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Concussions in the NHL: Waiting for Science

What do you do before you know (for sure)?

I like Gary Bettman. I was ready to like him before I had ever met him. He had gone to Cornell University; I went to Cornell. That was a good place to start. When I was president of the Toronto Maple Leafs, I dealt with him often, most directly in NHL governors’ meetings. He would sit at the middle of a long table at the front of a room with the league governors, usually team owners, beside him. Team owners are rich. In their own communities, they are important. They are also used to seeing themselves as important, and like to see themselves that way. In their communities and in their companies, they are also used to having their own way, and do not give up their way easily. To suggest that directing them is akin to herding cats is to give cats a bad name.

At the front table was this expressive, bug-eyed bundle of nerve endings. He spoke in bursts of words and emotions. Quick-witted, quick-tongued, aggressive, smart, well prepared — there was never any doubt who commanded that room.

His is a tough job. He presides over a league, but in many ways he also presides over a sport. In Canada, hockey matters. If Canadian NHL teams aren’t doing well — on the ice or off — the hundreds of thousands of kids and adults who play recreationally don’t seem to be doing as well. And because hockey seems to be a metaphor we as Canadians have applied to ourselves, and others have applied to us, when hockey isn’t going well, we don’t seem to be doing as well, either. As NHL commissioner, Bettman has a responsibility that the commissioners of the NFL, NBA, and MLB do not have.

In the U.S., Bettman has a different challenge. He has to try to make hockey matter for more than just an intensely dedicated minority, in more than just the North and Northeast of the U.S. In the U.S., it’s baseball and football, then basketball, then … hockey. It’s MLB and the NFL, then the NBA, then … the NHL. His is a perpetual struggle for attention and importance. To gain that status, it means having teams in parts of the U.S. where the struggle first must be for survival. Ask any CEO what it’s like when one quarter of his or her stores, for example, drag down the others. Ask them what they would do. Shut them down; focus on their business’ strengths. Bettman can’t do that.

In our dealings, I’ve disagreed with him at times, sometimes strongly, but I’ve found him right far more often than wrong. Of all the NHL presidents or commissioners I’ve seen or dealt with, as a fan, a player, an administrator, and a fan again — Clarence Campbell, John Ziegler, and (briefly) Gil Stein — Gary Bettman is easily the best.

Now Bettman, and one day his successors, have a bigger challenge: head injuries. Amid the dangerous mess of the past few years — the premature deaths of former players, suicides, career-shortening or career-ending concussions, and the grave uncertainty over the future of the NHL’s biggest star, Sidney Crosby, I was sure there would come a point when Bettman would say, “Enough.” That he would intervene as forcibly as he has on franchise and collective bargaining issues. Instead, he has left matters first to Colin Campbell, an NHL executive formerly in charge of player safety, and now to former star player Brendan Shanahan.

Bettman is a lawyer. A good lawyer understands his client’s position and advocates strongly for it. A very good lawyer gets inside his client’s position, tests and challenges it, shapes it where it needs to be shaped, and comes to know it, and embody it, as well as the client himself. Bettman is a very good lawyer. His relentless rigor gives him his confidence, his presence and posture. When a meeting begins, he’s sure — he knows — that he’s the smartest guy in the room. For him to be as aggressive and assertive, for him to be him, he needs to know that. That’s what allows him to herd his cats.

But on those matters where he can’t quite get inside his client as deep as he needs to go, when he can’t quite know something as they do, his manner changes. He knows how much hockey means to Canadians, but as an American, he can’t quite know. He knows how proud and noble, almost warrior-like, hockey players see themselves, but as someone who has never played the game, he can’t quite know. Often criticized in Canada for being an American (and all that means to Canadians), he has been a determined advocate for things Canadian. He knows that hockey’s soul resides in Canada. He knows that the NHL isn’t strong and healthy unless hockey in Canada is strong and healthy. On matters Canadian, he is respectful and deferential. He listens. About on-ice matters, he is the same. Respectful and deferential, he listens to his “hockey guys.”

The problem is that his “hockey guys” are so immersed in a game they have loved and played all of their lives, so steeped in and so respectful of its traditions and understandings, they haven’t fully seen all the changes that have occurred. They have seen the changes in technology, strategy, and training that have allowed now bigger players to go faster and with more forceful impact. To Bettman’s “hockey guys,” these are the natural evolutions of the game. They are good. They are allowed. (Indeed, if you’re going to have fighting, why not a better fighter? Why not the best?)

