The Inherent Tension of Trying to Make a Collision Sport Safe
(Inside Science) -- Kathleen Bachynski is an assistant professor of public health at Muhlenberg College in Allentown, Pennsylvania. Her new book, "No Game for Boys to Play," explores the history and culture of youth tackle football in the United States. Bachynski said the book grew out of her graduate student research on sports injuries.
The book covers the history of the sport, including its rise to become the country's most popular spectator sport and the huge increase in participation among boys and young men over the 20th century. Bachynski also describes how protective equipment marketers walk a tightrope to present the sport as both too dangerous to play unprotected and suitably safe if their equipment is used. The book also details medical debates about the benefits and risks of the sport -- discussions that began more than a century ago and are still happening today, as researchers continue to build a better understanding of how physical activity helps the body and how impacts can affect the brain.
This conversation between Bachynski and Inside Science's Chris Gorski has been edited for clarity and brevity.
Chris Gorski, Inside Science: Your book discusses not just the safety of football, but also its cultural history and the way the cultural aspects are baked into the way kids, parents and even institutions interact with the game. How did you decide what to include in the book?
Kathleen Bachynski: One of the questions I started off with was: How did a full-body collision sport became the most popular sport for boys, for children? That's kind of puzzling because that's a pretty high-risk thing to do. How did it become so closely tied to educational institutions, including high schools and colleges? And I kind of quickly realized I couldn't understand that without the cultural history.
It seems like every argument about the risk of the sport that you quote others making -- every piece of research that comes up that highlights the potential risks in football -- people made these points as far back as the 1800s.
I'd started the dissertation back in 2013. And that was sort of just before the public awareness really shifted. Will Smith starred in that movie "Concussion" in 2015. And there was a real shift. I went from always having to explain to people what I was doing and then having people say, "Oh, I've heard about that in the news."
It was unbelievable. And so it turned into a very different experience where it was no longer, "Oh, I'm doing this sort of obscure kind of project." It was then suddenly the challenge of, "I'm trying to keep up with everything happening in the news, as well as learn about the history at the same time."
I was surprised by the extent to which it seemed more like a story of a historical lack of change, if that makes sense. I was expecting when I first went into the project to see, "Oh, how debates have changed, and what's different." Certainly, there are many things different now. But I was more impressed, I think, by how similar some of the themes were, and how often I came across quotes from the 1890s or 1920s or 1950s, where I thought, "Gosh, you don't actually have to change much about this quote, and imagine it being said in 2019."
There are a lot of sports that you can begin as a kid and play in some form for decades, right? You can run, you can bicycle, you can play something like men's league hockey. But when you look at football, you have millions of people playing in youth leagues and in high school, and then there's a major cut down to college, and then another major cut down to the number of people playing professional football. It's kind of like there's no casual way to play this sport.
I think that makes it relatively unique. I don't know of anybody, at least in my public health circles, that is making the argument that there should be tackle football for 40- or 50-year-olds. We definitely encourage people across their lifetime to be involved in things like you mentioned, like running or pickup basketball or swimming or all kinds of activities. And we would normally be encouraging people in their 30s and 40s and 50s to get involved in a sort of local league or a local gym. But I think it's a good reason we're not encouraging 40- and 50-year-olds to start tackle football leagues, and that's because it's really dangerous.
I think a big part of that, which I talked about a little in the book, is how football is sort of seen as a particular kind of training specifically for boys and men. And it wasn't historically really offered for girls or women, but seen as a training for boys to be future military or business leaders.
It seems like there have been two major ways that physicians have gotten involved in these discussions, historically. One is by saying "Oh my gosh, this is really dangerous." And then one is, "This sport helped me become the person that I am, so everyone should do this."
