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Dr. Bennet Omalu

A forensic pathologist, Omalu conducted the autopsy of Pittsburgh Steelers center Mike Webster, which led to his discovery of a new disease that he named chronic traumatic encephalopathy, or CTE. He is currently the chief medical examiner of San Joaquin County, Calif. and a professor in the UC Davis Department of Medical Pathology and Laboratory Medicine. He spoke to FRONTLINE’s Michael Kirk on March 25, 2013.

A forensic pathologist, Omalu conducted the autopsy of Pittsburgh Steelers center Mike Webster, which led to his discovery of a new disease that he named chronic traumatic encephalopathy, or CTE. He is currently the chief medical examiner of San Joaquin County, Calif. and a professor in the UC Davis Department of Medical Pathology and Laboratory Medicine. He spoke to FRONTLINE’s Michael Kirk on March 25, 2013.

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    Mike Webster's Legacy

    So you walk into this autopsy room or whatever you call it, and there on the table is a big, heavy man, Mike Webster. Tell me the story of you walking in that room, what you see, what you do. ...

    ... So I was on call that Saturday morning. I woke up, fixed myself a cup of coffee. I was single. I was living in a condo. So I turned on the news to see what was going on, who was killing someone somewhere someplace.

    Because you knew that would appear on your table at some moment.

    Every day. (Laughs.)

    You mean you watched the news and see who dies.

    To see who dies and what my caseload will be. But ironically, all the channels were talking about this very prominent guy. I did not even know his name, Mike Webster.

    See, I grew up in Africa, in Nigeria. I never knew, I never had any reasonable encounter with football. I saw football on Sky News. I thought there were people dressed like extraterrestrials, you know, like they were going to Mars or something, headgears and shoulder pads. And I wondered why as a child why did they have to dress that way.

    So they were talking about this prominent guy who sold his Super Bowl rings, who did not compete well in the field of life after his retirement from football, who led somewhat an ignominious life from prominence to obscurity.

    Suddenly I wondered -- I'm like, "Wait a minute." If he played football for them to wear helmets and all those protective gear, that meant it was a violent game. That meant they were exposed to repeated trauma to justify the need to wear a helmet. And then I said to myself, if he had such a bizarre life after football, could this not be similar to what we see in boxers, dementia pugilistica? ...

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    Did you have any idea that he was on the table waiting for you?

    No, no, no --

    In fact, you figured --

    -- because he died in a hospital. He had a heart attack. So I dismissed it.

    And what difference would that make? What difference would it make that he died in a hospital?

    Well, remember, I work for a medical examiner. By law I would perform autopsies on cases that fell under the jurisdiction. If you have a known cause of death and if you were under the care of a physician, it may not fall under the jurisdiction of the coroner if there is a physician willing to sign the death certificate. ...

    So I got to work. There were the TV caravans. There was commotion at the office. So I came in, I parked, and I walked through people, and I got into the office, and I asked, "What is going on?" One of the technicians said, "Oh, Mike Webster was on the table." So I said, "Who is Mike Webster?" And everybody looked at me like: "Where is he from? Is he from outer -- who is this guy who doesn't know Mike Webster in Pittsburgh?"

    So I pulled the guy to the corner. I said, "No, who is he?" I didn't know. He teased me and said: "Oh, are you nuts? What do you mean you don't know Mike Webster?" So I said: "Wait a minute. Is he the guy they are talking about on TV?" He said, "Yes, yes, he is the guy."...

    I went back to my office to find out, to review his case file, why he was brought into the office. It turned out that a treating physician had listed post-concussion syndrome on his death certificate as a contributory factor to his death. Post-concussion syndrome is a traumatic disease, and if a traumatic disease qualifies as a contributory factor to death, that would categorize the case as an accidental manner of death, therefore falling into the jurisdiction of the coroner, of the medical examiner. ...

    There is a practice I have. I am a spiritual person. I'm a Catholic. I treat my patients, the dead patients, as live patients. I believe there is life after death. And I talk to my patients. I talk to them, not loudly but quietly in my heart when I look at them. Before I do an autopsy, I must have a visual contact with the face. I do that. I'll come out of respect; I'll look at the face.

    What did you see when you saw his face?

    I saw he was embalmed. He looked older than his age. And I said to him: "Mike, you need to help me. You need to help me. Let's prove them wrong. You are a victim of football, but you need to help me wherever you are. You need to. I can't do this by myself. I'm a nobody. But you need to help me. Let's prove them wrong."