To these natural evolutions, Bettman’s “hockey guys” have also seen some unintended consequences — most notably, more, and more serious, injuries — and have responded to them with efforts toward better protective equipment, better medical treatment, and, where these are not enough, “tweaks” to the rules. What they haven’t seen fully is that technology, strategy, and training, driven by the creativity of coaches, players, scientists, and entrepreneurs, always run ahead of equipment, medical treatment, and “tweaks” to the rules. Better helmets, more muscular necks and shoulders, MRIs, and Rule 48 haven’t offered the answer to 220-plus-pound players moving at 30 mph. Not even close. So concussions are more frequent and more serious. But to intervene with anything else — with significant rule changes or imagining a game played in a more head-conscious, “head-smart” way — to Bettman’s “hockey guys,” is unthinkable. Natural evolutions that change the nature of a game are OK, but anything else are “unnatural intrusions.” They are bad. They aren’t allowed. Bettman’s “hockey guys” forget that hockey’s natural evolution was once toward a jammed-up, goalless future until some president or commissioner intruded unnaturally with player substitutions and the forward pass. Imagine what the “hockey guys” of that time would have said.

When Bettman listens to his “hockey guys,” because as someone who never played the game he can’t quite know, this is what he hears.

I decided about two months ago to get back in touch with him (“Go Big Red!”). It was a few days after the start of the new season. I sent him an e-mail to congratulate him on the return of the Winnipeg Jets. A minute later, he e-mailed back. This led to a back-and-forth over the next several minutes, at the end each of us promising the other (when I’m in New York; when he’s in Toronto) that we’d catch up. Not long ago, we e-mailed each other again. I had been traveling; he’d been traveling. We’d both be away for the holidays, but sometime early in the new year, we would make this happen. And I had no doubt we would.

What I’d say to him is what I’ve said here, but also that it’s time for him to not be so deferential and respectful on hockey matters, on head injuries, but to take these on in his aggressive Bettmanesque way. The stories, almost every week, of another player being concussed (or, to allow for the possibility of a more acceptable earlier return to action, another player having “concussion-like symptoms”), or of a former player now living with the consequences of his head-injured past, are real. They have happened. They are not just a case of bad luck that will surely turn. You have to know that this is your future and the future of all those owners, governors, and players, every week, for so long as you and they are commissioner, owner, governor, or player. You can try to deny the problem or try to manage it or do something. And as overwhelming as it seems — just imagine if even most of this is true: the on-ice consequences, the post-career consequences for former NHL and recreational players, the liabilities, etc., etc. — a lot can be done. The changes that may be necessary are not undoable. Few are blaming you. Most know there is so much we don’t know and can’t know. We don’t know the dimensions of the problem. We don’t know the dimensions of the answer. But we do know there’s a big problem, and we do know there are some things we need to do.

Hockey isn’t the only sport in need of this action. If anything, football’s problem is far greater. Soccer and other sports are experiencing their own head-injury problems. Outside sports, the military is faced with many of its personnel suffering the effects of new, more concussive weapons. And for decades, we’ve imagined the problems without having paid much attention to the consequences of victims of head trauma in child-abuse cases.

It is OK not to know, I was intending to say to him. It is not OK not to begin to puzzle through with others toward some answers.

You and the NHL can do something. You don’t need to lead this effort — in fact, it’s better if you don’t, to avoid the conflicts of interest that would naturally occur and any perception of them, and so not to hold back the work. But you can acknowledge the seriousness of the problem and your determination to deal seriously with it, now and in the future. One way to signal this might be to help create some ongoing structure that would encourage and generate public discussion, ideas, proposals, and action on head injuries in sports, notably hockey. It could begin with an annual conference, hosted by a university, the first one in Canada, but in subsequent years in the U.S. and Europe. The NHL could be one of the major sponsors. You, and not just your “hockey guys,” could be there to show that on this “long run” problem you’re in this for the long run, and are willing to puzzle through with others how we can do better.

