Head Games

Two com­pet­ing labs are rac­ing to find the link be­tween con­cus­sions and long-term brain dam­age. The CFL’S sur­vival may hinge on the re­sults

The Walrus - - SCIENCE - by Brett Popp lewell pho­tog­ra­phy by Jalani Mor­gan

Five days be­fore he died, Rod Wood­ward sat in a re­stricted men­tal health pav­il­ion at a hos­pi­tal in White Rock, Bri­tish Columbia. He was happy as he dined on cake and ad­mired the clus­ters of bal­loons that dot­ted the room. It was Septem­ber 22, 2016, and af­ter his wife and nurses sang “Happy Birth­day” to him, he posed for a photo in the uni­form that had changed his life.

Wood­ward had once been a 200-pound foot­ball player who, on three dif­fer­ent oc­ca­sions, drank cham­pagne out of the bell of the Grey Cup — first as a ball­boy for the BC Lions, then twice as an all-star de­fen­sive back for the Ot­tawa Rough Riders. His ca­reer left him scarred and bat­tered, with a shoul­der so heav­ily re­con­structed that doc­tors used it as a case study on re­build­ing a joint. He’d re­tired at thirty-four with a base­ment full of tro­phies and a bank of mem­o­ries from the field. Even near the end of his life, the game was fore­most in his mind. He’d re­count to pa­tients and staff how, on a dis­tant birth­day, he’d once caught three in­ter­cep­tions at Lans­downe Park in a vic­tory over the Ed­mon­ton Eski­mos. Then, thirty sec­onds later, he’d re­peat the story again.

Al­most four decades had passed since Wood­ward left the game for good. He’d pur­sued a ca­reer as a coach be­fore be­com­ing a fi­nan­cial ad­vi­sor. He’d been a suc­cess un­til he racked up gam­bling debts and, in his mid-fifties, stole $185,000 from two el­derly clients. At sixty-five, he was sen­tenced to jail, though his fam­ily was never sure if he un­der­stood his crime. All they knew was that he’d grown para­noid with age. He be­lieved the govern­ment was track­ing his move­ments. He’d close the drapes, refuse to speak about cer­tain top­ics on the phone, and won­der if the tele­vi­sion was watch­ing him.

Di­ag­nosed with fron­totem­po­ral de­men­tia in 2012, Wood­ward of­ten for­got to eat. His ath­letic build di­min­ished un­til, even­tu­ally, the Grey Cup ring he’d won on a brisk day in 1973 slipped off his fin­ger and van­ished. His for­mer team­mates had mailed him a replica of the jersey he’d worn in that game. Now, on his last birth­day, he sat in that jersey, his old num­ber twen­tysix hang­ing from droop­ing shoul­ders.

Wood­ward fin­ished his cake, then got to his feet and started to dance. At the end of the party, his wife, Kay, kissed him good­bye, then left him to rest.

The next day, he fell near the very place he’d danced. Be­cause his brain was un­able to send out sig­nals warn­ing him to brace him­self, he smashed his shoul­der on the ground, break­ing it, and took one fi­nal hit to the head. Four days later, he was dead.

Among the con­do­lences Kay re­ceived was an email from Leo Ez­erins, a for­mer Hamil­ton Tiger-cat and the founder of the Cana­dian Foot­ball League Alumni

As­so­ci­a­tion. He wrote to say he was sorry to hear of Wood­ward’s pass­ing and asked if the fam­ily would be will­ing to do­nate his brain to a team of doc­tors in Toronto who were study­ing the ef­fects of con­cus­sions on CFL play­ers.

The re­quest left Wood­ward’s wi­dow feel­ing con­flicted. She wanted to learn the full ex­tent of the dam­age in­side her hus­band’s head, but was un­sure whether to trust Ez­erins and the Toronto doc­tors. She’d heard their re­search was be­ing used by the CFL to deny any con­nec­tion be­tween con­cus­sions sus­tained on Cana­dian gridirons and chronic trau­matic en­cephalopa­thy (CTE), a de­gen­er­a­tive brain dis­ease be­lieved to be short­en­ing the life­spans of play­ers. To Kay, it seemed clear that her hus­band’s strug­gles were the re­sult of the twenty-two years he’d spent col­lid­ing into other play­ers. She’d al­ready de­cided to sue the CFL for hav­ing en­cour­aged and fa­cil­i­tated his suf­fer­ing. Her lawyer placed a call to a com­pet­ing Amer­i­can lab that runs one of the big­gest brain banks in the world, and whose re­searchers have been in­stru­men­tal in link­ing re­peated head in­juries in con­tact sports to CTE.

And so the most cov­eted pos­ses­sion Wood­ward had left was re­moved from his skull, low­ered into a bucket of formalde­hyde, and prepped for the long jour­ney to a Bos­ton re­frig­er­a­tor. It would sit in that re­frig­er­a­tor for months, part of a grow­ing back­log of brains wait­ing to be an­a­lyzed.

It’s dif­fi­cult to re­mem­ber how foot­ball was viewed be­fore a se­ries of post­mortem dis­cov­er­ies linked the sport to neu­ro­log­i­cal rot buried deep in­side the skulls of de­ceased play­ers. But de­spite fif­teen years’ worth of head­line-mak­ing re­ports, there re­mains con­tro­versy over what the science has ac­tu­ally proven.

Much of that science has come out of Bos­ton Univer­sity’s CTE Cen­ter, where neu­ropathol­o­gist Ann Mc­kee and a team of seven­teen re­searchers have spent the last decade slic­ing up the brains of ath­letes, in­ject­ing the shav­ings with dye, and plac­ing them un­der a high-res­o­lu­tion mi­cro­scope. While most of the more than 400 brains the Bos­ton re­searchers have peered into come from foot­ball

play­ers, the bank’s spec­i­mens are also drawn from other sports: hockey, soc­cer, box­ing, wrestling, rugby, and even base­ball. The vast ma­jor­ity of those brains have re­vealed signs of ir­repara­ble dam­age that Mc­kee’s team blames on con­cus­sions.

When you sus­tain a blow to the head, your brain — grey gelati­nous mat­ter sus­pended in fluid — jos­tles against the walls of the skull. De­pend­ing on the lo­ca­tion of the dam­age, a con­cus­sion can lead to nau­sea. In some cases, the brain loses the abil­ity to send sig­nals to other parts of it­self, trig­ger­ing a phys­i­cal col­lapse or a mo­men­tary in­abil­ity to form sen­tences. Hit your head hard enough, and you’ll lose con­scious­ness. Post-con­cus­sion syn­drome can last months, even years, leav­ing vic­tims sen­si­tive to light, noise, and mo­tion. A brain that hasn’t healed from a con­cus­sion is prone to sec­ond-im­pact syn­drome, a more cat­a­strophic in­jury that can be fa­tal.

