CONCUSSIONS in Sports
Doctors point to "tangible evidence" that ex-wrestler Chris Benoit suffered from a dementia that so impaired his judgement that he killed his wife and son before taking his own life.
Former wrestler Chris Nowinski felt that Benoit's behaviour might have been caused by years of concussions.
Read an interview with Chris Nowinski.
The hunt for clues linking damage Benoit had done to his brain in the ring, and his last, ghastly acts, began with a phone call from the former wrestler and Harvard graduate, Chris Nowinski, to Mike Benoit for the brain of his dead son. Nowinski had a theory about the cumulative effects of years of concussions on the brains of athletes like Chris Benoit.
Nowinski had himself taken enough hits in the ring and on the football field to appreciate the long-term damage of concussions.
The Benoit murder-suicide struck Nowinski as being uncannily similar to the former football players who committed suicide after displaying increasingly erratic behaviour.
- Former Pittsburgh Steeler Terry Long died at the age of 45 in June, 2005 after drinking antifreeze.
- Ex-Pittsburgh lineman Justin Strzelczyk drove his car into oncoming traffic on September 30, 2004, crashing into a tanker truck, losing his life in the explosion. He was 36 years old.
- Former Philadelphia Eagle and father of three, Andre Waters, died of self-inflicted wounds when he took a shotgun to his head in November, 2006. He was 44.
Analysis of their brain tissue revealed the presence of a protein usually seen in the brains of elderly people with dementia, but almost never in normal middle-aged men.
Dr. Julian Bailes has studied more than 3,000 NFL players.
Doctor Julian Bailes at the Center for the Study of Retired Athletes, at the University of North Carolina, studied the after-effects of concussions among 3,000 former NFL players in their retirement years. (Read an abstract of their study)
"What really surprised us was the amount of mental and cognitive problems that they were having, and also depression," says Dr. Bailes.
"It was much more common than we would have expected, than a general population shows. It was correlated with the number of concussions or head injuries they had during their football playing career." (read more of the interview with Dr. Bailes and Dr. Omalu)
Mike Benoit hoped that the examination of his son's brain could provide some answers.
Chris Benoit's father, Mike, wanted to know one thing: Could Bailes find anything in his son's brain or clinical history that would explain why he, like the former football players, would behave so grotesquely out-of-character in the final hours of his life?
In a word, the answer was yes.
Dr. Bennet Omalu, who carried out the examination, diagnosed Benoit's brain as having Chronic Traumatic Encephalopathy, or CTE. In other words, his brain looked like that of an 80- or 90-year-old suffering from a type of dementia.
"You don't find that in a normal brain," said Dr. Omalu. "Chris's brain showed large amounts of these abnormal proteins affecting specific regions of his brain, affecting regions of his brain that maintained mood."
Dr. Omalu examines the brains of former athletes.
The ground-breaking research Doctors Omalu and Bailes had done in the football world could now provide answers to one of the most tragic puzzles to have gripped pro wrestling. Where observers had blamed Benoit's murder-suicide on "Roid Rage," the sudden, violent outbursts stemming from high levels of steroids in the body, something else altogether could explain it.
"We had a biological explanation," says Dr. Omalu, "indisputable…tangible evidence that [Benoit] suffered from a dementia that impaired his ability to, to judge himself....And that most likely within a reasonable degree of medical certainly, made him do what he did."
Just as the NFL has been reluctant to accept the conclusions drawn by similar studies in the past, World Wrestling Entertainment's Vince McMahon Jr. is already expressing his doubts.
"The findings themselves stated Chris Benoit had the brain of an 85-year old man with dementia," McMahon recently told CNN.
"And I would suggest to you that from a layman's standpoint, Chris Benoit could not do what he did for a living. He could not function as a normal human being. He couldn't even go to the airport if in fact that report were accurate."
|Julian Bailes is the chairman of the neurosurgery department at West Virginia University and a leading concussion researcher. He was a team physician for the Pittsburgh Steelers and helped set up the Centre for Study of Retired Athletes at the University of North Carolina.|
Bennet Omalu is a forensic pathologist, neuropathologist and epidemiologist who has studied the long-term mental and behavioural effects of concussions on retired athletes. Dr. Omalu has just published a book called Play Hard, Die Young: Football Dementia, Depression and Death.