The best brain scientists would be there to talk about what they know, and what they don’t know. Players who have suffered brain injuries will provide their personal stories. League officials at different levels, in different sports, will talk about what steps they have taken, what’s worked and what hasn’t. The best coaches and best players, past and present, will be there to talk about what they’ve been trained to do and what they’ve done all their lives. Faced with an opponent, in this case a new “head-smart” set of rules and way of playing that keeps you from doing some things one way, what do you do? What new creative answer can you come up with? What can you do that is even better than what you did before? Each year, there will be new findings, new ideas, and fresh challenges to players, coaches, officials, scientists, and entrepreneurs who, in their DNA, feed on fresh challenges.

There is no running away. Next week’s headlines have already been written. The need is to begin.

That’s what I was intending to say to him in January or February when I was sure we’d be in touch again. Then I saw his video interview on the New York Times website.

The Times had published an outstanding three-part series of articles by John Branch on Derek Boogaard, a 28-year-old NHL “enforcer” who had died a few months earlier. This was Branch’s follow-up video interview with Bettman. Bettman had experienced many interviews like this before, where he was asked to answer questions that weren’t really questions, about violence and fighting in the NHL, and he had his usual nervous energy mostly under control.

In response to a question, he began by telling his often-repeated story — fighting has a long history in “the game,” he said. Players move at 30 mph in an enclosed area; they carry sticks. There’s physical contact. Different from other sports, fighting in hockey is penalized only in a limited way — with a five-minute penalty, not expulsion from the game — not to sell tickets, as is often alleged, but because fighting acts as a kind of “thermostat,” as Bettman puts it, so that “things don’t go too far.” The threat of fighting helps to keep other matters in a game under control. And because fighting is this organic part of hockey, the frequency of fighting changes as the game changes, he says — sometimes more, sometimes less — so you can’t predict its future. As for the off-ice deaths in recent months of three former NHL “enforcers” — Boogaard, Rick Rypien, and Wade Belak — he reacted to the deaths more like a father than a commissioner, describing their deaths as a “tragedy” and his “almost disbelief at the coincidental timing of [them].” “The circumstances of all three were different,” he continued. “It was a tragic, sad, unfortunate coincidence.” When asked by the interviewer to clarify if he thought the circumstances, not the timing, were a coincidence, he replied, “Yes.”

Later, the interviewer pointed to the recent findings by Boston University’s Center for the Study of Traumatic Encephalopathy that Boogaard had the presence of CTE, chronic traumatic encephalopathy, a close relative of Alzheimer’s disease, in his brain, which is thought to be caused by repeated blows to the head. Boogaard is the fourth former NHL player — the others being Reggie Fleming, Bob Probert, and Rick Martin — to show these same indications. What about this research on CTE, the interviewer asked? “I think it’s very preliminary,” Bettman said. “There isn’t a lot of data and the experts who we talk to, who consult with us, think it’s way premature to be drawing any conclusions at this point because we’re not sure based on the amount of data evaluated.” He repeats how “preliminary” all this is, again citing the “handful of samples,” all the possible factors in these players’ deaths, how with CTE, Alzheimer’s, and dementia there’s so much we don’t know. “There’s a long way to go in medical science before people can make definitive judgments,” he concludes.

Gary Bettman has arrived at Stage 2 in the NHL’s response to fighting and violence. Stage 1, as embodied by Colin Campbell and former Boston Bruins coach and immensely popular TV commentator Don Cherry, was aggressive, belligerent, and dismissive. Look, this is hockey. This is how the game’s played. Always has been. If you don’t like it, don’t play it. Stage 2, as embodied in Bettman’s interview, is more modulated, more thoughtful-sounding, and more reasonable-sounding (aided by the interview’s setting, a room lighted dark and warm, almost cozy; there’s a reason 60 Minutes‘ interviews and congressional committee hearings are done in the glare of bright lights). Occasionally he strays into a lawyer’s gentle, prickly combativeness, but mostly he stays on his message: It is Boston University’s scientific work on the brain samples of former players that helped bring head injuries to a focus, he is saying. It’s science that I’m going to argue back. Science isn’t impressed with anecdote and story. Science demands proof. Four brain samples are merely four anecdotes, and that’s out of the thousands who have played this game. Mine is the reasonable, responsible position. Mine is based on science. Science demands proof, and I demand proof, too. And when science gives me what science insists upon for itself, I will go where science takes me. In the meantime, even with science on my side, I will continue cooperating with doctors and researchers and generate rule changes where appropriate. That’s how reasonable I am.

