League of Denial (25 page)

One afternoon, Omalu dropped by Hamilton’s office at Presbyterian University Hospital and asked if he would look at a special case he had been assigned at the coroner’s office.

“What’s the case?” Hamilton asked.

“I’m not going to tell you; just look at it,” said Omalu.

This was a favorite game among pathologists. You wanted the second opinion to come with a clean slate, not even a suggestion of bias. Omalu’s biggest fear was that Hamilton would look at the slides and tell him that what he was seeing was “no big deal,” perhaps a variant of Alzheimer’s that Hamilton had seen many times before.

Hamilton put a slide under the microscope. Then another. Then another.

This wasn’t Alzheimer’s disease, not even early Alzheimer’s. The game was getting intriguing. Hamilton looked at more slides, keeping his thoughts to himself. This was something he had taught Omalu: Don’t muse. Wait until you’re ready to make a diagnosis.

“Is this patient a boxer?” he asked finally.

That made the most sense. He figured it would not be unheard of for the body of a boxer to show up at the coroner’s office. Maybe he had died in the ring and this was a case of dementia pugilistica.

“No, this guy is not a boxer,” Omalu said, a smile coming over his face. “He’s an NFL football player. A Pittsburgh Steeler. This is Mike Webster.”

Hamilton’s jaw dropped, literally.

He knew immediately it was a new discovery, one with profound implications. In some ways Hamilton thought it was obvious; why hadn’t it been discovered before? But he had no doubts. The pathology—the haphazardly formed tangles, the scarcity of beta-amyloid—proved it.

“I mean, if I had really felt any kind of hesitation about the diagnosis whatsoever, I would have said no,” said Hamilton. “But it was so obvious, so logically beautiful. These are boxers with helmets on that are hitting each other all the time. And Bennet was feeling the same way. So we both came to the same conclusions without being unduly influenced. He didn’t say, ‘I want you to look at this case. It’s a brand new case of something that’s gonna be really big.’ He just said, ‘I want you to take a look at this case and tell me what you think.’ ”

Hamilton, half in jest, said they should call it “dementia footballistica.”

It was a once-in-a-lifetime discovery.

“I knew this was a billion-dollar kind of finding when I saw it,” he said.

Hamilton knew he needed more firepower. Omalu would be seen as a nobody—young, eccentric, and Nigerian. He wasn’t even officially a neuropathologist. Hamilton didn’t want to see him or the findings dismissed out of hand. Hamilton was known and respected, but he knew he needed to go higher.

He called up Steve DeKosky, chairman of UPMC’s Department of
Neurology, director of the Alzheimer’s Disease Research Center, and an internationally renowned expert in Alzheimer’s and related neurodegenerative diseases. Hamilton knew that if Steve DeKosky concurred that this was a new syndrome and was willing to stake his name and reputation on it, that would stamp it as serious science. DeKosky didn’t have time for games, and so Hamilton called him up and told him the story: how Omalu had an interesting case involving a 50-year-old man, how there were tangles of tau throughout the cortex but not in the hippocampus and very little beta-amyloid. Hamilton said he originally thought it was a boxer, only to be told by Omalu it was a 17-year veteran of the National Football League.

“
Really?
” said DeKosky.

DeKosky immediately flashed back to a conversation a few years earlier at a meeting of the Alzheimer’s Association. A colleague had recounted speaking with
a representative from the NFL Hall of Fame who was concerned about the plight of retired players. Too many were showing up at the annual induction ceremony with serious memory problems. DeKosky had been fascinated. He wondered about the connection between all those hits and the problems that were surfacing in Canton. DeKosky did a little research and found that the president of the Hall of Fame Players Association was a lawyer named Ron Mix, a Hall of Famer himself who had played 11 seasons as an offensive tackle, mostly with the Chargers. DeKosky wrote Mix, introducing himself and laying out the design for a longitudinal study that would track Hall of Famers over time. DeKosky never heard back. He hadn’t thought about it much until Hamilton’s phone call.

Even then, DeKosky was skeptical. He knew Omalu and viewed him the way almost everyone else did: “a wickedly smart guy” but cocky and prone to exaggeration. Hamilton told Omalu to pay DeKosky a visit.

Omalu figured he might get 5 to 10 minutes. Omalu, after all, was little more than a student; DeKosky was the department chair.

