Concussion Inc.

by Irvin Muchnick

  Dr. Maroon, Dr. Donohue, and a third member of the WWE medical team, Dr. Vijay Bahl, have UPMC practices. This raises questions about the UPMC ethics policy that took effect in February 2008.

  The UPMC ethics policy seems primarily aimed at the issue of pharmaceutical companies’ inducements to doctors, which can compromise patient care. However, there are also general conflict-of-­interest issues, as well as specific ones involving physicians’ relationships with the non-regulated supplement industry. Dr. Donohue is a co-­founder of a supplement company, which he aggressively promotes in media appearances. Dr. Maroon has written a book touting the same supplement and is cited prominently on its website.

  Dr. Maroon’s professional associations in pro ­football — as a doctor for the Pittsburgh Steelers and as a member of the National Football League’s concussion policy committee — are also noted. I point out the case of Richard Rydze, yet another UPMC physician who was dropped by the Steelers after he was found to have purchased huge quantities of growth hormone from the internet gray-market dealer Signature Pharmacy. I also review my previously published reports that Dr. Maroon’s NFL concussion work has been criticized as too passive, and that he and WWE last year gave ESPN misleading information about his access to the postmortem brain studies of WWE performer Chris Benoit, who committed double murder/suicide in 2007.

  9 September 2010..........

  We have more information on Dr. Joseph Maroon and WWE’s failure to disclose the October 1, 2008, meeting of experts at the West Virginia University Brain Injury Institute — where Maroon was shown studies of dead wrestler Chris Benoit’s brain.

  Among the participants in that meeting was Peter Davies, ­professor of pathology and neuroscience at Yeshiva University’s Albert Einstein College of Medicine. Davies holds an endowed chair in Alzheimer’s disease research and directs a center on Alzheimer’s and memory disorders. Here is Davies’ full statement to me:

  I was at a meeting in West Virginia in October 2008, originally at the request of Dr. Ira Casson, who at the time was a member of the NFL Head Injury Committee (I’m not sure exactly what it was called then). Ira asked me to try to look at the material collected by Dr. Omalu and Dr. Bailes, because I am considered to be an expert in the kind of pathology that Dr. Omalu had reported seeing in the brains of ex-NFL and WWE cases. Dr. Omalu was not an expert in this kind of pathology, and Dr. Casson wanted an outside expert to see if there was anything significant going on. I was not then nor am I now affiliated with the NFL. I flew to West Virginia at my own expense: Dr Maroon (who was also a member of the NFL committee) “brokered” the meeting, arranging for me to meet with Dr. Omalu and Dr. Bailes, and I did have the chance to examine several brain sections.

  It was clear that there was pathology in these ­cases, although Dr. Omalu had not done the kind of extensive staining of tissues that my lab has developed. I suggested to Dr. Omalu that my lab could do much more extensive staining on these cases to better define the pathology. Dr. Omalu readily agreed and sent me samples from several brains. We stained them and reported on our findings to the NFL committee in June 2009; a brief summary report was prepared ahead of the meeting and sent to Dr. Maroon, Dr. Omalu, Dr. Bailes, and the NFL committee. The issue I had been asked to address was the nature and extent of the pathology in these cases. I reported that there was a unique and very serious pathology. I did not and do not discuss individual cases in a manner that can lead to their identification, although others involved with examination of this material have done so.

  At the same time, the Boston University group also obtained samples of these cases from Dr. Omalu and has published extensively on their findings. There is no doubt that what is called CTE exists and is a serious concern for professional athletes in sports where the risk of concussions is high. Quite how common CTE is remains a question, as are the nature of the risk factors for development of CTE. I am now part of an NFL Players Association group trying to further investigate this.

  Having read your blogs, I should add that I have never had any involvement with the WWE, and that I have never been contacted by anyone with a declared interest in the WWE.

  4 January 2011..........

  The entrepreneurial careers of Dr. Bryan Donohue and Dr. Joseph Maroon expose a giant loophole of the University of Pittsburgh Medical Center’s ethics policy: the role of physicians in outside ventures, including with unregulated supplement companies. Donohue directs talent cardiovascular screening for WWE. Maroon, a team physician for the Pittsburgh Steelers and a member of the NFL concussion policy committee, is WWE’s medical director.