The Bos­ton re­searchers say that even sub-con­cus­sive blows — re­peated hits that aren’t di­ag­nosed as con­cus­sions — can dam­age neu­rons, caus­ing a pro­tein called tau to clus­ter and clot in­side cells, slowly killing them. These tau de­posits as­sume mis­folded shapes called neu­rofib­ril­lary tan­gles; as they spread, the brain de­te­ri­o­rates and loses mass. A sim­i­lar process oc­curs in other neu­rode­gen­er­a­tive dis­eases, such as Alzheimer’s, but in the case of CTE, the tan­gles are found wrapped around blood ves­sels. While the wreck­age this brings about is of­ten con­cealed within the brain’s deep folds, its symp­toms even­tu­ally be­come vis­i­ble: mood swings, cog­ni­tive im­pair­ment, im­pul­sive be­hav­iour, de­pres­sion, mem­ory loss, addiction, and sui­ci­dal thoughts.

A group of Toronto re­searchers, how­ever, has started to push back on the nar­ra­tive com­ing out of Bos­ton. Led by Charles Ta­tor, a highly dec­o­rated eighty­one-year-old neu­ro­sur­geon, the Toronto lab, which was founded in 2010, has be­come the world’s sec­ond-largest de­voted to con­cus­sion re­search. Com­pared to the Bos­ton re­searchers, Ta­tor’s team has found fewer in­ci­dents of CTE in the brains it has ex­am­ined. In fact, says Ta­tor, “We’ve seen ex­am­ples of peo­ple who’ve had mul­ti­ple con­cus­sions but who don’t have any ev­i­dence of the dis­ease. Like, none.” While re­search sug­gests that con­cus­sions can cause CTE, why, they won­der, aren’t all play­ers af­fected equally? What’s the thresh­old for how many con­cus­sions you have to sus­tain or how hard you have to be hit to de­velop CTE? Is it pos­si­ble that cer­tain play­ers are prone to the dis­ease for other rea­sons? Are there ge­netic fac­tors? In­te­gral to the Toronto team’s re­search: the brains of CFL play­ers.

The CFL re­ported that thirty-two con­cus­sions oc­curred dur­ing the reg­u­lar sea­son of 2016—an av­er­age of 3.6 per team, rep­re­sent­ing a drop of 29 per­cent from the pre­vi­ous sea­son. Yet that statis­tic doesn’t re­flect the count­less sub-con­cus­sive blows that may oc­cur on any play and that go un­doc­u­mented. For its part, the CFL con­tin­ues to as­sert that there is “no con­clu­sive ev­i­dence” link­ing con­cus­sions to CTE, a po­si­tion that ap­pears to find some back­ing in the science high­lighted by Ta­tor’s team. The CFL’S cur­rent stance is sim­i­lar to one the Na­tional Foot­ball League aban­doned in March 2016, two years af­ter agree­ing to pay an es­ti­mated $1 bil­lion in damages to more than 4,500 ex-play­ers.

De­spite the re­luc­tance of both leagues to ad­mit a di­rect re­la­tion­ship be­tween CTE and the game, the con­cus­sion crisis has al­ready al­tered the way foot­ball is played on both sides of the bor­der: rule changes, fines, and penal­ties re­lated to reck­less play have been im­ple­mented. But many say the changes are in­ad­e­quate. Hel­mets equipped with teleme­try sys­tems de­signed to mon­i­tor im­pacts to the head have been avail­able for years, but they’re not man­dated for use in the CFL. In­stead, the CFL has in­tro­duced an “in­jury spot­ter,” an in­di­vid­ual who mon­i­tors im­pacts via video from the CFL Com­mand Cen­tre, on the third floor of league head­quar­ters on Welling­ton Street East in down­town Toronto. Be­fore they

“The big­gest chal­lenge to the science is get­ting do­na­tions. They need brains to study, and I know where they can find them.”

are al­lowed to re­turn to the game, play­ers sus­pected to have suf­fered a con­cus­sion are ex­am­ined on the side­lines with the use of an app that eval­u­ates the fine move­ments of the eyes.

In the mean­time, the CFL is fac­ing two re­lated con­cus­sion law­suits. The first, filed in Van­cou­ver in 2014 by Ar­land Bruce, a for­mer all-star, is ex­pected to set a prece­dent that will dic­tate how the court treats the sec­ond case, a class-ac­tion law­suit that was filed in 2015 in the On­tario Su­pe­rior Court of Jus­tice. The class ac­tion in­volves Wood­ward and more than 200 other alumni, some of whom have ex­pe­ri­enced sui­ci­dal thoughts as a re­sult of what they be­lieve is go­ing on in­side their heads. Al­leg­ing that the CFL has tried to cre­ate an im­pres­sion that con­cus­sions in the game don’t cause longterm brain dam­age, these play­ers are seek­ing $200 mil­lion in damages — es­ti­mated to be the league’s en­tire rev­enue in 2016.

The law­suit, some be­lieve, could ul­ti­mately fin­ish off the CFL, his­tor­i­cally one of the more pre­car­i­ously fi­nanced leagues in professional sport.

On a rainy Fri­day in early March 2017, Ar­land Bruce, a thirty-nineyear-old Kansas-born for­mer wide re­ceiver, sat in a Van­cou­ver court­room. With tat­toos peek­ing out of the sleeves of his black suit, he kept his eyes fixed on the panel of judges while his lawyer ar­gued that it was the court’s duty to hear the case. But Bruce’s coun­sel was get­ting nowhere.

For three years, the CFL and its bat­tery of high-priced at­tor­neys have fought Bruce’s lit­i­ga­tion, ar­gu­ing that the courts are the wrong place to deal with the case of an oth­er­wise healthy look­ing two-time Grey Cup win­ner who al­leges he has CTE — a le­gal claim, the first of its kind against the CFL, that can’t be proven so long as his brain re­mains in­side his head. A BC judge ruled in the CFL’S favour back in 2016. But Bruce ap­pealed, and now he was back in the court­room for a sec­ond at­tempt to push his case to a trial.

A ten- year CFL vet, Bruce had been a mar­quee player who’d ex­plode off the snap, dart across the line of scrim­mage, and seek out open ground on a crowded field. It was af­ter one such snap on a Septem­ber night in 2012 at Regina’s Mo­saic Sta­dium that Bruce took off into the Saskatchewan zone look­ing for a pass, only to collide with a Roughrider. Bruce som­er­saulted into the air and then came down hard, his head strik­ing the turf. For sev­eral min­utes, he lay un­con­scious. In his af­fi­davit, he says that he has since been ter­ri­fied to go to sleep. Af­ter that hit, he com­peted in just one more game for the Lions. He was traded to Mon­treal, but he was no longer the player he’d once been.

Re­leased from his con­tract, Bruce soon found him­self un­em­ploy­able and sleep­ing in a truck parked un­der­ground at the Fair­mont Ho­tel Van­cou­ver. As a star of the game, he’d earned more than $1.5 mil­lion over a ca­reer that saw a top salary of $190,000. But he’d saved hardly any of it. One day, he walked, unan­nounced, into the of­fice of Robyn Wishart, a Van­cou­ver-based brain and spinal lawyer who’d made a name for her­self rep­re­sent­ing Gabrielle Car­teris, one of the stars of the orig­i­nal Bev­erly Hills, 90210, in an on-set in­jury case. Bruce was para­noid, delu­sional, and deal­ing with es­ca­lat­ing headaches. He told Wishart that the pain in his head made him feel as though he’d just been in a car ac­ci­dent. He won­dered if his years in the game had left him with CTE.

