Monday, November 23, 2015

Ridicule and rejection

When a purely scientific advance stands to jeopardize a very powerful interest, rejection can turn threatening.

Such was the case of forensic pathologist Bennet Omalu, a native Nigerian working in the Allegheny County coroner's office. Dr Omalu had no idea just how powerful the National Football League (NFL) was when he published the first diagnosis of chronic traumatic encephalopathy in Neurosurgery.

The NFL immediately mobilized a cadre of physicians on the organization's payroll to attack Dr Omalu's research. Dr Omalu, however, continued publishing, and the NFL continued its attack in kind, very often through physicians with a long history of working with, and for, the NFL.

"I was naive," Dr Omalu told GQ in 2009.[ "There are times I wish I never looked at [former professional NFL player] Mike Webster's brain. It has dragged me into worldly affairs I do not want to be associated with. Human meanness, wickedness, and selfishness. People trying to cover up, to control how information is released. I started this not knowing I was walking into a minefield. That is my only regret."

Even experts without any ties to the NFL initially discounted Dr Omalu's work.

"The credit must go to Bennet Omalu," neuropathologist Peter Davies, of the Albert Einstein College of Medicine in New York, said, "because he first reported this, and nobody believed him, nobody in the field, and I'm included in that. I did not think there was anything there. But when I looked at the stuff, he was absolutely right. I was wrong to be skeptical."

Because of Dr Omalu's persistence, the NFL has been forced to acknowledge chronic traumatic encephalopathy, and the wider sports culture has begun questioning the costs of repeated brain injuries in sports, both professional and recreational.

Incubators are standard equipment in neonatal intensive care units and have become so common that, in many ways, they are emblematic of the care given to premature babies in their first hours and weeks of life.

In the United States, however, for the first decades of their use, the only place infant incubators could be found was at amusement parks and "sideshows" alongside tattooed ladies and sword swallowers.
First pioneered by French obstetrician Stéphane Étienne Tarnier, infant incubators were initially used and refined throughout Europe in the late 19th century.[3] Martin Arthur Couney, who studied under one of Tarnier's assistants, first witnessed an infant incubator at the Berlin Exposition and decided to import them to the United States.

After they were largely rejected by the US medical establishment, Couney established a bank of incubators at Luna Park on Coney Island in New York. From 1903 to the early 1940s, Couney charged visitors 25 cents to view the premies on display, money that was used to pay for the babies' medical care so that parents did not have to.

It has been estimated that Couney treated about 8000 children and saved the lives of 6500 babies during his 4 decades on the Coney Island boardwalk.

In 1939, New York Hospital opened the first official training and research center for premature babies—36 years after Couney debuted his baby incubator in Luna Park. Couney died in 1950 in relative obscurity; however, the widespread adoption of infant incubators is a testament to his courage (and showmanship).

Ignaz Semmelweis may be the best known example of a physician ridiculed for an idea that is now accepted as common sense.

A Hungarian physician working in the maternity ward in Vienna in the mid-19th century, Semmelweis noted that puerperal fever was contagious—students and physicians were performing autopsies and then contaminating new mothers in the maternity ward with what Semmelweis, working prior to the germ theory of disease, termed "cadaverous particles."

Semmelweis advocated that doctors in obstetric clinics disinfect their hands following autopsies; at the clinic in which Semmelweis's hand-washing policy was implemented, the puerperal fever mortality rates dropped 90%, from 18.3% to less than 2%, in fewer than 6 months.

Despite Semmelweis's demonstration of the value of antiseptic techniques, by and large his ideas were rejected by the medical community, with a few notable exceptions. Semmelweis had believed that antiseptic hand washings would be widely adopted and save thousands of lives; when they were not, Semmelweis began publishing a series of vitriolic "open letters" against his critics.

Increasingly isolated and unpredictable, Semmelweis was admitted against his will to a Viennese insane asylum, where he was severely beaten; he died after 2 weeks.


  1. In July 2005, nearly three years after he first saw the body of former Pittsburgh Steelers center Mike Webster, Bennet Omalu’s paper about Webster’s brain is finally published in Neurosurgery: “Chronic Traumatic Encephalopathy in a National Football League Player.”

    When it arrives in the mail, Omalu holds it gently in his hands like it is parchment.

    “We herein report the first documented case of long-term neurodegenerative changes in a retired professional NFL player consistent with chronic traumatic encephalopathy (CTE). This case draws attention to a disease that remains inadequately studied in the cohort of professional football players.”

    Omalu marvels at it, the whole time in his mind talking to Mike Webster. “Here you go, Mike, look what we did.”

    Some time later, the phone rings. Now Omalu is sitting at his kitchen table with his head cocked to one side, balancing the phone against his shoulder; he is listening to some guy tell him that there is a problem.

    “Retracted?” Omalu said. “What do you mean they want it retracted?”

    “The demand is pretty forthright. From some notable doctors,” the guy says. He is from the journal’s editorial board, and he is saying three doctors have written a letter to the board demanding that the journal retract Omalu’s work...

    Retracted. You don’t just retract papers. Retraction was something you did if the author was found to be a fraud. Retraction would be a public humiliation.

    “It is a highly professional paper,” Omalu says, his voice rising. “Written and reviewed by highly respected scientists!”

    “We’ll need a response,” the guy says. “I’ll fax you the letter.”

    Omalu takes a deep breath and thinks: Wait a second. Who are these idiots demanding a retraction?...

    In the coming days, as he prepares his response, he begins to look into the identities of the members of the MTBI committee. It is one thing not to put a neuropathologist on your 14-member brain committee, quite another to have the committee headed by . . . a rheumatologist, as Pellman is.

    As a New York Jets team doctor, Pellman is of course on the NFL payroll, as are other scientists on the committee. (Dr. Pellman didn’t respond to Wall Street Journal requests for comment about this story.)

    Looking back through the literature, Omalu sees that Pellman put forth some conclusions back in 1994 when the committee was first formed. “Concussions are part of the profession,” he told reporters. “An occupational hazard.”

  2. (continued from above) Neurosurgery does not retract the article. In October 2008, the NFL makes what seems like another attempt to challenge Omalu’s work. It asks to send an independent researcher to West Virginia to look at Omalu’s slides and make his own judgment of the validity of Omalu’s so-called “discovery.”...

    It goes on like this for two days, slide after slide, the NFL’s independent expert saying “Wow.” Davies is transformed into a believer. It gets to the point where the only doubt Davies has is the staining of the slides themselves. Perhaps the technicians were not using state-of-the-art equipment, Davies says. He asks Omalu if he could take some tissue samples, pieces of brain, back to his lab in New York, where he could make new slides with his own equipment.

    “Sure, sure, sure,” Omalu says. “You take some pieces home, talk to your guys, see what you think.”

    So in his lab in New York, Davies runs his tests, and when he looks in the microscope, he is stunned all over again. The tau pathology is even worse—even more pronounced—than what he’d seen in West Virginia.

    He doesn’t believe his own eyes. He has his techs make new slides.

    When he looks in the microscope he sees the massive collection of tau tangles again.

    “Come look at this!” he says, calling in his team of researchers. “What the hell am I looking at? This will blow your socks off!”

    It is far more severe than anything any of them had ever seen in the most advanced Alzheimer’s cases—and in completely different regions of the brain.

    Davies writes a report for the NFL, detailing his findings, saying yes, Omalu was right. He speculates about the role of steroids, and of specific genetic markers, and other possible contributing factors worth pursuing, but the bottom line is that Bennet Omalu is right...

    The NFL never releases Davies’s report, never makes it public.

    Instead, the league commissions a new study, tries a whole different approach.(also unsuccessful)