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There’s a renewed debate over safety in football after Miami Dolphins quarterback Tua Tagovailoa’s two serious concussions and Buffalo Bills defenseman Damar Hamlin’s cardiac arrest. Defensive tackle-turned-pro wrestler-turned-neuroscientist Chris Nowinski has taken a stand. He tells Andy about the new research on the long lasting effects of chronic head injuries, why kids under 14 shouldn’t be playing tackle football, and how high schools and colleges can make practices safer.

Keep up with Andy on Post and Twitter and Post @ASlavitt.

Follow Chris Nowinski on Twitter @ChrisNowinski1.

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Check out these resources from today’s episode: 

• Learn about the Concussion Legacy Foundation and their latest campaign, Stop Hitting Kids in the Head: https://concussionfoundation.org/stop-hitting-kids-in-the-head
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• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Chris Nowinski

Andy Slavitt  00:18

This isn’t a bubble with Andy Slavitt. Go ahead and email me at inthebubble@lemonadamedia.com I do want to hear from you. So we’ve been taking on some tough topics recently, if you haven’t heard our episode and cryptocurrency, if you haven’t heard our episode on anti semitism, if you haven’t heard some of the other episodes recently, we’ve really been getting into some very tough topics. And look, I think the topic of American football, and violence and football, it’s kind of a tired topic on its surface. And I say that because I feel like we talk about it every couple of years, and not a lot changes. And we all know, people could get hurt playing these sports, that they’re done for our entertainment. And mostly that they’re just massive businesses, that people are making billions of dollars, and that all of us who watch sports or participate and go into games, or whatever, are in some ways complicit. And you know, we all read about if you didn’t see this injury to football player from the Buffalo Bills to Mr. Hamlin, we’re, this guy nearly died on the field. And I, you know, predictably, it’s sparked a whole, you know, renewed conversation about this. And I’m interested in that topic, but I’m interested in particular, at people who are willing to take a brave stand and say, Look, there’s a science here, there’s a right answer, there’s a wrong answer. And whether we get into it now or not, we ought to be talking about that answer. And we’ve found just such a person in Chris Lewicki, who actually has taken the stand, particularly as it relates to kids in sports. And I think, you know, what I appreciated about talking to Chris, is that there’s some actual clarity about what he thinks should happen. It’s not caught in this sort of traditional place of, it’s dangerous, but hey, everybody knows the risk. So we’re gonna keep doing it, because we all love watching it. I am not a huge football fan, necessarily, but I recognize the impact on our culture that it has. And I also recognize that it’s not just football. But what’s interesting about Chris is, he got into this topic, the hard way. He was an all IV Harvard football player, and then became a WWE professional wrestler. And then he became a neuroscientist. Okay, why would one go from being a WWE wrestler, to a neuroscientist, which I’m sure happens all the time. And that’s because he got some head injuries, some serious head injuries, which caused him to say, I’ve got to figure out what’s going on with my brain and other people’s brains. He is the co-founder and executive director of something called the concussion Legacy Foundation. He talks with physician, athletes, players, parents, leagues, about sports, and the risk of injuries and trauma. He’s familiar with a lot of really sad stories. And he’s developed a clear point of view, which he shares with me in this coming conversation. It’s a whether you like sports, love sports, don’t like sports, if you want to get into a topic that I think needs to be discussed. I think Chris does a fantastic job. And so I hope you enjoy. Let me bring him on.

Andy Slavitt  04:09

Well, welcome to the show.

Chris Nowinski  04:10

Well, thank you for having me.

Andy Slavitt  04:12

It seems like every once in a while, we kind of get dragged back into this discussion about football. And whether or not it’s a dangerous sport, or too dangerous sport. What’s kind of your sense of our relationship with the game these days?