By waiting for science, thousands of asbestos workers and millions of smokers died. The fact is, as a society we rarely have the luxury of waiting for science on big, difficult, potentially dangerous questions to meet its standard of proof. We need to take the best science we have, generate more and better information, then apply to it our best intuition and common sense — and decide. Scientists are always disparaging of politicians and other decision-makers for being so influenced by anecdote. But an anecdote, well observed, thorough, rigorous, and truth-seeking (not ax-grinding), can tell a lot. At any moment, it may also be the best information we have.

It is only by tragic fluke — his early death — that we have the Derek Boogaard “anecdote.” Normally, we’d have to wait many more years to know what had happened many years before. But now we have this gift from Derek Boogaard. The NHL can also learn from the NFL experience. Many more football players than hockey players are dying now in their 60s and 70s after having spent the last several years of their lives in the living death of dementia. Football, for that generation of players, just as with hockey, was played with primitive equipment. But in football, then as now, every play involves many collisions involving many players, and one final collision. In hockey then, the game moved much more slowly with players playing coasting, two-minute shifts with few collisions. In hockey now, the game moving in full-abandon, 35-second shifts with bigger players, the collisions are never-ending and shuddering. And hockey fighters, once normal-sized and untrained, inflicted little damage. Today, far bigger and having been trained in combat much of their lives, they can cave a face with one punch and have their brains rattled in return.

Gary Bettman said in his online video interview with the Times that he hasn’t talked to the doctors at Boston University. I hope he does soon. I also hope he has spoken with Derek Boogaard’s family and friends to hear, really hear, about what his life was like. And with Paul Kariya, Eric Lindros, and Keith Primeau — in depth — or with any of a number of players who have had their careers ended early, about what life felt like after their injury, and what it feels like now. Or — in depth — with Sidney Crosby. As hard as it was in the 10 months of recovery after his injury — the pain and discomfort, the unknowns, the hopefulness, the crashing disappointments — now must be his darkest time. It was the sheer routineness of this latest hit. So invisible amid the action that observers assumed it must have been from a collision with his teammate Chris Kunitz. So routine it was only on replay: Crosby and Bruins player David Krejci yapping at each other from their player benches — what could’ve caused that? — then running the action backwards; Crosby and Krejci shoving at each other on the ice after the whistle — what could’ve caused that? — and backwards some more; Crosby skating toward the puck near the boards; Krejci, the puck in his skates, bent over, his back to Crosby; as Crosby bumps him, Krejci turns slightly, his left elbow striking Crosby in the visor. It was the kind of light blow that is exchanged without notice or consequence hundreds of times in a game. Krejci, in everything that follows, looks befuddled — Why is he so mad? What did I do? But knowing how he feels, Crosby knows.

If after 11 months this is all it takes …

I hope Bettman and Crosby have a good long talk.

There are debates among doctors, now played out in the media, over the correlation between hockey’s blows to the head and CTE, between blows suffered now and a player’s long-term future. These debates will continue. But there can be no debate about the impact of those blows on players now. Almost every day there’s someone new — this week it’s star Flyers’ defenseman and tough guy Chris Pronger and his teammate Claude Giroux, the NHL’s leading scorer — both gone and for who knows how long. The debate about CTE is important, but it’s a distraction. The debate over fighting is a distraction. This is about head injuries. This is about what we can see. This is what we absolutely know. This is about now.

Bettman and the NHL cannot wait for science. They can’t hide behind science, using it as their shield. They must move, and move quickly, out of Stage 2 to Stage 3. No amount of well-modulated, reasonable- and responsible-sounding words change the fact that a hit to the head, whether by elbow, shoulder, or fist, is an attempt to injure that needs to result in expulsion or suspension. No amount of hopefulness and crossed fingers will change the fact that the NHL, like the NFL, must begin to imagine and introduce more “head-smart” ways to play. Bettman needs to be Bettman. We look back on those people 50 years ago who defended tobacco and asbestos and think, How could they be so stupid? Bettman and the NHL cannot wait for this generation of players to get old just so they can know for sure.

Ken Dryden is a Hall of Fame NHL goaltender and six-time Stanley Cup champion. He is also the former president of the Toronto Maple Leafs and a former member of the Parliament of Canada. He is the author of several books.

Previously from Ken Dryden:
Time for the NHL to Get Head Smart

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