The biggest evils are often hidden in plain sight.

Although baseball is America's favourite pastime, at least in sepia-stained clip packages desperately reminding us of this fact, football is by far the most popular sport in the US, with the NFL growing over the past few decades to usurp its competitors and become a multi-billion dollar business.

But something sinister is lurking beneath the gloss of game night. More and more evidence is coming to light of a decades-long cover-up, in which ex-players are displaying signs of serious brain damage - known as Chronic Traumatic Encephalopathy, or CTE - with results varying from the tragic to the merely debilitating.

A class action suit was filed in 2011, with over 5,000 ex-NFL players claiming the league knew of these links decades ago, and acted in covering up the findings. The NFL settled last April for $1 billion in order avoid a deep dive into their organisation - an unfathomable amount of money unless you stop to consider that the league makes more than this from various sponsorship deals in a single year.


CTE is a progressive, degenerative disease believed to be caused by repetitive brain trauma - which is basically par for the course when it comes to contact sports, such as various football codes, ice hockey and boxing. These don't need to be the full-on concussions that result in being knocked out, but can be a series of what are known as sub-concussive hits - or micro-concussions, if you prefer your trauma names to be cute - in which no obvious (to a third-party) symptoms are present. Ever "seen stars" or had a blinding headache after being slammed in the head? That's a sub-concussion.

The CTE Center at Boston University School of Medicine (BU CTE) date knowledge of CTE to the 1920s, when boxers were observed acting "punch drunk" - another cute name that belied a serious condition. Of course, it's not a particularly novel leap to suggest that repeated blows to the head will cause brain damage, but whereas this simple cause and effect can be viewed in real time in a boxing ring, this display is post-concussive syndrome - the immediate aftermath of such a blow.

What is more insidious about CTE is that it takes years, if not decades, to present itself, at which point most professional athletes are retired and years past ramming their heads into a mass of humans. The list of symptoms presented by the BU CTE Center are frightening: memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety and suicidal thoughts.

Last September, BU CTE reported they had found the disease in brain tissue from 87 out of 91 diseased ex-NFL players, and in 131 out of 165, once they included those who merely played semi-professionally at high school or college. It goes without saying this is concerning.

What makes CTE so troubling - aside from the obvious - is that there is no way to definitively test for it while the patient is alive, although early signs can be detected.

"The problem with CTE is that it's a diagnosis you have to make when you cut the brain open and look at it under the microscope. It's not something you can see on an X-ray or an MRI scan," Dr. Jeffrey Rosenfeld, Director of Monash Institute of Medical Engineering, Senior Neurosurgeon at Alfred Hospital, and one of Australia's leading academic neurosurgeons, tells

It also throws up some murky legal issues that could lead to dire consequences. Significant damage can be done while the brain is still developing.

"There is evidence that the developing brain is more vulnerable to injury than the mature brain," Dr. Rosenfeld explains, while also pointing out that teenagers have far less developed muscles around their neck, a major factor in protecting the head from jolting on impact.

If this is the case, then could it follow that the majority of blame lies with high school football programs?

If science does advance to the point where the NFL could reasonably argue that irreversible damage is done by the time players enter their league, are they able to wash their hands of this entirely? Could a raft of private and public schools be brought down financially by this? What about the junior programs that exist outside schools, and are funded by communities? Class action lawsuits often achieve little: there are multiple examples where suing a powerful body is lengthy, costly, and fruitless. But thousands of players and ex-players with untold wealth between them would have a lot more weight in the courts, and the media. Will the major television networks that air these games shy away as more science-backed scrutiny is placed on the issue? The NFL has already settled in the aforementioned class action suit, which would at least suggest some accepted culpability, but there are also the colleges that rely heavily on these games to bring millions in funding each year, which is distributed throughout various academic disciplines, while the athletes at the centre of this financial windfall remain unpaid, rushing towards brain damage 10 yards at a time.