How head injuries will end sport as we know it

Dr Bennet Omalu’s recent appearance on TMZ – the trashiest corner of tabloidism – was motivated by a need to defend Gisele Bündchen.

For 42 seconds of a 40 minute interview with Charlie Rose on CBS This Morning, the Brazilian supermodel spoke about repeated head traumas she has witnessed her husband suffer: "He had a concussion last year. He has concussions pretty much every . . ."

She stopped herself. Gisele's husband happens to be Tom Brady.

“I mean, we don’t talk about it but he does have concussions. I don’t think it is a healthy thing for your body to go through [punches her palm], you know? That kind of aggression all the time. That can’t be healthy for you, right?”

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Twitter exploded.

“I’m planning on having him be healthy and doing a lot of fun things when we’re, like, 100, I hope!”

The viciousness of the New England Patriots backlash, of macho ridicule, compelled Dr Omalu to call her an "angel of truth."

"When I heard the way Gisele was being treated because she spoke up it made me emotional, I shed a tear for her. That was why I agreed to appear on TMZ," he told The Irish Times this week.

“This is a woman. A beautiful woman. Beautiful in body, beautiful at heart, who was talking about her husband. This is her husband! Her family! Watching out for the good of her family, of somebody that she loves, who wouldn’t do that?

“She spoke out, in truth, ‘Now look, my husband, everybody adores him, people look at him as a product, but my husband is suffering.’ And people attacked her for that.

"You see the offensive character of this conformational way of thinking. You saw it in the movie Concussion, the guy playing Dr Julian Bailes"

Sports as religion

Dr Omalu has a brain freeze.

"From Saturday Night Live . . ."

The Donald is everywhere.

"Yes, Alec Baldwin! He was talking to Will Smith, [playing] myself, when he said 'God was number one' he showed two fingers and 'Football was number two' he showed one finger.

“Some of these sports are becoming religions in our lives. We are placing these sports above our humanity. Why would anybody attack, criticise, condemn the wife who was crying out in pain to protect her husband? What is wrong with them? That is why I called her an angel.

“Tom Brady has been playing for over 15 years, he started playing when he was a young kid. There is something that I want to say but I don’t want to say.”

You fear for Brady’s long term health?

“I love what Gisele is doing. I admire and respect her. Speak out! Speak the truth because, come what may, the truth must prevail. It might take a long time but the truth is empowering, it is enlightening.”

The fundamental problem here is the risk of exposure to repetitive blows or hits to the head with or without concussions. That is the issue.

His full name is Onyemalukwube, which translates roughly as “he or she who knows, speaks”, The Royal College of Surgeons have themselves a unique guest on Tuesday evening.

In 2005, this forensic pathologist turned the pugilist moniker “punch drunk” into chronic traumatic encephalopathy (CTE), following the autopsy of legendary Pittsburgh Steelers offensive lineman Mike Webster’s brain.

At the age of 50 “Iron Mike” died of a heart attack.

Concussion, the well crafted 2015 film in which Will Smith plays out Dr Omalu's stonewalling by the NFL after his research into CTE, was a box office disappointment. It wasn't mapped at the Oscars.

Harsh, undeniable reality

But he has not gone away, and what he represents never will. The end of sport as we know it has been decided, Omalu tells us. Growing knowledge about brain injury from contact sport, much like cigarette smoking in the 1960s, shows us a harsh, undeniable reality is coming.

"That is why my book – Truth Doesn't Have A Side – is coming out in August. If we do not begin with the truth we shall never discover a cure or a solution, okay?"

After each long answer, Dr Omalu politely inquires: “Am I making sense?”

He was. He is.

The brain has no capacity to regenerate itself. These games, you can never make them safe.

“The issue at stake here is not concussions. But I think the sports industry wants to make it about concussions. That is not true. The fundamental problem here is the risk of exposure to repetitive blows or hits to the head with or without concussions. That is the issue.

“So, if you look at all the protocols that have been established by sports leagues across the world they are making it about concussions.

“That shouldn’t be. What we need to let people know, especially parents, because children are my focus, is: when you play high impact sports, and by that I mean American Football, ice hockey, boxing, mixed martial arts, wrestling and rugby, your head is exposed to repeated blows and you may not suffer a documented concussion. All it takes is one season, one concussion and your child’s brain is permanently damaged.

“The brain has no capacity to regenerate itself. These games, you can never make them safe. You can never take away the head from rugby or boxing or American Football. We need to let people know that.

“That is why potentially dangerous games should only be for adults. Just like the rules we have for sky diving, for car racing. Only adults should be allowed play dangerous games.

“Am I making sense?”

The counter argument is deep rooted: contact sports cannot evolve to adult level without future professionals learning and honing technique as children.

The NFL doctor in Concussion states: "If just 10 per cent of the mothers of America decide football is too dangerous for their sons to play that is it, that is the end."

Omalu: “My counter proposition to that is children do not join the military until they are 18. Does that in anyway undermine the preparedness of our military? No.

“If you teach a child how to shoot a submachine gun how does that guarantee he will be a better shooter of submachine guns when he becomes an adult?

“Am I making sense?”

Not really in this instance. The 10,000 hour rule springs to mind, but Dr Omalu doesn’t miss a beat when offering the ultimate example of American society being forced to do the right thing.

“There have been times in human history where our ways of life have been dramatically, structurally changed. I will give you instances. In the United States of America there was a time when there was slavery.

