The Concussion Blog

BENNET OMALU

January 15, 2011 by telephone with Matt Chaney

Q. What football likes to do; this is what I learned in 20 years in the anti-doping issue, where we have so-called testing, and protection of players against drug use. Foremost, it’s very clear now, according to a host of experts worldwide, that so-called testing for steroids is bogus. It does not work. It’s invalid. It has huge faults in terms of its applications. Well, point being, football especially—but other sports too, especially the Olympics, and baseball, are learning by their example—football likes to [chuckle]… When it has a problem for which it’s being criticized for, it likes to go out and stable the science. It likes to go out and fund and/or hire scientists, to put together its prevention packages, and act like everything’s hunky-dory. And they do not share their science. They say they have a test, but they do not open it up to [peer review]—

Omalu: [he interrupts] A very good example, because WWE’s guilty of the same thing.

Q. Oh, really?

Omalu: This so-called ImPACT testing. That is a fraud, in my opinion. ImPACT testing is not a diagnosis tool. It is a forensic followup [model] to monitoring, to quantify or to evaluate the amount of damage. And to monitor, to see how a patient is improving.

Using the ImPACT testing in the acute phase of injury, to determine the amount of damage, actually makes the damage worse. Am I making sense?

Q. Oh, yes. Yes.

If anything, it actually makes the damage worse. OK.

I can allow you to re-cord if we’re going to talk about the science of concussions. You can re-cord, yes [pronouncing like ‘hit record’] …strictly the science ..… Just ask me questions specifically on the science.

Q. Yes, that’s kinda what I’m—what I’m interested in is the science. Let me say straight up I totally agree with your link of brain damage to football. I’m not even worried about that. I, I am, I totally agree with it, I have expert scientists, especially Chuck Yesalis of Penn State, who loves your literature, he loves your evidence, and he is also an historian on boxing injuries. He is well-familiar—he knows much of the literature that you’ve often referred to from boxing, as far as long-term brain damage—

Omalu: Why don’t you re-cord about, keep your questions strictly of the science. …

Q. Yeah, yeah. I understand. Well, the science of ImPACT, for instance. The science behind that. I’ve looked into this literature, behind ImPACT—

Omalu: Let me explain to you why that science is false…

Q. Yes.

Omalu: And people are making money from this.

Q. Please.

Omalu: Science—medicine is not like physics or mathematics, which are absolute sciences.

Q. Right.

Omalu: When you’re working in mathematical problems… there’s only one answer, to mathematics. It’s absolute, just like physics.

Medicine is not like that. OK. So you can tweak, you can change outcomes in medicine, based on what your assumptions are, because you cannot experiment with human beings. OK?

Q. Uh, hmm.

Omalu: Now, you know how the ImPACT came about?

Q. I heard the legend, the sales tale [laughs].

Omalu: OK. There were two PhD guys, who were obviously friends to Dr. Maroon. They didn’t have anything [for concussions]. The NFL didn’t know what was going on, so they put together this computer package. Essentially to make money from.

Q. Yeah, Lovell and Collins.

Omalu: They’re making money from this. I’m happy for them. But they should not [ignore] the science, in order to make money. And I’ll explain why. I’ll, I’ll try to be as simple as possible.

Q. Yessir.

Omalu: The brain is an electrical organ, just like the heart. OK. And the currency, the basic fundamental currency of brain function is what we call AP—[antoni? peta/pieta?]—AP for short. And it stands for action potential. And AP is simply an electrical current, generated across the membrane of the brain cell. OK?

Q. Uh, hmm.

Omalu: And what generates that electrical current is the movement of ions, sodium and potassium. And sometimes chloride. Sodium, potassium, chloride ions across the membrane. And in order to do that, they move through channels in the cell membrane. Am I making sense?

Q. Yes, to this novice. You bet. Yessir.

Omalu: All brain function goes through this basic mechanism. All brain function, everything that defines you as a human being, goes through this basic mechanism I have explained.