Chris Nowinski  04:32

And our relationships evolving? So we have to have this discussion every once a while because you know, football is so popular and so fun to watch that we sort of forget the human toll of it. And it’s not a conversation you want to be having while we’re trying to be entertained. But I feel it’s a very important topic. Partially you know, just because of what the players you watch go through, but really for the players we don’t watch, you know, so I when I played football, you know, I got sort have recruited into this ecosystem that really damaged my body and my brain in a lot of ways with […] was a kid. And it’s important over that 95% of the folks who are playing our kids. And if it’s dangerous for the pros, it’s dangerous for them too. And we can do better and how we protect them. And I think we’ve shown over the last 15 years, we are doing better. The question is how much further we have to go that we can feel comfortable about the sport that is very dangerous.

Andy Slavitt  05:27

I do want to get to kids, because you make a great point, we have a I don’t know at least I’d sometimes fall into this trap of thinking about pro athletes as almost not like the rest of us. There’s such great physical shape. They’re so strong, they’re so big, they’re so fast or such modern technology, you see them on TV, and you do forget that the real people but I do want to start with the NFL for the simple reason that, you know, there’s a bit of a trickledown effect probably, in how youth sports comport themselves relative to kind of watching the NFL. Do you think that the NFL has demonstrated that it takes injury seriously, or is it only taking it as serious as it has to?

Chris Nowinski  06:10

Yeah, I think historically, they’ve only taken it as seriously as they have to concussions were not discussed really in any meaningful what the coaches were discussed in the 90s, when Troy Aikman and Steve Young that hurt that there wasn’t a history before that, but let’s start there and say that the NFL is reaction was put together a research committee led by a rheumatologist, you know, not anyone who studies the brain and conduct some really badly designed studies that found that what they claimed is that nothing was wrong. And everything I’m doing was fine. And that was all. We’ve now shown to be incorrect research. So that was attempt number one. And then attempt number two came around when we started finding CTE in the brains of football players in the mid-2000s. And then there they are, they tried to cover it up.

Andy Slavitt  06:55

Can you explain CTE to us? For those who don’t remember all the details?

Chris Nowinski  06:59

Yeah, no, not that many people do know all the details. And we’re still figuring it out. But CTE stands for chronic traumatic encephalopathy. It’s a neurodegenerative disease that has a lot of similarities to like Alzheimer’s disease. And what we found is that too many hard hits to the head or repetitive traumatic brain injuries can spark a degenerative process in the brain that goes on for the rest of somebody’s life. And you’d starts in a few sort of known areas of the brain, the frontal lobes and some deep structures in the brainstem, and then sort of spreads to adjacent tissue and over your lifetime symptoms start showing up and sometimes show up and go away and sometimes show up and get worse, as your brain just sort of slowly rots in some way, shape or form. And the end stage of this diseases, dementia, if it advances long enough, and you have the wrong genetic structures and other things, you will, you will get dementia from this disease.

Andy Slavitt  07:52

So we’re basically not meant to take a lot of hard hits to the head. It’s what but I’m kind of hearing you say,

Chris Nowinski  08:00

Yeah, I mean, if you think about it from an evolutionary perspective, outside of combat, you know, people and abuse people have not taken 10 20,000 is to the head very much in human history. And actually, we talk about it’s the sort of the invention of hardshell molded plastic for helmets, and the invention of like, when we consider soft soccer balls today that allows us to be so many head impacts to be so widespread.

Andy Slavitt  08:25

Yeah, no, I’m reminded that soccer has come under some scrutiny as well. And I’m going to talk about that. But tell us a bit about your own story. You followed a path you mentioned, you played youth football, and you certainly stayed and played beyond that. And then you had a bigger career in sports. And then something happened to you. And I think people would love to hear your story if you don’t mind telling it.

Chris Nowinski  08:48

Yeah, the reason I got involved in this was not because I had this insight into my brain early on. I actually didn’t play youth Tech, I wanted to start playing in seventh grade. My mom sort of kept me out till High School. But I started playing football in high school I got recruited to play a lot of sports, are recruited to play at Harvard was an all-Ivy defensive tackle there. And I got out of there fine. Never had a diagnose concussion in my life at that point. And then after some time in healthcare and life sciences consulting, which was fun, but what didn’t feel was right for me at 22. I got into professional wrestling, and wrestled for the WWE for a couple years, and Monday Night Raw, and, you know, was on my way to something special until I got too many concussions. And it wasn’t just too many concussions. It was you know, I was getting taken hits, you know, accidental hits without blackout or, you know, forget where I was or get double vision. And I just never thought they were serious enough to mention that at that point, that we didn’t even have concussion protocols back then. So if I did mention them, who knows what would have happened but what ended my career was getting to in six weeks After the second one, I had daily symptoms that I just didn’t talk about, and took five more weeks of hits to the head. And somehow that just put my brain into a really bad place. And so I developed persistent post-concussion symptoms. I’ve never been the same.

