Bennet Omalu Concussion Research Papers

Rather than honestly deal with its burgeoning concussion problem, the National Football League went after the reputation of the first doctor to link the sport to the degenerative brain disease he named Chronic Traumatic Encephalopathy. 

What Happened

Four weeks into the 2002 pro-football season, the soon-to-be biggest problem for the National Football League was standing in a Pittsburgh autopsy room, looking down at the body of one of the most fearsome men to have ever played offensive lineman. As that future problem—Dr. Bennet Omalu, a Nigerian-born forensic pathologist tasked with that day’s routine autopsies—stared at the battered body of “Iron Mike” Webster, he made what would turn out to be a fateful decision: he asked his assistant to preserve the brain for future study.

What Omalu found in Webster’s brain—chronic traumatic encephalopathy (CTE), a progressive degenerative disease mainly associated with “punch drunk” boxers and victims of brain trauma—broke the NFL’s burgeoning concussion problem wide open. But instead of working with scientists and doctors to better understand the damaging effect of repeated concussions and how the league could improve the game to reduce head injuries, the NFL went after the reputation of Omalu and the other scientists who subsequently worked on CTE.

The NFL was no rookie at the Disinformation Playbook by the time Omalu published his initial paper on Webster in 2005. High-profile concussion-related retirements and injuries in the early 1990s had prompted reluctant NFL Commissioner Paul Tagliabue to create the NFL-run Mild Traumatic Brain Injury Committee (MTBI). Beginning in 2003, MTBI published research in the journal Neurosurgery (whose editor-in-chief consulted for the New York Giants) that heavily downplayed the breadth and severity of concussions.

As reporters Mark Fainaru-Wada and Steve Fainaru note in their book League of Denial, “The league used that journal, which some researchers would come to ridicule as the ‘Journal of No NFL Concussions,’ to publish an unprecedented series of papers, several of which were rejected by peer reviewers and editors and later disavowed even by some of their own authors.” A 2016 New York Times study found that much of the concussion data the committee used for its papers was significantly—and likely knowingly—flawed.

Omalu’s 2005 paper was particularly troubling for the league, as it concluded that Webster’s brain had “neuropathological changes consistent with long-term repetitive concussive brain injury.” The paper was published in Neurosurgery, of all places, an outlet chosen because Omalu and his co-authors believed that the NFL would be interested to hear of their research.

Instead, soon after the paper’s publication, Omalu received notice that MTBI was calling for its retraction. In their letter, the scientists—who did not identify their NFL connection, and none of whom were neuropathologists—called Omalu’s research “completely wrong” and even claimed that for Webster “there is no known history of brain trauma inside professional football.” Unbeknownst to Omalu when he was writing the article, the NFL retirement board in 1999 had determined that Webster qualified for disability benefits because repeated blows to the head had left him “totally and permanently” disabled, making MTBI’s critique of Omalu’s work absurdly hypocritical.

Omalu and his co-authors beat the attempt at retraction. Instead, Neurosurgery published Omalu’s second paper, which found CTE in the brain of former Steelers offensive lineman Terry Long. But the NFL continued to attack Omalu’s work, saying “it’s not appropriate science” and that his work was “purely speculative.”

The NFL’s efforts to undermine Omalu continued in 2007 after Roger Goodell took over from Tagliabue as NFL Commissioner. That year, the league held a Concussion Summit, inviting most of the prominent scientists who had been fighting the NFL on concussions to present their work. But Omalu was not invited, and his colleague Julian Bailes presented Omalu’s research instead. Bailes later confirmed that the NFL was ostracizing Omalu, saying that “they were trying to blackball him, lock him out, marginalize him. He was the whistle-blower.”

Omalu was not the only researcher the NFL attempted to undermine, however. Another expert, Dr. Ann McKee, was later brought in to look at the brains of former NFL players. She, too, faced challenges from doctors hired by the NFL. At her 2009 presentation to the NFL, Dr. Ira Casson—co-chair of MTBI since 2007 and one of the MTBI members who had called for Omalu’s first paper to be retracted—repeatedly questioned McKee’s work. Another doctor at the meeting, Colonel Jaffee, recalled that Casson “was the most challenging and outright mocking. These were pretty compelling neuropathological findings, and so I guess to outright deny that there could be a relationship, I didn’t think that was really making an honest assessment of the evidence.”

