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September 1, 2017
by Irvin Muchnick
I tried placing with major newspapers in New York an op-ed essay on the pandemic of Exertional Collapse Associated with Sickle Cell Trait (ECAST). The piece was definitively declined yesterday by the one paper that seemed to be taking a close look at it. The thinking revealed in my dialogue with the editorial page editor there is instructive.
It’s bad enough that the parents of America can’t get decent, level coverage of the dangers of the cradle-to-grave football industry and the subsidies of it by public parks and public schools. But you can’t even peep a meaningful discouraging word on the opinion pages.
The editor started by asking me, “Shouldn’t we wait and see whether this is in fact related to why he died before speculating? If it is related, then we could use this.”
I replied:
“You ask a fair question, but I think there’s an answer. It’s a two-part answer.
First, I wrote the piece because sickling death isn’t even in the conversation when these things happen. So putting it out there in public discussion helps pressure the medical examiner to consider this factor before issuing findings. Has the ME looked at New York State birth records, which should have required a notation as to whether Dominick was a sickle cell carrier? Remember (and as referenced in my essay) the Alameda County, California, coroner ruled “heart failure” in Ted Agu’s 2014 death, then revised the autopsy upon learning that the deceased had sickle cell trait. Not waiting for the authorities to do the once-over-lightly is part of the point of publishing this while the tragedy of Dominick’s death is still fresh in your readers’ minds.
My second answer is this: What I’m asking for is a commitment to publish my perspective. I don’t care if it’s today or tomorrow — or if you’re agreeing to let me revise it in a week and publish it then, in case an official autopsy or other information intervenes.”
The editor then asked, “But is this the kind of thing an autopsy would reveal? I’m a little uneasy about publishing a speculative diagnosis if we’re going to get a definitive, official medical judgment.”
I told the editor that I considered “a definitive, official medical judgment” a thin and passive reed on which to hang public-interest journalism. Yes, I said, “this is the kind of thing an autopsy would reveal — but only if the medical examiner is attuned to processing the real medical science that has emerged regarding this syndrome, and not rubber-stamping a generic finding friendly to the football establishment. The process involves investigation of timing and the order of events, not just slicing open body organs and making uneducated guesses. Again, that is the very point of publishing, even if you should happen to feel that my opinion and clearly labeled speculation here might be overstating the case for ECAST in Dominick’s death.”
I shared with the editor the deposition testimony of former Alameda County medical examiner Dr. Thomas Beaver, which is part of The Ted Agu Papers and was reported here at https://concussioninc.net/?p=11127.
The editor: “If the autopsy says this had something to do with the syndrome you describe, I’ll use the piece.”
No dice. For there is no telling when the Bess autopsy will be released or how thorough it will be. If the finding is that this was not ECAST — whether rigorously determined or not — then the conversation is dead. If there turns out to be official consensus that ECAST was the cause or a factor, then you can count on a mainstream”open forum” to enlist a football-friendly doctor who talks about how ECAST is new science that requires further study, and how the sport is making great strides in mandating water breaks during drills.
The first order of business is determining whether the young man did indeed carry sickle cell trait. New York State birth records should be able to establish this right now. Meanwhile, youth football death marches on.
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The death last week of 14-year-old Dominick Bess at a Bronx high school football conditioning session is a reminder that, while traumatic brain injury gets most of the headlines, the lethal dangers of this sport, in which no kid should be participating for public schools or on public fields, are multiple.
Though the medical examiner has yet to speak on the cause of death, and episodes like this one are usually written off as generic cardiac arrest or heat stroke, there is considerable circumstantial evidence that young Bess was the latest unacknowledged victim of one of football’s biggest killers: ECAST, which stands for Exertional Collapse Associated with Sickle Cell Trait.
Medical journal research spearheaded by Dr. E. Randy Eichner, a former University of Oklahoma football team physician, and Scott Anderson, still the Oklahoma head athletic trainer, shows that there have been at least eight ECAST deaths since 2010 in high school and college football. With more rigorous accounting of sickle cell trait and with better reporting of the many more youth football practice deaths, the number of confirmed ECAST incidents would certainly be higher. Critics believe that ECAST may account for as many as half of all non-traumatic injury football deaths — which makes sense when you consider that around 1 in 12 African-Americans carries sickle cell trait.