  Both are proponents of the red-grape extract resveratrol for its asserted benefits for a healthy heart, energy, and fighting cancer and aging. They have taken to hyping, for their own profit, a particular brand called Vindure.

  Though many among us might wonder if we could achieve just about the same effect by drinking a glass of grape juice every morning, as Larry King used to recommend in his radio commercials for Welch’s, the larger issue of supplement regulation is far from the only eyebrow-raiser for the UPMC clinicians affiliated with WWE. Equally troubling is Donohue’s exploitation of his UPMC credentials on behalf of Vindure even as the med center congratulates itself for more rigorous conflict-of-interest rules with respect to pharmaceutical companies. In at least some of his promotional efforts, Donohue doesn’t even disclose to potential medical patients and supplement consumers his equity interest in Vindure’s company, Vinomis Labs.

  Vinomis Labs, headquartered in the Pittsburgh suburb of Sewickley, launched Vindure in 2009. Donohue and Vindure were featured in a January 2010 article in a Pittsburgh lifestyle magazine called The Whirl, which was accompanied by a news interview — essentially an infomercial — on television station KDKA.2

  Donohue, who is listed on the Vinomis website as the company’s “chief medical advisor,” is one of its five founding investors, according to a 2009 article in the Pittsburgh Tribune-Review. In the original report on this blog on Donohue’s Vinomis connection last March, I noted that his Pittsburgh TV interview was a testimonial for Vindure, amounting to what people on Madison Avenue call a “Victor Kiam” (after the one-time owner of the New England Patriots who famously said on commercials that he liked Remington electric shavers so much, “I bought the company”).

  When I reviewed the YouTube clip for this current post, ­however, I did not see a reference there to Donohue’s part-ownership of Vinomis; either the original video got edited or my March report was mistaken about a detail that at least would give Donohue credit for having disclosed his stake.

  There is no disclosure by Donohue that he owns the product he is pushing in other elements of the campaign for Vinomis coordinated by EMSI Public Relations, which describes itself as a “pay-for-­performance” firm. In a news release headlined “Could Compound in Red Wine Help Cancer Patients? Resveratrol Being Tested for Effectiveness in Treatment and Prevention of Cancer,” he is quoted at length about “an abundance of very well done basic preclinical science” on resveratrol.

  “I have had occasion to introduce hundreds of patients to daily resveratrol supplementation, ranging from healthy adults interested in health maintenance and prevention to more elderly individuals with specific health concerns,” Donohue says. “The experience to date has been very gratifying. People have experienced greater energy, increased exercise tolerance, crispness and clarity of thought, and a general bounce in their overall level of well-being.”

  Donohue adds, “I prefer the product line from Vinomis, because their products contain a concentration of 98 percent resveratrol plus pure red wine grape concentrate, and their website is an outstanding resource for independent studies and scientific information about natural compounds.”

  The doctor is among the “food and health industry clients” who are available for media interviews through EMSI — in his case on the suggested topic “Overworked & Stressed Out? Top
Cardiologist Gives Tips on How to Stay Healthy Under These Conditions.” Bullet-point answers are “eat better,” “sleep better,” “exercise,” and “take supplements,” especially those at Vinomis.com.

  Dr. Maroon’s résumé raises related ethical flags. The company website promotes his book The Longevity Factor and says he “assisted Vinomis in the formulation of Vindure.” The Pittsbugh Tribune-Review story identifies Maroon as a partner in Xenomis LLC, which licensed the Harvard Medical School research on which Vindure is based, receives royalties from Vinomis, and shares “five to ten percent” of those royalties with Harvard.

  (The product itself, one of many resveratrol supplements on the market, is manufactured in South Carolina by a subsidiary of General Nutrition Centers. The Harvard medical research, spearheaded by David Sinclair, has just moved from experiments on mice to human trials.)