Despite the NFL’s attempts to fight off concussion science—both by harassing Omalu and through myriad other efforts—momentum built against the league, forcing it to take action. In 2009, Goodell disbanded MTBI and replaced it with a new research entity. In 2012, the NFL donated $30 million to the National Institutes of Health (NIH) for brain research. That relationship was fraught with problems, however: a 2016 Congressional report accused the league of trying to influence the research, causing NIH to leave $16 million of the NFL’s donation on the table. In 2016, the NFL added both new concussion rules and a new $100 million initiative called “Play Smart, Play Safe,” with $60 million going toward technological development—such as better helmets—and $40 million going toward medical research into head injuries. The league is additionally working on its $1 billion plan to settle the thousands of concussions lawsuits filed by former players. Still, concussions remain a major problem for the league and for the sport at large.

Why It Matters

In July 2017, the Journal of the American Medical Association (JAMA) published findings from a study of the brains of 202 deceased football players, 111 of whom had played in the NFL. The results were stunning. Of the 202 players, 177 had CTE. And of the 111 former NFL players, 110 had CTE—a 99% percent result.

There was selection bias inherent in the study—many of the brains were donated because players’ families suspected CTE. But as the New York Timesnoted, even if you add in the brains of the 1,200 other NFL players who have died since the study began, and give each one a negative result for CTE, the prevalence of CTE would still be unusually high at almost nine percent.

Exactly what CTE does to the brain requires further study, but to date, CTE has been associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and progressive dementia. In the JAMA study, of the 84 participants with severe CTE, 89 percent had behavioral and/or mood symptoms, 95 percent had cognitive symptoms, and 85 percent had signs of dementia. Even in players with mild CTE, 96 percent had behavioral and/or mood symptoms and 33 percent had signs of dementia.

NFL efforts to suppress scientific evidence of links between football and concussions not only put its own players at risk for memory loss, impulse control problems, and progressive dementia, but also put at risk the thousands of college athletes and more than one million youth athletes who play tackle football, many of whom were completely unaware of the risks. NFL leadership on the issue of concussions could have helped across all youth sports. Around 300,000 high school athletes suffer from concussions every year, and while awareness of the risks of concussions now seems to be growing—likely due, in part, to increased awareness of the problems in the NFL—“concrete laws and practices still lag behind the science,” as the Atlantic reported in August 2017.

By undermining concussion science for so many years and by harassing and marginalizing the scientists whose research added to our understanding of the dangers of concussions, the NFL clearly showed how powerful business entities can threaten independent science—a particularly chilling phenomenon when the independent research is specifically intended to protect lives.

Further Reading

Dr. Bennet Omalu

Bennet Omalu in 2015

BornSeptember 1968 (age 49)[1]
Nnokwa, Idemili South, Anambara State, Nigeria
ResidenceLodi, California
NationalityNigerian and naturalized US citizen
Alma materUniversity of Nigeria, Nsukka(MBBS, 1990)
University of Pittsburgh Graduate School of Public Health
(MPH, Epidemiology, 2004)
Carnegie Mellon University
(MBA, 2008)
OccupationMedical Doctor, Forensic Pathologist, Professor, Medical Examiner
Known forThe first to discover and publish findings of chronic traumatic encephalopathy in American football players while working at the Allegheny County Coroner's Office in Pittsburgh.[2]
Notable workTruth Doesn't Have a Side: My Alarming Discovery about the Danger of Contact Sports
Spouse(s)Prema Mutiso
Children2
Websitewww.bennetomalu.com

Bennet Ifeakandu Omalu (born September 1968[1]) is a Nigerian-American physician, forensic pathologist, and neuropathologist who was the first to discover and publish findings of chronic traumatic encephalopathy (CTE) in American football players while working at the Allegheny County Coroner's Office in Pittsburgh.[2] He later became the chief medical examiner for San Joaquin County, California, and is a professor at the University of California, Davis, Department of Medical Pathology and Laboratory Medicine.

