The Most Violent Game

#HBC | Acrostic

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Netflix's series Last Chance U is a documentary about Junior College Football (JUCO) at East Mississippi Community College (EMCC) and Independence Community College (ICC). The series features junior college football players who are looking to rack up their accomplishments in order to make it into Division I schools with Power 5 Conferences. On the flip side, several players from Division I schools have dropped down to JUCO schools due to being kicked out of their own schools for reasons like possession of illegal substances (often marijuana), physical altercations, poor academic behavior, or not being compliant with the demands on the field. These fallen talents play in JUCO in order to regain what they lost, a chance to prove themselves on the D1 field and to be able to transition that success into a multi-millionaire contract with the national football league (NFL).

Numerous traumatic injuries occur during a typical football game. Trauma in the technical sense is defined as injuries that are linked to a mechanism of injury (MOI) related to a physical force e.g. acceleration, impact, recoil, etc that is connected to the patient. In the case of football, the MOI would be players colliding into one another repeatedly over the course of a regular season. In order to deal with the pain related to these injuries, patients on the JUCO level are not simply taking ibuprofen (Motrin) or acetaminophen (APAP/Tylenol). They are comfortably numbed by an injection of ketorlac (Toradol) which is extremely effective for mitigating pain as an NSAID due to its effectiveness on musculoskeletal pain. Toradol when administered in a hospital is strictly monitored on a 5-7 day restriction in post-surgical patients or patients involved in poly-trauma related accidents. Ironically, prolonged dependence on NSAIDs is known for inhibiting prostaglandin synthesis due to this being a primary pathway for its analgesic effect. However, as a catch-22 prostaglandins are responsible for bone remineralization, therefore prolonged reliance and repeated intramuscular injections in the gluteus, oral, or IV access trades short-term benefits for serious long-term consequences.

In World War II, both Allies and Axis power experimented with amphetamine and metamphetamine use on bomber pilots in order to enhance their concentration during long flights. Although this wasn't successful in long term usage due to pilots presenting with agitation, soldiers were still given stimulants in order to enhance their ability to kill enemy combatants. Football in and of itself can be considered a frightening game without the use of player doping, however the use of analgesics and other medications to "improve" player performance makes every tackle, collision, and injury that much more frightening. When it came to initially addressing these issues, the NFL commissioner and the physician representing the NFL denied ramifications related to traumatic encephalopathy (CTE). Any trauma, especially trauma connected to the head can have a variety of significant complications when it comes to living a normal life. Mike Webster known as "Iron Mike" was known for taking a number of hits during the 16 years he played and earned his spot into the Hall of Fame. Unfortunately, Webster was reported to have suffered from substance abuse in order to cope with amnesia, depression, dementia, and constant pain. When the alcohol wasn't sufficient, he would use electroshock weapons on himself in order to fall asleep. He formally died at the age of 50 of a heart attack.

When Bennet Omalu a forensic pathologist assessed Webster's brain, he found no signs of injury. Imaging scans known as CT and MRI came up negative. However, when observing slides of brain tissue under a microscope, it was discovered that there was far too many depositions of Tau protein in areas that were believed to be related to trauma. Initial debate from the NFL Commission was that the deposits of Tau could have been related to early onset of Alzheimer's or Parkinson's Disease. However, neuropathologists & neurosurgeons disagreed with this differential as the deposits would have been located in entirely different areas if they were actually related to onset of these diseases in someone as young as 50. The NFL continued to discredit Omalu stating that his literature was unscientific and questioned his standing as a licensed physician asking for the article published in Neurosurgery to be redacted. Despite being pressured on a regular basis by the NFL commission, Omalu still held on to his scientific convictions of CTE and further substantiated his case when he autopsied the brain of Terry Long, another professional football player who committed suicide by ingesting one gallon of antifreeze (Frontline).
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Violence has been split into several different categories. Some of these categories are self-directed e.g. suicide or self-mutilation, collective violence e.g. structural violence or economic violence, warfare, non-physical, interpersonal, targeted, and everyday (Wikipedia). Many of these categories were developed off of a framework from the World Health Organization (WHO). Several of these categories overlap with the aforementioned case of football, however some are less obvious than others. Football is a violent game with high risk to both parties, however the reason why it is such a prevalent American past time is because the high risk comes with high rewards. Aside from status and reputation, the financial payout of playing in the NFL for a rookie contract still comes out to millions of dollars. However, rookie contracts were designed to be fundamentally unfair in that the major payout to players came at the tail end of a contract. Therefore, if a player is injured or no longer usable, then they may not end up receiving a large portion of their contract.

