Transcripts For CSPAN Traumatic Brain Injuries 20171013

Live on capitol hill, the house is not in session but democrats on the energy and Commerce Committee holding a meeting looking at a trage. Theyll hear from med looking at traum brain injury. Theyll hear from medical professionals. Its about to get under way. Frank pallone, the Ranking Member of the energy and Commerce Committee, is leading the meeting. Mr. Pallone thank you, all, for being here today. I want to thank all of our participants at this joint energy and commerce and judiciary democratic forum. I want to thank our Judiciary Committee Ranking Member i call him chairman, mr. Conyers. I havent been in this position so i can refer to you as chairman but not myself. So thank you, chairman conyers, for joining us to examine the ongterm impacts of repetitive brain traumatic and particular trauma associated with sports. I look forward to the dialogue. Every week this time of the year Football Players at all levels take the field and engage in a contact sport they enjoy playing but may be farmful 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 nown as sub sorry subconcussive hits. Boston University Researchers ed by dr. Ann mckee, dr. Bob tern and dore Chris Nowinski said they have a marketedly increase of mood disorders like depression and this research has found langage between head mpacts 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 exclues 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 ife, kim adamle, and dr. Ell Eleanor Perfetto who is the widow of ralph wenzel. 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. Id also like to challenge we invited the nfl to attend but they declined. The science has raised enough red flags about repetitive head trauma that its incumbent to those who organize Contact Sports to make the game as safe as possible. This must come from all levels of play including the highest level of football. Since the nfl recognized the link between repetitive hits and brain trauma 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 issues 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 you get the bill. [laughter] mr. Conyers top of the morning, everybody. To be pleasure it is 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 it will mittee 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 is a very is unusual forum and im glad of it. When i was chairman of the Judiciary Committee, we held a football 2009 on 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 xamining the brains of 111 deceased National Football League Players which found that n 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 1. 6 in life, between llion and 3. 8 million sports and related sports and recreational related concussions occur each year, ccording 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. Theres rally there was a rally in alabama on september 22, he mocked the National Football leagues efforts to prevent brain injuries claiming 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 an ers at all levels, incredibly violent sport. I thank all the panelists and the members for being here today, and i turn it back to r. 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 and Commerce 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. Who is andre levy starting 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 concultant 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 thats 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 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 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. Brain bank has rains 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, 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 almaloid. C. T. E. 3. 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 diagnosis 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 nerve pathologists sponsored by the National Institute of neurological disease and stroke and National Institute of bio medical and bioimaging defined patho lesion. A 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 career or the number of years between starting to play and retirement from the sport. Recently we reported the largest and most methodlogically 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 panelists 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 side 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 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 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 Players or 91 . D 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, 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 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 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, 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 published original articles, we were careful to acknowledge there is selection bias. That is most of the Football Players 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 clinical professionals. They have no Laboratory Tests 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 doing nostic accuracy rate that would be impressive, even for a tirtiary center focused on medical 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 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 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 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 meck nistic insights into insights. Stic we need to evaluate this study found if ccl11 can be 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, especially Football Players 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 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 funding. C. T. E. Needs to be recognized as an alzheimersrelated neurodegeneration and part of the National Research 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 neurodegeneration. If we are truly concerned about the brain and Mental Health of future generations of americans, including military serviceperson ell, we will commit to Additional Research for funding for c. T. E. Thank you. Mr. Pallone thank you, dr. Mckee. Let me also mentioned we have been joined by congresswoman Sheila Jackson lee from texas. Thank you for being with us. Just so you know what we will do is well hear next from dr. Bob stern. The rest of the panelists have agreed to not make Opening Statements so we can go right to questions and so thats what well do after dr. Stern. Thank you for being here. Dr. Stern good morning, Ranking Member pallone, Ranking Member 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 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 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 founded by the National Institute of Neurological Disorders and stroke. That study brings together a network of approximately 50 investigators from around the country, from 10 Major Research institutions. The study referred to as the diagnosis c. T. E. Research project is aimed at developing methods of diagnosising c. T. E. During life, and were studying several hundred former professional Football Players, former college Football Players and then 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 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 during the period leading up to age 12 in boys. Therefore, our group has conducted a series of Research Studies 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 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 mber 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. 