SUBJECTS — U.S. 1991 – Current; Medicine; Sports;
SOCIAL-EMOTIONAL LEARNING — Courage;
MORAL-ETHICAL EMPHASIS — Trustworthiness; Responsibility; Citizenship.
AGE: 13+; MPAA Rating: PG-13 for thematic material including some disturbing images, and language;
Drama; 2015, 2 hours, 3 minutes; Color. Available from Amazon.com.
HAVE STUDENTS READ THE BOOK! Books tell more complete stories than two-hour movies. Concussion, same name as the film, reads like a novel. Based on thousands of hours of interviews with Dr. Omalu, his family, friends, associates, and others, the book delves deeply into Dr. Omalu’s childhood in Nigeria, his battle with chronic depression, his emigration to the U.S., his discovery of Chronic Traumatic Encephalopathy (CTE), the league’s efforts to develop pseudo-science disputing the growing evidence that retired NFL players had high rates of early onset dementia, the NFL’s campaign to discredit Dr. Omalu, and much more. Written by Jeanne Marie Laskas, the journalist who broke Dr. Omalu’s story in a 2009 magazine article, Concussion, the book, is accessible to tenth-grade-level readers and above. The book is interesting if read before the movie, in which case the film can be a treat to reward the class for the effort of reading the book, or after the movie when students will be interested in reading about the characters they saw on the screen.
This film is a dramatization of Dr. Bennet Omalu’s discovery of CTE. The story told by the movie makers is true in that Dr. Omalu, a pathologist who emigrated to the U.S. from Nigeria, discovered CTE when he performed an autopsy of Pittsburgh Steelers star Mike Webster, the NFL tried to create pseudo-science to dispute the growing evidence that repetitive head trauma led to early onset dementia. The NFL attacked Dr. Omalu and his research but a small group of people believed in Dr. Omalu’s work and supported him, and finally, the truth won out as one retired NFL player after another died of early onset dementia. (There are clear parallels between the response of the NFL to CTE and the response of the tobacco companies in the 1950s and 1960s to scientific studies showing that cigarette smoking causes cancer and heart disease.) The major events of Dr. Omalu’s life and his character as portrayed in the movie are reasonably accurate. The struggle of the NFL to discredit Dr. Omalu and his research and the efforts of Dr. Omalu and others who believed that repeated head trauma in football was a causative factor in early onset dementia are telescoped into a few scenes; however, what is shown is consistent with what actually occurred.
SELECTED AWARDS & CAST
Selected Awards: 2016 Golden Globe Award Nominations Will Smith Best Actor; African-American Film Critics Association (AAFCA) 2015 Will Smith Best Actor.
Featured Actors: Will Smith as Dr. Bennet Omalu; Alec Baldwin as Dr. Julian Bailes; Albert Brooks as Dr. Cyril Wecht; Gugu Mbatha-Raw as Prema Mutiso; David Morse as Mike Webster; Arliss Howard as Dr. Joseph Maroon; Mike O’Malley as Daniel Sullivan; Eddie Marsan as Dr. Steve DeKosky; Hill Harper as Christopher Jones; Adewale Akinnuoye-Agbaje as Dave Duerson; Stephen Moyer as Dr. Ron Hamilton; Richard T. Jones as Andre Waters; Paul Reiser as Dr. Elliot Pellman; Luke Wilson as Roger Goodell.
Director: Peter Landesman.
BENEFITS OF THE MOVIE
Concussion is a well-written inspiring tale of David vs. Goliath with excellent acting, direction, and cinematography. With a few minor exceptions, the movie conveys the essence of the actual occurrences.
Students will be introduced to the problem of injuries caused by concussion and repeated head trauma in football and other sports. They will learn the mechanism of traumatic brain injury from blows to the head, that even the richest and most powerful corporations cannot always hide the truth, that one person with integrity can make a difference and the contribution that immigrants make to American society. (These lessons will be even stronger for students if they read the book.)
The incident with the FBI raiding the office of Dr. Wecht is incorrect. While Dr. Wecht’s office was raided and he was subjected to a politically motivated prosecution from which he was eventually acquitted, the prosecution of Dr. Wecht had nothing to do with Dr. Omalu’s discovery of CTE. In addition, we have no information that Dr. Omalu’s wife was followed and suffered a miscarriage. These errors are easily corrected. Otherwise, there are no problems with this film from the standpoint of an educator or a parent.
