Truth Doesn't Have a Side

by Bennet Omalu

  Are brain scans/MRIs effective in diagnosing CTE?

  There is currently no brain scan that has been approved by the Food and Drug Administration for the definitive diagnosis of CTE. Experimentally, using various modalities of brain scans, there are changes that we are observing in brains of patients with permanent brain damage, CTE, and PTE.

  What is the treatment for CTE (assuming that a determination/diagnosis can be made pre-death)?

  The treatment of CTE when it is presumptively diagnosed in a living person involves symptomatic relief and long-term management. As of today, there is no cure for CTE.

  Are you suggesting that the only way to prevent CTE is less-contact or noncontact sports?

  Yes. As a physician and epidemiologist who has been involved in the investigation of more than twelve thousand deaths, I am convinced that there is a God, and as human beings, we cannot be God. We cannot create life, and we can never have all the answers for all the questions that exist in our lives. As of today, medicine as a science does not have the cure for many diseases, not even a cure for diseases as common as strokes. The brain does not have any reasonable ability or capacity to regenerate itself. A brain cell does not divide to create a new brain cell and regenerate the brain. This is where we are today. Death of brain tissue from all types of injuries is permanent. Based on where we are as human beings in our faith journey and in our science, the only way to prevent CTE is to avoid blows to the head in every human activity. This is why volitional exposure of a child to the risk of any type of brain injury is not the wise thing to do in the twenty-first century for our children.

  Is shaken baby syndrome basically CTE? Does it present the same issues?

  In the world of forensic pathology, shaken baby syndrome is now known as non-accidental trauma (NAT) in a child. In non-accidental trauma, the child can suffer severe abusive head injuries. All types of severe head injuries can cause permanent and irreversible brain damage, which can manifest as CTE or PTE later in life.

  What are the symptoms of CTE?

  CTE can manifest with a broad variety of symptoms, which can be divided into cognitive, behavioral, and mood disorders. Symptoms may begin immediately and persist permanently. Symptoms may abate significantly, but residual symptoms may persist permanently. Symptoms may improve over time. Symptoms may not manifest over a long, delayed period, sometimes up to forty years, but begin to manifest in a subtle but progressive manner. Symptoms may go unnoticed, but when a physician tests the child or adult, symptoms will be elicited. The cognitive symptoms may include, but are not limited to, loss of memory or memory impairment; diminishing intelligence or loss of intelligence; impaired ability to study and learn or to assimilate new knowledge and information; inability to engage in complex, derivative, or extrapolative reasoning and thinking; inability to engage in executive functioning; and impaired language capacity and functioning. The behavioral symptoms may include, but are not limited to, impaired ability to focus on tasks and remain attentive for long periods; increasing tendency to engage in criminal and violent behavior; increasing impulsivity; increasing irrational risk-taking behavior, paranoid behavior, sexual improprieties, and aggression; disinhibition and loss of learned behavior and social decencies; chronic alcoholism; chronic drug abuse; inability to obtain, sustain, and maintain jobs; impaired financial functioning and bankruptcies; and impaired ability to maintain and sustain intimate relationships. The mood disorders may include, but are not limited to, major depression; rampant fluctuations in mood from highs to lows, and lows to highs; exaggerated reactions to daily life stressors; impaired ability to control emotions and drives; and suicidal behavior, suicidal ideations, suicidal attempts, and completed suicides. Other physical symptoms may include insomnia; inability to fall asleep and stay asleep; headaches and migraines; impairment of motor functioning; and movement disorders that may resemble amyotrophic lateral sclerosis (ALS) or Parkinson’s disease. Not every patient will manifest with all these symptoms, and not every patient will manifest the same way. Symptoms may range from negligible, mild, moderate, severe, and marked to debilitating.

  Are seizures a sign of brain damage?

  All types of brain injury can cause permanent physical damage to the brain, which can manifest as PTE or CTE. One of the most prevalent types of PTE is Post-Traumatic Epilepsy. Therefore, seizures can follow all types of brain injury. I have personally encountered several football players who suffer from Post-Traumatic Epilepsy.