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 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 from exercise. Therefore, the goal should be to make sure that children can take advantage of all the benefits of Sports Participation 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. 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 . Would you say . No, i said seniority, not civility, although you are 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. It 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, 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. Dr. Mckee, can you tell us what the evidence shows about the effect of subconcussive hits on the brain . 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 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 neuro imaging. 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 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 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 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 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 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 participation in tackle football before age 12 greatly increased the risk of i dont know whats going on. Is it me . Bad microphone somewhere. R. Pallone well try again. 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 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 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 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 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 to the game. We actually need to start hinking 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 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 art of this and involve former linebacker deandre levy and get players, explayers into this. A Detroit Free Press letter that you believe that Football Players 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 t 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 this could very well be something more than forgetfulness. And 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 risk s are aware of the 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 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 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 intangably 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 . I think that every parent should be fully informed with all of the information that has been disseminated through Boston University or other sources. Cars ons they should be informed as to what risks they are subjecting their kids to. Any Football Player 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. And so i always sort of looked at my life as something football is something very temporary. Nd the issues that are there when ues that start 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 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 have had the opportunity to come in contact 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 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. Think, again, every parent should know exactly what they are signing their kids up for. Last year, i have been a very cal advocate for some of the players who have sustained traumatic brain injury and concussion so forth. Last year i petitioned the Surgeon General and center for Disease Control to do the same thing with football and Contact Sports as they have done with steroid. 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 . 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. 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 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. I think what dandre said shocks that were so far into this and the players still dont know. But also parents dont know. I think im going and the players still dont know. To pick on somebody because they went on record on this. I was surprised in response to dr. Sterns recent study on youth football, the way the pop warner fought this with dishonest statements. Not with truth, not with we still dont know, but with actual, factual dishonest statements. For example, the executive director of pop warner in response to the last study went on the radio and said its important for parents to know this research was not Peer Reviewed. It was Peer Reviewed. Thats not a debatable thing. The medical director of pop warner in response to dr. Mckees research was quoted saying, if i can find the right one, i dont think the real risk accrues until you play professionally. There have been very few that have been discovered at the College Level only. And that was in response to a paper that dr. Mckee published 48 out of the first 53 college Football Players were costive for c. T. E. My concern and what i fight every day is still really an advocate at heart though i finally wrapped up my ph. D. In may is we need to get let people make the right choice for themselves. To me as a guy who played football in college, im mbarrassed that members of the Football Community are actually giving people misinformation as they are trying to make the best choice for their child. I actually now Football Community thank my mot frequently for making me wait until high school to play football. She is probably watching right now. So hi, mom. Thank you again. Thats the advice that i would give to every parent right now is that its very clear from the research that there is danger each additional year you play. Id love to hear the thoughts of the other panelists who played more and much better football than i did. If there is any advantage to actually playing as young person as a Football Player. What im hearing in listening to whether its harry carson has gone on record many times or mike ditka or john madden or jim harbaugh or joe namath, all these people, hall of famers saying there is no advantage to playing football young. Do not play football young. If you want to play, even if you think its the greatest game in the world, wait until high school. Thats the best advice we can give parents today. Mr. Conyers anybody else . Following up on that. I agree. I think you can develop your childs skills without football. If you love football and want him to play football and you can develop their skills without putting on a helmet and older pads. Mr. Levy you can play flag football. Sign them up for soccer. There are ways you can develop them and get the benefits of sports without the neurological damage. There is no benefit for it from putting on a helmet on a 7yearold. If they maintain an interest and drive it will take to even reap football, they have to maintain that through taking away and introduced to high school, senior level, if they still have the interest, we can maybe talk to them then. The amount of work, hours, and energy it football, they have to takes to get a scholarship if thats the first point of getting something from football and playing professionally, the energy, time, and cheer work ethic that it takes to get anything from it, you can put that somewhere else. Its not going to happen magically. Energy and anything you put into football put it somewhere else. Try to go that path until you figure it out. Ntil the nfl figures it out. Mr. Conyers thank youall for your mr. Conyers thank youall for your comments. Mr. Chairman, i yield back. Mr. Pallone thank you, mr. Chairman. You can say whatever you want, sure. Hats why youre here. Mr. Adamle make a long story short. I had epilepsy, i was diagnosed with it 19 years ago. The reason why i had it diagnosed i was on the air and