HOW ACCURATE IS CONCUSSION?
The portrayal of Dr. Omalu by Will Smith is masterful and portrays many of the doctor’s characteristics including his amazing educational achievements, his commitment to scientific integrity, his persistence, his adherence to the Catholic religion, his fondness for expensive clothing, and his love for the United States. The description of the mechanism of traumatic brain injury is accurate, as is the portrayal of the illness and tragic death of Mike Webster and other NFL players. However, the suffering of these men and their families cannot be told in a single film. The seriousness of CTE among retired NFL players is not exaggerated. (NFL actuarial data shows that one-third of all NFL players were likely to develop football-related dementia at “notably younger ages” than the general population.)
The portrayal of many individuals who played a part in the story is essentially truthful, including that of Dr. Julian Bailes, the neurosurgeon who supported Dr. Omalu and became his partner in the effort to reveal the effects of concussion and repeated head trauma, and the portrayal of Dr. Wecht, the colorful Pittsburgh coroner who was Dr. Omalu’s mentor. There are many scenes which recall real events, such as: Dr. Omalu’s testimony in the murder case in which he secured an acquittal of the defendant by demonstrating that the man’s hemophilia meant that he could not have been the murderer, the way in which Dr. Omalu approaches an autopsy, i.e., to solve a riddle, the visit to Drs. Hamilton and Dekosky for confirmation of his findings, the demand for the retraction of Dr. Omalu’s article by scientists in the pay of the NFL, the NFL concussion conference from which Dr. Omalu was excluded and in which Dr. Bailes was ridiculed, , the close association between Dr. Bailes and Dr. Omalu, Dr. Omalu’s relocation to California, the fact that Dr. Omalu could never move into the dream home in a Pittsburgh suburb that he had already purchased, the offer of the position as chief medical examiner for Washington, D.C., and last but not least Dr. Omalu’s description of his idealistic view of the relation between heaven and the U.S.
The filmmakers have altered the story in a number of respects. What follows is a list of the inaccuracies in the film and a number of important omissions. In the view of TWM, only the first two need to be told to classes; the remaining inaccuracies or omissions are good for teachers to know for class discussion.
- Dr. Wecht, Dr. Omalu’s mentor, was the subject of a politically motivated prosecution by the federal government, but it had nothing to do with Dr. Omalu’s discovery of CTE and the efforts of the NFL to discredit Dr. Omalu’s research. Dr. Wecht’s office was raided several months before Dr. Omalu’s article was published. Wecht was a Democrat, and the U.S. attorney for Pittsburgh was a Republican who wanted Dr. Wecht out of the coroner’s office so that a member of the Republican party could take the position. Dr. Omalu, despite the fact that he swore never to serve as a witness against Dr. Wecht, was coerced by the government to testify in the case. The FBI threatened to have Dr. Omalu sent back to Nigeria if he did not cooperate. This destroyed his relationship with Dr. Wecht. Dr. Omalu was forced out of the Pittsburgh coroner’s office, when Dr. Wecht’s successor turned out to be the expert witness who had testified for the government in the criminal case shown at the beginning of the film. This was the case in which Dr. Omalu secured the acquittal of the hemophiliac defendant. Dr. Omalu humiliated the prosecution expert at the trial, and the expert never forgot it. When this same man took Dr. Wecht’s position as the Pittsburgh coroner, Dr. Omalu resigned rather than be fired. Dr. Omalu’s resignation had nothing to do with his brain research. Dr. Omalu was unemployed for many months but finally found the position in California himself. Dr. Wecht had nothing to do with it, and it took many years for Dr. Wecht to forgive Dr. Omalu for testifying at the trial.
- Dr. Omalu’s wife did not have a miscarriage; there was no physical threat to Dr. Omalu or his family, although he was warned about the possibility of a physical threat, and in his darkest moments, Dr. Omalu did fear it. The scenes of Dr. Omalu’s wife being followed and the miscarriage were added for emotional emphasis.
