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The first time anyone started to wonder if it was safe for Tua Tagovailoa to keep playing football was early in the 2022 NFL season. Tagovailoa is the starting quarterback of the Miami Dolphins and one of the league’s promising young stars. During a game against the Buffalo Bills, an onrushing linebacker shoved Tagovailoa in the chest just after he threw the ball downfield. The push was a gentle one, by NFL standards, but Tagovailoa was backpedaling and fell to the ground with enough force that his head snapped back and hit the turf. The referee threw a penalty flag: 15 yards for roughing, one of various rules meant to tame a violent game. Tagovailoa hopped to his feet and tried to jog upfield. He couldn’t. After a few steps, his body fell slack, as if he were Woody from Toy Story and a human had just entered the room. The outward signs suggested that Tagovailoa had a concussion and should be kept out of the game. Instead, he returned for the second half. The Dolphins said he had a back injury.
Just four days later, Tagovailoa was on the field again, playing one of the Thursday-night games the NFL has added to its weekly schedule in a bid for entertainment hegemony, despite concern that the condensed schedule increases the chance of injuries. In the second quarter, Tagovailoa was scrambling to escape a 350-pound defensive lineman who finally managed to grab him around the waist and slam him to the ground. This play was clean, as far as NFL rules go, but the national television cameras zoomed in and found Tagovailoa motionless on his back. His hands were frozen just inches from his face with each finger jutting in a different direction. Medical staffers raced on to the field. They eventually strapped Tagovailoa to a stretcher and rolled him away. There was no denying the concussion this time.
By this point, the danger of brain injuries in football had been widely known for more than a decade. Beginning in the 2000s, a stream of retired NFL players suffering from dementia, depression, and other brain ailments had been diagnosed with chronic traumatic encephalopathy, or CTE, a disease that results from repeated blows to the head. There were calls for systemic reforms to the game, concerns about whether children should be allowed to play — then-President Obama said that if he had a son, he wasn’t sure he would let him — and questions about whether there was a future at all for a sport whose competitors were risking debilitating long-term health effects.
But by the time Tagovailoa went down in 2022, football had never been more popular. Tagovailoa missed just two games — his backup had to be replaced with another backup after suffering a concussion of his own — and he returned to lead the Dolphins until a game against the Green Bay Packers, when a linebacker dragged Tagovailoa down from behind and his head hit the ground again. This concussion ended his season — although not before he finished the game — and he considered retirement at just 24 years old. Instead, he spent the offseason training in jiujitsu with the idea that the martial art could help his neck learn to protect itself the next time a 350-pound man drove him into the ground. Tagovailoa played all of last season without a concussion, but that streak ended in the second week of this season, when he raced toward the first-down line with a defender closing in and did what football players have done for a century: lowered his head and used it as a battering ram. You can guess what happened next.
Tagovailoa’s third NFL concussion — or was it his fourth? And should we count the one he suffered in college? — provoked more pointed questions, but pretty much all of them were directed at him: “Isn’t it time to retire? Don’t you need to think of your wife and kids?” No one was asking what the NFL needed to do, or whether football had a future. “Those who said all this awareness would kill football were wrong,” Chris Nowinski, who has been a leading advocate on the issue of brain injuries in sports for nearly two decades, told me recently. “Football continues to be more popular in just about every measurable way.”
It’s not because the problem has disappeared. A third of the way through this NFL season, dozens of players, on almost every team and at pretty much every position, have been concussed: With Tagovailoa at quarterback, you could almost field a playoff contender from the roster of concussed players alone. Lane Johnson, one of the league’s best offensive linemen, was spotted vomiting on the sideline after hitting his head. Malik Nabers, the New York Giants star rookie wide receiver, admitted that he couldn’t even remember the play that knocked him out last month. And these concussions represent just a sliver of the billion or so times this season that football players from elementary school to the pros will bang their heads in collisions big and small, many of which doctors say are just as likely to cause long-term brain damage as they accumulate.
This week, Tagovailoa returned from “injured reserve” — a designation for players too hurt to come back on the field for at least a month — and gave a defiant press conference. He said he had not considered retirement this time, and the Dolphins hope he’ll be available to play against the Arizona Cardinals this Sunday. “I love this game,” Tagovailoa said. “And I love it to the death of me.” It wasn’t clear if Tagovailoa had considered the haunting implication of his comment, but the press conference summed up America’s decade-long transition from crisis to acceptance. We had plenty of questions for Tagovailoa. Why did we stop having questions about football itself?
Football has always been hazardous. The New York World published an editorial cartoon in the 1890s in which “Death” is listed as “The Twelfth Player in Every Football Game.” What’s changed is how much we understand about that danger and what we’re willing to do about it. In 1905, after 18 people died playing football, Theodore Roosevelt dedicated part of his presidency to reforming the game. The forward pass was legalized, which decreased the amount of time players spent ramming their heads into one another, and various tweaks were made over the next century to ensure the game remained palatable to both the people who played and those who watched it.
