Broken at Both Ends

By Jerry D. Fife, M.Ed.  |  ProTect Athletics  |  September 7, 2026

In the span of eight days in September 2026, two peer-reviewed studies landed in the same conversation about the same disease in the same population. One told us how many former NFL players have chronic traumatic encephalopathy. The other told us what happens when those players try to collect the compensation the NFL settlement was designed to provide them.

Read together, they describe a system that fails athletes twice. Once on the front end, when there is no one qualified to protect them from accumulating the damage. Once on the back end, when the institution built to recognize and compensate that damage cannot find it.

The critique lives between the two studies, not inside either one.

What the First Study Found

On August 25, 2026, a study led by Dr. Daniel Daneshvar of Harvard Medical School was published in the BMJ. The researchers examined 1,712 former NFL players who died between 2008 and 2021. Of those, 338 donated their brains for study. Among the donors, 315 — 93.2 percent — had confirmed CTE.

That 93.2 percent is not a rate for all former NFL players. Donation is voluntary. The players most likely to donate are those who suspected CTE, or whose families did. The study accounts for this by modeling estimated prevalence across the full 1,712. The conservative floor for the most recent and best-documented period, 2016 to 2021, is 24.5 percent. At minimum, one in four former NFL players from that window had confirmed brain damage. Not suspected. Confirmed at autopsy. The actual number is likely higher.

The headline stopped there.

The study found something else. The lead investigator noted that many former players may also be living with conditions that have nothing to do with CTE and are treatable: sleep disorders, cardiovascular disease, hormonal imbalances. A former NFL player who develops symptoms does not walk into a clinic wondering whether it might be sleep apnea. The cultural verdict arrived long before he got there. He played professional football, and in the minds of everyone around him, including his own, that fact settled the question. When the conclusion precedes the evaluation, no one looks for another answer, and conditions that could be treated simply go undiagnosed. That is a different failure than the one the JAMA study documents, but it belongs to the same broken system.

What the Second Study Found

Eight days later, on September 2, 2026, a study led by Anna Aaronson and senior author Dr. Michael Alosco of Boston University was published in JAMA Network Open. It examined 33 former NFL players who shared two characteristics: they had been diagnosed with CTE at autopsy, and they had completed the NFL Concussion Settlement’s Baseline Assessment Program (BAP) during their lifetimes.

The BAP is the cognitive testing program the settlement uses to determine whether a former player meets the diagnostic threshold for compensation. Its scoring algorithm, however, does not align with the clinical standard that exists outside the settlement. In 2021, the National Institute of Neurological Disorders and Stroke established a formal diagnostic category for living patients suspected of having CTE: Traumatic Encephalopathy Syndrome, or TES. Because CTE can only be confirmed at autopsy, TES gives doctors a framework to evaluate, document, and treat living patients based on their symptoms, history of head impacts, and how they are functioning day to day. The JAMA study compared those players’ BAP ratings against their neuropsychological test scores and CTE stage at autopsy to find out how well the settlement’s tool actually performs.

The answer was damning. Across all 33 participants with autopsy-confirmed CTE, approximately 4 in 10 were rated as cognitively unimpaired by the BAP’s scoring criteria, regardless of disease stage. The failure was most acute among the most severely affected.

Seven of the 33 players had advanced CTE, Stage 3 or Stage 4. Six of those seven showed measurable cognitive impairment on standard memory and cognitive tests. All seven received the BAP’s lowest impairment rating: Level 0.

Seven players. Advanced CTE confirmed at autopsy. Six with measurable impairment on objective testing. All seven invisible to the mechanism that was built to find them.

The researchers concluded that the settlement’s diagnostic algorithm differs from the clinical standards normally used to diagnose cognitive disorders, and that the BAP is “likely suboptimal” in identifying former players owed compensation under the agreement. That is the language of peer-reviewed science. In plain terms: the system cannot find what it was built to find.

The Space Between the Two Studies

These studies were published independently, by different research teams asking different questions. But they describe the same failure from opposite ends.

Years of research have documented that brain damage accumulates across a player’s entire career, beginning at the earliest levels of organized contact football. The BMJ study describes what that accumulation produces at the end of a professional career.

The JAMA study describes what happens after. After the career. After the diagnosis. After the death. When the family sits across from a compensation framework that uses an algorithm that cannot identify Stage 4 CTE in a man who died at 65.

Between those two endpoints (the first hit and the failed claim) is an entire career of accumulation that the system was not designed to interrupt.

The End That Can Be Fixed

That interruption is what we exist to provide.

Researchers cannot yet prevent CTE. The science of diagnosing it in living patients is advancing but not complete. The algorithm the NFL’s concussion settlement uses to determine which former players qualify for compensation will be challenged, revised, and argued over in courts for years.

For more than twenty years, CTE research has been published and the coverage has followed. The work has been real and valuable. Scientists have built careers on it. Families have used it to pursue compensation. Institutions with the most at stake have invested in their own research to influence how the disease is described and managed. But the athlete practicing right now, on a Tuesday afternoon on a youth field where no trained safety professional is required to be present, has gotten nothing from any of it that protects them in that moment. Research tells us what has already happened. Coverage tells people what research found. Neither one puts a qualified person on that sideline. The gap between what the science has established and what youth athletics actually looks like is not a problem of information. It is a problem of structure. Those are not the same thing.