  If I have played football but stopped and have never suffered a concussion, am I still at risk for contracting CTE?

  Yes, you are still at risk of suffering CTE later in life. The cause of CTE is not concussions but blows to the head. Each and every blow to your head you receive while playing football—with or without a helmet, with or without a concussion—increases your risk of suffering permanent brain damage, which can manifest as CTE later in your life. Concussions do not cause brain damage; blows to the head do. Concussion is a disease by itself, which is an outcome or product of a blow to the head and belongs to the spectrum of diseases caused by blows to the head, which we now call the Traumatic Encephalopathy Syndromes. The spectrum of diseases following brain trauma and brain damage is not limited to just CTE and PTE. CTE and PTE also belong to the Traumatic Encephalopathy Syndromes.

  Are the injuries/CTE from getting hit or doing the hitting the same?

  The two are the same. No matter whether you are getting hit or doing the hitting, your helmeted head is sustaining blunt force trauma, and your brain is sustaining repeated subconcussive and concussive injuries. However, the person who is hit and is not aware he or she is being hit may be more likely to suffer angular-rotational-acceleration-deceleration injuries of the brain, which may be more dangerous.

  Are you happy with the changes you are seeing in the NFL and in other sports?

  No, I am not satisfied with the changes I am seeing in the NFL and in other sports. It remains disheartening to me that executives and physicians of these sports organizations still deny that football, ice hockey, wrestling, mixed martial arts, and other high-impact, high-contact sports can cause permanent brain damage. The changes that have been made do not address the fundamental issue of exposure of the human head and brain to repeated blows. The focus has been on concussions, which is a misappropriation of the science. Concussions do not cause brain damage; blows to the head do. Concussion is a disease by itself, which is an outcome or product of a blow to the head and belongs to the spectrum of diseases caused by blows to the head. Once a concussion has occurred, the injury is permanent; it cannot be cured. The symptoms may abate, but the brain remembers the concussion in a cumulative manner over time. Therefore, there are no changes made by the NFL or other leagues that will adequately address the risk of brain injury in football, ice hockey, boxing, wrestling, mixed martial arts, rugby, and other high-impact, high-contact sports like BMX biking. Boxing can never be made safe. Football as we play it today can never be made safe. Skydiving can never be made safe. This is why my position has always been that for adults, we can play these games as much as we want without any reservation whatsoever. I will be one of the first to stand up to defend the right of an adult to exercise his or her individual rights, free will, freedom, and liberty to play any game he or she wants to play—but not for our children. It is our moral duty as a society to protect our children from all types of harm and to help every child reach his or her God-given intellectual and cognitive capacities. Brain injuries suffered while playing football, ice hockey, and other high-impact, high-contact sports steal away the gift of life from our children. Given my position, only children eighteen years old and older should play football as we play it today. This means we can still enjoy college football and NFL football as we play and enjoy them today!

  What is the one thing you would like parents to know about their children and CTE?

  Every parent who loves and cherishes their children and recognizes that the gift of life is the greatest gift of al
l must not allow any child to play high-impact, high-contact sports like boxing, football, ice hockey, mixed martial arts, wrestling, and rugby. Caution should be exercised when your child plays the less-contact, less-impact sports such as soccer and lacrosse, which must be modified for our children as well. When you allow your child to engage in these contact sports, you are exposing him or her to the risk of permanent brain damage, which can manifest as CTE. CTE steals away that gift of life from your child and can permanently ruin your child’s life when he or she becomes a teenager or a young adult. Our children should play only less-impact and less-contact sports or noncontact sports until they turn eighteen and become adults, at which point they can do whatever they want to do, including joining the military and playing high-impact, high-contact sports. The fundamental issue is not concussions but repeated blows to the head—with or without concussions, with or without helmets. We must mitigate the exposure of our children’s brains to all types of blows to the head in all types of sports and in all types of human activities. We must be cautious when our children play the less-impact and less-contact sports. I believe noncontact sports are safest for our children.

  What age is appropriate for playing tackle football?

