Dr. Bennet Omalu, the famed forensic pathologist who discovered Chronic Traumatic Encephalopathy (CTE), recently spoke at NCI at Frederick about his upbringing as well as the trials he faced while working to educate the NFL about CTE. Along with Omalu, Dr. Gary Small, a professor of Psychiatry at the University of California, Los Angeles, spoke about his work utilizing brain imaging to map brain trauma in living patients. Omalu and Small were invited to Frederick by Karen Wylie, Ph.D., science officer, the Congressionally Directed Medical Research Programs, USAMRMC.
The talk, titled The Science and Humanity of Chronic Traumatic Encephalopathy (CTE), covered most of Omalu’s life, starting with his birth in Nigeria during the country’s civil war. His parents were refugees, and Omalu himself was born in a mountain village hideout. His parents named him Bennet (“blessed”) Ifeakandu (“life is the greatest gift of all”) Omalu (“if you know, you must come forth and speak”), a name that Omalu has taken to heart and from which he has drawn inspiration throughout his life.
As a child, he was malnourished and underdeveloped. He didn’t play sports with his siblings or friends, and he eventually became depressed and withdrawn. But, he says, at the height of his loneliness, he learned about the power of imagination and knowledge, and he decided to devote himself to learning and education.
He became an excellent student and enrolled in medical school, a common practice for the smartest students in Nigeria, though Omalu had no interest in becoming a physician at the time. In fact, he wanted to be a commercial airline pilot, a career he felt was in line with his self-image as “a simple man with simple pleasures who wanted to lead a simple life.”
Despite his misgivings, Omalu completed medical school and came to the United States to work at the University of Pittsburgh. There, he had the opportunity to analyze former Pittsburgh Steeler “Iron” Mike Webster’s brain, which led to his hypothesis about the degenerative brain condition that came to be known as CTE.
Lacking institutional support and facing strong opposition from the NFL, Omalu spent his own money to travel the country talking to football players and continue researching CTE. He published a paper on his findings, but his colleagues dismissed his work, and he was ultimately fired from his job in Pittsburgh.
Undeterred, Omalu continued to evaluate brains at his home, and he often spent his own money to send tissue samples to labs for evaluation. He believes strongly in seeking the truth and has even found a common thread between his research and his faith that has helped him endure.
“Society will want you to believe that science and faith do not go together; I will tell you that is not true. Science and faith have a common endpoint: the truth,” Omalu said.
In a sense, Omalu seems to attribute some of his success to the headwinds he has faced. He believes in the value of working independently because there is no one—whether a lawyer, journal editor, or colleague—to tell him to stop, and he says his discovery may not have been possible if he was following the standard groupthink or adhering to what he calls “conformational intelligence.”
Omalu now talks often about conformational intelligence, which he sees as thought processes controlled by societal expectations and norms and which he believes is prevalent in academies, universities, and institutions. He also remains undaunted by the resistance his CTE research has faced because, in his words, “if you refuse as a group to evolve, science leaves you behind.”
“The talk was a fascinating personal account of the adversity Dr. Omalu faced as he was trying to learn and define why NFL players were dying earlier than would have been expected and with cognitive issues that impacted their quality of life,” said Howard Young, Ph.D., Senior Investigator, Cancer and Inflammation Program, and one of the organizers of Omalu’s visit.
“As a huge organization—the NFL—was trying to discredit and silence him, he persevered and has now impacted athletics around the world. Few if any physicians/scientists have made such an impact on sports medicine. His talk was complimented by that of Dr. Gary Small, who described the latest brain imaging technology and the efforts to identify biomarkers that could be predictive of concussions/head trauma.”
The Spectrum of CTE
Since identifying CTE in football players, Omalu has continued to pursue a more nuanced understanding of the disease. In conjunction with Small, Omalu hopes to change the narrative surrounding traumatic brain injuries.
According to Small, Omalu was the first researcher to connect the brain damage he was seeing to a clinical syndrome. But that was only the beginning—Small argues that CTE is not a single diagnosis but should be viewed as a spectrum. Together, they are working to identify the different “stages” of CTE in brain scans.
“We should look at CTE as a spectrum and look at Alzheimer’s as an end-point of various disorders, kind of like cirrhosis of the liver,” Omalu said. “CTE doesn’t look like Alzheimer’s in the beginning, but CTE patients share many symptoms of Alzheimer’s in late stages.”
As part of their research into traumatic brain injury (especially in the military), Small’s group has developed a marker for FDDNP-PET scans that attaches to abnormal proteins (called “Tau”) and can identify Tau build-up. It gives researchers an opportunity to see plaque/tangle abnormalities long before patients develop memory loss or other outward symptoms of brain damage.
Recently, the FDA recommended plans for a Phase III study of FDDNP-PET as a method for brain trauma diagnosis. Given a successful outcome, the FDA may grant approval, but first, Small’s group needs to study the method on a larger number of patients, show that doctors can consistently read and evaluate the scans, and differentiate between stress-induced and trauma-induced cases of post-traumatic stress disorder (PTSD).
In the meantime, Omalu and Small have begun testing NFL players using FDDNP-PET. Last year, the first NFL player tested with FDDNP-PET passed away, giving Small and Omalu the opportunity to compare the brain scans to a posthumous analysis of the actual brain. The results were highly correlated, and Omalu said a paper detailing the results should be published soon.
As they continue their quest to understand traumatic brain injury, Omalu and Small could be opening the door to solving problems far beyond the football field. Though CTE is notoriously problematic in former NFL players, combat veterans—particularly those who are blast victims—share many similarities.
Small says he sees FDDNP-PET as a potential “military readiness” test that could identify trauma-induced PTSD and help get soldiers the care they need. Additionally, Omalu pointed out that 60–80% of violent criminals in America have a history of traumatic brain injury (the CDC reports anywhere from 25–87%), which means that the importance of Omalu and Small’s research extends to all corners of society.
“Although both the talk, and the person who gave it, are much more complicated than could be revealed in any simple quote, I think that the most important messages can be boiled down to two main points,” said Stephen Hughes, Ph.D., chief, Retrovirology Replication Lab, Center for Cancer Research. “First, believe the data, and what the data tell you, even if (especially if) the answers are not what those in positions of power and authority want to hear, and 2) in science, the truth will come out sooner or later, even if the initial discovery is made by someone who is not in a position of power or authority and [if] those who are initially reject the truth.”