This trait should not be confused with sickle cell disease, a form of anemia or blood disorder triggering chronic health crisis. Those with the trait can lead normal lives but need to be vigilant for the onset of episodic sickling attacks during extreme exertion. Lay people can easily mistake these for ordinary heart failure.
ECAST is, literally, a political football. Despite mounting data that it is a leading cause of football and, to some extent, military training deaths, sickle cell disease advocates and fundraisers don’t want to call attention to the trait. They likely feel that, in a society where racial discrimination is pervasive, they shouldn’t be promoting factors that could stigmatize blacks. This is especially challenging because sports and military service may be the closest things in American life to pure meritocracies.
Unfortunately, the taboo reinforces annual and preventable loss of life. Last year Eric Goll died suddenly during an offseason football workout at Chadron State College in Nebraska. The school said it was not aware that Goll had sickle cell trait, even though he should have been screened for it when he was a freshman two years earlier.
But even when a school knows, the competitive and commercial pressures of the college football industry can eclipse safety measures. Such was the case at the University of California-Berkeley in 2014, when Nigerian-American player Ted Agu, who was known to the football and medical staff to be a sickle cell carrier, perished during a bizarre offseason punishment drill overseen by athletic trainer Robert Jackson and strength and conditioning coach Damon Harrington. The university withheld crucial information from the county medical examiner, whose initial autopsy ruled the incident a coronary. But discovery and deposition testimony during the Agu family’s subsequent wrongful death lawsuit against Cal persuaded the coroner to make an almost unprecedented revision of his findings.
The Agus settled their lawsuit for $4.75 million. I am currently suing the university in state court, under the public records act, for release of internal documents that would allow taxpayers to better understand the background. (The parties have jointly asked the court to pause the litigation docket while we explore a possible settlement.)
Trainer Jackson had also been a responsible party in the 2008 sickling death of a Haitian-American football player, Ereck Plancher, at the University of Central Florida. Jackson is now out of the football industry. Incredibly, however, Cal conditioning coach Harrington has moved to the same post at Grambling State, where the squad is nearly 100 percent black.
In the case of Dominick Bess, his mother had immigrated from the Caribbean island of Montserrat, where estimates of sickle cell trait among the population there of African ancestry run as high as 15 percent. Heat stroke, another common false flag in deaths of this sort, was unlikely, as it was only 79 degrees last Tuesday morning in the Bronx. What we do know is that on this second day of football conditioning at Mount Saint Michael Academy, Dominick was made to sprint repeatedly. A teammate said he was overworked and tired, and that Dominick himself said he was tired and asked for water. His father said he was described as “gasping for air.” The alleged response of the supervising coach was that age-old exhortation: “One more lap.”
Concussions and chronic traumatic encephalopathy — the slow-moving brain deterioration probably caused by accumulation of subconcussive hits — are plenty scary by themselves. So are spinal cord injuries and internal organ devastation. But the ECAST factor deserves to be amplified as American parents ponder the fraught future of football. And as with every aspect of the football debate, it should gain intensity and moral clarity at the sport’s non-adult and non-professional levels.
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Concussion Inc.’s ebook THE TED AGU PAPERS: A Black Life That Mattered – And the Secret History of a Covered-Up Death in University of California Football is available on Kindle-compatible devices at http://amzn.to/2aA2LDl. All royalties are being donated to sickle cell trait research and education.
Op-ed article for the Daily Californian on my Public Records Act lawsuit:http://www.dailycal.org/2017/04/25/lawsuit-uc-regents-emblematic-issues-facing-college-football/
“Explainer: How ‘Insider’ Access Made San Francisco Chronicle and Berkeley J-School Miss Real Story Behind Death of Cal Football’s Ted Agu,” https://concussioninc.net/?p=10931
Complete headline links to our Ted Agu series: https://concussioninc.net/?p=10877