. It is not just financial. The children have to watch their father decline, they see their father in rage, become aggressive. Many times, to the wife. They see the father unable to carry on a conversation. They see them restless. Y girls our one daughter was adopted in 2004 at 13 from an orphanage in the ukraine. Horrible circumstances that she came to be in the orphanage. She thought she was safe and in the family. Ago, she moved out and told me, mom, i cannot stand to watch another parent die. She was gone for a year and did not come back. She is now back. Our youngest daughter has become more of a friend and a bit of a caregiver to her dad. Because mike has difficulty with everyday living things. He is the most intelligent man that i know and his recent testing happened again. He is brilliant. He is charismatic. He retains that. He had a huge cognitive reserve. His bank account of knowledge and expertise. In everyday living, the executive frontrunning is huge functioning is huge. Its all a series of decisions, sequence of, organization. Those are gone. Mike and his testing is down in the first percentile is none. Turning on the tv, operating your phone. He loses everything. His zipper is always down. I think up in a draw the line. I could go on and on. The devastation is huge to the family. These children have been affected. To college, where they live, many have lost our homes or had to downsize. The wives are trying to hold it together. Heard. To be harde coalescing, trying to pioneer what needs to be done , sharing what can be done. Mike and i, through the Concussion Legacy Foundation<\/a>, honored to be ambassadors of rise above. Were trying to give hope and inspiration to the families as well as the affected players. E do not have a chore how do you live with it yet though with different with , and a sensemism of purpose and contribution. We are so glad that you are here with us. Thank you mrs. Sherman. Mrs. Chairman. Next to go to our congresswoman. Yumi. Ope you can march 14 of 2016, i came to a roundtable and i had prepared questions from my staff. This was with the nfl and the energy and commerce committee. I asked the question of dr. Miller fromen jeff the nfl. The health and welfare of the leak. There aid, is connection between cte and football. For the first time he said, oh yes, of course. I had no idea what kind of explosion there was outside on this. The other thing i did not understand is the power of football. We are talking about a multimillion dollar orb multibilliondollar industry. Hen it comes to college this is the way some schools survive, the revenue of football. It is not just the money. It is the culture. Lightsball, friday night and small towns around the country. We still hear from the president about the good old days when there was more violence and football. This, this game and proud to be part of the team. John conyers held a hearing in 2009 and research has been going on for a long time. You so grateful to all of who advocate, researchers and the players and families who have incredible coverage. Me,el like, and correct they are blocking this huge which ishere football. I want to make sure we have an dr. Per federal to have your words. Idea abouty love the a morning warning. When you allow your children to play the game, to understand what the consequences could be. Doctor im sure you can do with the message. Finally, i want to say, what has been your experience with football. I also want to say that i am from chicago. Live in evanston mike, i remember well when you work at northwestern with the. Ears and on television i want you to know that, in a survey of 87 holes in the 2549go area, there are less Football Players<\/a> been there were in 2008, at the high school level. Almost a 20 level decline. Came inest year drop 2016, 8 months after the movie concussion came out. School young magnet high canceled the remainder of its football season because it did mikeave enough players ditka would tell his kids, you have to think about golf. Encounteredu bumping up against football in your struggle to get the word first membernt to thank conyers for the hearing that we had. It was a Pivotal Point<\/a> in changing the direction of this conversation and it made a difference. I am in a different position than i was in 2009. My husband was ill, and a longterm care facility and my husband passed away in 2012. We struggled with the disease for almost 20 years. At first, like the story you heard, not having any idea what was going on. Later, getting a diagnosis in 1999. He had to go into longterm care because i could no longer care for him at home. In 2012, my husband died. E spent most of his life he was 62, roughly 225 pounds. He had been to 50 or 275 during football. When he died. He weighed 145 pounds. His brain was half the size it should have been for a man his size and age. At thein was functioning level of a one and a halfyearold. For several years, he could no longer stand or walk. He could no longer feed himself. He was completely taken care of by the caregivers and myself. We set fed him every bite of food for several years. To understand the progression over time and the magnitude of what happens to an individual. If i had answered the question about what parents should be doing about the child playing football, they should not. Just push them in front of a moving car. That is the impact we are talking about. When you see the progression of the disease over time, the devastating impact on an individual, the spouse, the family. When they get to be disabled on our medicare system. Because that is who is paying for a lot of this when testing and things are being taken care of. To add to the aspect of medicare, once you get to that point, where we are in the lawsuit against the nfl, you do get a letter that says we have been notified you are one of the people who might be getting a settlement. By the way, all that medicare money, we will be taking that that. I believe rightly so because medicare did pay for it. But the families, who need that less, well get far far because Insurance Companies<\/a> and the medicare system will be taking it back. The spread, magnitude, ramifications are still far, far bigger the and people understand and can and can conceptualize until they start to hear it at a forum like this. I thinkt, i will say this has made a difference. I believe the first hearing made a significant difference and forums like this can make a difference for getting the word out there. I think it helps to spread that word. There is more that can be done so players know, their wives know. By have been saying for the last 15 years that i would talk to any wife. When my husband was alive, i made the often the offer. Anyone who would like to come and see what is happening, i would be happy to introduce them to my husband. Not one Single Person<\/a> ever took me up on that. By had several former players say to me, i thought about it, i was just too scared. If you can answer my question. You have a lawsuit. I do not know what you can talk about. What has been the response to have experienced. You mention doctors about how football is all the way down to pop warner is pushed back. But i am wondering if there has compensation. Or one of the benefits the nfl 88 froms called plan john mackey. His number was 88. That just states that, when and given a diagnosis of dementia, they are entitled you can apply for benefits. That has been unwieldy and the denyssion has been deny, or deny and delay until they die. Many wives that have difficulty have had difficulty obtaining it. Because of the nature of my , i was able to put together a portfolio of mikes application and we were able to obtain that. I know many families have tried for years and have not been able to obtain funds for that. The plan 88 pace for outofpocket expenses related medical expense related to caregiving for dementia. That is a nice benefit to have. It has been difficult to obtain. In the actual settlement case, as you said, the nfl is formidable. The wives are coming up against it. We have wives to our attorneys, hoping to leave. And because we have to fight the attorneys. When the latest things that have come out is that there is a 5 that is going to be put into the pot to pay for future attorneys fees because they are anticipating many thousands more of players in the pipeline who will be experiencing this. What the attorneys are trying to what take that 5 out of is due to the players. Many of the attorneys i mentioned the pot. 112. 