The NFL began looking at concussions and brain injuries in football in the 1990s, though not with great seriousness. The doctor put in charge of the effort was a rheumatologist, and a survey in 2004 found that many NFL players at the time knew basically nothing about what football might be doing to their brains. Around this time, Nowinski, a college football player at Harvard who went on to become a professional wrestler, started talking to doctors after he suffered a kick to the chin in a wrestling match that led to a concussion. Concussions weren’t temporary, he learned; they could produce CTE and leave lasting brain damage. The thousand or so smaller blows to the head that football players suffer every season, in games and in practice, can have just as much of an effect. CTE had primarily been associated with boxers, but researchers were starting to find the disease in retired football players.
In 2006, Nowinski, who now runs a nonprofit called the Concussion Legacy Foundation, persuaded the family of Andre Waters, a former Philadelphia Eagle who killed himself at the age of 44, ten years after retiring from the NFL, to let researchers look at his brain. His brain tissue looked like that of an 85-year-old with Alzheimer’s. Nowinski relayed the story of Waters’s brain to Alan Schwarz, a sportswriter who was freelancing for the New York Times, primarily about baseball. Schwarz wrote a front-page story in the Times about Waters, and the paper eventually hired him full-time. Schwarz went on to write more than a hundred articles on the subject for the paper. “What the New York Times and I did is that we proved that, in general, if you play in the NFL, you are at vastly greater risk of later-life cognitive decline,” Schwarz said.
The NFL’s early response was largely to deny the seriousness of the issue, but it eventually became impossible to ignore. A 2009 study of a thousand retired NFL players found that those between the ages of 30 and 49 had received a diagnosis of dementia, Alzheimer’s, or another memory-related disease at a rate 19 times higher than the national average for that age group. A grim parade of former players killed themselves: Dave Duerson, Ray Easterling, Junior Seau, and Jovan Belcher, a 25-year old linebacker for the Kansas City Chiefs, who killed his girlfriend before driving to the team’s practice facility and killing himself in front of the team’s head coach and general manager. When doctors looked at each of their brains, they found CTE. “People should have damn well known it was an issue by 2011 or 2012,” Schwarz told me. “There are rookies in the NFL right now who were 10 years old when this information was out there. It would be remarkable if they didn’t know what the potential effects of football-related head trauma are.”
As the evidence mounted, an idea started to take hold: Football was doomed. The game would go the way of boxing or horse racing — sports that were once at the center of society only to be sidelined in part because they were deemed immoral. In 2009, Malcolm Gladwell wrote a piece for The New Yorker comparing football to dogfighting after NFL star Michael Vick was suspended indefinitely for his involvement in a dogfighting ring. It required a Gladwellian leap to compare dogs forced to attack each other to NFL players paid handsomely for taking such a risk, but Gladwell argued that if NFL commissioner Roger Goodell spent as much time thinking about the ethics of sending football players out to hit one another in the head as he had about Vick’s dogs, “he’d start to have similar doubts about his own sport.”
The concussion conversation was suddenly everywhere, from PBS to ESPN. In 2012, Gladwell appeared in a public debate at NYU alongside Buzz Bissinger, the author of Friday Night Lights, during which they both argued that college football should be banned. “Schools should not be in the business of encouraging young men to hit themselves over the head,” Gladwell said, adding that there was “no way to remove those hits without turning tackle football into touch football.” He believed that fans themselves might start asking whether it was ethical to watch the game. (A week earlier, the writer Ta-Nehisi Coates, who had written often about his love of football, said that he had had enough, and would stop watching the NFL following Junior Seau’s suicide.) Gladwell and Bissinger’s opponents in the debate were Jason Whitlock, a sportswriter who has since become a right-wing commentator, and Tim Green, a former NFL player. They argued that the medical evidence was still inconclusive but largely conceded that football was dangerous and based their defense instead on American principles. “If you believe in freedom, you can’t have the ‘free’ without the ‘dumb,’” Whitlock said. He put football in the category of vices we tolerate because we enjoy them, alongside cigarettes, alcohol, and porn. By the end of the talk, Gladwell and Bissinger had support from more than half of the crowd.
But could football, and the NFL juggernaut, really disappear? That year, economists Tyler Cowen and Kevin Grier wrote a piece for ESPN’s Grantland in which they argued it was “not pure fantasy to suggest that it may be done for good in the not-too-distant future” and laid out a chain of events that could lead to its demise. Parents would stop letting their kids play the sport; high schools and colleges would stop fielding teams; the talent in the NFL would dry up; advertisers would no longer want to be associated with brain injuries; and the specter of liability would make the whole thing untenable. Cowen and Grier said the end might come quicker than anyone thought: “This slow death march could easily take 10 to 15 years.”
