Monday, January 27, 2014

An Independence Scorecard for the NFL Head, Neck and Spine Committee

This week my course on "The Governance of Sport" is discussing League of Denial by Mark Fainaru-Wada and Steve Fainaru. The Fainaru brothers document a systematic effort by the NFL to co-opt experts who downplayed the risks of concussions to football players.

They explain that in 1994 the NFL set up an expert advisory committee, the Mild Traumatic Brain Committee, which was compromised from the start:
[NFL Commissioner Paul} Tagliabue's concussion committee was made up entirely of NFL insiders. Nearly half the members were team doctos, the same men who had been sending players back on the field for years. .  . Before the MTBI committee had puiblished a word of scientific research, it had staked out a position as a defender of the NFL.
With the NFL presently being sued over its role in downplaying the risks of concussions, you'd think that it would have cleaned up its advisory process to meet higher standards of expert advice. Indeed, the NFL revamped its committee in 2010, installing new co-chairs and renaming it the Head, Neck, and Spine Committee.

The NFL explains:
As part of its ongoing efforts to protect and support the health and safety of its players, the NFL has established several health committees to advise Commissioner Goodell, the NFL and the 32 teams of the NFL on health-related issues, policies, research and programs. These committees are comprised of independent experts from relevant scientific and medical fields who serve as volunteers.
One of the co-chairs, Dr. Richard Ellenbogen of the University of Washington, also touts the committees lack of conflict of interest:
I should note, neither Hunt Batjer or I [committee co-chairs], and no member of our committee, is paid. We have no conflict of interest, we declare this at the National Institutes of Health every time we apply for a grant. Since we get no money for doing this, we’re in the most enviable position of all, which is we can tell the NFL and the commissioner the truth, all the time, every day.
What is a "conflict of interest," anyway? A committee that I participated on several years ago used the definition accepted by the National Academy of Sciences in the context of expert advisory committees (here in PDF):
The US National Academy of Science uses this definition: “The term ‘conflict of interest’ means any financial or other interest which conflicts with the service of the individual because it (1) could significantly impair the individual’s objectivity or (2) could create an unfair competitive advantage for any person or organization….[Conflict] means something more than individual bias. There must be an interest, ordinarily financial, that could be directly affected by the work of the committee. Conflict of interest requirements are objective and prophylactic. They are not an assessment of one’s actual behavior or character…."
What role should individuals with a conflict of interest have on an expert advisory committee? We explain:
The desired norm . . . should be to appoint advisory committees whose members are free of conflicts of interest. (Relevant experts who have conflicts could still make presentations to a panel.)
Even FIFA recognizes what it means to have "independent" advisors:
 [An advisor]  shall not be considered independent if, at any time during the four years preceding his term, he or any family member (spouse, children, stepchildren, parents, siblings, domestic partner, parents of spouse/domestic partner and siblings and children of domestic partner):
  • held any paid position or material contract (directly or indirectly) with FIFA and/or any Member, Confederation, League or Club (including any of their affiliated companies/organisations);
  • was employed by FIFA’s outside legal counsel or by FIFA’s auditor (and was engaged in auditing FIFA);
  • held any paid or voluntary position with a non-profit organisation to which FIFA and/or any Member, Confederation, League or Club makes annual payments in excess of USD 100,000.
Let's apply the criteria of "independence" recommended by FIFA and the US National Academy of Sciences to the NFL's current membership of its Head, Neck, and Spine Committee.

With just a cursory examination it is easy to see that there are at least 8 (of 34 members) who are not independent and would be judged to have a conflict of interest, as defined by the NAS. They are:
* Ronald Barnes, Senior Vice President of Medical Services, Head Athletic Trainer, New York Giants
* T. Pepper Burruss, Head Athletic Trainer, Green Bay Packers
* Henry Feuer, M.D., FACS, Associate Professor of Neurosurgery, Indiana University School of Medicine; Member, Indiana Spinal Cord and Brain Injury Research Fund Board; Team Neurosurgeon, Indianapolis Colts; Co-Medical Director, Indiana Sports Concussion Network
* Richard Gliklich, M.D., President, Quintiles Outcome, Inc.
* Merril Hoge, Former Player; ESPN Analyst
* Thom Mayer, M.D., Medical Director, Studer Group; Medical Director, NFL Players Association; Founder and CEO, BestPractices, Inc.
* Joseph Skiba, Equipment Director, New York Giants; Member, NFL Injury and Safety Panel, Foot and Ankle Subcommittee
* Anthony Yates, M.D., FACP, Clinical Assistant Professor of Medicine, University of Pittsburgh School of Medicine; Co-Director, Corporate Health Program, University of Pittsburgh Medical Center; President, NFL Physician Society; Team Physician, Pittsburgh Steelers
A more comprehensive evaluation may identify others.

Long story short: The NFL's Head, Neck, and Spine Committee does not come as advertised, nor does it meet basic standards of independence and standard guidelines for managing conflicts of interest.


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