League of Denial (29 page)

That was the second thing: The big wet kiss Omalu had been expecting from the league would not be forthcoming. Instead, the NFL’s doctors took out their scalpels and long knives. Omalu had gotten a hint of how controversial his study would be during
the torturous review process, as he was asked to cleanse the paper of any suggestion that the
NFL’s MTBI committee should have confronted the issue of long-term brain damage years earlier.
An original version of the manuscript included a preamble detailing the history of the MTBI committee. It gave a summary of the retirements of Al Toon and Merril Hoge and stated that after Hoge’s premature retirement, for the first time “NFL executives and medical personnel took notice of the possible neurodegenerative sequelae of professional football.” None of that made the final draft.

The paper was published as a “Special Report” in the July 2005 issue of
Neurosurgery
. After a brief period of deceptive calm, Omalu received a call from a man who identified himself as
Donald Marion, a member of
Neurosurgery
’s editorial board. Marion told Omalu that doctors from the NFL’s MTBI committee were calling for his paper to be retracted.

“You know what that means, what that would mean to your career?” Marion said.

Omalu knew. He sat down and wept. He knew that in the world of scientific research, a demand for a retraction was the nuclear option. It generally was reserved for allegations of fraud, plagiarism, or cheating.

“But I haven’t done anything wrong,” Omalu pleaded.

Marion said that he had been asked by Apuzzo to mediate the dispute. He told Omalu that he would receive a copy of the NFL’s demand and that he should confer with his coauthors to put together a response. That evening, Omalu e-mailed DeKosky and Hamilton, summarizing the conversation.

Omalu indicated that he had the impression Marion believed the demand was without merit and might have been directed by the league office. “Interestingly he thinks their paper is laughable and politically motivated,”
Omalu wrote to his colleagues. “He has asked me, however, to write up a very simple scientific explanation without becoming political. He said they all know that it was the NFL that may have instructed Dr. Pellman and his group to pen the commentary.”

Despite Marion’s reassurances, Omalu was terrified. As he prepared to read
the NFL’s letter at his Pittsburgh apartment, he poured himself
a shot of Johnnie Walker Red and gulped it down. The letter was signed by the three leading members of the MTBI committee: Elliot Pellman, Ira Casson, and Dave Viano.

“We disagree with the assertion that Omalu et al.’s recent article
actually reports a case of chronic traumatic encephalopathy in a National Football League (NFL) player,” the letter began. “We base our opinion on two serious flaws in Omalu et al.’s article, namely a serious misinterpretation of their neuropathological findings in relation to the tetrad characteristics of chronic traumatic encephalopathy and a failure to provide an adequate clinical history.

“These statements are based on a complete misunderstanding of the relevant medical literature on chronic traumatic encephalopathy of boxers (dementia pugilistica). A review of the relevant medical literature, including that cited by Omalu et al., in the chronological order in which it was published demonstrates the flaws in Omalu et al.’s assertions.”

As Omalu read on, he began to relax. “By the time I got to the third paragraph I smiled,” he recalled. “I even laughed. I knew that Pellman, Casson, and Viano did not know the subject and that their letter was embarrassing and shameful. I said to myself, ‘Isn’t it un-American?’ I respect this country, I’m a foreigner, but I came here to chase my dreams, that the three doctors who are the heads of the NFL Brain Injury Committee don’t even know the basic science of brain damage. I became angry.”

The letter was six pages long, longer even than the original paper, much of it a scientific overview of the history of CTE in boxers. Pellman, Casson, and Viano used phrases such as “complete misunderstanding,” “completely wrong,” and “completely lacking.” They made two primary arguments: that Omalu et al. had a case that didn’t meet the criteria for CTE and that there wasn’t enough clinical evidence showing Webster was mentally impaired. They insisted Omalu’s findings met only one of the four standards necessary to call this CTE even though Omalu and his colleagues had never claimed this was identical to what was found in boxers. The NFL doctors suggested that the clinical history on Webster was essentially useless because it had been limited to a few phone calls with family members. They pointed out that Webster had no history of concussions or any indications that he had ever left a game because of a blow to the head.

“Omalu et al. go on to state that ‘there was no known history of brain trauma outside professional football.’ In fact, there was no known history of brain trauma
inside
professional football,” they wrote, suggesting
that during his 17-year career in the NFL there was no evidence that Webster’s brain was so much as jostled.

Casson, Pellman, and Viano suggested alternative theories for what might have happened to Webster’s brain, theories that the league would continue to cite for years: alcohol, steroids, possible drug abuse. Ironically, the theories were reminiscent of those proposed by defenders of boxing after Martland, like Omalu a medical examiner, described Punch-Drunk Syndrome in boxers in 1928.

“We have demonstrated that Omalu et al.’s case does not meet the clinical or neuropathological criteria of chronic traumatic encephalopathy,” they wrote. “We, therefore, urge the authors to retract their paper or sufficiently revise it and its title after more detailed investigation of this case.”

It was signed:

The doctors didn’t identify their connection to the NFL, as if they were merely independent physicians who had banded together in their outrage.

Omalu wondered about their backgrounds.
He did some quick research and had to laugh: Pellman, the committee chairman and now one of Omalu’s main critics, was a rheumatologist. The head of the NFL’s brain committee was an arthritis expert?

When he finished,
Omalu e-mailed Hamilton and DeKosky. “To say the least, it is a laughable commentary,” he wrote.

Hamilton wasn’t at all amused. “I read over their critique and I do not think it is laughable.… It is very serious indeed,” he responded. Hamilton was more confident than ever about the validity of their research; the criticism was baseless, he felt. What concerned him was the NFL’s attempt to erase their work from the record. He thought it was the work of a self-interested corporation trying to censor his independent research. “I like to think of them as being honorable scientists who are
simply stating an alternative hypothesis, but the fact that they wanted me to trash the paper and say that it was bad science, that cued me in to that they were kind of, oh, setting up walls,” he said. “Trying to set up a barrier. To shut it off. To try to make sure that everybody knew that these Hamilton and DeKosky, Wecht, Omalu characters were just insane.”