“He was in re­ally bad shape,” re­calls Wishart, who agreed to rep­re­sent him on a con­tin­gency fee ba­sis. A month into the 2014 CFL sea­son, she launched a law­suit against the league on Bruce’s be­half. In it, Wishart con­tends that the league mis­rep­re­sented the dan­gers of con­cus­sions through­out Bruce’s ca­reer and failed to pro­vide him with ad­e­quate care — es­pe­cially af­ter the hit in Saskatchewan that left him with signs of post-con­cus­sion syn­drome: fog­gi­ness, mem­ory loss, anx­i­ety, per­son­al­ity changes, and a sen­si­tiv­ity to light and sound.

But the league’s han­dling of Bruce’s post-con­cus­sion syn­drome was just one part of Wishart’s ini­tial case. She also dragged Charles Ta­tor into the law­suit, nam­ing him as a de­fen­dant. Ar­guably the most fa­mous Cana­dian neu­ro­sur­geon alive, Ta­tor is a pro­fes­sor at the Univer­sity of Toronto and an in­ter­na­tion­ally acclaimed con­cus­sion ex­pert. But to Wishart, Ta­tor is a lead­ing ad­vo­cate for the type of science the CFL has re­lied on to dic­tate its poli­cies on con­cus­sions.

In Bruce’s state­ment of claim, Wishart al­leges that, af­ter hav­ing ac­cepted fund­ing from the CFL and team­ing up with Leo Ez­erins and the alumni as­so­ci­a­tion to gain ac­cess to the brains of re­tired play­ers, Ta­tor be­gan “down­play­ing and ob­fus­cat­ing” the re­search of in­de­pen­dent sci­en­tists and neu­rol­o­gists. (Ta­tor de­nies ever hav­ing re­ceived fund­ing from the CFL.)

At the heart of her al­le­ga­tions is a con­tro­ver­sial aca­demic study of six de­ceased CFL play­ers that was co-au­thored by Ta­tor, Ez­erins, and four oth­ers. The study, pub­lished in the May 2013 is­sue of The Fron­tiers in Hu­man Neu­ro­science, found that CTE was present in 50 per­cent of the brains an­a­lyzed. How­ever, the pa­per was pub­lished

un­der the ti­tle “Ab­sence of Chronic Trau­matic En­cephalopa­thy in Re­tired Foot­ball Play­ers with Mul­ti­ple Con­cus­sions and Neu­ro­log­i­cal Symp­toma­tol­ogy.” The au­thors go on to chal­lenge the es­tab­lished link be­tween con­cus­sions and CTE, stat­ing that ex­ist­ing post-mortem re­search was “lim­ited by bi­ased sam­ples.” In other words, peo­ple do­nated their brains for au­topsy be­cause they al­ready had rea­son to sus­pect they had CTE.

Wishart re­calls how an­gry that study made her. The ti­tle alone, she says, was “hor­ri­bly mis­lead­ing.” In the state­ment of claim, she al­leges Ez­erins’s au­thor credit was proof that the study, if not the en­tire project, had been tainted by a con­flict of in­ter­est.

Also in the state­ment of claim, Wishart draws at­ten­tion to com­ments from Ez­erins that, she al­leges, show he put the league’s sur­vival ahead of player safety. He once told a re­porter that the Bos­ton CTE re­searchers were on a “feed bag” and sug­gested that the long-term im­pact of con­cus­sions might be “psy­cho­so­matic.” Wishart fur­ther al­leges that Ez­erins tried to shut down a cog­ni­tive test be­ing run out of Mcmaster Univer­sity on twen­ty­five re­tired Tiger-cats. Ez­erins says he didn’t sup­port the Mcmaster study, be­cause he was led to un­der­stand that it wouldn’t be able to ef­fec­tively de­ter­mine cog­ni­tive de­cline. But, in the claim, Wishart quotes Ez­erins as hav­ing made the fol­low­ing state­ment: “It is a very im­por­tant is­sue and we want to make sure it does not re­flect poorly on the game of foot­ball.”

For nearly three years, Ez­erins and Ta­tor stood ac­cused of neg­li­gence in the Bruce case be­cause of their work on the “ab­sence of CTE” study. The al­le­ga­tions against both men were never proven, and were ul­ti­mately dropped by Wishart. Speak­ing af­ter the fact, Ta­tor says he found his in­volve­ment in the Bruce case ut­terly per­plex­ing; Ez­erins — whose name was at­tached to the study be­cause he pro­cured the brains that were used — says it kept him up at night. It never made any sense to ei­ther of them that they should be pros­e­cuted for pub­lish­ing work in a peer-re­viewed jour­nal.

Bruce’s case, how­ever, soon de­volved into a dis­pute that has noth­ing to do with foot­ball, league neg­li­gence, or the com­pet­ing science about de­gen­er­a­tive brain dam­age. To stave off a trial, the league ar­gued that the court has no ju­ris­dic­tion to re­solve dis­putes be­tween em­ploy­ers and union­ized work­ers. It pre­sented Bruce’s ap­peal as a sim­ple case of “health and safety,” mean­ing it should be han­dled by ar­bi­tra­tors un­der the CFL’S col­lec­tive bar­gain­ing agree­ment. It was a smart play: a judge sided with the CFL in 2016 and then again dur­ing the March 2017 ap­peal, which Wishart lost in a unan­i­mous rul­ing. But Wishart in­tends to keep press­ing for a trial. “I want to take this all the way to the Supreme Court,” she says.

Ta­tor ar­gues that, by tar­nish­ing the mo­tives of his team, Wishart’s ac­tions are hampering the progress of science. The real vil­lains, he says, are the hold­outs who refuse to ac­knowl­edge the dan­gers of ag­gres­sion and vi­o­lence in con­tact sports. But in the eyes of many ex-cflers, Wishart’s a cru­sader. “Once Bruce’s case was out there,” she says, “I started hear­ing from for­mer play­ers spread all over the place.” She be­came a kind of le­gal shep­herd, herd­ing those play­ers into the class-ac­tion law­suit now tar­get­ing the CFL, trav­el­ling ev­ery­where from Bos­ton and Los An­ge­les to Ed­mon­ton and Cal­gary to in­ter­view bro­ken-down leg­ends who made small sums of cash in re­turn for risk­ing their minds and bod­ies in pur­suit of a sto­ried chal­ice.

Wishart be­lieves she’s fight­ing a long war on be­half of the for­saken and the vul­ner­a­ble. She de­scribes a fran­tic call she once re­ceived from the mother of a for­mer player who had locked him­self in a room. Ter­ri­fied that her son was plan­ning to end his life, his mother had pulled Wishart’s

name off the in­ter­net. “She called me scream­ing,” Wishart says. “That’s when I told her to call out the names of the play­ers on the class-ac­tion suit. Let him know he’s not alone.”