“When a proposition was made to eradicate slavery a big part of America fought a war, hundreds of thousands of people died, to stop that way of life. But when it was changed it made America and the world a better place.

“So when it comes to sports, this is what we know today. As a society we evolve. It is part of who we are as a species.

“Science guides human evolution. Knowing what we know today it is actually an ethical determination: would you rather undermine the intellectual development of a child for sports entertainment to enrich a certain field or would you rather protect the God given intuition and intellect of a child?”

He is clear: children should not be playing rugby or American Football, they should not be allowed head the ball in soccer.

“There was a recent paper that came from Sweden in August that shows that damage in the brain cells of children has an economical impact and cost. When the students brains are damaged in early childhood in sports it prevents them from obtaining their full intellectual competence, and it results in lost productivity which will impact the American economy by €1.3 trillion over 30 years.

“So, society can try and survive without children playing these games. This is not anti-sports. There are so many non-contact sports for children. Leave these sports for adults.

“We need a change of mind, to evolve, for the better of society.”

This sounds like a crisis point. A revolutionary juncture . . .

“I wouldn’t use the word revolutionary because this did not begin today. If I may draw your attention to a paper printed in 1957. It was published by the American Academy of Paediatrics: ‘No child should engage in high impact, contact sports like American Football, boxing and wrestling because it undermines their full muscular skeletal development.’

“So this is not revolutionary. Even [the Greek physician] Hippocrates in 400BC recognised the dangers of concussions. I would rather call it evolutionary. We are evolving.

“Am I making sense?”

Perspective of the truth

The counter argument feels overwhelming. That so many communities in the US and all over the world are built upon contact sporting teams, in their schools and everyday life, does not sway Omalu’s perspective of the truth. Why? Because he has examined the brains of sporting heroes on an autopsy slab.

In many rugby games this season a player has been removed for a Head Injury Assessment. The suspicion of concussion is allayed when they pass the test but on return to the field, or in the days that followed, they struggle. See Beauden Barrett last month. Rory Scannell in the Pro12 final. The George North case.

Has the HIA carried rugby into extremely dangerous territory?

“Thank you for asking that question. This is another example of misappropriation of the science.

“You cannot use a neuropsychiatric test to make a diagnosis of brain damage. That is a fact. To subject a player to a neuropsychiatric test and tell him you have not suffered brain damage is malpractice.

“But we continue to do it and everybody allows it.”

The HIA can be extended over a 15 minutes period. In October Johnny Sexton, Leinster v Montpellier at the RDS, underwent and passed a HIA within five minutes of leaving the field following a high tackle by Frans Steyn.

In the 21st century a game that damages your intellect is not a game.

“That is not diagnostically valid. You cannot use a neuropsychiatric test by the side of the playing field and make a diagnosis or judgement if somebody has suffered brain damage or not.

“That is wrong. But we let it happen because we have some type of infatuational bond to these games, where we allow these games to take over our lives and our ways of thinking.

“So, the player [has] suspected brain damage, you do a neuropsychiatric test, he passes, you send him back to the field, he receives 10, 20 more hits to his head. It is causing irreversible damage to his brain.

Hippocratic Oath

“I guarantee you five, 10 years later he begins to have problems. Who is at a loss? Society, his family. That’s why I have taken this stance, as a physician; I swore to the Hippocratic Oath: First, do no harm.

“In 2017 there is no justifiable reason why a child under the age of 18 must continue to play rugby. That is the age of consent. That is when your brain becomes developed as an adult.

“That is why in America there are so many things you cannot do until you reach the age of 18.”

It’s too dangerous? “Yes, the way we play [contact sport] today. A game is meant to rejuvenate you. A game is meant to recreate who you are, to make you a better person. In the 21st century a game that damages your intellect is not a game.

“This is so basic, this is common sense!”

And yet Omalu continues to face resistance; the wrath of the NFL, he was ignored, he lost his job. But his life’s work continues.

“I was always an outsider anyway.”

People working inside a professional sporting body, Dr Omalu believes, can have their perspective altered by conformational intelligence. He means societal norms and traditions, by their environment and a culture that prioritises winning.

“Conformational intelligence actually makes you less of an intelligent person, it makes you more emotional, it makes you more obsessive, more addictive and it makes you tribal.

“You see that in every aspect of our lives today. We see it in our politics. We are becoming more tribal in our ways of thinking, more emotional, and it leads to us acting out violently.

“We have always seen that in our sports. It shouldn’t be so.”

Fundamentally disagree

Plenty of medical experts who fundamentally disagree with Dr Omalu will be present in the RCSI on Tuesday to hear him speak.

“I think it’s one of the reasons why many physicians are giving me awards, including the honorary doctorate from the Royal College of Surgeons. They see my authenticity.

“I am not employed by any sports organisation or university that is benefiting from sports with these issues. I have no conflict of interest. My guiding post is my faith. And the truth.”

Dr Omalu will be joined on a panel that includes Dr Rod McLoughlin, the IRFU’s head of medical services, Professor John O’Byrne, orthopaedic and FAI team surgeon, and Dr Pat O’Neill, the former Dublin manager and medical consultant in orthopaedic medicine.

“I challenge everybody: if you think and know what I am saying is wrong, come forth and speak.”

“Come up to the stage, let’s debate,” he added. “Many of them will cower away, and hide under cover because they know in their heart of hearts that what I say is the truth.”

The MyHealth public lecture "Knocking Out Concussion in Sport" will be streamed live at www.rcsi.ie/myhealth.