Early life[edit]

Omalu was born in Nnokwa, Idemili South, Anambra in southeastern Nigeria on September 30, 1968,[1] the sixth of seven siblings. He was born during the Nigerian Civil War, which caused his family to flee from their home in the predominantly Igbo village of Enugu-Ukwu in southeastern Nigeria. They returned two years after Omalu's birth.[3] Omalu's mother was a seamstress and his father a civil mining engineer and community leader in Enugu-Ukwu. The family name, Omalu, is a shortened form of the surname, Onyemalukwube, which translates to "he who knows, speak."[3]

Education and career[edit]

Omalu began primary school at age three and earned entrance into the Federal Government College Enugu for secondary school. He attended medical school starting at age 16 at the University of Nigeria, Nsukka. After graduating with a Bachelor of Medicine and Bachelor of Surgery (MBBS) in June 1990, he completed a clinical internship, followed by three years of service work doctoring in the highland city of Jos. He became disillusioned with Nigeria after presidential candidate Moshood Abiola failed to win the Nigerian presidency during an inconclusive election in 1993[3] and began to search for scholarship opportunities in the United States. Omalu first came to Seattle, Washington in 1994 to complete an epidemiology fellowship at the University of Washington. In 1995, he left Seattle for New York City, where he joined Columbia University's Harlem Hospital Center for a residency training program in anatomic and clinical pathology.

After residency, he trained as a forensic pathologist under noted forensic consultant Cyril Wecht at the Allegheny County Coroner's Office in Pittsburgh. Omalu became particularly interested in neuropathology.

Omalu holds eight advanced degrees and board certifications, later receiving fellowships in pathology and neuropathology through the University of Pittsburgh in 2000 and 2002 respectively, a Master of Public Health (MPH) in epidemiology in 2004 from University of Pittsburgh Graduate School of Public Health, and a Master of Business Administration (MBA) from Tepper School of Business at Carnegie Mellon University in 2008.[4][5]

Omalu served as chief medical examiner of San Joaquin County, California from 2007 until he resigned in 2017 after accusing the county's Sheriff, who doubles as Coroner, of repeatedly interfering with death investigations to protect law enforcement officers who killed people.[6] An assistant forensic pathologist who joined the office for the opportunity to work with Omalu resigned a few days earlier citing similar allegations.[7]

Omalu is a professor in the UC Davis Department of Medical Pathology and Laboratory Medicine.[5]

Research on CTE[edit]

Main articles: Concussions in American football, Concussions in sport, and Chronic traumatic encephalopathy (CTE)

Omalu's autopsy of former Pittsburgh Steelers player Mike Webster in 2002 led to the re-emergence of awareness of a neurologic condition associated with chronic head trauma called chronic traumatic encephalopathy, or CTE, which had been previously described in boxers[8] and other professional athletes. Webster had died suddenly and unexpectedly following years of struggling with cognitive and intellectual impairment, destitution, mood disorders, depression, drug abuse, and suicide attempts. Although Webster's brain looked normal at autopsy, Omalu conducted independent and self-financed tissue analyses.[9] He suspected that Webster suffered from dementia pugilistica, which is a form of dementia that is induced by repeated blows to the head, a condition found previously in boxers. Using specialized staining, Omalu found large accumulations of tau protein in Webster's brain, which affect mood, emotions, and executive functions similar to the way that clumps of beta-amyloid protein contribute to Alzheimer's disease.[9]

Together with colleagues in the Department of Pathology at the University of Pittsburgh, Omalu published his findings in the journal Neurosurgery in 2005 in a paper titled "Chronic Traumatic Encephalopathy in a National Football League Player." In it, Omalu called for further study of the disease: "We herein report the first documented case of long-term neurodegenerative changes in a retired professional NFL player consistent with chronic traumatic encephalopathy (CTE). This case draws attention to a disease that remains inadequately studied in the cohort of professional football players, with unknown true prevalence rates."[10] Omalu believed the National Football League (NFL) doctors would be "pleased" to read it and that his research could be used to "fix the problem."[9] The paper received little attention initially, but members of the NFL's Mild Traumatic Brain Injury (MTBI) Committee later called for its retraction in May 2006.[11] Their letter requesting the retraction characterized Omalu's description of CTE as "completely wrong" and called the paper "a failure."[3]

Omalu later partnered with Julian Bailes, a neurosurgeon, concussion researcher, and then chairman of the Department of Neurosurgery at West Virginia University School of Medicine, and West Virginia attorney Robert P. Fitzsimmons to found the Brain Injury Research Institute which established a brain and tissue bank.[3]

