Transcripts For CSPAN Traumatic Brain Injuries 20171125 : co

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 haven't 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 long-term 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 harmful to their health in the future. there are a lot of concerning questions that we will discuss today. at the very least athletes and their families need to know they are being informed about the health risk and the risks associated with contact sports are being mitigated to the greatest extent possible. with more and more research coming out, the evidence is becoming clearer and clearer, the effects of repeated head trauma, even those received during one's youth, can accumulate and cause serious and devastating conditions and these conditions can stem from injuries once considered minor known as sub-- sorry -- sub-concussive hits. boston university researchers led by dr. ann mckee, dr. bob stern and chris nowinski said they have a marketedly increase of mood disorders like depression and this research has found language between head impacts and c.t.e., a degenerative brain disease. these researchers examined the brains of 111 deceased national football league players whose families chose to donate their brains and 110 of the deceased players suffered from c.t.e. during their lifetimes. i'm pleased we're 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 it's hit and how this triggers neurological effects and whether it's 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 there's research that needs to be done, that should not be an excuse for inaction. what is not in dispute is the connection between head trauma and football and degenerative diseases like c.t.e. a number of our panelists today played professional football or have family members who did. i'd like to welcome former nfl player, harry carson, mike adamle. we're joined by mr. adamle's wife, kim adamle, and dr. eleanor perfetto who is the widow of ralph wenzel. they have witnessed first-hand exposure to the long-term impact. they can speak to the challenges they live with and witnessed as a result of this trauma and they can also speak to the concerns of the future and whether they believe they will be adequately supported by the nfl or other organizations as they face future challenges. i would also like to mention that we invited the nfl to attend but they declined. the science has raised enough red flags about repetitive head trauma that it's incumbent to those who organize contact sports to make the game as safe as possible. that commitment must come from all levels of play including the highest level of football. since the nfl recognized the link between repetitive hits and they need to commit to brain trauma they need to commit to supporting independent , research, meaningfully reducing the risks and supporting players suffering from the effects of long-term brain injury. so this forum is critically important. it's 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 that's simply not enough. but i'm hopeful today's 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. i'm not going to mention my colleagues by name because they are each going to be part of this forum and discussion. but i do want to say looking at the people that are up here, my colleagues that are up here really many of them have played a major role in dealing with shoes so i appreciate the fact , they are here today. let me call on ranking member -- i call him chairman of the judiciary committee, congressman conyers, for an opening statement. thank you for letting us use your room as well. mr. conyers: you get the bill. [laughter] mr. conyers: top of the morning, everybody. what a pleasure it is to be here with our energy and commerce ranking member frank pallone and all my colleagues in sponsoring this event. it's an important event, and it's taken a little while to get there and we got a long way to go. today's forum brings together some of the nation's leading experts from the medical research and athletic communities to review the causes, effects and treatments of concussions and other head trauma. in particular, the forum examines what is known about brain injuries, what gaps exist in scientific literature and what is being done to address those gaps. the following year, the judiciary committee -- it will also feature firsthand accounts from individuals who suffered from sub-concussive trauma or have witnessed its long-term effects on their loved ones. and that's why we have eight people -- this is a very unusual forum and i'm glad of it. when i was chairman of the judiciary committee, we held a hearing in 2009 on football head injuries which was prompted by the mounting scientific evidence connecting head injuries in football and cognitive problems later on in life. during that hearing, the national football league refused to acknowledge a connection between head injuries on the football field and the subsequent development of brain diseases. the following year, the judiciary committee held a hearing in detroit, michigan, followed by forums in houston and new york city as part of our ongoing commitment to calling attention to this problem and examining ways to prevent head injuries in youth, high school and in college football as well. and this brings us to today's forum where our medical panelists will discuss their recently published studies examining the brains of 111 deceased national football league players which found that an astounding 110 of them had chronic traumatic encephalopathy, also known as c.t.e. for short. although scientific evidence clearly links head injuries in football to cognitive problems later in life, between 1.6 million and 3.8 million sports and related -- sports and recreational related concussions occur each year, according to the center for disease control. the extent of injury is particularly problematic for our youth as most brains are not fully developed until 25 years of age. as a result, a concussion is more dangerous for youth than it is for an adult. so i hope the panelists today will provide guidance on how we can better protect all athletes, especially our young athletes. and i would be remiss if i did not briefly comment concerning the president of the united states' recent series of statements concerning our nation's professional football players. there was a rally in alabama on september 22, he mocked the national football league's 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. they're ruining the game. they're 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 amendment's free speech protection. ironically, president trump has not uttered a single word about the actual underlying issue. the glaring disparities in how african-americans 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, today's forum allows to return to the actual facts and evidence and consider how we can best protect football players at all levels, an incredibly violent sport. i thank all the panelists and the members for being here today, and i turn it back to mr. pallone, my colleague and friend. mr. pallone: thank you, chairman. thank you so much for your comments and, again, for having -- letting us have a place to have this forum today. i wanted to introduce the panelists, but normally members of congress get to make opening statements when they come to these forums and we are not doing that today because they all agreed not to in order for us to get to the panelist. let me at least introduce everybody up here, if i could. first on my left is jan schakowsky, she's a member of the energy and commerce committee. she's from chicago. she's probably done more on this issue than any other member. i have to be honest. she's 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 co-chair 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 i'm going from my left. director of the c.t.e. center at boston university. we have dr. robert stern who's director of clinical research for the boston university c.t.e. center. then we have dr. chris nowinski who is co-founder of the concussion legacy foundation and co-founder 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 he's my favorite. 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 40-plus 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 she's an educational consultant and school psychology teacher with three decades of experience conducting cognitive assessments. and then last is dr. eleanor perfetto who is senior vice president of strategic initiatives for the national health council. and she was the caregiver for her spouse, ralph wenzel, prior to his death due to c.t.e. so, thank you all. you are all such experts and personal knowledge of what we're dealing with today. i was going to start -- i would like to have two people start, and that is dr. ann mckee first. if you would make a statement. dr. mckee: yes, thank you, ranking member pallone, ranking member conyers and distinguished members of the committees. this is a great honor and a great pleasure to be here and i am going to try to summarize the the work that we've 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 sub-concussive 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 long-term effects of exposure to repetitive head trauma and c.t.e. the v.a., bluff brain bank has brains and spinal chords of 450 athletes, military veterans who experienced head trauma. we diagnosed c.t.e. in over 280 individuals and published the clinical and pathological features of over 70% of the confirmed cases reported 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 alkaloid. we begun to investigate how the protein spreads from one nerve cell to another to result in widespread disease. in 2013 we defined the pathological features for the of c.t.e. and developed a -- 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 alzheimer's disease. this hallmark c.t.e. lesion allows for the precise pathological diagnosis of c.t.e. this unique lesion of c.t.e. is present in small areas of the brain in the beginning of the disease and it becomes widespread and distributed throughout the brain in advanced disease. two consensus panels of expert pathologists sponsored by the national institute of neurological disease and stroke and national institute of bio medical and bio-imaging defined this lesion as a patho lesion. research by biomedical engineers have also suggested the reason this lesion as a patho lesion. 