by Bennet Omalu
In response to the crisis, the National Football League assembled a panel of doctors to study the problem of concussions and head injuries and to make recommendations on how to make players safer. The head of the committee, Dr. Elliot Pellman, was the New York Jets team doctor. He was also a rheumatologist, not a neurologist. Under Dr. Pellman’s direction, the National Football League’s Mild Traumatic Brain Injury (MTBI) Committee studied brain injuries for more than fifteen years and produced more than sixteen scientific papers, which were published from 2003 to 2009 in Neurosurgery—the official journal of the Congress of Neurological Surgeons and one of the most respected medical journals in the world. The first two papers actually received warm reviews. Both studied how concussions occurred and the kinds of hits that produced the most concussions among NFL players. However, neither looked at the long-term effects of concussions, nor did they explore any links to long-term brain damage.
The NFL’s first two papers were initially submitted for publication on April 21, and June 10, 2003, and were published in October and December 2003, respectively. The third paper was actually submitted on the same day as the second, June 10, 2003, with the fourth paper submitted to the journal on November 11, 2003. This means that all the research for the first four papers was completed about the same time. The second two papers showed the NFL’s concussion committee’s true intention. Rather than focus on the possible delayed and persistent effects of brain injuries suffered while playing football, the NFL chose to collaborate with a sister multibillion-dollar industry, the helmet industry, to synthesize data, propose, position, and justify that helmets are the answer to brain injuries and concussions suffered while playing football. The propositional value would be to make us believe that helmets protect us and prevent head injuries in football. The game could then continue to thrive; more helmets would be sold; and the two industries would continue to make their billions in revenues and profits.
As expected, these NFL papers posited in no uncertain terms that concussions were extremely rare in the NFL. In their view, in the off chance that a concussion did occur, there was nothing to worry about, since it is the mildest form of traumatic brain injury. However, being the benevolent organization that they are, the NFL joined with helmet manufacturers to make the supposedly concussion-proof helmet. Of course, all of this is ridiculous. The actual scientific fact is that there is nothing mild about a concussion. The human brain suffers serious microscopic injuries from both concussive and subconcussive blows to the head. No helmet can prevent this damage, for no helmet can stop the brain from moving around and colliding with the inside of the skull at the moment of impact.
Yet, to the NFL, the so-called “concussion crisis” was not a crisis at all, for they were already at work to solve the problem. You need to remember that Mike Webster was never diagnosed with a concussion, at least not officially, and yet he suffered massive and permanent head trauma from both concussive and subconcussive hits. That is not the message the NFL wants us to hear. They want to make us believe that concussions are the problem. And if they can prove that concussions are mild and are extremely rare in football, then football must be safe. We can continue to watch and to play, and we will not have to worry about any long-term consequences. As we continue our love affair with the game, the money keeps on pouring in for the select few.
While the NFL’s concussion committee worked to make it appear that football players are at no risk of long-term brain damage, they actually admitted in the fourth paper that subconcussive hits can and do cause long-term brain damage, at least for boxers. The committee wrote, “It is well accepted that chronic encephalopathy of boxers results from the accumulation of damage from multiple subconcussive blows to the head over a prolonged period of time, not the number of concussions sustained.”5
They went on to say, “There was no evidence of chronic encephalopathy in this group of football players who had sustained a relatively small number of multiple concussions.”6 The authors did admit that some players demonstrated permanent postconcussion syndrome, but “they clearly did not have chronic encephalopathy such as that seen in boxers.”7
In essence, what they were then saying was that repeated blows to the head in boxing caused brain damage, but repeated blows to the head in football did not. They made this claim even after players like Mike Webster were awarded disability payments by courts and the league’s retirement board—after concluding that football caused their brain injuries. The NFL’s official research team ignored this fact and instead concluded that football does not cause brain damage because the helmet provides enough protection to keep the brain unharmed.