A few symptoms of football’s supposed death did start to appear. Youth participation decreased — Michael Wilbon, one of ESPN’s biggest names, said he would not let his son play the game — and a handful of NFL players cited brain injuries in retiring early. For a while, television ratings were down. The NFL settled a class-action suit in which it agreed to compensate former players who suffered from brain injuries. (The league has since paid out more than $1 billion in claims to more than 1,600 former players and their families.) Will Smith starred in a Christmas Day movie as one of the doctors who helped discover the link between football and CTE.
And more and more retired NFL players were suffering from brain diseases. Tim Green, the retired NFL player who defended college football against Gladwell and Bissinger, had played the game since grade school and spent eight seasons as a defensive end for the Atlanta Falcons. During the debate, he admitted that football was a dangerous game but insisted that more evidence of the risks of CTE was needed before drastic action should be taken. “Show me the studies,” Green said onstage. “Show me proof.” Four years later, in 2016, Green was diagnosed with ALS, which he acknowledges most likely came from football. He can longer talk and uses a device to translate words that he types out into a facsimile of his voice.
Nevertheless, football did not die. In 2012, when Cowen and Grier made their prediction, the NFL’s annual revenue was around $10 billion. It now brings in more than $20 billion. The top 30 prime-time television broadcasts last year were all NFL games, except for the Oscars and a reality show that Fox aired immediately after the Super Bowl. “People who predict football’s demise, or significant reformation, misunderstand that football is almost in perpetual motion,” Schwarz said. “Football is not in the business of making itself obsolete. Football is going to adjust to the degree it needs to adjust in order to maintain a pipeline of two things: players and fans.”
The NFL began to institute reforms. New on-field rules were put in place: Defenders were prohibited from lowering their heads to tackle an opponent with their helmet or from hitting “defenseless” players in the head or neck. Contact was limited during practice, and the league instituted a “concussion protocol” every concussed player must follow before returning to the field. There were now “spotters” at every game, whose sole job is to survey the field for players who might be injured, and independent neurological consultants to offer a medical diagnosis that would theoretically be uninfluenced by a team’s desire to get its players back on the field. Concussions were still happening every Sunday, but the league appeared to be trying to alleviate the problem and it became easier for fans to watch with a cleaner conscience.
The media also stopped covering the subject with the same urgency. “You know enough about the press to know that one reporter comes along and is able to gain traction with something, it gets exposed and then everybody moves on,” Schwarz said. Investigative journalism in the sports world has shrunk — the sports department Schwarz worked for at the Times no longer exists — and the NFL was now in business with practically every major media company. Even Schwarz admitted that it became hard to find fresh ways to write about the issue. “It got tedious — ‘Oh my God, another dead player had CTE,’” he said. “It got to be sort of, ‘Duh.’”
When we spoke, Schwarz said he could think of only one thing that might produce an actual recalibration of how Americans think about football’s risks. “Everything would be different if an NFL player died on the field due to head trauma,” Schwarz said. “If Tua were to seize up and somehow not recover, then that would change the entire conversation.” (A dark irony of Tagovailoa’s latest concussion is that the hit was delivered by Bills safety Damar Hamlin, who went into cardiac arrest after a hit on the field during Monday Night Football last year.) Chris Nowinski wasn’t sure it would. “I love Alan, but a player can die on the field from a brain injury and it’s not gonna change anything,” he said. “People will say, ‘It’s only happened once in the history of the NFL.’ They’ll compartmentalize.” In September, a few weeks after Tagovailoa’s concussion, Brett Favre, who is now 55 and one of the most famous players in NFL history, announced that he had been diagnosed with Parkinson’s, which he believes is the result of playing football. Favre’s revelation was in the news for a day.
Another answer to the question about why football’s concussion crisis did not bring down the sport is a more discomfiting one: Americans may not have cared so much about brain injuries in the first place. Morality was one reason boxing and horse racing became less popular, but another was the fact that other sports simply became much more enjoyable to watch. Football is the perfect game for the streaming era, offering a couch-bound viewing experience that’s better than being in a stadium, even if high-definition TVs have made it clearer just how brutal the game can be. (I don’t mean to cast stones: I recoil anytime I see a big hit in a football game, but I also now watch more football than I ever have before.) The media love to declare a crisis, but concussions would not be the first or last time that articles in the Times and The New Yorker or debates at NYU were unrepresentative of the country’s level of concern about a particular issue. When I reached out to Tyler Cowen, he said that his prognostication of football’s death had been off in part because he misread people’s concern for their health and the health of others. “COVID changed my mind on this,” he told me in an email. “A lot of people simply will do foolish stuff, such as not vaccinating, even when their lives may be on the line.”
