Exclusive: PFA 'ignored' doctor's warning over brain damage in 1993

A leading doctor has claimed that football may have missed the chance to save players from irreversible brain damage after the Professional Footballers’ Association failed to act on his repeated suggestions for research more than two decades ago.

Dr Mike Sadler said that he tried to raise the issue in letters to PFA chief executive Gordon Taylor between 1993 and 1997 but that he received no help or encouragement and what he describes as a “quite dismissive” response.

It intensifies the pressure on Taylor following anger over his £2.29 million salary and there were fresh calls last night from the Jeff Astle Foundation, a charity set up to support the families of former footballers with dementia, both for him to stand down and for a parliamentary inquiry into an issue that it says has been “swept under the carpet”.

Sadler, who was then a consultant in public health medicine and is now clinical director at the Southampton NHS Foundation Trust, had become concerned after noticing how many former players appeared to be developing premature neurological disease.

This was reinforced when he met ex-Liverpool manager Bob Paisley, who himself had Alzheimer’s, and in conversations with then Southampton captain Kevin Moore, who would subsequently be diagnosed with dementia in his forties and die in 2013 aged just 55.

Sadler was concerned about both heading and collisions and, in one letter written in 1997, told Taylor that the issue “deserves attention” and “it may be that those players who are vulnerable could be identified before any serious issue is caused”.

Moore had informed Sadler that he suffered multiple head trauma during games and his family have told The Telegraph that they believe he was killed by football. He is the first known Premier League player to have died from dementia.

The Football Association and PFA did launch limited research shortly before Astle died in 2002 of what a neuropathologist attributed to the type  of dementia – chronic traumatic  encephalopathy (CTE) – that is caused by repeated head trauma. That study was published in 2015 but ultimately disowned by the FA and deemed inconclusive by the PFA. It was then only this year, following a Telegraph campaign, that new comprehensive research has begun. Results are not expected until at least 2020, a wait of more than 25 years since Sadler first  approached the PFA.

“I am glad this matter is being  investigated now, but believe it should have been investigated much earlier, which may have enabled us to save some footballers from brain injury in the succeeding years,” said Sadler. “I initially wrote to Gordon Taylor directly, in late 1993 or early 1994, suggesting a study comparing former players, with goalkeepers as a comparative subset of footballers who didn’t routinely head the ball, with the general population.

“I received a fairly dismissive reply, saying that the PFA didn’t keep records that would enable this study, but offering no other thoughts or encouragement. Through Kevin, I asked Iain Dowie, then Saints’ PFA rep, to take a letter to the next PFA meeting, which he did, but again without positive response.”

In 1995, and as also revealed by The Telegraph, Baroness Elaine Murphy warned the FA following a study about football and dementia in the medical journal she was then editing. She says the FA “were very short and refuted any such association could exist”.

Sadler’s concerns deepened in 1997 when The Lancet published  research of Finnish footballers that showed brain lesions, thought to be due to repeated head trauma. “So I wrote to Gordon Taylor again, but without response,” he said.

The PFA did commit £100,000 towards new research into an international head injury project last year, as well as committing to the FA/PFA football study, and Taylor said on Tuesday that funding on this issue would be more than £500,000.

Taylor also said that the PFA’s work in the area pre-dated Astle’s death and that they had been “closely involved and represented on the FA Medical Committee” since the 1990s on all health and safety issues, including dementia and concussion.

He also pointed to the new “if in doubt, sit them out” concussion protocol that was lobbied for by the PFA and introduced in 2015, as well as the research since 2002 that the PFA has helped fund.

Taylor has denied ignoring the issue and says that he does not know of  another football organisation in the world that has done more.

“We are  aware of the literally dozens of research projects throughout the world on  this issue,” he said. “No causal link has yet been established between  heading the ball and various neurological problems such as dementia and CTE.  “This is a problem for society in general with people living longer  including our many former members. We are providing medical, financial help  and respite care where appropriate and approved  by our trustees and management committee.”

Although the specific impact of heading has not been proved, there is now growing research - to go with the Astle autopsy - that is  making a direct link between  dementia and football.

Dr Bennet Omalu, who first  discovered CTE in American footballers, says that it is “obvious” that there is a “higher prevalence in  retired soccer players”.

Taylor did not respond to Sadler’s account of his attempts to raise it with him during the 1990s but is adamant that the issues and the points he raised were being acted upon.

The first Premier League era victim

Mandy Moore still winces as she recalls how it often was for her late husband, Kevin, after so many of his 623 matches as a professional footballer.

“He had stitches and scars around his eyes,” she recalls. “There were times when he could not even remember parts of a match after taking a kick or an elbow in the head.”