  According to his UPMC bio, Maroon also is on the board of directors of Mylan, a Pennsylvania company that markets generic pharmaceuticals. Since Maroon wouldn’t talk to me, I can only speculate on how he or UPMC might rationalize his outside business activities. In the case of generic drugs, they certainly save patients money over name-brand equivalents. Maroon may well be a true believer in the benefits of Vindure, too. But even in that event, he owes the public transparent disclosure of his financial interest.

  Maroon’s most visible hat is with the Steelers and the NFL. He was among the league spokesmen who testified last year at hearings of the House Judiciary Committee, which focused public criticism of the early deaths and mental illness of former football players who had suffered serial untreated concussions during their careers.

  The proportions in which Maroon is part of the solution and part of the problem remain open to debate. At UPMC, he has helped develop a patented system of concussion prevention and treatment programs, known as ImPACT, which includes baseline neurological testing and more precise protocols for determining when an athlete is ready to return to action following a head injury. In 2010, the NFL donated $1 million to Boston University to study dead athletes’ brains and further CTE research, and more recently NFL Charities added nearly as much for independent research on such related topics as youth sports concussions and post-career dementia.

  At the same time, many concussion reform advocates do not place Maroon on the aggressive end of the continuum of experts acknowledging CTE. After last year’s scathing criticism by the Judiciary Committee, the NFL shook up the leadership of its concussion committee; Maroon, who was not one of the co-chairmen, still serves on it, according to league spokesman Greg Aiello.

  I asked Aiello whether team physicians were governed by a formal ethics policy similar to UPMC’s. Aiello said, “The doctors are obligated to follow the code of ethics of their profession and of their specific medical societies (i.e., AMA, American Orthopaedic Society of Sports Medicine, American Medical Society for Sports Medicine, etc.).”

  One passage of the American Medical Association policy which applies to Donohue and Maroon is Opinion 5.02, “Advertising and Publicity”: “A physician may publicize him or herself … provided that the communication shall not be misleading because of the omission of necessary material information …”

  WWE spokesman Robert Zimmerman has not responded to an email query on whether the company considers its wellness team practitioners bound by the same standards as those of the NFL.

  WWE created Maroon’s title of medical director in 2008. In the past generation, pro wrestling has had an astronomical rate of occupation-­related deaths under age 50 — multiples higher than even football’s. In 2006, shortly after one of its biggest stars, Eddie Guerrero, had a fatal heart attack at 38, WWE instituted what it calls a “wellness policy.” The WWE program includes testing for steroids and other drugs.

  In 2007, another WWE headline performer, Chris Benoit, murdered his wife and their seven-year-old son before killing himself at their home in suburban Atlanta. In his postmortem toxicology, Benoit had a testosterone-to-epitestosterone ratio of 59 to 1 (the Olympic pre-doping maximum is 4 to 1), but he had been deemed clean under wellness policy tests because of a “therapeutic use exemption.” Two months earlier, Benoit’s wife, a victim of domestic violence at various times, had texted him, “We both know the wellness program is a joke.”

  During the Linda McMahon Senate campaign last year, Maroon told the Hartford Courant, “We have no talent now on steroids.” Dave Meltzer, publisher of the Wrestling Observer Newsletter, called the inaccuracy of that statement “mind-boggling.”

  In terms of Maroon’s medical specialty of neurology, the matter of closest interest was his response to a study of Benoit’s brain tissue, which showed a large accumulation of tau proteins, the sign of CTE. The examination was conducted by a forensic pathologist, Dr. Bennet Omalu, one of the pioneers of this research, at the behest of the Sports Legacy Institute. SLI had been started by a former WWE performer and Harvard graduate, Chris Nowinski, who retired from the ring as a result of his own concussions.

  Much like Maroon and the NFL originally, WWE tried to ­discredit or downplay CTE research. But the hiring of Maroon to coordinate WWE’s wellness policy coincided with the addition of Maroon’s ImPACT testing and of Donohue’s area of expertise, cardiovascular screening. In total, five out of the wellness program’s eight medical professionals listed at the WWE website are from UPMC.

