The National Football League's stance on concussions has changed in the past few years. Despite the changes to their platform, the NFL has not been active in the creation of health policy, and healthcare providers are unable to implement policies to protect American football players from mild brain injuries and concussions.
In a commentary from Volume 34, Issue 2, 2013 of Journal of Legal Medicine, published by Routledge, Daniel S. Goldberg J.D., Ph.D. evaluates strategies which regulated industries typically use to build their brand when faced with accusations of occupational harm - in this case the NFL. One of the more common strategies Goldberg believes an organization will use is manufacture of doubt. "I would describe the manufacture of doubt as the systematic attempt to create scientific doubt regarding the causal links between a given industry and public health harms," he explained. "The creation of that doubt is only a means to the end to forestall regulatory and policy action intended to minimize the harm by internalizing the costs to the regulated industry itself."
The commentary explains manufacture of doubt first with a discussion of the tobacco industry's use of doubt years ago and the public health issue of tobacco use now, and then follows up with the concussion litigation against the NFL. According to Goldberg, the NFL manufactures doubt through two means: documents not released to the public and vagueness in the language of statements made by the NFL during the litigations. "There is almost a universal agreement among scholars that understanding the history of public health is essential to crafting just public health policy in the present," wrote Goldberg.
While manufacture of doubt is not illegal, it's a major ethical issue. Citing examples such as increasing evidence of chronic traumatic encephalopathy (CTE) - a degenerative brain disorder most frequently associated with former boxers - as well as actual plays occurring on the field in previous seasons, Goldberg asserts that the NFL concussion litigation creates not just issues for health care policy, but also implicates a broader concern for public and population health. Accordingly, mild traumatic brain injuries are a more prevalent issue at the lower levels of football, such as collegiate, high school, and even peewees.