The man ul­ti­mately came out of the room. “That was just one phone call. I get them of­ten. I get wives. I get chil­dren. I don’t get play­ers as of­ten as I get a loved one.” She says clients fall into three cat­e­gories: those who have lost mo­tor con­trol, those who have lost im­pulse con­trol, and those who have lost both. “My goal is that no CFL player will kill them­selves,” she says.

Foot­ball’s ties to Canada are about as old as the coun­try it­self. The first game gen­er­ally rec­og­nized as a pre­cur­sor to North Amer­i­can foot­ball was played on Cana­dian soil in 1861 — a full four­teen years be­fore the first or­ga­nized in­door hockey game in Canada, and eight years be­fore what is of­ten cited as the first foot­ball game in the United States.

Even in those early years, the Cana­dian and Amer­i­can games were played dif­fer­ently — a fact that be­came ap­par­ent in 1874, when a team from Mcgill Univer­sity trav­elled to Cam­bridge, Mas­sachus­setts, to square off against Har­vard in a cross­bor­der skir­mish that would change the Amer­i­can game for­ever. It was that en­counter that in­tro­duced Amer­i­cans to the idea of “downs” — a set num­ber of plays in which the of­fen­sive team car­ry­ing the ball has to ei­ther over­run the de­fend­ers and score

or force its way far enough over an in­vis­i­ble line of bat­tle to gain more downs and main­tain pos­ses­sion of the ball.

Both the Amer­i­can and Cana­dian vari­a­tions were cod­i­fied in the years that fol­lowed. Both ini­tially in­volved a three-down struc­ture, though the Amer­i­cans even­tu­ally added a fourth. This change ul­ti­mately made play­ers more fo­cused on try­ing to phys­i­cally carry the ball past the de­fend­ing line, while Cana­di­ans have be­come more in­tent on throw­ing the ball into en­emy ter­ri­tory.

Per­formed on a field of mock bat­tle, Amer­i­can foot­ball was ini­tially pop­u­lar among the sons of Civil War vet­er­ans. It’s easy to imag­ine they en­joyed out­flank­ing op­po­nents, charg­ing the field, and fly­ing their school colours over a van­quished foe. In Canada, the game took shape as a dis­play of grit be­tween the lead­ing schools of On­tario and Que­bec. By 1884, the pre­de­ces­sors of the Hamil­ton Tiger- Cats, Mon­treal Alou­ettes, and Toronto Arg­onauts were all vy­ing for the pre­cur­sor to the Grey Cup.

Early re­ports of con­cus­sions in the game date back to the late nine­teenth cen­tury, though the term was used to de­scribe ev­ery­thing from tem­po­rary con­fu­sion to co­mas or even deaths on the field. The sport’s risks at­tracted real scru­tiny in Canada and the US af­ter the Wash­ing­ton Post re­ported that forty-five foot­ball play­ers had died from in­juries sus­tained on Amer­i­can gridirons be­tween 1900 and 1905. The mount­ing vi­o­lence caused then pres­i­dent Theodore Roo­sevelt to urge a se­ries of changes to the Amer­i­can game: the for­ward pass was even­tu­ally in­tro­duced, as was a new rule that called for play to be stopped when a player fell on the ball. But, for “rea­sons of tra­di­tion,” says Steve Daniel, the CFL’S head statis­ti­cian and des­ig­nated his­to­rian, those rules weren’t ap­plied north of the bor­der un­til 1929. Daniel has spent the last decade com­pil­ing and an­a­lyz­ing statis­tics from 5,400 games and more than 100 years of Cana­dian foot­ball. Ac­cord­ing to Daniel, the only player to die af­ter suf­fer­ing in­juries on a CFL field was an Amer­i­can line­backer named Tom Pate. Pate was a twenty-three-year old Univer­sity of Ne­braska grad who’d gone un­drafted

by the NFL and signed with the Tiger-cats in 1975.

Late in the fourth quar­ter of his twelfth game for Hamil­ton, Pate sprinted straight into two Cal­gary block­ers while try­ing to give chase to a Stam­peder who was en route to a touch­down. The front page of the next day’s Cal­gary Her­ald showed an im­age of Pate mid-air. One Stam­peder had just taken out his knees while an­other blocked him high. Pate went into con­vul­sions shortly af­ter that photo was snapped, his head hav­ing smashed into the turf of Mcmahon Sta­dium. He was un­con­scious when they took him off the field and died three days later. The of­fi­cial cause of death was an aneurysm.

“Amer­i­can foot­ball has a lot of these sto­ries, but this is the worst that I can find on a CFL field,” says Daniel. “It just so hap­pens the player was an Amer­i­can.”

Of the more than 5,000 liv­ing CFL alumni, 75 per­cent are Amer­i­cans who earned a frac­tion of what they would have made in the NFL. (In 2014, CFL salaries were roughly $80,000 per sea­son.) At last count, more than seventy of those Amer­i­can play­ers have al­leged that they’ve suf­fered de­bil­i­tat­ing brain dam­age on Cana­dian gridirons. Yet a group of CFL alumni and sci­en­tists ar­gue that Cana­dian foot­ball may not be the threat it’s of­ten con­sid­ered to be. It may even of­fer a so­lu­tion to a big­ger prob­lem: Amer­i­can foot­ball.

Ez­erins and oth­ers have taken the lower rate of CTE dis­cov­ery in Toronto as a sign that the game might be safer up here. Those who make such an ar­gu­ment point out that CFL fields are twelve yards wider and ten yards longer than those in the US, a cir­cum­stance that may limit the force of c0l­li­sions. Though the CFL re­sisted the for­ward pass for years, Cana­dian foot­ball is now more of an aerial game than any­thing else. The three downs in the Cana­dian game make the of­fen­sive team more in­clined to try to throw the ball up the field than to at­tempt to gain yardage by run­ning the ball across the line of scrim­mage, which is where some of the most bru­tal hits still oc­cur.

But per­haps the most fun­da­men­tal dif­fer­ence is that in the NFL, op­pos­ing line­men are sep­a­rated by just eleven inches. When play be­gins, they ex­plode into one an­other from less than a foot apart. In the CFL, the dis­tance is one yard. As a re­sult, the line­men who serve as im­mov­able ob­jects are gen­er­ally smaller in the CFL.

“Whether all of this makes Cana­dian foot­ball safer is a le­git­i­mate ques­tion,” says Ta­tor. “I don’t think we have data that would back up such a claim right now, but ten years from now, we might.”

Mc­kee scoffs at the very idea. “Head trauma is head trauma,” she says. “I find it frus­trat­ing that there’s so much dis­cus­sion about whether this dis­ease ex­ists — the ev­i­dence is more than am­ple. Of course we need to do more re­search. But the con­ver­sa­tion shouldn’t be whether foot­ball is as­so­ci­ated with it, be­cause it is, but how to pre­vent it. Our mis­sion is to cure this dis­ease, not to de­stroy the CFL or any other league.”

What we now call CTE was first iden­ti­fied eighty-nine years ago by a foren­sic pathol­o­gist named Har­ri­son Mart­land. He an­a­lyzed the symp­toms dis­played by a gen­er­a­tion of bat­tered prize fight­ers — speech im­pair­ments, slowed move­ment, con­fu­sion, and tremors — and con­cluded that they’d been brought on by re­peated blows to the head. He called the con­di­tion “punch-drunk syn­drome,” or de­men­tia pugilis­tica, and es­ti­mated that nearly half of all for­mer box­ers had it.

