Confronted with unhappy and increasingly unhealthy retired players, the NFL is embarking on a study of concussions - estimated to cost as much as $3 million - in search of evidence of chronic brain dysfunction.
Dr. Ira Casson, co-chairman of the league's research team on concussions, this week said he hopes to answer the ominous question "of whether or not a career in the NFL results in any kind of chronic brain injury."
To a number of retired players, including several former Colts, that answer is already in.
Merril Hoge was forced to retire from the Chicago Bears after suffering two concussions within the span of 42 days early in the 1994 season. He says he never had a follow-up evaluation after the first one and was back on the practice field five days later.
When Hoge, a running back, suffered a second concussion six weeks later, he says he stopped breathing in the locker room and nearly died.
"Because I was not re-evaluated, I was allowed to play early and I took another blow to the same frayed area [of the brain] that wasn't healed," said Hoge, an NFL analyst for ESPN. "Normally what happens, it's fatal. Second impact syndrome kills you. ... I got lucky. I [only] spent two days in intensive care."
Jim Cheyunski, a linebacker who played with the Colts in 1975 and 1976, remembers being out on his feet and still calling defensive signals.
"It's unfortunate, but we don't get backed up for all the blood and guts we put out for them," Cheyunski said. His nine-year career left him with an artificial knee, a fused back and depression.
Joe Perry, a Hall of Fame running back who played for the Colts in 1961 and 1962, suffers from pugilistic dementia. At 80, his memory lapses have been increasing at an alarming rate. Perry, who began to play during the leather helmet era, has no doubt the head trauma he endured during a 14-year NFL career is responsible for his impairment.
"When you get cracked on the head and keep getting cracked on the head, you lose your memory and everything else," Perry said. "Whether it comes back to you, it still takes a toll on you."
Casson, a neurologist at Yeshiva University's Albert Einstein School of Medicine, said the concussion committee already has done preliminary work on the study of retired players.
The committee will physically examine and neurologically test several hundred retired players and compare those results with a control (non-football) group over a period of years.
"We'll try to see if people who have suffered multiple concussions appear to have significant effect on brain function," said Dr. Andrew Tucker, a member of the committee and team physician for the Ravens.
Casson said his committee also will try to determine whether mouth guards make a difference in mild traumatic brain injuries by testing crash-test dummies similar to those used in the auto industry. "There are claims about a lot of mouth guards that at the moment are unproven," he said.
Casson and Dr. David Viano of Wayne State University became co-chairs when Dr. Elliot Pellman stepped down as chairman last week after 13 years. Pellman, who remains on the committee, had been criticized heavily in recent months over his qualifications and methods in directing it. His colleagues have been quick to defend him.
"We don't plan to change anything in the committee," Casson said. "We are planning to continue the work that he started. If we can do half the job he did, we'll be doing well."
The NFL's policy on concussions has come under scrutiny with the suicide of former safety Andre Waters and the revelation by former New England Patriots linebacker Ted Johnson that he is addicted to amphetamines and suffers from depression and mental lapses. Before this year's Super Bowl, Johnson told The New York Times, The Boston Globe and ESPN that he believes his symptoms are related to repeated concussions in the NFL.
Those cases follow the well-documented deaths of former Pittsburgh Steelers linemen Terry Long and Mike Webster. Both suffered from mental impairment that was linked to brain trauma from their playing careers. Long committed suicide two years ago, and Webster died of heart failure in 2002.
Hoge played with the Steelers from 1987 through 1993 and was a teammate of Long's and Webster's.
"I don't think there's any question that what they sustained, what they dealt with as far as their career, had an effect on that," Hoge said. "To what degree, I don't know for sure. But I would say it was significant."
Pellman's group has reported there is "no evidence of worsening injury or chronic cumulative effects of multiple [concussions] in NFL players."
In 2005, the committee also wrote that players returning to play after a concussion don't incur "significant risk of a second injury either in the same game or during the season."
Both assessments have been sharply criticized by experts in the brain injury field.
N. Carolina research
The University of North Carolina's Center for the Study of Retired Athletes reported in 2005 that retired NFL players "faced a 37 percent higher risk of Alzheimer's than other U.S. males of the same age" after a survey of 2,552 players.
In 2003, a study by the Center said 91.7 percent of repeat concussions in NCAA football players occurred within 10 days of the first injury, and 75 percent came within seven days.
The NFL has criticized the UNC studies because they were culled from surveys, not scientific data. Dr. Kevin Guskiewicz, the research director for the Center, counters by saying UNC has invited in more than 65 players for exams and neurological tests and now has data on more than 150 players.
"Those with three or more concussions were at five-fold risk of being diagnosed with mild cognitive impairment after age 50, compared to someone with no prior concussions," he said.
As the father of three boys who play football, Guskiewicz said his motivation is safety.
"I try to be careful not to paint this ugly, ugly picture," he said. "Clearly, there are [retired players] who are doing just fine. Some say we're trying to paint this ugly picture. That's ridiculous. I've been doing this for 15 years. My goal is to help improve the game to make it a more safe game, regardless of what level it is."
Casson and Tucker say their studies are applicable only for NFL players. Though the study of college players shows a high recurrence of concussion when players return within a week, the NFL's numbers suggest players can - and do - return more quickly without incident. One of the NFL studies said 51.7 percent of players who suffered some form of concussion returned to the same game.
"That's a much higher percentage than you'd see in high school or college," Tucker said. "But we know older brains seem to recover from concussions more quickly than young brains. Our data shows that the risk of recurrent concussion in the postconcussion period was extraordinarily low. The length of time between the first and second concussion [averaged] over one year."
Casson suggested the NFL player has been conditioned to the violence of the game by the time he reaches the NFL and is better able to withstand the punishment. He pointed to age, better physical conditioning and the weeding-out process as reasons NFL players are less prone to concussion than high school and college athletes.
Tucker acknowledged there is no single accepted guideline that all NFL teams follow in treating concussions.
"However, NFL team physicians have been educated through our efforts, and I imagine you'll find they're going to abide by the recommendations and general guidelines all sports providers abide by," Tucker said. "That is, you wait until symptoms resolve before a player returns to play.
"We're the beneficiary of an elite-level athlete who seems to recover quicker."