An op-ed piece in TheNew York Times today chastised the NFL medical professionals for acting as if the evidence that concussions and repeated blows to the head can cause long-term brain injury were new. The piece cites research published in the Journal of the American Medical Association in 1928 that came to that very conclusion, from a study of former boxers who had been rendered, as the saying goes, "punch drunk."
How is it, says Deborah Blum, the piece's author, that we are still discussing this problem as new and perhaps unproven, 80 years after the fact?
It's simple. As Upton Sinclair said, "It is difficult to get a man to understand something when his salary depends on his not understanding it."
The NFL, and football in general, has not developed its warrior culture of clashing helmets, hand-to-hand combat, and hard-hitting sacks and tackles in a vacuum. Or even against the wishes of not only its coaches and owners, but the people who come to the coliseum to watch the gladiators grapple. As the Super Bowl looms this weekend, the crowds that gather to watch will be hoping more for battle than ballet. Without the bloodshed, of course, and with some really poetic passes and fakes, speed in motion, brilliant strategy, and breathtaking feats of impossibility in the fray. But battle, nonetheless.
There is money and excitement in the combat, so seeing the medical evidence that the action is not entirely without bloodshed or casualties is a really inconvenient truth. But the culture of football is also so closely linked with its fierce contact element that changing its approach to that element is not a simple switch.
Can a sport's culture change? Given that football players already wear far more padding than they used to, the easy answer is "yes." At least to some degree. And sportscasters are now making an effort not to glorify getting "jacked up" or the sounds of clashing helmets. Nobody gets a sense that they like it; it's just that sportscasters and networks recognize the fact that, somehow, a tide has turned.
But the truth remains that changing any culture is a slow and difficult process--especially in sports where participants get a certain amount of pride in the fact that it's not entirely safe.
Take, for example, the sports of flying and SCUBA diving. Both activities started out as necessarily "macho" endeavors, because the technology for each was pretty rudimentary, and the environments in which they operated were naturally hostile. An article in California Medicine in 1970 (23 years after Jacques Cousteau and Emile Gagnan invented the first regulator and open-circuit breathing system) estimated that SCUBA diving was approximately 96 times more dangerous than driving a car.
I don't have the exact statistics on early flying fatalities, but they were staggeringly high. A fighter pilot's average life expectancy in World War I was something in the order of three weeks. And in Ernest Gann's classic book Fate is the Hunter, he devotes five full pages to a double-column list of early airline pilots who died on the job, just flying the line. And that was after engines and materials had progressed considerably from the days of the barnstormer.
But those early risks meant that those who took on those risks took a lot of pride in survival. The swaggering barnstormers knew they were defying death, as did the diving pioneers of Jacques Cousteau's early era. And so a kind of "macho" culture evolved; one where risk-taking was at least tacitly admired.
Today, the culture associated with SCUBA diving is markedly different. Those who dismiss safety or regulations are not held up as heroes, but as idiots, and there's a much greater focus on safety practices like having a dive buddy, decompression stops, and strict adherence to dive times and depths. Recreational SCUBA diving still has some risk (each year, somewhere around 100 people still die out millions of divers, worldwide), but its safety record, and its culture, have shifted dramatically toward the safety end of the scale.
How did the SCUBA industry improve its safety record so dramatically? Throughout the 1960s and 1970s, a greater emphasis on training and technique was certainly was a piece of it. But improved equipment also meant that the sport could start attracting less physically fit and risk-tolerant people into its midst. And the greater number of clients that allowed meant more money for SCUBA industry operators. So there was an incentive to skew toward safety. There may have been other factors at play, as well. But at some point, a critical mass developed to turn the tide, and the sport developed a culture and reputation as something relatively "safe," with safety as a high priority for its promoters and participants.
Aviation, on the other hand, has remained a tougher nut to crack. It still requires a lot of training and investment of money to become a pilot, and airplanes are far more expensive to buy, and far more complex to maintain, than SCUBA equipment. So despite all the manufacturers' efforts to market the idea of "an airplane in every garage," the pilot population, unlike the SCUBA population, has not grown significantly in the past three decades. As a result, the old guard who pride themselves on their bravery remain a larger percentage of the pilot population. And there is less internal pressure for the culture to change.
Given that football is not about to start attracting less physically fit individuals, and that the NFL is not about to become a recreational family sport, what is perhaps surprising is not that it's taken this long for the tide to start turning with regard to the injuries its players sustain, but that it's even beginning to turn now.
What caused the shift? The fact that football, unlike flying or diving, is a spectator sport. So even if we're not playing on the teams, we--the ticket-buying, bet-placing, television-watching public--influence its culture. And over the past year, enough evidence and stories emerged, with enough publicity, in enough places, that even if we wanted to believe otherwise, it became difficult to avoid the truth. Images of former hero athletes no longer able to conduct their daily lives, or even fill out a form without help, began to tweak our collective conscience. It's hard not to have the realization lodge, somewhere inside, that this heartbreaking damage occurred, at least in part, because of our own selfish desire for entertainment.
