This time was supposed to be different, or so the NFL said.
For its first 16 years, the league’s Mild Traumatic Brain Injury Committee was a joke, headed by a rheumatologist with no education, experience, or expertise in brain research. (The rheumatologist in question—Dr. Elliot Pellman—was, though, then-commissioner Paul Taglibue’s personal physician.) Its members published a series of papers that downplayed and belittled concussions. So the MTBI was disbanded, replaced with the Head, Neck and Spine Committee, and stocked with scientists who had been critical of the NFL and its handling of concussions.
On paper, it sounded like change, maybe even the start of a new era. But as described in a report issued today by Democratic members of the House Committee on Energy and Commerce, the new committee members and other league doctors are working just as hard to protect football as the old ones. In this case, multiple scientists tied to the NFL and its influential HNS Committee actively tried not only to stop funding of a Boston University study, headed by a doctor who had been critical of the NFL in the past, but also to shift the National Institutes of Health money that would have funded it to themselves.
This issue has come up before. In February, ESPN reported on how “the NFL’s largesse is a secretive funding apparatus with its own set of rules, one that often rewards league doctors, punishes critics and, some researchers believe, steers research away from potentially uncomfortable truths about the relationship between football and brain disease.”
Today’s report from the Energy and Commerce Committee does not mince words, getting straight to this point in the executive summary: “The NFL’s Head, Neck and Spine Committee members played an inappropriate role in attempting to influence the outcome of the grant selection process.” And it goes on to detail just how the NFL uses its own doctors to influence concussion science in the way it likes.
First, there’s the continuing presence of Pellman, an infamous quack from whom the league has long tried to distance itself. Back in December, I reported that he was still around and overseeing one of the league’s most visible concussion programs, the ATC spotters. Today, Pellman is one of the first people cited in the report as trying to wrangle money away from BU. In June, he fired off this email to Dr. Maria Freire, president and executive director of the Foundation for the NIH, name-dropping one leader of the HNS Committee. (Emphasis added here and elsewhere is mine.)
I received some information that Walter [Koroshetz] and the NINDS is close to signing off on awarding Boston University the monies for the third and final stage of the NFL grant for the longitudinal study. There are many of us who have significant concerns re BU and their ability to be unbiased and collaborative. Betsy Nabel (now NFL Chief Medical Officer), Richard Ellenbogen, Russell Lonser and others are included in that concerned group…I’m hoping that you could communicate our concerns and slow down the process until we all have a chance to speak to figure this out.
Though not a member of the HNS committee, Dr. Elizabeth Nabel was hired by the league, saying she wanted to “improve the health of all players in the NFL and to make the game as safe as possible.” Here she is, lobbying against the study the NFL doesn’t want because she’s worried Dr. Robert Stern won’t be unbiased enough.
... “Dr. Stern, who may also be with this group, has filed independent testimony in the NFL/Players Association settlement. I hope this group is able to approach their research in an unbiased manner.”
In a separate email, she attached Dr. Stern’s affidavit in the 2014 class action case against the NFL. Dr. Nabel also questioned the peer review process that led to the selection of Dr. Stern’s grant proposal. Dr. Nabel expressed concern that members of the BU-led group and members of the review board had co-authored articles together. She wrote, “I am taking a neutral stance here, but I believe the concern is that members of the study section had published within the past two years with Dr. McKee or Dr. Cantu, who the grant applicant believes will receive the [Notice of Grant Award.]”
So a doctor who is inherently biased by her job with the NFL is worried about another scientist not being unbiased enough in his research involving the NFL? Got it. (One person later wrote back to Nabel, explaining the NIH’s conflict of interest rules and how what she had brought up did not violate them.)
Later on that month the groups involved decided to try and work out their differences, and a conference call was arranged. It included members of the HNS Committee: Dr. Richard Ellenbogen, Dr. Mitchel Berger, and Dr. Hunt Batjer.
On the call, the HNS members raised concerns about bias in NIH’s peer review process and Dr. Stern’s affidavit in favor of former NFL players. They also raised issue about balance related to money going to only one institution, given that funding under prior research grants had been divided across multiple institutions.
The HNS committee doctors thought more than one group of researchers should get the money. In case you were wondering why they might think that, the next paragraph supplies a possible motivation:
Although Dr. Ellenbogen participated as a representative of the NFL on this call, he had also been an applicant for the $16 million grant. His application, in conjunction with Dr. Kevin Guskiewicz at the University of North Carolina (UNC) and Dr. Mike McCrea at the Medical College of Wisconsin, had not been selected. Drs. Ellenbogen, Guskiewicz, and McCrea are all members of the NFL’s HNS Committee.
What a coincidence! Changing how the funding worked would not only take money aways from a scientist critical of the NFL, but also give more money to people who consult with the NFL. (In fact, the Ellenbogen-Guskiewicz-McCrea study had come in with the second-highest score, losing out to BU.)
Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, said that Ellenbogen continued trying to influence the process after that call:
According to Dr. Koroshetz, Dr. Ellenbogen called him again separately soon after the June 29, 2015, conference call to reiterate his opposition to awarding the grant to Dr. Stern. At that time, Dr. Ellenbogen told Dr. Koroshetz that he could not recommend that the NFL fund the BU study, because he believed that Dr. Stern had a conflict of interest and that the grant application process had been tainted by bias.
As for paying for two studies, not one, that idea failed after one doctor said that doing so would require “an additional funding commitment from the NFL.” The NFL didn’t want to do that, asking to wait until a September meeting to address the issue. At that meeting, the NIH rejected paying for two studies for several reasons, claiming that there was no conflict of interest with the BU researchers, that their process was appropriate, and that “none of the other grant proposals had adequate scores to justify funding an additional group of researchers.”
The NFL-backed scientists, though didn’t stop trying to get the money for themselves. Afterward, another member of the HNS committee, Dr. Russell Lonser, reached out to Dr. Leighton Chan at NIH’s Clinical Center with an idea for a program he thought was worth expanding with the NFL money—and it also included Ellenbogen, Guskiewicz, and McCrea. Chan ran the idea up the chain to NIH Director Dr. Francis Collins for his consideration. He rejected it.
The influence peddling of these scientists, especially the HNS members, did not go unnoticed by Congress. Today’s report spends an entire section near the end blasting the HNS committee members:
The NFL repeatedly emphasized the “independent” nature of the HNS Committee members, and suggested that the actions of those members did not reflect the official positions of the League. The uncertainty surrounding whether scientists were reaching out as representatives of the NFL or as independent researchers led to unnecessary confusion in the relationship between NIH, FNIH, and the NFL.
Despite their expertise as researchers and physicians, members of the HNS Committee cannot approach the NFL-FNIH-NIH partnership claiming to be impartial observers. They are under the same obligations as paid NFL staff when it comes to observing guidelines for donors to FNIH.
Dr. Ellenbogen is a primary example of the conflicts of interest between his role as a researcher and his role as an NFL advisor. He had been part of a group that applied for the $16 million grant. After his group was not selected, Dr. Ellenbogen became one of the NFL’s primary advocates in expressing concerns surrounding the process with the BU grant selection. He not only participated on a conference call with NIH and FNIH on behalf of the NFL; he also reached out to Dr. Koroshetz separately to share that he would be unable to recommend to the NFL owners that they fund the Boston University (BU) study. This series of events raises significant questions about Dr. Ellenbogen’s own bias. It is clear that he should not have been communicating directly with Dr. Koroshetz or any other NIH staff about the grant selection process.
Dr. Lonser’s role similarly raises concerns about the lack of clarity in the roles of HNS members as NFL advisors. Dr. Lonser initiated the conversations between the NFL and Dr. Chan at NIH’s Clinical Center to explore using the NFL funding in other ways. As with Dr. Ellenbogen, it was inappropriate for Dr. Lonser to be communicating directly with NIH staff in this manner. Attempts by the NFL HNS Committee advisors to influence how funding is allocated by NINDS are inappropriate, whether intramurally or extramurally, and in direct contravention of NIH policy prohibiting donor involvement in the grant decision-making process.
The NFL’s response to these concerns, per the report, is that the HNS committee is “very informal” and doesn’t need the NFL’s permission to lobby on its behalf.
According to Miller, the HNS Committee members had suggested to the NFL leadership that they raise concerns with the BU grant, and Miller stated that the NFL leadership completely defer to the HNS Committee members on what is appropriate. Miller acknowledged that there were multiple communications between NIH and HNS Committee members to which he was not a party.
It’s fitting that near the end, the report calls back to the disgraced MTBI committee, wondering out loud if anything beyond the name has changed.
The NFL’s interactions with NIH and approach to funding the BU study fit a longstanding pattern of attempts to influence the scientific understanding of the consequences of repeated head trauma. These efforts date back to the formation of the NFL’s now-discredited MTBI Committee, which attempted to control the scientific narrative around concussions in the 1990s.
In this instance, our investigation has shown that while the NFL had been publicly proclaiming its role as funder and accelerator of important research, it was privately attempting to influence that research. The NFL attempted to use its “unrestricted gift” as leverage to steer funding away from one of its critics. The League, its players, and the public have a vested interest in advancing our knowledge of the relationship between degenerative diseases and sports-related head trauma.
The NFL later issued a statement insisting that is is “deeply committed to continuing to accelerate scientific research and advancements in this critical area, and [...] ready to support additional independent research to that end.” But the actions of its own scientists suggest that only one end is considered appropriate for the NFL: NFL scientists reaching NFL-approved conclusions. All these years later, the names have changed, but the end result remains the same.