i was just doing a normal sportscast the night of bulls beat the portland trail blazers, 9690. Michael jordan had 26 points. The next thing i know i felt like this wave coming over my body. And the next thing after that i went in my room and my shirt was dripping wet. I went to a neurologist, preeminent guy in chicago at the time. He said he did all this checkup work, he said, you know, youve got a big lesion on your left temple hemisphere. My opinion is that youve got that from playing football. This is before c. T. E. My dad was an allpro linebacker from the browns, a doctor who played without a facemask and leather helmets. I loved the game ever since. Having players who played in the 80s and early 1990s, we talk about getting knocked out in concussions and stingers, red badge of courage. Yada, yada, i played on special teams. Coaches loved the fact that we leapt over the pile of players trying to block us and hit the receiver with our heads. And the guy would blow up. Wed slap each other, high five. Coaches would come over and hug you for doing this great thing. A lot of guys didnt know what the hell was going on. It wasnt until two years ago that i went to the doctor again just to get a routine checkup on the epilepsy, he said, yeah. We think we have that under control, but weve also found out just looking at some of m. R. I. s, that your epilepsy looks like its going down. We also think that you have a lot of symptoms that are current with c. T. E. I jumped up and i said, hey, wait a minute. Youre not supposed to be able to find this until were dead. I dont want to die right now. I got a kid and family. Tell me what i can do. They gave me a whole list of things. Basically athletic and eating food and the right stuff. If i have another bite of kale i think ill puke. But the real think thing here, i can feel the decline every single day practically. You are going around like this, and then the next thing you know you drop down a little bit. Are you not as sharp as you once were. Then you drop it down a little bit. You start to get scared. When you get scared, a lot of things happen. My wife who knows all about this, shes got the credentials, she sees this is something that nobodys really talked about, is what happens guys who played in the 80s and 40 years old, whatever, their families have taken a huge hit because of or husband or father, that i dont think any of us knew was going to happen. To talk for for her a couple seconds. Families are the ones who suffer the most from this c. T. E. Stuff. Mr. Pallone i should say my wife always tries to feed me kale, too. It stinks. Mrs. Adamle i put in a smoothy, doesnt know the difference. Thank you for this opportunity. And id like to also state that i would if i may, speak for the thousands of families out there. Im part of a group of women, nfl wives, a facebook group. There are approximately 2,500 of us in this group. Were in the trenches. Were just beginning to learn about c. T. E. , what it is, what does that mean, what are we supposed to do. Ure men our men, our husband that is we love, have been demonstrating these bizarre behaviors and symptoms for 12 to 15 years. And we havent known what was going on. A great experienced loss in ajor chaos and our families. If you look at statistics, the divorce rate for nfl players is 75 . I think in the general public its Something Like 51 . In our group we talk about it and you would be surprised at the number of us who are divorced, yes, mike and i did divorce at one point when his symptoms became so severe and we didnt know what was going on. Our lives were torn apart. But how many have divorced and now finding out whats actually reunited. Ve its partly out of understanding and understanding that the love wasnt gone. This was out of our control. Its also partly out of the fact that these men need us. They are not able to live on their own. So we have had to become in the trenches, in our family, day by day. We have had to become the primary breadwinner. We have had to take care of our men. I can talk more about that in specifics. The facts and whats going on in the brain, but how that translates to everyday life is pretty catastrophic. Pretty traumatic. We have to we have to handle all the medical affairs, all the scheduling of appoints, their medical needs are huge. The number of medications alone. So you are handling not only thety traumatic. Daytoday of taking care of the men, but youre also managing the system, medical system, insurances, disability, getting the pensions in place. Now we have a lawsuit. We have to note law. The lawyers dont know whats going on with this case. And so the wives are doing their best to navigate the system, to not work, to share what we know because everybody wants a part of this. Out of the thousands of cases that have been filed in the settlement, case action suit, approximately 100 have been paid out. Often much less than the original amount that they were entitled to. Most of the money thats been million, has. 5 been to the attorneys. They have their money. There is a lot more involved in that. But the women, the wives, are the ones trying to navigate that system. Trying to address all of the steps that need to be taken, all the documentation. Hoop after hoop battling the attorneys, battling the nfl where they may have a diagnosis and now they come back, they have to get it over again or find some little piece hat to disqualify them. The financial loss, many of the men, they lose their jobs. They lose their livelihood. 15 to 20 years of productivity. The affect on the family is not just financial. The children have to watch their father decline. They see their father in rage. They see their father become aggressive. Many times to the wife. Hey see their father unable to carry on a conversation. They see them restless. Mikerls, our one daughter, and i adopted in 2004 at the age of 13 from an orphannage in ukraine. Horrible circumstances that she came to be in the or fannage. Orphanage. She thought she was safe and in a family a little over a year ago she moved out, she told me, mom, i cannot stand to watch another parent die. And she was gone for a year and didnt come back. Shes now come 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. Hes the most intelligent man i know. And hes just had recent testing again. His Word Knowledge is sue is superior. Hes on the air, amazing, brilliant, charismatic. He retains that. He had a huge cognitive reserve. His bank account is of knowledge and expertise. But in the areas of everyday living, the executive functioning is huge, the executive functioning, everything we do is a series of decisions and sequences and organization, those are the very things that are gone. Mike in his testing over and over is found in the first percent identical, there is none. Turning on the tv. Operating your phone. He loses everything. Nd mike, im soarry, the zippers always down. Its over and over mrs. Adamle im going to draw the line. Mrs. Adamle this is real stuff. But i could go on and on. The devastation is huge to the families. These children have been affected. Whether they can go to college, where they live. Many of us left our homes. Had to downsize. And the wives are trying to hold it all together. We need to be heard. Were pioneering what needs to be done, were sharing what we can do. Mike and i through the Concussion Legacy Foundation ere honored to be the ambassadors of a project, rise above. Its where what were doing, were trying to give hope and inspiration to the families out there, as