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 methodologically case series of individuals with c.t.e. ever published in the journal jamma. the methods used in this study were superior to all previously published case series on c.t.e., a panel of four 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 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%. and 110 of 111 nfl players, or 99%. the study also found that nearly all former nfl players had severe c.t.e. and in players with either mild or severe c.t.e., behavioral, mood and cognitive problems were frequent. dementia was common among those players with severe c.t.e. so what is the prevalence of c.t.e. in the general population? the jamma study was not a population study and could not be used to determine how common c.t.e. is in the general population. it was also not representative of all living football players, 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 don't 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. there's 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 family's 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 gnostic accuracy rate that would be impressive, even for a tertiary center focused on medical disease with all of the state-of-the-art medical devices. selection bias is a factor for donors for all sorts of brain banks including at the b.u. alzheimer's brain bank. fewer than 5% of those brain donors have been diagnosed with c.t.e. so these critical caveats and the fact we've been able to amass 177 instances of c.t.e. in football players over a brief eight-year period is an indication that c.t.e. is not rare. c.t.e. may be under-recognized 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 that's 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 non-athletes with alzheimer's disease and non-athlete controls. we also took postmortem samples of cerebral spinal fluid from individuals with c.t.e. controls and alzheimer's disease and found the levels of ccl-11 in the c.f.f. were similar -- were normal in the controls of alzheimer's disease but elevated in c.t.e. again, suggesting that ccl-11 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 -- mechinistic insights. we need to evaluate this study to see if ccl-11 can be found in living individuals and whether the levels can predict the severity of the disease in living individuals. c.t.e. is a risk for football players, 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 sub-concussions. 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 alzheimer's-related neuro degeneration 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 alzheimer's disease and other neuro degeneration. if we are truly concerned about the brain and mental health of future generations of americans, including military service, we will commit to additional research for funding for c.t.e. thank you. mr. pallone: thank you, dr. mckee. let me also mention that we have been joined by congresswoman sheila jackson lee from texas. thank you for being with us. just so you know what we will do is we'll hear next from dr. -- dr. bob stern. the rest of the panelists have agreed not to make opening statements so we can go right to questions and so that's what we will do that 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 long-term 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. i'm honored to be the lead investigator of a $16 million, seven-year 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 diagnosing c.t.e. during life, and we're studying several hundred former professional football players, former college football players and men of the same age who never had any exposure to these repetitive hits or brain trauma. all of these folks undergo extensive testing over a three-day period at one of our four sites around the country and then return three years later for a follow-up 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. i'm 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 sub-concussive 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 didn't 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 three-fold and increase the odds of having problems with behavioral regulation by two-fold. 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, we've examined the relationship between the estimated total number of head impacts someone sustains playing football and later life problems. in the study published earlier this year, we found a strong dose response relationship between the estimated total number of head impacts, experienced through youth, high school and college football. and the risk for developing cognitive, mood and behavioral impairments later in life. in layman's 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, it's really important to note that participation in sports and athletics during childhood can have many important benefits including the development of teamwork, self-confidence 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 brain-related difficulties later in life. that's a difficult balance and requires a combination of unbiased scientific information and just plain common sense. in closing, i want to thank you for your interest in addressing this important issue and for your continued commitment for protecting the health and safety of all athletes. i also want to express my gratitude toward congress in general for continued support of n.i.h. funding but also to underscore the need for expanded funding for brain research. thank you. mr. pallone: thank you, dr. stern. let me explain that the rest of the panel are going to be answering questions and shouldn't hesitate if the question isn't directed to you and you want to answer, please, you know, indicate that you'd like to. and in terms of our questions, it's going to be the two of us as co-chairs or whatever and then we're going to go based on seniority with the rest of you, ok? what did you say? no, i said seniority, not civility, although you are -- though civility is important as you often mention to me. i'm sorry about that. sorry, steve. let me start out. in recent years we've 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 head-to-head tackles. this focus on concussions seems to obscure the more important issue. that is, there's a growing body of research, continuous sub-concussive hits may contribute to long-term 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 sub-concussive hits on the brain? sub-concussive 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, it's the length of their playing career or their exposure to football and the many hits that occur on every play of the game. it's 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 it's the low-level hits, the routine hits, especially that occur in football nearly on every play of the game, that lead to long-term 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 sub-concussive 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 sub-concussive hits, either one of you, dr. stern? dr. stern: let's 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 sub-concussive trauma, was directly associated with changes to the white matter of the brain in just one season of play. that's just the little kids. there's 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. that's just the immediate short-term 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 there's 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 sub-concussive hits and c.t.e.? either want to answer that? dr. mckee: again, it's the same. what we're 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. we're working on this risk profile. that's 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 high-risk category. but we're not there yet. mr. pallone: i don't know if you can answer this. the concern, of course, is, you know, sub-concussive 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: it's really important to understand there isn't a very clear diagnosis of what a concussion is. the clinical diagnosis at this point. there's no test that specifically says this person had -- has had a concussion. so there's this continuum of what's 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 don't have those symptoms you can't 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 long-term consequences. mr. pallone: then it's possible somebody who never had a concussion but just played one season because of the number of sub-concussive hits could actually have significant changes to their brain, i guess, huh? dr. stern: you know, one season of play, i'm not that concerned about. we don't know, though. we just don't know. but the combination of duration that someone plays, the number of hits they get while they're playing, perhaps on the position they play, the age that they started, all those things come together. we're 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 developing -- don't know what's going on. is it me? >> bad microphone somewhere. mr. pallone: we'll try again. [no audio] mr. pallone: so your group recently published a study including participation in tackle football before age 12 greatly increases the risk of developing cognitive issues later in life and in a separate study you found the more hits a player received whether through youth, high school or college the more likely that player was to struggle with mood and behavioral impairments later in life. talk about how much of a concern these sub-concussive 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 