It wasn’t un­til Septem­ber 28, 2002, that events were set in mo­tion that would lead to the dis­cov­ery of the syn­drome in the brain of a foot­ball player. On that Satur­day, a Nige­rian-born foren­sic pathol­o­gist named Ben­net Omalu walked into a Pitts­burgh coro­ner’s of­fice to ex­am­ine the body of Mike Web­ster, a dead Pitts­burgh Steeler. Web­ster had been a nearly 270-pound cen­tre line­man in the NFL. Dubbed “the strong­est man in foot­ball” by CBS , he’d hike the ball, then cross the line of scrim­mage with more fe­roc­ity than any other player of his gen­er­a­tion. It was said he hit like Rocky Mar­ciano, though he used his head in­stead of his fists.

When his play­ing years were over, he de­scended into a sort of mad­ness, some­times us­ing a stun gun to put him­self to sleep. He died of a heart at­tack at the age of fifty, but those who saw his corpse re­marked that the body looked like that of a man twenty years older. Omalu re­moved Web­ster’s brain and, over a se­ries of months, waited for it to be sliced into thin sec­tions, which were in­jected with dye. He then placed these sam­ples un­der a mi­cro­scope. What hap­pened next has

been the sub­ject of films, doc­u­men­taries, and more than a decade’s worth of lit­er­a­ture, both jour­nal­is­tic and aca­demic. The spe­cial­ized stain­ing al­lowed Omalu to tag the tau pro­tein de­posits that had ac­cu­mu­lated in Web­ster’s brain, and prove the pres­ence of CTE.

His con­tro­ver­sial find­ings were pub­lished in the jour­nal Neu­ro­surgery. Omalu be­lieved that the NFL’S doc­tors would want to know more in or­der to ad­just the way foot­ball was played. In­stead, the league’s doc­tors chal­lenged his find­ings and called for the ar­ti­cle to be re­tracted (it wasn’t). But the CTE di­ag­noses kept com­ing — in sev­eral cases, be­cause of sui­cide. An­dre Wa­ters, a re­tired Philadel­phia Ea­gle who’d shot him­self in the head at forty-four. Justin Strzel­czyk, an­other Steeler, who, af­ter an al­most forty-mile-long high-speed po­lice chase, drove over a me­dian and rammed his pickup truck into a tanker. His body was thrown eighty yards.

In June 2007, Omalu be­gan work­ing with the Sports Legacy In­sti­tute, an or­ga­ni­za­tion es­tab­lished by neu­rol­o­gists based in West Vir­ginia and Mas­sachusetts. One of the forces be­hind the in­sti­tute’s founding was Chris Nowin­ski, a then twenty-eight-year-old Har­vard grad who’d played col­lege ball but made his name and rep­u­ta­tion as a wrestler in the World Wrestling En­ter­tain­ment (WWE). He’d suf­fered con­cus­sions dur­ing his foot­ball ca­reer, but it was the one he took from a boot to the chin in a wrestling ring that left him with post-con­cus­sion syn­drome and un­able to per­form his job. In the mid­dle of some matches, he’d for­get the chore­og­ra­phy and whether he was sup­posed to win or lose. He re­tired af­ter one in­ci­dent in which he leaped off his bed and slammed head­first into the wall. He was asleep at the time, but later took it as a sign that some­thing was wrong with his brain.

Nowin­ski wasn’t a doc­tor, but he was smart, out­go­ing, and per­sua­sive. He be­gan to view him­self as both a sur­vivor of post­con­cus­sion syn­drome and a po­ten­tial vic­tim of CTE—A dis­ease he felt des­per­ately needed to be stud­ied. Be­fore the in­sti­tute was even set up, he’d al­ready con­vinced the fam­i­lies of Wa­ters and Strzel­czyk to send the play­ers’ brains to Omalu. Nowin­ski be­came known as the “Brain Chaser.” He would mon­i­tor news for the sui­cides and deaths of any ath­lete he sus­pected had suf­fered from con­cus­sions. Then he’d cold call their fam­i­lies. “I don’t know what made me good at it,” he says.

Af­ter al­most a year of work­ing to­gether, Nowin­ski and Omalu had a fall­ing out over dif­fer­ing opin­ions on the di­rec­tion of the in­sti­tute. Omalu left to set up an­other cen­tre in Davis, Cal­i­for­nia. But Omalu’s work there has been over­shad­owed by the grow­ing body of dis­cov­er­ies com­ing out of Ann Mc­kee’s lab in Bos­ton Univer­sity’s CTE Cen­ter, which has be­come the largest hub in the world for the post-mortem study of con­tact-sport ath­letes; Nowin­ski and his arm’s-length or­ga­ni­za­tion, now called the Con­cus­sion Legacy Foun­da­tion, se­cure hun­dreds of brains for Mc­kee. An av­er­age of two ar­rive each week.

Dur­ing a tour of the brain bank in late March, Mc­kee opened a re­frig­er­a­tor and pointed out the Tup­per­ware con­tain­ers filled with sliced-up rem­nants of the men they once de­fined. She noted that the spec­i­mens were all in­stantly rec­og­niz­able to her. She didn’t need a nametag to iden­tify them. “I’ve been do­ing this for a long time,” she said. “I’m con­stantly hear­ing that I’m mak­ing all this up, that it’s a con­struct of my imag­i­na­tion. No­body wants this dis­ease to be true. I wish it weren’t true.”

But Mc­kee’s find­ings are only one part of the dis­pute. There are those who have a prob­lem with the fact that so many brains in sport find their way to the same steel au­topsy ta­ble in Bos­ton. Which is why the Univer­sity of Toronto got into the con­cus­sion busi­ness.

Bald, ex­cept for some white friz­zled hair above his ears, Charles Ta­tor wears a suit and tie un­der a white lab coat and sits in a small of­fice over­look­ing the atrium of the Toronto Western Hos­pi­tal on Bathurst Street. He’s sur­rounded by stacks of files, an au­to­graphed Cana­dian foot­ball, a sculp­ture of a spine, and nu­mer­ous sci­en­tific and med­i­cal tro­phies col­lected over a fifty-six-year ca­reer as a leader in the study of the hu­man brain. It has been about ten years since he con­ducted his last surgery, but he re­mains ac­tive in the field as the founder and di­rec­tor of the Cana­dian Con­cus­sion Project. It was Ta­tor who, af­ter read­ing the early re­search com­ing out of Omalu’s and Mc­kee’s post-mortem stud­ies, said, “We need to get into that.”

“Not long ago, con­cus­sions were viewed as a waste of time—barely worth study­ing,” he says. “As a re­sult, they’ve been very ne­glected both on the clin­i­cal and re­search side. But a mythol­ogy has evolved in re­cent years, which is a whole other prob­lem.” He agrees that con­cus­sions are sig­nif­i­cant in­juries that need to be pre­vented, and has spent years urg­ing the NHL to take head trauma more se­ri­ously. But he is uneasy about the nar­ra­tive that he says orig­i­nated in Bos­ton and was then fed to the me­dia and, by ex­ten­sion, the play­ers — namely, that if you take enough hits to the head, you’re des­tined to de­velop CTE. That’s not what his team has been find­ing.