- The Omalu/Bailes partnership is shown. However, it also included Robert P. Fitzsimmons, Mike Webster’s attorney, who championed the retired football player’s cause and sued the NFL for disability benefits for Webster. After Webster died, Mr. Fitzsimmons continued the lawsuit seeking damages for Webster’s family. In the last years of Mike Webster’s life, he relied on Fitzsimmons tremendously, and they became very good friends.
- As shown in the film, the publication of several articles on traumatic head injury among former NFL players that appeared in the New York Times were important in forcing the NFL to act. The articles came about due to the efforts of Christopher Nowinski who was an early associate of Dr. Omalu, Bailes, and Fitzsimmons. Nowinski was a former professional wrestler who suffered from the effects of concussions incurred in the ring. However, he found a doctor who advised him to quit, and as the only pro-wrestler with a Harvard education, Nowinski was able to mount a campaign against repetitive head injuries in football, a cause of brain injury in more people than were injured in wrestling. Nowinski split with the Omalu/Bailes/Fitzsimmons group, formed The Sports Legacy Institute (since renamed as the Concussion Legacy Foundation), Nowinski made a career of campaigning to reduce traumatic brain injury in the U.S., including in the NFL. Nowinski effectively froze Dr. Omalu out of the competition to examine the brains of deceased former NFL players who had symptoms of CTE. This entire episode and Mr. Nowinski’s existence are excluded from the film.
- Before Dr. Omalu’s autopsy of Mike Webster, a number of researchers, including Drs. Julian Bailes, Kevin Guskiewicz, Robert Cantu, and William Barr, were pursuing statistical epidemiological studies showing that retired football players were suffering from increased rates of dementia at earlier ages than the normal population.
USING IN THE CLASSROOM
As set out above, TWM strongly suggests having students in grades ten through college read the book Concussion. The book affords an opportunity for students to experience non-fiction at its best. All of the discussion questions and assignments suggested below will be helpful for students who have read the book as well as for those who have only seen the movie.
Preparation: The Helpful Background section above, How Accurate is Concussion, provides information that teachers can use to enhance class discussions.
Before showing the movie, tell the class that the movie is pretty much accurate except for two incidents that were put into the film for effect and that after the movie is finished, students will get to guess which scenes are not accurate.
After the film has been shown, pose the question to the class, “Which scenes do you think are the least accurate?” This will provide an excellent opportunity to discuss with the class some of the other information in the Helpful Background section. The two scenes that are inaccurate are described in items 1 and 2 of that section.
After the discussion warn students that many people watching the film may come away with the impression that it has been scientifically proven that CTE is caused by concussion or repeated traumatic head injury. However, that link has not been proven. There is substantial evidence that traumatic head injury is a contributing factor in the remarkable statistic that 1/3rd of retired NFL players will develop football related dementia at an early age relative to the rest of the population. However, there are many NFL players who don’t get CTE, and there could be other contributing factors such as drug use or genetic predisposition. As yet, we don’t know what those other factors are. The one variable we can control is the number of concussions and repetitive traumatic brain injuries suffered by football players.
After watching the film, engage the class in a discussion about the movie. Here are some suggested questions and good responses.
1. Dr. Omalu and some other parents will not allow their children to play football. Yet, playing football or other contact sports are good experiences for many students. What should a student think about before deciding to sign up to play any contact sport, especially football?
There is no one correct answer. Strong discussions will cover the following topics. Benefits of participation include: a) enjoyment of playing the game; b) improved strength and conditioning; c) improvement in social status from being on the team; d) an outlet for aggression; and e) learning to work with a team and character building (if the coaches are true educators and not primarily interested in winning). Detriments include a) risk of injury – how serious, how long-lasting, how frequent and what resources are available for medical care; and b) diversion from schoolwork which is the only way to economic security for the vast majority of students. Other considerations are whether for the particular team, the league, and the sport as a whole, the adults, the coaches, and those in charge act in ways that are beneficial to the students/players. There are two questions on this topic: first, whether those in control act with character and teach sportsmanship, honesty, and obedience to the rules, or whether they are focused on winning at all costs. The second is whether those in control are focused on benefits to the players as opposed to their own benefits or the institutional benefits that success on the playing field will bring. Unless the student is one of the infinitesimal group of athletes who have a chance at a professional career, doing well in academics is the best way to economic success and security.
