Of the 338 former National Football League players whose brains were examined after death between 2008 and 2021, 315 had chronic traumatic encephalopathy.
That is 93.2 per cent. But it’s not the most useful number because the disease can only be confirmed by cutting into the brain after death, which means every one of those 338 cases exists because a grieving family agreed to have the man’s brain removed and sent to a lab in Boston. Families do not volunteer for that on a whim. They do it because they spent years watching him forget things, lose his temper, stop managing his own affairs, and they want to know why.
The men whose brains were examined are, by design, the men whose families already suspected something was very wrong.
I have cheered for the Detroit Lions since I was a kid. Billy Sims, then Barry Sanders, then decades of disappointment with occasional flashes of brilliance. I am not writing this as someone who came to football late and disapproved on arrival.
In any other industry…
Consider the same numbers in any other workplace. A plant where a quarter of the retirees, at absolute minimum, are confirmed to have an incurable neurodegenerative disease traceable to the job. A regulator would be on site. Orders would be posted. Workers would refuse the task and be legally protected in doing so, and the employer would be explaining itself to an inspector, then to a court.
Nobody would accept the argument that the exposure is the point of the job. In Canada, that argument has been unavailable to employers for about half a century.
The comparison group in the study makes the scale plain. Community brain donors with no documented history of repeated head impacts show CTE rates between zero and 1.3 per cent. Cohorts with contact sport exposure run from five to 72 per cent. Professional football sits in its own weather system entirely.
The prevalence is only part of the story here. Another chapter is how thoroughly this disease evades the official record. The study autors reviewed medical files and interviewed family members and diagnosed dementia in 202 of the 338 donors. Death certificates listed a neurodegenerative disease as a primary or secondary cause for only 82 of them. Nearly 70 per cent of the dementia cases never made it onto the paperwork.
Dementia was present in 58.2 per cent of the donors whose certificates blamed cardiovascular disease, and in 52.3 per cent of those whose certificates said injury. The researchers went and looked at what those injuries were. They were falls, in nursing homes and memory care clinics.
Every occupational disease has passed through this stage: real, widespread, and statistically invisible because the death is filed under whatever finally stopped the heart. Asbestos took decades to move from a mill floor to a compensation schedule for exactly this reason. Surveillance systems record proximate causes. Employers, insurers, organized labour and legislators respond to what the systems record.
The clinical picture is not subtle either. Among donors with stage IV CTE, the most advanced form, 90.4 per cent had dementia. Just 7.7 per cent were living independently when they died, and 43.3 per cent were in memory care or a nursing home. Dementia in this group began at an average age of 63.4. These are men who were paid to play a game in their twenties and lost their minds a decade before most people retire.
There is one finding that upsets the usual dose-response comfort. If I’m only exposed to asbestos once, I’m probably OK. But the line between total years playing football and CTE is fuzzy, at best. Sure, more playing time made it worse. But less play did not appear to make it safe. Whatever determines who develops the pathology in the first place, at these exposure levels, the study could not find it in the career length.
(Total years of football were associated with stage IV disease and with high-severity disease, but not with whether a player had CTE at all. Everyone in this cohort had already crossed whatever exposure threshold matters.)
They signed up for it, right?
The reflexive defence is consent. These are adults, many of whom are extraordinarily well paid, who chose the work knowing the risk. That defence has a specific status in occupational health law, which is none.
A worker cannot sign away the right to a safe workplace, and an employer cannot purchase an exemption from its duties. We settled this because we understood that when a job is lucrative, prestigious, or the only thing a person has trained to do, consent is a thin instrument. Football is all three at once, and it recruits from children.
Still watching on Sunday
So the honest position is not that I have stopped watching. The honest position is that the entertainment continues because the workforce is small, glamorous, self-selecting, and generates enough revenue to absorb the settlements.
Scale changes the arithmetic. There are roughly 1,700 dead former players in this study, spread across 14 years and a continent, and no single site where the harm accumulates visibly enough to draw an inspector. Nobody has to look away, because there is nothing arranged in front of them to look at.
The researchers are careful about what they can claim. CTE can only be confirmed after death. Donation of the brain is not random, and the donors had longer careers and more Pro Bowls than the men who were not examined. The findings cannot be extended to the wider football community, they say, because every man in the cohort had exceptional exposure.
All of that is true and yet none of it moves the floor.
Which leaves the season starting, and me watching it, and the death certificates that will eventually be filed for the men I’m cheering for on the field this year. Most of them will say cardiovascular disease.
