by Bennet Omalu
Before I started the paper on Terry Long, which I titled “Chronic Traumatic Encephalopathy in a National Football League Player: Part II,” I had to respond to the NFL’s criticism of the first paper. And the criticism had been harsh.
Dr. Donald Marion was the one who called and explained the situation to me. In that phone call, he spoke in a calm but affirmative way as he explained the implications of what was going on. “The NFL’s concussion committee has demanded a retraction,” he said, “and the editorial board is going to consider their arguments to see if they are valid.” My heart sank a little. “However,” he continued, “I don’t think every doctor who disagrees with a paper should request that it be retracted. That’s not good science. Periodicals like ours provide a platform for debate. Both sides may present their data, and ultimately the truth will prevail. We put your paper through a rigorous peer review process, and we felt the scientific basis of the paper was sound. That’s why we published it.”
“So what do I do now?” I asked.
“I will fax the NFL’s letter to you. You’ll have two weeks to respond. Then we go from there.”
“Thank you,” I said, more than a little relieved.
“Do you have any questions?” Dr. Marion asked.
“No, sir, I don’t,” I said.
“Good. Now listen, Bennet, I don’t want you to get down or feel rushed. All I’m asking is that you understand the seriousness of the situation and respond accordingly. Focus on the science. Don’t attack on a personal level. Review your data, and let it speak.”
When I sat down to write my response, that was what I tried to do. However, as hard as I tried, my emotions came through. I could not help myself. The letter demanding my retraction came from Drs. Pellman, Casson, and Viano, all members of the NFL’s Mild Traumatic Brain Injury Committee. While Dr. Casson is a neurologist, Dr. Pellman is a rheumatologist, and Dr. Viano is a biomechanical engineer who did crash-test studies with dummies for General Motors. None were neuropathologists, and yet they found fault with my neuropathological work. The bulk of their reasoning came down to this: I claimed Mike Webster’s problems came as a result of head trauma he suffered from playing in the NFL for seventeen years. However, they said I failed to show a medical history of trauma. In my paper, I wrote that Mike Webster had no known history of brain trauma outside of professional football. In their counterargument, they responded, “In fact, there was no known history of brain trauma inside professional football either.”1
When I read that line, I nearly fell out of my chair. I asked myself, Have they ever even watched football? Former Pittsburgh Steelers Craig Wolfley, who was a left guard next to Mike Webster while Terry Long was at right guard, described playing in the NFL to the Pittsburgh Post-Gazette. “‘I used to laugh when people would ask what’s Sunday like,’ he said. ‘I would say, well, you get about six inches from a brick wall and you ram your head into it about 75 to 100 times. Ha, ha, ha. Well, it’s not so funny years later when you realize it’s consistent trauma.’”2
What was obvious to the players on the field was apparently not obvious to these leading researchers of the great and mighty National Football League. Dr. Pellman worked on the sidelines in NFL games. How could he have missed the violent collisions taking place in every play? How is this happening in America? I wondered.
Prior to focusing on Mike’s history of brain trauma, Drs. Pellman, Casson, and Viano argued that the accepted form of traumatic encephalopathy is that found in boxers—dementia pugilistica or punch-drunk syndrome. Because Mike Webster did not demonstrate the same symptoms, he obviously did not have dementia pugilistica and therefore did not have CTE. Yet that was exactly the point I had made. Of course Mike Webster did not have dementia pugilistica, simply because he was not a boxer, and his brain did not show the changes we would expect to see in a brain with dementia pugilistica. The patterns of tau proteins, amyloid proteins, and other changes spread across Mike’s brain were consistent with a new condition—CTE—and also consistent with the pattern of impacts a football lineman encounters throughout the course of an ordinary game and a career. I wondered if these men had even read my paper, since they built one of their primary arguments on a point on which we both agreed.