Now. When you suffer the concussion: Concussions disrupt the membranes of the brain cells, as the skeleton of the brain cells, OK?

Q. Uh, hmm.

Omalu: And, in addition to all the effects, it disrupts these channels, OK?

Q. Right!

Omalu: So what happens is [?fulloined? loid?] trauma. What you do is remove the person from all types of stimulation.

Q. Right.

Omalu: You remove him from play. You remove him from school. You remove him from all types of intellectual stimulation. Otherwise, you would cause permanent damage to those channels. OK?

Q. Right. Uh, hmm.

Omalu: Now. What an ImPACT does is: OK, somebody has suffered the damage, there’s a concussion. The channels are open. And then you go and subject them to intellectual stimulation—because the neuro-psychotic testing is a highly intellectual challenge.

Q. Right.

Omalu: And doctors who are out there, who are not associated with the NFL, will tell you, that if somebody suffers a concussion and you subject him to the ImPACT testing, it makes the symptoms worse. [see for lit on neuropsych testing in acute phase].

Q. Right.

Omalu: So, ImPACT should not be used! They say if somebody suffers a concussion, let them to the test by the field—that is scientifically flawed.

Q. Right.

Omalu: ImPACT should not be used as a primary diagnostic tool. That is not what it is, for concussions. It is a tool that is used to monitor the recovery of the patient and to quantify the amount of damage symptomatically.

I was at a conference where Collins was speaking. And he said a patient, a high-school student passed the ImPACT, and then he [Collins] told his parents he was cured, he should go back to play. And I challenged him: ‘How can you say a patient is cured because he passed ImPACT? Based on what?’ He became very defensive and started attacking me. I just told him, ‘Just to avoid legal, medical-legal issues, somebody suing you, don’t make such statements.’

Q. Right.

Omalu: What he should simply say, ‘The person has passed ImPACT, the ImPACT test, period.’ Nothing else, doesn’t mean anything. It just does not mean… anything.

Q. Yeah, they claim [validation/reliability] literature. But they’ve done most of the studies, Collins and Lovell [laughs].

Omalu: The literature published by them is the same as the literature by Pellman, Casson, and Viano, that has now been discredited.

Q. It is influenced [by football politics], don’t you think?

Omalu: It’s, it’s corruption [of information]. It’s, um… corruption, at various levels. But that is the name of the game. That is the life we’re living. Life is not perfect. Life is unfair.

Q. Yep. Yeah, it is.

Omalu: That is just life. But it’s, it’s, um, is an imperfect system.

Q. Yeah, there are several glaring limitations, it seems like. You know, the classes I had in biology and chemistry, just as a general student, if I had proposed, for instance, to assess, properly assess concussions, and I had present my little model to my teacher, and I’d said, ‘Now one limitation here, is that I must rely on accurate self-assessment [by] athletes who were injured.’ Not just to mention general practitioners who are not trained in this application—and I’ve looked online, at all of these directions for ImPACT and all this—it’s very confusing, I think.

Omalu: Let me, let me be honest with you. ImPACT and other types of neuro-psychotic testing should not be used as a primary diagnostic tool. They should not be used in the a-cutephase, and by a-cute what do I mean… in the first two weeks of an injury.

Q. Right.

Omalu: OK? That is [reason] one.

Two. The brain is a post-mitotic organ. What does that mean? It means the brain cells do not have the ability to divide and create new cells.

Q. Right.

Omalu: Otherwise, if they had the ability to divide and create new cells, you have super human beings. You have human beings with supernatural ability. OK?

Q. Right.

Omalu: So, a very good example I always give people: When you suffer a stroke, your stroke cannot be cured. You’ve suffered a stroke.

Q. I had one by the way.

U-ha. So what the doctors would do is to minimize the damage of this stroke, to prevent it from progressing. Am I making sense?