The "Oh my gosh, this is really dangerous" people were around since the beginning of the sport. And that's actually where I got the title of the book from. There was an editorial published in the Journal of the American Medical Association, which is one of the most prestigious medical journals still today in the United States, back in the early 20th century, where the editors said that football was "no game for boys to play." And I found it incredibly striking, that there would be an editorial with such a clear statement about the medical perspective on football. And needless to say, that was ignored.
And then on the other hand, you had physicians who often were closely tied to the sport. Some of them had played football themselves. Or maybe they were a team physician, or otherwise sort of associated with football. And exactly as you say, they very often sort of looked at football and said, "This made me who I am. And part of why I became, for example, an orthopedic surgeon or team physician or what have you is that I want to supervise the sport and encourage others to play it as well." I do think those physicians became even more influential in the 1950s. And that's because that's the period of time when sports medicine started to come into its own as a medical specialty.
As a reporter who covers sports safety, I noticed that there are a lot of contentious conversations, often found on Twitter and in article comments. One perspective comes from people who consider themselves to be very pro sports safety. They suggest that many people are influenced unduly by something like a research grant from a sports league or from another group. And then there are doctors who say they take care of kids with sports injuries every day, and they object to being accused of not having kids' best interests at heart. So you have these people coming at the same question of keeping kids safe from different standpoints.
And there's also a long history of that, which I found really interesting in the book. And I think part of it, at least the way I see it, is sort of the inherent tension of trying to make a collision sport safe. Kind of hard to do.
It seems like there are pressures and norms that influence the questions that people are allowed to ask or the changes that they're allowed to advocate for.
I sort of mentioned this towards the end of the book. I was looking at hockey. Body checking is one of the riskiest mechanisms in hockey. There is good evidence that if you don't body check, you don't have nearly as many injuries, including concussions. For the youngest children, I think it's been accepted and acknowledged that we won't have 8-year-olds body checking each other.
And so there's sort of room in the conversation in hockey for making recommendations against a particularly risky mechanism in the sport for kids, but it's been a lot harder in football to see that happen. There's certainly a conversation about at what age should we restrict kids from tackling, but needless to say, at least as things currently stand in 2019, we still have kids as young, you know, as 5 or 6, who are allowed to participate in full-tackle leagues. And so I think part of that is cultural. I don't think there's a lot of scientific evidence that, you know, tackling at age 8 is way safer than body checking.
I was reporting on a story recently about a consensus statement issued in JAMA Pediatrics. And the authors that I talked to from that paper said they wanted to base their findings and recommendations on what there was good evidence for. But their study, as far as I understood it, was trying to find evidence that something is not safe rather than looking for proof that it is safe.
Yeah, and that's an issue I also found really long-standing. Pediatrician John Reichert in 1958 basically said the burden of proof should be to show that football is safe. And he specifically said, you know, the assumption basically should be that amateur children's bodies are too vulnerable for body contact sports, and the burden of proof rests with those who want to show otherwise. And then on the other hand, there was Creighton Hale, who was the vice president of Little League Baseball, who was very supportive of competitive athletics for kids. And in 1959 he basically took the other point of view [in the Journal of Health, Physical Education, and Recreation]. He said, you don't have enough evidence to show that this harms children long-term. He basically said the burden of proof was on the other side. So I think this is a really long history that we have of who has to show evidence of what. I think we see this a lot in public health, even beyond sports.
What do you think should happen with this cultural touchstone that our country has of football?
I'll start off by saying these are adult decisions. It's up to adults to decide what risks are and aren't appropriate for kids. A child can't give informed consent, a child can't fully ascertain and make decisions on short- and long-term risks. I have to say my read of the history is that I see decades of adults, I think, in many ways, abdicating that responsibility to protect kids.
Something that can absolutely happen on the local level is to say, "we're not going to impose those risks on the youngest kids." That can look like not only offering flag football, but other kinds of activities that are low-risk. But I really do think what I would like to see moving forward is more school administrators and parents and educators and all the different kinds of people making these decisions taking very seriously the responsibility to protect kids against brain injuries.