How Big a Hit are You Willing to Take?

As you may recall, concussions in football is one of my hobbyhorses.  So of course I was interested when I saw that Kevin Cook had a NYT op-ed on the subject.  If you follow the topic, you’ve probably seen most of the data, but he had some interesting information about how the NFL screens players:

The N.F.L. now uses simple written or computerized cognitive tests to assess concussions. Before each season, players are shown a page featuring 20 words and asked to write down as many as they remember when the page is taken away. The same with 20 simple pictures: Draw as many as you can remember. Later, after an on-field hammering rings their mental bells, the pros take the same test. Match your baseline results or sit out.

Some players cheat. They purposely give wrong answers on the preseason baseline test in hopes of passing the test when they’re concussed. But no screening plan is foolproof, and this one has the virtue of simplicity.

I’m a methodology nerd, so I was obviously interested in how they were doing the test, and I’m a Bruce Schneier fan, so I’m also interested in the logistics of cheating, but  the way the players exploit the test is more than a little terrifying.

Think what it must be like to take an exam and try to guess how cognitively impaired you’re going to be in a few months.  Imagine deliberately answering questions wrong or misremembering words and knowing you’re modeling the person you’re going to become.

I wonder if the players who cheat try to set the baseline low, so they’re sure to pass or whether they set some secret failsafe.   Are some of them thinking, “It’s ok if I can only remember 12 words, but if I drop down to eight, I do want someone to step in and stop me.”  That’s a pretty sickening choice to make.

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    • Taosquirrel

      This was a very good movie.
      And I love your customer review of it, hehe.

  • I wonder if the players who cheat try to set the baseline low, so they’re sure to pass or whether they set some secret failsafe. Are some of them thinking, “It’s ok if I can only remember 12 words, but if I drop down to eight, I do want someone to step in and stop me.” That’s a pretty sickening choice to make.

    If my experience is any guide, definitely the former. Football players (and athletes in general) aren’t interested in constraining their future actions under the assumption that future!them will be cognitively unable to make the right decision. Part of this is a culture of “toughness”, part of it is a lack of understanding as to the actual cognitive affects of a concussion, but I think the biggest part of it is the “teenagers think they’re invinicble” failure. Football players don’t legitimately believe they’re going to get lasting brain damage, no matter what the evidence says.

    I hate to say this, but I think that even asking this question is giving most athletes far to much credit. They see the dichotemy of “I get to play or I don’t”, and they choose getting to play (whether for economic, social, cultural, or other reasons). Those that make this choice aren’t actually weighting the risk as less than what the professionals say it is, they’re weighting the risk as essentially zero.

    But I certainly can’t speak for all of them. AMA Request: professional football player who faked his concussion scores 🙂

  • Owlmirror

    There’s no “d” in “Schneier”.

    A “schneider” is a tailor, but I’m not sure if “schneier” is a spelling variant, or just has a different origin.

    • leahlibresco

      Thanks for the catch

  • Men do take risks. Women don’t get why. Liberal do-gooders try to prevent them from taking risks. There is something about facing your fear and coming out victorious that men need to do. I won’t try and explain it but if I am ever in a dangerous situation I want a guy who gets that to be in charge. Don’t give me the guy who ran from every fight. Give me the guy who made the other guy scared of him. That is who I want to follow when we are in real trouble.

    • Courage doesn’t consist in destroying one’s health and cognitive ability for sport.

      • OK, how do you build courage in a risk-free environment?

        • David

          That’s one thing for professional players, but the vast majority of football players never make any real money from it, but still get the brain damage (albeit for fewer years). And most high school football players aren’t even aware of the risk of permanent brain damage; nor really capable of understanding the consequences. Any parent who lets their under-18 kid play tackle football is guilty of child abuse, as far as I’m concerned. And I’m not some sort of anti-sports nut; heck, I even enjoy watching football, but I’ve become convinced that its effect on the lives of the people who play it is unacceptably high, especially for those not being compensated by extremely high incomes.

          • David

            And I meant that to reply to CCG below, oops.

        • “How do you build courage in a risk free environment?”