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    Examining Mike Webster's body

    Doctor, when you looked at Mike Webster's body, when you look at any body but especially the body of a football player, do you start at the feet, and did you see injuries all over his body, his hands?

    No, no. Ironically, in fact I will tell you later, they don't have any injuries externally. They don't have any injuries externally.

    In fact, when I opened up his skull, in my mind I had a mental picture of what his brain would look like based on my education. I was expecting to see a brain with Alzheimer's disease features, so a shriveled, ugly-looking brain.

    But upon opening his skull, Mike's brain looked normal. It looked normal. So when I saw it -- and again, there was so much commotion outside I was oblivious of; I was focused on what I was doing. When I saw his brain, I was actually disappointed, and I'm like, "No, this is a joke."

    So the technician took out the brain, handed it over to me. For autopsies we examine the brain in the fresh state unless there is something unusual, then we fix the brain in a chemical called formalin so we could analyze it later.

    So I picked up the brain to cut it. I was thinking -- a lot was going on through my head. ... So I stopped. I said: "No, let me fix this brain. Let me spend time with this brain. There is something. Something doesn't match." ...

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    So you didn't open him up everywhere and take --

    No, no, we did, we did, but my interest wasn't in -- I knew what he died from. My interest was in his head. I had to explain, I had to prove, because I had told Mike, "We'll prove them wrong."

    So you were keeping your promise to Mike.

    Yes, that you're a victim of football, that people are refusing to recognize it.

    What do you mean a victim of football?

    In 1969 the United Kingdom House of Lords, where you have all your colleges of physicians of London, issued a position paper, and these are top, top, top doctors in their fields, establishing that brain damage is an occupational hazard of contact sports. This was in 1969. ...

    So then I knew all this. I knew all this. I mean, this is injury epidemiology; this is very well-established in the literature.

    So then in 2002 I knew that he was, based on the literature -- not based on some voodoo I had done, but based on the literature -- that his presenting symptomatology was more likely or more likely than not due to repeated blows to the head he suffered in playing that game where people dress up like extraterrestrials and slam into one another. That was how I perceived football.

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    You said "presenting symptomatology." What was the presenting symptomatology?

    That he lost all his money, that he was living like a vagabond, was a drug addict. He was suffering severe depression. Sometimes he couldn't find his way home. He had a progressive deterioration in his socioeconomic status, in his personal life and interpersonal relationships.

    At some point he was homeless. These are the constellation of symptoms that were published in 1927, and even before 1927, as far back as the 18th century. ...

    ... Besides shriveled, are there other things you can readily identify that say: "Wait a minute. This is something new. This is something different"?

    His age. His age alone. To have Alzheimer's disease at such a young age. It's either you have Down syndrome or you have one of the family of Alzheimer's; that is extremely rare, you find maybe in the Scandinavian countries, and there will be a family history. OK? When I heard his age and his symptoms, I dismissed it was not Alzheimer's disease period. And when I saw his brain then, even without doing any other study, I was convinced this was not Alzheimer's disease.

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    OK, so you fixed the brain. They section it, they stain it, and they send you back slides. Is that --

    I fixed the brain, and because I did not understand what was going on, I chose to forget about it. It was causing me such distress, if you could call it that.

    Really?

    Yeah, because I couldn't explain it. So what I did was I went to the library and I started ordering papers. I remember one of the librarians called me, said he simply wanted to confirm I was who I was, because I was ordering too many papers, because I wanted to read, to find out is there some disease entity I wasn't aware of. But I kept on going.

    In the literature, everybody was giving it descriptive names, like nobody gave it generic names. Nobody had the, I could say the courage to give it a specific disease, identify it as a specific disease entity, describe the pathology, OK, so that eventually it would have its own international Classification of Diseases number. ...

    So I processed the brain; I examined his brain. There were no features of Alzheimer's disease. I kept it very quiet, because I was afraid. My youthful exuberance was manifesting itself -- I was aware of that -- so I kept it very quiet. I could be wrong. So I did this.

    I sent the tissues to the University of Pittsburgh brain lab to Dr. [Ronald] Hamilton, who was my teacher, a very good guy. So they ran the tests. Nobody knew whose brain it was. So one day I stopped over for a conference, and I stopped over at the lab to pick it up. I got it. I was afraid to look at it. So I left it on my desk for maybe another couple of months, because I was, you know --

    What were you afraid of?