Q. You bet. I’ve been through this routine.

Omalu: Once you’ve suffered the stroke, it is permanent. Even if you die 50 years later and we examine your brain, we see the stroke. It creates a space in your brain.

Q. Wow. Yep.

Omalu: Same applies to concussions. And a concussion is simply fracture. You know how you break your bone? That is what a concussion is, but now it is on the cellular level. A concussion is a fracture of the skeleton of the brain cells…

If you fracture your bone, the NFL will keep you out of play for the entire season, doesn’t it?

Q. Right.

Omalu: They say it is a season-ending injury. But the bone has the ability to divide, and create new bone, and heal. A fracture can become healed. OK?

Q. Right.

Omalu: But—a fracture of the brain, which is a concussion, does not have the ability to heal as well as the bone. So, if the brain is a most-sensitive [post-mitotic] organ, the bone is more resilient, but somebody fractures his bone you keep him out of play for three months.

But if somebody fractures his brain, you keep him out of play for only two weeks? Does that make sense even if you’re not a doctor?

Q. [chuckling] No.

Omalu: And this is the same historical precedence… Generally speaking, mankind does not empathize with brain diseases as well at they empathize with physical ailments.

Q. There’s no doubt. My oldest brother, Doctor, was a gran mal epileptic.

Omalu: Yes. People stigmatize [brain illness]… This negative response, culturally, for diseases of the brain. Talk about mental disorders, psychological diseases, people wouldn’t empathize with you. Rather, they would stigmatize you and ostracize you.

And I can see the same cultural trend in football. Because it is a disease of the brain, if people complain, they say, ‘Oh, you are whining. You are not tough.’ They ostracize you, they expel [fire] you from the league. It’s the same cultural trend.

So the two-week out-of-play… Remember when Pellman and Casson said… if a person suffers a concussion, oh, put him back to play in the same game.

Q. [we chuckle together] That’s not even the lowest of medical ethics

Omalu: A boxer, the two-week guideline they are using: What is the basis for it?

Q. No one can answer that for me. I’m asking that question [1-2 weeks in football].

Omalu: …[for acute-phase isolation; lengthy rest overall] when I said this, they attack me. ‘There’s no literature!’ That is not true. There’s  an abundance of literature out there.

Too, DTI, diffusion tensor imaging studies have confirmed that when you suffer concussion, of all types of brain diseases, the effects of this trauma remainfor months, for sometimes years.

Q. Yes.

Omalu: Evidence! Even on the pathological level. When you suffer brain trauma, it’s permanent. Effects of concussion arepermanent.

But—if … a player wants to go back, you let him know these things are permanent, the more concussions, the more impacts that you receive, the great the risk that you will end up badly [which is benchmark ballers present and past look for, dramatic signs].

Q. Right.

Omalu: If a player sustains severe traumatic brain injury—and this thing they call mild traumatic brain injury—someone suffers an impact to his head, is knocked out and becomes unconscious, that is not mild. That is a misclassification, and it is that attempt to mitigate and diminish the seriousness of concussion—that is why they classified it as ‘mild traumatic brain injury.’ There is nothing mild about a human being being knocked out of conscious, from a blow to his head.

Q. Right. That’s what I’ve wondered too: This is mild traumatic?

Omalu: It’s not mild. There’s nothing mild about it. We need to change that attitude.

I have proposed, and I remain by it: If anybody suffers an impact to his head that knocks him unconscious, that makes him present with immediate symptoms where he is dizzy: he should be kept out of play for three months. That is my opinion.

Q. And that’s including for players who are even conscious, correct? Any sort of dizziness, you believe they should rest long time?

Well, for those who do not have loss of consciousness, they have dizziness, they cannot go back to play [immediately]. I don’t think that two weeks is sufficient, in my opinion.

Q. Right. Right.

Omalu: Now. When we now move forward, DTI is now emerging as a very useful tool, maybe biomarkers, where we can now actually quantify in a more objective manner the amount of damage.