that's my particular concern. dr. stern: there are so many questions we don't have answers for at this point. there's 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 long-term 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 bobble-head 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. we're 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, there's 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 that's -- that we haven't seen much change in terms of the nfl. we need to really think about keeping contact fully out of practice. we need to reduce head hits by stylistic and behavioral changes to the game. we actually need to start thinking about some very severe changes to the game so that the players wouldn't be having collisions and tackles on every play of the game. that's the issue in football, collisions, tackles and sub-concussive hits are an intrinsic part of the sport. in another sport it's random but in football as well as boxing it's intrinsic and that's what the nfl has not dealt with to date. mr. pallone: thank you. chairman conyers. mr. conyers: thank you very much, chairman pallone. this is -- i want to get to a part of this and involve former linebacker deandre levy and get some of you players, ex-players into this. you stated in a "detroit free press" letter that you believe that football players are, quote, almost numb to the risk of c.t.e. because it's part of the job. i think we as players have to acknowledge it and talk about it in a real way and demand answers. would you comment, please? mr. levy: yeah. well, let me say that was a conversation i had in the locker room i had with eight or nine guys. we -- the locker room is a loose environment. we joke a lot. we joke about memory. issues we have with our memory like our partners at home telling us something three, four times. we all chime in and relate to that. not one of the players knew about the links -- about any of the research we're 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 it's normal because that's just -- i don't know. that's 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 we're cued in and paying attention to it, i don't 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 don't know why and i can't control it. i can't come out of a funk. it's like a fog over me. a lot of guys i think have the same issue but don't know how to link it. we don't talk about emotional issues for the most part in the locker room. a guy isn't going to come in and tell you he's feeling depressed or anxious or sad and doesn't know why. mr. conyers: do you think that players are aware of the risk associated with playing football? mr. levy: i think we are aware we will have bad shoulders, we will have bad backs, have bad knees. i think a lot of us know that's 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 it's gone. once it's gone it's 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 don't want to think about it because honestly it's 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 you're going out there pursuing your dream trying to provide for your family, try to create some financial freedom for your family, you don't want to go out there and be scared or timid and think about the long-term effects. i think a lot of guys will intangibly put it out. mr. conyers: does anything occur to any of you about what needs to be done to raise the awareness of this issue? mr. carson: i think that every parent should be fully informed with all of the information that has been disseminated through boston university or other sources. 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 i'm 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. and the issues that are there or issues that start when you're young, parents should understand that there's a physical risk that you assume when you play. i think all of us understood the physical risk. but when we played, myself, mike, eleanor's 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 can't replace the brain. you're dealing with issues of the brain and the brain is really the most complicated organ in the body, and you don't know what's going to happen, you know, once you're removed from playing the game, you are so far removed from whether it's pop warner, whether it's high school, whether it's college or even the nfl, once you're removed from the game, who do you complain to? there's nobody that you can complain to because your career is over and, you know, i prnlly -- i personally have had the opportunity to come in contact with people who are in their teens and having neurological issues. young people who played high school ball and now they're in their 20's and they're having neurological issues. individuals who never even got to the nfl who are having neurological issues, having played the game, so the issue, while we focus on the nfl, is more widespread than anyone really knows. i think, again, every parent should know exactly what they are signing their kids up for. last year, i have been a very vocal advocate for some of the players who have sustained traumatic brain injury and concussion so forth. last year i petitioned the surgeon general and center for disease control to do the same thing with football and contact sports as they have done with cigarettes. that is put a warning on the consent form so that they'll know exactly what they are signing their kids up for. mr. conyers: what might it say? mr. carson: understand that your child or the participant could be subject to some kind of neurological injury that might affect them for the rest of their lives. mr. conyers: let me ask my final question. what advice would any of you on this distinguished panel give to parents who may not be here today or may not be getting in on this hearing? mr. nowinski: i'd 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 we're eight years later,famt through football. i think what d'andre said shocks me that we're so far into this and the players still don't know. but also parents don't know. i think -- i'm going to pick on somebody because they went on record on this. i was surprised in response to dr. stern's recent study on youth football, the way the pop warner fought this with dishonest statements. not with truth, not with we still don't 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 it's important for parents to know this research was not peer reviewed. it was peer reviewed. that's not a debatable thing. the medical director of pop warner in response to dr. mckee's research was quoted d saying, if i can find the right one, i don't 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 saying 48 out of the first 53 college football players were positive 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, i'm embarrassed 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 thank my mother frequently for making me wait until high school to play football. she is probably watching right now. so hi, mom. thank you again. that's the advice that i would give to every parent right now is that it's very clear from the research that there is danger each additional year you play. i'd 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 i'm hearing in listening to whether it's 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 it's the greatest game in the world, wait until high school. that's the best advice we can give parents today. mr. conyers: anybody else? >> following up on that. i agree. i think you can develop your child's 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 shoulder pads. 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 7-year-old. if they maintain an interest and drive it will take to even reap any benefits of 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 takes to get a scholarship if that's the first checkpoint of getting something from football and playing professionally, the energy, time, and sheer work ethic that it takes to get anything from it, you can put that somewhere else. it's 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. until the nfl figures it out. mr. conyers: thank you all for your comments. mr. chairman, i yield back. mr. pallone: thank you, mr. chairman. you can say whatever you want, sure. that's why you're here. mr. adamle: make a long story short. i have epilepsy, i was diagnosed with it 19 years ago. the reason why i had it diagnosed was i was on the air and i was just doing a normal sportscast the night of bulls beat the portland trail blazers, 96-90. 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, pre-eminent guy in chicago at the time. he said he did all this checkup work, he said, you know, you've got a big lesion on your left temple hemisphere. my opinion is that you've got that from playing football. this is before c.t.e. my dad was an all-pro 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 1980's and early 1990's, 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. we'd slap each other, high five. coaches would come over and hug you for doing this great thing. a lot of guys didn't know what the hell was going on. it wasn't 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 we've also found out just looking at some of these, whatever, m.r.i.'s, that your epilepsy looks like it's 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. you're not supposed to be able to find this until we're dead. i don't 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 , i think i'll 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. ,you are 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, she's got the credentials, she sees -- this is something that nobody's really talked about, is what happens guys who played in the 1980's and 40 years old, whatever, their families have taken a huge hit because of -- or husband or father, that i don't think any of us knew was going to happen. i would like for her to talk for a couple seconds. because 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 really stinks. mrs. adamle: i put in a smoothie. he doesn't know the difference. thank you for this opportunity. and i'd like to also state that i would -- if i may, speak for the thousands of families out there. i'm part of a group of women, nfl wives, a facebook group. there are approximately 2,500 of us in this group. we're in the trenches. we're we're just beginning to learn about c.t.e., what it is, what does that mean, what are we supposed to do. we are in the trenches. we have been living it. our men, our husbands that is we we love, have been demonstrating these bizarre behaviors and symptoms for 12 to 15 years. and we haven't known what was going on. many of us experienced a great deal of major chaos and loss in our families. if you look at statistics, the divorce rate for nfl players is 75%. i think in the general public it's 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 didn't know what was going on. our lives were torn apart. but how many have divorced and now finding out what's actually going on have reunited. it's partly out of understanding what happened and understanding that the love wasn't gone. this was out of our control. it's 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 what's going on in the brain, but how that translates to everyday life is pretty catastrophic. pretty traumatic. 