    Of the unknown. I was afraid of letting Mike down. (Laughs.) I was afraid. I don't know. I was afraid I was going to fail.

    So one day I had a very busy day. It was I think a Friday night. I was single, was at work around 7:00, was in my office. … So I saw his slides. So I said, "Oh, Mike Webster." So I pulled them down.

    While munching on my apple I put the slides in and looked. Whoa. I had to make sure the slides were Mike Webster's slides. I looked again. I looked again. I saw changes that shouldn't be in a 50-year-old man's brains, and also changes that shouldn't be in a brain that looked normal. …

    I saw abnormal proteins in his brain, so-called neurofibrillary tangles, threads. But I looked at several, you know, the topographic distribution. It was different from Alzheimer's disease. Again, that complicated my disposition, my state of mind. So I took the slides home, said, "This is something I need to spend time with." ...

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    'I was convinced this was something.'

    After I looked at it over and over and over, I was convinced this was something, I said: "OK, it's something, but don't make the mistake other people make and just publish it and give it a descriptive name. Name it a disease, give it a name, present it as a disease. Package it. Develop a pathogenetic concept for it."

    And again, then I was attending business school at Carnegie Mellon University, so I had taken classes in brand management: How do you create brand equity? How do you commoditize information or equitize information, add value to something that has no value? I know in branding, a name is very important, and not just a name, a name people can remember, a name that has a good acronym, OK?

    But at the same time, I was thinking of the possibility that I could be wrong. So rather than boxing myself into a corner, give it a descriptive name that has a good acronym, so if you're proven wrong you could hide under this descriptive terminology. "Hey, that is nothing. 'Chronic' means long-term, 'traumatic' means it's associated with trauma, 'encephalopathy' means a bad brain." So I had both ends covered. ...

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    The next step in epidemiology is to have your peers confirm it. When you find a sentinel case, you show it to your peers who confirm it, you publish it, you look for a second case. Then with the third case it becomes a case series. You publish the case series. The next thing now, is a cohort. You look for a cohort; you describe the cohort. These were the phases I learned in epidemiology.

    I chose to show it to Dr. Hamilton, and I called Dr. Hamilton, stopped over. I said, "Look at these slides." He looked at them, said, "Oh, Alzheimer's disease." He said: "Wait a minute. How old is this patient?" I said, "50." He said: "Really? What were his symptoms?" I said, "That's Mike Webster."

    He looked at me. He was like -- you could see he was puzzled, and I just asked him: "This is what I think. Am I crazy or not?" He said: "No, you're not. This is something." He said, "OK, why don't you go show it to Dr. DeKosky?" Dr. Steven DeKosky is a big, established name in Alzheimer's disease research. He is a prominent neurologist. He is now the dean of the University of Virginia Medical School. ...

    So I came. He said, "Oh, Dr. Hamilton said you have an interesting case." I said, "Yes." So I showed him, said, "This is Mike Webster." And he confirmed, he said, "No, this is not Alzheimer's disease. This is something else. This may be similar to dementia pugilistica." I said, "Yes."

    Rather than spending two minutes in his office, I spent two hours. We were talking. When I left his office that day, such a prominent, established guy, me, a nobody, and he gave me two hours of his time, I knew I was onto something. ...

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    'I thought the football industry would be happy with our new discovery'

    So I was excited. I thought the football industry would be happy with our new discovery. I thought naively that discovery of new information, unraveling new information, redefining concepts, I thought the football industry would embrace it -- again, about my business experience -- utilize it, turn it into some type of utility, some type of utility function to enhance the game.

    And save lives or something?

    Yes, just like, enhance the game and enhance the lives of the players, and save, on a macroeconomic level, eventually save money for the entire country, because there are tangible and intangible costs of CTE in terms of family's lost income, so much. It is a multidimensional disease.

    So I thought it was something of great utility function, something of value that will enhance the brand of the football industry, some type of equity. That was what I thought in my naive state of mind. But unfortunately I was proven wrong, that it wasn't meant to be that way. ...

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    How did they react, the National Football League?

    (Laughs.) You know how they reacted. OK, let me tell you.

    The paper, when I published the paper, when I completed the paper after spending hundreds of hours, I sent the paper to Dr. DeKosky, to Dr. Hamilton, to [pathologist] Dr. [Cyril] Wecht. Everybody reviewed, gave their contributions; we packaged it. It was now ready for submission, and it was a sentinel case. That is the first step in a new disease definition.