They were interviewed by fifth estate reporter Bob McKeown.
Bob McKeown: Dr. Bailes, start by telling me what drew your interest to working with athletes in 2000, football players.
Dr. Bailes: Yes we studied the health of 3,000 players in their retirement years. We found the typical joint problems, heart problems, elevated triglycerides and so forth. But what really surprised us was the amount of mental and cognitive problems that they were having and also depression.
Bob McKeown: Why would that be such a surprise?
Dr. Bailes: Well because it was much more common than we would have expected, than a general population shows. And secondly, it was correlated with the number of concussions or head injuries they had during their football playing career.
Bob McKeown: Where did you take it from there? Where did you take that particular researchH?
Dr. Bailes: Well we continued to look at it. We have brought quite a few of them in to examine them personally in more detail and we continue to analyze what other respects they may have. And another big component we found was the problem of depression, clinical depression being diagnosed in their retirement years or treated for depression. And this likewise was correlated with the number of head injuries or concussions they sustained during their playing career.
Bob McKeown: What was the reception by the athletic community, the NFL, to the suggestions that these players were depressed because of their injuries?
Dr. Bailes: I think there was great scepticism, there is great scepticism, doubt. They had criticized our technique, the method of study. They criticized our results. And so we're looking forward to them doing similar studies and perhaps they will be better funded than we were and can do more detailed or sophisticated testing. And perhaps we'll be proven wrong, but until that time, we have the only study of retired players and it's been published more than once in peer reviewed medical literature.
Bob McKeown: Start with (former NFL'er Mike) Webster and give me a little bit more detail. How did you come to examine the body?
Dr. Omalu: Okay. Webster, he had a heart attack. But his primary care physician had listed post-concussion syndrome on his death certificate. And that would make it post-concussion syndrome is an accidental manner of death and that would make it a coroner's case. It would fall under the jurisdiction of the coroner. And then I was an assistant, a deputy coroner in Pittsburgh. And I was the pathologist on duty that day so I had to by law perform an autopsy on his body.
His brain looked normal. His brain looked grossly normal. However, from my knowledge I knew the brain of an individual with advanced brain disease could look normal on MRI, on CT scan, by naked eye examination. So we subjected his brain to highly sophisticated, very sophisticated tissue testing in a tissue brain research lab. And amazingly it turned out to be positive for advanced dementia, what you see in people in their 70s, 80s and 90s. And this was a 50 year old individual.
Bob McKeown: What was the advancement, what was your contribution to this prcess that hadn't been available before: Dr. Bailes describes your remarkable work. What was remarkable about the work that you'd done?
Dr. Omalu: It was remarkable because all the other doctors that had seen him did not identify the disease while he was living. And autopsies have been performed on retired athletes who had died but nobody in the history of medicine, in the history of sports medicine, ever stopped to subject the brain tissue to such tissue - sophisticated tissue testing.
Bob McKeown: And what that because of the technology that was available to you or just your own interest?
Dr. Omalu: Knowledge. Because I'm a forensic pathologist and also a neuropathologist and also an epidemiologist. So I could put together multifaceted components of high knowledge, very advanced knowledge. And I derived he could have been suffering from a disease similar to punch drunk syndrome.
Bob McKeown: Dr. Bailes, do you remember your reaction to this finding? You were asked to review.
Dr. Bailes: Well I did and I knew Mike Webster fairly well personally. And so we were shocked at his personal demise. And then also really shocked in a way to see that for the first time these sorts of changes were documented by special brain stains as has been described, which has not been known before.
Bob McKeown: But your were looking at the manifestation of a syndreome that had never been seen before, is that fair?
Dr. Bailes: It had never been described in football players, that's correct. In boxers it had been appreciated in the past but wasn't known or felt it was possible to have this occur from playing football.
