Starting quarterbacks Alex Smith, Michael Vick, and Jay Cutler were all knocked out of NFL games this week with concussions. Was the rash of concussions this week an aberration? Or was it a new norm for the league? Sports talk show host Jim Rome even tweeted, “Make the game safer?? A dude gets hurt on every single play now.”

I wonder if these injuries represent the beginning of the end for football.

Let me start by saying that I am in no way arguing that we should eliminate football. I do think that a plausible scenario can unfold, though, where the sport essentially ruins itself.

Also I must mention that more astute observers than me have made this same argument. Buzz Bissinger (author of Friday Night Lights), Malcolm Gladwell (New Yorker columnist and author of Blink, Tipping Point, and other bestsellers), and economists Tyler Cowen and Kevin Grier have discussed some of these sobering issues.

Recent events have started to make me think they could eventually be correct.

As the concussions to Cutler, Smith, and Vick suggest, head injuries are a significant threat to the NFL and football at all levels and ages. While the injuries themselves aren’t new, the media attention on them and its effect on parents could be.

Youth footballFormer NFL MVP quarterback Kurt Warner raised eyebrows earlier this year by stating that he wouldn’t want his sons to play football. Current and former players roundly criticized Warner for that opinion. However, a growing number of parents across the country share his sentiments. I hear these parents’ fears all the time.

Right now it might only be a minority of parents holding their kids out of football. With more attention given to head injuries and their long-term effects, I expect more parents to encourage their kids to play other sports. It might take years, or even a generation, but the elite athletes might gradually migrate to other sports.

Also read: “Would you let your son play football?” Experts weigh in

Without a doubt, the NFL and other football organizations recognize a problem exists and are trying to decrease the risk of head injuries. But is it too late? Or is it even possible?

Gladwell, in an interview in Slate Magazine, argues that the sport can try to minimize the danger. “But remember the issue isn’t concussions,” he points out. “It is ‘repetitive subconcussive impact.’ It’s not the one big hit. It is the cumulative effect of thousands of little hits that lineman and defensive backs (the most affected positions) endure, play after play. Can you take the “head” out of line play? You can. But then what you are left with would no longer be called tackle football. It would be called touch football.”

Football injuryMany former players have sued the NFL for failing to disclose the risk of permanent brain injuries from football-related head trauma. This lawsuit could hasten football’s demise. Similar lawsuits against schools, school districts, coaches, and team physicians at any level of football could have the same effect. One legal victory, or even simply the threat of a multimillion-dollar lawsuit against a school, could cause insurance providers to stop covering the school’s football program.

In an article in Grantland, Cowen and Grier compare this scenario to a similar one in healthcare. “As our broader health care sector indicates (try buying private insurance when you have a history of cancer treatment), insurers don’t like to go where they know they will take a beating. That means just about everyone could be exposed to fear of legal action.”

The fear of lawsuits and skyrocketing costs of insurance could create a domino effect where schools and school districts across the country eliminate the sport.

The Dr. David Geier ShowShould schools eliminate football? In the Zone segment from Episode 59 of The Dr. David Geier Show.

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Many football proponents hope that technological advances in helmet design might decrease the risks of head injury. It is worth pointing out that many experts argue that improvements in helmet design will have a minimal impact on injuries overall.

Likewise, rules changes, education about the dangers of head injuries, and improved recognition of injuries are unquestionably good starts. But without dramatic changes to the sport itself, injuries will still occur.

Factor in a talent pool slowly depleted of the country’s best athletes who would be forced to play in leagues outside of high schools and colleges, and you could potentially have a sport that barely resembles the football we currently watch on Saturdays and Sundays.

Please don’t misunderstand me. I am a huge football fan. I hope that I will be wrong and that we can truly make the sport safer. I simply worry that the narrative of NFL and college football is quickly turning from championships and the sport’s enormous popularity to season-ending and career-ending injuries and suicides. And I worry that there is little that the sport can do to ultimately reverse that decline.

Do you disagree with my “worst-case scenario” prediction? I would love to hear your thoughts, as I expect that my worries might seem unfounded by many of you. Let me hear what you think! Share your comments below!

Note: The following post appears as my sports medicine column in the November 16, 2012 issue of The Post and Courier.