well as the affected players, of what you can do. We dont have a cure, so how do you live with it . How do you live with it with dignity, optimism, with energy and excitement and with a sense of purpose and contribution. Mr. Conyers were so glad you are here with us. Thank you, mr. Chairman. Mr. Pallone thank you, chairman conyers. Next were going to go to our congresswoman schakowsky. Are you ok with that . Ok. 14 of 2016sky march i came to a round table and i had prepared questions from my staff. This is with the nfl and the energy and Commerce Committee, and i asked the question first of dr. Mckee and then of jeff miller from the nfl, who is head of health and welfare of the league, and i said is there a connection between c. T. E. And football . I guess for the first time he said, oh, yes. Of course. There is a connection. I had no idea what kind of explosion there was outside on this. The other thing i didnt understand is the power of football. Were talking about a multimillion dollar, multibillion dollar industry hen it comes to college. This is the way some schools through the revenue of a football. Its not just the money, its the culture of football. The friday night lights in small towns around the country. We still hear from the president about, you know, good old days when there was more violence in ootball. Im really new to this new to the game and proud to be part of the team, but john conyers held a hearing in 2009 and research has been going on for a long time. Im just so grateful to all of you to advocate, to researchers, and especially to the players and families who have such courage. I feel like, you can correct me film wrong, you are kind of blocking this huge empire out there which is football. Courag i feel like, you can correct me film wrong, i do want to make sure that we an opportunity to dr. Cant see it from here. , to have your words. I really love the idea, mr. Arson, about a warning when you allow your children to play the game to understand what the consequences could be. First, let me ask dr. Perfetto, im sure you came here with a message. Then finally, i want to say what has been your experience with football, i just want to say, too, im from chicago. I live in evanston. I remember well when you were at northwestern and with the bears and on television. I just want you to know that in a survey of 87 schools in the hicago area, there are 2,549 less Football Players than there were in 2008 at the high school level. Almost a 20 decline. The biggest year drop came in 2016, eight months after the movie concussion came out. High y young magnet school, you may know about them, canceled the remainder of its football season this year because it didnt have enough players. High school, you may know about them, canceled the remainder mike ditka would tell his kids, you ought to think about golf. And so i just wondered what ave you encountered bumping up against football in your struggle to get the word out . First dr. Perfetto. Dr. Perfetto thank you very much. I want to thank chairman conyers for the hearing we had in 2009 because in my view it was a very Pivotal Point in changing the direction of this conversation and it really made a difference. Thank you for that. I am in a different position than i was in in 2009. That time my husband was still quite ill. He was in a longterm care facility being cared for, and my husband passed away in 2012. We struggled with the disease for almost 20 years. At first very much like the story that you heard, not having any idea what was going on. Then later finally getting a diagnosis in 1999. He had to go into longterm care in 2007 because i could no longer care for him at home. Husband died. This is a man who spent most of his life, he was 62, roughly 225 pounds, for most of his life, he had husband died. This is a man who spent most of his been 250 to 275 when he was playing football. When my husband died, he weighed 145 pounds. His brain was half the size it should have been for a man his size and age. His brain was functioning as dr. Mckee estimates at the level of about a 1 1 2yearold. For several years before his death, he could no longer stand or walk. He could no longer feed himself. He was being completely taken care of by the caregivers at the home and by myself. We fed him every bite of food he ate for several years. To understand the progression over time and the magnitude of what happens to an individual, if i had answered the question earlier about what should parents be doing about having their child play football, they absolutely should not be. Why dont you push your child in front of a moving car. Thats the impact were talking about here. When you see the progression of the disease over time, when you see the devastating impact it has on an individual, on the spouse, on the family, and when they get to be disabled on our medicare system, because thats who is paying for a lot of this, when all these testings and things are being taken care of. Aspect to add to the of medicare, once you get to that point where were in this lawsuit against the nfl, you do manage you do get a letter that says we have been notified that youre one of the people who might be getting a settlement from the nfl. Oh, by the way, all that medicare money that was paid, well be taking that back. I believe rightly so because medicare did pay for that, but it means that the families who need that money will get far, far less because Insurance Companies and the medicare system will be taking all that money back. The spread, the magnitude, the ramifications, the Ripple Effect are so far, far bigger than people really understand and until an conceptualize they star to hear at a forum like this about the things that have happened and going on. With that ill say that i think that this has made a difference. I believe the first hearing made a significant difference. Like this can make a difference like this can make a difference for getting that word out there. And i think it really helps to spread that word. Theres so much more that can be done so that players know, so that their wives know. But i have been saying for the last 15 years that i would be happy to talk to any wife. At the time my husband was still alive, i made the open offer. Any husband and wife who would like to come and see whats happening and really understand, i would be happy to introduce them to my husband at the time he was alive. Not one Single Person ever took me up on that. But i had several former players me, i thought about it. I was just too scared. Ms. Schakowsky if you could answer, anybody, you have a lawsuit, i dont know what you can talk about there, but what has been the response that you have experienced me, i thought you mentioned a little bit, dr. Nowinski, about how football is wait down to pop warner, has pushed back. Im just wondering if theres been any health and compensation. Mrs. Adamle one of the benefits that the nfl offers is called plan 88. Whose number was 88, hence the name. And basically that just says is given an explayer a diagnosis of dementia, then they are entitled to not entitled, you can apply for benefits. Thats often been and will be the expression has been denied, deny, deny, delay until they die. Many wives have had a great deal of difficulty obtaining that. I think because of the nature of my background and understanding assessment and documentation and able to put as together a portfolio of mikes application and we were able to obtain that. I know many families have tried for years able to put together and have not been able to obtain funds for that. The plan 88 pays for any outofpocket expense related to medical expense related to their care giving for dementia. So thats a nice benefit to have. But its been difficult to obtain. In the actual settlement case, as you said, the nfl is formidable and the wives are coming up against it. We have wives in the group who are attorneys helping to lead. Because were happy to also fight the attorneys. The attorneys, one of the latest things thats come out is that theres a 5 that is going to be put into the pot to pay for future attorneys fees because they are anticipating many thousands more players in the popline pipeline will experience this. What the attorneys are trying to do is take that 5 out once again the players settlement. Many of the attorneys, i mentioned the judge brodie put aside 112. 