Over the next couple of weeks,
the men exchanged e-mails discussing the main points of their defense: Webster’s brain had widespread neurofibrillary tangles in several areas that “for a 50-year-old, are very very ‘unnatural’ ”; that although Webster suffered other ailments, none was consistent with the presence of these tangles; that the boxing papers the NFL cited—in particular Corsellis’s seminal research—also lacked detailed clinical histories; that the pattern of the tangles—throughout the cortex but nowhere in the hippocampus—is significant in that it signaled neurodegenerative disease inconsistent with Alzheimer’s or other known disorders.

Hamilton wrote in one e-mail to his colleagues: “Without any clinical history, most neuropathologists familiar with dementing disorders would ask: did this patient engage in boxing? So when told that he played football, I think most would say, ‘Yeah, OK.’ ”

Of course, there were no neuropathologists on the NFL committee.

Omalu, Hamilton, and DeKosky also
dug further into the history of Webster’s life after football. The NFL had blistered them for the limited clinical information documenting his mental illness, describing it as “completely lacking.” Omalu and his colleagues discovered that just a few months earlier a federal judge had awarded Webster’s family $1.8 million in a lawsuit against the NFL’s disability board, which had compiled testimony from five doctors who concluded that Webster had brain damage.

“Their comments about us not having the detailed clinical history is stunning in its hypocrisy,” DeKosky wrote in an e-mail to Hamilton.

As the group prepared its response to the NFL, Omalu knew he had another secret weapon that he thought would blow the NFL’s protestations out of the water:
He had discovered another case of CTE in a dead football player.

On June 7, 2005,
Terry Long killed himself by drinking antifreeze. Long had played eight seasons in the NFL for the Pittsburgh Steelers, lining up alongside Mike Webster for five of those seasons in the mid-1980s. In some ways,
Long was like Webster: an undersized hulk who bulked up through weight training and steroids. Long was 5-feet-11, at least 280 pounds, “half-crazy,” as one former Steelers employee described him. At the same time, Long had a bighearted personality that drew him close with the Rooney family and his coach, Chuck Noll, whom Long viewed as a father figure.

After graduating from high school, Long enlisted in the military and served two years with the Special Forces Unit of the Army’s 82nd Airborne Division. He played football at Fort Bragg—“I hated the military but loved playing football,” he later said—and earned a scholarship to play at East Carolina. There he was designated “Strongest College Football Player in the Nation” after squatting, bench-pressing, and dead lifting a combined 2,203 pounds at the North Carolina State AAU Powerlifting Championships. He had a 40-inch waist, a 54-inch chest, 21-inch arms, a 20-inch neck, and 30-inch thighs. He ran the 40-yard dash in 4.8 seconds.

Long was an All-American at East Carolina and was selected by the Steelers in the fourth round of the 1984 draft. He played in 105 NFL regular-season games and 4 playoff games. In his final season, 1991, he
tested positive for steroids at the beginning of training camp. When Noll told him, Long wept. The next day, he tried to commit suicide, first by sitting in a running car inside a closed garage and then, when that attempt was foiled by his girlfriend, by eating rat poison.

Like Webster’s, Long’s life after football was a
dramatic downward spiral marked by bouts of depression and mood swings as well as a series of bad business decisions that led to financial problems. In 2003, a chicken- and vegetable-processing plant he owned was destroyed by fire. Two years later, on March 29, 2005, he was charged with setting the fire to collect $1.1 million in insurance, and he filed for bankruptcy that same day. Long also was accused of defrauding the state of $1.2 million in a separate business scheme. Soon afterward, he again tried unsuccessfully to kill himself, this time by drinking a bottle of Drano.

A little over two months later, Long’s body lay in the Allegheny
County coroner’s office—another dead Pittsburgh Steelers offensive lineman who had essentially lost his mind.

In the years to come, Pittsburgh brain researchers would sit back in wonder at the string of events that turned their city into “
Ground Zero” for the NFL’s concussion crisis, as the
Post-Gazette
’s Chuck Finder put it. First, Noll’s offhand remarks to Maroon in 1991 about the lack of quantifiable evidence for a concussion, which led to the development of ImPACT and one of the most successful concussion research institutions in the country at UPMC. Then Webster, his condition diagnosed by the young Nigerian pathologist who happened to be working that day. This time, Omalu wasn’t on call.
The autopsy was performed by Abdulrezak Shakir, Omalu’s Iraqi colleague, who had worked in the coroner’s office for 17 years. It is not common practice to save the brain during a forensic autopsy; after being weighed and examined, the vital organs usually are sewn into the body cavity. But Shakir, thinking about Omalu’s research, preserved Long’s brain for his colleague.

Omalu repeated the process he had followed with Webster. When the tests came back, he had “Chronic Traumatic Encephalopathy in a National Football League Player: Part II.”
Omalu sent the slides to Hamilton, who responded with an e-mail: “I have looked over your new NFL case. Fantastic! It is classic ‘dementia pugilistica,’ at least according to the entire chapter in Esiri and Morris (I will copy for you).”

This time, Wecht, the celebrity pathologist, wasn’t interested in waiting for a medical journal to publish the findings.
He went straight to the media with the news: Terry Long had sustained brain damage from playing football.

Shakir’s autopsy report left no room for doubt: Long’s brain damage had been caused by “repeated mild traumatic injury while playing football.” The brain, Wecht said, showed signs of meningitis—inflammation—that stemmed in part from all the blows Long had taken playing football.