By Les Carpenter
Washington Post Staff Writer
Wednesday, April 25, 2007
PITTSBURGH -- Bennet Omalu knows why his phone calls often bring silence on the other end. He introduces himself as a forensic pathologist, which means he is trained to examine dead people. He explains that he's also a neuropathologist, which means he is trained to examine dead people's brains. He says all this through a thick accent that is the result of a childhood spent in Nigeria.
Then there is the matter of what he is seeking in those calls: the brains of recently deceased professional football players.
Coming over the phone in slightly broken English, with a complicated explanation of a medical phenomena that most coroners have never heard of or believe to be true, the request to have the brain pulled from the freshly deceased player's head and shipped here to be studied might as well come from Mars.
"They insult me," Omalu said. "They say, 'What do you think you are doing?' " Then they say no.
Omalu, 37, a man who knew nothing about football and was a soccer goalie in his homeland, believes he has proven that repeated concussions in football lead to early-onset dementia, very similar to the boxing ailment known as "punch-drunk syndrome," possibly leading to dementia and depression.
Omalu has been able to examine four brains -- those of former Philadelphia Eagles defensive back Andre Waters, former Pittsburgh Steelers offensive linemen Mike Webster and Terry Long and former Denver Broncos running back Damien Nash. Webster, Long and Waters all showed signs of severe punch-drunk syndrome, and Long and Waters committed suicide. Nash, who died Feb. 24 after collapsing following a charity basketball game, did not. But he was just 24 and barely had played in the NFL.
And while the link between Webster, Long and Waters, who all suffered emotionally and intellectually in their post-football lives, has encouraged some researchers, others question the validity of Omalu's work, suggesting his research is sloppy and the evidence is insufficient. Either way, he needs more brains.
That is not easy to accomplish.
"Just call me a brain chaser. That's what I do," Omalu said with a laugh.
He is a smallish man with a wide face and a big smile who favors pinstriped suits and chats without the detached air of many doctors. He came to the United States in 1994 to do his residency at the University of Washington. He was drawn to pathology because he never really liked any other field of medicine. He found it all too boring. Along the way, he discovered he loved to study the brain.
Five years ago, while working at the Allegheny County medical examiner's office, he came to work and discovered Webster's body on the slab. The former Steelers center caused a stir in the coroner's office mainly because he was one of the most beloved Pittsburgh players of the 1970s and '80s. But Webster had fallen on hard times after football; he seemed scattered and irritable, eventually lost all of his money and distanced himself from his family.
Watching coverage of Webster's death (the cause was not released), Omalu was shocked that the people who talked about him on television mocked his intelligence. Omalu wondered if perhaps Webster suffered from dementia pugilistica, or punch-drunk syndrome. When he arrived at work and discovered he would be doing the autopsy on Webster, he pulled out the brain and found it to look unblemished. Still, he wanted a further look.
When slides were made of the matter, then magnified 200 times, the telltale red flecks of abnormal protein appeared. The proteins appear when the brain is hit, Omalu said, but disappear as the healthy brain cells devour them, leading to recovery. Yet when the brain suffers too many blows, the brain cells can't keep up with the protein and eventually give up and die, leaving just the red flecks.
"No brain of a 40- or 50-year-old should look like this," Omalu said. The only people who would have such markings, he added, were boxers, very old people with Alzheimer's disease or someone who had suffered a severe head wound. Webster was only 50.
There is a good chance that Omalu is the only person who would have thought to check Webster's brain for punch-drunk syndrome. Since few pathologists are trained as neuropathologists, they never would have seen the textbook pictures of the abnormal proteins that Omalu had observed in medical school.
"Another doctor would have cut up the brain," Omalu said.
Omalu was on duty when Long killed himself. Once again, Omalu preserved the brain, had slides made up and discovered the same red flecks. He also faced a skeptical medical field that shrugged off Webster's problems as non-football related. But by then, he had made a believer of Christopher Nowinski, a former football player at Harvard who had wrestled in World Wrestling Entertainment under the name Chris Harvard. Nowinski had been forced to retire from wrestling in 2003 because of numerous concussions and wrote a book on the ordeal called "Head Games: Football's Concussion Crisis."