5 million to pay for the attorneys fees so that the players did not have to pay that. Who are already stretched financially in their care the attorneys were paid out of that. However many attorneys are also charging their clients upwards 1 2 on top of what they are receiving. When the players and their families protest that and ask about the double dipping or ask them to justify what they are charging, then they are now putting liens on the settlement amounts that the families had received. So many families are not receiving any money. And when they do receive it, its got one family in particular i think of the husband has a. L. S. They were to receive, and he was diagnosed at quite a young age. I believe hes in his young 40s, they were to receive several million. I think it was possibly 4 million. They received 1. 2 million. So they were asking where did the other moneys go to . Went to attorneys and their liens. The claims administrator took out what he assumed was given to medicare. And this family had not used medicare. Was s an assumption that taken out. They had to go through more paperwork proving they didnt to get that back. And then theres still even after doing all that, was taken out. There was still Social Security 8 not accounted for. They still dont know 1. 8 not accounted for. They still dont know. I received emails when the other wives found out i was coming here, other emails documenting much of the same. Another wife whose husband had a diagnosis. They submitted there was still their registration. And now the nfl is coming back nd saying questioning his diagnosis. They submitted dr. Perfetto there is this tremendous barrier. First i think there are two things. One is that the way that the set manyment was laid out, what the families are going to get, had lots of caveats around it that were very misunderstood and were very complicated to understand. And it really had to do with getting less money the older you were when you were diagnosed. The problem with that is that the nfl had hidden so much information for so many years that there were so many people who would have been diagnosed many years earlier at a younger age. If the nfl had not within been hiding that information. If for example i probably would have known almost 10 years before my husband was diagnosed if the nfl had released information rather than covering it up. That of course means that these people are getting less money because of their age of diagnosis. That was a big problem with the way it was being calculated. That has never been resolved. Plus there are other things that take that deduction off. There is also these hurdles that are being put in place for it to be difficult to be able to collect. Here i am somebody who has been front page of the New York Times with my husband on this issue, and my application has been rejected several times. Front page of the New York Times if coy add, there is one important caveat to what you are hearing. When they refer to being diagnosed, its not being iagnosed as c. T. E. Dr. Stern c. T. E. Is not covered at all by the settlement unless it was diagnosed after death a year and a half ago. No one else moving forward after death will get any payment for diagnosis of c. T. E. One diagnosed with c. T. E. During life, one diagnosed with. During life, whatever we come up with as a way to diagnose it, or if someone has severe did he mentiona and no other reason for it, if they are told they have c. T. E. , they dont get ompensation. Dr. Nowinski you asked about the Industry Response. There was one big moment for me in terms of what the Industry Response would be Going Forward and that was laid out very well in Ranking Member pallones Democratic Committee report last year in 2016 on the nfls not fulfilling their commitment to the foundation for research on c. T. E. That to me was a line in the sand that said, lets picture what happened. This is dr. Sterns study now being funded by n. I. H. It was supposed to come from nfl money. The quick history is in 2012 the nfl had been proven so many times to be funding the wrong things in their interest they said fine, we give up. When n. I. H. Chose what the best research is to help these guys to help people like me to give us hope, they refused to fund it and they made up a whole bunch of embarrassing to those doctors who were involved, embarrassing reasons why they wouldnt fund it. Now were 16 million short. The studied was delayed. Now the nfl is a do over saying 100 million but tonight of it 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 also showed was falsely marketing to children. The Industry Response to say were reliving big tobacco again is worth saying because i feel like thats what were seeing aytoday. Jackson lee. Ms. Jackson 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. Take the time to acknowledge that we have had hearings in houston and washington on the Judiciary Committee, 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, football widows traumatic journey, which dr. Perfecto, in sympathy to you. , d then to mikes story adamle, to have the Chicago Tribune say your words were, it shook my world. Id like us to have that in the record. To carson as well when 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 pli extensive, to put in the roll call which is a tragic headline in and of itself, the New York Times, nfls tragic roll call which has mike webster jr. , ken stabler, frank , 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. On et me, if i could, focus mr. Carson, mr. Adamle, who i understand received another diagnosis and that is when you determined or was determined while you d c. T. E. 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 for the love of game, but also for certainly that was your work. Needs one of the things we to accept. That is your work. And you go to work every day and you put your very best in that work. 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 need to accept. 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 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. T me start with you, mr. Carson, i want to take up dr. Terns and dr. Mckees challenge, the n. I. H. Should certainly be doing Major Research in this. Certainties for Disease Control. 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. Where the question of is the responsibility where does the responsibility lie at the top . 