Ta­tor chooses his words care­fully as he de­scribes the grow­ing rift be­tween his pathol­o­gists and the ones in Bos­ton. “There’s room for more than one school of thought on this,” he says. When asked about Wishart’s al­le­ga­tions that he and his lab have col­lab­o­rated with the CFL to down­play the link be­tween con­cus­sions and CTE, he says it’s ab­surd that any­one would ac­cuse him of ma­nip­u­lat­ing his science to serve the game of foot­ball. Ta­tor ex­plains that he re­lies on Ez­erins and the CFL Alumni As­so­ci­a­tion for one thing: brains. He stands be­hind his aca­demic in­tegrity.

Given the stakes, how­ever, it seems in­evitable that the two labs would find them­selves at odds. There’s a story, which Nowin­ski ini­tially hes­i­tates to share, about a dé­tente he tried to bro­ker be­tween his team in Bos­ton and Ta­tor’s team in Toronto. “When Toronto an­nounced that they were start­ing up, I reached out to Ta­tor and said, ‘In­stead of us com­pet­ing for the same brains, why don’t you col­lect and study the brains from Canada and we’ll do the same down here?’ But

“My son loves the game—when I see him hit some­body, I cheer. I fear for him. But at least he knows what he’s get­ting into.”

Ta­tor re­fused.” ( Ta­tor doesn’t re­call that spe­cific re­quest.)

Wood­ward wasn’t the first dead Cana­dian CFL player to have a brain that was cov­eted by both camps. Back in 2010, when Ta­tor’s group was just get­ting started, Ez­erins be­gan reach­ing out to alumni while they were still alive. His ra­tio­nale was sim­ple: “We’re all part of the same fra­ter­nity. It’s tragic to see these men go down. I see it more than any­body. The big­gest chal­lenge to the science is get­ting do­na­tions. They need brains to study, and I’m the guy who knows where they can find them.”

Al­though Ez­erins has helped bring fif­teen brains to Ta­tor’s re­searchers, he re­grets hav­ing lost out on the brain of Doug Maciver, a per­sonal friend and for­mer nose tackle who spent nine sea­sons in the league. Maciver had told Ez­erins that he’d been knocked out sev­eral times. He’d ex­pe­ri­enced mood swings in his later years. He even­tu­ally suc­cumbed to a heart at­tack, but he’d be­come con­vinced be­fore he died that some­thing was wrong with his head. When Ez­erins learned of his friend’s death, he fol­lowed up with the fam­ily about a dis­cus­sion he’d had with Maciver about do­nat­ing his brain. But it had al­ready been com­mit­ted to Bos­ton. Ez­erins says he tried to ne­go­ti­ate its re­turn. Nowin­ski says that, by that point, the mat­ter was out of his hands.

Still, the Toronto team quickly came into pos­ses­sion of other brains — Jay Roberts’s for one. A for­mer Rough Rider who’d moved north from Iowa to play in 1964, he’d stayed in the town that made him a cham­pion. He died, af­ter suf­fer­ing from lung can­cer, on Oc­to­ber 6, 2010, at the age of sixty-seven. His was the first CFL brain to be har­vested for study. Next came the brain of Peter Rib­bins, a Blue Bomber who’d suf­fered from amy­otrophic lat­eral sclero­sis (ALS) and Parkinson’s, and died in the Cay­man Is­lands at six­tythree. Twelve days later, Tony Proud­foot, a sixty- one-year- old Alou­ette with the same ail­ments as Rib­bins, passed away in Mon­treal. Bobby Kuntz — a seventy-nineyear-old Tiger-cat who’d long suf­fered from Parkinson’s, died in Water­loo on Fe­bru­ary 7, 2011.

Their brains found their way to the of­fice of Lili-naz Hazrati, a mem­ber of Ta­tor’s team who works at Toronto’s Hos­pi­tal for Sick Chil­dren. By mid-2011, Hazrati had dis­sected all four spec­i­mens. She found no traces of CTE in the brains of Proud­foot or in Rib­bins, but did iden­tify them in those of Roberts and Kuntz. Hazrati says she has found some ev­i­dence sug­gest­ing that head trauma on CFL gridirons is lead­ing to CTE, but cau­tions that it’s in­con­clu­sive. “We spec­u­late that con­cus­sions cause CTE,” she says. “But I’m not 100 per­cent sure that’s the case. We lack proper con­trols to make that link.”

She tells the story of a Toronto lawyer in his early for­ties who suf­fered from Als-like symp­toms and died in his house four years ago. One of Hazrati’s col­leagues called her and asked if she’d look at the lawyer’s brain. She put his tis­sue un­der the mi­cro­scope and saw the ob­vi­ous pat­terns of CTE. “I went back and I asked the man’s wife, ‘Did he have any his­tory of con­cus­sions? Did he play any sports?’ And his wife said, ‘No, he did not suf­fer any con­cus­sions.’” Hazrati pub­lished her find­ings in the March 2017 is­sue of the In­ter­na­tional Jour­nal of Pathol­ogy and Clin­i­cal Re­search, claim­ing to have iden­ti­fied the first case of CTE in a pa­tient with no his­tory of head trauma. Her method­ol­ogy has been ques­tioned by both Mc­kee and Nowin­ski, who point out that there’s no real way for her to know whether the pa­tient had suf­fered head trauma in ear­lier stages of his life.

But of all the brains Hazrati has ex­am­ined, one that stands out is Todd Ewen’s. Ewen was a for­mer NHL en­forcer who got his name on the Stan­ley Cup with the Mon­treal Cana­di­ens in 1993. He died in 2015 from a self-in­flicted gun­shot wound to the head. “Todd Ewen killed him­self be­cause he thought he had CTE. But the brain was clean — no CTE. His wife was

com­pletely up­set with me. His kids were up­set with me.” They wanted Hazrati to ex­plain why he’d com­mit­ted sui­cide, but she couldn’t.

Ac­cu­rate sui­cide statis­tics about for­mer CFL and NFL play­ers are hard to come by. But when Ed­ward Ri­ley, a pro­fes­sor at Stan­ford Univer­sity and an anes­the­si­ol­o­gist, be­gan look­ing at the data from a 2016 Cen­ters for Dis­ease Con­trol and Pre­ven­tion study on sui­cide mor­tal­ity in re­tired NFL play­ers, he no­ticed an alarm­ing spike — twelve sui­cides in the last decade, more than in the pre­vi­ous sixty years com­bined. In a let­ter to World Neu­ro­surgery, he posited that this spike may not be a re­sult of CTE, but of con­ta­gion.

Sui­cides, Ri­ley ar­gues, may be feed­ing off one an­other. The loss of adu­la­tion that comes at the end of a ca­reer can plunge play­ers into a deep and dark de­pres­sion. And the pub­lic­ity around CTE may be in­ad­ver­tently val­i­dat­ing sui­cide as an op­tion for cer­tain de­pressed play­ers by sug­gest­ing a pos­si­ble link be­tween their emo­tional state and the dis­ease.