Bob McKeown: And how did you know Mike Webster personally?
Dr. Bailes: I was a team physician for the Pittsburgh Steelers during part of the time that he played and also I knew him personally off the field as well.
Bob McKeown: And did you see him shortly before his death?
Dr. Bailes: I saw him in his retirement years absolutely.
Bob McKeown: Can you describe how he presented?
Dr. Bailes: Well he was a shadow of his former self, both physically but also I think psychologically and mentally. And again he was one of the greatest football players to ever play. He was a great warrior, great team-mate and he had really become homeless and helpless during those final years of his life, even though he was only in his late 40s.
Bob McKeown: Do you remember your first contact, either of you, with Mike Benoit?
Dr. Bailes: The first was several - a series of telephone calls yes.
Bob McKeown: In which he asked what?
Dr. Bailes: Well he asked, after we went through what we felt was an appropriate mourning time and appreciation for what he was going through, he posed the question basically, could you physicians find anything in my son's clinical history or the examination of my son's brain that would explain why he like many of the football players or all of the football players you examined have very uncharacteristic behavioural and mental problems and have something show up in the brain that would explain it.
Bob McKeown: And when you gave him a positive, do you remember his reaction?
Dr. Bailes: I think he was relieved. I think he was at a much greater level of understanding that perhaps we were on to something and it would have tremendous implications not only for Chris and the Benoit tragedy but also for others.
Bob McKeown: What are those implications?
Dr. Bailes: Those implications imply that it is possible in modern day contact sports, which we know contain bigger and stronger and faster players, regardless of whether it's boxing, ice hockey, wrestling, football, that are colliding at incredible velocities and that this may translate to tearing of brain axons and brain damage that if perhaps all the sequences occurred correctly and maybe with some genetic predisposition, that it could lead to an outcome that's catastrophic or very, very poor in terms of the brain damage.
Bob McKeown: What are the implications for the NFL? Better still what are the implications for the WWE?
Dr. Bailes: I think the implications for the WWE is that ah you know, they have gone to a somewhat theatrical show that involves great heights. It involves jumping off ladders and ropes and it involves high velocity collisions. And I think the implications to me are that ah that you know, that brain injury may seem minor or trivial or not even be noticed but it is possible that that accrues with time and could end up in a catastrophic or major brain damage and some expression of that.
Bob McKeown: You're saying more than is possible, you're saying likely ...your experiments.
Dr. Bailes: It's likely although the numbers are small. I mean you have a lot of people wrestling and fortunately very few major events and catastrophic happenings like Chris Benoit had.
Bob McKeown: Knowing what you know about the NFLPA and the WWE how aggressively will they defend themselves?
Dr. Bailes: I'm sure they will aggressive defend themselves and defend their sport and that's understandable. But I think we need to get beyond that to a greater understanding of the science and really analyzing what we have found in every football player we examined who had this sort of clinical outcome. Every case had advanced changes in the brain which you should never see in ones of that age. So the odds of that are maybe a million to one that it would occur by change. I think those are serious findings that need to be addressed seriously and hopefully they will.
Bob McKeown: When you said it's a million to one shot that you'd find this in this kind of sampling, how large was the sampling and how did you choose the people you sampled?
Dr. Bailes: I would look at it the other way. If this is never to be seen - if the odds of this tow protein, if the odds of the abnormal brain proteins being seen in someone in their 30s or 40s is one in a hundred and if you see it in every single athlete that you study and they all had a clinical or behavioural manifestation which was very similar, ending in suicide, then the odds of them all being positive I think are a million to one. I think that they are very compelling findings that mean that every organized body that has contact with athletes need to appreciate the fact that brain injuries may be more severe than we previously thought.
Bob McKeown: And what's been...organizations like the NFL's take on this, do you anticipate?
Dr. Bailes: Well I anticipate they will look at it. I anticipate they will scrutinize it carefully. They say that they are going to do their own studies and we have acknowledged that and will appreciate that they can do it perhaps in a better funded and more detailed manner than we can or we could. And we look forward to their findings.