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 the day-to-day of taking care of the men, but you're also managing the system, medical system, insurances, disability, getting the pensions in place. now we have a lawsuit. we have to know the law. the lawyers don't know what's going on with this case. and so the wives are doing their best to navigate the system, to network, 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 that's been paid out, $112.5 million, has 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 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 that -- 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. they see their father unable to carry on a conversation. they see them restless. my girls, our one daughter, mike and i adopted in 2004 at the age of 13 from an orphanage in ukraine. horrible circumstances that she came to be in the 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 didn't come back. she's 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. he's the most intelligent man that i know. and he's just had recent testing again. his word knowledge is superior. he's 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 percentile there is none. , turning on the tv. operating your phone. he loses everything. and mike, i'm sorry, the zipper's always down. it's over and over -- mrs. adamle: i'm 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, if they can go to college, where they live. many of us lost our homes. had to downsize. and the wives are trying to hold it all together. we need to be heard. we are coalescing. we are trying hard. we're pioneering what needs to be done, we're sharing what we can do. mike and i through the concussion legacy foundation were honored to be the ambassadors of a project, rise above. it's where what we're doing, we're trying to give hope and inspiration to the families out there, as well as the affected players, of what you can do. we don't 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: we're so glad you are here with us. thank you, mr. chairman. mr. pallone: thank you, chairman conyers. next, we're going to go to our congresswoman schakowsky. are you ok with that? ok. ms. schakowsky: march 14 of 2016 , i came to a round table and i had prepared questions from my staff. this was 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 didn't understand is the power of football. we're talking about a multimillion dollar, multibillion dollar industry when it comes to college. this is the way some schools survive through the revenue of a football. it's not just the money, it's 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 football. i'm 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. i'm just so grateful to all of you to advocate, to researchers, and especially to the players and families who have such incredible courage. i feel like, you can correct me if i am wrong, you are kind of blocking this huge empire out there, which is football. i do want to make sure that we give an opportunity to dr. -- i can't see it from here. dr. perfetto, to have your words. i really love the idea, mr. carson, 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, i'm 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, i'm 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 chicago 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. whitney young magnet high school, you may know about them, canceled the remainder of its football season this year because it didn't have enough players. mike ditka would tell his kids, you ought to think about golf. and so i just wondered what have 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 2009. that time, my husband was still quite ill. he was in a long-term 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 long-term care in 2007 because i could no longer care for him at home. in 2012, my husband died. this is a man who spent most of his life -- he was 6'2", roughly 225 pounds, for most of his life, he had 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 1.5-year-old. 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 don't you push your child in front of a moving car? that's the impact we're 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 that's who is paying for a lot of this, when all these testings and things are being taken care of. then just to add to the aspect of medicare, once you get to that point where we're in this lawsuit against the nfl, you do manage -- you do get a letter that says we have been notified that you're one of the people who might be getting a settlement from the nfl. oh, by the way, all that medicare money that was paid, we'll 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 really can conceptualize until they star to hear at a forum like this about the things that have happened and going on. with that, i'll say that i think that this has made a difference. i believe the first hearing made a significant difference. i believe forums like this can make a difference for getting that word out there. and i think it really helps to spread that word. there's 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 what's 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 say to me, i thought about it. i was just too scared. ms. schakowsky: if you could answer, anybody, you have a lawsuit, i don't know what you can talk about there, but what has been the response that you have experienced with football? you mentioned a little bit, dr. nowinski, about how football is all the way down to pop warner has pushed back. i'm just wondering if there's been any help and compensation. mrs. adamle: one of the benefits that the nfl offers is called plan 88. from john mackey, whose number was 88, hence the name. and basically that just says that when an ex-player is given a diagnosis of dementia, then they are entitled to -- not entitled, you can apply for benefits. that's 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 diagnosis, i was able to put together a portfolio of mike's application, and we were able to obtain that. i know many families have tried for years and have not been able to obtain funds for that. the plan 88 pays for any out-of-pocket expense related to -- medical expense related to their care giving for dementia. so that's a nice benefit to have. but it's 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 we're happy to also fight the attorneys. the attorneys, one of the latest things that's come out is that there's 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 pipeline will experience this. what the attorneys are trying to do is take that 5% out once of 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 . the attorneys were paid out of that. however many attorneys are also charging their clients upwards of 20, 25, 33.5% 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, it's 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 he's in his young 40's. 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? it 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. it was an assumption that was taken out. they had to go through more paperwork proving they didn't to get that back. and then there's still even after doing all that, there was still social security 8 not million not accounted for. they still don't 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 their , registration. and now the nfl is coming back and 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 settlement 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 been hiding that information. 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. it is still that way. 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 literally on the front page of the "new york times" with my husband on this issue, and my application has been rejected several times. >> i could just add that there is one important caveat to what you are hearing. when they refer to being diagnosed, it's not being diagnosed as c.t.e. 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. but no one diagnosed with c.t.e. during life, whatever we come up with as a way to diagnose it, or if someone has severe dementia and there is no other reason for it, if they are told they have c.t.e., they don't get compensation. 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 pallone's democratic committee report last year in 2016 on the nfl's not fulfilling their commitment to the foundation for research on c.t.e. that to me was a line in the sand that said, let's picture what happened. this is dr. stern's 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. we will let nih choose. 