We can now have [return-to-play mandate/agreement]… where it should not be less than a month, in my opinion. A player should be given the option.

Q. Yeah, I saw, for instance, Dr. Ann McKee made that same statement to NPR Radio, in October, or November of 2009: She said, she said athletes should not return for one month or longer, depending on the severity. And I’ve contacted her by email and she will not comment on that quote, anymore, for instance.

Omalu: I think you know the NFL gave them money?

Q. Oh, yes.

Omalu: I think they’re being shut up. That is again that corruption… You know, the NFL doesn’t like me, and I think it’s actually good for me [credibility-wise]. It makes me independent, and I’m free to say whatever I actually believe based on the science. It’s not based on me as a person [or associations].

I actually challenge anybody who thinks he knows this subject better than I do. Where was he when Dr. Omalu was discovering CTE?

Q. Yep.

 

Omalu: It is something shameful that the NFL, despite all the money they have, did not identify this disease [wonder if they did and didn’t announce, like tobacco]. It was an ignominious outsider like me [per NFL rebuke] who makes the link.

And even when I made it, they attacked me, they delegitimized me, they insinuated that I was a voodoo doctor from Africa and that I should not be trusted. Made some statements… that had visceral undertones. [quiet]

Q. Right. Right. I understand. I’ve seen their game.

Omalu: Ok. And then now Nowinski goes to give an award to the NFL commissioner?

Q. [laughs] Yeah, I saw that.

Omalu: That is shameful.

Q. Yep. It seems shameful to me that you would accept money from them in the first place.

Omalu: And you give them an award.

Q. And they’re spreading a lot of money around now, aren’t they? The NFL, they’re funding neurologists [and others] all over the place, aren’t they?

Omalu: Well, they’ve not given me any money, which is funny, for my experience as a physician. When a physician discovers something and moves the science forward—my discovery has moved the science forward—any serious-thinking physician in the country, in the world, would acknowledge that Dr. Omalu’s discovery has moved the science forward.

Before Mike Webster, did anybody talk about concussions? Nobody. And that is why I have presented in meetings… CTE as Mike Webster’s disease. …

So that is my opinion. I stand by my three-months return-to-play [proposal], especially for somebody who develops loss of consciousness. I’ve been told that that is too long a time, there’s too much money involved, um [sighs, laughs]… Human life is invaluable.

Q. Now you’re to the crux of this, because football, American football, human life is not valued above the game. It never has been. That’s what the whole culture is delude about… I want to talk to you more about the three-month layoff. Let’s talk about pro players at a different level. If these people want to do this as professionals, and they have a union that goes by quick-return-to play and everything else, well, OK, a lot of people can say that’s their business. But—when we talk about juveniles, and all sorts of health policies and laws, even for media… there are laws protecting juveniles against obscene media, for instance. And here it is in football, that no one even thinks about some sort of minimum for juvenile concussed athletes. That’s what I’d like to ask you: How about juvenile concussion—

Omalu: If a juvenile, there’s no option about it. Any concussion, out of play for the season. There’s no question about it. OK? For juveniles, any concussion.

But… the concussion is not what causes CTE. What causes CTE? Do you know?

Q. It’s the repeated blows, isn’t it?

Omalu: Thank you very much. You are an excellent student and you are very knowledgeable.

But NFL wants you to believe that it is concussions that cause CTE. Why? Because for every documented concussion [in an individual], there are hundreds, if not thousands blows to the head. [second-impact damage, then, would be Zach Frith, Preventes, etc.]

Q. You bet. You bet.

Omalu: Eh? Since somebody suffers a documented concussion, am I just looking at that single blow that knocked him out? I’m looking at all the other blows he got before he was knocked out.