  Whatever progress has been achieved by the wellness policy is sullied by questions about the overall integrity of WWE’s investment in the occupational health and safety of its talent in light of its long history of inaction coupled with misleading or false public statements. From 1996 to 2006, WWE had no comprehensive steroid testing, which had originated in the wake of the 1991 federal conviction and imprisonment on steroid-trafficking charges of George Zahorian, one of WWE’s Pennsylvania ringside doctors.

  The year before hiring Maroon, WWE founder and chairman Vince McMahon told both CNN and investigators for Congressman Henry Waxman’s House Committee on Oversight and Government Reform that the promotion was banning “chair shots” to the head from its arsenal of physical theater. In fact, WWE wrestlers continued to bash steel chairs on each others’ craniums until January 2010 — by which time Vince’s wife, Linda, was already deep into her unsuccessful self-funded $50 million Senate campaign.

  Besides sometimes joining WWE in criticizing CTE research as hyped, Maroon has given UPMC-credentialed cover to other corporate statements of dubious faith. In October 2008, Maroon met with Dr. Omalu and Dr. Julian Bailes at the West Virginia Brain Injury Research Institute, where Maroon was shown slides from the Benoit brain study. Five months later, another WWE wrestler who had been fired earlier, 33-year-old Andrew Martin, died from a prescription drug overdose, and Martin’s father donated his brain for a similar study by the West Virginia doctors. They found CTE — making it two for two among dead wrestlers tested.

  Yet in a statement to ESPN, which reported the findings, WWE said it was “unaware of the veracity of any of these tests, be it for Chris Benoit or Andrew Martin … WWE has been asking to see the research and test results in the case of Mr. Benoit for years and has not been supplied with them.”

  Maroon, who knew otherwise, said nothing. In the course of legal threats directed at me for my reporting, WWE lawyer Jerry McDevitt has maintained that what the statement to ESPN really conveyed was that WWE challenges the “chain of custody” of the Benoit brain tissue purportedly under study — in other words, the company demands further proof that the histologic slides produced by Drs. Omalu and Bailes were not from the brain of someone other than Benoit.

  The nexus of Donohue’s and Maroon’s controversial consultancies for WWE is two wrestlers’ dramatic deaths during the Linda McMahon Senate campaign. In December 2009 Samoan-American wrestler Eddie Fatu — age 36, stage name “Umaga” — died of a heart attack, which was blamed on the familiar pattern of steroid and painkiller abuse. The autopsy found tha
t Fatu, 406 pounds, had an enlarged heart. Had the WWE cardio screening program not detected the condition? If not, why not? Six months earlier, Fatu had been fired by WWE for refusing to go to drug rehabilitation. Two years before that, he had been suspended for being one of the dozen-plus company performers found by prosecutors on the customer list of the internet steroid dealer Signature Pharmacy.

  And in August 2010, Lance McNaught, who had wrestled for WWE as “Lance Cade,” died of “heart failure” at 29. There is reason to wonder whether Fatu or McNaught, or both, had CTE. Regardless, the latter’s prescription pill addiction could be traced at least in part to an October 2008 segment on the cable show Raw in which he was smashed 19 times with a chair, including once flush on the head. This, of course, occurred during the period between Vince McMahon’s 2007 public statements about banning chair shots to the head and the actual imposition of the policy in 2010.

  Meanwhile, a closer examination of Chris Benoit’s July 2007 autopsy report, produced by the Georgia Bureau of Investigation, reveals that he, too, had an enlarged heart — as did the wrestlers Davey Boy Smith, Eddie Guerrero, and many others who died young prior to the start of both the WWE wellness policy and its cardiovascular screening component.

  One thing Senator Richard Blumenthal, who defeated Linda McMahon for his seat, and others probing pro wrestling need to examine closely at this point is whether WWE cardiovascular screening under Drs. Maroon and Donohue is meaningful, transparent, and effective. In general, more information must be generated on this industry’s “cocktail of death” — different permutations and interactions, in individual cases, of heart disease, steroid abuse, prescription pharmaceutical toxicity, and CTE/concussion syndrome. The history of the problem, along with its scale and public health implications, suggests that the leading pro wrestling promotion has forfeited the argument that it can be trusted to regulate itself.