Nathan Kalman-Lamb and Derek Silva, The End of College Football: On the Human Cost of an All American Game. University of North Carolina Press. Chapel Hill. November 2024. 272 pp, $24.95 (Paperback), ISBN 1469683466.

Daniel Silofsky, Playing Through Pain: The Violent Consequences of Capitalist Sport. University of North Carolina Press. Chapel Hill. May 2025. 256 pp, $24.95 (Paperback), ISBN 1469685876.

Violence is a constitutive feature of most modern sports. It may be overt, as in American football and ice hockey, or be apparently absent, as in cricket, but visible in adjoining spaces like spectator behaviours and in social life. The politically fraught, multi-nation Fédération Internationale de Football Association (FIFA) World Cup has recharged the debate about elite sport and violence, a theme long engaging academic discourse.

Two recently published books deepen and broaden the scope of this debate. Their ambit, however, is more than violence; it is about the structural ethos that impels/enforces the cultivation and performance of violence in sport. Through distinct narratives, they expose the entrenched and organic connection between sports and the voracious profit-oriented consumer society, raising questions about the ethicality of sports in the service of such a system.

The End of College Football: On the Human Cost of an All American Game by Nathan Kalman-Lamb and Derek Silva (2024) is a sharp indictment of one of America’s favourite games, football, (specifically College Football, the precursor, feeder and cultural anchor to the National Football League), a game that generates millions in revenue, and even more importantly, is an integral part of the cultural context of American life. It’s a national passion, and a reality that Americans cannot imagine doing without. And yet that is exactly what Kalman-Lamb and Silva propose: the abolishing of (American) College football, calling it “morally unsustainable”. The book’s focus is the American university sports system, where sports scholarships are often the only way poor students, good at sports, may obtain a college education.

The book is grounded in the painstakingly recorded, often disturbing, systematic narratives of 25 former (American) football players. The interviews by themselves would make for an absorbing, nuanced and often gut-wrenching reading of the world of college football. Over six well-laid out chapters the text weaves these accounts into a convincing indictment of the unethical and immoral practices of racial capitalism that ground the university athletic system. The introduction describes the overall sociological perspective of the book, framing it as a “polemical call to action against a system of violent, racialized labour exploitation” (p 3) in institutions of higher learning.

The authors challenge the three major arguments that are often presented to defend the relevance of college football: football provides great opportunities; student athletes are well-compensated, and importantly, they are considered and cared for as students first and athletes after. College football players are recruited with the promise of “free” education, but this promise is limited by structural conditions. To talented young men, mostly poor and Black (largely African-American), college education is unaffordable. With the four-year costs of tuition, room and board running upwards of USD 430,000 in the “Power Five” universities, being offered a spot on the College teams, with the promise of a high paying career in the National Football League (NFL) as well as an education, is a dream come true. Universities frame this as “fair compensation”.

Unfortunately, the demands of the sport ― elite training, and the rigours of match playing in a highly competitive system ― often make it impossible for players to choose desirable courses and careers or even complete their academic requirements. In other words, while they are, in theory, “paid” in the form of education, they are denied the substantive value of education. The authors identify this as “wage theft”. And because these players are mostly racialised athletes, it is a form of racialised wage theft. Further, the promised opportunities are ephemeral, often disappearing with injury or poor performance. In consequence, “the pedagogical mission of universities [cannot be reconciled] with the inherent harm caused by the sport itself”. Universities that have an obligation to nurture and protect youth, have contrarily become locations that inflict damage. The only rational solution is to abolish college football. This leap that the authors take here, admittedly from a well-constructed springboard, may still be too wild. Recognising this, the authors suggest an interim path, perhaps equally unimaginable in the current US context: to charge no fee for college education (and so, access to livelihoods), so that youth are free from the structural compulsion to view sport as work.

The book devotes considerable attention to the politics of concussion (CTE-chronic traumatic encephalopathy) injuries in football in which the medical system is complicit. Given that the management of these injuries is possible if they are recognised early, rules have been incorporated to ensure their swift identification during play. However, CTE in its early stages does not disable the athlete and its diagnosis is either missed or often deliberately ignored by the medical team, influenced as it is, by coaches and administrators who in turn operate on the understanding that injuries that do not disable, may be ignored. CTE progressively disables the athlete forcing them to retire from the game even before they are drafted into the major leagues, with no compensation for injuries as yet “undiagnosed”, nor healthcare insurance. As one footballer says of the administrators: “Their chief priority is to the programme, not the athlete.” The footballers’ testimonies lay out heartrending tales of these injuries and the lifelong consequences of their deliberate neglect in the pursuit of the game.

This book’s distinctive contribution to unravelling the political economy of American football is in exposing the undergirding racialised capitalist system that dominates the game, presenting a compelling analysis of the intimate and intricate connections between corporatised games, in this instance, football, and the system that both nurtures and feeds off them. The authors question the ethicality of a professional sport that commodifies players in the interest of corporate good. Importantly, the book begins a conversation on the legitimacy of a racialised system that forces underprivileged athletes to the lowest rungs of what the authors term the persistence of the “plantation model” of the economy.