5rodie put aside million to pay for the attorneys fees, so the players did not. We were army stretched financially. So, the attorneys were paying that out. But many attorneys are also charging their client upwards of 20 , 30 , 33. 5 on top of what they are receiving. And families protest that and ask about the double dipping were asked them to justify what they are charging, they are now putting on the settlement amount families are supposed to receive. Many are not receiving money and when they do receive it, one family in particular, the husband has als. They were to receive he was diagnosed at a young age, his young 40s. They were to receive several million. 1. 2 milliond dollars. They were asking, where did the other money go . It went to attorneys and theirliens. The claims administrator took out what he assumed was given to medicare. The family had not use the family had not used medicare. It was an assumption. They had to go through more perl more paperwork to prove they did not. That,after doing all of there was still 1. 8 million unaccounted for. They still do not know. That is one example. Theceived emails when otherwise found out i was coming, other emails document the same. Another wife, whose husband had a diagnosis. They submitted their registration. Now, the nfl is saying questioning his diagnosis. I just want to add one thing. There is this tremendous barrier. First, i think there are two things. Was the way the settlement laid out, what the families were going to get, had lots of caveats that were very misunderstood and were complicated to understand. It had to do with getting less money the older you were when you were diagnosed. The problem with that is the nfl had hidden so much information for so many years, that there were so many people who would have been diagnosed years earlier, at a younger age, if the nfl had not been hiding the information. I probably would have known almost 10 years before my husband was diagnosed, if the nfl had released information rather than cover it up. That means people are getting less money because of their age and diagnosis. That was a big problem with the way it was being calculated. Plus, there are other things that take that the duction. There is also these hurdles being put into place for it to be difficult to collect. Beeni am, somebody who has on the front page of the New York Times<\/a> with my husband on this issue and my application has been rejected several times. If i could add that there is one caveat to what you are hearing. When they referred to being diagnosed, it is not being diagnosed with te. Byt is not covered at all the settlement. Unless it was diagnosed after just. 1. 5 years ago. No one else moving forward after death will get payment for diagnosis of cte. But no one diagnosed with cte during life whatever we come up with, as a way to diagnose it or if someone has severe dementia and there is no other reason or it. If they are told that they have cte, they do not get compensation. Quicki could have one point. He talked about industry response. I think there was one big moment for me in figuring out what the industry was sponsored be going forward. Well in 2016. The nfl is not fulfilling their commitment to the N H Foundation<\/a> for cte. That was the line in the sand that said, lets picture what happened. The study was being funded. Proven tohe nfl had be funding the wrong things, that were in their interest. They gave up. Chose, to give us help, they refused to fund it and made up wouldnt fund it. Now were 16 million short. The study was delayed. Now the nfl is a do over saying we will give 100 million, but none of it will go to c. T. E. They are not funding the biggest problem facing this group of people. While they are still putting money into recruiting children into the game, things like the heads up football program, which the New York Times<\/a> also showed was falsely marketing to children. That was the industry response. To say were reliving big tobacco again is worth saying because i feel like thats what were seeing daytoday. Mr. Pallone jackson lee. Ms. Lee let me thank all of you for being here. After the 2009 hearing that we had with judiciary, we went to houston, texas, and had a hearing to deal with this issue. And frankly, it saddens me that were here in 2017 and listening to some of the most provocative testimony. Im going to take the time to acknowledge that we have had hearings in houston and washington on the Judiciary Committee<\/a>, and then in new york with a field hearing as well in 2010. And there have been other hearings in detroit. And i hope we will get back. The real issue is, what are we going to do . And what are we doing now . Id like to put into what i know will be some form of a record, the New York Times<\/a>, football widows traumatic journey, which dr. Perfecto, in sympathy to you. And then to mikes story, adamle, to have the Chicago Tribune<\/a> say your words were, it shook my world. Id like us to have that in the record. Harry carson as well when to restate some of the points made about 110 out of 111 brains were donated by deceased former players showed signs of c. T. E. And then of course dr. Mckee who has said there is no question there is a problem in football. People who play football are at risk of the disease. I also think its important, although this is probably not fully extensive, to put in the roll call which is a tragic headline in and of itself, the New York Times<\/a>, nfls tragic c. T. E. Roll call which has mike webster, jr. , ken stabler, frank gifford, and a number of others who are listed here. I wont read the entire list. It is certainly evidence that we have a longstanding problem. To hear the families testimony is particularly challenging to me. So let me, if i could, focus on mr. Carson, mr. Adamle, who i understand received another diagnosis and that is when you determined or was determined that you had c. T. E. While you still lived. The joy that has been noted already that is given to america because you young men, as you were young, took to the Playing Field<\/a> for the love of game, but also for certainly that was your work. Thats one of the things we need to accept. That is your work. And you go to work every day and you put your very best in that work. I will deviate for a moment because im going to ask you about the owners. Because we have to come together. I believe there should be legislation that instructs and demands. Because the nfl is a corporate entity with federal oversight, both in terms of taxation and also in the antitrust question, we have a role in the United States<\/a> congress, and we must demand a position and demand oversight and demand a response. We cannot do this any longer. And so with a little point that i just have to make, the complete, how should i say, hysteria that is created by young men who have taken a knee, who still go out and play, who still love this country, who still reverently kneel because there is a petitioning of grievances they desire to do, that is the minds and heart of the hierarchy of the nfl, and i dont know why this that impacts across the board, young men in the prime of their life, who love the game, chosen this as a profession to provide for their families, and it is ongoing. It is stunning to me. Let me start with you, mr. Carson. I want to take up dr. Sterns and dr. Mckees challenge, the n. I. H. Should certainly be doing Major Research<\/a> in this. They have enormous capacity to do this research. I just come from the n. I. H. A couple weeks ago. They have enormous compass to the do this research. Thats one component that i think. I know that my colleagues are probably looking at. And then the question of where does the responsibility lie at the top . You mentioned young people, but ill get to the nfl and come back to the question early age playing. Mr. Carson, if i can, as you were playing, this happened after the fact, is this on any agenda for the nfl owners meeting . When it was at its peak, was there some nfl effort, and i am looking at a concussion policy, but going beyond that rather than saying this is out of sight and out of mind and let them go into the courts, is there any understanding that the core survival of this league, it may look like there is a neverending source of young men who want to play from all walks of life, all backgrounds, is there any crisis understanding of where were on this . Mr. Carson . Mr. Carson lets just understand that to an nfl owner , a player is a commodity. The average career of an nfl player, when i played, and this is back in the 1970s and 1980s, was about 3. 