Players are put in a sort of economic bind as they are dependent on their contract to pay for their livelihood, but their livelihood is at stake when they try to meet the ends of their contract. In addition, even finishing out a contract could result in a pyrrhic victory as the player could sustain so many injuries after retirement without having a team physician hook them up with narcotics or a powerful NSAID like ketorlac (Toradol) that they need to rely on alcohol, marijuana, or other substances in order to mitigate the pain. The fact that drug-seeking behavior becomes a baseline and any constructive outlet such as aggression no longer has a constructive output, players could potentially suffer a similar situation as soldiers coming back home with PTSD as they find that they no longer fit in with civilian life following years of commitment to the sport.

The justification for this form of this mutually agreed violence could be seen as being institutional and economic. Players consent to harm one another on the basis of playing a game with the potential for great returns. Society endorses such a game as being an American past time and throws major financial backing to allow the game to continue. The NFL becomes a large institution that is able to employ its own team of lawyers and physicians to repudiate scientific journal publications and to prevent players from actually getting additional compensation for injuries related to actually playing the game. All in all, it's a dirty arrangement, however is it really an isolated case? And if there are parallels to be drawn from the violence that occurs on and around the football field, what does this mean for your average Joe?
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A study published in 2018 has identified an alarming increase in ADHD among children between the ages of 4 - 17 from 6.1% in 1998 to 10.2% in 2016. In 2016 the CDC found 6.1 million children between the ages of 2 and 17 were diagnosed with ADHD. Coincidentally, prescriptions for medications for ADHD have also increased astonishingly as have sales for ADHD related medications. From 2002 to 2010, three new brand medications entered the pipeline to treat ADHD: Straterra, Vyvanse, and Intuniv in order to address the sudden ADHD epidemic and SAMHSA reported that in 2015 an estimated 119 million Americans aged 12 or older used prescription psychotherapeutic drugs in the past year representing roughly at least a third of the United States's total population. This sudden reliance on pain relievers, tranquilizers, stimulants, and sedatives just to account for prescription drug dependency alone raises a simple question, why are we becoming increasingly dependent on medication?

There are a lot of people who will step up to bat and argue that increasing reliance on ADHD has no relationship with increased expectations of students in the school system citing that there are genuine issues with obsessive compulsive disorder (OCD), biochemical imbalance, and other neuropathologies. I don't deny any of these being genuine concerns, but I'm curious how aware they are of other individuals diagnosed with ADD or ADHD seeing as patient files are largely protected by HIPAA and there are very few meta-study analysis attempting to discern the signal noise from actual patient cases. The New York Times in 2013 published an article called, "Drowned in a Stream of Prescriptions" which followed the story of Richard Fee who hanged himself in his bedroom closet following his substance abuse of Adderall. Richard Fee was a premedical student who was interested in passing the MCAT or the medical admissions test. The MCAT is a multi-disciplinary test that covers biochemistry, physics, chemistry, psychology, and a variety of other topics. It's a ridiculous test, however Mr. Fee was up to the task, the only thing impeding him however was the sudden discovery that he had ADHD. As a college graduate and at the age of 23-24 it was a late diagnosis, however it explained why he was having significant issues with focusing on studying for the exam. The medications had a profound positive effect enabling him to focus, however Mr. Fee developed a dependency to the medication and was suspected of taking above the prescribed amounts. As a result he would often enter a manic like state representative of bipolar type I and would become incoherent and unfocused. His parents who were concerned attempted to prevent him from obtaining more of the medication, but he would find a way to subvert their expectations ultimately resulting in his untimely demise. In April of 2015 the MCAT released a new version of the examination, it became even more comprehensive covering more subjects resulting in the difficulty of the exam being harder than before.

