Part VI: The Life and Contributions of Bennet Omalu MD

The following timeline illustrates the key points on the issue of CTE, Omalu and the NFL:

2002 Omalu performs autopsy on Mike Webster; discovers CTE histopathologically

2005:  Omalu publishes CTE findings in Neurosurgery; NFL MTBI Committee demands a retraction

2006:  Omalu publishes second case (Terry Long); NFL continues to deny findings; Andre Waters dies and Omalu discovers CTE on examination of the brain

2007 Omalu is marginalized; loses access to NFL player brains

2009:  Congress holds hearings on CTE; NFL sets to dissolve MTBI Committee

2011:  NFL acknowledges long-term effects of repetitive head trauma and CTE

2015:  film Concussion released, dramatizing Omalu’s struggle

2016:  NFL agrees to 1-billion-dollar settlement with former players; CTE firmly established

2016:  The American Medical Association recognizes Dr. Bennet Omalu with its most prestigious honor, The Distinguished Service Award.

 In addition to athletes, Omalu also states he reported the first case of CTE involving a military veteran, a former soldier in Iraq who returned home depressed, began using drugs, became disposed and eventually committed suicide.  “It’s the shockwaves,” states Omalu. “Whenever you are within 50 yards of artillery.  The physics is indisputable.  When the shockwave hits your head, it’s a sub-concussive effect.  In training and on the battlefield, these soldiers shoot these things hundreds of times.  Non-stop, for hours.”

Omalu states his depression is now under good control thanks to psychotherapy and medicine.  In 2015, a major motion picture premiered about his discovery and ordeal.  “It wasn’t the movie Concussion that brought me out of this depression.  It was psychotherapy, but even more, the medication bupropion.  It has changed my life.  It balances out the neurotransmitter milieu that my brain is lacking.  Clearing my depression is the single biggest accomplishment of my life.  It’s not CTE.  I’m not kidding.  I’m much more fulfilled now.”

In summary, let’s review the matter.  Dr. Omalu was born during the War of Biafra, to a father who was an alcoholic and an orphan.  He focused on education as a pressure release valve against chronic depression and was able to complete medical school and journey to a land where everything seemed possible:  America.  Omalu worked hard and became a specialist in neuropathology and was hired by one of pathology’s greats, Cyril Wecht.  On a rainy morning in 2002, Omalu heard a television story about Mike Webster, a local player and NFL great.  He heard disturbing news about his post-career mental and physical health, and then, remarkably, found Webster on his autopsy slab on when he drove into work that morning.  Even though Webster died of an obvious heart attack, Omalu insisted on evaluating Webster’ brain, both out of curiosity and intuition.  Though the gross examination was normal, he fixed the brain at his own expense and what he found ignited the country, and the medical world, on fire and catapulted him into the international spotlight.  Omalu connected the physical and mental health problems to the pathology he witnessed under the microscope.  He thought he would get a pat on the back by the medical world at least, but instead, a firestorm ensued and Omalu found himself at the intersection of medicine, culture, common sense, a multi-billion-dollar industry called the NFL.  What followed was more apropos of a Twilight Zone episode, then the recognition Omalu was deserving of.   The NFL’s product, the beloved game of football, arguably now America’s national sport, was being threatened.  The threat was emanating from the outside, not from within, which could have been controlled.  The evil being wielded from the outside and swung at the very head of the NFL was a club labelled with the word concussion, or so they thought.  The real problem was repetitive sub concussive head injuries.  It’s hard to imagine that a sport, foundationally based on violence, would have ignored or trivialized concussions at its highest levels.  A concussion would just be the tip of the iceberg in reality.   An iceberg floats innocently in the water, but its massive bulk is only fifteen percent visible.  Lurking beneath the beautiful tip, unseen, a dangerous jagged mass loomed to boats unaware.  In football, the larger problem is, again, repetitive sub concussive injuries sustained over years of play, not necessarily concussions.  Concussions are not the root cause of CTE.  After several prominent NFL quarterbacks were being sidelined by concussions in 1994, the media began to take notice, which meant the NFL was under pressure to take notice.  Team physicians were typically orthopedists, as musculoskeletal injuries were much, but not all, of what was typically seen on football teams.  Orthopedists had no training in concussions and didn’t appear to know much of the literature on the subject.  There didn’t appear to be any literature generated by the league either, despite its nearly 100-year history.  The commonsense reason would be that the league didn’t want to know.  It could only bring trouble to uncover and expose that rotting carcass.  Similarly, Major League Baseball, behind closed doors, understood they had a steroid problem in the 1990’s, but business was good, so they turned the other cheek and did nothing, under the guise that publicly, they just didn’t know. “Steroids?  What’s that?”  It was a plausible excuse, to those at the top.  We just didn’t know.  Same with the cigarette industry.  They just didn’t know about the association between cigarettes and cancer. 