In November 2006, Omalu published a second Neurosurgery paper based on his findings in the brain of former NFL player Terry Long, who suffered from depression and committed suicide in 2005. Though Long died at 45, Omalu found tau protein concentrations more consistent with "a 90-year-old brain with advanced Alzheimer's."[9] As with Mike Webster, Omalu asserted that Long's football career had caused later brain damage and depression.[12] Omalu also found evidence of CTE in the brains of retired NFL players Justin Strzelczyk (d. 2004 at 36 years old), Andre Waters (d. 2006 at 44), and Tom McHale (d. 2008 at 45).

In summer 2007, Bailes presented his and Omalu's findings to NFL Commissioner Roger Goodell at a league-wide concussion summit. Bailes later said that the research was "dismissed". The NFL's MTBI committee chair, Dr. Ira Casson, told the press: "In my opinion, the only scientifically valid evidence of a chronic encephalopathy in athletes is in boxers and in some Steeplechase jockeys."[11]

The NFL did not publicly acknowledge the link between concussions sustained in football and long-term neurological effects until December 2009,[11] seven years after Omalu's discovery. However, as late as 2013, the annual meeting of the American Academy of Clinical Neuropsychology (AACN) included a debate between two sports concussion experts regarding the validity (or existence) of CTE.[13] Finally, in March 2016, the NFL's senior vice president for health and safety policy, Jeff Miller, testified before congress that the NFL now believed that there was a link between football and CTE.[14]

Omalu has also discovered CTE in the brains of military veterans, publishing the first documented case in a November 2011 article.[15] Omalu found evidence of CTE in a 27-year-old Iraq War veteran who suffered from post-traumatic stress disorder (PTSD) and later committed suicide. Omalu's paper links PTSD to the CTE spectrum of diseases and calls for further study.

Omalu is lead author in a study published in November 2017[16] that for the first time confirmed CTE in a living person. A chemical tracer, FDDNP, binds to tau proteins, detectable by positron emission tomography, and associated with the distinctive topographical distributions characteristic of CTE. Tested on at least a dozen former NFL players, it was confirmed postmortem in former linebacker Fred McNeill.[17]

In popular media[edit]

Omalu's efforts to study and publicize CTE in the face of NFL opposition were reported in a GQ magazine article in 2009 by journalist Jeanne Marie Laskas.[9] The article was later expanded by Laskas into a book, Concussion (Penguin Random House, 2015), and adapted into a film of the same name where Omalu, portrayed by Will Smith, is the central character. The film has been criticized for not being truthful to the actual events.[18][19] Nevertheless, the movie's production led to the creation of a foundation named after Omalu to advance CTE and concussion research.[20]

In September 2016, Omalu attracted media attention when he suggested on Twitter that Hillary Clinton was possibly poisoned and advised members of her presidential campaign to "perform toxicologic analysis of Ms. Clinton's blood." He further tweeted, "I do not trust Mr. Putin and Mr. Trump. With those two, all things are possible."[21]

Omalu's book Truth Doesn't Have a Side: My Alarming Discovery about the Danger of Contact Sports was published in August 2017 by HarperCollins.[22][23] He previously wrote Play Hard, Die Young: Football Dementia, Depression, and Death, published in 2008.

Personal life[edit]

Omalu is married to Prema Mutiso, originally from Kenya. They live in Lodi, California and have two children, Ashly and Mark.[3] He is a practicing Catholic and became a naturalized U.S. citizen in February 2015.[24]

See also[edit]

References[edit]