Bob McKeown: Dr. Omalu, take me through the process of sort of the chronology of what went on, Chris Benoit and your finding in that case, starting with his death.
Dr. Omalu: When he died, Chris Nowinski - I had been - we had been walking together. So Chris gave me a call to confirm that ah he could pursue Chris Benoit's case. So he told me he - his story, his background, that he had sustained concussions while wrestling. And that he died violently. He had committed two homicides, committed a suicide.
So I confirmed that that would be a high index case, a case I would be interested in looking at. And I examined his pre-morbid history of drug abuse -
Bob McKeown: In English, what does that mean?
Dr. Omalu: Pre-morbid history?
Bob McKeown: Yeah.
Dr. Omalu: His behaviour profile, his behaviours before he died. He had documented history of depression, of mood disorders, of some quasi-religious experiences. And he was simply acting out of character.
So I thought that was a high index case and I encouraged him to contact the medical examiner who performed the autopsy. We examined his brain here and then sent it to a highly specialized brain lab. And ran out almost about 250 different types of staining, looking at specific regions of the brain. These are very sophisticated tissue analysis.
So I remember after about two months all the tissue slides came back and I looked at them here in Dr. Baile's department and we made a confirmatory diagnosis of CTE, Chronic Traumatic Encephalopathy, simply meaning Chris Benoit's brain looked like the brain of an individual suffering from a specific type of dementia and this type of dementia you see in people in their 80s and 90s which was extremely unusual.
Mr. Benoit was only 40 years old, extremely unusual. You don't find that in a normal brain, not even - and Chris's brain showed large amounts of these abnormal proteins and affecting specific regions of his brain, affecting regions of his brain that maintained mood. So we had a biological explanation, indisputable. ... question of tangible evidence that he suffered from a dementia that impaired his ability to, to judge himself, ability to, to socially inhibit himself, his ability to simply be a refined human being. And that most likely within a reasonable degree of medical certainly made him do what he did.
Bob McKeown: When you say medical certainty do what he did, are you including the murder of his wife and child.
Dr. Omalu: Yes.
Bob McKeown: You're convinced that he was beyond - that he was a victim as much an an executioner.
Dr. Omalu: Yes.
Bob McKeown: That it was an accident.
Dr. Omalu: Yes. Because all the cases - again based on the ... principles of -
Bob McKeown: Say it again.
Dr. Omalu: General sub-type principles of medicine, common knowledge, established facts, published literature, these individuals are not fully cognitive, aware of what they are doing. And all the cases we've looked at and all the cases published in literature, most of them had impairment of their behaviour, of their cognition, of their intellect. Most of them were depressed. In fact, all of them were depressed. And a good number of them committed suicide; almost all of them attempted suicide once or twice in their lives.
Bob McKeown: The difference here though is for the first time you're implying that even homicide is part of this, potentially part of the syndrome. So when I ask you what the implications are, are you being modest in saying that we're going to have to wait and see? This is potentially a time bomb or a major explosion, legally, ethically, politically. Have you ocnsidered those consequences?
Dr. Omalu: This is not the first time it's happened. This is not the first time a retired boxer, a retired sports athlete is abusing his wife or beating - become involved in criminal violent behaviour, even killing his spouse.
Bob McKeown: Oh really.
Dr. Omalu: If you searched in the literature.
Bob McKeown: I see. But Benoit I take it have become more of a flashpoint.
Dr. Omalu: Yes because now we have indisputable tissue ... unquestionable evidence.
Dr. Bailes: I agree. And of course it's difficult and medicine and science can't always explain human behaviour. But this gives us maybe for the first time we think indisputable evidence that there was advanced changes in his brain. His brain had widespread extensive shocking areas all throughout of dead brain cells and their connections. We think maybe that brain was in a behavioural sense de-af... and disconnected. No longer able to cope with normal life's events and stressors. We don't think it was (roid) or steroid rage. We think it's a different syndrome than that. And we think that it is a very - fortunately a small number but a very important syndrome to understand.