On Satur­day, March 4, while his son was at a train­ing camp with the Stam­ped­ers, Alon­dra John­son hugged his wife, Mar­guerite, climbed into his Cadil­lac, and sped off into Los An­ge­les traf­fic. The then fifty-one-year-old Hall of Famer had de­cided to skip out on the in­ter­view sched­uled for this story. He turned onto the free­way and pressed down on the throt­tle as he made for Mul­hol­land and the canyon roads that cut through Mal­ibu. He of­ten thought of just end­ing it on those roads — of veer­ing hard into a wall and let­ting the laws of physics do the rest. That day, he ex­ited left to­ward the coast and drove un­til the im­pulse faded. It was dark when he re­turned home.

On Sun­day, he apol­o­gized. “Yes­ter­day was bad. I didn’t feel up to hav­ing this con­ver­sa­tion.” He says he has felt am­biva­lent about the game ever since it cast him aside at the age of thirty-eight. He spent the last dozen years try­ing not to re­flect on past glo­ries or de­feats. He pawned off much of his mem­o­ra­bilia, in­clud­ing his Grey Cup rings. And now, he’s su­ing the league — the most for­mi­da­ble all-star at­tached to the class-ac­tion law­suit.

John­son was one of the big­gest names in the league dur­ing the 1990s and early 2000s. He spent thir­teen years with the Cal­gary Stam­ped­ers and com­peted in six Grey Cup cham­pi­onships. When he re­tired, he did so with the sec­ond-high­est num­ber of tack­les in CFL his­tory. He was the hard­est hit­ter in the game, the man quar­ter­backs feared most. He’d clench his teeth, fix his eyes on the man in the pocket, and smash his way through the of­fen­sive line with a fe­roc­ity few oth­ers could match.

But he says he played his en­tire ca­reer with headaches. His brain would start pound­ing ev­ery sea­son at the start of train­ing camp. Still, he out­lasted al­most ev­ery other Stam­peder, hold­ing onto his job for thir­teen years in a mar­ket where play­ers tend to last no more than two and a half sea­sons. Af­ter he was cut from the Stam­ped­ers, he man­aged to eke out an­other quar­ter of a sea­son with the Roughrid­ers, who needed a line­backer. After­wards, with no money, a bat­tery of in­juries, and a dwin­dling sense of pur­pose, he drifted from couch to couch. He stayed in Canada for five years. When his fa­ther died in a car ac­ci­dent in 2009, he packed up what lit­tle he had left and headed home to help care for his mother in LA.

He soon got a job in con­struc­tion and tried to move on with his life. But, grad­u­ally, his wife and oth­ers close to him started notic­ing that his be­hav­iour was chang­ing. She’d find him cry­ing while read­ing about his past; some­times, he’d dis­ap­pear for hours on a drive head­ing nowhere. Since 2010, the cou­ple had been pay­ing in­creas­ing at­ten­tion to the re­ports of CTE. Then, in May 2012, Ju­nior Seau shot him­self in the chest. Seau had been one of the game’s big­gest stars, record­ing 1,846 tack­les in a twenty-year NFL ca­reer. John­son re­calls shak­ing when he heard the news. He had been com­pared to Seau his en­tire CFL ca­reer. Both were Cal­i­for­nia-born lineback­ers, both had played the game for longer than av­er­age, and both were known as the hard­est hit­ters in their re­spec­tive leagues. (Upon ex­am­i­na­tion, Seau’s brain showed ev­i­dence of CTE).

John­son was still try­ing to make sense of Seau’s sui­cide when he suf­fered a mys­te­ri­ous seizure dur­ing a bar­be­cue with friends. Through her own re­search, Mar­guerite learned about the doc­tors in Toronto and Bos­ton, and about Bruce’s case. “I know he has a brain in­jury,” she said. “I don’t need a di­ag­no­sis. I’m mar­ried to it.” She and John­son de­cided to stay in the US to deal with their med­i­cal needs, but she reached out to Wishart.

Soon John­son had signed on to the clas­s­ac­tion suit. Do­ing so brought him a wave of un­wanted at­ten­tion from re­porters, who latched onto his name. Many of them ques­tioned how John­son could sue the league for his own ail­ments while sup­port­ing his son’s at­tempt to get a con­tract north of the bor­der. “It’s hard to ex­plain,” he says. “My son loves the game — when I see him hit some­body, I cheer. It’s in our blood. I fear for him. But at least he knows what he’s get­ting into. We didn’t know any­thing.”

He didn’t re­ceive much sup­port from his old CFL friends for his de­ci­sion to join the law­suit. “It wasn’t easy to do this,” he says. “I don’t want to look like I’m try­ing to cash in. Foot­ball gave me ev­ery­thing I have. But we’re vet­er­ans, and we need look­ing af­ter. Right now, I have things to live for. But I wake up ev­ery day won­der­ing what’s go­ing on in­side my head.” In his wal­let is a card that de­clares his last wish: that his brain find its way to Bos­ton.

Aft er she do­nated her hus­band’s brain, Kay Wood­ward would stand in her din­ing room and stare at his cre­mated re­mains, which she kept in an urn sur­rounded by flow­ers and pho­tos from his ca­reer. De­spite all the ways she be­lieved the CFL hurt her hus­band, she had loved be­ing the wife of a Grey Cup win­ner. She clung to her mem­o­ries of watch­ing Pierre Trudeau per­son­ally con­grat­u­late the mem­bers of the 1976 team. She loved think­ing of her hus­band driv­ing with the top down on his MG, cruis­ing to the sta­dium, then strap­ping on his hel­met and pads and do­ing what he did best. Each day since his death had been hard. “I know it’s not right,”

“Ev­ery day, I watch guys I played with de­te­ri­o­rate be­fore my eyes. You don’t know how tragic it is to see them go down. I could be next.”

she says. “But I want them to find it in his brain. I want them to tell me that he had it.”

She’d al­ready told the Bos­ton team about Wood­ward’s 125 con­cus­sions. She could re­call at least two in­ci­dents when he’d been knocked un­con­scious. She hadn’t no­ticed many changes in him, then. He’d al­ways been a neat freak, but in re­tire­ment he got ob­ses­sive about tidi­ness. He’d yell over spills and rant about the im­por­tance of keep­ing things clean.

He took that ob­ses­sive-com­pul­sive be­hav­iour with him to the In­vestors Group, where he was known as a dili­gent worker un­til he turned fifty, at which point his life went off the rails. He lost his job in 2001 and was even­tu­ally charged with fraud and theft. His de­fence lawyer strug­gled to get through to him. A re­porter cov­er­ing his sen­tenc­ing de­scribed him as a “thor­oughly beaten man, a galaxy away from his glory days.” To his wife and son, he seemed like a lost child while he was in prison. When he got out, he was changed. He’d wan­der away from home and re­turn, con­fused, in the back of a po­lice car. That’s when Kay took him to see the doc­tor, who told them Wood­ward’s frontal lobe was shrink­ing as a re­sult of de­men­tia.