When Nowinski heard of Waters's suicide last fall, he called the medical examiner in Florida, requesting the brain for Omalu. When the coroner refused, Nowinski contacted Omalu, who discovered that the brain mostly had been destroyed.
After getting permission from Waters's family, Omalu was able to salvage small chunks of Waters's brain. Upon examination, Omalu found the same red streaks as in the brains of Webster and Long.
"In medicine, three cases make a series," said Julian Bailes, the chairman of the neurosurgery department at West Virginia University and a leading concussion researcher. "You can report that. When they published the findings about Mike Webster, a skeptic could say, 'This is a chance occurrence.' Then Terry Long died and was brought, serendipitously, to the same medical examiner's office, but people could say 'maybe that was a coincidence.' But a third case makes a series."
All of which prompts Bailes to call Omalu's work "breakthrough research."
Others are not so sure. Ira Casson, the co-chair of the NFL's Committee on Mild Traumatic Brain Injury and a neurologist at Long Island Jewish Hospital, said Omalu has not provided complete medical histories on Webster and Long, relying instead on anecdotal evidence from the families rather than actual records. He also questions whether a real diagnosis can be made on Waters from such small fragments.
Casson also said there were "glaring deficiencies" in an article Omalu published on Webster, claiming that Omalu made Webster's brain trauma seem worse after being questioned on his initial findings. He said Omalu needs to have a wider sampling than just football players to prove his thesis.
Omalu has heard many of these criticisms. He realizes there are not many people who would make the calls he has, but he also can't let go of the red flecks he saw on the slides and the effects they have had on the families of those players. He still can feel the warmth of the embrace Waters's mother, Willie Ola Perry, gave him when he told her what he found inside her son's brain.
"She was so glad to know that [he] didn't do this on his own, he was sick," Omalu said.
Every time he seems unsure of what he's doing and frets that another coroner is going to mock his request, he thinks of that hug or the smile Webster's son Garrett gave him and picks up the phone.
He'll read of a former NFL player dying, especially under suspicious circumstances, and he'll make a call, first to the coroner and then to the family. He looks for candidates who might want to donate their brains when they die. He even said he phoned the office of boxer Muhammad Ali, whose Parkinson's disease is believed to have been caused by too many blows to the head. But Ali's people were so horrified at the thought of discussing the possibility of the boxer's death they quickly ended the call.
He realizes his inquiries are going to put off people and is certain his accent is a burden. He thinks people are convinced he is out to ruin football and are threatened the moment they pick up the phone.
"They seem to think: 'A foreigner is coming in to teach something of value to us. Is he telling us to stop playing football? Who is he?' " Omalu said. "It's not about the game, it's about the science."
When he thinks his accent might get in the way, he asks Nowinski to make the calls.
"It's extremely awkward to ask," Nowinski said. "I spend 15 minutes before picking up the phone to practice how actually I am going to put it. You only get one chance."
When he first called the Waters family after Andre's death, they told him no. In the time he was able to finally persuade them to say yes, the full brain already had been destroyed. Nowinski and Omalu were fortunate the medical examiner's office had kept some small parts of the brain that could be examined.
It shows the urgency Nowinski and Omalu feel to make sure they don't let any further opportunities slip away.
"Calling people within days of a passing is not comfortable," Nowinski said. "But the long-term good is better than the negatives of the call. It gives the answers to strange behaviors. And it's helped give meaning to a tragic situation. By doing what they've done, they've helped a whole lot of people."
Omalu is hopeful he soon will have another brain to examine, though he will not provide the name of the deceased former player whose family has given him permission to look at the brain. It will be someone people will know, he said. He is certain he will find the same red streaks in this brain as he did in the others. And when he releases those findings, he is sure more people will answer when he and Nowinski call about brains.
"You kind of can't stop because of the importance of the findings," Nowinski said. "To not keep going would hurt a lot of people."