football player being tackled

The repetitive head trauma that is common in professional football is a risk factor for the degenerative brain disease called chronic traumatic encephalopathy.

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Q&A: NFL medical adviser discusses league’s plans for new neuroscience research

Last year, in a move to counter charges that it has neglected the health and safety of its players, the National Football League (NFL) tapped Elizabeth “Betsy” Nabel as its first chief health and medical adviser, a paid position to which she told The Boston Globe she devotes about 1 day a month, plus some nights and weekends. (She and NFL have not disclosed her salary.) And last week, Nabel answered Science’s questions on the heels of NFL’s 14 September announcement that it will devote $40 million in new funding to medical research, primarily neuroscience relevant to repetitive head injuries—with grant applications judged by an NFL-convened panel of scientists, rather than by National Institutes of Health (NIH) study sections.

Nabel is well known to many medical scientists as the cardiologist who directed the National Heart, Lung, and Blood Institute at NIH, then left that job in 2009 to become president of a prestigious Harvard University–affiliated teaching hospital: Brigham and Women’s Hospital in Boston. Nabel’s new role with NFL came under media scrutiny in May, when a report by Democrats on the House of Representatives Energy and Commerce Committee found that NFL inappropriately tried to influence the way an earlier, “unrestricted” donation from the league to NIH was spent. It revealed, for example, that last year Nabel expressed concerns to NIH’s neurology institute director Walter Koroshetz about the objectivity of an NIH study section and of a principal investigator whose team the peer reviewers had just awarded a $16 million grant. Robert Stern and his group at Boston University, with others, were proposing to image the brains and chart the symptoms of scores of college and professional football players across time. NFL suggested that the scientists, who have led in establishing the link between repetitive head injury and the neurodegenerative brain disease chronic traumatic encephalopathy (CTE), were not objective. The scientists were to have been paid from $30 million that NFL donated to NIH in 2012. After the league objected to its $16 million going to fund the Boston University–led team—it did offer to fund $2 million of the amount—NIH’s neurology institute ended up wholly funding the 7-year grant with its own money.

Last week, four leading Republican members of the House Energy and Commerce Committee requested a review of whether NFL indeed acted inappropriately, by the inspector general of the Department of Health and Human Services, NIH’s parent agency; the Republicans in their request suggested that it was rather NIH’s actions in dealing with NFL that should be scrutinized. This Republican-sought report is the review “requested by Chairman [Fred] Upton” (R–MI) that Nabel refers to below. Her answers have been edited for brevity.

Q: How did you end up in the NFL job?

A: The NFL has an unmatched platform to advance progress in the prevention and treatment of head injuries, among many other health issues—not just in professional football, but for athletes of all ages and across all sports. The advancement of science and research in this field is of critical importance—and we must all work together to understand what it is telling us in order to adapt accordingly. The commissioner [Roger Goodell] asked me to advise the league to accelerate and strengthen these efforts.

Q: What do you feel has been scientifically established at this point about the connection between football and CTE?

A: There is an understanding that a connection exists between repetitive head injuries and long-term effects on the brain, such as CTE. However, there are many unanswered scientific questions related to causation, pathophysiology, diagnosis, and treatment, which must be addressed. This is why the NFL has been working to accelerate independent research, so that its efforts to protect players in all sports, at all levels, can be more and more effective over time.

Q: What is NFL’s goal with this new research money, why is it disbursing it now, and how should independent neuroscientists go about applying for it?

A: In order to disburse that funding in a transparent and peer-reviewed manner, the NFL’s Head, Neck and Spine (HNS) Committee will work with a new, independent Scientific Advisory Board (SAB). The SAB will comprise leading physicians, scientists, and other experts to identify the most compelling proposals for research into concussions, head injuries, and the long-term effects. The members of the new, independent SAB will be announced by the end of September. We anticipate it will consist of five to seven individuals with expertise in traumatic brain injury, as well as medical areas relevant to the players’ health and safety. The SAB will work with members of the medical committees, including the HNS Committee, to establish research priorities and to develop request for funding proposals.

Q: What criteria will applications for the new $40 million in funding be judged on, by NFL’s SAB?

A: The criteria will be established by the SAB.

Q: NIH already has a robust peer-review mechanism in place that has a long track record of success. Why did NFL not simply channel the new $40 million to NIH, as the league did with its initial $30 million investment in sports injury–related research in 2012?

A: We continue to work closely with NIH to advance scientific understanding of concussion and head injury in athletes, members of the military, and the general population.

Q: The NIH question arises because a report compiled by House Democrats released in May charged that NFL inappropriately opposed, through an earlier gift to NIH, a longitudinal study led by researchers at Boston University that had been approved by NIH peer reviewers. Why did NFL oppose funding it?

A: The NFL has never wavered in its commitment to advance the science and understanding of concussions and traumatic brain injuries. As I’m sure you saw, Chairman Upton has requested a thorough and objective review of the NIH by the Office of Inspector General, for the U.S. Department of Health and Human Services. The committee’s letter provides background material showing the NFL's Head, Neck and Spine Committee acted appropriately throughout the process.

Q: The congressional report also noted that you personally opposed the NIH study section’s decision to fund the study. Can you more fully explain why you did?

A: Again, I would refer you to Chairman Upton’s letter, which demonstrates that I did not interfere with or oppose NIH’s review or funding decisions. As a prior NIH institute director, I respect the integrity of the NIH peer-review process.

*Correction, 21 September, 10:29 a.m.: An earlier version of this article stated incorrectly that Nabel had, in an email, labeled a Boston University research team led by Robert Stern as “a more marginal group.”  Nabel’s email was suggesting a collaboration between Stern’s team and two other groups whose grant applications for a funding program had not scored as well. “Dr. Nabel has not and would not refer to Dr. Stern, his colleagues or their work as 'marginal,'" a spokesperson for Nabel tells Science.