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 wouldn't fund it. now we're $16 million short. the study was delayed. now the nfl is a do over saying give $100 million, but none of it will go to c.t.e. they are not funding the biggest problem facing this group of people. while they are still putting money into recruiting children into the game, things like the heads up football program, which "the new york times" also showed was falsely marketing to children. that was the industry response. to say we're reliving big tobacco again is worth saying because i feel like that's what we're seeing day-to-day. mr. pallone: jackson lee. ms. lee: let me thank all of you for being here. after the 2009 hearing that we had with judiciary, we went to houston, texas, and had a hearing to deal with this issue. and frankly, it saddens me that we're here in 2017 and listening to some of the most provocative testimony. i'm going to 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? i'd 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. and then to mike's story, adamle, to have the "chicago tribune" say your words were, it shook my world. i'd like us to have that in the record. harry carson as well when to restate some of the points made about 110 out of 111 brains were donated by deceased former players showed signs of c.t.e. and then of course dr. mckee who has said there is no question there is a problem in football. people who play football are at risk of the disease. i also think it's important, although this is probably not fully extensive, to put in the roll call which is a tragic headline in and of itself, "the new york times," nfl's tragic c.t.e. roll call which has mike webster, jr., ken stabler, frank gifford, and a number of others who are listed here. i won't read the entire list. it is certainly evidence that we have a long-standing problem. to hear the families' testimony is particularly challenging to me. so let me, if i could, focus on mr. carson, mr. adamle, who i understand received another diagnosis and that is when you determined or was determined that you had c.t.e. while you still lived. the joy that has been noted already that is given to america because you young men, as you were young, took to the playing field for the love of game, but also for certainly that was your work. that's one of the things we need to accept. that is your work. and you go to work every day and you put your very best in that work. i will deviate for a moment because i'm going to ask you about the owners. because we have to come together. i believe there should be legislation that instructs and demands. because the nfl is a corporate entity with federal oversight, both in terms of taxation and also in the antitrust question, we have a role in the united states 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 don't know why this that impacts impacts across the board, young men in the prime of their life, who love the game, chosen this as a profession to provide for their families, and it is ongoing. it is stunning to me. let me start with you, mr. carson. i want to take up dr. stern's and dr. mckee's stern's and dr. mckee's challenge, the n.i.h. should certainly be doing major research in this. they have enormous capacity to do this research. 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. that's one component that i think. i know that my colleagues are probably looking at. and then the question of where does the responsibility lie at the top? you mentioned young people, but i'll 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 and i ame nfl effort, looking at a concussion policy, but going beyond that rather this is out of sight and out of mind and let them go into the courts, is there any understanding that the core survival of this league, it may look like there is a never-ending source of young men who want to play from all walks of life, all backgrounds, is there any crisis understanding of where we're on this? mr. carson? mr. carson: let's just understand that to an nfl owner , a player is a commodity. the average career of an nfl player, when i played, and this is back in the 1970's and 1980's, was about 3.6 years. today, the average career is about 3.4 years. so you have to draft every year and players who are injured, lose a step or whatever, they are discarded and the nfl or teams move forward. so the issue of concussions is one that i think nobody really wants to talk about it, but i have seen players who have sustained multiple concussions , and at the end of the year , they are allowed to either go into free agency or not re-signed. d'andre probably could speak a little bit more on that because he's more recently removed from the game. to the owners, the players are just a commodity. they really don't 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, it's sort of like leasing a car. you get to ride that car around. after a couple of years, the car might look good outside. but there's so much damage that has been done to the engine. well, that's with the nfl player. there are so many players who still look good physically, recently removed from the game, but down the road they are just a hot mess because their brains have been jostled and bruised and so forth. i have seen so many players. i sit in a very unique position because when i came into the league, i saw the older players and i saw how those older players who had left had deteriorated. and passed away as a result of dementia and alzheimer's and so forth. i was diagnosed in 1990 with post concussion syndrome. i served as my own specimen for the last 27 years, listening to my own body, but when i started talking about the whole issue of concussions, there are players who basically laughed because we all played through getting dinged. but i paid very close attention to my diagnosis. the doctor who diagnosed me with post concussion syndrome, at first i thought i was going -- perhaps i had a brain tumor or something. he said it was post concussion syndrome. i asked him, will i live? he said you'll live, you have to learn how to manage it. over the past 27 years, i learned how to manage it and i have been very vocal about this issue. because there are so many players who are dealing with the issues of traumatic brain injury. not just players in football. but players in other contact sports. 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. that's why i have been an advocate on behalf of players who have played the game. if you ask me given what i know now, would i do it all over again? hell, no, i would not do it over again because you only get one brain and you have to take care of that brain. i basically am the dictator in my family because i have an 8-year-old grandson who turned 8 yesterday. and i already informed members of my family that he will not play football. he'll play any other sport. he can play tennis, golf, swim, baseball, but he's not playing a contact sport. and he lives in south carolina. that's football country, south carolina, the south, s.e.c. conference, and all that. so i have made that decision for my family given what i know now. i would not have -- i would not have done what i did. i just have so much respect for the guys who have played the game. the one thing i never wanted to do is disregard those who played the game and not acknowledge that football players are very dignified, very strong men. whenever they lose their dignity as a result of playing the game, it angers me. i'm not a part of the concussion lawsuit. i did that by choice. because i feel it's more important for me to continue to share my story on my own situation as opposed to people thinking, well, he's only saying that because he stands to benefit financially. i'm not looking to benefit financially, but i'm 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 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 don't go the route of other former players like a junior seau. i only wish that those guys were my friends, and i only wish i could have spoken with them to tell them that what they have, they can live with. and there was no need to commit suicide. but they did. and by committing suicide, they put everybody sort of on notice that there is something going on. if you don't acknowledge that there is something wrong with players when they leave the game and they can no longer take care of themselves or they fall into a deep depression, then those individuals who committed suicide, you could say they committed suicide in vain because they certainly shot themselves in their chest and not their head because they knew something was going on. ms. jackson lee: thank you. thank you, mr. carson. passionate words that you have said are not going unnoticed and not in vain. if i could go to mr. adamle and then mr. levy. as i understand it, you have said that you were diagnosed with epilepsy then the c.t.e. diagnosis came to your shock. and your comments about having this as a priority for the owners, do you see it? should it be? and mr. levy, i'll be asking you, we need to find a way to intervene on how the game is played and the idea of tackles. your story about your sense of their -- sense of how crucial this is for those who played and those who are playing. mr. adamle: i would say there is a lot of guys who are assistant coaches on different teams across the league who are former players. and they know what's going on with regards to that. i just don't -- the other night, on thursday night football, on the opening kickoff a guy is laid out on the field with a concussion. and it just rang a bell. going to what harry was saying about the former players. there is a lot of guys, the pre-59ers, guys who would like, god, everybody from -- did anybody see super bowl 49, before the game, they paraded out every single m.v.p. and the first guy came out and he was like this. bart starr was there. all these guys. just was so incredibly sad. and there is a lot of those people