          Well, courage is about enduring difficulties and pains for the sake of some desired good. Risk doesn’t necessarily enter into it. There are risk-free activities (e.g., extensive study) that still require fortitude of the person doing them (reading for hours at a time is incredibly difficult, for me anyway). Or to take a better example of courage, dying for someone else requires tremendous courage. Is there risk? Well, not exactly, since you know you’re going to die. The courage is in your ability to sustain the desire to do this based on the goodness of the act, despite the pain and loss associated with it. Courage endures. But(!) it endures for a purpose. This was the point of my earlier comment. Sport is activity done for no purpose. That’s pretty much the fundamental idea of sport. (A trip to the OED is really informative on this point.) Now, the cultivation of some game can be an art, and as an art can merit a certain degree of sacrifice, proportionate to the excellence of what’s produced. But sometimes sacrifices don’t make any sense. Cutting off one’s left hand in order to win at monopoly would be absurd, no? Well what’s the difference between that and football? If playing monopoly caused pain, disability and brain damage would you endorse it as a way of cultivating manly courage? I don’t think so.

          To summarize: Risk is not bad. Facing dangers is not bad. But only if it’s done in the pursuit of a genuine good, proportionate to what’s being risked. Tootsie pops are good, but not worth risking the death of a child. Winning a football game is good, but not worth brain damage or permanent disability.

          • FWIW, I played football in high school, and while I’m not on board with Randy’s division-by-gender, this “football teaches courage” argument is actually a pretty good one. I’ve often told people that I learned more in my four years of football than I ever did in the high school classroom.

            It’s really hard to find things that are scary, challenging, courage-building, and safe. There’s a very real sense in which football is risk-for-risk’s-sake, but that’s not the same thing as saying “Sport is activity done for no purpose”. The point of football (at least for me) was that I had a very real fear of pain, of hitting other players, of failing and embarassing myself in front of my peers, and overcoming that fear was a self-contained good thing (this is distinct from being afraid of lasting brain damage. That’s not a fear I want to overcome)

            That said, while I honestly haven’t read much research on this, the little I have read has pushed me towards the conclusion that football might just be too dangerous (were I a parent, I would have to see a lot of good research before allowing my own kid to play). But it does seem like you might be massively undervaluing the benefits football gives to those who participate.

          • Yours is a totally reasonable and good point. In high school I did competitive speech and debate because I was terrified of public speaking, not because I wanted to win trophies. In many ways it was a vain activity, but by helping me develop that courage, it was conducive (in a small way, at least) to virtue in more important parts of life. I can see that football requires courage of a different, in some ways better, sort, and potentially cultivates other virtues as well (we don’t need to go into that).

            I guess when I was writing I wasn’t thinking so much of high school players. I was thinking more of college/professional athletes who have to deal constantly with the fact that their knees could give out, or they could end up with back problems, or they could get a concussion, and all while devoting massive amounts of time to the training necessary in order to be competitive. This too cultivates courage, but at some point it might do so contrary to prudence (i.e., the right order of priorities and ends in your life), and thus reveal the “courage” you’re demonstrating by not caring about injuries to actually be a vice: foolhardiness, pertinacity, etc. Learning to devote yourself to a difficult activity and bear the pain of it is extremely valuable, but if the activity itself isn’t valuable then there has to be a limit put on the amount of actual sacrifice made to performing it, in order for it to continue to be virtuous.

    • I’m not convinced that football has anything to do with facing your fears, unless you’re talking about fear of grave bodily injury, and quite frankly that seems a very healthy fear to have and not one you want to beat out of people.

      • Grave injury is not typical. It is normally the fear of physical pain you face. Not being paralyzed by the fact that you might get hit. Not being shy to hit someone else. But always under control. You don’t want penalties. It is a good way to teach people to be aggressive and smart at the same time. To play morally is not to play soft. You take the same attitude into your professional life. Just because you are Christian does not mean you can’t destroy the competition.

        Can the game of football be made safer. Probably. Maybe we even need a new game. But if we don’t let boys learn how to channel their aggression and gain control over it then we fail them. Most people who comment on football don’t get that. They just don’t understand why they can’t just do lawn bowling instead.

        • Still doesn’t seem to me to have anything substantive to do with facing fear. Anyone dedicated to a physical sport will encounter physical pain at some point; they don’t care, otherwise they wouldn’t do it. So that hardly seems to qualify as requiring any sort of moral fiber.

          But maybe I’m confusing fear with FEAR.