If we didn't have those twinges of guilt, the impassioned arguments of people like Gay Culverhouse, the former president of the Tampa Bay Buccaneers who's become a leading advocate for disabled players, would not have had such an impact. Indeed, the NFL's initial resistance to the growing swell of publicity and medical reports this past fall arguing a link between on-the-job head injuries and neurological problems later in life felt very much like an unfortunate delayed reaction on the part of its managers. The public got over its reluctance to see the evidence before the industry did.
Football is still a contact sport, and its appeal will remain rooted in its conflict. So it's unlikely to become domesticated anytime soon. But quarterbacks now routinely wear rib protection. Helmets are larger. Change has already begun creeping in around the edges, if only to protect each team's assets. And we, the spectators, have adjusted. Just as collegiate ice hockey players today can't imagine a world in which face guards didn't exist, we will soon get used to players going off the field and not coming back in the game--and a culture that doesn't glorify the crash of helmets quite so gleefully.
The old guard might complain that the sport is losing its edge. But what we gain is an ability to enjoy the game with a little less guilt. We may still cringe at some of the more spectacular take-downs on the field. But at least our consciences won't have to cringe, as well.
Angela Merkel has served formal notice that she will lead the German wandering away from the American alliance.
Seven years after the end of the Second World War, on the 10th of March 1952, the governments of the United States, the United Kingdom, France, and the newly established Federal Republic of Germany received an astounding note from the Soviet Union.
The Soviet Union offered to withdraw the troops that then occupied eastern Germany and to end its rule over the occupied zone. Germany would be reunited under a constitution that allowed the country freedom to choose its own social system. Germany would even be allowed to rebuild its military, and all Germans except those convicted of war crimes would regain their political rights. In return, the Allied troops in western Germany would also be withdrawn—and reunited Germany would be forbidden to join the new NATO alliance.
Should you drink more coffee? Should you take melatonin? Can you train yourself to need less sleep? A physician’s guide to sleep in a stressful age.
During residency, Iworked hospital shifts that could last 36 hours, without sleep, often without breaks of more than a few minutes. Even writing this now, it sounds to me like I’m bragging or laying claim to some fortitude of character. I can’t think of another type of self-injury that might be similarly lauded, except maybe binge drinking. Technically the shifts were 30 hours, the mandatory limit imposed by the Accreditation Council for Graduate Medical Education, but we stayed longer because people kept getting sick. Being a doctor is supposed to be about putting other people’s needs before your own. Our job was to power through.
The shifts usually felt shorter than they were, because they were so hectic. There was always a new patient in the emergency room who needed to be admitted, or a staff member on the eighth floor (which was full of late-stage terminally ill people) who needed me to fill out a death certificate. Sleep deprivation manifested as bouts of anger and despair mixed in with some euphoria, along with other sensations I’ve not had before or since. I remember once sitting with the family of a patient in critical condition, discussing an advance directive—the terms defining what the patient would want done were his heart to stop, which seemed likely to happen at any minute. Would he want to have chest compressions, electrical shocks, a breathing tube? In the middle of this, I had to look straight down at the chart in my lap, because I was laughing. This was the least funny scenario possible. I was experiencing a physical reaction unrelated to anything I knew to be happening in my mind. There is a type of seizure, called a gelastic seizure, during which the seizing person appears to be laughing—but I don’t think that was it. I think it was plain old delirium. It was mortifying, though no one seemed to notice.
What's the healthiest way to keep everyone caffeinated?
“I don't have one. They're kind of expensive to use,” John Sylvan told me frankly, of Keurig K-Cups, the single-serve brewing pods that have fundamentally changed the coffee experience in recent years. “Plus it’s not like drip coffee is tough to make.” Which would seem like a pretty banal sentiment, were Sylvan not the inventor of the K-Cup.
Almost one in three American homes now has a pod-based coffee machine, even though Sylvan never imagined they would be used outside of offices. Last year K-Cups accounted for most of Keurig Green Mountain’s $4.7 billion in revenue—more than five times what the company made five years prior. So even though he gets treated like a minor celebrity when he tells people he founded Keurig, Sylvan has some regrets about selling his share of the company in 1997 for $50,000. But that’s not what really upsets him.
She lived with us for 56 years. She raised me and my siblings without pay. I was 11, a typical American kid, before I realized who she was.
The ashes filled a black plastic box about the size of a toaster. It weighed three and a half pounds. I put it in a canvas tote bag and packed it in my suitcase this past July for the transpacific flight to Manila. From there I would travel by car to a rural village. When I arrived, I would hand over all that was left of the woman who had spent 56 years as a slave in my family’s household.
The condition has long been considered untreatable. Experts can spot it in a child as young as 3 or 4. But a new clinical approach offers hope.
