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May 30, 2014

How many kidneys is your NFL career worth?

If the latest lawsuit by former players against the NFL teaches us anything, it's that it's finally time to do away with the entire practice of team doctors.

The suit, filed Tuesday by eight retired players, including three from the Super Bowl Shuffling 1985 Chicago Bears, alleges that the league administered painkillers without prescriptions in order to mask injuries and keep the players on the field, resulting in long-term disability and drug addiction. The plaintiffs filed the suit separately from the ongoing NFL concussion case and hope to gain class-action status, saying that more than 500 former players have agreed to sign on.

Knowing all we now know about the NFL's priorities, this lawsuit isn't exactly surprising. There's enough outrage here to go around, so let's reserve some for any team doctors, who, faced with the glowing specter and bountiful resources of the almighty Shield, allegedly couldn't help but sell out.

The conflict of interest inherent in the team doctor-player relationship is clear. A physician's primary responsibility is to his patient, but that gets muddled when the prestige and the paycheck come from the organization employing both. The line is even further blurred when you consider the increasingly common practice of million-dollar sponsorship deals between teams and local hospitals, whose doctors receive exclusive contracts to treat athletes and get touted as "the official physicians" of a running back near you. The team, and the league, is best served when the player can continue taking the field, no matter how many pharmaceutical Band-Aids it takes. So the physician is sorely tempted to issue a diagnosis based on half-truths and prescribe a treatment that will get the product - I mean, the patient - ready to go by game day.

Now, I'm not suggesting all NFL doctors are crooked or that they consciously look past players' interests in favor of the teams'. Frankly, it doesn't really matter if they do it on purpose or not - no doctors should be put in a position in which they're forced to consider anything but their patients' needs. That's as true with league-employed physicians as it is with doctors who prescribe drugs made by pharmaceutical companies or other medical suppliers with which they have cozy relationships.

Speaking of which, this lawsuit also highlights the problematic relationship the NFL has with the pharmaceutical industry, a relationship fostered by the enormity of the health-care lobby and the ineffectiveness of the FDA.

Thursday on ESPN Radio's "Mike and Mike," former NFL defensive end (and Columbia Lion) Marcellus Wiley discussed his intention to join the painkiller lawsuit, describing the full-body pain he still experiences after his 10-year pro career. Wiley was recently hospitalized after he was unable to get out of his car because of debilitating muscle cramps. After three days treating him, doctors informed Wiley that he had acute renal failure. That a former athlete who has maintained healthy habits suffered from kidney problems at the age of 39 was puzzling to everyone - until Wiley read up on some of the drugs he and his teammates were fed during his playing days, in particular Vioxx and Toradol.

To refresh your memory, Vioxx was an FDA-approved pain reliever sold in the United States for five years until it was discontinued in 2004, when a study linked its use to higher rates of heart attacks and strokes. In total, 25 million Americans and 84 million people worldwide were prescribed Vioxx - in addition to however many NFL players were administered the drug illegally - as it was sold as a substitute to aspirin with fewer side effects. Its maker, Merck, pleaded guilty to criminal charges and paid nearly a billion dollars in fines over fraudulent marketing.

Toradol is an injectable pain reliever and blood thinner that's still extremely popular throughout sports, not just football. Touted as a "magic potion," it supplanted cortisone as the painkiller du jour once the latter was discovered to cause tissue damage, and bone degeneration, but it has been linked to joint damage as well as disease of the liver, stomach and yes, kidneys. In 2011, ESPN the Magazine's Eddie Matz explored the rampant use of Toradol among NFL players, many of whom receive injections on a daily basis. One former team doctor expressed concerns with drugs such as Toradol used primarily to numb and desensitize: "Do drugs like Toradol enable players to play, or do they cause further injury?" he wondered, as Matz noted that the drug's long-term effects were unknown. Wiley said his doctors recently informed him that prolonged Toradol use combined with his history of asthma (which team doctors knew about) likely caused his renal failure.

These violations of the principle of informed consent are a lynchpin of the ongoing concussion lawsuit and the recent painkiller suit against the league. It's also indicative of the look-the-other-way culture the pharmaceutical industry and its millions have managed to build around its drugs. But Big Pharma isn't wholly to blame for the misuse of Toradol. The FDA is certainly culpable for being utterly useless in allowing such drugs to remain on the shelves - remember that Vioxx was pulled by its manufacturer and only once word of its side effects caused massive public backlash - but it does prove to have some value in the printing of warning labels department. Mostly, though, it's the team doctors, who seem to have taken recklessness to a new extreme by continually administering a dangerous drug whose black-box warning clearly states that it's meant for short-term use (five days, max), not the course of a player's career.

Some have questioned the role the athlete's own personal responsibility should play in this whole situation. After all, NFL players are allowed to consult personal physicians and seek second opinions. But as long as teams continue to employ doctors who are readily available to players on sidelines and team locker rooms, that doesn't seem entirely realistic. Even if those doctors routinely educated the athletes on the risks of their treatment, football culture often causes players to act against their own interests. If a second-string player who can't bank on his name or fame for leverage feels symptoms indicating injury outside the normal wear and tear of the game, his fear of being cut might ultimately trump his fear of long-term internal damage. The NFL is built on an image of toughness; playing through pain is instilled in athletes as a badge of honor, a sign of a true warrior. It serves everyone's financial interests to ignore individual health and bypass proper medical procedure in the name of keeping those warriors on the field - brain damage and renal failure be damned.

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