Andy Slavitt  10:18

Could you describe what that’s like? Yeah, so.

Chris Nowinski  10:21

So it started with like, the first thing I noticed was a throbbing headache the moment it happened, and that headache came and went, it was probably around for most of the time for 15 years. And when I would exercise, it would get worse. And I would get a throbbing headache plus get a little foggy, which was really the thing that prevented me from ever get be able to get back in the ring as I can trust myself once I got moving, which is not an uncommon symptom. And then I developed REM behavior disorder. So when I dreamed I would act out my dreams and move around your body is supposed to observe your brain paralyzes your body, for the most part when you dream, see it or hurt yourself. But that broke for me, and I started hurting myself. And you know, and then whatever else sort of comes with that I just, I couldn’t, I couldn’t think straight could remember stuff very well for a while. But most of that’s come back. But the reason I got into this is because most people do bounce back quickly from concussions, and no one could understand why I wasn’t including me. And so it’s that last concussion I had was really the first one diagnosed, and over the Odyssey of finding doctors who could get me back to work. That’s when I started learning. Oh, though, this concussion thing is much different than I thought it was. It was much bigger than I thought it was. And it’s been sort of swept under the carpet for generations. Because it’s not good for sports. And people like the NFL were sort of actively sort of trying to undercut it. So I wrote a I wrote a book about sort of what I went through. And the fact that the NFL is covering this up and saying, Hey, we can do this better. And that’s sort of how this whole thing started and started the concussion Legacy Foundation and everything was because I just couldn’t get better. I, I understood, eventually understood why by doing the right research.

Andy Slavitt  12:06

Okay, let’s take a quick break, I want to come back and talk about the risks people are taking, whether they know they’re taking those risks, whether it’s all fair, what role we play, and whether kids should even be playing football at all.

Andy Slavitt  12:42

As you roll forward from what you were discussing earlier, the NFL, what are the protocols supposed to be today? What’s the big thing that the NFL is supposed to put in place that is supposed to move past the controversy of when they were caught, as you said, covering up for concussions and kind of all of the CTE that was found in autopsies that I think you’ve written about?

Chris Nowinski  13:08

Yeah. So if we want to jump into protocols and talk about, you know, the what happened to attack a viola this year, is really what sort of put it in other cities.

Andy Slavitt  13:16

He’s the quarterback for the adult Miami Dolphins. Yeah. Okay.

Chris Nowinski  13:20

And so this sort of happens every few years that there’s a really badly mishandled concussion case, it puts a big spotlight on this and always moves the protocol forward. So if you go back to 2007, eight, when we first start having this conversation, there was no protocol. You could be knocked unconscious and the NFL was would say, publicly, there’s no evidence to say going back in after you wake up is a problem. And then we basically the neuroscience community sort of pushed back and said, No, your brain needs time to recover, just like your hamstring does. And putting people back in with a concussion makes the injury worse, one of the long term effects can in careers, and even you can die from second impact syndrome. So then the question became, well, what is the proper way to evaluate somebody who’s had a concussion? Or you think is that a concussion determine if it’s actually happened, and if it’s safe to return them. And so these protocols came out of this idea that players want to play when they’re healthy. But when they definitely have a concussion, we should protect them from themselves and remove them. The problem is that a big money sport like football, people really want to be in the field and you have an injury that you can’t definitively diagnose, ever. So I concussion there’s no blood tests, there’s no scan, it’s a doctor’s decision based on the presence of signs or symptoms, and a mechanism of injury where something I hadn’t had. So at the beginning, you know, the other protocol is basically like, if they think you have a concussion, which is subjective and they pull you out, they put you through some questions, and they decide whether you have one or not, and it’s safe to return. And that got get kept getting more and more codified so what happened on the sideline then became like a universal every team has to follow this protocol. And then it became the discussion then moves to what happens on the field to put you in that protocol. And there have been, I can remember going back now there was a time where Stuart Bradley Philadelphia Eagles player like got up, fell over on his face got up again, they left him in the game, and then it became okay if you if you fall over, you should, you should come to the sidelines to be tested. And then there was a time when Tom savage a quarterback with a Texans had a fencing posture where he was knocked unconscious and his arm went up. And no one apparently saw it who had a choice about whether should go back, the doctors missed it. So that it became if anyone shows fencing posture, they can’t go back in, and they’re going to put somebody up in the booth to watch the game case, the doctors and rest don’t see it. And so the NFL just keeps layering up, and adding more and more resources to try not to be embarrassed about putting somebody who obviously has a brain injury back into harm’s way. And so with two, we just learned that still not a foolproof system.