6 years. Today, the average career is about 3. 4 years. So you have to draft every year and players who are injured, lose a step or whatever, they are discarded and the nfl or teams move forward. So the issue of concussions is one that i think nobody really wants to talk about it, but i have seen players who have sustained multiple concussions , and at the end of the year , they are allowed to either go into free agency or not resigned. Dandre probably could speak a little bit more on that because hes more recently removed from the game. To the owners, the players are just a commodity. They really dont care, in my opinion, about the health and welfare of the player. Because once they are no longer part of the team, they have already moved on with fresh players. To me, its sort of like leasing a car. You get to ride that car around. After a couple of years, the car might look good outside. But theres so much damage that has been done to the engine. Well, thats with the nfl player. There are so many players who still look good physically, recently removed from the game, but down the road they are just a hot mess because their brains have been jostled and bruised and so forth. I have seen so many players. I sit in a very unique position because when i came into the league, i saw the older players and i saw how those older players who had left had deteriorated. And passed away as a result of dementia and alzheimers and so forth. I was diagnosed in 1990 with post concussion syndrome. I served as my own specimen for the last 27 years, listening to my own body, but when i started talking about the whole issue of concussions, there are players who basically laughed because we all played through getting dinged. But i paid very close attention to my diagnosis. The doctor who diagnosed me with post concussion syndrome, at first i thought i was going perhaps i had a brain tumor or something. He said it was post concussion syndrome. I asked him, will i live . He said youll live, you have to learn how to manage it. Over the past 27 years, i learned how to manage it and i have been very vocal about this issue. Because there are so many players who are dealing with the issues of traumatic brain injury. Not just players in football. But players in other Contact Sports<\/a>. Along with service men who are in the military, who are dealing with posttraumatic stress disorder and post concussion syndrome. They are dealing with head trauma. And they literally think that they are going crazy. Thats why i have been an advocate on behalf of players who have played the game. If you ask me given what i know now, would i do it all over again . Hell, no, i would not do it over again because you only get one brain and you have to take care of that brain. I basically am the dictator in my family because i have an 8yearold grandson who turned 8 yesterday. And i already informed members of my family that he will not play football. Hell play any other sport. He can play tennis, golf, swim, baseball, but hes not playing a contact sport. And he lives in south carolina. Thats football country, south carolina, the south, s. E. C. Conference, and all that. So i have made that decision for my family given what i know now. I would not have i would not have done what i did. I just have so much respect for the guys who have played the game. The one thing i never wanted to do is disregard those who played the game and not acknowledge that Football Players<\/a> are very dignified, very strong men. Whenever they lose their dignity as a result of playing the game, it angers me. Im not a part of the concussion lawsuit. I did that by choice. Because i feel its more important for me to continue to share my story on my own situation as opposed to people thinking, well, hes only saying that because he stands to benefit financially. Im not looking to benefit financially, but im going to continue to say the things that need to be said honestly, speaking for my own experiences. I admire what the folks here at Boston University<\/a> have done in regards to collecting brains and research and everything, but i lived my own life and i have had the opportunity to come in contact with so many individuals who never even got to the nfl but they are having so many problems from a neurological standpoint, and i try to be a beacon for them. Someone who can share with them so that they dont go the route of other former players like a junior seau. I only wish that those guys were my friends, and i only wish i could have spoken with them to tell them that what they have, they can live with. And there was no need to commit suicide. But they did. And by committing suicide, they put everybody sort of on notice that there is something going on. If you dont acknowledge that there is something wrong with players when they leave the game and they can no longer take care of themselves or they fall into a deep depression, then those individuals who committed suicide, you could say they committed suicide in vain because they certainly shot themselves in their chest and not their head because they knew something was going on. Ms. Jackson lee thank you. Thank you, mr. Carson. Passionate words that you have said are not going unnoticed and not in vain. If i could go to mr. Adamle and then mr. Levy. As i understand it, you have said that you were diagnosed with epilepsy then the c. T. E. Diagnosis came to your shock. And your comments about having this as a priority for the owners, do you see it . Should it be . And mr. Levy, ill be asking you, we need to find a way to intervene on how the game is played and the idea of tackles. Your story about your sense of their sense of how crucial this is for those who played and those who are playing. Mr. Adamle i would say there is a lot of guys who are assistant coaches on different teams across the league who are former players. And they know whats going on with regards to that. I just dont the other night, on thursday night football, on the opening kickoff a guy is laid out on the field with a concussion. And it just rang a bell. Going to what harry was saying about the former players. There is a lot of guys, the pre59ers, guys who would like, god, everybody from did anybody see super bowl 49, before the game, they paraded out every single m. V. P. And the first guy came out and he was like this. Bart starr was there. All these guys. Just was so incredibly sad. And there is a lot of those people whose families are screwed up. I disagree if i had to do it all over again, i think maybe about 95 of the players would say, yes. The reason why they would say yes because of the wonderful friendship and camaraderie that they did down the line. You look at dave from the 1985 bears, that whole team was the closest group of people i have ever seen and still see. Its sad that what happened with dave. It shouldnt have happened. It doesnt happen with anything else. As far as the game being its going to be here for a long time. What kind of things can you do to help it . Well, my dad, going back to being a doctor, he didnt let me play until i was in the 10th grade, until i was fully prepared physically to go out there and do that