    The next question was, where do I publish this paper? During my research I had found out that the NFL, Dr. [Paul] Tagliabue, the then-NFL commissioner, when people like Troy was his first name again, several players had retired --

    Aikman. Troy Aikman?

    I think Troy Aikman. There was another one that retired in the '80s.

    Steve Young?

    The other one was Merril Hoge and some other players who retired prematurely because of concussions, so-called concussions. So they set up a committee to look into the issue of concussions, what is going on. ...

    They had published most of their papers in the Neurosurgery journal. Because I thought this was something that had some value that will enhance the game, I said: "OK, let me take it to their home turf. Let me take this paper to the Neurosurgery journal and publish it in the NFL-endorsed journal." ...

    When you submit a paper to a journal, the standard practice is they will send it to two reviewers who will review it. If the two reviewers agree this is a good paper, it's published. They'll make some comments, make some changes. Assuming the two reviewers disagree, it's sent to a third reviewer who will now come, so if it's two-to-one, OK. Do you know the number of people that reviewed this paper? There were over 18. ...

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    So it gets published, much to your surprise, I suppose, at some point.

    At some point there was a commentator, reviewer, who said, "Bennet" -- because at some point, now they knew who I was -- "Bennet has done so much work on this case that in fact, his responses to the reviewers is almost 30 times the length of the paper," because I had written hundreds of pages of responses to the reviewers' comments.

    So you were fighting for it.

    I was fighting really, yes. It was almost like an intellectual battle. But one thing that encouraged me, though, was while I was encountering them on the field of battle, if you call, intellectual battle, I was encouraged, and I'll tell you why.

    Yes, I was a young, insignificant person, a nobody, but in my intellectual engagement or intercourse with them I found out that they were not in control of the subject better than I was. I realized that, hey, Bennet, you may actually know this subject better than these people who are the powers that be. ...

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    Correct me if I'm wrong. It seems like this threatens the very heart of American football.

    Yes, some of them actually said that I'm attacking the American way of life. "How dare you, a foreigner like you from Nigeria? What is Nigeria known for, the eighth most corrupt country in the world? Who are you? Who do you think you are to come to tell us how to live our lives?"

    It's that fundamental what you discovered?

    Yes. It depends on your perception, though. My perception is, again spiritually, simply the truth, and the truth shall set you free. I'd rather want to be told the truth and I will deal with the truth than be wallowing in ignorance and darkness and lies.

    And it has tremendous implications for little children who play football to high school kids to college kids to professionals.

    Well, it's really part of positive thinking. You take the information, the implications, and turn it into something positive. You rather embrace knowledge and use it to create more positive knowledge and make more positive impacts. It depends on how you look at it. ...

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    But they didn't do that. Why?

    They didn't do that. Even with respect to today, they have not done that. Why not? I don't know. There are things that are just beyond me. I don't know.

    But I think initially the intent was to delegitimize it, because I will tell you, finally we published it, and again I kept it quiet, if you notice. Then one day I was at home, again in my condo. My phone started going off, my pager. So finally I called the office. I'm like, "What is it?" "Oh, Dr. Wecht is looking for you."

    So I called him. He said, "Bennet, Bennet, where are you?" I said, "I'm home." He said, "OK, what are you doing at home?" I said, "I'm just chilling out, sir." He said: "Good, good. I want you to be chilling out, because there is something I need to tell you." I said: "What is it, sir? Is everything OK?"

    He said, "The NFL doctors have sent a letter accusing you of fraud, that your paper should be retracted."...

    So I couldn't even read the letter; I was shaking. I reached out in my kitchen. There was a bottle of Johnnie Walker Red, scotch whiskey. That was the best thing, because I was so nervous, sweating. I'm like, "Is this how my career will come to an end?," because the only time you request for a retraction is if there is criminal behavior or fraud. ...

    I poured a shot of -- I just gulped it down. So I now read the paper, and I remember when I was reading it I was shaking, but after I read the first paragraph I smiled. Why? Because what they said in the first sections of the letter were embarrassingly ridiculous and was the least bit expected from such a high-profile organization. And I said, "How can a nobody like me know the subject better than the top three NFL doctors who are in charge of trauma in the NFL?"