  1. ^ abc"About Bennet Omalu", Bennet Omalu Foundation website.
  2. ^ abLaskas, Jeanne Marie (24 November 2015). "The Doctor the NFL Tried to Silence". The Wall Street Journal. Archived from the original on 25 November 2015. Retrieved 25 November 2015. 
  3. ^ abcdefLaskas, Jeanne Marie (2015-11-24). Concussion. Random House Trade Paperbacks. ISBN 9780812987577. 
  4. ^"CV: Bennet Omalu", UC Davis Medical Center
  5. ^ ab"Bennet Omalu, M.D., M.B.A., MPH, CPE, DABP-AP, CP, FP, NP". University of California, Davis Department of Pathology and Laboratory Medicine. Retrieved 1 September 2015. 
  6. ^Small, Julie (December 4, 2017). "Autopsy Doctor Resigns, Says Sheriff Overrode Death Findings to Protect Officers". KQED. Retrieved 2017-12-11. 
  7. ^Small, Julie (November 27, 2017). "Autopsy Doctor Quits, Alleges Sheriff Interfered in Death Probes". KQED. Retrieved 2017-12-11. 
  8. ^Sabharwal RK, Sanchetee PC, Sethi PK, Dhamija RM. Chronic traumatic encephalopathy in boxers. J Assoc Physicians India. 1987 Aug;35(8):571-3.
  9. ^ abcdeLaskas, Jeanne Marie. "Game Brain: Football Players and Concussions". GQ. Archived from the original on 11 November 2015. Retrieved 9 November 2015. 
  10. ^Omalu, Bennet I.; DeKosky, Steven T.; Minster, Ryan L.; Kamboh, M. Ilyas; Hamilton, Ronald L.; Wecht, Cyril H. (2005-07-01). "Chronic traumatic encephalopathy in a National Football League player". Neurosurgery. 57 (1): 128–134; discussion 128–134. doi:10.1227/01.neu.0000163407.92769.ed. ISSN 1524-4040. PMID 15987548. 
  11. ^ abc"Timeline: The NFL's Concussion Crisis – League of Denial: The NFL's Concussion Crisis - FRONTLINE". FRONTLINE. PBS. Retrieved 2015-11-09. 
  12. ^Omalu, Bennet I.; DeKosky, Steven T.; Hamilton, Ronald L.; Minster, Ryan L.; Kamboh, M. Ilyas; Shakir, Abdulrezak M.; Wecht, Cyril H. (2006-11-01). "Chronic traumatic encephalopathy in a national football league player: part II". Neurosurgery. 59 (5): 1086–1092; discussion 1092–1093. doi:10.1227/01.NEU.0000245601.69451.27. ISSN 1524-4040. PMID 17143242. 
  13. ^"Sports concussions debate: Does CTE really exist?". Science Daily. Loyola University Health System. June 19, 2013.
  14. ^Belson, Ken; Schwarz, Alan (2016-03-15). "N.F.L. Shifts on Concussions, and Game May Never Be the Same". The New York Times. ISSN 0362-4331. Retrieved 2018-01-03. 
  15. ^Omalu, Bennet; Hammers, Jennifer L.; Bailes, Julian; Hamilton, Ronald L.; Kamboh, M. Ilyas; Webster, Garrett; Fitzsimmons, Robert P. (2011-11-01). "Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide". Neurosurgical Focus. 31 (5): E3. doi:10.3171/2011.9.FOCUS11178. ISSN 1092-0684. PMID 22044102. 
  16. ^Omalu, Bennet; et al. (2017). "Postmortem Autopsy-Confirmation of Antemortem [F-18]FDDNP-PET Scans in a Football Player With Chronic Traumatic Encephalopathy". Neurosurgery. doi:10.1093/neuros/nyx536. 
  17. ^Kounang, Nadia (November 16, 2017). "Ex-NFL player confirmed as 1st case of CTE in living patient". CNN. Retrieved 2017-12-11. 
  18. ^Engber, Daniel (December 21, 2015). "Concussion Lies: The film about the NFL's apparent CTE epidemic feeds the pervasive national myths about head trauma.". Slate.
  19. ^"'Concussion' Subject Bennet Omalu Exaggerated His Role, Researchers Say". CBS New York. December 17, 2015.
  20. ^"About the Foundation | Bennet Omalu Foundation". bennetomalufoundation.org. Retrieved 2015-12-25. 
  21. ^Boren, Cindy. "The man who discovered CTE thinks Hillary Clinton may have been poisoned". The Washington Post. Retrieved 2016-09-13. 
  22. ^Peterson, Gary (August 24, 2017). "Why it took a foreign-born doctor to blow the whistle on the NFL's concussion epidemic". Bay Area News Group. 
  23. ^Almond, Elliott (August 25, 2017). "'Concussion' doc's six sports kids should never play". Bay Area News Group. 
  24. ^"Bennet Omalu Foundation launches in Pittsburgh". Pittsburgh City Paper. Retrieved 2016-01-05. 

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