Dr Bennet Omalu Case Summary

INTRODUCTION

Moral courage is standing up for something one believes in, even when there are forces who oppose your opinion. In the case of Dr. Bennet Omalu and the discovery of chronic traumatic encephalopathy (CTE) in football players, the National Football League (NFL) did not want this information presented as it would pose a significant threat to the NFL’s continued success. Dr. Omalu stood by his research conclusions as the NFL worked to discredit him and his medical research.

The Beginning

Dr. Bennet Omalu was born in September, 1968 in Nnowka, Nigeria in the midst of the Nigerian Civil War. The war caused him and his family to flee and not return to their village, Enugwu-Ukwu, Nigeria for two years. Dr. Omalu’s father was a

civil engineer and his mother was a seamstress. (Bennet Omalu Foundation, n.d.) While growing up in Nigeria, Dr. Omalu’s only exposure to football was seeing it on Sky News. Omalu said “I thought there were people dressed like extraterrestrials…And I wondered…why did they have to dress that way.” (Taddonio)

Dr. Omalu entered the University of Nigeria Medical School at the age of 16 and graduated in 1990. He then completed a clinical internship, which he followed up by working for three years providing doctor’s services in a rural mountain village. (Bennet Omalu Foundation, n.d.) After his time providing services in the village, Dr. Omalu came to the United States to continue his education. His education included being a visiting epidemiology research scholar at the University of Washington, Seattle, School of Public Health, pathology residency at the Harlem Hospital Center, New York City, and fellowship training in Forensic Pathology and Neuropathology at the University of Pittsburg Medical Center. Dr. Omalu also obtained his Masters in Public Health: Epidemiology from the University of Pittsburgh and his Masters in Business Administration from Carnegie Mellon University. (Omalu, 2016)

The ‘Sentinel’ Case

Dr. Omalu began working for the Allegheny County (Pennsylvania) Coroner’s office in 2000 as an associate forensic pathologist. In September, 2002, Dr. Omalu was assigned to conduct the autopsy of retired Pittsburgh Steelers football player Mike Webster. “Iron Mike”, as he was known, had died at 50 from an apparent heart attack. (FrontLine, n.d.) Dr. Omalu had heard Webster had suffered from severe dementia, including delusions, paranoia, explosive behavior, and loss of memory since his retirement 12 years earlier. (Omalu, et al., 2005) But Webster’s brain surprised Dr. Omalu. He expected to see mush or contusions, which are typically found with dementia pugilistica (also known as punch-drunk syndrome in boxers), but Webster’s brain looked very normal. There was also no shrinkage, which is usually seen in Alzheimer’s patients.

Because of these reasons, Dr. Omalu asked and received his supervisor’s and Webster’s personal representative’s permission to conduct further tests of Webster’s brain, including a microscopic analysis of the brain tissue. (Laskas, 2009) Dr. Omalu began slicing Webster’s brain, staining the samples and ordering slides from the laboratory. After a time, Dr. Omalu had to start paying for the specialized slides himself because of the volume of his slide orders. After a few months of research, Dr. Omalu found on a new set of slides “brown and red splotches. All over the place. Large accumulations of tau proteins. Tau was kind of like sludge, clogging up the works, killing cells in regions responsible for mood, emotions and ecutive functioning.” (Laskas, 2009).

Dr. Omalu speculated that the protein buildup may be caused from postconcussion syndrome. Postconcussion syndrome is also known as mild traumatic brain injury, and is the result of repeated concussions of the brain. [CITE] Dr. Omalu consulted with his boss and scientists at the University of Pittsburgh, where they agreed this was a disease or a variant to the disease found in boxers and had not been seen before. After deliberation, Dr. Omalu developed the name CTE for this disease or variant thereof, which would pose symptoms similar to Alzheimer’s disease and dementia. By then, Dr. Omalu had spent close to $100,000 of his own money to further this research.

Dr. Omalu, along with several colleagues published a research report in the Neurosurgery Journal entitled “Chronic Traumatic Encephalopathy in a National Football Player” in July 2005. Dr. Omalu determined that “repetitive impact to the head, like the players take in football, causes microscopic injuries to the brain. Hundreds of these blows over time cause permanent brain damage.” (NPR, 2015) Part of the article stated “the autopsy revealed ‘neuropathological changes consistent with long-term repetitive concussive brain injury” and that this case was a “sentinel case that draws attention to a possibly more prevalent yet unrecognized disease.” (Engber & Fatsis, 2013)

When the research was published, Dr. Omalu thought the NFL would be pleased with the results and “…the league would adapt his findings into ‘some type of utility function’ to enhance the game and make it both safer and more profitable.” (Taddonio, 2015) Dr. Omalu also sent a letter to the NFL proposing “a prospective study to examine the brain of every retired NFL player who died. This is the best way to confirm we are not speculating.” The NFL did not acknowledge the letter. (Gregory, 2015)

The Webster Case Response

The NFL did not take kindly to the CTE research presented by Dr. Omalu and his colleagues. The NFL’s Committee on Mild Traumatic Brain Injury (MTBI) prepared and submitted to Neurosurgery a written response to the report that attempted to “delegitimize and marginalize Omalu and his research results”. (UCDavis Medicine, 2015) The MTBI’s letter stated many things regarding the presented research. Arguments put forth included the research having flaws and inconsistencies in its assertions including Dr. Omalu misinterpreting his own neuropathological findings, as well as a lack of history of the subject. The MTBI felt the paper contained circular reasoning and the research did not meet the accepted criteria for CTE.

The MTBI requested Dr.

Omalu issue a retraction of the paper and alluded to the research being a misunderstanding of the medical literature of CTE of boxers (dementia pugilistica). Dr. Omalu and his colleagues drafted a response to the MTBI’s criticisms that stated they would be happy to collaborate with the NFL and the MTBI to develop an optimal research program regarding CTE. Others who also commented on the initial article for the most part backed Dr. Omalu et al in their position that this was the initial case and as stated more research was needed to solidify these findings. Dr. Omalu expressed his great frustration with the MTBI’s response in a later interview, especially regarding the issue that his research did not mention or allude to punch drunk syndrome.

Subsequent CTE Research

Justin Strzelczyk

Justin Strzelczyk was an offensive lineman for the Pittsburgh Steelers who died in a fiery car crash at the age of 36 in 2004. Shortly before Strzelczyk’s death, he began complaining about depression and hearing voices he called ‘the evil ones’. “He was experiencing an apparent breakdown…when, during a 40-mile high-speed chase police chase…his pickup truck collided with a tractor-trailer and exploded, killing him instantly.”

Dr. Omalu and a colleague received permission to examine Strezelczyk’s brain for signs of CTE. The examination showed red spots on his brain, or early signs of brain damage which was likely caused by persistent head trauma Strzelczyk sustained while playing football. Other doctors confirmed Dr. Omalu’s findings in this case.

Terry

Long

Retired NFL player Terry Long committed suicide at the age of 45 in June, 2005 by drinking antifreeze. Long had become destitute and was suffering from memory loss and dementia. Long had also been in and out of psychiatric wards for multiple suicide attempts. Dr. Omalu’s examination of Long’s brain showed a large buildup of tau proteins and that the proteins made Long’s brain look like a 90-year old person’s brain with advanced Alzheimer’s disease.