kind of stuff. Maybe we ought to think about that as a way chris and i have talked about that. Learn how to play in space and move. Im a little off the old soviet Red Army Hockey<\/a> team. They won six consecutive olympic games. They finally were dethroned in 1980. They had a coach who traveled the countryside and he went to different houses where there were Young Athletes<\/a> ready to play hockey. They were like 13, 14, 12. What he did, they had a four month camp. They brought them all to someplace outside of moscow, and they first, it was all about movement and freedom and the first month, all they did was skate. No puck, no hockey stick. And they learned how to move in space. Two months later, they get back on the skates, this time with a puck on their hand. Then eventually the stick. So they knew how to move. It makes all the difference in the world. If were going to still do this. Its a little bit farfetched , but knute rockne when he had four horsemen, he had those kids play ballet, do ballet like three times a week just to learn how to move in space. You can now its so we have lost that capacity, i think. That kids need to just know how to do that first. If its still going to be around. I think its still going to be around. If were a coach, this is a good guy named Rod Marinelli<\/a> was the defensive coordinator for the bears a couple years ago,. He is now with dallas. He said in a preseason camp i was visiting and talked to him, he said, mike, you know what, we cant tackle again. We dont have enough time. We cant. Its a lost art form. It truly is. You look when he played, harry didnt lead with his head. He grabbed him around the waist. You can watch ole dick butkus films. Same thing. Everybody thinks he was this murderous guy, dirty player. No, he knew how to play the game. And i think you would agree with this, harry, we need if its not going away, lets do the right things to make it still happen. If its possible. It may not be able to happen. Mass times acceleration equals force, mass is bigger, accelerations are greater. Its going to happen. Ms. Jackson lee thank you very much. Thank you for that. Mr. Levy, it seems that there is the concern about turning style, training style, changing style, changing practice with owners and what you have seen in the course of your playing. Do they understand the gravity of this . Does there need to be a federal intervention . Mr. Levy yeah. I dont think the owners are in touch with it. Its a business. Were a number. Our bodies and brains are disposable. I dont know. I cant speak for every team. I have only been with one team. But i mean, i never sat down and talked with the owner. There is no connection between the players because right now were the only ones that will , even care about the issue. I dont think you can really change football by tackling a certain way because before me, as a linebacker, before i get into a tackle, im getting into a collision with a 250 pound fullback. Nobody sees that. I have to do that routinely. Its just inherently in the sport. I have to run into a 300 pound blocker at the line thats bigger because i have to make a tackle. Those are the hits, i take two or three hits before i could get to the tackle, which could be a routine soft tackle. Its not a collision. You see guys get small collisions on the ground. You see guys big collisions where you think for sure they are not going to get up and they get up. Its the small routine. I think right now before until we get enough research to learn more, i think we should try to mitigate and limit those risks. I dont know why were still in practice, even. 20, 30 subcollisions in practice, going against my teammates, our offense, hitting a tackling dummy. As a linebacker, im taught to hit with my head and hands. Its inherently a violent sport. Just to survive and not get injured, you are going to open yourself to some of the risks. Right now, we should try to find ways to limit those risks and cut down on the unnecessary collision. I dont think we should be in any collisions other than on sunday. Makes no sense. I went in the games on sunday with my neck and head aching because of wednesday and thursday. I think we can cut that down until we figure out a more substantial answer, i think right now i think the players that dont know, right now they are going they dont in a know whats coming. We got to find a way to get the message into the locker room. Its funny, i think chris spoke more on a macro way the nfl has responded to c. T. E. , but even if my experience, like the letter you brought up, the moment i said anything about t. I had two it i had two callers telling my , i shouldnt talk about t i it. I dont know if its c. T. E. Or general nfl rule, only talk about football. I posted simply the research. I spoke with dr. Stern a couple summers ago and wrote the paper and i was told not to talk about , it the first day it was out. Im like, it could have been just because nobody wants to talk anything other than football. It didnt sit well with me when im talking about brain injury. My brain. Its not my shoulder. Its my brain. It controls everything i do, we think, we feel. If i dont have the right to speak about that as a player, it speaks about the culture of the nfl. What the conversations are. Thats indicative of the conversations we dont hear. The closeddoor conversations between the owners, they are still trying to find ways to silence this. Mr. Pallone thank you. Ms. Jackson lee youre saying congress should act, right . Mr. Levy yeah. Mr. Pallone thank you. Next is congressman steve cohen from tennessee. Mr. Cohen you all can hear me. First, i want to thank mr. Conyers for having set up the hearing that we had when the democrats were in the majority. I participated in those hearings. They were good hearings. They stopped because the republicans are the majority. And like on most things, the republicans care about management and they care about wealthy white men. And they dont care about labor and they dont care about , humans. They dont care about health care. They dont care about injuries and workers comp. Its unfortunate. Thats why were here now because the democrats who are here. What mr. Carson said, i could go about a leased car, i could go further but i say its more like a sharecropper. And sure you all want to play and get paid a lot, but you are i love the game. Ollie maxom was my favorite from a thousand years ago. The owners are in the boxes and the only injuries they are possibly being subjected to is cirrhosis of the liver and they stay up there and watch the game and high five each other and make tons of money. Because this is what they can do, they can buy teams. And own players. Its a lot like sharecropping or slavery. They are the owners. They dont care what happens to you. They use you for 3. 2 years, and they go on. Its like they won the game. It is just awful whats going on. The knee is the whole thing theyre concerned about and they should be concerned about the players, brain injury, concussions, and other situations. Let me ask you this, i think dr. Mckee might have asked, is the nfl doing enough . Theyre not. But what else should they be doing . They are Funding Research<\/a> but the research they are funding is to minimize the effects of c. T. E. , to deflect attention from c. T. E. , and to obscure facts that weve established. I have a 6 million grant that i got from the original nfl money that was given to n. I. H. Weve done an absolutely amazing job over the last four years. Most of the brain donors who have come in came in from that funding. We have published. I have lost count of how many papers weve published. Theres zero chance of any renewal for that grant because all my research implicated this as being a larger problem for the nfl. Mr. Cohen and thats important. It shows the problem. Im thinking about now is what are they doing on the field as far as play, tackling and all that . Are there penalties, repercussions . Mr. Levy no, nothing other than fines and penalties. You can fine guys, i think theyre trying to suspend guys for certain