whose families are screwed up. i disagree -- if i had to do it all over again, i think maybe about 95% of the players would say, yes. the reason why they would say yes because of the wonderful friendship and camaraderie that they did down the line. you look at dave from the 1985 bears, that whole team was the closest group of people i have ever seen and still see. it's sad that what happened with dave. it shouldn't have happened. it doesn't happen with anything else. as far as the game being -- it's 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 didn't 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. i'm a little off -- the old soviet red army hockey team. they won six consecutive olympic games. they finally were dethroned in 1980. they had a coach who traveled the countryside and he went to different houses where there were young athletes ready to play hockey. they were like 13, 14, 12. what he did, they had a four month camp. they brought them all to someplace outside of moscow, and they first, it was all about movement and freedom and -- the first month, all they did was skate. no puck, no hockey stick. and they learned how to move in space. two months later, they get back on the skates, this time with a puck on their hand. then eventually the stick. so they knew how to move. it makes all the difference in the world. if we're going to still do this. it's a little bit far-fetched , but knute rockne when he had four horsemen, he had those kids play ballet, do ballet like three times a week just to learn how to move in space. you can -- now it's so -- we have lost that capacity, i think. that kids need to just know how to do that first. if it's still going to be around. i think it's still going to be around. if we're a coach, this is a good -- guy named rod marinelli was the defensive coordinator for the bears a couple years ago, . he is now with dallas. he said in a preseason camp i was visiting and talked to him, he said, mike, you know what, we can't tackle again. we don't have enough time. we can't. it's a lost art form. it truly is. you look when he played, harry didn't lead with his head. he grabbed him around the waist. you can watch ole dick butkus films. same thing. everybody thinks he was this murderous guy, dirty player. no, he knew how to play the game. and i think you would agree with this, harry, we need -- if it's not going away, let's do the right things to make it still happen. if it's possible. it may not be able to happen. mass times acceleration equals force, mass is bigger, accelerations are greater. it's going to happen. ms. jackson lee: thank you very much. thank you for that. mr. levy, it seems that there is the concern about turning style, training style, changing style, changing practice with owners and what you have seen in the course of your playing. do they understand the gravity of this? does there need to be a federal intervention? mr. levy: yeah. i don't think the owners are in touch with it. it's a business. we're a number. our bodies and brains are disposable. i don't know. i can't 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 we're the only ones that will , even care about the issue. i don't think you can really change football by tackling a certain way because before me, as a linebacker, before i get into a tackle, i'm getting into a collision with a 250 pound fullback. nobody sees that. i have to do that routinely. it's just inherently in the sport. i have to run into a 300 pound blocker at the line that's 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. it's not a collision. you see guys get small collisions on the ground. you see guys big collisions where you think for sure they are not going to get up and they get up. it's 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 don't know why we're still -- in practice, even. 20, 30 subcollisions in practice, going against my teammates, our offense, hitting a tackling dummy. as a linebacker, i'm taught to hit with my head and hands. it's 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 don't think we should be in any collisions other than on sunday. makes no sense. i went in the games on sunday with my neck and head aching because of wednesday and thursday. i think we can cut that down until we figure out a more substantial answer, i think right now i think the players that don't know, right now they are going -- they don't in a know what's coming. we got to find a way to get the message into the locker room. it's funny, i think chris spoke more on a macro way the nfl has responded to c.t.e., but even if my experience, like the letter you brought up, the moment i said anything about t. i had two it i had two callers telling my , i shouldn't talk about t i it. i don't know if it's c.t.e. or general nfl rule, only talk about football. i posted simply the research. i spoke with dr. stern a couple summers ago and wrote the paper and i was told not to talk about it the first day it was out. i'm like, it could have been just because nobody wants to talk anything other than football. it didn't sit well with me when i'm talking about brain injury. my brain. it's not my shoulder. it's my brain. it controls everything i do, we think, we feel. if i don't have the right to speak about that as a player, it speaks about the culture of the nfl. what the conversations are. that's indicative of the conversations we don't hear. the closed-door conversations between the owners, they are still trying to find ways to silence this. mr. pallone: thank you. ms. jackson lee: you're saying congress should act, right? mr. levy: yeah. mr. pallone: thank you. next is congressman steve cohen from tennessee. mr. cohen: you all can hear me. first, i want to thank mr. conyers for having set up the hearing that we had when the democrats were in the majority. i participated in those hearings. they were good hearings. they stopped because the republicans are the majority. and like on most things, the republicans care about management and they care about wealthy white men. and they don't care about labor and they don't care about , humans. they don't care about health care. they don't care about injuries and workers comp. it's unfortunate. that's why we're here now because the democrats who are here. what mr. carson said, i could go about a leased car, i could go further but i say it's more like a sharecropper. and sure you all want to play and get paid a lot, but you are -- i love the game. ollie maxom was my favorite from a thousand years ago. the owners are in the boxes and the only injuries they are possibly being subjected to is cirrhosis of the liver and they stay up there and watch the game and high five each other and make tons of money. because this is what they can do, they can buy teams. and own players. it's a lot like sharecropping or slavery. they are the owners. they don't care what happens to you. they use you for 3.2 years, and they go on. it's like they won the game. it is just awful what's going on. the knee is the whole thing they're 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? they're 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 we've established. i have a $6 million grant that i got from the original nfl money that was given to n.i.h. we've done an absolutely amazing job over the last four years. most of the brain donors who have come in came in from that funding. we have published. i have lost count of how many papers we've published. there's 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 that's important. it shows the problem. i'm thinking about now is what are they doing on the field as far as play, tackling and all that? are there penalties, repercussions? mr. levy: no, nothing other than fines and penalties. you can fine guys, i think they're trying to suspend guys for certain type of blows. but that's just teaching players to aim blower. my helmet hits your knee is still my brain being moved in my skull, i think. yeah, that's all the extent of it. it is not talked about. in the nfl it's always kind of, every few years it's a hot topic. a couple of years ago, it was, the last few years it's been domestic violence in training camp we get a big presentation and talk about that. a few years before that it was when michael sam came out, it's 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, i'm sure this year they'll be talking about players protesting. through all of that, there's 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 that's trying to capitalize on the hot topic. football is huge. a $12 billion industry. ok, we have a solution but i joke, i don't 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 doesn't crack you put . you put a lot of money into creating a nice package, but if you shake it up, the brain is in fluid. you're shaking this around, you put the most beautiful package, drop it from the roof, it won't crack, but the brain is still moving and tapping around in there. but mike is saying is true. we should have better helmets that you. do they have to estimate possible right now? >> here is what happens to a lot of guys. he launches himself off the ground and there is no such thing as a complete wrapup anymore. i don't know how you legislate that. but they could do it almost every single time for that matter. here is the thing about concussions. people have known about this a long, long time. there was a guy, steve reed, he was my -- the team for northwestern, and he did this longitudinal study started in 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 i'm not sure that equipment can make a difference. >> may i present a statement? again, i've been sort of, i was trained to be an educator, i wasn't 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 you guys down here. mr. carson: the brain is inside the skull. the brain is inside the skull. the helmet doesn't protect the brain, it protects the skull. there's no way you can protect the brain when, you know, you're 