Omalu handed over the slides. DeKosky examined them under a microscope.

DeKosky was stunned. Hamilton had been right.

“This will change everything,” DeKosky thought to himself. “This will change everything forever.”

He felt that Omalu had discovered “a new syndrome. Or, actually, the rediscovery of the physics that says if you beat the hell out of a human brain, this is one of the kinds of degenerative processes that occurs. I knew it was going to change everything, but quite frankly, it was so controversial that I just thought it’s going to take a long time before this is accepted.”

But that sealed it: If Steve DeKosky agreed, the only other step was to take it public by publishing the research in a medical journal.

That was no small task. It would be another year before
the paper was completed. Omalu needed to expand on his research into head trauma and brain injury. DeKosky had to compile a clinical history of Webster by interviewing his family and creating a portrait of how his brain had short-circuited after his retirement. There was also the question of what to call the syndrome. Omalu thought it was critical that he come up with a name already in circulation so that if anyone attacked the findings, he could point to its earlier use in the medical literature. He also wanted something with a good acronym for lay people to remember and understand. In his review of the literature, Omalu saw references to chronic insanity, chronic encephalopathy, traumatic neurosis, traumatic encephalopathy, and occasionally chronic traumatic encephalopathy. Those terms, he thought, were all used generally, not to describe a specific disorder such as dementia pugilistica. He settled on chronic traumatic encephalopathy, or CTE. He thought it was easy to remember, and the language fit:
Chronic
meant long-term,
traumatic
referred to trauma, and
encephalopathy
was a damaged brain.

To a man, the researchers thought they were providing a service to the NFL. DeKosky resurrected his letter to the Hall of Fame, explaining Omalu’s findings and expressing the researchers’ interest in doing a long-term study.

Omalu titled the paper “Chronic Traumatic Encephalopathy in a National Football League Player.” He was the lead author. Hamilton, as the senior neuropathologist, also was listed, along with two of Omalu’s colleagues who contributed a section on genetics. In scientific literature, the position of final author is traditionally bestowed as a gesture of respect for the scientist who made the research possible, the “senior author.” Omalu initially picked DeKosky, an obvious choice.
He had validated the findings, and his presence gave the paper stature. But Wecht, the coroner, was irate. He was Omalu’s mentor, the man who had made him. Webster had been autopsied in his lab. In the end, “Wecht really didn’t have anything to do with” the paper, said DeKosky, but he ceded the position, in part because he worried that Omalu might “be fired if he ticked the guy off too much.”

The paper laid out the story of Mike Webster’s brain, though it didn’t name Webster directly, instead describing the subject as a “50-year-old professional football player who died approximately 12 years after retirement from the NFL.” Any true football fan who read it—not that any would—could have deduced from the “premortem history” that it was Iron Mike. The authors described the subject as an offensive lineman who was drafted into the NFL at 22 and played 17 seasons, 245 games overall, including 177 consecutive games in a 10-year window and 19 playoff games. Telephone interviews with family members revealed a man suffering from depression, memory loss, and signs of Parkinson’s disease.

The first sentence got right to the point: “We present the results of the autopsy of a retired professional football player that revealed neuropathological changes consistent with long-term repetitive concussive brain injury.” Translation: This football player got brain damage from the daily pounding of his sport.

The authors described it as a “sentinel case that draws attention to a possibly more prevalent yet unrecognized disease.” They recommended additional study to explore this “emergent professional sport hazard.”

Omalu first submitted the paper to the prestigious
Journal of the American Medical Association (JAMA)
. Three days later the paper was rejected. Omalu sent out a disappointed e-mail to his collaborators and suggested that they try submitting the paper to a journal called
Neurosurgery
. Reviewing the literature, Omalu had come to believe that
Neurosurgery
was “
the official journal of the NFL committee on MTBI,” as he wrote to Hamilton and DeKosky.

Submitting the paper to
Neurosurgery
made sense, because Omalu, Hamilton, and DeKosky all believed the NFL would welcome their discovery. Linking football and brain damage wasn’t great news, of course, but the league, they thought, would have to confront the implications
that football causes brain damage and react accordingly, if only to protect the product.

They were scientists. In the years to come, they would all look back and reflect ruefully on
how naive they had been.