type of blows. But thats just teaching players to aim lower. My helmet hits your knee is still my brain being moved in my skull, i think. Yeah, thats all the extent of it. It is not talked about. In the nfl its always kind of, every few years its a hot topic. A couple of years ago, it was, the last few years its been Domestic Violence<\/a> in Training Camp<\/a> we get a big presentation and talk about that. A few years before that it was when michael sam came out, its gay player. We talk about equality, treating people equally. Then it was gun control before that and Domestic Violence<\/a>. Every year whenever the hot topic comes, im sure this year theyll be talking about players protesting. Through all of that, theres never been anything talking about c. T. E. Mr. Cohen we had our hearings in the past, a Helmet Company<\/a> came, they had opportunities to improve helmets. Mr. Levy i think thats trying to capitalize on the hot topic. Football is huge. A 12 billion industry. Ok, we have a solution but i joke, i dont know how accurate it is, but to me putting money into a helmet is like when we were in junior high trying to think of a great package you know you try to think of a way to wrap an egg so you can throw it and it doesnt crack you put. You put a lot of money into creating a nice package, but if you shake it up, the brain is in fluid. Youre shaking this around, you put the most beautiful package, drop it from the roof, it wont crack, but the brain is still moving and tapping around in there. I put in a 2,000 helmet, run into something, i dont know what the forces are, if we have any physicists in here. But what mike is saying is true. We should have better helmets that you. Do they have to estimate possible right now . Here is what happens to a lot of guys. He launches himself off the ground and there is no such thing as a complete wrapup anymore. I dont know how you legislate that. But they could do it almost every single time for that matter. Here is the thing about concussions. People have known about this a long, long time. There was a guy, steve reed, he was my the team for northwestern, and he did this longitudinal study started in 1964, he went until about 1968, he had at least one guy in a game a defensive player and an offensive player, two guys, they had this pack on the back of their helmet. And it had this needle that went up and down at after this, it was able to see what the force was. Not whether or not it was a concussion thing or anything. But he said basically a guy getting hit is like being hit by a, you know a 747. Just the impact of the game we play. So im not sure that equipment can make a difference. May i present a statement . Again, ive been sort of, i was trained to be an educator, i wasnt trained to be a Football Player<\/a>, it was just something i fell into and just the educator side of me, i took enough science and i wish i was a scientist like you guys down here. Mr. Carson the brain is inside the skull. The brain is inside the skull. The helmet doesnt protect the brain, it protects the skull. Theres no way you can protect the brain when, you know, youre running at a high rate of speed or get hit or whatever. The brain is going to go and hit against the inside of the skull and if im not mistaken, the skull is the boney area inside of the skull, correct . So youre going to have tears on the brain when off violent when you have a violent collision. And oftentimes there are many times when, you know, its not a big collision, its just incidental contact, whether its somebodys knee hits you in the head and youre not really prepared for it. So ive had helmet companies aproach me to be on their board and try to convince me that theyre trying to make safer helmets. It really doesnt matter. Because the helmet protects the skull, it doesnt protect the brain. Mr. Cohen i want to finish up, i know mr. Mcnerney needs to go and i need to leave. Kent hull died of a liver condition. One of his Family Member<\/a>s is a friend of mine. Good friend that Family Member<\/a> told me that was caused by all the drugs he was given, started at Mississippi State<\/a> and through the buffalo bills, keep him where he was able to play each and every game. Keep him going. How much of a problem is that in the nfl . Players being drugged up so that they dont feel the pain and go out and play and the effect that that has on players as well . I cant comment on that. I played so long ago, it was a different era. There was a lot of drugs back in the 1970s and 1980s and there were a lot of guys who were being shot up to play in games. Mr. Carson it was like novocain or cortisone or Something Like<\/a> that. I am really far removed from the game, perhaps he can share, hes more recent, hes the baby of the group here. He can share his thoughts. Mr. Levy i think theyve gotten better with it the last few years. My first few years in the league, i could get vicodin like skittles. Any antiinflammatory, pain killer to get you through the week. And as a player, i mean, its on the doctors hands to control it, i think, and monitor, especially when consider some of the psychological effects it may have, maybe him going in four times a day and getting two vicodin each time is not good. It goes back to education. Its a 16week season, people are trying to make it through, doctor says its all right, its all right. Mr. Cohen i think it killed him. You said skittles. Trump said, if theres one poisoned skittle, you dont eat the package if your skittles had 10 than defective, you dont eat the skittles, but they dont want to think about that, but its good with muslims. Mr. Pallone thank you, steve. Congressman mcnerney. Mr. Mcnerney i want to thank everyone here and everyone listening to us too. I think the more the word gets out, the better off were going to be. I heard a couple of things i want to rehash. Dr. Mckee, you mentioned that at a minimum, 10 of the nfl players are going to be affected or are affected by c. T. E. And that this is the question you asked is this an acceptable risk . I think thats a profound question at this point. Dr. Stern, your question was do we want to have children engage in sports we want to have children, its not a question, we want to have children engaged in sports but how do we do it without risk of c. T. E. And related problems . In the prior set of questions, the technology came up. Can we make a helmet thats going to save peoples brains . And the thing is that deceleration injuries are whats causing it. Is there any sort of technology that you can see that would make a difference . Dr. Mckee no. The solution to this is not going to be technology. As henry carson said, the skull is essentially natures helmet. These are forces, acceleration, deceleration, Rotational Force<\/a> the brain expands, elongates during the course of the collision and it actually breaks the individual nerve cells because of the stretching and twisting of the brain inside with these whiplash type injuries. So a helmet is never going to prevent that. And its the constant nature of these whiplash or accelerationdeceleration injuries. Thats why football is dangerous. Thats why theres this risk. And thats what really needs to be addressed if we want to make this a safe sport. I dont think the sport will be safe and still look like the game we play now. Mr. Mcnerney it seems to me, the nfl is a tough nut to crack, but with children and parents we have an opportunity there. It might be a good idea to put together some sort of program to develop new rules for junior football and then maybe another set of rules if applicable for High School Football<\/a>. And then i think those rules will over time migrate to the nfl. So what would be the best way . Would it be to form a commission, how would we decide what rules should apply to junior football . As a scientist, i dont do rules. However, echoing what dr. Mckee said a helmet is not the answer. And theres been a lot of discussion, a lot of messaging, lets put research into it, lets build a better helmet. Mr. Stern tok to prevent concussions. And theres been all this messaging