          • The pain of training is not really what I am talking about. That pain is important to face but we expect it and know it is doing us good. I was referring to playing while possibly getting hit at any point. Not just tagged and possibly losing some game advantage but really, physically hit and having it hurt a lot. That is a much more primal fear. It is easy to let that fear shut down our reason and we just freeze. Football teaches you not only to think but think quickly and act decisively in those situations.

    • Maiki

      How did this become a men vs women thing? both men and women I’ve seen are willing to damage their bodies for sport — even if the sports might be different.

      • Really? You don’t think gender has any impact here? Interesting.

        • Steve

          While men make up the majority of professional athletes and certainly bring in far more money than women typically do (think NBA vs. WNBA), the point of doing potential harm to your body in this instance has more to do with athletes vs. non-athletes then men vs. women. That there are more men is incidental to the point of this post.

          • It is not the athlete. It is the warrior. Most sports don’t have that aspect of physically intimidating the other guy.

    • And what does this have to do with faking your scores so you can continue to to play football while concussed? There are risks, and then there are stupid risks.

  • Owlmirror

    Hm; does this work?

    $latex \LaTeX&s=0$

  • guest

    Bruce Schneier last name is his domian name. How do you spell one right and the other wrong?

    • Because schneider is a real word, allowing autocorrect to strike at the one not ensconced in a URL. Relax.

  • CCG

    I disagree with this being terrifying. If it truly was terrifying, the players would back out, which they can do any time, and make a good living as a football coach somewhere. No one forces them to play professional football.

    Terrifying is being the military, where there’s no way out. Pro football players make a conscious choice that money is worth more than their mental health. We have seen players getting concussions for years, and yet at all levels of play people are still desperate to get on the field. Running across a highway is terrifying, but if you choose to do it weekly because someone offered you $2,000,000 a year for it, don’t blame anyone but yourself if you get hit.

  • grok87

    I think terrifying is the right word. Sometimes we are our own worst enemies. As the gospel for today says:
    “Jesus said to his disciples: “To you who hear I say, love your enemies,
    do good to those who hate you, bless those who curse you, pray for those who mistreat you.”

    So what if your enemy is yourself?

  • This has nothing to do with the current post topic (although maybe — a “big hit” in another sense?), but rather harks back to the “Sondheim festival” of a few weeks back. Leah, check this out: a never-published never-performed Sondheim script, possibly the first post-college musical he ever wrote. Of interest, yes?

    • leahlibresco

      Oh, awesome!

  • Doragoon

    Is the problem that someone is doing something that could damage their health, or that someone is paying them to do it? Like with prostitution, is the promiscuity the problem, or is it the fact that they are getting paid? There are a lot of things that consenting adults can do that might harm their health. Should we worry about them all, or just when money is involved.

    IMO, Anything worth doing is worth doing for money.

    • Maiki

      prostitution has *both* the problem of extramarital sex and the commercialization of human relationships (treating something essential to a human being as a thing to be sold). Similarly, voluntarily harming your body for a good motive is less bad than harming your body in pursuit of great wealth — the human body is not an object to be bartered, that evil compounds the mistreatment of the body.

    • deiseach

      The problem is partially that the excessive risk of permanent damage and impairment is being run because the specators want to see gladitorial combat and the managers/coaches/owners see being willing to “play the man, not the ball” as evidence of committment and being a good player, over skill and technical ability.

      This has been an ongoing debate in association football (what you call soccer) over here; the consensus has been that English teams are more physical and more direct, which makes matches visually exciting and involving, but that European teams are more skilled, which is better play but can come across as ‘boring’. This is expressed in a criticism from 2007 of the Champions League semi-final involving two English teams:

      “If Didier Drogba was the best player in the first match it was purely because he was the one who ran the fastest, jumped the highest and crashed into people the hardest. Such extreme intensity wipes away talent, even leaving a player of Joe Cole’s class disoriented. If football is going the way Chelsea and Liverpool are taking it, we had better be ready to wave goodbye to any expression of the cleverness and talent we have enjoyed for a century.”

      It’s not a matter of cowardice or being soft and unwilling to play a ‘man’s game’ if measures are put in place to reduce the risk of permanent, debilitating injury. If repeated trauma to the brain means that someone faces the possibility of decades living in a state where their ability to function is grossly impaired – including their ability to earn a living and take care of themselves – then I don’t see why it’s a bad idea to reduce that risk.

    • Is the problem that someone is doing something that could damage their health, or that someone is paying them to do it?