In the second book, Playing Through Pain: The Violent Consequences of Capitalist Sport (2025), Daniel Sailofsky advances a long-overdue Marxist theoretical framework to contextualise violence in sports. The corporate-led, profit-oriented system of elite sport treats violence as a commodity. Media stories of brave young sportsmen playing through their injuries not only make good copy but consolidate the myth of masculinity and of the “warrior” sportsman. In this narrative, violence becomes integral to the performance of modern sport at its competitive best. It enhances the saleability of sport and the sportsmen, generating fan interest and stadium takes.

In eight chapters Sailofsky discusses the nature of violence in sports and its critical importance in understanding the modern elite sporting system. The focus is on sports in the United States that he properly locates within the capitalist economic system, in which he situates violence as a consequential component of modern sport. Athletes’ labour is exploited, even as fans and spectators are offered ever more spectacular sporting events that rake in huge profits. While this broad thesis is widely accepted, Sailofsky extends it with a close reading of the systematic training reinforced by market rhetoric of “no pain, no gain” in the pursuit of extracting surplus value from sport. In Sailofsky’s conceptualisation, violence causes not only physical and emotional harm, but also social harm in multiple dimensions.

An important focus of the book is care labour in sports, ie, the support system around professional sports, often largely comprising mothers, wives, and girlfriends. The theorisation of care labour incorporates an essential element in the organisation and production of modern sports and recognises the unacknowledged labour that enables athletes to produce entertainment for the working masses. This is perhaps the most blatantly unethical means of keeping the capitalist system in good health. For this reason, an elaboration of the complex dynamics of care labour in the specific context of elite sports would have been welcome.

Sailofsky’s chapter on the debilitating life-threatening concussion injuries is an eyeopener. The link between football and CTE has, he acknowledges, entered the cultural mainstream. But because the eventual effects of concussion are slow to show, over a million highschoolers continue to play football every year. As long as football continues to produce revenue, footballers are encouraged to wear their injuries as badges of courage, and no one will stop the gravy train. Here lies the difference between a worker and an athlete: in the former, injury is ignored as long as it does not interfere with production. In sport, injuries play another role; they become commodities themselves. Aggression and violence in sport are de rigueur, they are necessary. The “normalisation” of violence spills over into everyday life, evidenced in sexual abuse and domestic violence. Media discourse underplays such incidents, seeing them only in terms of their impact on the market value of the athletes.

Athletes labour in the service of the system — in the selling of the product of sport. Keeping the athlete in working order is critical to the enterprise. Their downtime is tightly regulated, making “playing through pain” an adage, a mantra. Beyond play, the system takes no responsibility for their welfare. Why then do athletes stay in the system? Can they not opt out? Sailofsky reiterates what others have pointed out elsewhere, viz, that the silence of those who are subject to unfair and violent conditions is ensured by threats of the loss of hard-won privileges and access. Moreover, structural factors become coercive, compelling athletes to remain in the system regardless of their suffering. The precarity of labouring lives is a logical component of western capitalist history. The confrontation between the economic logic of the sports organisation and its defined social obligations, so well elucidated here, is what brings up the issue of ethics. Ethical sport is closely linked to the issue of human rights and cuts across class, ethnicity and community.

This prompts a consideration of the complicit role of the medical establishment. Care in the practice of biomedicine is more than rendering physical succour. In condoning injury-causing violence within sport that repeatedly puts young people in harm’s way, often with lifetime consequences. By prioritising the needs of the sporting system above those of the athlete, has not medicine compromised its ethical obligation?

Daniel Sailofsky has produced a sharp and compelling critique of violence in sport, employing Marxist analysis in unfamiliar territory and addressing structural, cultural and political complexities. It will, one hopes, prompt a deeper understanding of sporting systems in capitalist economies in the global South as well.

Although constructing sports in a Marxist framework, Sailofsky (as well as Kalman-Lamb and Silva) is evidently well aware that a Marxist revolution isn’t imminent. Acknowledging this, he proposes “harm reduction” through people-oriented structural change in the conduct of sport and envisages new forms of play and sport. He proposes holistic cultural change, where sport is mass- based, public-funded and participatory. Citing several innovative approaches to sport, he keeps coming back to the fact that sustaining people-oriented sport — a Marxist premise for healthy sport? — is next to impossible in a consumerist society in pursuit of profit. Would the book, one wonders, have been a more compelling read had he not bothered to address the thorny, perennial question of “what is to be done”?

That neither book is quite convincing in suggesting possible interim solutions sketches its own story. Developing healthy sports in the context of a rapacious global market economy does appear to be a Utopian dream. On the other hand, both books present hardnosed, well-grounded critiques of the system that has dehumanised sport, and are especially thought-provoking in contexts where corporate sport is just making headway.

Author: Padma Prakash ([email protected], https://orcid.org/0009-0002-5206-7066) Phd Candidate, Centre for Sports Policy Studies, University of Toronto, CANADA.

Conflict of Interest: None declared                                                                                                                                                                                        Funding: None

To cite: Prakash P. Playing the game: At what cost? Indian J Med Ethics. Published online first on August 13, 2026. DOI: 10.20529/IJME.2026.049

Submission received: February 10, 2026

Submission accepted: July 18, 2026

Manuscript Editor: Sanjay A Pai

Copyright and license
©Indian Journal of Medical Ethics 2026: Open Access and Distributed under the Creative Commons license (CC BY-NC-ND 4.0), which permits only noncommercial and non-modified sharing in any medium, provided the original author(s) and source are credited.