This is a good day, Samantha tells me: 10 on a scale of 10. We’re sitting in a conference room at the San Marcos Treatment Center, just south of Austin, Texas, a space that has witnessed countless difficult conversations between troubled children, their worried parents, and clinical therapists. But today promises unalloyed joy. Samantha’s mother is visiting from Idaho, as she does every six weeks, which means lunch off campus and an excursion to Target. The girl needs supplies: new jeans, yoga pants, nail polish.
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At 11, Samantha is just over 5 feet tall and has wavy black hair and a steady gaze. She flashes a smile when I ask about her favorite subject (history), and grimaces when I ask about her least favorite (math). She seems poised and cheerful, a normal preteen. But when we steer into uncomfortable territory—the events that led her to this juvenile-treatment facility nearly 2,000 miles from her family—Samantha hesitates and looks down at her hands. “I wanted the whole world to myself,” she says. “So I made a whole entire book about how to hurt people.”
As Republicans in Congress try to fend off the flurry of scandals, they are haunted by a question: Is this as good as it’s going to get?
The speaker of the House strode to his lectern on a recent Thursday to confront another totally normal day on Capitol Hill: health care, tax reform, a president under investigation, rumblings of impeachment.
“Morning, everybody!” Paul Ryan chirped. “Busy week!”
It was indeed: Less than a day had passed since the appointment of a special prosecutor to investigate Russia’s involvement in the presidential campaign; just a few hours since President Trump angrily tweeted that the investigation was “the single greatest witch hunt of a politician in American history!”; and only minutes since the Russia-linked former national-security adviser, Michael Flynn, had begun defying congressional subpoenas. A few days prior, the president had been accused of revealing sensitive intelligence information to the Russian foreign minister.
The increasingly illiberal European country offers shelter to a growing number of international nationalists.
In February 2017, at the state of the nation address, Viktor Orbán, the prime minister of Hungary and the leader of the far-right, anti-immigrant Fidesz party, offered his vision for the country in the coming year. “We shall let in true refugees: Germans, Dutch, French, and Italians, terrified politicians and journalists who here in Hungary want to find the Europe they have lost in their homelands,” he proclaimed.
In reality, Orbán’s “refugees” have been moving to Hungary, and Budapest in particular, for years. A small clique of Identitarians, or aggrieved nationalists from Sweden, the United Kingdom, the United States, France, and elsewhere, all motivated by their disdain for their home countries’ commitment to liberal values, have found an ideological match in his Hungary, where two extreme far-right parties, the governing Fidesz and Jobbik, the largest opposition party, make up most of the National Assembly. Jobbik is the first European political party to champion a border wall. Its members frequently express open anti-Semitic and anti-Roma sentiments, and prioritize the preservation of “Hungary for the Hungarians.”
The permissiveness of Republican leaders who acquiesce to violence, collusion, and corruption is encouraging more of the same.
In the annals of the Trump era, May 25, 2017, will deserve a special mark. Four remarkable things happened on Thursday, each of which marks a way that this presidency is changing the nation.
The first remarkable thing was President Trump’s speech at the NATO summit in Brussels. Many European governments had hoped—which is a polite way to say that they had suggested and expected—that Trump would reaffirm the American commitment to defend NATO members if attacked. This is the point of the whole enterprise after all! Here’s how it was done by President Obama at the NATO summit after the Russian invasion of Crimea:
First and foremost, we have reaffirmed the central mission of the Alliance. Article 5 enshrines our solemn duty to each other—“an armed attack against one … shall be considered an attack against them all.” This is a binding, treaty obligation. It is non-negotiable. And here in Wales, we’ve left absolutely no doubt—we will defend every Ally.
Today in shoesplaining: Until your career is at its height, ladies, maybe you should stick to flats.
It went like this. At a reverse-demo event in New York last night, Jorge Cortell, the CEO of the healthcare startup Kanteron Systems, noticed a female attendee wearing shoes. He snapped a picture of the shoes. He then tweeted the picture of the shoes. This is what he said:
Sexist! the people cried. No, it's not! Cortell responded. His #brainsnotrequired musings were merely protective, he explained, of the health of the shoe-wearer. And, by extension, of the health of us all. Heels are dangerous. Heels are dumb. High-heeled shoes are not, as it were, "sensible shoes."
Colleges are adjusting to increasing contact with adults who are more ingrained in their children’s lives than ever.
Stacy G.’s daughter was having a meltdown. Her daughter, a sophomore at a prestigious private college, wanted an internship at Boston Children’s Hospital, a plum job that would look great on her applications to graduate school. After four weeks of frantically waiting for the school to arrange for an interview at the hospital, Stacy called her daughter’s adviser at the internships office to complain.
“For $65,000 [in full attendance costs], you can bet your sweet ass that I’m calling that school ... If your children aren’t getting what they’ve been promised, colleges are going to get that phone call from parents,” Stacy said. “It’s my money. It’s a lot of money. We did try to have her handle it on her own, but when it didn’t work out, I called them.”