Andy Slavitt  16:01

So do you feel like people are well informed enough when they make a decision to play a sport like football or another sport where they could risk a head injury, that they understand the science enough and they’re making a well informed decision? Or is it that really not the case yet,

Chris Nowinski  16:19

it would be impossible to say it’s the case because we can’t tell anybody what their risk of developing CTE is, because we can’t diagnose it yet living people. So we’re basically playing catch up on a disease that was first sort of identified and give it a name 100 years ago as punch drunk and boxers. But there was no academic study happening on the disease from like, 1970. Until we started the brain bank at Boston University, we co-founded in 2008. So like there was nothing going on in this very important period of science. So the scenario we sort of imagined as the most common age people now start is 13, or 14. And we can’t tell them the risk of them getting this brain disease. But what we do know is that risk goes up every year they play. And what we do know is in the college players have been studied, who again, probably the most symptomatic, but 90% of them have had it and it’s about two thirds of the college players, and it’s a quarter of the high school players. And it’s it, the question becomes how skewed you think that sample is? And so can a 13 or 14 year old make a good decision based on incomplete data? And the answer is no. And then the question is, do we adults buy into this connection enough to at least put reasonable protections in place? And I’ll say the answer today is not really, right. Like we have concussion protocols now, but there’s no evidence that sitting out after you already have a brain injury is going to make that you less likely to develop CTE. So I would think, like an example of we’re taking this seriously would be are we take giving children the fewest number of head impacts that we can within the constructs of the games exists today. And even that’s not happening, right. So what we’ve we shine the light to as an advisor, the NFL player Association over a decade ago saying, Look, you know, even if we don’t understand everything, what I can tell you is 60% of your head impacts are happening in practice. And none of that matters. That’s not what you’re getting paid to do. So why don’t you fight back and say, I want to take out those headaches, I still play the game for the money. But let’s learn another way to practice and the NFL adopted that because the player Association fought for that. And that’s not happening at any of the lower levels.

Andy Slavitt  18:29

You know, you watch something like for example, the Damar. Hamblin situation, no, that wasn’t a hit to the head, it was a hit to the chest. And I imagine people feel somewhat complicit or at least part of them, in that you’re watching the sport for entertainment, as you say, and we forget the actual risks that people are taking. And, of course, all the money encourages them to take that risk. And I imagine once kids start on a path where they’re going to choose sports over some other career, and they’re going to try to play professional sports, you know, it’s sort of do or die financially. That is, if you’re going to make some money, get some acknowledgement, make great achievements in your sport, you know, you’ve already sort of decided to take that risk. And so you’re only bound by the rules. And as you say, if they change the practice, protocol, just make it make it not possible in the pros to practice and get a concussion, then that’ll do it. But the whole system basically implies that they know it’s bad in practice, they also know it’s bad in games. So I think people would love to think that there is an answer, which can turn the game safer for people and still make it enjoyable. Does one exist?