As I always remind medical students and resident physicians when I teach them, medicine is not an absolute science like mathematics or physics. One plus one will always be an absolute outcome—two—but in medicine, it is not like that. Medical research can always attain a desired or expected outcome based on how you tweak your research parameters, what assumptions you make, what principles you apply, what methodologies you adopt, what cohort you study, and what error rates you apply. You may perform a research study and come up with one outcome; another person may perform exactly the same research, make subtle and barely noticeable changes in the scientific assumptions and principles, and come up with a completely different outcome. Medical research in the hands of a conniving mind is a very dangerous tool that can be misappropriated for all kinds of intents and purposes.
In their seventh paper, published in January 2005, the NFL put forth questionable data and concluded that when a professional football player suffers a concussion, which in their opinion is the mildest form of brain injury, the concussed player should be returned to play the same day he suffered his concussion. They further concluded that when a concussed football player is returned to play the same day or in the same game in which he suffered a concussion, his clinical outcomes are better and he has less risk of permanent brain damage than a player who is taken out of the game completely following a concussion! They claimed that these players do not show any increased risk of subsequently developing a prolonged postconcussion syndrome or any other type of brain injury, including a repeat concussion, second-impact syndrome, any bleeding inside the skull or brain, or brain edema.8 To make matters worse, the research team recommended that the same standard should be applied to high school and college football players when they are known to suffer concussions. I am sickened to think of how many former players now suffer from irreparable brain damage because a team doctor followed this recommendation.
• • • •
One of the final research papers produced by the NFL’s Mild Traumatic Brain Injury Committee reached the logical conclusion of the research their team carried out, beginning with its inception in 1994. The committee summarized its research with these words:
When the immunohistochemical results are extrapolated to professional football players, concussions result in no or minimal brain injury. Repeat impacts at higher velocity or with a heavier mass impactor cause extensive and distant diffuse axonal injury. Based on this model, the threshold for diffuse axonal injury is above even the most severe conditions for National Football League concussion.9
That is, the NFL concluded that concussions on the football field result in no or minimal brain injury. Even worse, their “research” determined that the forces generated in head-to-head collisions on the football field do not rise to a level capable of producing serious injuries. In other words, football is safe for the brain. There is no need to worry. Other papers in this series concluded that repeat concussions pose no risk of greater injury than a single concussion and that it is safe for a player who has been knocked out to return to play in the same game.
As of the time of this writing, these positions have changed in that players now must pass a rigid concussion protocol before they are allowed to return to play. However, as recently as March 2016, one of the most influential owners in the NFL, Jerry Jones, told the Washington Post that it is absur
d to claim there is a link between football and permanent brain injury and the disease CTE. He said, “We don’t have that knowledge and background and scientifically, so there’s no way in the world to say you have a relationship relative to anything here. There’s no research. There’s no data.”10 Indianapolis Colts owner Jim Irsay equated the risks of long-term brain injury to taking an aspirin. In a March 27, 2016, interview he said, “I believe this: that the game has always been a risk, you know, and the way certain people are. Look at it. You take an aspirin, I take an aspirin, it might give you extreme side effects of illness and your body . . . may reject it, where I would be fine. So there is so much we don’t know.”11
All of this is completely and totally absurd. Any “research” that concludes concussions do not cause brain injuries flies in the face of two thousand years of accepted medical facts and common sense. The same is true of the National Football League’s findings that players who have been knocked out can safely return to play in the same game without risk of further injury. Their research is very similar to studies produced by tobacco companies that claimed smoking is not harmful in any way. When you consider that the original head of the NFL’s MTBI Committee was a rheumatologist, not a neurologist or neurosurgeon or neuropathologist, their conclusion makes a little more sense. I cannot even begin to describe how wrong both Jerry Jones’ and Jim Irsay’s statements are. To compare the risk of debilitating injuries like those suffered by Mike Webster—and many, many other players—to that of taking an aspirin is more than insulting to those whose lives have been permanently altered by the game. It is an outrage.