After reading the letter, I became so upset that I had to sit down and calm myself. Once my heart rate was back to normal, I wrote out my response. Although I tried to keep emotions out of it, that proved impossible. Thankfully, my coauthors edited out much of the emotionalism. We came away with a reasoned response that Dr. Marion found sufficient. The response letter had some humor in it. In a way, I prodded my critics and suggested they were idiots, but I didn’t come out and say it in those terms. I basically said these guys cannot be serious. If you read the letter, you will understand what I am talking about.3
In the end, Dr. Marion rejected the NFL’s call for a retraction. In fact, he also penned a response to the NFL’s letter, which appeared in the May 2006 issue of Neurosurgery, alongside the NFL’s letter and my group’s response. I am very thankful for his thoughtful response to the critics of my paper. Just as he urged me to do, Dr. Marion focused on the science. He upheld my methods, but he did more than that. In his final paragraph, Dr. Marion chided the tone of the Pellman group’s letter. Dr. Marion wrote, “As members of the Mild Traumatic Brain Injury Committee of the NFL, and clinician-scientists that are clearly devoted to the investigation of sports-related concussion, Drs. Casson, Pellman, and Viano should welcome the contribution from Omalu et al. and consider the findings of that report highly relevant to their own research, rather than recommending retraction of the article.”4 I felt both validated and free to investigate fully the new case before me—that of Terry Long.
• • • •
In life, Mike Webster and Terry Long had been teammates. Mike was the established veteran when the Steelers drafted Terry. When Mike left as a free agent and signed with the Kansas City Chiefs for his final two seasons, his mantle passed to Terry. In death, they worked together once again. Terry took up the baton from Mike in the relay race for the truth. Just as I felt Mike’s spirit urging me on, I felt the same from Terry.
With Mike, I went public with my findings in the Neurosurgery paper. After I told Dr. Wecht that I had confirmed Terry had CTE, the second definite case, he decided to go public right away. Dr. Wecht held a news conference in which he told reporters that Terry Long had the same brain disease as Mike Webster, and that disease caused him to kill himself. News outlets all across America ran variations of the headline that appeared in the Pittsburgh Post-Gazette: “Wecht: Long Died from Brain Injury: Had Head Trauma from NFL Days.”5 More than a decade later, a headline like this has unfortunately become all too common, as CTE is found in the autopsies of former players ranging from Hall of Fame legends like Frank Gifford to those who had barely gotten started in the league, like former New York Giants safety Tyler Sash, who died at the age of twenty-five. However, in 2005, this was huge news that shook the football world, especially in the Midtown Manhattan headquarters of the National Football League.
The counterattack began the day after Dr. Wecht’s claims went public. Longtime Pittsburgh Steelers neurosurgeon Dr. Joseph Maroon called Dr. Wecht’s claims about Terry Long “preposterous and a misinterpretation of facts” and “fallacious reasoning.”6 Dr. Maroon had been with the Steelers since 1981. He was there when both Mike Webster and Terry Long played. Other NFL doctors chimed in. Some suggested that what I was doing was not science—or at least it was questionable science. They dismissed me as a dangerous human being who should not be trusted. Reading between the lines, I saw an insinuation that I was a foreigner who was attacking an American way of life. I started receiving phone calls, many of them filled with threats, either blatant or implied. More than once, I noticed cars following me as I drove. They did not try to hide the fact that they were tailing me.
The office where I worked had also been rocked by unexpected news. An investigation by the FBI led to a grand j
ury indictment of Dr. Wecht on eighty-four counts that all came down to alleging he used the county’s government resources to benefit his private consulting company.7 Dr. Wecht was forced to resign, although he had done nothing wrong. I was called as a witness against him. It was like testifying against my own father—that is how close I felt to Dr. Wecht. The case dragged on for three years before finally coming to trial in 2008. In my testimony, I tried my very best to say good things about Dr. Wecht, like a son would say of his beloved father, to let the jury know that in front of them sat a very good man who had been very good to me and made me who I am. All the charges against Dr. Wecht were later dismissed by the court, but by then, the damage was done.8 Neither of us remained in the medical examiner’s office by the time he was cleared. I had moved on to California—but I’m getting ahead of myself.