from the nfl down about concussions. That is what permeates our discussion all the time is concussion this, concussion that. It is so important that so much has been done to prevent concussions, to manage concussions presently. When were talking about c. T. E. And these longterm complications, its not the symptomatic concussions, its not the big hits, its not the spearing, its the repetitive hits, part of the game that is just part of the game. So when it comes to changing rules, policies, i think it has to start with appropriate messaging. That those changes should not necessarily be just to reduce concussions, to manage concussions, but to take the head out of the game, to protect our brains as much as possible. So we dont have these longterm problems. We have to focus on the subconcussive, routine hits and not keep talking about concussion. I was just thinking, if were not going to be able to change the nfl and cant make the players safe, and weve been talking about children, it seems to me if we go to the source. Go to the families. The source will eventually dry up or the nfl will change because its being forced. To so how do we reach the parents . Ive been a School Psychologist<\/a> for decades, it seems to me our Public Education<\/a> system might be one institution in place that we might be able to make some inroads. Ms. Adamle i know i spent my my doctoral studies were in working collaboratively with families and parents. How do we work with them . I dont think merely giving them facts, mr. Cohen spoke to the culture and coming from the south. Youre not going to change peoples minds that quickly by stating statistics. But by working with parents, making it mandatory if your child is going to play, you need to come to these series of webinars where we present it, we start a dialogue with parents and start to help them to understand and make more informed decisions about what is going on should their child play, all the factorers around that. I think thats one thing that you could start to do where we have something in place already. You can start with School Psychologist<\/a>s doing it, who have knowledge of cognitive assessment, learn, the impact of these things on learning. You could involve the School Social<\/a> workers. And i think you always need to, speaking to the culture, we talked about the coaches. Coaches have a certain mindset in this culture. I think we need to work with them specifically, giving them a great deal more education on this. And again working within a process to change that mindset. If i can give a quick answer. The simple answer is we need to stop hitting kids in the head. Stop hitting them in the head on purpose. Which is where somehow where we ended up with sports. So just to give the fast answer, all these sports that kids play were invented for adults. College athletes, around that age. We moved them down to kids to get them better, recruit them, create businesses, whatever it is, and we want them exercising. We didnt always change the rules to respect what its like to be a child. Some sports are changing now. We are excited we got u. S. Soccer to ban heading up until 11, it should probably be 14. Asking a child to use their head to hit a project isle back. U. S. Hockey raised the age to football is now on an island, theyre the only ones saying, its still a good idea to hit this 5yearold in the head 300 times. I think we can all be confident theres never a good reason to hit a child in the head 500 times. Its not something any of us do to ourselves ever. I bet no one in this room has been hit in the head in the last month. Guys are walking away from millions of dollars to not take this risk. We need to focus on the culture of weve got to stop hitting kids in the head in sports and change the rules of the sports. Mr. Mcnerney its not just hitting in the head. If you hit somebody in the shoulder, your head will accelerate and decelerate as well. Who would be the best qualified to decide what is allowed . Youth football, who would be the best qualified to make that . The industry has proven they are not the right people. Ill pull another quote out that executive director pop warner said, if we convert to flag, which is what we promote. Play flag, sevenonseven wed lose 90 to 95 of the players because parents would put them to another league. Just to realize the problem we have, we have the shell game of nobody owns youth football. So everybody in youth football, even though we all know its a bad idea is scared to say were going to have an age minimum. Pop warner is going to lose people to American Youth<\/a> football, lose their people to this league or that league. Its got to come from outside football. Thats the answer. Its not nfl has proven theyre not the right people to do this. I think the government has a role in protecting our kids and i think our government, and you need to figure out through which you want to do it. C. D. C. , Public Health<\/a> expert, i dont care. But it needs to come from without football if we want to push a solution forward. Mr. Mcnerney one final question. Mr. Carson and mr. Levy. Could you tell me about your observations with former players. Were players all experiencing this kind of problem . Whats your experience in terms of other players . I was diagnosed in 1990 with postconcussion syndrome. Mr. Carson that was probably the best thing for me to have done because i had so many things going on and i realy didnt know exactly what it was. Sensitivity to bright lights and loud noise and so forth. And so many other things. So i had a name to go with what i was dealing with. Ive been able to live with it over the years. When i first started talking about it, there were players who literally laughed because during that era of football, we were all sort of trained to go out and play and if you got dinged and you got con cussed, you know, you may have walked to the other teams huddle and you got a laugh out of it. And but you know, we all knew that, you know, youre going to get dinged just playing the game. So then there became players who would call me and they would say, harry, im having some problems. I know youve been very upfront about talking about this issue but let me tell you what im going through. So it takes a lot for a Football Player<\/a> to open up to another guy about issues that are going on with him. And so i try to point them in the right direction and more and more players started dealing with issues. Not only were the players dealing with issues and were coming to me, there were the wives of players. Who would ask if i could point their husbands in the right direction. So you know, there are so many, and i know this is not just a coincidence, there are so many former players who are dealing with neurological issues now that, you know, i call them undiagnosed brain injury survivors. Im a diagnosed brain injury survivor because i knew what i was dealing with. Ive been able to live with it. For all those other guys, theyre undiagnosed. And theyre just sort of wandering, you know, theyve lost jobs, theyre dealing with all these issues. And you know, mike and his family his wife, thats a clear example of what many of these guys are going through now with their spouses. So more needs to be done. More needs to be more resources should be available to families of men who have played the game. They did a very good job of explaining what the issues are. But its well beyond what you see on the surface. As i said earlier, its not just an nfl problem. Theres so many individuals who never even got to the nfl who are dealing with these issues. And theyre reaching out for help. Mr. Mcnerney im going to yield back. Mr. Pallone thank you. Mr. Cicilline. Mr. Cicilline i want to begin by thanking both chairman conyers and chairman pallone for convening this forum. And thank the witnesses for being here and being courageous enough to share your stories, to engage in ground breaking, and your presence here today is already improving the situation by continuing to raise this issue. As i listened to the testimony of all this, i think the