2. Dr. Julian Bailes, neurosurgeon and concussion researcher, who became Dr. Omalu’s partner in the effort to reduce repetitive head trauma in football asked the NFL, “Why don’t you take the head out of the game? Just take it out of the game! Let the linemen start from a squatting position instead of getting down for head-to-head. Have them stand up like they do on pass protection. So there’s not this obligatory head contact.” The NFL has never responded to this suggestion nor have they changed the rules as Dr. Bailes suggested. NFL play still has the “head in the game.” Answer two questions:
- Why are the heads of football players still “in the game?” and
- It is said that the brutality of football is necessary to satisfy the blood lust of the fans. Do you think that this is a valid reason for keeping the players’ “heads in the game?”
(a) The NFL believes that the fans want a game with “head in it” and the NFL has a financial interest in keeping its fans happy.
(b) People differ on the answer to this question. There are “sports” that would not exist if the blood-lust component was removed, such as boxing, professional wrestling, and various martial arts competitions. Many people refuse to watch these spectacles because they don’t like violence. However, in football, the most beautiful and exciting moments come without head-to-head contact such as when a receiver catches a pass or a runner breaks away for a long gain. It can be argued that the reliance on the three-point stance (feet and one hand on the ground, which requires the head to be down) and the head-to-head combat is not essential for football.
Concussion and CTE
3. What are the biomechanics of a concussion?
Concussion results from a rapid change in the velocity of the head. The brain essentially sloshes around in fluid within the skull. When the skull stops suddenly, the brain continues on until it smashes up against the inside of the skull. Depending on the amount of force involved, this causes injury to the brain tissue and internal bleeding. Even one concussion or repeated low-level impacts to the head can cause brain injury.
4. What is “second impact syndrome?”
When a person gets a second concussion before a first concussion is allowed to fully heal, the effect of a second concussion is much worse than the level of impact would normally cause.
5. The brain is 75 to 80% water. In that watery form float 300 billion nerve cells. How are they attached to each other and what does a shearing injury due to the structures that attach the nerves to each other?
The cells are attached to each other and supported by membranes and micro skeletons made of certain types of proteins, including tau proteins. A rotational or shearing injury rips these membranes.
6. Not all football players develop early onset dementia. Does this mean that concussions or repeated head trauma are not a causal factor in the development of CTE and that there is no need to reduce repeated head trauma in football?
It means that head trauma combined with some other factors such as drug use, genetic predisposition, or some other factor causes the injury. We don’t know what those other factors are. The factor that we can control is repeated trauma to the head which means that until we can discover what those other factors are, head trauma should be reduced, and the head should be taken out of the game.
7. What is the argument for the contention that the rigid plastic helmets introduced into football in the 1940s led to additional concussions and repeated lower-level brain trauma?
By preventing direct injuries to the head and skull the new helmets made it possible to tackle with the head. It made football players more confident that they are protected from head injury. This can give a player a false sense of confidence and encourage him to lead with his head, increasing the cumulative number of situations in which the head is suddenly stopped and the brain is pushed up against the skull. Omalu pp. 9, 70 & 71;
8. Should we look to the NFL for leadership in the protection of the health of football players?
As to the first question: Experience tells us that we should not rely on the NFL to protect its players. Many of the NFL’s actions relating to concussion injury and the high rates of dementia among retired football players demonstrate that the NFL has trouble motivating itself to protect the health of its players. For example, the players were forced to sue the NFL for just compensation for CTE. Mike Webster’s family was forced to the sue the NFL for disability payments.
9. Does the NFL have a responsibility to investigate whether CTE is caused by playing football, report its findings to its players, and take remedial action to take the head out of the game if there is evidence that CTE is caused by playing football?
The argument against responsibility by the league is that the players know that football is dangerous and they are well-paid for their work. On the other hand, basic fairness would dictate that when the league is making money on the performances of its players it has a duty to actively investigate the link between CTE and playing football, report its findings and take effective remedial action. The league has many more resources than any one player and access to more information on the situation.