The storm of criticism leveled at me after we announced that Terry Long had CTE stirred up a fire of anger inside me. The NFL’s researchers had criticized my first paper for not including enough of Mike Webster’s medical history. I decided to apply my role as a forensic pathologist to CTE. When crimes are committed, I do more than examine the body; I go out and conduct postmortem interviews with family members and social contacts. I decided to do the same with my CTE cases.
Even though I had finished my work with regard to Mike Webster, I began with his family and friends. His son, Garrett, told me about both the good times and the bad with his father. He helped me understand the frustration the family felt in their inability to help Mike. I also spoke with his ex-wife, Pam. She said something I was hearing over and over again from the families of other players: “Bennet, if you had only come sooner before Mike died. I did not know how sick Mike was. If I had known, maybe I could have helped him more.”
One interview not only helped me understand Mike; the man I interviewed became a lifeline for me. Bob Fitzsimmons had been Mike Webster’s attorney for several years. As I spoke with Bob, I quickly realized this was a man I could trust. We developed a friendship. Bob became my attorney, adviser, mentor, and friend. He is one of the angels God placed in my life to help me survive the storm that my discovery of CTE unleashed. Bob had already fought the NFL on behalf of Mike, suing the league for disability payments for the head trauma Mike suffered while playing. More than three years before Mike Webster died, Bob had already started the campaign to prove that football had permanently altered Mike’s brain. In the process, Bob became one of the few people in the world Mike completely trusted in the last few years of his life. I soon learned why. I feel the same way.
Because of his own battle with the NFL, Bob was very sympathetic to my struggles. He also offered me hope, because he had gone up against the NFL’s toughest lawyers and won. On October 28, 1999, the NFL’s disability board admitted that football had damaged Mike’s brain. However, even then, the board refused to grant the full amount that Bob was seeking for Mike. That prompted Bob to file another suit, all of which was a precursor to the class action suit brought against the NFL by more than five thousand former players.9 Bob was not intimidated by the NFL, and he saw it for what it was. In his own fight for justice for Mike Webster, he had gone up against many of the same people who were now criticizing me, including Dr. Maroon, the Steelers team neurosurgeon. Dr. Maroon said that making the claim that football had damaged Mike’s brain was highly questionable.10 Incidentally, Dr. Maroon was one of the doctors who devised imPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the most widely used neuropsychological exam, which they assert helps determine when a player can return to play after a concussion. The test is used even though the FDA has stated that imPACT cannot be used for the diagnosis of a concussion or to determine appropriate treatments for a concussion.11 Every sports league on every level—from youth leagues to the professionals—uses imPACT. However, I am very doubtful of a test that supposedly protects the brains of players when it could not protect the brains of the players on the team where the test was first developed. To put it simply, imPACT does not play any role in preventing or improving brain damage after an athlete has suffered a concussion!
Through all of this, Bob Fitzsimmons and I bonded. We are still close friends to this day.
After interviewing Mike’s friends and family, I went to see Terry Long’s family. Family members told me how Terry changed toward the end of his playing career. He had become depressed and attempted suicide for the first time in 1991, at the beginning of his last season with the Steelers. After his playing career ended, he jumped into one risky business venture after another, taking huge risks that invariably failed. He increasingly became a very scared and paranoid man. His wife, Lynne, told me he had huge mood swings. He jumped from being kind and gentle to being hostile in a matter of moments. In time, he became more and more withdrawn, locking himself in his house for days to avoid all outside contact. Lynne said the same thing Pam Webster told me: “Why didn’t you come sooner? I didn’t know he was sick. Maybe I could have helped him.” Her words broke my heart.