    And their argument was, "Oh, CTE, the disease Dr. Omalu described, does not exist, because it is not dementia pugilistica." Of course, I never said it was dementia pugilistica. That was why I did not call it dementia pugilistica. But it is a disease that is in the same group as dementia pugilistica. Rather than calling it dementia pugilistica, call it CTE, because you cannot be categorizing it by sport. ...

  14. Ψ Share'They insinuated ... I was practicing voodoo'

    So the NFL and the MTBI Committee and [then-committee chair] Dr. [Elliot] Pellman and others not only go to work on you and your reputation, but they go to work on the idea of CTE, on safety things. ...

    And they went to the press. They insinuated I was not practicing medicine; I was practicing voodoo. ...

    So let's go back to the letter.

    The letter. So I spent the whole day responding, and I was a bit emotional, so I hit back. So I sent the letter out to Dr. Wecht, Dr. DeKosky, Dr. Hamilton, tempered it down, made it look friendly. So we sent the letter, and the section editor reviewed it. ...

    I was vindicated. And I said to Mike, "Sir, I think I'm proving them wrong." Then I met his wife. I met his son. And his wife said to me that she wished she knew before Mike died, that she thought Mike was just being a bad person, that she would have been more sympathetic; she would have treated him like a man who was sick, not a man who was a bad person. I was vindicated, and I forgot all about it.

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    But within two years of Mike Webster's death, I came to work one morning, and everybody there said: "Hey, there is the brain guy. We have another case for you." I said, "What are you talking about?" They said, "Oh, Terry Long died." I'm like, "Who is Terry Long?" He said: "Oh, he's another NFL player. He died. You were not on duty so Dr. [Abdulrezak] Shakir who did the autopsy saved the brain for you. His brain looked normal." I said: "Really? Another football player?"

    To be honest with you, back then I didn't know about football. I didn't even know what a quarterback was. I didn't know about line of scrimmage. I did not know nothing about football.

    So I chose to speak to Terry Long's wife, because I wanted to see if Terry Long's symptoms were similar to Mike Webster's, and of course they were similar. Mike Webster attempted suicide multiple times. Terry Long attempted suicide multiple times. Terry Long ended up succeeding in killing himself. How? He drank ethylene glycol, antifreeze. ...

    Well, you looked at Terry Long's brain, or I guess slides, the sections, the stained sections of where they had the slides, and you saw CTE. Then what? I mean, did you feel --

    When I saw Terry Long's case, I became more convinced that this was not just an anomaly, a statistical anomaly. But with a second case, again, my epidemiology, my knowledge in epidemiology, a second case may still be a statistical anomaly. ...

    Mike Webster was CTE Part I, Terry Long CTE Part II. I was waiting to get to the third case to make it a case series, because once you see a case series, that means this is less likely to be a statistical anomaly. You're seeing a trend.

    A cohort.

    Yes. So that wasn't the -- I published it, the second case. I didn't face so much challenge. And then the third case, I think it was Andre Waters.

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    When I got Andre Waters, I was humbled. But it was a double-edged sword, because I began to be exposed to their lives. It started becoming personal to me. I started meeting the family members. I had now met Mike Webster's family, Terry Long's family and the Waters family. I actually went down to Palm Beach to spend time with Andre Waters' mother.

    Why, Dr. Omalu?

    Remember the promise I made to Mike Webster? Another person I made a promise to was Chris Benoit, the wrestler.

    I have a total of -- I can't remember -- is it eight or seven certifications and degrees? And I remember when I was going to business school my father now said to me: "Bennet, yes, I encouraged you to become educated, but why all this education? Why are you doing it? What is your motive? What I want to tell you, if your motive is for selfish reasons to become domineering all over the world, then I must warn you that is dangerous, but if your motive is to use your knowledge to help other people, to enhance the lives of other people, make a difference in the lives of other people, then it is good." OK?

    And again, my younger sister who has a Ph.D. in energy, international energy law, when I was fighting the battle of Mike Webster, I called and I said: "You know what? I'm getting tired." And she called me out immediately and said, "No, Bennet." She is religious, too. She said: "You think it's by chance that this is happening. Everybody has a calling, that the mighty God --" we are Christians -- "doesn't give you a cross to bear by reckless abandon. He gives you a cross to bear because he knows you can bear that cross. With your knowledge, you can help these people, and you're even in a better position because you don't have any direct or indirect emotional attachment to football."

