November 18, 2016

Report: NFL team doctors' dual obligations could 'threaten player health'

Daily Briefing

Doctors employed by National Football League (NFL) teams may have conflicts of interest that jeopardize players' health, according to a new report by researchers from Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics.

The report is part of a broader study of player wellbeing funded by the NFL Players Association (NFLPA). However, "Harvard officials stress that neither the union nor the league has any control over the studies," Rick Maese reports for the Washington Post.

For the report, researchers spent two years examining the NFL's existing medical system, under which doctors and trainers are employed directly by teams, which set their salary and make hiring and firing decisions regarding most medical personnel. Harvard researchers interviewed current and former players, consulted with legal experts, reviewed documents from the NFL and the player's union, and spoke with players' advisers. The researchers also twice requested to speak with league officials and current team doctors, but were denied. 

The report concludes that current NFL practices need to be reformed. "The intersection of club doctors' dual obligations creates significant legal and ethical quandaries that can threaten player health," the report states. Glenn Cohen, a Harvard Law School professor who coauthored the report, said that the "conflict of interest is that [doctors and trainers] serve two people—they serve the player and the serve the [team]."

The report cites an unnamed player who said some players do not trust physicians who are employed by their team.

The report offers 76 recommendations, including that the NFL and NFLPA create a committee that would oversee hiring, firing, and compensation for team doctors. Teams would be permitted to hire one doctor directly who can coordinate with the independent physicians, but not make assessments or deliver care directly. 

The NFL pushes back

The NFL strongly disagreed with the report's conclusions. Jeffrey Miller, the NFL's EVP of health and safety, sent a letter to researchers that was published alongside the report. He wrote that the study called for "several unrealistic recommendations that would not improve player care." Miller also said that the report did not identify any instances in which a team doctor acted against a player's best interest.

Miller's letter also outlined several steps that the NFL has taken in recent years to protect player wellbeing, including funding research and making numerous rule changes to reduce the chance of injury.

An NFL official who reviewed the report told the Washington Post, "At some point, policy changes need to be based on fact." The NFL also noted that players already have the option of seeking a second opinion at the team's expense.

NFL spokesperson Brian McCarthy added that the league would review the report and discuss its recommendations with teams, medical staff, and the NFLPA.

Other reaction

The researchers said they were surprised by the NFL's reaction to their findings. Holly Fernandez Lynch, the executive director of the Petrie-Flom Center and one of the report's authors, said, "I did not expect that we would have to have this conversation about whether there is, in fact, a conflict because it's so obvious on its face."

NFL 'improperly' withheld money to influence NIH concussion study, congressional report says

Other experts said the NFL's reaction was evidence there is a conflict of interest. Steven Joffe, vice chair of medical ethics at the Perelman School of Medicine at the University of Pennsylvania, called the NFL's response "frankly terrifying." He added, "The fact that the NFL and the NFL Physicians Society would deny it is to me the biggest flag in this whole report that there's a serious problem here that needs to get fixed."

But other experts with firsthand experience treating NFL players said the report reached the wrong conclusions. Christopher Wahl, who served as the head team physician for the San Diego Chargers from 2013 through 2015, said he was never pressured to change his assessment of a player's health. "While I think you can't deny there are theoretical conflicts of interest, there's no motivation for physicians to do the wrong thing for players," he explained (Swetlitz, STAT News, 11/17; Maese, Washington Post, 11/17; ESPN, 11/17).

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