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 i knowdirnl looking at a concussion policy. But going beyond that, rather than saying oh, this is get these guys out of sight, out of mind, let them go into the courts, is there any nderstanding 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 all backgrounds, is there any crisis understanding of where were on this . Mr. Carson . Mr. Carson lets just owner a to an nfl players commodity. The average career of an nfl 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. When i played,d so you have to draft every year , players who are injured lose a step, or whatever they discarded and the nfl, or teams move forward. So the issue of concussions is one that i think nobody really wants to talk about t. 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 would 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. Carr a couple of years, the 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 good outside. But theres so much damage that has been done physically, recently removed from the game, just wn the road they are a hot mess because their 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 nd 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 listening to ars, my 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 a brain tumor or something. He said it was post concussion syndrome. I asked him, will i live . E said youll live you have to learn how 20tomanage 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 learn how 20tomanage traumati injury. Not just players in football. But players in other contact of sports. 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 an amily because i have 8yearold grandson who turned 8 yesterday. And i already informed members 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 contry, 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. Me the one thing i never wanted to playedisregard those who the game and not acknowledge at Football Players 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 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 neff even got to the nfl but they are having so many 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 other former players like a. Unior seau i only wish that those guys were my friends and i only wish i 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. Acknowledge that there is something wrong with players when 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 commit committed suicide, could you say they committed suicide in vain because they certainly shot themselves in their chest and not their head because they knew omething was going on. Ms. Jackson lee thank you. Thank you, mr. Carson. Passionate words that you have unnoticed andoing not in vain. If i could go to diagnosed with epilepsy then the c. T. E. Diagnosis came to 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 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 who are f guys 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 just rang a bell. Going to who are assistant coaches what harry wa about the former players. E ere is a lot of guys, th 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 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 hi to do it all over again, i think maybe about would say, layers 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 would s yes. 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 team. They won six consecutive olympic games. They finally were deroiled in 1980. They had a coach who traveled the countryside and he went to different houses where there were Young Athletes 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 all about it was 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 kidshorsemen, had he those 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 marinelli was the defensive coordinator for the bears a couple years ago, now with dallas. He said in a preseason camp i m the was visiting and talked to him, 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. 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. Seems that there is the concern about turning style, changing style, changing practice with owners and what you have seen in the course of your playing. Do they understand the graphity of this gravity of this . Does there need to be a federal intervention . Mr. Levy yeah. 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. 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 small collisions on the ground. You see guys big collisions where you think for sure they are not going to get up and they do. 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 headaching 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 they dont know whats coming. They dont 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 macroway 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 callers telling my i shouldnt talk about t 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 i was out. Im like t. Could have been just because 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 owners 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 steveon fromtown tfpblet steve cohen from tennessee. R. Cohen youall 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 further but i say its more like a sharecropper. And sure youall want to play and get paid a lot, but you are i love the game. Ollie maximumon was my favorite from 1 maxom was my favorite team. The owners are in the boxes and the only injuries they are subject 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. Ecause this is what they can do, they can buy teams. And own players. Its a lot like sharecropping or slavery. They are they gone 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 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. R. Mckee 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. Im thinking about now is what are they doing on the field as tackling and all that. Are there penalties, repercussions . Mr. Levy no, nothing other than fines and penalties. You can fine guys, i think theyre try to trying to suspend guys for certain type of blows. But thats just teaching players to aim blower. My helmet hits your knee is still my brain being moved in my skull, i think. Yeah, thats all the extent of it. Its not talk 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 in Training Camp we get a big presentation and talk about that. Few years before that it was michael sam came out, its gay player, we talk about equality, treating people equally. Then it was gun control before that and Domestic Violence. 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 came, they had opportunities to improve helmets. Mr. Levy i think thats trying to capitalize on the hot topic. 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 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 move mping. I put in a 2,000 helmet, run into something, i dont know what the forces are, if we have ny physicists in here. Were going to have mr. Cohen do we have the best helmets possible now . Short of getting nascar helmets. Everyone is Walking Around like this because the things are so heavy. It goes back to mass times acceleration. Its a physics equation. I dont know if that ever can mr. Adam lee a good friend mr. Adamle a good friend of mine played for the bears. When he was younger he was able to get down and make the proper tackle. Now hes old every, lost a step, the only way to get at this guy, he launches himself off the ground, theres no such thing as a complete wrapup any more and you see that way too often. I dont know how you legislate that. You can do it a couple of times a game. But they could do it almost every single time for that matter. Heres the thing about concussions. People have known this for a long, long, long time. There was a guy, steve reed, he was my the team for northwestern, and he did this longitudinal study started in 1946 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 . Ive been sort of, i was trained to be an educator, i wasnt trained to be a Football Player, 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 ou 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 . Tears on going to have the brain when off 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 Members is a friend of mine. Good friend that Family Member told me that was caused by all the drugs he was given, started at Mississippi State 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 play sod 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 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. Social security a 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 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 ame 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. 