Chris Nowinski  19:41

No. No, it’s Yeah. And you were you were mentioning, you know, people growing up in the game and all that, you know, one of the great ironies of the game is that when people are old enough to understand what CTE could be and think long term about what they want out of their life, they’re already so far into the system, that it’s hard. You see them struggle, I talk to an NFL rookie this year in the middle of the season, tracked me down through an old teammate to say, like, look, I’m, you know, I, I went out to college, I, you know, I was focused on academics first, I never thought this football thing would work out, but it worked out. And I’m making money, it’s fun, but I’m realizing that if I keep going, I may impair my ability to have the career I really wanted to have. And it’s like, I don’t know whether to walk away or not. And it’s like, that should be the decision, the conversation you’re capable of having before even get on there. Now he’s been playing for 15 years may already have the CTE. And now he’s finally aware enough to leave. So it is a complex thing. If we think the future of football, like I’m all for somebody used to be a professional wrestler, let people hit me in the head of the folding chair, like, you can do a dangerous thing. If you want to, to, you know, earn your living to care your family, you know, it’s more dangerous to be a police, you know, police officer or a firefighter or serve in the military, like those are real life and death jobs. So there’s not it’s not an ethically is that you can’t go run into that person and tackle them. But the question is, who should be doing it? And what should they be told about it? And worse, how they should? How should they be protected? And so I think what happened Hamlin was sort of I think a lot of our emotion about the whole safety issue happened in a moment, right? You’re watching someone literally fight for life and death after you’ve been reading about them fighting for life, fighting for love their life off the field in a much slower way that you can’t see. And so I got it all realized, like, we want him to survive so much, because we also want to keep watching football, and love it. Besides the human side of it is caring for him. And what a special guy he was. So are he is thank God, he survived. So that I think the way forward is this shouldn’t be a game for children. Right? We know it’s dangerous, where we launched a campaign in September called Stop hitting kids in the head to just make it very explicit. Like, there’s no,

Andy Slavitt  22:00

it sounds pretty rational.

Chris Nowinski  22:03

There’s no good reason to ever expose a child to 500 head impacts every fall like you don’t care what you think you’re teaching them, it’s not necessary.

Andy Slavitt  22:11

So you run into disagreements, you run into people who really push back and say, No, this is a way of life. This is how we do things. This is how I grew up, or whatever their argument is, right?

Chris Nowinski  22:22

Yeah, you do. And it’s, it’s a few different reasons, right? There’s people who did it themselves, and they’re fine. And that’s, you know, sort of mental trick of, you know, I, you know, I did it, I’m fine. It made me who I was, now, I want my child to have the same experience. And you can understand that completely. Right? And then there’s the, you don’t tell me how to parent my own kid. Right. And there’s the, the evidence isn’t complete. And, you know, you’re studying mostly NFL players or college players, and there’s no, you know, necessarily evidence that it’s gonna happen to my kid after a few years. So I mean, it’s, it’s a hard thing, no one wants to be told to do it with their kid and no one wants a fun activity to be taken away. The good news is by educating the public on this youth tackle football participation is down about 40% Since we started, so used to be over a million kids playing every week in the fall to now about 600, some 1000, I think it’ll continue to drop, but there’s been no, no one’s come out and said this should never happen. Partially because youth football, unlike other youth sports is really a bunch of small capitalist organizations like popcorn and American youth football competing for kids, rather than a national governing body, setting the rules for the sport. So, so it’s a battle, understandable battle. And that we’re not trying to say anyone who chooses to let their kid do this as a bad parent, we’re more looking at it from the idea of, again, it’s not fair to give a kid a brain disease. Football is one of those unique sports where you don’t need to do it Young. To be good at it. It’s just about being a great athlete. There’s an alternative called flag football, that gets people to where they need to be physically and get less you learn rules of the game. So it’s basically from our perspective, it’s just a better to better choice.

Andy Slavitt  24:07

I will take one final break and we’re gonna come back and talk about violence and sports and how some of your research Chris is changing the way we look at the game. So you’ve taken a bold stand against something that for people is a lifestyle, a cultural issue, which is pretty brave to do, and you you’ve, you’ve use science to do it. And as you said, you’ve gotten pushback, if you want many converts.