    I had been objective. Who knows, if I had grown up in this country and loved football, I could have just examined Mike Webster's brain and threw it away, blocked it out, because the impact, yes, it could end up eventually, in generations undermining football. But there is nothing in life that is more important than the life of somebody, even just one. You know the parable of the lost sheep. One sheep got lost. The parable, the shepherd kept 99 and went after the one. It is that one life lost is more valuable than any other activity. So these were the psychological forces, the emotional energy behind me.

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    And that got you down to Florida to be with Andre Waters' mother?

    Yes, to empathize. And I wept. I remember that day when I was flying back. I saw his mother, his mother, and she told me the story of the last time she saw Andre. He was such an emotional wreck. And to make it very sad now, and it's better, they are having such symptoms, people know, "Hey, it's CTE." They didn't know what it was. They just thought he was just becoming someone else or was just becoming nasty.

    I drove down to see his niece that lived with him the final three years of his life, and the sad thing was these people were living in such obscurity and in so much pain, and yet nobody recognized. Nobody even noticed. Nobody.

    And in that process, like now I've started even meeting more retired players, and I found out these people are suffering. I went to a funeral once, and there I was in the corner and I noticed these two big men. One was limping. And I noticed they were coming toward me, so I actually was trying to move closer to the door, OK, so if anything happened I could at least exit. One of the ladies I knew and said, "Bennet, I need to introduce you to my husband." I said, "Oh, really?" She said, "Oh, he is a retired NFL player." I said, "Really?" ...

    So they came at me. They said: "You know what? What you're saying is very true, that there is a culture among them not to admit that you're having problems; that 'He is losing his memory'; that 'He has lost all his money. He can't even keep a job, has this very bad depression,' and he wonders why is he depressed. Life is not bad, but he is depressed." And the other guy, too, was confirming it, said he can't -- that his job -- and started crying. I started crying.

    Then that was when I now started getting interested in football. Then when you watch football, it's such this big, impressive endeavor, but yet nobody talks about the retired players, nobody. And if you notice, it was only after CTE that people even started acknowledging that there were problems. It took so much [of] a toll, and that is why I said, "You know what, going back now" -- because not just that; they exposed me to the politics, the politics of science, the politics of TV, the politics of the press -- that now if I look back, I'm like: "You know what? I wish I never met Mike Webster." ...

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    What has actually happened to you?

    Me?

    Yeah.

    I'm not happy. Before Mike Webster, I led my life. Nobody called me. I did my own thing. Nobody thought I had anything to fight over with them. I led a very simple, easy life. …

    But CTE has dragged me into worldly affairs, unnecessary competition. Some people think just -- you know the song by Bob Marley, "Who the Cap Fit, Let Them Wear It"? It said your best friend would be your worst enemy and your worst enemy your best friend. And songs like "Rat Race." CTE drew me into that. But if it's destiny, so be it. But I really sincerely wished it didn't cross my path of life, seriously. ...

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    So the NFL decides to put a convention together where they talk about it, a conference together where they talked about it. Are you invited?

    No. See, what happened, -- before I answer that, another milestone in my experience was Chris Nowinski, [the former wrestler and co-founder of the Sports Legacy Institute]. ... Nowinski contacted me -- again my naiveté -- positioned himself [as if] he's writing a book, he needs to talk to me, blah, blah, blah, so I spoke to him. OK, he needs to make this public. For some reason, it now blew into this media quagmire that I wasn't prepared for. ...

    During the media blitz, the NFL took notice and organized this conference in Chicago. I was not aware of it. Nobody ever told me. How I got to know was Dr. [Julian] Bailes called me and said, "The NFL is putting together a conference on CTE that you were not invited"; that he thinks they are going to attack me at the conference -- "They will dismiss you"; that if I don't mind, could I give him my data so he could show them at the meeting and at least have somebody speaking on my behalf?

    Why would he do that? Go backward, and introduce Bailes to us. ...

    He used to be the doctor for the Steelers, and he actually, the fourth case I had, Justin Strzelczyk, Julian knew him and treated him. The way he died Julian thought something was wrong but just couldn't figure it out. So after Andre Waters, Julian called me and said: "Look, can you find out who did the autopsy on Justin Strzelczyk? Let's see if we still have some brain tissue. I think he had CTE."

    So we found some brain tissue, analyzed it, and we found out yes, he had CTE. So Julian was enthused.