approach were seeing to brain injury and concussions and subconcussive injuries is similar to a larger problem in our Health Care System<\/a>, we talk about physical injuries to knees and shoulders and backs but we our Health Care System<\/a> doesnt reflect the same focus or understanding of injuries to the brain. I think were seing that play out here in the same way we do in our General Health<\/a> care and well being and prevention and Health Care System<\/a>. I also, you know, im listening, carefully, because i played pop warner, played High School Football<\/a> and got hit in the head a lot. Didnt play in college but at the time these issues were not discussed by anybody. My parents are alive they love me, im sure theyd be horrified at the dangers they exposed me to. There was a great piece written by the chairs they have u. S. Consumer Product Safety Commission<\/a> and the federal trade commission entitled helmets protect heads not brains, to mr. Carsons point. The question i have is, are there efforts that can be undertaken in youth, whether pop warner High School Football<\/a>, that will make play in those forums safe for young, developing brains or not . Are there protocols that could be put in place . New coaching techniques . New tackling techniques . Or is the danger so great because of the age of those participants that it cant be done safely . I guess thats my first question, id ask both the players and scientists and anyone else who wants to weigh in on that. If i could start, i dont think we know that theres a safe time. Just because some of the research looks at age 12 or age 14 or age 11, there is not necessarily a safe time for the head to be hit and the brain to be moved around the way you described over and over and over again. Mr. Stern its not made to do that. So putting it off is fantastic. Putting off exposure to any of those hits through youth football, i think needs to be done. But when is it a safe time . We dont have that answer. So to do what can be done to at least reduce the overall exposure to these hits by having no contact practices, by doing something to the change of the way the game is played on the field during games, to do whatever can be done to reduce the overall number of hits, i think, is critical. Theres no safe time, necessarily, start, or number of years to play. I think another way to look at that is theres no evidence that any tackling technique will make any major difference. Even if there was, if your best solution to preventing a child from getting a brain injury every time youre destinned to youre destined to fail. You cant ask them to tackle to the ground, their head is going to get hit. Especially when their head is much, much larger with respect to their body so you cant keep their head out of the collision. In terms of longterm solutions, as a former Football Player<\/a> yourself, when i meet them and say they they say they played i have to ask, are you interested in pledging your brain to dr. Mchughs brain bank. Mr. Cicilline absolutely. Or you can become a dictator, as i, and not allow your child to play. The life that i have lived in i have seen, im sort of what oprah. What i know i know pretty damn sure. I am not willing to take that risk with my eightyearold grandson. Im just not. If you put your kid out there, bad things can happen. Im not willing to allow my eightyearold grandson, who is so precious to me, to be injured in any way. If he scrapes is the or Something Like<\/a> that, thats fine. But the brain, that is an altogether different matter. Looking at it in a little more depth, when we are talking about brain development, and the doctors have mentioned there is no safe time or age we cant pinpoint that. Ive mentioned there are critical periods of development when we talk about impulsivity or attention. Its not just that the brain is being damaged at this point. It potentially would lead to what we are seeing with the older players. For the younger brain, the damage that they have, it will affect their ability to learn in school, to self regulate, manage their own behavior, their affective behavior regulation could be impaired. What that means is less ability to control themselves, and maybe getting in trouble with the law. Making bad decisions, recklessness, not furthering their education. It has far more effects in society, especially for our young men. There is a huge crippling effect for the damage that could occur. My last question do you what is your general impression if there is any change in culture within professional football . Are coaches, staff more conscious of these issues . Do you have a sense that they are hearing about the implications of this, even if they are reluctant to make big changes . No. None . In my experience, no. We have twoadays, but we still have helmets the organization doesnt want to put the idea in players heads that they can get degenerative disease. Its not talked about. In the locker room theres a little poster on the wall that has concussion written really big, but theres nothing about the longterm effects. I spoke earlier about having a conversation with a handful of teammates, and we talked and shared stories and had similar issues. At various levels, we all had the same issues. None of them could connect they didnt know about the research, about anything. It was just concussion, concussion, because thats the buzzword for the nfl to distract players from deeper issues. Bill belichick was one of my coaches when i was with the giants, and weve remained friends over the years, and when the last collectivebargaining agreement was agreed to, he sent me a text, and said harry, now you could still play, because in terms of practice, there is very little contact. So, the nfl has done a lot in making the game look safer, but there is no way to make the game safer. Because football is what it is. It is a contact sport. People are flying around at great speeds, and they hit one another. So many players now are not even being concussed in practice, they are being concussed in games. I will give it to them, they are at least making the effort to try to make the game safer, but by nature of the game, you cant make it any safer than it is. Thank you very much. I want to thank all of you. This was an amazing morning, and i think weve learned so much, and we appreciate not only the experts, but all the players and their families who really give us insight into whats going on. We have this forum because we want to get to the bottom of certain things. I appreciate everything all of you said. I dont think we have any more questions, so please feel free, otherwise we will conclude the forum. Does anyone want to air anything . Im going to ask you as a congressman from new jersey to do what you can with your colleagues to institute a system for parents to understand exactly what their kids are doing, and what they are signing their kids up for. We call it informed consent. Inform the parents, and if they want to consent to allow their kids to play, then god bless them. There are so many parents now who are not willing to assume that risk. They did not know the information out there now before. So, again, if you go to the Surgeon General<\/a> or the center for Disease Control<\/a>, i think that would help people to make more definitive decisions as to whether or not they will allow their child to play. I appreciate it. From when i started here, i had some mentors like senator lautenberg and my predecessor in congress, the real battle of a member of congress is trying to implement the right to know. I can hear the senator saying it right now. I think that is what you are our saying. Anduld definitely follow up see whether it is through outreach, orr more whatever combination. I appreciate that and will take your word. Anyone else . Important that we focus on protecting our future players and doing what we can. But i want to raise to the Committee Probing<\/a> attention that this may be a growing problem over the next couple of decades, just based on the people who have already played. Not necessarily those who have