  There is no age that is appropriate for playing tackle football, just like there is no age that is appropriate for smoking. However, adults have the right, free will, freedom, and liberty to do whatever they want to do—as long as it does not cause injury to or undermine the safety of another person. But when it comes to children, we need to protect them from all things that have the potential to cause harm to them, and tackle football is one of them, just like smoking and child abuse and neglect are.

  Is hockey safer than football for high schoolers?

  Ice hockey is a high-impact, high-contact sports and is as dangerous as football. Other dangerous high-impact, high-contact sports that can damage the brain are football, rugby, boxing, wrestling, and mixed martial arts.

  Acknowledgments

  To my collaborator, Mark Tabb, and my literary agent, Steve Ross—thank you so much for believing in me, inspiring me to step forward, and supporting me to write this book. I am deeply grateful. I give you credit for this book, for without you two, there would not have been this book. May God continue to bless you most abundantly.

  To all the angels in my life, through whom I received God’s blessings:

  •my father, John Omalu; my mother, Caroline Omalu; my brothers and sisters, Onyi, Winny, Uche, Ikem, Chizoba, and Mie-Mie. You are my essence.

  •my in-laws, Sam, Chuma, Ibe, Chineme, Loretta, Nneka, Mummy, Susan, John, and Tom. You have enriched our lives immeasurably

  •my uncle, Remy

  •my teachers, who were the wind beneath my wings—Dr. Carlos Navarro, Dr. Cyril Wecht, Dr. Ronald Hamilton, Dr. Abdulrezak Shakir, and Dr. Clayton Wiley

  •Jeanne Marie Laskas, who was the angel to first tell the world about me and who did me justice

  •my agents, Don Epstein, Elyse Cheney, and Matthew Snyder, who guided me and kept me out of trouble

  •Andy Ward, you are a true leader

  •my Hollywood family—Peter Landesman, Will Smith, Jada Smith, Gugu Mbatha-Raw, David Wolthoff, Larry Shuman, Ridley Scott, Giannina Scott, Amal Bagger, Albert Brooks, David Morse, Mike O’Malley, Hill Harper, Adewale Akinnuoye-Agbaje, and every cast and crew member of the movie Concussion. You have made me who I am, and I remain deeply grateful and indebted to you. May God bless you most abundantly and grant you your hearts’ desires.

  Peter and Will, you did such a phenomenal job. You said you would do me justice—and yes, you really did! Words cannot express what gratitude I have inside me for what you have done for me. You lifted me up when I was down and out in the cold, and you invited me in to the warmth of your hearts. I now take you two as my brothers. My family is deeply grateful to you for honoring my father and placing his picture in the movie.

  David Wolthoff, I am simply dumbfounded when it comes to you. You believed in my story when no one else would. You kept the faith in me and continued pushing on. Simply put, there would have been no movie without you. I am profoundly grateful, David. Together we shall continue doing great things.

  To my Sony Pictures family—Tom Rothman, Amy Pascal, Doug Belgrad, Elizabeth Cantillon, Jennifer Mcgrath, Elena Russell-Nava, and every Sony employee who worked on Concussion, especially during the promotion. I had fun, and you took very good care of me. Without you, my story would not have been told. You extended a hand of friendship to me, pulled me up, and helped mold me into what I am today. I remain deeply grateful to you.

  To Father Carmen D’Amico and my St. Benedict the Moor parish family in Pittsburgh, you guided me to the light of Christ and empowered my faith. I am deeply grateful. Without you, I may not have discovered the preeminence of God in all things visible and invisible.

  To my Greater Talent Network family—David, Jennifer, Kristine, Jillian, and every staff member I have worked with—you lifted me up and made me shine. I am deeply grateful. To my San Joaquin County family, the board of supervisors; every county coworker who serves our county, especially at the district attorney’s office, the sheriff’s office, and the San Joaquin General Hospital, I count myself deeply lucky and honored to serve with you. I am deeply thankful for all your support. Together may we continue to bring good light upon our county. Tori, Steve, Deepak, Sue, Annette, Barbara, Lek, Micky, Toby, Mike, Dan, Jose, Frankie, Ted, Etta, Kathryn, and Alex—on a daily basis, you are the struts that keep me standing. I am deeply thankful.