Enter the hand-picked doctors of the Mild Traumatic Brain Injury Committee, an industry-sponsored group financed by the NFL.  Hardly an independent jury, and, what’s worse, consisting of some of the very doctors who should have taken notice in the first place, but didn’t.  Who could pick a better group to study the problem, then the very doctors who missed it in the first place.  Instead of distinguishing themselves investigating a serious health concern like Martland did and Corsellis did, they published a series of studies between 2003 and 2006, nearly 9 years after commencing on the endeavor, and publishing only after Omalu’s groundbreaking paper.  Coincidence?  Moreover, their work marginalized concussions and even signaled, in their seventh paper, that players could return to the game on the same day the concussion had occurred without risk.  When Omalu presented the findings of his first case, the medical intellects of the MTBI Committee reviewed the only known neuropathologic literature on the subject and concluded, correctly, that what Omalu had discovered was not Dementia Pugilistica histopathologically.  To the committee, Dementia Pugilistica was the only known form of Chronic Traumatic Encephalopathy.  So, if wasn’t Dementia Pugilistica, they reckoned, it couldn’t be CTE, therefore Omalu was wrong.  Look at the pathology, they pointed out:  No Cavum Septum Pellucidum involvement, Tauopathy but not primarily in the depths of the cortical suci (in DP, the tauopathy is widespread), no cerebellar scarring and no prominent involvement of the Substantia Nigra, which gives the Parkinson’s-like symptoms of DP.  In this they were completely correct.  Unfortunately for the MTBI Committee, Omalu said upfront this was not Dementia Pugilistica, and confirmed this with other perplexed brain experts, which is why he became so excited about the findings and why he grew to prominence after his paper was published in Neurosurgery.  The MTBI Committee was so blindly focused on protecting their reputations and protecting the NFL’s brand, of which they prospered from, they completely missed the point.  Omalu was agreeing with them.  What he was disagreeing with them on was that what he found was caused by repetitive sub concussive hits, not necessarily concussions.  Mike Webster, if you remember, never officially suffered a concussion in his playing career.  Only 25,000 car crashes.  Omalu understood that DP was likely a variant of CTE, how could it not be, but was clearly not the cause neuropathologically in these football players.  DP falls under the umbrella of CTE, not the other way around.  The MTBI Committee was listening, but they did not hear.  They were looking, but they did not see, and their assumption that because the findings did not represent DP, that it was not CTE, was disastrously incorrect.  Their call for a retraction of the paper compounded their lack of medical standing on the issue. 

Omalu called the disorder Chronic Traumatic Encephalopathy, which makes sense as the condition is chronic, it is caused by trauma, and it does cause encephalopathy or disease of the brain.  For this he is also harassed by his critics.  They say the name CTE was already taken.  They point to Dementia Pugilistica, which is obviously a form of CTE.   Some suggested calling it Chronic Progressive Traumatic Encephalopathy, as we have seen, but the name never took off. It remained Dementia Pugilistica.  They were never used as a generally agreed upon specific disease entity and never with Omalu’s pathological discoveries attached to it.  Afterall, it’s not like he tried to name it Omalu’s Disease.  The debate is petty. 

Omalu has pride in his discovery and when he gets challenged by the media or other scientists on something he knows to be right, something that he has proven to be correct, he has a tendency to be less articulate and more emotional.   This explains his defensiveness with the press.  It also seems understandable in someone who comes from another country, Africa, and who has made an important discovery that seemingly everyone is trying to deny or dispute.  He also has a tendency to speak very frankly, like when he says no one should play football, or at least kids below eighteen years old shouldn’t, until they can make educated decisions on the risk.  This is hard to swallow for most American’s, given their love affair with football. when he says outright football as we know it, should stop being played.  But it is a rational and obvious conclusion to come to.  Football could be made safer with rule changes and better player and coaching discipline, but the sport cannot, inherently, be made safe.  Culturally, people love the game of football and are not willing to see it go away.  It’s a perfect blend of athletic ballet coupled with the ever-present anticipation to witness bodily violence.  Omalu also unwittingly opened himself up to resistance from anyone benefitting from the hulking financial behemoth the football industry has become, including the television stations with their multibillion dollar contracts which would be at risk, and all of footballs affiliated industries, stadium workers, grounds crews, parking attendants, security services, hot dog manufacturers, beer companies, potato chip makers, helmet manufacturers, and all footballs main advertisers, including products synchronizing to NFL games, not to mention the betting parlors.  In America, Saturdays are for college football and Sundays are for professional football.  Its written in stone, and football has become a near religious experience for tens of millions of fans.  With all of this at risk, and knowing the game couldn’t be made safe in any meaningful way, it was easier to kill the messenger, Bennet Omalu, then to destroy the game and the industry.  This humble man from Nigeria, whose mother told him he may be small in stature, but he could still have a large impact on the world, and that it was up to him, has now fulfilled that destiny.  This gentle, pious African, who is now as American as apple pie, and whose lifework has positively advanced humanity, and who stoically shouldered vicious attacks from an enormous industry that surrounds itself with a huge protectorate called the mainstream media, is now known throughout the entire world.  Bennet Omalu made an important discovery.  He was strong enough to take a stand when attacked by all sides.  Ultimately, he knew that truth didn’t have a side.   He stood by his unpopular belief that professional contact sports, and amateur contact sports, although fun, may have hidden dangers.  Like Martland, Omalu believed it was his duty to expose the risk, especially to an audience that didn’t want to hear.  He was not afraid to enter the dangerous intersection where medicine and culture collide and he stood tall despite the risk.  As history will bear out, humanity will owe Dr. Bennet Omalu a colossal debt of gratitude.