None of that is the Athletic Safety Organization’s lane.

Let the record show something before we go further. The NFL has some of the most qualified sports medicine professionals in the world. Team doctors, certified athletic trainers, neurologists, and mental health specialists are part of every franchise’s staff. The equipment managers working alongside them every day are among the most credentialed professionals in the sport. The settlement itself reflects the league’s acknowledgment that a responsibility to its players exists. None of what follows is aimed at any of them.

The NFL is not the problem in this story. The problem is every level of organized athletics that precedes it.

A player who reaches a professional roster at 22 has already spent twelve or more years in environments that had none of that infrastructure. Youth leagues. Middle school programs. High school teams. Small colleges. Environments where no trained safety professional is required to be present, where no one is required to assess whether conditions are safe before play begins, and where there is no mandated plan for what happens when someone goes down on the field. The damage the BMJ study is now documenting did not begin in a professional training camp. It began long before anyone with the right training was required to be watching.

That upstream stretch is our lane. More than 8 million students participate in high school athletics in the United States every year. The vast majority play in environments where no trained safety professional is required to be there. That is not a policy debate. It is every practice, every game, every season.

That gap is not inevitable. It is a choice. High-risk industries like construction and chemical manufacturing are required by federal law to have a designated person whose job is to identify dangers and address them before anyone gets hurt. OSHA calls this person the competent person: someone specifically trained, with the actual authority to stop unsafe conditions before they become injuries. Athletics has no equivalent. We send children onto physically demanding fields and fill the safety role with good intentions and whoever is available.

Good intentions do not stop CTE from building. Every industry that manages physical risk applies safety in layers: first, eliminate the danger if possible. If not, reduce it. Then control exposure by putting someone trained and authorized in charge of managing it. Protective equipment comes last, after everything else is already in place. Athletics has done this backwards. The helmet goes on first. The person who should be deciding how much contact is safe, whether the conditions are safe to play in, and what to do when someone is hurt is often not required to exist at all.

What a trained safety professional provides is not another piece of gear. It is everything that should have been in place before the gear came out of the bag. No credential prevents every injury. No safety system in any industry promises that. But every industry that has built and applied this system shows fewer injuries and less cumulative harm. Athletics has every reason to expect the same.

What We Are Building

The Athletic Safety Organization was built to close that upstream gap. The work happens through four credentials.

The Sports Safety Essentials (SSE) curriculum starts at the base. It trains the coaches and staff who are present at nearly every practice and game to meet the state-mandated safety standards that already exist in all 50 states. Many of those people have never been trained to those standards. SSE was built to close that gap. The Youth Safety Officer (YSO) credential goes a step further, placing a designated person at the event level with one job: safety. Someone in the room who owns the safety function entirely, because in most youth athletic environments, no one does.

For programs too large for a single safety officer and too under-resourced for a full-time professional, the Athletic Safety Manager (ASM) builds that mid-level capacity where there was none. At the highest level, the Director of Athletic Safety (DAS) is the full professional standard, modeled directly on OSHA’s competent-person designation: an individual with recognized knowledge, organizational authority, and documented accountability to identify hazards and act. No federal standard currently requires anyone to fill that role at the youth and scholastic levels of sport.

These credentials were not designed to treat CTE, and they were not designed to undo what the BMJ study and the JAMA study are documenting. That damage accumulated across decades of athletic participation in environments that had no structural safety floor. The purpose of what we are building is to ensure that the next generation of athletes does not become the next generation of research subjects.

We are building that floor now. Not because a law said so. Because the data has made the case that waiting for a law means waiting for the next study to document the next generation of damage.

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References

1. Daneshvar DH, et al. “Prevalence of chronic traumatic encephalopathy at death in National Football League players: retrospective population based cohort study, 2008-21.” BMJ. August 25, 2026. bmj.com
2. Aaronson A, Alosco ML, et al. “Neuropsychological Profile of Autopsy-Confirmed Chronic Traumatic Encephalopathy.” JAMA Network Open. September 2, 2026. jamanetworkopen
3. Cooper L, Harper R, Wham GS, Cates J, Valovich McLeod TC. “Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School-Aged Athlete: A Summary Statement.” J Athl Train. 2019;54(5):498-507. nata.org
4. National Federation of State High School Associations. “2022-23 High School Athletics Participation Survey.” NFHS, 2023. nfhs.org
5. Stamm JM, et al. “Age of First Exposure to Football and Later-Life Cognitive Impairment in Former NFL Players.” Neurology. 2015;84(11):1114-1120. doi:10.1212/WNL.0000000000001358
6. United States Department of Labor. OSHA Standard 29 CFR 1926.32(f). Competent Person Definition. osha.gov
7. Katz DI, Bernick C, Dodick DW, et al. “National Institute of Neurological Disorders and Stroke Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome.” Neurology. 2021;96(18):848-863. doi:10.1212/WNL.0000000000011850

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Jerry D. Fife, M.Ed. is the Co-Founder and COO of Athletic Safety Organization dba ProTect Athletics, a 501(c)(3) nonprofit building the first OSHA-equivalent safety credentialing framework for athletics. His career includes safety administration with the National Safety Council and VOSH, Virginia’s state OSHA equivalent. He is the lead curriculum architect of four progressive safety credentials designed around demonstrated competency rather than course completion.