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 i'm not mistaken, the skull is the boney area inside of the skull, correct? so you're going to have tears on the brain when off violent a violentu have collision. and oftentimes there are many times when, you know, it's not a big collision, it's just incidental contact, whether it's somebody's knee hits you in the head and you're not really prepared for it. so i've had helmet companies aproach me to be on their board and try to convince me that they're trying to make safer helmets. it really doesn't matter. because the helmet protects the skull, it doesn't 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 don't feel the pain and go out and play and the effect that that has on players as well? >> i can't comment on that. i played so long ago, it was a different era. there was a lot of drugs back in the 1970's and 1980's 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, he's more recent, he's the baby of the group here. he can share his thoughts. mr. levy: i think they've gotten better with it the last few years. my first few years in the league, i could get vicodin like skittles. any anti-inflammatory, pain killer to get you through the week. and as a player, i mean, it's on the doctor's hands to control it, i think, and monitor, especially when consider some of the psychological effects it may have, maybe him going in four times a day and getting two vicodin each time is not good. it goes back to education. it's a 16-week season, people are trying to make it through, doctor says it's all right, it's all right. mr. cohen: i think it killed him. you said skittles. trump said, if there's one poisoned skittle, you don't eat the package if your skittles had 10% than defective, you don't eat the skittles, but they don't want to think about that, but it's 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 we're 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 that's 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, it's 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 that's going to save people's brains? and the thing is that deceleration injuries are what's 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 nature's 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 it's the constant nature of these whiplash or acceleration-deceleration injuries. that's why football is dangerous. that's why there's this risk. and that's what really needs to be addressed if we want to make this a safe sport. i don't think the sport will be safe and still look like the game we play now. mr. mcnerney: it seems to me, the nfl is a tough nut to crack, but with children and parents we have an opportunity there. it might be a good idea to put together some sort of program to develop new rules for junior football and then maybe another set of rules if applicable for high school football. 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 don't do rules. however, echoing what dr. mechanickey said a helmet is not the answer. and there's been a lot of discussion, a lot of messaging, let's put research into it, let's build a better helmet. mr. stern tok to prevent concussions. and there's been all this messaging from the nfl down about concussions. that is what permeates our discussion all the time is concussion this, concussion that. it is so important that so much has been done to prevent concussions, to manage concussions presently. when we're talking about c.t.e. and these long-term complications, it's not the symptomatic concussions, it's not the big hits, it's not the spearing, it's 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 don't have these long-term problems. we have to focus on the subcon -- subconcussive, routine hits and not keep talking about concussion. >> i was just thinking, if we're not going to be able to change the nfl and can't make the players safe, and we've 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 it's being forced. to so how do we reach the parents? i've 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. ms. adamle: i know i spent my -- my doctoral studies were in working collaboratively with families and parents. how do we work with them? i don't think merely giving them facts, mr. cohen spoke to the culture and coming from the south. you're not going to change people's 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 that's 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 process to change that mindset. >> if i can give a quick answer. the simple answer is we need to stop hitting kids in the head. stop hitting them in the head on purpose. which is where somehow where we ended up with sports. so just to give the fast answer, all these sports that kids play were invented for adults. college athletes, around that age. we moved them down to kids to get them better, recruit them, create businesses, whatever it is, and we want them exercising. we didn't always change the rules to respect what it's 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, they're the only ones saying, it's still a good idea to hit this 5-year-old in the head 300 times. i think we can all be confident there's never a good reason to hit a child in the head 500 times. it's 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 head in the last month. guys are walking away from millions of dollars to not take this risk. we need to focus on the culture of we've got to stop hitting kids in the head in sports and change the rules of the sports. mr. mcnerney: it's 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. i'll pull another quote out that executive director pop warner said, if we convert to flag, which is what we promote. play flag, seven-on-seven we'd 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 it's a bad idea is scared to say we're 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. it's got to come from outside football. that's the answer. it's not -- nfl has proven they're 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 don't 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? what's your experience in terms of other players? >> i was diagnosed in 1990 with post-concussion 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 didn't 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. i've 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 team's huddle and you got a laugh out of it. and -- but you know, we all knew that, you know, you're going to get dinged just playing the game. so then there became players who would call me and they would say, harry, i'm having some problems. i know you've been very upfront about talking about this issue but let me tell you what i'm 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. i'm a diagnosed brain injury survivor because i knew what i was dealing with. i've been able to live with it. for all those other guys, they're undiagnosed. and they're just sort of wandering, you know, they've lost jobs, they're dealing with all these issues. and you know, mike and his family -- his wife, that's 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 it's well beyond what you see on the surface. as i said earlier, it's not just an nfl problem. there's so many individuals who never even got to the nfl who are dealing with these issues. and they're reaching out for help. mr. mcnerney: i'm going to yield back. mr. pallone: thank you. mr. cicilline. mr. cicilline: i want to begin by thanking both chairman conyers and chairman pallone for convening this forum. and thank the witnesses for being here and being courageous enough to share your stories, to engage in ground breaking, and your presence here today is already improving the situation by continuing to raise this issue. as i listened to the testimony of all this, i think the approach we're seeing to brain injury and concussions and subconcussive 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 doesn't reflect the same focus or understanding of injuries to the brain. i think we're 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, i'm listening, carefully, because i played pop warner, played high school football and got hit in the head a lot. didn't play in college but at the time these issues were not discussed by anybody. my parents are alive they love me, i'm sure they'd 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. carson's 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 can't be done safely? i guess that's my first question, i'd ask both the players and scientists and anyone else who wants to weigh in on that. >> if i could start, i don't think we know that there's a safe time. just because some of the research looks at age 12 or age 14 or age 11, there is not necessarily a safe time for the head to be hit and the brain to be moved around the way you described over and over and over again. mr. stern: it's 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 don't 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. there's no safe time, necessarily, start, or number of years to play. >> i think another way to look at that is there's 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 you're destinned to -- you're destined to fail. you can't 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 can't keep their head out of the collision. in terms of long-term 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.mchugh's brain bank. mr. cicilline: absolutely. >> or you can become a dictator, as i, and not allow your child to play. the life that i have lived in i have seen, i'm sort of what oprah. what i know i know pretty damn sure. note willing to take that risk with my eight-year-old grandson. i'm just not. if you put your kid out there, bad things can happen. i'm not willing to allow my eight-year-old grandson, who is so precious to me, to be injured in any way. if he scrapes is the or something like that, that's 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 can't pinpoint that. i've mentioned there