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'Are the physicians looking out for the health of the players, or are they just trying to keep them on the field?" That was the question posed by a leading medical ethicist in light of allegations that team doctors for the National Football League engaged in questionable, and possibly illegal, use of prescription drugs to manage player pain.

It is not a new question; it's also been asked in connection with the league's lagging response to concussions and other injuries suffered by players.

That the subject is still being raised exposes the fundamental problem with how NFL players are treated: Doctors who decide whether a player is healthy enough to play are employed by teams that have a stake in the game.

A review by The Washington Post's Rick Maese of sealed court documents in a federal lawsuit against NFL teams by former players painted a disturbing picture of the use of powerful painkillers and anti-inflammatories.

The account included descriptions of teams violating federal prescription drug laws, disregarding guidance about controlled substances from the Drug Enforcement Administration and giving medication to players without telling them what they were getting.

A spokesman for the NFL dismissed the allegations as "meritless." NFL teams and their medical staffs, Brian McCarthy told The Post, "continue to put the health and safety of our players first, providing all NFL players with the highest quality medical care. Any claim or suggestion to the contrary is simply wrong."

So why did only 47 of 100 players who were surveyed by the Associated Press say they thought the league's clubs, coaches and team doctors have the athletes' best interests at heart?

Even more damning were the results of a two-year player health study by researchers from Harvard University, which found "an undeniable conflict of interest" in the league's current system.

"The intersection of club doctors' dual obligations creates significant legal and ethical quandaries that can threaten player health," according to the 493-page report released in November.

The Harvard report noted that players and teams have a shared interest in health, but there are areas when those interests diverge, such as when a player wants to return to play from an injury more quickly than recommended in order to avoid termination of his contract.

No matter how principled or well-intentioned the doctor, researchers wrote, there is an inherent conflict of interest in serving two masters.

Among the report's recommendations were separating medical teams that provide care for players from staff who evaluate players for business purposes, and banning doctors who treat players from reporting to team management or coaches.

The NFL recognized the value of independent medical judgment when it insisted that unaffiliated neurotrauma specialists be stationed at all games to approve the return of any player who has suffered a concussion.

The recent disclosures of alleged abuses should prompt the league to accept the need for further reforms.

- The Washington Post

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