Chris Nowinski  24:51

Yeah, yeah. I mean, we I think we’ve seen that the numbers going down is a big deal. But I mean, I remember there’s a division one football coach who stopped me in it dinner when he was still coaching. He said, Listen, I, when this came out 10 years ago, I pulled my kid out of third grade tackle. And then he put it back in in high school and the kids not playing college. And those are even football people are, I think are making better decisions right there. They’re now like real, especially people who are in the football ecosystem, a lot of them are realizing they’re losing friends. You know, I lost. You can see that picture back there. That’s my Harvard team in 99. We just lost our captain, he died, the CT and stage two, you know, Harvard captain, the best guy among us, for young kids was the man even got his MBA from Dartmouth after playing in the NFL. And he died from alcoholism. And then when, of course, I was certainly at CT. And that was the difference between someone who can get better from alcoholism and someone who can’t

Andy Slavitt  25:47

you tell us about the relationship between addiction and CTE? It was so we

Chris Nowinski  25:51

don’t have we haven’t really done the data on that. It’s hard to gather that from a brain bank study, I what I will tell you is, I can’t believe how many former football players are dying from addiction issues. And how many reach out to us on a regular basis, or their wives that are struggling with alcohol, or painkiller because it was such a pain issue in football, or other things. And I think there’s a strong link. And it can imagine with frontal lobe damage, but you never know.

Andy Slavitt  26:19

So I picturing people in physical decline, mental decline, maybe with some degree of regret, maybe they have mixed feelings about whether they should have played or not, but maybe they have some amount of regret. In here you are, you’re your football career over and you’re only in your 40s, where many people have most of their lives ahead of them. And you can understand where addiction comes into play to understand where self-medication comes into play. And I think it might be useful, even if it’s somewhat painful to listen to, for you to describe the life of someone who has been playing for, as you say, 1520 years. And they’re starting to face that those symptoms and the decline.

Chris Nowinski  27:04

Yeah. So I’ll tell you, I just spoke to the wife of an NFL player that we’re, that is reaching out for help. So he’s in his late 30s, he just got diagnosed with Parkinson’s disease, which is your odds about Parkinson’s are about four times higher if you played the NFL. So that’s a very, very difficult diagnosis and one that’s going to be hard to deal with for the rest of his life. In a slowly loses, he developed tremors as well as his ability to walk and slowly won’t be able to make, you know, his face will become frozen, and his cognition will start to become more impaired. So there’s he’s got that he’s got other issues from recently. toradol is a painkiller that used to be very popular to be given to players the day of games so that they would feel this basically, they use different surgeries as an anti-inflammatory, for pain. And they were giving the players game day. And so as he’s got kidney issues from that, so there’s is facing potentially going to have to go on dialysis at some point, again, is this 30s. And then, and then there’s just chronic pain issues from orthopedic injuries,

Andy Slavitt  28:21

if that’s the type of story you hear commonly.

Chris Nowinski  28:25

That is that I mean, again, it’s not like everybody, but it’s the you know, people reach out for help. That’s the that’s the stories we hear that, you know, I talked to another player who was reaching out for a study on cognition because he’s worried and his issue is 330 pounds still, because people don’t lose the weight after their NFL career. And part of that is because they’ve already had orthopedic injuries. And so exercise hurts and so like they don’t do as much it also your body sort of your fat cells sort of delve a memory, it’s like, when you start losing weight, your cells want to get back to wherever you were, they think something’s wrong. And so it’s hard to lose weight and keep it off. And so people don’t realize that when they become linemen that 13 Or, you know, in their teenage years, and they’re told gain weight, even if it’s good weight, that weight doesn’t necessarily come off. And so yeah, it’s I mean, it’s one of those things like, football is a ton of fun. But you can see why he will like playing it, like watching it. And you’ll never be part of a larger gang in a school, you know, where any people have your back and you’re part of something special. But these risks that come from it are not appropriate for children and not something that we talk about or celebrate and they’re hidden. And if you end up losing, drawing that short straw and getting these bad things like it can ruin your life. And that’s why it needs to be talked about.