“I thought they were gonna call me and embrace me and say, ‘Motherfucker, you’re such a hero,’ ” Omalu said. “I thought they were just gonna come and embrace me and give me a kiss on my cheek.”

The NFL rolled out
Paper Number 5 in
Neurosurgery
in November 2004. By then, the league’s Mild Traumatic Brain Injury Committee had moved well beyond concussion videos and crash-test dummies. With each new study, the NFL was mounting a scientific argument. In essence, that argument amounted to this: Don’t worry, be happy. Concussion rates in the NFL are extraordinarily low. The number of concussions is a meaningless predictor of future injuries; theoretically, one can have an infinite number of concussions and still be fine. There is no link between football and brain damage because football players don’t get brain damage. To those on the other side of the argument, there was a kind of ham-fisted logic about this science of denial. NFL Commissioner Paul Tagliabue had created a research arm that exactly mirrored his skepticism about the so-called concussion crisis.

NFL Paper Number 5 dealt with the modest 8 percent of players who had missed at least one game because of a concussion, described by Pellman and his colleagues as “the most severely injured of the NFL concussion cases.” Who were these players, and what happened to them? To start with, they were mostly quarterbacks, defensive backs, wide receivers, and kick returners “injured in high-speed, high-acceleration collisions.” Although this observation ignored the violence taking place in the Pit, it made some sense. The players on the perimeter were being hit with extraordinary force. It stood to reason that the most spectacular
collisions were likely to result in the most severe injuries. Quarterbacks, who were often exposed and used their brains more than any other players, were perhaps most sensitive to the effects of concussions, as seen in the cases of Aikman, Young, and many others. Not surprisingly, these players had more acute symptoms: lingering memory loss, disorientation, sensitivity to light, lethargy, and so on.

From there, Pellman and his colleagues went on to draw
a number of conclusions that left some of the nation’s leading concussion researchers shaking their heads in wonderment. One finding was that even these severely injured players recovered very quickly and, when they returned, were not at greater risk for further injury. This conclusion ran counter to nearly all previous research, which held that one concussion left you predisposed to another. But the NFL’s logic was the same as in the previous studies: The fact that players went back on the field was an indication that they were fine; otherwise team medical personnel wouldn’t have cleared them. It is perhaps germane to note again that nearly half of the NFL’s concussion committee was made up of team doctors. Pellman, who was one, commended them for their superb diagnostic skills. He noted that only a small percentage of these players had been allowed back on the field the same day they suffered their injuries, an indication that “NFL team physicians and athletic trainers are extremely effective in screening out the most severely injured players on the sidelines within a short period of time after injury.” NFL doctors might actually be “overly conservative and cautious,” Pellman and his colleagues posited, in light of how quickly the players recovered and the risk of long-term brain damage—a risk that Pellman and his colleagues calculated was exactly zero:

“This 6-year study indicates that no NFL player experienced … cumulative chronic encephalopathy [brain damage] from repeat concussions. While the study did not follow players who left the NFL, the experience of the authors is that no NFL player has experienced these injuries.”

The NFL hadn’t actually
studied
retired players, but that didn’t stop the league’s experts from concluding that none had sustained long-term brain damage. Pellman and his colleagues would repeat this statement, in some form, over and over and over.

Except that not even the NFL believed it to be true.

The MTBI committee’s controversial assertion that football didn’t cause brain damage, which would create so much trouble for the NFL, was undermined by the league’s quiet dealings with Webster and other injured veterans. At the same time the MTBI committee was publishing its research, Bob Fitzsimmons, Webster’s lawyer, and a Baltimore attorney, Cy Smith, had taken the Bert Bell/Pete Rozelle NFL Player Retirement Plan to court to try to get more money for Pam Webster and the kids. The retirement board, of course, had determined in October 1999, while Webster was still alive, that he had had irreparable brain damage from repeat concussions related to his career. Webster’s cognitive difficulties, the board wrote, were “the result of head injuries [he] suffered as a football player with the Pittsburgh Steelers and Kansas City Chiefs,” a statement Fitzsimmons would describe as “the proverbial smoking gun.” Now, over four years later, Pellman’s committee—a separate entity but also under Tagliabue’s control—was denying in a prestigious medical journal that such injuries were possible.