Football is far and away America’s biggest sport. But considering what’s been learned in recent years about the possible brain damage that comes along with it, should we keep it on its pedestal?

For over a century, baseball was unrivaled as “America’s pastime.” With an appeal transcending geography and social class, it was the racial integration baseball in 1947 that began to break the camel of segregation’s back, even though Black players were playing pro football as early as the 1920s.

But by the 1990s football had pushed baseball to the side of the sports stage. Each fall the ratings landscape is dominated by NFL games, with the Super Bowl being the year’s most-watched television program, a fact reflected by that year’s lucky TV network being able to charge millions of dollars for each 30-second ad spot. Today the NFL generates well over $10 billion in revenue annually, while the NCAA adds an additional few billion for the football pot. That’s at least as much is generated each year by the sales of recorded music in the entire world. Football is entertainment on the grandest scale.

That entertainment reaches down to children. Organized tackle football is played by children as young as 5 and is a staple of nearly every high school in the country. Needless to say, kids also make up a large part of football’s vast viewing public. And what they see onscreen are the gladiators of our time, glorified for their strength, courage, and fierceness in battle. To be sure, football is an artful, even beautiful game; but what is obvious to even the uninitiated eye is its violence. However controlled, rule-governed, and usually ethical as it may be, it is a violent sport. It may not be like boxing or mixed martial arts combat, where the central goal is to harm one’s opponent to the point of his being unable to continue to fight; but as legendary Green Bay Packers coach Vince Lombardi one said, “Football isn’t a contact sport, it’s a collision sport.”

Something we’ve learned since Lombardi’s time is that those collisions may result in long-term consequences. Of particular concern is chronic traumatic encephalopathy (CTE), a rare neurogenerative disease widely believed to result from suffering multiple head injuries. Its link to football stems from the fact that the condition has been found in nearly every deceased college or professional football player whose relatives donated their brains for study. A 2017 JAMA Neurology article, for example, noted that out of 171 such brains, 164 were diagnosed with CTE.

For years CTE was the NFL’s dirty little secret, with the league’s efforts to mute discussion of the condition popularized in the 2015 film Concussion, which stars Will Smith as Dr. Bennet Omalu, the real-life neuropathologist who discovered and first published on CTE after his 2002 autopsy of Mike Webster, the Hall of Fame center for the four-time Super Bowl champion Pittsburgh Steelers of the 1970s.

Despite being only 50 at the time of his death, Webster had suffered from amnesia, depression, and dementia after his football career, symptoms believed to be characteristic of persons with CTE. However, because at present CTE can be diagnosed only during an autopsy, it is impossible to know whether CTE is the cause of such symptoms in a living person.

But once these symptoms evince themselves, it’s too late anyway: CTE is an irreversible condition. The need, therefore, is to prevent anyone from getting CTE in the first place. And this is where the question of whether tackle football should be played at all gets asked.

Despite the seeming universality of CTE in the brains of former players examined for the condition, the data is not so clear-cut. For starters, as a small team of authors pointed out in Scientific American last year, most of the brains examined thus far have been of players who were symptomatic for CTE. Establishing a definitive link between football and CTE would begin with the requirement of a randomized study of a large number brains of former players, symptomatic and not.

Things get murkier still when the authors consider perhaps the best longitudinal study of how former high-school football players—specifically, Wisconsinites from the Class of 1957—fair emotionally and psychologically over the course of their life. “We were surprised to find,” they write, “that playing high school football did not have a statistically significant harmful effect on later-life cognition and mental health in this sample. Moreover, it did not have an effect on anxiety, anger, hostility, or alcohol abuse later in life.”

They note, however, that changes in football since the studied cohort played the game. “Advances in helmet technology aimed at preventing catastrophic head injury may have had the unintended consequence of encouraging players to ‘lead with their heads,’ increasing exposure to concussive and sub-concussive blows,” the authors note. “Current athletes are bigger and faster and may be exposed to more powerful blows. Today’s player is probably more likely to enter high school with one or more prior head injuries, due to a trend towards young athletes ‘specializing’ in football at younger ages and playing year-round.”

Then there’s the question of freedom. Football is a game Americans love to watch and play, and anyone who doesn’t like is free not to participate as either player or spectator. Of course football is not the only pastime that carries with it a level of risk. Boxing, bicycling, ice hockey, skydiving, auto racing, and even skiing each lead to at least dozens of serious injuries and deaths per year. And if you’re looking for the sporting activity that results in greatest percentage of traumatic brain injury in adults, you’ll find it not in football—or in any contact sport, for that matter—but in horseback riding.

In children, though, contact sports are indeed the number-one cause of such injuries, which is another reason why discussion about football’s safety is well advised, particularly here at the dawn of another NFL season, when hundreds of millions of people will watch massive men collide at high speed and be rewarded with cheering crowds, product endorsement deals, and many millions of dollars.

In the final analysis, discussion may be more important than any concrete action. Honest, open, informed discussion about the dangers of any activity is what helps people and parents put themselves in the best position to decide what they and their children should or shouldn’t be doing. That may be particularly important when it comes to football, which is likely to endure as America’s favorite sport for a long time to come.

About the Author:

Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.

His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. Contact: [email protected]