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Harvard University wants the NFL, the NFLPA, and everyone complicit in the NFL industrial complex—all the way down to media and fans—to take steps toward policies that will “protect and promote” the overall heath of football players.

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The university has released the findings of a two-year study called “The Football Players Health Study at Harvard University.” The study was funded by the NFLPA, though the report says the study was entirely free of NFLPA interference, and that the union was only allowed to review the report to make sure no confidential information was revealed.

The report—titled “Protecting and Promoting the Health of NFL Players: Legal and Ethical Analysis and Recommendations”— is a whopping 493 pages long, and was compiled by three researchers from the university’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics.

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The executive summary of the report lists its intents as such:

First, to identify the various stakeholders who influence, or could influence, the health of NFL players. Second, to describe the existing legal and ethical obligations of these stakeholders in both protecting and promoting player health. Third, to evaluate the sufficiency of these existing obligations, including enforcement and current practices. And fourth, to recommend changes grounded in that evaluation for each of the identified stakeholders.

The stakeholders identified by Harvard include anyone who has ever played, worked for, or even watched the NFL:

The study is thorough and well-intended, but anyone familiar with the realities of the NFL—from league to clubs to coaches to players—will recognize most of its recommendations as idealistic pipe dreams. The study lists its “Guiding Ethical Principles” as such:

Decent people recognize that yes, the NFL should not treat its players “as a commodity solely for promotion of its own goals,” but what has the NFL demonstrated if not exactly the treatment of most of its players as expendable? The players know that, and it inherently informs the decisions they make about the limits of their own health and safety. Every year there are dozens of players who lose their jobs to injury or age because the NFL doesn’t believe in guaranteed contracts. Very few players—think the perennially injured Rob Gronkowski—have the luxury of job security in the NFL. This fundamental truth in the NFL means that players are not fully capable of exercising their “empowered autonomy,” in Harvard parlance.

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The report will get attention for its call for the league to establish true independence for its medical providers. The report proposes each team carry two separate medical staffs: one with “exclusive loyalty to the player,” and another with “exclusive loyalty to the club.” The report recommends that the players’s medical staff be “appointed by a joint committee with representation from both the NFL and NFLPA,” and the club’s medical staff provide “evaluation of players for business purposes.”

The intent here is to eliminate conflicts of interest regarding player health:

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[I]t is evident that club doctors face an inherent structural conflict of interest. This is not a moral judgment about them as competent professionals or devoted individuals, but rather a simple fact of the current organizational structure of their position in which they simultaneously perform at least two roles that are not compatible. The intersection of club doctors’ dual obligations creates significant legal and ethical quandaries that can threaten player health. Most importantly, the current structure of NFL club medical staff— how they are selected, evaluated, and terminated, and to whom they report— creates an inherent structural conflict of interest in the treatment relationship and poses concerns related to player trust, no matter how upstanding or well-intentioned any given medical professional might be.

The NFL has already taken issue with this suggestion. The Washington Post got their hands on a lengthy letter that NFL spokesperson Jeff Miller—the one who accidentally admitted a link between CTE and football—sent to the study’s researchers. From the Post:

On Nov. 1, Jeffrey Miller, the NFL’s executive vice president of health and safety, sent the researchers a 33-page response in which he rejected any suggestion that NFL doctors have conflicts of interest and called the proposed change “untenable and impractical.” He said researchers have called for “several unrealistic recommendations that would not improve player care.”

The report “cites no evidence that a conflict of interest actually exists,” Miller wrote. “. . . The Report identified no incident in which team physicians were alleged to have ignored the health status of players, failed to adhere to patient confidentiality consent procedures, or made recommendations to clubs that were contrary to the health of players.”

Remarkably, the researchers were not expecting by this reaction:

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In interviews, the Harvard researchers say they were surprised by the league’s response.

“I had expected we’d maybe be quibbling around the margins of how it would actually be implemented,” said Holly Fernandez Lynch, the executive director of the Petrie-Flom Center and one of the report’s authors. “I did not expect that we would have to have this conversation about whether there is, in fact, a conflict because it’s so obvious on its face.”

“Admitting you have a problem is the first step to get over,” added Harvard law professor Glenn Cohen, another of the report’s authors, “and while we think many of the people who serve as club medical staff are wonderful doctors and excellent people — this is not to besmirch them or their reputation — it is not going to produce a good system if you’re operating under an inherent structural conflict of interest and one that is corrosive to player trust.”

Surprisingly, Harvard’s researchers seem to have no concerns about the league’s “Unaffiliated Neurotrauma Consultant” arrangement:

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The Unaffiliated Neurotrauma Consultants are crucial to the effective operation of the Concussion Protocol, a signature component of player health. There is no indication that neutral doctors have done anything other than perform the roles assigned to them by the CBA and Concussion Protocol. Consequently, we make no recommendations concerning neutral doctors. Indeed, the neutrality of these doctors is a positive benefit to players, and we should look for additional opportunities to have neutral doctor input and involvement.

Reasonable people would agree that the use of neutral doctors for concussion spotting is the ideal protocol, but anyone who witnessed how the program failed Cam Newton and Case Keenum would have a hard time claiming that there have been no missteps.

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One recommendation in the study that I did find truly useful and possibly effective was for the NFLPA to make amendments to its regulations for agents and financial advisors.

Proper financial advice and planning can help a player determine when to retire (if he has that choice), maximize a player’s career earnings, potentially provide the player with a comfortable retirement, help mitigate the consequences of the health issues suffered by many former players, and help avoid financial distress evolving into physical or mental distress.

Ensuring higher standards of financial advisement in an effort to mitigate some of the financial pressures that players feel might indeed leave them in a position to make career decisions that are informed by their health more than their wallets.

At the bottom of the pyramid of responsibility identified by the Harvard researchers sits you, the common fan.

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We recommend that fans recognize their ability to bring about change concerning player health. At the same time, increased fan interest and engagement through social media has also resulted in inappropriate behavior, such as cheering injuries or Tweeting racist remarks. Thus, we also recommend that fans recognize that the lives of NFL players are more than entertainment, and that NFL players are human beings who suffer injuries that may adversely affect their health. Fans should not advocate, cheer, encourage, or incite player injuries or pressure players to play while injured.

The report is published in full on Harvard’s website, though it is also offered in various breakdowns including its top 10 recommendations and the executive summary.