There is no question that a macho ethos permeates football, which has drawn the sport into broader American culture wars. “Football has become soft like our country has become soft,” Donald Trump said during his 2016 campaign for president. In 2018, the head football coach at the University of North Carolina said that he feared the game was becoming unrecognizable and that “if it does, our country will go down, too.” Andrew Sendejo, then a defensive back with the Minnesota Vikings, started wearing a hat that read: “Make Football Violent Again.” (Sendejo retired in 2021 after suffering two concussions in a single season — the third and fourth of his career — and then went on to found a company that sells supplements “to maximize brain health.”)
Predictions that youth football would collapse as parents kept their children off the field have also not come to pass. Youth football participation steadily decreased for more than a decade after news about CTE started to break, but it is on the rise again. Roughly a million boys still play high-school football — twice the number that play either basketball or soccer — and it remains possible in much of the country to sign up your 5-year old to be a linebacker. Most surveys of parents find that they understand there are risks but that they also don’t want to keep their kids from playing. The enduring appeal of youth tackle football is often chalked up to the promise of a college scholarship, but for many parents and kids, football is simply the best of a limited number of options. Earlier this year, when student reporters at the University of Maryland visited the small town of Lexington, Mississippi, which is in the state’s second-poorest county, one parent pointed out the football team remains popular in part because the entire county has no swimming pools, no soccer fields, no tennis courts, and no YMCAs. (Youth-football participation has gone down more dramatically in wealthier communities.) Tackle football’s continued popularity among young people was, in this sense, a sign of a bigger failure. Last year, researchers found an advanced form of CTE in an 18-year-old high-school football player who killed himself. By early September of this season, three boys had died from brain injuries they suffered while playing high-school football.
Fans, it seems, have chosen to believe the NFL has largely done what it can. “They addressed the majority of the ethical issues — the stuff that made them look bad — and now suddenly the story is ‘It’s just sad,’” Nowinski said. “What people are missing is that football has gotten more ethical, but it’s not necessarily safer.” The point was that, because the NFL was no longer denying the problem, and every NFL player should now know the risk they are taking with their brains, a large part of the ethical burden on the league and its fans has been lifted. At the same time, while the number of reported concussions in the NFL has trended down over the past decade, they haven’t gone away: In fact, the number has increased in each of the past three seasons, and last year’s total of 219 is roughly equivalent to the total from 2018. (The total also doesn’t include the blows to the head that go unnoticed.) Because doctors can only diagnose CTE postmortem, after cutting into someone’s brain, we still have no way of knowing for sure whether CTE is developing in Tagovailoa’s brain or anyone else’s. But researchers have now examined hundreds of brains of former players and found that the portion who had CTE has remained consistent at around 90 percent.
Even so, Nowinski didn’t want to tell Tagovailoa what to do. “The reality is that the NFL doesn’t have to be safe,” Nowinski said. “If the players aren’t being lied to, they can choose to have a dangerous job.” The NFL’s chief medical officer, Allen Sills, said that the league would not get involved in Tagovailoa’s decision, citing “patient autonomy and medical decision-making really matters.” Football had entered its era of personal responsibility, and I started to see its forgotten concussion crisis in the same light as other emergencies, like COVID or climate change. There was, of course, a swath of people who denied the issue was a problem at all, but even among those who acknowledged its seriousness, there was often little appetite for more collective action. Wear a mask if you want. Bring a bag to the grocery store. Your brain, your choice.
When I spoke this week to Sills, who is also a neurosurgeon at Vanderbilt University, he highlighted the cultural changes in football and other sports in recent decades. In the bad old days, players often tried to play through the pain of a concussion, risking further damage to their brains. Now, he said, the league has data showing that nearly half of the time a player is evaluated for a concussion, the athlete has reported the potential injury himself. In other words, players know that continuing to bash their brain is bad. When I asked Sills what additional changes the league might make, he didn’t get into specifics but said there was no “finish line when it comes to health and safety” and that the NFL’s goal is “to reduce avoidable head contact as much as we can.” The word avoidable, by Sills’s own admission, is doing a lot of work. After all, there is no way to completely take the tackling out of tackle football.
Then again, even the people most affected by those hits — the ones reporting their concussions — don’t seem to want to take the violence completely out of football. On Wednesday, the same day Tagovailoa returned to the Dolphins practice field, Grayson McCall, the 23-year-old starting quarterback for North Carolina State University’s football team, announced that he was retiring from football in the middle of the season. McCall has a history of concussions and suffered another brutal hit earlier this month when three defensive players crashed into him at once and sent his helmet flying through the air. “I have battled injuries my whole career, but this is one that I cannot come back from,” McCall wrote in an Instagram post announcing his retirement. But he wasn’t turning his back on football. McCall said he wanted to get into coaching, to “serve and lead the next group of kids with a dream.”