      Although it may make people squeamish when phrased that way, the fact that they’re getting paid for risky behaviour isn’t really that unusual. Think of NASCAR riders, professional skiers, etc. The problem with high school football is that the kids are making uninformed decisions. They have no idea the damage they can do to themselves, and kids mostly think they’re invincible at that age anyway.

  • Funny how there seems to be a never ending concern over the latest health crisis related to behavior that happens outside the bedroom. I mean, really. Almost every year we have the latest health pandemic scare that doesn’t have to do with sex. The most we get from any of the problems related to sex is ‘here, wear this condom, that will probably work, let’s move on.’ But anything and everything else? Why, it’s a pandemic! Not saying that we shouldn’t look into things, and work for health and safety. My son plays football, so I’m all for it. But think if we turned our attention with the same laser focus on the problems that float in the wake of modern sexual standards. What might the discussion be then? Who knows what we might conclude.

    • Steve

      Sorry, how is this relevant to anything that is currently being discussed here?

      • Because while I see studying this and seeing if there is something that can help with the problem of concussions as a good thing, I also see it as one more in a long line of recent ‘Oh no! Watch out! Another health catastrophe on the horizon!’ narratives being focused on today. I especially notice this when set against the stunning silence that comes out regarding the misery, suffering and problems that are often related to sexuality as currently advocated in our modern world. I just can’t help but notice a disparity there.

    • Alan

      You mean things like creating HPV vaccines, AIDS research, massive amount of time and money spent trying to alleviate the AIDS epidemic in Africa?

      In what world are you living in where you don’t see how much is invested in sexually related health issues?

      • Alan, show me once where the emphasis has been on ‘maybe we need to rethink our modern approach to sexual behavior’. The emphasis with the concussions in football, or obesity, or anyone of a dozen other recent health alarms isn’t just ‘let’s increase funding.’ It’s a willingness to consider the most radical changes in behavior, and doing whatever is needed to combat the problem.

        I can’t help but notice that, while we’ll push for AIDS research or continue insisting that condoms will solve it all, there is a line we won’t cross. The media just never seems prepared to draw a line between sexual behavior and the problems that result from modern approaches, especially in terms of calling for radical changes in how we’ve approach attitudes about sex in recent decades.

        And it’s not just AIDS of course, that can be a problem resulting from various approaches to sexuality, but you could be forgiven for thinking of only that. After all, it is the closest thing we get when it comes to the media focusing on any problems that might even remotely be associated with sexuality.

        • Alan

          Why should we rethink our modern approach to sexual behavior? Just because you think that is a solution to sexual health issues doesn’t make it so and I don’t accept your premise.

          But that wasn’t what you said at first, you said “The most we get from any of the problems related to sex is ‘here, wear this condom, that will probably work, let’s move on.’ But anything and everything else?”. And that is patently untrue, there is plenty of conversation, research and action across a wide variety of approaches to sexual health issues from education to treatment to cures.

  • if we turned our attention with the same laser focus on the problems that float in the wake of modern sexual standards. What might the discussion be then?

    Probably “Here, wear this condom, that will probably work, let’s move on.” Really, sex isn’t a problem unless somebody makes it one. If it takes place between two consenting people of legal age it’s a pretty harmless activity.

    • In a perfect world, sure. But in this world, sexuality expressed in certain ways can lead to many problems. And does. Not just psychological or emotional ones either. But actual real life physical ones. My point is, you never, ever hear the same drumbeat of ‘Wow! We need to do something about all the problems arising from different approaches to sex!’ In fact the general narrative is ‘I don’t see any problems with sex, seems natural, nothing ever goes wrong there as long as it’s two or more consenting adults, let’s move on.’ Despite some common sense evidence to the contrary.
      You’d think once in a while that would turn up in the dire warnings. You’d think.

      • sexuality expressed in certain ways can lead to many problems

        Well sure. But in that case it isn’t sex, or sexual standards, that’s the problem — it’s the inappropriate expression (or use/abuse) of sex. Purely sex-related problems (e.g., STDs, teen pregnancy) are in fact largely solved by condoms and other forms of birth control. Problems such as rape or pedophilia aren’t about sex, they’re about some underlying pathology that gets expressed sexually. Those cases should be viewed a symptom of a psychological or mental problem, not an indictment of sex itself.