    He had also written books and papers on concussions, some of them in boxers. So he had a relationship with the NFL. He was wiser than I was, much older, and he knew the politics better than I did. So he adopted me, almost like a "mentee." He became my mentor. I respect him. ...

    So he goes to the conference, and he presents on your behalf and his behalf. And what happens? I mean, are they angry? Are they intense?

    From what he told me at the end of the meeting, they said to people, the consensus was: "Look, Omalu should not be trusted. Omalu should not be trusted. Yes, there may be a problem with concussions, but we don't think it's as bad as Omalu is claiming." ... I think they thought that with time I would burn out and it would fizzle out, but unfortunately I think they underestimated my resolve. …

  20. Ψ Share
    Others on this topic:
    A League In Denial?
    A secret, off-the-record meeting with an NFL doctor

    So, Dr. Omalu, there is a secret meeting, an off-the-record meeting after the Terry Long case where you are told the implications of what it is you were doing. I know you can't tell me who was at the meeting or won't tell me who was at the meeting, but what was said?

    ... So there was a meeting arranged. It was held late at night, around 8 p.m. -- people flew in from different places -- at the University of Pittsburgh Medical Center. There were about seven people at the meeting, so I showed them the slides.

    One of the doctors there was a prominent NFL physician. So after the slide viewing, we started discussing the cases, the implications, and the NFL doctor at some point said to me, "Bennet, do you know the implications of what you are doing?" I looked. He was on my left. I said, "Yeah, I think I do." He said, "No, you don't."

    So we continued talking, talking. At some point he interrupted me again: "Bennet, so do you think you know the implications of what you are doing?" I said, "I think I do; I don't know." He said, "No, you don't."

    So we continued talking again. Then a third time he interrupted me, and I turned to him, and I said, "OK, why don't you tell me what the implications are?" He said, "OK, I'll tell you." He said, "Your work suggests or is suggesting or is proving that football is a dangerous sport, and that if 10 percent of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football."

    So I looked at him. I shrugged about it. And he said to me: "So you need to be very careful. You need to tone it down. Don't speak to the press. Just focus on the science."...

  21. Ψ Share

    But you are asking football to acknowledge that it's dangerous, even though everybody associated knows that its very violence, that its nature is the reason it is so popular. You are asking it to change first by acknowledging that it's dangerous and second by doing something about the very thing that's dangerous, which imperils the original idea of football.

    Well, I don't know where to look at it as a physician. As a physician, I'm somewhat an advocate of patients. How come before Mike Webster no NFL player was told or knew that there was an intrinsic risk of brain damage from playing football?

    Players, even today you talk to some players who were not told either by fault or default that while you play football, your brain suffers repeated blows, impacts, and such repeated impacts have a risk of permanent brain damage with or without the helmet. Why not? I'm asking a question.

    You tell me.

    I don't know. (Laughs.) I don't know. And it remains a puzzle to me. ...

  22. Ψ Share

    So the implications of organized football not telling the 10 percent mothers or others of the dangers of repeated head injuries to their children, what are the implications of that?

    Some people have paid prices, their lives. Some people, while adding value to entertain us, while contributing to the American experience, pay the ultimate price with their lives, and unfortunately were not aware while they were entertaining us that they were slowly losing their lives.

    If you are a military person and you sign up to become a member of the military, you know there is a reasonable chance that you will die, that you could suffer permanent body harm, but a football player signs up at 4 years old -- which is very sad.

    The child of 6, 7 years old signs up. He is told it is a sport; there are benefits; you're a football player. You're a college football player, there are some benefits. As a professional player you're going to make money. But nobody tells them that you're also losing your life as you do that.

    And then when players lost their lives after retirement and started manifesting the symptoms of CTE, they were dismissed as losers, as irresponsible, as people who were not intellectually capable to compete outside the protection football afforded them.

    There is something un-American about that. And I am speaking sincerely as a foreigner who believes America is the only heaven on earth, is the place closest to the heavenly experience. ...

  23. Ψ Share

    When we talked to Mike Webster's doctor, he talked about how you could see the physical trauma on him, his feet were cracked and all of his hands were broken, and there was scar tissue on his head. When you went in to do the autopsy, is that something you could observe?

    ... Mike looked older than his age. He looked beat up. He looked worn out. He looked drained. His hands were all swollen, osteoarthritic, degenerative, because the insult to the body, the repeated insults -- because that is what it is; you are insulting the integrity of your body -- expedites the degeneration or aging of your body.