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. Owever, echoing what dr. Mechanickey 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. Think about how 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 subcon cuss i, 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 for decades, it seems to me our Public Education system might be one institution in place that we might be able to make some inroads. 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 Psychologists doing it, who have knowledge of cognitive assessment, learn, the impact of these things on learning. You could involve the School Social 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 rocess 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 136789 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 had had edhead 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 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 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 wow 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 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 wiveses 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 elp. 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. Nd thank the witnesses for being here and being courageous enough to share your stories, to , and in Ground Breaking 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 subcon cussive injuries is similar to a larger problem in our Health Care System, we talk about physical injuries to knees and shoulders and backs but we our Health Care System 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 care and well being and prevention and Health Care System. I also, you know, im listening, carefully, because i played pop warner, played High School Football 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 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 warn ore High School Football, 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 n 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 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 ail. 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 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. Absolutely. You, ive a car here for will share it with you. Bacardi here for you. Here for you. Or you can become a dictator, and not allow your child or grandchild to play. Again, the information out there , but they largely developed, and the life ive lived and what ive seen, im sort of like oprah. What i know, i know pretty dam sure. Im not willing to assume that risk with my eightyearold grandson. Perfect tackle. If you put your kids out there, bad things can happen. Allow myot willing to eight euro grandson, who is so. Recious to me, to be injured if he scrapes his knee or something, 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. 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 order 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, they are affect his their affect his behavior regulation their affective behavior regulation could be compared. 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 see solicitor generals impression about, if there is withinnge in culture professional football. Our coaches more conscious of coaches,ues are 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 to a days, but we still have helmets, we dont want organization doesnt want to put the idea in players heads that they can get degenerative disease. Its not talked about. I think it needs to be 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. To the nfl has done a lot look into making the game a lot into making the game safer, but there is no way to make the game safer. It is a contact sport. People are flying around at great speeds, and they had one another. Are not evenrs now being concussed and 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 gives us insight into whats going on. We have this for him because we want to get to the bottom this forum because we want to get to the bottom of certain things. I appreciate everything all of that 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 systemues to institute a 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. Again, if you go to the Surgeon General or the center for Disease Control, 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 might predecessor ofcongress, the real battle a member of congress is trying to implement the right to know. The senate are saying it right now. Particularly this committee, our energy and congress committee, it is about the right to know. I think that is what you are saying. I will definitely follow up on that. I will see if it is through legislation or more outreach or whatever combination, so i appreciate that. Anyone else . Its so important we do focus on protecting our future players and doing what we can, but i want to raise to the committees attention that this may be a growing problem over the next couple decades, just based on the people who have already played. Not necessarily those who played in the nfl and prose nfl andpros nfl and pros. There are approximately 12 million americans who played High School Football. A smaller fraction who play College Football, and they are now in their late 50s, early 60s. They started to play at the of the bigf the era helmets, the facemasks, and the beginning of organized youth football. Start until the late 50s, the helmets and facemasks. Startfootball didnt until the late 60s or 70s. The disease that we look at, cte , one of those diseases that gets worse with age. A degenerative brain disease. These folks who are now in their late 50s, 60s, and now we are going to have millions of them over the next couple decades. They are the ones who we may be seeing. In my research, hopefully to figure out how to diagnose them. Sadly, and dr. Mckees Research Need to dopass, we something now to help with that potential epidemic. That means increasing Research Funding so we can, as quickly as we can, learn to diagnose and treat it, learn to slow it down enough to prevent the symptoms altogether. Thank you so much. Yes, go ahead, dr. One short comment. Building off what harry said, i want to say this. We were pretty harsh on football today. I want to recognize and thank the people within the game who have been trying to fight that fight. We talked about limits in the nfl. That was pushed through by the Players Association. I want to thank this is an interesting thing, where we now face it is the Football Players and coaches versus football as an industry. It is amazing we see these gentlemen come together as Football Players