played in the nfl, the pros. There are approximately 12 million americans who played High School Football<\/a>, smaller factions who played College Football<\/a>, who are now in their late 50s, early 60s. They started to play at the beginning of the era of the big helmets, facemasks and the beginning of organized youth football. The big helmets, facemask did not stay until start until the 50s. Pop warner did not start until late 60s or 70s. The disease that we look at, cte , is one of those diseases that gets worse with age. It is a degenerative brain disease. These folks in their late 50s, early 60s. Were going to have millions of them over the next couple of decades. They are the ones we may be seeing, in my research. When they are alive, hopefully to figure how to diagnose them. In dr. Mckees research, after the past. We need to do something now to help with the potential epidemic over the next couple of decades. That means increasing research can,ng, a quickly as we learn to diagnose it and treated and slow it down so we can prevent dimms altogether. Symptomst the altogether. When short comment building off of what harry said we talked about. I guess i want to say that we were harsh on football. I want to recognize and thank the people within the game who have been trying to fight that fight. We talk about nfl limits pushed through the Players Association<\/a>. This is an interesting thing really thece Football Players<\/a> and coaches versus the industry. It is amazing to see john and come together as Football Players<\/a> looking out for one another. It will take a lot more of that if we want a chance to fight this ink within our lifetimes. Because it is a life and death issue. This is also a call to action for the former Football Players<\/a>. That we haveden more than just about anybody else. We struggled to find powerful voices within the active players. We need that if we want a shot. Going to turn to you, chairman conyers, to conclude. I just want to thank everybody for everything that has been said. This has been an important day. And the subject matter is going in and out ofof the congress to do more. I am grateful to all eight of you who have participated so fully. And i am proud of the members, our colleagues appear who did a great job of helping put this thing together. . Ont you think is there a possibility that i could think Sheila Jackson<\/a> lee . For anyone who saw me pop in and out, our constituents are. Round we must respond to them. Those who were able to sit behind you and listen were moved by the importance of this hearing. I, too, want to thank chairman pallone and conyers. If someone can give me i would like to leave with a pointed issue or issues to focus on that who we will have to reach out to. Just get these quick points. These are not questions that require long answers. I want to know, the Players Association<\/a>, do we have them . To have them understanding how serious this is . I believe so. So we know that is an ally we can work with and know that these young men are not sharecroppers. They should not be treated as commodities, which, mr. Carson said, they are working professionals. Ofice i mentioned the idea the knee, because i believe all rights have all people have a right to petition our government. What do we need to say to the owners . Conscience. Eir lee . Isrley adam there one sentence that you want to share . Football, but,ay being with mike for as long as we have been together, it has been his whole life her. I hear the players talk and see these bonds of friendship, true brotherhood. They share this love that transcends time. When mike says he would play again or other players have said that, it is because of that. It is not because of the throw of the hit or because of how many touchdowns they got or how much money they made. He never made more than 40,000 40,000. It is those bonds, the brotherhood. Is thatstriking to me kind of love and commitment to the sport and one another and that the owners do not share in that, dont honor it. It seems to be the right thing to do with an entity like the who iss on practically in another country in terms of money they make. If they are not reaching out to the their brothers, it is right thing to do. But theyre throwing up obstacles. Something want to say ge . Maybe we should get to the wife ife ownerss ownerswives. I feel a sense of urgency to act. The two doctors who have offered, i do not want you to be shy. There is a space and role for the United States<\/a> congress to help not only these men but this , production line of young men. No matter how much you tell families to not play football, is there a role, direct and we have to be able to discern how that is activated. Do you think there is a role for this . Understand, maybe because i am naive, why there is not an Occupational Safety<\/a> issue that we raise with the nfl. If this is such an occupational hazard, why are we allowing it . Or why do they not have to be more responsible for the negative outcomes dec s . They have an epoch obligation to continue to make sure they remain healthy. Particularly if the injury was sustained during football. I would just add another role, in terms of funding for research. Chronicw, research and is notic encephalopathy considered a disorder related to alzheimers disease under the funding increase for alzheimers disease. There are other neurodegenerative diseases that are part of that grouping of alzheimers and related disorders. This is very dissimilar to alzheimers. As stated, the more we can learn, the more we can help our understanding and future treatment. We need funding for tt four cte. So we can get to answers as quickly as possible. Hopeam most grateful and i this up alone will zero and for the dude the judiciary commitment Judiciary Committee<\/a> as well. Me assure you, it is not we do not feel we have a role. Doesroblem is the majority not necessarily see our role. We have to try and convince them. I wanted to say that my staff reminded me that the Players Association<\/a> did want to send someone. They have been supportive. But, for timing purposes, they were not able to send anyone. But it was not because they did not want to. Again, thank you so much for being here. We intend to follow through. We understand that. Thank you so much. Computer history museum, a conversation with dr. Anthony ion. He talks about issues, including how your zip code is more important than your genetic code in determining how long you will live. I went to medical school at johns hopkins. For those of you who may not know, it is located in east baltimore. It it is one of the worst slums in america. It was a shock to me, cause i had grown up in canada and we have a deep level of investment in its people. Universal health care, universal childcare, paid sick leave, vacations. Heavy investments in public art and infrastructure. When i got to east baltimore and saw the conditions, i was shocked. It triggered this thinking that, in the u. S. , does where you live alternately shape your health more than any of your genetic factors. Interested my i graduated medical school and went through studies and policy, i got interested in how do you illustrate these differences between neighborhoods and the impacts, the cumulative impacts on Peoples Health<\/a> . You can watch the rest of that at the Computer History Museum<\/a> of california here on cspan. Next, a look at how character and other attributes are significant to the presidency. Columnistork times david brooks and historian robert white. Past administrations and how they compare to the trump white house. From grand rapids michigan, this is one hour and 15 minutes. So. Character in the presidency. It is quite a subject, isnt it . Lucky. E are we thought we would open a brief","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia600104.us.archive.org\/8\/items\/CSPAN_20171126_075800_Traumatic_Brain_Injuries\/CSPAN_20171126_075800_Traumatic_Brain_Injuries.thumbs\/CSPAN_20171126_075800_Traumatic_Brain_Injuries_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240630T12:35:10+00:00"}