        • Delphi, then find for me the latest media frenzy over all the problems that result in ‘inappropriate expressions (or use/abuse) of sex. Consider this. The same could be said of eating. Eating doesn’t cause any problems at all. But the inappropriate use/abuse apparently does, since we’re approaching the great pandemic of obesity with the same passion with which we went into WWII. That’s what I’m saying. Concussions in football? Sure, let’s look into it. But once again, we have a ‘media frenzy’ just like we do over obesity, or the latest animal flu, or this or that illness or health crisis. I’ve barely made it a whole week without hearing something about it.

          In fact, every year this whole ‘latest health threat’ media storm is as predictable as a President’s day furniture sale. Except, of course, where it relates to drawing lines from sex (however expressed) and the carnage and suffering and expenses in its wake. For some reason, there the media is stunningly silent. That was my point.

    • Ted Seeber

      And if you truly believe that consent happens, I’d like you to do some case studies in divorce court.

      • I fail to understand either the relevance or the substance of your comment. Are you implying that there’s no such thing as consensual sex? That’s simply nonsense. Of course consent happens, all the time. Otherwise it’s rape, and that ends up in criminal court, not divorce court. Well, or maybe both.

        • Ted Seeber

          I’m saying that there is no such thing as truly informed consent in a sexual relationship- or in any other relationship. There are always hidden issues in any contract- the question is, are you going to override your own happiness to stick to the covenant that you’ve made, or are you going to bail at the first sign of trouble? Or are you going to come back later and claim that you didn’t give an informed consent and thus the other person needs to pay you X number of dollars?

          It is the informed part that is the stickler. Human beings are notoriously bad at predicting the future at this scale.

        • Ted Seeber

          Oh, and I’m also implying that *without a written contract, there is no consent* and thus all casual sex, heterosexual or homosexual, is indeed a form of rape.

          • Doragoon

            Actually, that’s called adultery, but that word isn’t used any more so I could see how you overlooked it.

          • Alan

            And that is part of why you shouldn’t be taken seriously. As if oral contracts, or simply a mans word, has no meaning whatsoever.

            Your expansive definition of the word ‘rape’ (to include contraception, sex without written contract) is such an abuse of language that you could say you are raping it. Seriously, you make communication a pointless game – you are just one big equivocation fallacy trying to use emotion (attached to the word rape, but because of what it actually means not what you say it means) as your weapon rather than logic. The only conclusion that can be drawn is that you are simply too emotional for logical discussion.

            But at least there is a bright side here – you exclude prostitution from rape, so you can always do that.

  • Pedro Paulo Jr

    This is not a new cheating technique. In the 18th episode of the last season of Good Wife there was a case where a NHL player testified that NFL players usually cheat by making mistakes on the baseline questions in order to not get caught by the test.

    If you are interested in this subject I suggest you watch The Good Wife, S03E18

  • Alex Godofsky

    Leah, this should update your priors (a small amount) to think it’s more likely that football players have a legitimate preference for playing vs. simply underestimating the risks involved.

  • Ted Seeber

    The idea of cheating on this test just proves to me what I already know about many pro-sports enthusiasts; they aren’t exactly the wisest bunch of people around.

    • I was going to say that you shouldn’t say the players aren’t smart, just that they might have a low time preference. But then it occurred to me that time preference might be the difference between wisdom and smarts.

      • Ted Seeber

        Yep. Exactly. One can have an IQ of 400 and still not have the time preference God gave a mongoose.

  • g

    Leah, I think you may have misinterpreted the article slightly. You write about “how cognitively impaired you’re going to be in a few months” and “the person you’re going to become”, but surely the point of the tests is that they’re given *shortly after a concussion” to answer the question “can this person safely go back on the field right now?”. They’re measuring short-term impairment, not long-term damage, and a low score on the test isn’t indicative that you’ve become a different person but that you’re currently not in proper working order and need to recover before you start playing again.
    (But I’m as horrified as you are about the general phenomenon of brain injury in American football, and I agree that willingness to cheat in this sort of way is a Really Bad Thing.)

  • When there’s that much money on the line it doesn’t surprise me at all that people would cheat to stay in the game. Look at this list of the average NFL salaries. Who wants to jeopardize a million-dollar-a-year income? Especially when so few of them have (sadly) so little else to fall back on, because they’ve been passed through the educational system with barely a glance at a textbook? According to a 2009 NY Times article, 78 percent of N.F.L. players are bankrupt or under financial stress because of joblessness or divorce within two years.