    And that is the same thing we see in the brain. The brain itself -- CTE essentially is expedited aging of the brain with degeneration of the brain cells. ...

    In addition to the hands, what other insults are we talking about that you could see from the autopsy?

    Impacts to the body, his skeleton, his joints. And the parallel is we don't really see the emotional damage, which is linked to the brain, because CTE also damages the part of your brain that is responsible for your emotions, for your mood. Every domain of human functioning is compromised by continuing, repeated insults, physical insults. And NFL players will tell you that they know that because they inflict injury and cause harm to other players. They will tell you that.

    Did he have knee things?

    He had osteoarthritis. His knee was all swollen. His hands were the one I really noticed. His hands were all big. His skin was very course and aged. He looked much older than 50.

    How old?

    If I had not been told his age, I would say he looked like 70. And the retired players will tell you that when they retire from football, life is a struggle, even to get out of bed. So the question we have to ask ourselves really is what is the human cost? What is the human cost? Would you let your son play football? ...

  24. Ψ Share

    You must see the little kids playing football and you know what's happening to them. What do you see when you watch --

    I don't watch football.

    Even the little kids. You drive by, you see them in the neighborhood, and you think --

    Because what happens to me when I watch football, my blood pressure goes up. I become depressed, because you see that each impact, what goes through my mind is the brain, how the brain looks like. ...

  25. Ψ ShareWhy he believes all NFL players have CTE

    From your analysis, from what you've seen, what would your estimate be of how many NFL players that are playing the game right now probably have CTE?

    OK. Based on my experience, there has not been any NFL player I've examined that did not have CTE.

    Now, the degrees of advancement of the disease will be different, and they have different types. So my opinion is, based on my experience, is all of them. …

    Did you say all of them?

    All of them. All the NFL players I have examined pathologically, I have not seen one that did not have changes in their brain system with brain damage.

    And your guess is it's not just a special group you are seeing who happen to kill themselves or whatever. It would be present even in active players even now?

    I think in active players who have played through high school, college, each and every one of them, in my opinion, has a certain degree of brain damage. CTE is progressive. Let me give you a good example.

    No, finish the -- CTE is progressive; therefore --

    The longer they live, the more advanced the disease becomes. Am I making sense to you?

    Until they become Mike Webster.

    Yes. Some of them may not degenerate as quickly as Mike Webster did, but as they get older. Am I making sense to you? There is individual variability, like in every other disease. Like high blood pressure, you have people who have high blood pressure, mild high blood pressure, moderate high blood pressure, serious high blood pressure, malignant high blood pressure, but it's the same disease with the same risk factors. ...

  26. Ψ Share
    Others on this topic:
    Junior Seau's Suicide

    As a last question, the Seau case. Why did you want Junior's brain? Why did -- I guess Boston wanted Junior's brain? Why did the NIH [National Institutes of Health] get Junior's brain? Not about the politics of it, but why the interest in Junior's brain? ...

    When Junior Seau died, just like every other case, people called me. I don't follow football, so I said, "Who is Junior Seau?" They said, "Oh, you don't..." -- just like Mike Webster -- "You don't know Junior Seau?" I'm like, "How do I?" They said, "Oh, he's even bigger than Mike Webster." They said: "Oh, he just died. He committed suicide."

    OK, just like I always do, I called a colleague of mine. That colleague of mine introduced me to the medical examiner in San Diego. I spoke to the medical examiner. The medical examiner spoke to the family. Finally connected me to his son. We did everything -- spoke to the son; he gave us verbal consent.

    And the medical examiner requested that I come down. They've never had such a big case before -- I'm an expert in this field, to help him. So by 3 a.m. I was driving to San Francisco to board a flight. I got to San Diego by around 6:30 a.m. I went to the office. I assisted at the autopsy. I took out the brain, processed the brain, did everything.

    Then I packaged the brain. I was about leaving for the airport. But the son called and was saying all types of very ugly things about me, very ugly. ... Initially I was extremely offended at, "Look at all I've suffered for players, and look at what a player's son is telling me." That was one of the reasons I said I wish I never got involved in it. So the next thing he said, he doesn't want me touching his father's brain.

    I was very demoralized. I remember that there was -- people didn't notice when I got into the cab I was crying. I'm like, "What have I done?"...

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