Q. Thousands. Thousands.

Omalu: Ok. Now, they are talking about money [so] it’s shortsighted, to be honest with you. You return this player back, in two weeks, then in his 30s and 40s, he’s suffering different levels of dementia. Think about the cost of that person’s disability, social incapacitation to the general society.

Q. Yeah, and that’s who pays the [heathcare] bills, isn’t it? Not the NFL.

Omalu: It’s the general society, and not just the cost of the disease. What about the cost of that person’s disability… [and diversion] of that individual’s contribution to society? The [potential] earnings of that individual that are lost?

So you have lost income, the impact on the immediate family, and you also have expenses—healthcare expenses—of that individual for life. In the long run, it’s more expensive to society, in general, to return that player to play within two weeks. …

At the end of the day, it’s more expensive to return the player to play [quickly]… –he notes MBA study preaches long-range fiscal planning…

Because of short-term adrenaline rush, OK, almost a masochistic attitude. You want to excite people. Almost reminds of the old, ancient Roman gladiatorial sport. You want people to yell and scream! Just for the season. Just for that moment! Meanwhile, you are sacrificing the life of an individual.

And I’m a Christian. What passes through my mind is the parable of the lost ship. Where a ship, of a hundred ships—one got lost. And the other ninety-nine went after the one. One member of society is as valuable as the entire society.

Q. Yeah, because if you can’t protect one member, how are you gonna protect everyone.

Omalu: Thank you so much.  … One person, one life, is as valuable as everyone else, every person’s life.

And I think it’s high time we stop. We need a big paradigm shift in our football mentality. We should realize that we are currently intoxicated by football. We are suffering from a persistent football intoxication.

Q. Wow.

Omalu: And we need to stop. We need to inflect. … –notes football began as soccer-type game, positions staked on field, before moves to scrimmage, etc. …– notes in 1800s began as safer game… We see everybody now cloistering around a central line. It increases the incidence of impacts. And the incidence? Of wearing rigid helmets, it gives players the impetus to weaponize the helmets, to weaponize your heads. … I stopped watching football, just because of this. …

Q. –I note my disagreement about ‘behavior modification’ on the field… That is absurd!

Omalu: You cannot modify behavior when you do not modify the culture. Behavior is a consequence of the culture. The attitude. Expectations. So you can’t, you can’t count on players to modify their behavior; you need to modify the parental culture, because it’s the culture that sponsors, that induces such behavior. Am I making sense?

Q. Oh, absolutely.

Omalu: I want to tell you something, in fact… I know how I discovered Mike Webster. I wasn’t in search of any fame, or any recognition. I was just a young man who was intrigued by brain trauma. I realized we didn’t know so much about a brain. So I was just doing my bit to understand. I thought the brain was a very sexy organ, honestly. I thought the brain was beautiful. I thought the brain was more beautiful than the best-looking woman on earth.

Q. I understand…

Omalu: So because of that enthusiasm, and the excitement [within], I stumbled across something, which I recognized [CTE]… and God gave me the courage to present it to the world. It was something good. But even to my chagrin and my confusion, the NFL has never… I don’t know how many years later… has never reached out to me.

Q. Yep.

Omalu: The NFL has never reached out to me, even to respond to my letters. All they have done is to delegitimize me, to grant me a persona non gratis, somebody not worthy of recognition. Doesn’t that tell you a lot?

Q. It tells me everything. We have walked in some parallel paths; we have walked in some parallel paths, I’ll tell you that. Because they’ve done the same thing with me, and my good friend Steve Courson, who was Mike Webster’s good friend.

Omalu: … I’m a very sincere, trustworthy person, because as a Christian you need to be transparent. Even if they had offered me… Because what they could’ve done was [offer to buy him out]… Let’s get him to be a concultant to the NFL… multimillion… That would’ve been a different ballgame, because I would have taken their money and still said my stuff… –says media person suggested NFL did background and decided he was not ‘their type’… but knew he ‘wouldn’t dance to their tune’…

But I believed in what I believed in, and I knew it was a valid as the air I breathe. I wasn’t dissuaded. I’m a man of faith. We should not fear … Am I making sense?