In March of 2019, United States federal prosecutors discovered that 33 parents of college applicants paid more than $25 million to a paid consultant who could stage fake exams to fraudulently inflate test scores and bribe college officials. Colleges and universities are far more expensive to enter into now than ever before with the average cost to attend a university increasing eight times the amount of the increase in wages. Due to this drastic increase in tuition, students are forced to not only take on federal subsidized and unsubsidized loans, but also private loans with high interest rate. By taking on these loans, students are under the impression that they are taking on a short term loss (via student debt) to achieve long term gains (a lifelong education). However, along with increased tuition costs there is increased competition as attendance in post-secondary education has only been on the increase with each additional year. With the demand for performance being higher and a lot riding on students, school itself becomes a performance game with every class evaluating students with every test they take and giving them a feedback score to evaluate how they performed against their peers. Similar to how the BCS Formula evaluates top teams to decide which team gets to play in national football tournaments, most professors utilize a normal distribution curve to evaluate which letters should be attributed to points earned on an examination. As a rite of passage per the end of each semester, schools force students to run through a finals sprint in which anything and everything covered in any given course is fair game for question with the test potentially accounting for more than half of the final grade.

Although I believe that a biochemical imbalance theory has merit when it comes to explaining psychiatric and neurological problems, there is a lot that leaves to be explained. First and foremost, when diagnosing for a "diseased" brain that is riddled with ADHD are there serotonin markers, dopamine markers, and norepinephrine markers? From what I'm aware of it is contraindicated to insert a syringe into someone's brain tissue just to get a numerical reading and even then more dubious as to whether that sample would be indicative of the pertinent neurotransmitters that are present in the synaptic junction. Which is to say that when it comes to hardliners of the biochemical imbalance theory, they are often not keen on actually establishing a numerical system analogous to how one would characterize leukocytosis as usually being a value above 11,000 per mm^3. If there is no strict quantification for balance, then how can one distinguish a balanced mind from an imbalanced mind? If a 5 year old is expected to write a program in C++ because he's in a super accelerated program, but can't meet that expectation then does that mean their frontal lobe is somehow diminished and must be rectified? When the expectations in the past were that a 50 year old is accomplished for being able to utilize MS-DOS as an operating system then I would argue that there has been a relatively large gap in proficiency expectation from one generation to the next. Other interesting journal papers in neuroscience have discussed that the frontal lobe does not stop developing until possibly late into the 20s to mid 30s. The frontal lobe is responsible for judgment, control of inhibition, and has a large part in making logical conclusions. If this area of the brain is responsible for a majority of processes involved in learning and adopting appropriate behavior for a school environment, then why are children between the ages of 4-17, 2-17, and 12+ already being diagnosed & treated for failing to succeed in the most current iteration of our education system?
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I think of violence as being not so much an action as an ethos. Why? It's because there is so much competition for a perceived limitation of spots that it feels like there is institutional violence, economic violence, and some degree of non-physical being directed your way. The fact that caffeine is the most consumed stimulant by nearly the entire population of the world is alarming, this existing separate from the increasing need for prescription stimulants and psychotherapeutic medications in order to survive in today's economy. I think that if you take an ideological stance of non-violence that the unspoken ramifications are numerous. Believing that there is a chance for an amicable resolution without putting up an individual fight means that everyone who has adopted a violent predisposition is already one step ready to take something that could have been shared equally. There is a philosophical situation known as the Prisoner's Dilemma that highlights how one prisoner will always win the most reduced sentence by screwing over their fellow prisoner who will end up with a maximum sentence. Another theory that highlights the failure of a good will type clause in human relations is the Tragedy of the Commons. Even our modern economic theory has significant influence from John Nash's Nash equilibrium which states that equilibrium is achieved among players because each person creates their own strategy to obtain what they want after considering the strategy of their opponents. At the end of all this you may be wondering, "So what the hell is the most violent game?"
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Mortal combat.
 
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