Public discussion about widespread brain injuries has generally related to the plight of soldiers returning from Iraq and Afghanistan, where hidden roadside bombs frequently leave survivors with crippling head injuries. But there’s another rising conversation about brain injuries, one related to the head-pounding hits that professional football players regularly take in their game’s weekly blocking and tackling.

A growing body of evidence, gleaned from the histories of brain fog and early onset dementia suffered disproportionately by many retired players who incurred repeated concussions in their football careers, suggests a strong linkage between the two. It’s past time for the National Football League candidly to acknowledge that link and devise more protective treatment and care for injured players, active or retired.

Players with brain injuries

Players are learning to recognize the link. A long list of retired stars, journeyman players and their wives and families have been trading stories — regularly reported in The New York Times over the past several years — of men so crippled by brain fog and early dementia that they have difficulty in their late 40s and early 50s remembering how to perform simple tasks.

Some have trouble driving to the store, or going shopping, or performing the routine functions of their lives. Some have just quit trying to do routine tasks. Wives gather in support groups. Physicians have related the players’ cognitive difficulties to the cumulative effects of concussions, many of which the players used to try to ignore or play through.

Knowing when not to play

Recent studies have focused on the effects of resuming play too early after a concussion, or not quitting after a second or third concussion. In the main, they have persuaded football teams at all levels — from early school and college teams to the professional level — to treat concussions as the serious conditions they are and to stop players from resuming play before they are healed. In some cases, players are advised to quit the game altogether to avoid further injury.

Yet in a hearing before the House Judiciary Committee on Wednesday to explore the effects of concussions and the NFL’s response, Roger Goodell, the NFL commissioner, declined to say whether he believed there was a link between players’ diminishing cognitive state and concussions.

In a careful response, seemingly crafted to avoid culpability and the requirement for stiffer corrective action, he said “I can think of no issue to which I’ve devoted more time and attention than the health and well-being of our players, and particularly retired players.” He said later in the hearing that the NFL is “changing the culture of our game for the better.”

Though he wouldn’t say it, the game culture being replaced is likely responsible for much of the problem. That view has been buttressed by former players who have long spoken of how coaches, and the players themselves, used to downplay injuries. Coaches traditionally were more concerned about when a player could return than the extent of his injuries. Some teams encouraged players to keep playing, and cut, sometimes without pay, those who didn’t. Players themselves commonly played through injuries to keep their job, and some still do. That pressure clearly exists, whether or not it’s official.

Mr. Goodell did the NFL no favors by failing to bring to the hearing the three doctors who form the league’s research committee on concussions, and whose attendance lawmakers said they had requested. The committee did hear from researchers who have found brain damage comparable to that suffered by boxers in 10 deceased NFL players, most of whom were less than 55 years old when they died.

The NFL’s flawed position

Had he attended, the NFL’s co-chairman of the medical committee on concussions, Dr. Ira Casson, would have had to answer questions regarding criticism of the league’s study and its vague position on the cause of cognitive impairment. Independent observers have generally criticized the league’s study of brain disease in retired players as a flawed exercise marked by sampling and statistical problems and conflicts of interest.

The NFL could easily improve its handling of brain injuries and causal factors. Stefan Fatsis, an independent critic and author who trained with the Denver Broncos in 2006 as a place-kicker, has recommended some sensible reforms to help end the league’s ethos of playing first and ignoring early brain injuries. He recommends that teams, the league and the players’ union, and the not the teams’ owners, employ doctors and operate under a leaguewide medical system that is not beholden to the owners, whose primary goal is to get injured players back on the field.

Smart reforms

He recommends that doctors inform players about their injuries before they tell club officials; that players be allowed to view their medical records at any time; that teams be required to report every injury to the league, and make comprehensive injury data available; that grievance procedures be reformed to prevent the cutting of injured players; and that payments to injured players be excluded from the teams’ payroll caps to remove the financial incentive to cut injured players. We would suggest that the NFL also ban player celebrations of violent hits, and hits above the shoulders.

Such reforms would push the NFL to respect and properly care for players. More broadly, they would help set a standard on treatment of concussions that would influence colleges, high schools and youth leagues improve education about, and treatment of, concussions among young people across the country.