Andy Slavitt  29:46

Yeah, it’s so hard to tell a young person about something that they might feel or regret 2030 years later, right. Yeah, exactly. But it’s important that you’re doing that. I want to just finish by asking you about other sports because you know more and more research As done, the more people are pointing to things like, Gee, should you really be heading the ball at soccer? I grew up playing soccer. You know, that wasn’t a question. Are there other sports that you could point to that you’ve seen research on or you’re doing research on that you also point to parents as places of concern?

Chris Nowinski  30:20

Well, I’ll probably stick to neuro on that just because certain repetitive stress injuries are a tough thing to sort of quantify there’s certain sports where you have to be you know, in a crouch the whole time squatting and things where you know, that can’t be good for your knees and, but mostly for me, it’s brain and it’s been hitting that all the time. And I think I think you’re right that the mean, football, rugby, the tackling sports, you’re gonna get hit in the head hundreds of times. And it’s just the reality. Soccer is one of the easiest fixes, right? Because a most of the heading is coming in practice, you know, and can’t get that many hitters in the game and be what we’re talking about now, with some schools getting rid of heading outside the box, because reality is you don’t really need it. Like if you’re trying to score goal or defending goal sure, like you can make an argument to use your head but the middle of the field, you know, play it off your chest, get you know, what, why would you want the 50 yard punt taken off your forehead, right? It’s just, it’s just sort of going after all of these sacred cows of like, we do it because of tradition, and saying, Well, actually, now that we know things, but I mean, you know, you and I are old enough to remember all the ridiculous training things even we did as kids that we now look back and think are insane. Like I had to have a talk with somebody, we do a warrior workout called the 30 day challenge as part of our exercise, or one of our things for veterans with brain injuries, and set up the doing 38 Push-ups, 30 squats and 30 Sit ups. And I’m like, didn’t we get rid of sit ups? Like I think it’s terrible for your lower back. It’s like, it used to be the core of exercise.

Andy Slavitt  31:51

That’s why I stopped doing situps for sure, yeah.

Chris Nowinski  31:54

But so yeah, so I mean, it’s, it’s, it’s all these sports can be done safely. And it’s just it’s not, you have to just say unpopular things, to get them there. And we can get there.

Andy Slavitt  32:05

Yeah, it takes a bravery. So as I finish up, I want to just play ahead to what you think the sport will look like, in 10 years and 20 years, I can’t see the future I can, I’m always wrong if I’d say what’s gonna happen the future. But I have a hard time actually picturing football, working the way it does today, in 10 years, or 20 years’ time as the knowledge that you’ve talked about, becomes embedded in our consciousness as more and more players age. As more and more of these stories emerge as more research emerges, as more parents become aware, which is not to say that, you know, people won’t still love the game or still want to participate in game. But it feels like you’ve described a league that basically doesn’t care and condones it and you’ve described a system that will only stop at whatever the rules actually are, they won’t, they won’t take safety measures above and beyond that, unfortunately. So it feels like that leaves the society with almost no choice, but to take some action. So I’m wondering where you think it’s if you’re watching the game, and 10 or 15 years, what it looks like?

Chris Nowinski  33:10

Well, yeah, I mean, it changes slower than you think. Although if you look back to 15 years ago, it was different. We used to celebrate those big hits across the field to defenseless receivers, and now you get ejected for it. I think I mean, the future of football is relatively simple. It’s just how fast we get there. It’s no tackling until 14, I think, at some point high schools are going to have to have a reckoning of Is it a good idea for public schools to be getting, you know, trying to make kids smarter, while giving them the risk of a brain disease, the moment of reckoning is going to come when we can diagnose early CTE and living people. Because if we start running, if we could run the print, you know, blood tests on 16 year olds, and we find out that, you know, 5% of the kids on a football team already have it. Can you even continue doing that. But once you get to the age of college, and Pro, you can do anything you want. And so those will be thriving, because it’s such a good sport of TV, and you’ll just keep seeing iterations of it, you’ll find that a bench of the three point stance is gone in 10 years, right? We’ve learned that you can still play football, but not get so close to ground where to move forward, you have to lead with your head, you know, you can do more and angles and standing up. So we’ll just see tweaks will see a lot more throwing than running. It’ll keep moving in that direction. But, but the real changes will come for kids and high school students. And