• • • •
When I examined Mike Webster’s brain in 2002 and 2003, I had no idea any of this so-called research was going on, for the papers had not yet been published. I did not know the National Football League was in the process of loudly proclaiming that the brains of its players were not at risk. “There is no danger here,” they essentially said in response to the so-called concussion crisis. “There is nothing to see. Just move along.” The NFL’s response to concussion danger is very much like the cigarette industry’s response to all the evidence of the dangers of smoking. Big Tobacco produced reams of “research” demonstrating how safe cigarettes are, even though knowledge of the dangers of smoking goes back to the days when tobacco was first discovered in the Americas. The 1999 Academy Award-nominated film The Insider chronicles the way in which the truth finally came out. In many ways it is quite similar to Concussion, although the message of The Insider is more easily accepted by the public.
The NFL had a more receptive audience to the research and message of denial. The millions of football fans in America—who each week engage in a form of conformational cast of the mind and of cognitive dissonance—find it easy to believe these super-sized men on the football field are indeed superhuman. These players overcome in weeks the kinds of injuries that would probably keep a normal person down for months or longer. As violent hits play out on the television screen, fans jump back and scream, “How can anyone get up from that?”—only to see players jump to their feet and run back into the huddle, ready for more. Even though fans’ eyes told them no one could walk away from these “car wrecks” unscathed, conformational intelligence told them not to worry. The NFL’s research told fans everywhere exactly what they wanted to hear: the game is safe and fun, and we can watch and enjoy without guilt. The players are fine. The games will go on. We should all sit back and enjoy.
Then I came along and found evidence of long-term, destructive trauma inside the brain of an NFL player. Why had no one ever found this damage before? There is only one reason: no one else had ever looked for it! No one wanted to know the truth! If they had, they would have discovered it years, perhaps decades, before I ever met Mike Webster.
Mike Webster was the first case, but as you will discover as you continue reading, he was not the last. Over the past decade and a half, more and more brains of football players have been studied, and CTE has been found to be widespread. And it is not only in the brains of football players, but in the brains of other athletes who play high-impact, high-contact sports like wrestling, ice hockey, boxing, mixed martial arts, and rugby. We do not yet know what percentage of people who play football and other high-impact, high-contact sports will develop CTE. I believe the percentage is very high. I firmly believe that O. J. Simpson has CTE, a topic I will return to later. Even though we cannot yet know exactly how many current or former players have CTE, since the disease can only be confirmed via autopsy, one thing is very clear: 100 percent of those who have ever played or ever will play football at any age are at risk of brain injury and permanent brain damage. One hundred percent. Not just professional football players, but anyone who plays football at any level. All are at risk.
This is why I am so adamant that children under the age of eighteen should not be allowed to play football or other high-impact, high-contact sports. Children should not play football, because the developing brain is especially susceptible to long-term damage from trauma. Studies have found the human brain does not fully develop until between the ages of eighteen and twenty-five. Why then would we expose the brains of our children to trauma?
We have laws against smoking until the age of eighteen or older. The legal drinking age is twenty-one. One could argue that smoking is actually safer for a child than football. I know that sounds outrageous, but hear me out. Smoking damages the lungs and leads to pulmonary and heart diseases, as well as greatly increasing the risk of cancer. Cigarettes shorten lives. Football-related brain disease, including CTE and PTE (Post-Traumatic Encephalopathy), takes away one’s life even as the body goes on living, and it may eventually shorten one’s life. I have met or heard from countless grieving mothers who have told me how their sons’ behaviors drastically changed. These young men went from having energetic, intelligent, outgoing, vibrant personalities to being withdrawn and depressed. Men as young as the early twenties struggle to remember something as simple as where they live. They erupt in sudden outbursts of anger, becoming violent when they have never been violent before. To their family members, they look the same on the outside, but inside something has changed. The man they once knew is gone because his brain has been permanently altered.