Seven months af­ter Wood­ward’s death, the doc­tors in Bos­ton called to tell Kay that large por­tions of her hus­band’s brain were rid­dled with neu­rofib­ril­lary tan­gles — a hall­mark of CTE. “This was among the worst we’ve seen,” ex­plained Thor Stein, the lead neu­ropathol­o­gist on Wood­ward’s case. Stein es­ti­mated that the dis­ease had be­gun to spread through his brain in the early 1980s.

As Kay lis­tened, she let her tears flow. Her hus­band’s con­di­tion had put her fam­ily through years of torment. “He would have been deal­ing with this for thirty years,” she says. “I know now it was the dis­ease that changed him.”

There’s a statue out­side the old Cana­dian Foot­ball Hall of Fame in Hamil­ton. Cast in stain­less steel and alu­minum, it de­picts two foot­ball play­ers at the mo­ment of im­pact. One holds his arms out­stretched, leap­ing for a catch, while the other sets in for the tackle, his head cocked to the side as he rams his shoul­der into the leap­ing man’s torso. Forged as a last­ing de­pic­tion of a touch­down pass, it looks eerily sim­i­lar to the hit that trig­gered the pho­tog­ra­pher to snap Tom Pate in midair, the mo­ment be­fore he fell back­wards. For forty-five years, the two men in that statue have done what no player re­ally can: avoid the in­evitable col­lapse. But now they stand in limbo on top of a cracked pedestal be­side a park­ing lot — relics in need of at­ten­tion.

To peak and then de­cline is the tragic arc that unites all ath­letes. But sports have a life­span, too. A cen­tury ago, box­ing and horse rac­ing were the most pop­u­lar pas­times in North Amer­ica — a heavy­weight ti­tle bout or a thor­ough­bred horse race was the ath­letic equiv­a­lent of a royal corona­tion. Now they’re just sideshows, richer in lore than in ac­tual ap­peal.

Foot­ball has grown into a sport far big­ger than al­most any other in North Amer­i­can his­tory. But the game’s sig­nif­i­cance seems to be de­clin­ing, es­pe­cially in Canada. Pub­lic ap­a­thy can be felt on school­yard gridirons across the coun­try: the num­ber of high-school teams has dropped since 1977 — the same year 69,083 fans set an at­ten­dance record as they crammed into Olympic Sta­dium for a Septem­ber show­down be­tween the Ar­gos and the Alou­ettes. In Toronto, fan sup­port has plum­meted: last year’s Grey Cup­strug­gled

to sell out. Game at­ten­dance is dwin­dling through­out the league, even in the tra­di­tion­ally strong mar­kets of Ed­mon­ton and Cal­gary. South of the bor­der, the NFL still dom­i­nates the sports land­scape. Yet TV rat­ings have fallen there, too, as has par­tic­i­pa­tion in tackle foot­ball by boys aged six to twelve.

Here in Hamil­ton, Ez­erins spends his time li­ais­ing with vet­er­ans and also pro­mot­ing the sport among youth. His ra­tio­nale: if Cana­dian foot­ball is to have any fu­ture, it must prove that it is worth sav­ing. Not just to the pathol­o­gists or the lawyers study­ing the case, or to the gen­eral pub­lic de­bat­ing whether to tune in, but to the young men de­cid­ing whether com­pet­ing for the Grey Cup is worth the risk.

Stand­ing at the fifty-five-yard line in­side Tim Hor­tons Field, home of the TigerCats, Ez­erins peers up past the empty grand­stands to the ban­ners that bear the names of his for­mer team­mates. He still feels pride when he steps onto this field, de­spite the phys­i­cal toll the game took on him — that’s the price he had to pay for liv­ing out his dream and earn­ing a Grey Cup ring. “Ev­ery day, I watch guys I played with de­te­ri­o­rate be­fore my eyes. You don’t know how tragic it is to see these big men go down. In the­ory, I should be next.”

For the last six years, he has re­cruited alumni for an on­go­ing study aimed at de­tect­ing CTE in for­mer play­ers who are still alive. He di­rects them to Carmela Tartaglia, a Toronto-based neu­rol­o­gist and Ta­tor’s col­league. Tartaglia is one of the first re­searchers in Canada to be­gin test­ing a revo­lu­tion­ary biomarker that can bind to the tau pro­teins as­so­ci­ated with CTE in a liv­ing brain. A suc­cess­ful method of track­ing the progress of brain dam­age in real time would help re­searchers fig­ure out why some ath­letes get the dis­ease and oth­ers don’t. It might also make it pos­si­ble to distinguish the symp­toms of con­cus­sions from those of other con­di­tions — chronic pain, de­pres­sion, or anx­i­ety, for ex­am­ple. A big con­cern for Ta­tor’s team is that play­ers who suf­fer from treat­able con­di­tions may be for­go­ing help be­cause they’ve been led to be­lieve they have CTE.

By now, about a hun­dred par­tic­i­pants, most of them be­tween the ages of thirty and eighty-four, have en­tered Tartaglia’s lab in down­town Toronto. Af­ter they slip into hos­pi­tal gowns, a doc­tor in­jects ra­dioac­tive trac­ers into their arms. They’re then slid into a PET scan­ner, where they stay for about an hour while Tartaglia watches their brains on a screen.

Tartaglia has yet to fi­nal­ize her re­sults. There’s mount­ing pres­sure, she says, to find some­thing. She op­er­ates un­der the rule of pub­lish or per­ish, just like her ri­val clin­i­cians in Bos­ton, where alumni of the NFL have be­gun tak­ing part in a sim­i­lar study. Con­firm­ing CTE in vivo is the holy grail of con­cus­sion re­search. But there’s a risk in­volved, she says, in re­veal­ing your find­ings be­fore you re­ally know what they mean.

Tartaglia be­lieves she some­times sees the tau pro­teins that char­ac­ter­ize the dis­ease — they sur­face on her screen as red-dyed clus­ters in tis­sue that is oth­er­wise green. Spot­ting them isn’t al­ways emo­tion­ally easy for her, she says, since there’s noth­ing she can do to help these play­ers. While her goal is to find a way to pre­vent the dis­ease in the minds of the liv­ing, she has to know for cer­tain what it is she’s look­ing at — and to es­tab­lish cer­tainty, she needs to get deeper in­side their brains. Be­cause the test to con­firm CTE can only be done post­mortem, the play­ers will have to move on to the next stage of the study. Ul­ti­mately, she says, they will have to die.

Left Leo Ez­erins, a for­mer Tiger-cat, stands in Tim Hor­tons Field in Hamil­ton, On­tario.

above Leo Ez­erins wears his 1986 Grey Cup cham­pi­onship ring, which he won while play­ing for the Hamil­ton Tiger-cats.

left Charles Ta­tor leads the world’s sec­ond­largest team de­voted to con­cus­sion re­search.

above A signed CFL foot­ball is dis­played in Ta­tor’s of­fice at Toronto Western Hos­pi­tal.

above Lili-naz Hazrati is part of the Toronto team study­ing de­ceased play­ers’ brains.

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