His friend and former team-mate Iain Dowie says that they would stay behind to practise heading. “Maybe 100 balls a day,” says Dowie. And then there were the shuddering match incidents. “I don’t know how many times Kev, God bless him, got concussed,” says Dowie. “But I remember an incident as the ball dropped in the box. Kev slipped and the lad was about to smash it in. Kev put his head between the ball and him. The lad kicked his head and it went for a corner.”

Moore was 39 when he retired in 1996 following a 20-year career and what now makes his story so striking was both the tragically young age at which he died and the era in which he played.

This was not an elderly player struck down with such a devastating and aggressive form of dementia but a defender from the Premier League era who, as well as spells at Grimsby, Oldham, Bristol Rovers and Fulham, had been a Southampton team-mate of modern icons like Alan Shearer and Matthew Le Tissier. He is the first known Premier League player to have died of dementia and was still in what should have been the prime of life in his mid-forties when his family noticed changes.

He had unexpectedly lost his job as Fulham’s safety officer and training ground manager. He began forgetting appointments and had some minor car accidents. He became unsteady on his feet and he started making rash decisions that were completely out of character.

A diagnosis of Pick’s Disease - a rare form of dementia affecting the front of the brain - was made in 2007 and his decline would be cruelly rapid. For his daughter, Sophie, a gap of 10 months between visits when she was living in Australia was startling. “I knew a few things would change but I was left very shocked,” she says. “I felt like I didn’t recognise him as my dad any more.”

Moore eventually needed full-time care and he died in April 2013 on what was both his wedding anniversary and 55th birthday. The family were very conscious of his 30 years spent heading a ball on an almost daily basis, especially as he had been renowned for his bravery and aerial prowess.

“My abiding memory was him scoring at Wembley in the Zenith Data Systems final in 1992,” says Le Tissier. “It was the only time I’ve seen a guy head the ball downwards and into the top corner. He was your archetypal 120 per cent man.”

Although former England striker Jeff Astle died in 2002 from brain disease that both a coroner and neuropathologist attributed to playing football, the link was not being widely made.

There was a sad irony, then, in how Moore himself had been sufficiently concerned when he was still playing to have discussed it with Dowie and a doctor friend. They both raised the issue with Gordon Taylor, the chief executive of the Professional Footballers’ Association.

Mandy Moore also wrote to him following Kevin’s diagnosis and received a reply from Taylor.

There were no words of sympathy and, even though she says there was no request to cover care costs, the letter stated that the organisation would be bankrupt within a year if it paid care home fees for members.

Taylor estimated in the letter, written in 2008, that 1,000 of his members required such care and that the annual bill would be around £15 million. The PFA’s latest annual was income £27.9 million.

The Moore family were taken aback by the letter’s tone and, while grateful for the wider help Kevin received from the PFA in terms of education after football and his pension, as well as some payments to help with medical treatment, felt a huge difference in how they were sympathetically supported by the Royal Institute of Chartered Surveyors, of which Moore was also a member after qualifying in later life.

Dementia caused by head trauma has since been named chronic traumatic encephalopathy and, while definitive diagnosis can only be made by examining the brain in post-mortem, Moore’s symptoms were consistent with the disease.

“It seems like common sense,” says Mandy. “This is not about banning football or heading but getting research done so that players know where they stand and risks are mitigated. I am glad that the research has started but it was long overdue.” Dowie agrees. “I feel sure football did play a part – there is no doubt in my mind,” he says.     

'I suffered concussion so often I forgot the scoreline' - Iain Dowie

There were five or six games in my career where I did not know the score the following morning. I said to my wife: “I don’t remember it.” I did not get concussion a handful of times. It was dozens. Maybe 50 times. And I played on with it. I would have a kaleidoscope sensation around my eyes, but being injured in games and then playing on happened all the time.

I was punched off the ball on my debut. Bang. Out of the blue. It was a proper punch on the temple. He did not knock me out, but he could have. That was life back then – there were elbows and punches.

The game is nowhere near as violent today. You could get hurt regularly and it was not just the heading that was a concern.

Very few in the game talked about the impact of head injuries and it should have been dealt with. I think it was swept under the carpet.

I used to discuss the issue at length with Kevin Moore, my old Southampton team-mate. Kevin died aged 55 in 2013 after developing a rare form of dementia. I was concerned because I remember Kevin bringing it up with me.

He was a very bright lad and I was one of six players on the Professional Footballers’ Association committee.

I do remember mentioning it and Gordon Taylor’s response, whenever I raised anything of a medical nature, was inclusive. My experience was that Gordon dealt very thoroughly with things you brought up.

It is easy, in hindsight, to look back, but I do think the governing bodies should have maybe taken more of a look at it. I am glad that the research has started.

It is a very serious issue that needs resolving. I am not sure about banning heading among youngsters, but limiting the amount of heading is something that needs to happen.

Iain Dowie played for Southampton, West Ham United and Queens Park Rangers, before retiring in 2001.