looking out for one another. It will take a lot more of that if we want a chance to fight this thing within our lifetimes. Is also a call to action for former Football Players. This is a burden that we carry. A burden that we have more than anybody else. Thoseuggle to find powerful voices within football asking players to fight this fight. Im going to turn to you, chairman, to conclude. I want to thank everybody for everything that has been said. Day has been an important on the subject matter. Uss going to spur a lot of in and out of the congress to do a lot more, and i am grateful to all eight of you who have participated so fully, and im tty proud of the members our colleagues up here, who did a great job in helping to put this thing together. Dont you think . [applause] is there a possibility i could, to sheilabriefly jackson lee . Thank you. Let me indicate, constituents are always around. Those who to them, are able to sit in the room behind you and listen, they were moved by the importance of this hearing, and i, too, want to thank the chairman and members. If somebody would give me i would like to leave with a pointed issue or issues, focused on who will have to reach out to who we will have to reach out to. Let me get these quick points, which i will they are not questions that require long answers. The Players Association, do we chris,em echo i know, you are working do we have them understanding how serious this is . I believe so. So that is an ally we can work with, and no that these young men are not sharecroppers, they should not be treated as such, like commodities . They are professionals who are working. I mentioned the idea of the knee , because i think all americans have the right to petition their government. Our spouses, wives, professionals. What do we need to say to the owners . To strike their conscience . Dr. Adam lee, is there one sentence you want to share . What is striking to me, i didnt play football obviously, but being around it, being with mike for as long as weve been together, its been his whole life. I hear the players talk and see how they interact, these bonds of friendship and brotherhood. They share this love that transcends time. And when mike says he would play again, it is because of that. It is not because of the thrill of the hit or how many touchdowns they got, how much money they made. He never made it than 40,000 playing the game. It is their bonds, the brotherhood. What is striking to me is that kind of love and commitment to the sport, to one another, and the owners dont share in that, dont honor that. It seems to me to be the right thing to do with an entity like the nfl, who is practically another country in terms of money they make. If they are not reaching out to help their brothers it is the right thing to do. Instead, they are throwing up obstacles. The only thing i would add to that is pardon me maybe we wives get to the owners rather than the owners. Thet is understood what families go through, it could benefit the cause. I feel a sense of urgency to act, and the two doctors that , if dr. Mckie, dr. Stern there is any role for the United States congress to help not only farm,men but this ongoing production line, rather, of young men. No matter how much you tell football to play is there a direct and proficient role . We obviously have to be able to discern how it is acted on, but do you think there is a role for this . I think there is a role. Maybe its because im naive, i dont understand why there isnt an Occupational Safety issue we race with the nfl. If this is such an occupational hazard, why are we allowing it . Why dont they have to be more responsible for the negative outcomes . To me industry hasentire been built on the athleticism of these individuals. They have an ethical obligation to continue to make sure they remain healthy, particularly if the injury was sustained during the play of football. I would add that another role is in terms of funding for research, that right now, research and chronic dramatic encephalopathy is not considered a disorder related to alzheimers disease under the funding increase for alzheimers disease. There are several other nero degenerative diseases that are part of alzheimers and other related disorders the more we can learn about this disease and help our understanding of the future treatment of alzheimers, we need funding for cte, as if it is one of the siblings of alzheimers disease, so we can get to answers as quickly as possible so the scientific findings can help lead to better decisionmaking. I am most grateful, and i for thewill see a role Judiciary Committee as well. I see other elements we will review. Thank you very much. Its not that we dont feel we have the role, its that the republican majority doesnt necessarily see the role. We have to try to convince them. I did want to say, my staff reminded me that the Players Association and want to send somebody today. They have been supportive. I guess for timing purposes, they were unable to send anybody. It wasnt that they didnt want to. For beingall so much here today. We do intend to follow through, because we understand that. Thank you so much. [applause] [chattering] you can find this hearing online on our video archive on cspan. Org. We will continue to live, to the white house momentarily. The New York Times the president will make good to disavow the iran deal he will stop short for now of unraveling the accord or even rewriting it. Mr. Trump will declare his intention not to certify irans compliance with the agreement, and that doing so takes the congress the decision whether to reimpose sanctions. Well take you live to the white house, the president expected to speak momentarily. Undersociated press u. S. Law, the president facing a sunday deadline to notify congress whether iran is compliant. Beforee earlier today the values voter summit here in washington, and a lot of speeches still to come. We will cover those speeches at 2 00 on cspan 2. Here on cspan, waiting for hisident trump to hear comments on iran. The wall street journal reporting this morning, the president expected to announce that he wont certify that iran is complying with the 2015 multinational nuclear agreement. ,e will take tehran to task more broadly, for its practices ranging from its missile tests to its support of violent groups. The president was set to make this afternoon, should take place shortly. The president late yesterday, the white house announcing it would stop reimbursing insurers for subsidies to help paying for low income people to pay for outofpocket costs, ending months of speculation whether payments would continue, when a federal judge ruled last year they were making they were being paid illegally. Reacting to the ending of those payments, the ranking democrat on the latest and worst in his yearlong effort to create trumpcare by sabotage. Part of the comments by senator patty murray of washington. Two minutes. [chattering] shortly here at the white house, we will hear from President Trump on the iran nuclear deal, the jpoa. , writing that the president called it the worst deal ever, planning to reannounce that to announce his refusal to certify their compliance. The story says the president will also ask congress not to reimpose economic sanctions right away. If congress were to reimpose sanctions, iran would object and likely back out of the deal, causing it to collapse. President trump, shortly, here on cspan, the values voter summit. Our coverage throughout the day began on cspan two this morning