Andy Slavitt  34:28

yeah, well, we grew our kids up in Minnesota, which is you knows a big hockey town. And one of the guys in my company, son was a big rock star hockey player. This kid was on his way to the pros, and sustained an injury after he was drafted before he went, ended up never playing a game got deeply depressed, got addicted to opioids, and the rest is history. And of course at the time that I heard the story I was it was it. I didn’t know that it was part of a larger large, large trend. I thought I knew this guy very well. And I knew the story of his son. And he was really thinking about leaving, what he was doing to go actually speak to high schoolers, who were thinking about playing hockey and telling them not to, because he basically didn’t, he said, My son never went to class. He never had to go to class. He always got past we, he always did this thing where he would be on these travel hockey teams. So he would be away during the school year. I encouraged it as his dad, because I thought he was great. And all that got all the glory, and he get these goals, and everybody would love him. And he loved himself. But it was his only identity. He said the thing that was hardest, if anything, and the biggest regret, is his entire identity was as an athlete as a hockey player. And when he no longer had that he had nothing. And that’s what led to suppress it as much as anything else. Yeah,

Chris Nowinski  35:56

no, I mean, it’s only gotten worse. I think in the last couple decades that we overemphasize sports for kids so much. And then I and that’s conversation I have now with my peers who have kids, and I waited. So my son, I have a four year old daughter and two year old son, and to also I was already can tell is going to be great athlete, and I’m like, we are focusing on science, and he’s gonna do theater, he’s do all these other things. So play sports, too. But we’re never going to say like sports is the most important because it does, it can mess with you. If you if you peak too early, before you profit from it. It can be a detriment.

Andy Slavitt  36:32

This is why back in the 70s. I was purposely on the beat Team in sports. Yeah, see, I knew because I knew that I was I was purposely not very fast. Not very strong, not very coordinated or athletic. Because I was, you know, I was just ahead of the game, I think I feel

Chris Nowinski  36:49

the same way is why you never want to be too attractive. Because people will just be nice to you all the time. You’ll never learn anything. Right?

Andy Slavitt  36:57

I made all the right choices clearly. Well, it’s been a real pleasure to talk to you. And I’m really glad you’re doing better. I’m really impressed that you’ve taken such a strong stand based on what you know, against. And then it is so nice. It is not easy to take a stand in situations where you’re already you’re part of that club. And you’re saying something that not as popular. People don’t want to hear, but you think needs to be said. That’s what they used to call leadership. That’s what I call leadership. So very, very impressive. And thanks for what you do.

Chris Nowinski  37:30

I appreciate it. Andy, really nice to talk to you. And yeah, we’ll keep fighting the good fight that not hard to try to protect the guys that you know, you went and fought with for so many years. And that’s the way I look at it is taking care of the guys to carry you.

Andy Slavitt  37:58

Let me tell you we have coming up next week. Mike Osterholm is with us. It’ll be a great conversation. You all know Mike as the OG godfather of public health, opinionated, ornery son of a gun, we’ll have a good time, then we’re going to talk about the issue of 2023. Without a doubt, the biggest litmus test issue in 2023. The gas stove, that’s right, the gas stove. And at one hand, it’s the story of how I think the climate issue is gonna be fought and hand to hand combat. It’s going to be fought and head to head combat, every time somebody tells you that there’s something that’s better for the planet. And it’s something that you don’t want to do, or you don’t want to hear. It’s good to create controversy. It also falls right into the trap of being this culture war, and why a stove could turn into a culture war. Only we in America could turn the stove and new culture war. So we’re going to contribute to that war. We’re going to take a position I’m not sure what our position is, yep, we’re gonna take a strong position, either for or against the guest of by actually doing something unique these days, we’re gonna give you facts. We’re going to tell you exactly what is known and unknown, what is being overplayed, what is being underplayed? How it’s being hyped up, how it’s turned into a culture war. I will never have so much fun talking about an appliance. I promise you. Okay. Have a great, great, great weekend. We’ll see you on the other side of it.

CREDITS  39:37

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.