Q. Very much so. … Cantu told me a month ago [his findings on Nathan Stiles]…

Omalu: I will stay away from that [declines comment]. I’m a team player. I’m working with the [Miami County, Kansas] medical examiner myself …

Q. When you guys are ready to release information, please alert me.

Sure, sure.

Q. [I related how Cantu defended concussion management as valid/reliable, but I noted Stiles and then he let go some info; my discussion of Cantu leads to…]

Omalu: Let me make a statement here. Policies are made in science based on the prevailing and emerging evidence. And the evolving ways of thinking.

Our understanding of brain injury has advanced in a very fast pace in the past 10 years. Current policies in football are based on what we knew 20 years ago.

Q. Right.

Omalu: That has changed. Policy-making and policy-enactments in football are not on par with the advances in science. Why? Because the advances of science are further confirming that football is a dangerous game.

Why do you think that football has not been accepted as a valid game outside the United States of America?

Basketball now is played all over the world. But no [tackle] football. And mark my words: Do a study: How many physicians’ children, how many physicians’ children play football?… –says colleague came to him, confirmed his medical-legal practice, pressed him on question: ‘Don’t you think parents’ allowing children to play football amounts to child abuse?’…  [on one level] Yes. We’ve charged parents for lesser childhood endangerment. But it’s a highly contentious [issue]; it’s like gun control. [laughs]

Remember, societal trends or changes are usually induced by the elite. Now society today, the more educated you are, the more likely you’ll become part of the societal elite, upper-middle class. Doctors generally belong to upper-middle class…

Q. I note increasing legal risk for personnel, such as trainers

Omalu: I think it’s going to change. It’s going to be gradual. I don’t think people should be [too alarmed[. But there’s no question in my mind, in another generation football be regarded as boxing is today. It’s still going to remain, but it’s going to be a less popular sport. It’s going to be further removed from mainstream America, like boxing today. It’s no longer mainstream.

Q. … Football is going to be too expensive and risky to host, for public schools.

Omalu: It’s going to be gradual. I think football has become a public health risk. Like I said, we are still intoxicated by football. In time, that intoxication is going to wear off, gradually. … It may take, in my estimation, about a generation…

–says NFL doc once told him, ‘If 10 percent of [football] parents in this country start believing that football is a dangerous game, that is the end of football, do you know that?’ I said to him, ‘Well, I don’t know that because that is not a concern of mine. My concern is to establish the scientific facts. What the social impact is, should not be my concern, because I am not a social scientist.’ He looked at me, like OK, you are confirming what people say you are, a very bright guy. I said, ‘If you say so, sir,’ and that was it. …

I’ve not made money from this. I don’t want to make money from this. I don’t plan to become a wealthy man. All I need to is to be able to take care of my two kids and my wife. Have a roof over our head, have two cars, can afford to go out once in a while to eat. I go to church, I say my prayers, I’m happy.

That’s one that has happened. Now, I’m also a forensic pathologist. I perform autopsies every day on dead people. Every autopsy I do reminds me of my own mortality. Reminds of my own mortality. I’ve done autopsies on people my age, on people that are older than I, doctors, lawyers, politicians. As every autopsy I do, it reminds me of my mortality and reminds me of the vanity of our pursuits in life. So that makes me more focused. That helps me to establish my priorities of what I want out of life. Which many other people don’t have [daily opportunity of such reminder]. … It’s a unique opportunity [for perspective] that I’ve been given by my job. …

See helmets. A helmet is a façade. … Helmets do not protect your brain. I’ve seen cases, motorbike accidents, somebody wearing a helmet. –not a scratch on the person’s head or neck… The scalp is clean, the skull is intact. You now open up the skull: The brain? The brain is completely mushed.

–30–

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