9. Ultimately, who is responsible for the violence in football?
The fans. The people who make money from the game are also responsible. The players too bear some responsibility, because now they know some of the risks and they voluntarily play the game. However, the main driver for violence in football are the fans. With respect to violence in football, “We have seen the enemy and he is us.” A good discussion of this question will raise the issue of why many fans love the violence inherent in football.
10. What motivates football players to knowingly risk their health to play the game. Answer for high school, college, and professional players.
For all levels, it is the glory and prestige of being a star athlete. For many, it is the love of the game. In college, one can add the slight possibility of making it in the NFL. For NFL players the money is also a major factor because they have to provide for their families.
11. Are there any other sports whose players are at risk for concussion injury? If so, name them. Do you think the risk is as great as in American football?
These include hockey, soccer (called football everywhere except the U.S.), rugby. There could be more.
12. This film came out in 2015 and was very popular. It started a debate throughout the U.S. about whether football was a safe sport for young people to play. There were dire predictions that youth football would collapse if just 10% of U.S. mothers kept their children from playing football. However, youth sports are still going strong while the evidence that CTE is caused by concussion injury has only increased. Develop a theory to explain this phenomenon.
Any good discussion of this question will raise the issue of motivated blindness and the normalcy bias. See discussion at Section on Motivated Blindness and the Normalcy Bias in the Learning Guide to the film Cowspiracy.
MORAL-ETHICAL EMPHASIS (CHARACTER COUNTS)
(Be honest; Don’t deceive, cheat or steal; Be reliable — do what you say you’ll do; Have the courage to do the right thing; Build a good reputation; Be loyal — stand by your family, friends, and country)
See Discussion Question #s 2, 8 & 9.
(Do what you are supposed to do; Persevere: keep on trying!; Always do your best; Use self-control; Be self-disciplined; Think before you act — consider the consequences; Be accountable for your choices)
See also Discussion Question #s 2, 8 & 9.
(Do your share to make your school and community better; Cooperate; Get involved in community affairs; Stay informed; vote; Be a good neighbor; Obey laws and rules; Respect authority; Protect the environment; Volunteer)
2. Evaluate the extent to which the following people fulfilled their obligations to be good citizens: Dr. Omalu, the persons who were in charge of the NFL, Dr. Bailes, the doctors who worked for the NFL and cooperated in the pseudo-science that attempted to deny the tie between repetitive head trauma and early onset dementia.
Dr. Omalu and Dr. Bailes stood up for what was right, got involved, and cared for others. The heads of the NFL and the people who worked for them, including the doctors who endorsed the League’s pseudo-science, simply looked out for their own financial interests at the expense of the players.
ASSIGNMENTS, PROJECTS & ACTIVITIES
Any of the discussion questions can serve as a writing prompt. Additional assignments include:
1. Compare the conduct of the National Football League with respect to the evidence that repeated head injury caused early dementia in football players with that of the tobacco companies in the 1940s, 1950s, and 1960s when they denied that cigarette smoking causes cancer and heart disease.
2. Look up the latest research on the connection between brain trauma (including concussions and less severe repetitive brain trauma) and the early onset of dementia in football players. Write a report of your findings.
3. Research and write a report on the current actions taken by the NFL to curb concussions and repetitive head trauma in football. Develop and justify an opinion about whether the NFL is doing enough to protect the health of its players.
4. Research the taxpayer subsidies for professional football teams. [An excellent book dealing with the subject is League of Denial — The NFL, Concussions, and the Battle for Trust by Mark Fainaru-Wada and Steve Fainaru.]
5. Write a report on which sports, other than American football, put players at risk for repetitive head injury. Using studies and published data compare the risks of repetitive head injury in those sports to the repetitive head injury in football.
6. Research the steps being taken to prevent head injury to players in three American football programs at schools or in youth leagues and compare them to each other. Compare them to the latest guidelines established by Pop Warner or some other nationwide youth football organization.
7. Watch the documentary film League of Denial: The NFL’s Concussion Crisis (2013, Directed by Michael Kirk). Fill out the Film Study Worksheet for a Documentary Seeking to Persuade the Viewer On a Matter of Political or Social Significance for the documentary and the Film Study Worksheet for a Work of Historical Fiction for Concussion. Then respond in depth to the following questions and justify your responses: (1) What were the advantages and disadvantages of each presentation – the documentary and the drama? (2) What are the strengths and weaknesses of each? (3) Which is the more believable presentation?