I included the details of Terry’s life in the second paper. My reasons were twofold. First, I wanted to disarm the critics of the first paper who said I did not include enough of Mike Webster’s medical history. Second, I wanted to show the kind of man Terry Long was. While the paper was titled “Chronic Traumatic Encephalopathy in a National Football League Player: Part II,” this NFL player was more than a statistic; he was a man.12 Including details of his life was my way of affirming his humanity as a child of God. This was not just a football player whose life had been cut short by brain trauma suffered while playing football; this was a son and a husband, a kindhearted man who funded a scholarship at his alma mater.
I submitted the paper to Neurosurgery in January 2006. The same team came alongside me as coauthors. Dr. Abdulrezak Shakir, the pathologist who conducted Terry Long’s autopsy, also contributed to the paper. Surprisingly, in June of that year, Neurosurgery agreed to publish after the usual back-and-forth with reviewers. The paper appeared in the November 2006 issue. Two months earlier, the NFL had published Part 13 of their research into concussions. Their paper declared that new football helmets with thicker, more energy-absorbing padding were the answer to the concussion problem.13 They weren’t. This was yet another systemic and systematic ploy of the NFL to misappropriate medical science, either by fault or default, and thus mislead the public.
One month after the second paper was published, my home phone rang. Prema answered. Another former NFL player had died. The caller, Chris Nowinski, asked if I could help get consent from the family to have the brain examined for CTE. I did not know Chris well at that time, but I agreed to help him. The player, Andre Waters, had died in Tampa, Florida.
This was not the first time Chris had called my house. Over the previous few months, he had called multiple times and left messages about a book he was writing. I did not know who he was, so I was not interested in his book. Sometimes in our lives, our spirits guide us to do or not to do something for reasons we do not really know or understand. I think the Spirit was guiding me away from Chris. But after many calls and messages, Prema, who did not want to hear any more of his messages, firmly asked me to receive his call and speak to him. I did. Given the way things played out with Chris, I should not have, but that’s another story.
A few weeks later, I was on a plane to Florida. Tests revealed that Andre Waters did indeed have CTE.
At this time, I had taken possession of the residual, formalin-fixed brains of Mike Webster and Terry Long. An attempt was made by some detractors to destroy the brains. The technician who was asked to secretly destroy them called me and advised me to obtain written consents from the families. She did not think such valuable brain specimens should be destroyed. This technician proved to be another angel in my life.
I was now examining these brains on my balcony in my condo. Prema secretly took pictures of me examining these brains, for she wondered what a weird man she had married, a man who examined human brains at
home. But I had to do what I had to do, since no institution or university in the United States of America offered me any platform to continue my work.
Andre Waters became the third confirmed case of CTE, and in the world of medical science, three cases are not a coincidence. It is a precedent and a trend. I immediately planned on writing a third paper. This time, I believed that those who had dismissed my research would have to take notice. Mike Webster and Terry Long were not outliers. I believed we had just touched the tip of the iceberg.
Unfortunately, word got out about Andre in a way over which I had no control. The news that Andre Waters had CTE did not break on the pages of Neurosurgery. Nor did it become public through the Allegheny County medical examiner’s office to the Pittsburgh Post-Gazette. Instead, the story broke on the front page of the New York Times. On the morning of January 18, 2007, the newspaper ran this headline: “Expert Ties Ex-Player’s Suicide to Brain Damage.”14 Chris Nowinski gave the story to his close friend—freelance reporter Alan Schwarz. As soon as the Times ran that front-page story, football-related brain trauma and CTE went from a debate held on the pages of a medical journal to a national topic of conversation everywhere, from the halls of Congress to the family dinner table.
At the time, I thought this would be a good thing. I believed the debate would result in more research into brain trauma and contact sports and change the way in which football and other games are played. In my naiveté, I still thought this news would be welcomed by football and, even more, by America.
I was wrong.
The New York Times story unleashed a storm of attacks unlike anything I had ever experienced before. I had awakened an angry sleeping giant and the object of his wrath was me, Omalu—the little man from a faraway land who dared threaten the giant’s greatest love. I found myself pulled into a fight I could not win. I only hoped I could survive it.