are critical periods of development when we talk about impulsivity or attention. it's not just that the brain is being damaged at this point. it potentially would lead to what we are seeing with the older players. for the younger brain, the damage that they have, it will affect their ability to learn in school, to self regulate, manage their own behavior, their affective behavior regulation could be impaired. what that means is less ability to control themselves, and maybe getting in trouble with the law. making bad decisions, recklessness, not furthering their education. it has far more effects in society, especially for our young men. there is a huge crippling effect for the damage that could occur. >> my last question -- do you see the solicitor general's -- what is your general and russian if there is any change in culture within professional football? are coaches, staff more conscious of these issues? do you have a sense that they are hearing about the implications of this, even if they are reluctant to make big changes? >> no. >> none? >> in my experience, no. we have two-a-days, but we still have helmets -- the organization doesn't want to put the idea in players' heads that they can get degenerative disease. it's not talked about. in the locker room -- there's a little poster on the wall that has "concussion" written really big, but there's nothing about the long-term 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 didn't know about the research, about anything. it was just concussion, concussion, because that's 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 we've remained friends over the years, and when the last collective-bargaining agreement was agreed to, he sent me a text, and said harry, now you could still play, because in terms of practice, there is very little contact. so, the nfl has done a lot in making the game look safer, but there is no way to make the game safer. because football is what it is. it is a contact sport. people are flying around at great speeds, and they hit one another. so many players now are not even being concussed in practice, they are being concussed in games. i will give it to them, they are at least making the effort to try to make the game safer, but by nature of the game, you can't 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 we've learned so much, and we appreciate not only the experts, but all the players and their families who really give us insight into what's going on. we have this forum because we want to get to the bottom of certain things. i appreciate everything all of you said. i don't think we have any more questions, so please feel free, otherwise we will conclude the forum. does anyone want to air anything? >> i'm going to ask you as a congressman from new jersey to do what you can with your colleagues to institute a system for parents to understand exactly what their kids are doing, and what they are signing their kids up for. we call it informed consent. inform the parents, and if they want to consent to allow their kids to play, then god bless them. there are so many parents now who are not willing to assume that risk. they did not know the information out there now before. so, again, if you go to the surgeon general 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 my predecessor in congress, the real battle of a member of congress is trying to implement the right to know. i can hear the senator saying it right now. 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? >> it's so important we do focus on protecting our future players and doing what we can, but i want to raise to the committee's 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 pros. there are approximately 12 million americans who played high school football. a smaller fraction who played college football. and they are now in their late 50's, early 60's. they started to play at the beginning of the era of the big helmets, the facemasks, and the beginning of organized youth football. they didn't start until the late 50's, the helmets and facemasks. youth football didn't start until the late 60's or 70's. 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 50's, 60's, 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, in dr. mckee's research after they pass, we need to do 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, doctor. >> 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. it 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. we struggle to find those powerful voices within football asking players to fight this fight. and we need that if we want a shot >> i'm going to turn to you, chairman, to conclude. >> i want to thank everybody for everything that has been said. this has been an important day on the subject matter. it's going to spur a lot of us 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 i'm pretty proud of the members -- our colleagues up here, who did a great job in helping to put this thing together. don't you think? [applause] is there a possibility i could yield, just briefly, to sheila jackson lee? >> thank you. let me indicate, constituents are always around. responding to them, those who 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 chairmen and members. if somebody would give me -- i would like to leave with a pointed issue or issues, focused on 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 have them? i know, chris, 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 know 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. adamle, is there one sentence you want to share? >> what is striking to me, i didn't play football obviously, but being around it, being with mike for as long as we've been together, it's 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 don't share in that, don't 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 should get to the owners' wives rather than the owners. if it is understood what the families go through, it could benefit the cause. >> i feel a sense of urgency to act, and the two doctors that have -- dr. mckee, dr. stern, if there is any role for the united states congress to help not only these men but this ongoing farm -- production line, rather -- of young men? no matter how much you tell families not to play football -- is there a direct and efficient 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 it's because i'm naive, i don't understand why there isn't an occupational safety issue with the nfl. if this is such an occupational hazard, why are we allowing it? why don't they have to be more responsible for the negative outcomes? to me, their entire industry has 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 alzheimer's disease under the funding increase for alzheimer's disease. there are several other neurodegenerative diseases that are part of alzheimer's and other related disorders -- the more we can learn about this disease and help our understanding of the future treatment of alzheimer's, we need funding for cte, as if it is one of the siblings of alzheimer's disease, so we can get to answers as quickly as possible so the scientific findings can help lead to better decision-making. >> i am most grateful, and i hope -- will see a role for the judiciary committee as well. i see other elements we will review. >> thank you very much. >> it's not that we don't feel we have the role, it's that the republican majority doesn't necessarily see the role. we have to try to convince them. i did want to say, my staff reminded me that the players association had wanted to send somebody today. they have been supportive. i guess for timing purposes, they were unable to send anybody. it wasn't that they didn't want to. thank you all so much for being here today. we do intend to follow through, because we understand that. thank you so much. [applause] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2017] >> sunday evening on c-span, a discussion about health clear and equality. here is a preview. to medical school at johns hopkins. for those of you who may not know, johns hopkins medical school is located in east baltimore, which is probably one of the worst slums in america, if not north america. it was a shock to me, because i grew up in canada. canada has a deep level of investment in its people -- universal health care, childcare, paid sick leave, vacations, heavy investments in art and infrastructure. i grew up in montreal. when i got to east baltimore and saw the conditions, i was quite shocked. it triggered this thinking in my head that in the u.s., does where you live ultimately shape your health than any of your genetic factors? --ind of got interested in when i graduated medical school, i went through a whole bunch of studies and policy -- i got interested in how you illustrate these differences between neighborhoods, and the ultimate cumulative impacts on people's health. >> a discussion about health care, equality, and technology from the computer history museum in mountain view, california. 6:30 p.m. eastern on c-span. cam videos student documentary competition is underway. students across the country are busy at work, sharing their experience with us through twitter. ♪ late to enter. our deadline is january 18, 2018. we are asking students to choose a provision of the u.s. constitution, and create a video illustrating why it is important to you. our competition is open to all middle school and high school students grades 6 through 12. cash prizes will be awarded. the grand prize of $5,000 will go to the student or team with the best overall entry. for more information, go to our website studentcam.org. michelle obama talked about her life in the white house, and after her tenure as first lady at the annual pennsylvania conference for women. shonda rimes is the creator and executive producer of television shows "scandal" and " grey's anatomy>" she moderated the discussion. this is just over an hour. ♪

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