'Is football any better than dog fighting?" That's the question writer Malcolm Gladwell asks in an Oct. 19 New Yorker article on football and the high rate of brain injuries associated with the sport.

Gladwell's analogy is admittedly flawed. The point of dog fights, like boxing matches, is for participants to do their best to harm their opponents. Injuries in football, while inevitable if one plays long enough, aren't the point of the game. Players who get concussions are collateral damage. But in both sports, a participant's willingness to ignore threats to his own well-being and to go on despite the pain is valued and even extolled. That's a problem.

The danger when a player returns to the field too soon after "getting his bell rung" is far greater than previously recognized. The effects of blows that slam the brain against the skull are cumulative. Repeated concussions, when followed by even a minor blow to the head, can do long-term damage and cause personality changes, memory impairment, depression severe enough to lead to alcoholism, drug use or suicide, diminished cognitive abilities and premature dementia.

Professional coaches, athletic directors, trainers and doctors have been educated about the newly discovered risks. The same can't be said of volunteer coaches, players, parents and spouses.

Gladwell cited a recently released study that involved more than 1,000 randomly-selected retired NFL players. "Of those who were older than 50, 6.1 percent reported that they had received a diagnosis of 'dementia, Alzheimer's disease or other memory-related diagnoses.' That's five times higher than the national average for that age group," Gladwell said. For players between the ages of 30 and 49, the rate of cognitive disabilities was 19 times the national average.

Improvements to helmets have helped, but they've been unable to dramatically reduce the incidence of concussions. Coaches have limited the number of full-contact practices and have sidelined players for longer periods after they've been suspected of having a concussion. That too has helped. And helmet rules are being considered for girls - they often do not wear helmets in sports like lacrosse, though boys do - because female athletes have been getting bigger, stronger, faster and more aggressive.

Though it seems logical to think that brain injury rates would be far higher in the NFL, where players are enormous, the incidence is higher for high school players. Their bodies, especially neck muscles that can absorb some of the force of a blow to the head, are not as well-developed. Young athletes are also far less skilled, and the size disparity among them is far greater.

A few weeks ago, following the death of a high school football player from a brain injury, the state of Washington adopted a law that requires high school players to get cleared in writing by a doctor before they can be allowed to play. Because many steps are being taken to address the issue in New Hampshire, a similar law seems unnecessary.

The state's Interscholastic Athletic Association, in conjunction with medical experts, has been making an all-out effort to educate high school coaches, trainers and others about concussion prevention and the limitations that should be placed on the activities of players who suffer them. Rules and procedural manuals are being rewritten, and doctors have been meeting with parent groups to explain the risks children face from playing football and other sports.

A lot more education and study are still needed. Volunteer coaches in youth leagues, who may share the same "win-at-all-cost" mentality as the worst professional coaches, and parents with dreams of college scholarships who urge their children to "just shake it off," are poorly informed. The benefit of playing sports is worth the risk of injury, but everything that can reasonably be done to minimize that risk must be done.