BRIDGES TO READING
As stated above, the book Concussion by Jeanne Marie Laskas is excellent reading. The article that broke the story is also well written, see Bennet Omalu, Concussions, and the NFL: How One Doctor Changed Football Forever by Jeanne Marie Laskas, Gentleman’s Quarterly.
LINKS TO THE INTERNET
- Bennet Omalu, Concussions, and the NFL: How One Doctor Changed Football Forever by Jeanne Marie Laskas, Gentleman’s Quarterly;
- Concussion Lies — The film about the NFL’s apparent CTE epidemic feeds the pervasive national myths about head trauma. by Daniel Engber on Slate;12/21/15;
- The NFL Is Not Big Tobacco 53 What the analogy gets wrong about football and corporate villainy. by Daniel Engber on Slate; 3/13/16;
- N.F.L.’s Flawed Concussion Research and Ties to Tobacco Industry by Alan Schwarz, Walt Bogdanich and Jacqueline Williams, New York Times; 3/24/16;
- Jeanne Marie Laskas On Head Injuries And The NFL And The Upcoming Movie Concussion Interview with Jenne Marie Laskas on The Norris & Long Show, 12/10/15;
- Here’s How the NFL Might Combat Concussions by Daniel Roberts, Fortune Magazine 12/31/15;
- NFL faces a new concussion-related lawsuit by A.J. Perez, 3/29/16; the case makes Civil RICO claims;
- Timeline: The NFL’s Concussion Crisis by Lauren Ezell, PBS Frontline, Timeline: 10/8/13;
- Web site of the Brain Injury Research Institute the organization organized by Dr. Omalu, Dr. Bailes, and attorney Fitzsimmons to study CTE;
- Website of the Concussion Legacy Foundation;
- Frequently Asked Questions About CTE Boston University CTE Research Center, accessed 9/26/17;
- Paid to Give Concussions by Emily Kaplan, Sports Illustrated, December 9, 2015, accessed on 9/26/17;
CCSS ANCHOR STANDARDS
Multimedia: Anchor Standard #7 for Reading (for both ELA classes and for History/Social Studies, Science, and Technical Classes). (The three Anchor Standards read: “Integrate and evaluate content presented in diverse media, including visually and quantitatively as well as in words.”) CCSS pp. 35 & 60. See also Anchor Standard # 2 for ELA Speaking and Listening, CCSS pg. 48.
Reading: Anchor Standards #s 1, 2, 7 and 8 for Reading and related standards (for both ELA classes and for History/Social Studies, Science, and Technical Classes). CCSS pp. 35 & 60.
Writing: Anchor Standards #s 1 – 5 and 7- 10 for Writing and related standards (for both ELA classes and for History/Social Studies, Science, and Technical Classes). CCSS pp. 41 & 63.
Speaking and Listening: Anchor Standards #s 1 – 3 (for ELA classes). CCSS pg. 48.
Not all assignments reach all Anchor Standards. Teachers are encouraged to review the specific standards to make sure that over the term all standards are met.
In addition to websites which are linked in the Guide and selected film reviews listed on the Movie Review Query Engine, the following resources were consulted in the preparation of this Learning Guide:
- Laskas, Jeanne Marie, Concussion, New York, Random House, 2015
- Fainaru-Wada, Mark, and Fainaru, Steve, League of Denial — The NFL, Concussions, and the Battle for Trust, New York, Crown, 2013;
- Omalu, Bennet, Play Hard, Die Young Neo-Forenxis Books, Lodi California, 2008;
- Culverhouse, Gay, Throwaway Players, The Concussion Crisis From Pee Wee Football to the NFL, Lake Forest, CA, Behler Publications, 2012
- Easterbrook, Gregg, The King of Sports, Football’s Impact of America, New York, St. Martin Press, 2013;
- “Head Games — A Concussion Study Guide” by Luke Rodsiler, PhD., in Screen Education, No. 87, August, 2017, pp. 55 to 59;
This Learning Guide written by James Frieden and was last updated on September 30, 2017.