Think critically about for-profit donor entities and their commitments to health

At my job as a primary care doctor in a federal safety net clinic, I was given a free T-shirt to wear the following day. It reads “Crucial Catch — Intercept Cancer” in between the logos of the National Football League (NFL) and the American Cancer Society (ACS). This celebrates the 8-year partnership of almost $18 million dollars donated to fund cancer screening and prevention. These philanthropic gestures of large donors help to fund valuable projects and raise visibility, as demonstrated by my entire clinic staff getting ready to sport their campaign gear. However, recent history of the NFL delineates motives which are not aligned with health and wellness of their players, and such philanthropic gestures from large corporations warrant speculation.

While the NFL shows collaborative and financial support for cancer, the relationship is more complicated with another disease: chronic traumatic encephalopathy (CTE). This neurodegenerative disease can be diagnosed post-mortem on autopsy, and current research overwhelmingly depicts a strong correlation of this disease and football players. In a landmark study, McKee et al discovered 110 of 111 donated brains from former NFL players had CTE, most with severe pathology who had exhibited cognitive and behavioral symptoms. New research in mouse models show physical impact injury from hits, independent of concussion, correlates with CTE pathology. Concern continues rising for the health and welfare of past football players, and more importantly for identifying and mitigating risks of current players, including over one million high school athletes. In 2013, after years of incorrect data and undermining risks, the League agreed to $765 million in settlements to players for covering up the risks of CTE.

Amidst rising public awareness, in 2012 the NFL pledged $30 million to the National Institute of Health for brain injury investigation. In 2016 a congressional committee became involved citing evidence that the NFL was influences the NIH funding recipients, and in July 2017, the relationship ended with over half the funds unspent, drawing widespread speculation. In 2016, the NFL agreed to pay $100 million to brain injury research, much of which has went into helmet development, considered by many concussion experts to be risk reduction but not elimination, as if going from a cigarette to an e-cigarette.

During 2017, the NFL continued funding a small institute in London, the International Concussion & Head Injury Research Foundation. Their website reads like a prepared statement for the NFL: “Only through stringent and controlled medical investigation will we ever establish if there is any correlation between recurrent head impact in sport and neurodegenerative disorders,” disparaging the accumulating evidence from a variety of U.S. institutions. Now, in 2018, the NFL is again making a $17 million donation to be distributed among the Department of Defense, an NIH study called TRACK-TBI, and the National Institute of Aging. While this newest donation is laudable, given the league’s history ridden with motives for self-preservation, it should be received with caution and more appropriate regulatory buffers between the funder and the research.

I challenge every individual, including those acting as part of anything from a community health center to a major medical organization, to think critically about for-profit donor entities and their commitments to health. Recent contributions of the NFL to concussion research have been fraught with scandal and deception, leaving me uncomfortable to showcase such an industry in the clinic. These complex relationships are pervasive in our work. While the medical profession has come a long way regards to reporting industry affiliations and more offices and institutions declining “free lunches” from pharmaceutical representatives, there continues an uncomfortable, uphill battle to fight. For another example, according to their last financial statement, the American Heart Association accepted $12 million from AstraZeneca who held the patent for Crestor at the time of donation. Though their widely followed guidelines for cholesterol management mention individual relationships with industry, this disclosure is not forthright on their widely-used society guidelines.

Ultimately, although I applaud the NFL’s charity towards cancer prevention, I struggle with how the league manages its commitment towards its own players’ safety and well-being. While I had been excited by the opportunity to wear casual jeans with a new T-shirt, I will sit this advertising opportunity out.

Emi Okamoto is an internal medicine physician.

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