  To my University of California, Davis family, Dr. Lydia Howell and Dr. Ralph Green—you gave me an academic home and supported me when everyone else looked away. I am deeply grateful.

  To my friends, Bob Fitzsimmons, Jimmy Adegoke, Obinna Okoye, Jennifer Hammers, and Julian Bailes, thank you so much for the support you have given me. Your friendship has been a source of tremendous grace and peace to me. May God bless you most abundantly.

  To Mike Webster, Terry Long, Andre Waters, Justin Strzelczyk, Chris Benoit, Fred McNeill, and every other athlete and military veteran I met in death in the search of the truth and light of our faith and science, I honor you and thank you for teaching us so much with your lives. Together we shall prevent yet another child, man, or woman from suffering what you suffered. Thank you so much for the enlightenment you offered us in your death and for glorifying the truth.

  To everyone else—especially every person I should have mentioned but could not mention because of the limitation of space in this book—whose paths have crossed with mine, I want you to know that all I feel in my heart is love, the love of us all as one family of mankind. May we all continue to enjoy that peace of our oneness. I wish you every happiness and joy.

  Notes

  Chapter 2: Child of War

  1.Mathew 5:14–16.

  Chapter 5: “Heaven Is Here, and America Is Here”

  1.Isaiah 43:18–21.

  Chapter 7: Through the Wilderness

  1.Hebrews 11:1.

  Chapter 11: A Divine Appointment

  1.As of this writing I’ve performed more than eight thousand autopsies and participated in the investigation of more than ten thousand death cases.

  Chapter 13: A Game-Changing Diagnosis

  1.Cited in Mark Fainaru-Wada and Steve Fainaru, League of Denial: The NFL, Concussions, and the Battle for Truth (New York: Random House, 2014), 138.

  2.Ibid., 57.

  Chapter 14: Nearly Over before It Begins

  1.Mathew 18:20.

  2.John 11:22.

  3.John 14:13–14.

  4.John 15:7.

  5.John 15:16.

  6.John 16:23.

  Chapter 15: The NFL = Big Tobacco

  1.From the 1993 case Daubert v. Merrell Dow Pharmaceuticals.

  2.See Mark J. Denger and Norman S. Marshall, “Californians and the Military: Admiral Joseph Mason ‘Bull’ Reeves, USN,” www.militarymuseum.org/Reeves.html (accessed February 1, 2017).


  3.“Competitive athletics: a statement of policy: report of the Committee on School Health, American Academy of Pediatrics,” Pennsylvania Medical Journal 60.5 (May 1957): 627–29.

  4.Laura Purcell, MD, and Claire M. A. LaBlanc, MD, “Policy Statement—Boxing Participation by Children and Adolescents,” American Academy of Pediatrics, Council on Sports Medicine and Fitness, Canadian Paediatric Society, Healthy Active Living and Sports Medicine Committee, Pediatrics 128.3 (September 2011): 617–23.

  5.Elliot J. Pellman et al., “Concussion in Professional Football: Repeat Injuries—Part 4,” Neurosurgery 55.4 (October 2004): 870, www.researchgate.net/publication/8256145_Concussion_in_Professional_Football_Repeat_Injuries-Part_4 (accessed February 1, 2017).

  6.Ibid.

  7.Ibid.

  8.See Elliot Pellman et al., “Concussion in Professional Football: Players Returning to the Same Game—Part 7,” Neurosurgery 56.1 (January 2005): 79–92, www.researchgate.net/publication/8112277_Concussion_in_professional_football _Players_returning_to_the_same_game_-_Part_7 (accessed February 1, 2017).

  9.Anders Hamberger et al., “Concussion in Professional Football: Morphology of Brain Injuries in the NFL Concussion Model—Part 16,” Neurosurgery 64.6 (June 2009): 1174, https://www.researchgate.net/publication/26258655_Concussion _in_professional_football_Morphology_of_brain_injuries_in_the_NFL _concussion_model_-_Part_16 (accessed February 1, 2017).