The brain is where the mind resides, along with our intellect, our moods, and our emotions. Our brains define us as human beings. The core of our being rests in the 2.8 pound, semi-solid, Jell-O–like mass that rests in a liquid bath inside our skulls. When the mind goes, we cease to be. Shouldn’t we then do everything we can to protect the most vulnerable among us—our children?
The most sinister aspect of CTE is the fact that the symptoms may not immediately manifest themselves. Damage done to the brain in the teen years may not reveal itself for years, perhaps a decade or more and even into one’s forties. The damage shows up as memory loss; impulsiveness; diminished intellectual capacity; mood disorders, including depression and rampant fluctuations in mood; suicide attempts and actual suicides; changes in personality; increasing tendencies toward violence and criminal behavior; disinhibition; sexual improprieties and indiscretions; alcohol abuse; drug abuse; and exaggerated responses to life’s daily stresses.
Every time I hear a news story of a former football player arrested for criminal behavior, especially domestic violence—and especially when this behavior comes suddenly, out of the blue—I suspect the cause can be traced back to head trauma suffered on a football field back in their days in Pop Warner football, high school football, and college football. Again, why would we expose our children to such risks?
• • • •
When I first started writing the Mike Webster paper, I knew this was where I would end up. I was beginning to realize how the NFL had tried to cover up this truth. By moving forward with the paper, I put myself on a collision course with the most powerful sports league in the world. They believed I would not survive. Over the course of the next few years, there were many times I thought they were righ
t. If not for the grace of God and the strength given by the Holy Spirit, I would have given up the fight and my voice would have been silenced. Yet God sustained me. He gave me my resolve and my voice. God is the one who empowered me, because at its roots, CTE and sports-related brain trauma are spiritual issues. God loves His children and wants to protect us from harm. Shouldn’t we do the same for our fellow human beings?
Chapter Sixteen
“In the Name of Christ, Stop!”
Early in the fifth century, an ascetic monk from the east felt compelled to travel to Rome, a city he had never visited before. He arrived to find huge crowds all moving in one direction. Since he did not know why the Spirit had led him to the city, he decided to follow the crowd. He quickly became caught up in the festive mood that permeated the crowds. His sense of expectation rose as the push of the crowds led him to the coliseum, where he sat down with the rest of the people and waited to see what might happen next. He did not have to wait long. Two gladiators came out into the arena and began fighting with swords and shields. Telemachus had never seen such a sight. Horrified by the sight, he stood on his seat and shouted, “In the name of Christ, stop!” No one paid any attention to him. The rest of the crowd cheered at the top of their lungs as the two gladiators began to draw blood from each other.
As the crowd cheered, Telemachus ran down from his seat and jumped into the arena. He went straight to the two gladiators, shouting, “In the name of Christ, stop!” The fighting men ignored him until he put himself between them. When the crowd saw him interfering with their entertainment, they began to boo and shout for him to get out of the way and let the show continue. Telemachus would not budge. “In the name of Christ, stop!” he shouted again. The crowd went from annoyed to enraged. A gladiator pushed Telemachus to the ground. As he lay in the dirt, the angry mob surged toward him. One man threw a stone at him, striking him in the chest. Another stone came flying in—and then another and another. He shielded himself with his arms, but the flurry of stones was too strong. Telemachus tried to get up from the ground but was knocked back down as a rock struck him in the head. A stream of blood spurted out. The blood only seemed to stir up the anger of the mob even more. “In the name of Christ, stop!” he said one last time. The stones continued to rain down, even after the small monk stopped moving. When it was clear he was dead, the anger of the crowd turned to revulsion over what they had done. Those who had cheered for blood felt very different when it covered their own hands. Saint Telemachus could not stop the gladiator combat show in the Roman Coliseum that day, but his death ultimately moved Emperor Honorius to ban the fights forever.1