Concussion: There’s More to the Story than the NFL

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week's article.

Like millions of Americans, my holiday included a trip to the movies. Though Star Wars was the runaway box office favorite for most, mine was a choice in line with my professional and personal interests—healthcare, and sports. I sawConcussion, the true story of neuropathologist Dr. Bennet Omalu’s challenge to the National Football League’s handling of concussions and chronic traumatic encephalopathy (CTE).

The story centers on Dr. Omalu’s investigation of Pittsburgh Steeler legend Mike Webster’s death on September 24, 2002. (1) Omalu’s autopsy revealed a correlation between CTE and the All-Pro’s repetitive concussions and untimely death at 50. It also chronicles steps taken by the powerful National Football league to discredit his findings and drive him from the profession.

Omalu is depicted as an accidental hero in the plot. He was on duty the day Webster’s body was brought to the morgue. Nigerian born, he had no appreciation for who Mike Webster was or what #52 meant in Steeltown. He was a quirky clinician, prone to carry on conversations with corpses as he worked, asking their help in uncovering their stories of death. He was often at odds with the senior administrators and the object of ridicule from his peers as a result of his unusual professional habits.

Upon discovering the correlation between Webster’s brain tissue and CTE, Omalu sought corroboration for his research, eventually co-authoring a monograph published in Neurosurgery. (2) But the story gets more complicated as the powerful National Football League is threatened.

The league first sponsored its own research in 2003 – the first of 16 scientific papers by its Mild Traumatic Brain Injury (MTBI) Committee aimed at discrediting Dr. Omalu’s work. (3) It investigated Omalu and his collaborators with the assistance of the FBI, threatening their professional and personal wellbeing. Scenes in league offices depict the vastness of the NFL enterprise–an industry with 32 teams, annual revenues of $11 billion and a CEO’s compensation package worth $44 million last year. (4) In the end, after the deaths of other players with similar symptoms were examined, the NFL conceded that Omalu was right and they were wrong. But not before running Omalu and his family out of Pittsburgh. (5)

In one particularly compelling scene, Omalu (played by Will Smith) asks his mentor, Dr. Cyril Wecht (played by Albert Brooks), “Why? Why are they all doing this?” His reply is telling: “They’re (the NFL) terrified of you. Bennet Omalu is going to war with a corporation that has 20 million people on a weekly basis craving their product the same way they crave food. The NFL owns a day of the week, the same day the Church used to own. Now it’s theirs. They’re very big.”

I am a football fan: I played in college and am keen to watch the collegiate playoff between Clemson and Alabama next Monday. And I am a student of our healthcare system and the role physicians play at its center. Concussion is about both. It’s one of my three all-time favorite movies about the medical profession along with The Doctor (1991) and Patch Adams (1998).

In The Doctor, William Hurt played Dr. Jack MacKee, a successful surgeon short on bedside manner and long on self-confidence. When he undergoes treatment for throat cancer, his life changes. Compassion and empathy become central to his practice. His transformation from arrogance to humility is the storyline.

In Patch Adams, Robin Williams plays Dr. Hunter “Patch” Adams, a physician whose personal bout with depression frames his unconventional approach to patient care centered on humor and compassion. After receiving a gift from a thankful benefactor, he founds the Gesundheit! Institute in West Virginia to advance his unorthodox methods.

In Concussion, Dr. Omalu insists on being addressed as “Dr. Omalu” by everyone every time. He is a proud clinician quick to recite his credentials and prone to defend his unorthodox clinical methods. In the end, he wins the NFL battle but not before his life is turned upside down.

These stories have one dominant theme in common: they show the best and worst of the medical profession.

All three characters faced criticism from their peers who were threatened or uncomfortable with their work. The lives of the three central characters changed as a result of their personal circumstances but not without negative repercussions from their peers seeking to bully them into conformity. MacKee was mocked by fellow surgeons who preferred treatment of “cases” over connecting with patients as people. Adams faced rejection from the Virginia medical board, which was suspicious of his unorthodox manners. Omalu could no longer practice in Pittsburgh. The stories of the three share the human side of medicine—the toll it takes on the lives of its practitioners when confronted with inconvenient circumstances or facts and the pressure exerted by their peers who seek their conformity.

Gallup surveys show physicians are trusted by patients: they trail nurses and pharmacists, but sit at the top of the professional esteem ladder. (6) As a society, we respect the profession, yet we acknowledge it has its share of bad actors who game the system for personal gain. We like to believe our physicians stand up against institutional bullies who’d have their way over their professional judgement, and we depend on them to make treatment decisions on our behalf.

Surveys also show the majority of physicians are unhappy: they are offended by challenges to their clinical judgment, report cards that compare them unreliably, mandates to use information technologies that add administrative cost without commensurate improvement in efficiency and accuracy, and reimbursement cuts. But the most discouraging element of the profession for most physicians is the prospect they’re losing the trust of their patients as they caution against the erosion of the physician-patient relationship. (7)

Concussion is worth watching for all of us in healthcare. It’s a story about more than professional football. It reminds us of what’s good and bad about the profession of medicine, and the emotional toll it frequently takes when members of its ranks part company with others in the profession. It’s about a physician dedicated to his patient, a famous dead man. And it’s about the science of medicine—sometimes fallible, always important, and rarely incorporated into standard practice as judiciously and speedily as desirable.

Bennett Omalu found fulfillment in being a doctor, though not without paying a cost.

Paul

P.S. This year, 80 of 128 NCAA Division 1 Football Bowl Subdivision (FBS) teams played in 40 bowl games including three with losing records. The NFL just ended its 16-week regular season last week and 12 of its 32 teams will now enter their playoffs culminating in the Super Bowl February 7 in Santa Clara, California. Football is as American as baseball and apple pie, but healthcare is more important, and its MVPs are the physicians, nurses, and professionals who serve us every day. They do not play in front of stadium crowds and cheerleaders. They work in front of anxious patients and out of the spotlight sought by very few. As the New Year starts, it’s a good to be reminded.

Sources
1-“The Autopsy that Changed Football,” PBS Frontline, October 6, 2013

Concussion” Cast: Will Smith, Alec Baldwin, Gugu Mbatha-Raw, Arliss Howard, Paul Reiser, Luke Wilson, Adewale Akinnuoye-Agbaje with David Morse and Albert Brooks. Written & Directed By: Peter Landesman. © 2015 Sony Pictures Digital Productions Inc. 

2-Omalu BI, DeKosky ST, Minster RL, et al. “Chronic traumatic encephalopathy in a National Football League player,” Neurosurgery: 2005;57(1):128-34

3-Pellman, Elliot J. M.D.; Powell, John W. Ph.D.; Viano, David C. Dr. med., Ph.D.; Casson, Ira R. M.D.; Tucker, Andrew M. M.D.; Feuer, Henry M.D.; Lovell, Mark Ph.D.; Waeckerle, Joseph F. M.D.; Robertson, Douglas W. M.D. “Clinical Studies: Concussion in Professional Football: Epidemiological Features of Game Injuries and Review of the Literature,” Neurosurgery: 2004:54(1):81-96

Pellman and his colleagues wrote in January 2005 that returning to play after a concussion “does not involve significant risk of a second injury either in the same game or during the season.” But a 2003 NCAA study of 2,905 college football players found just the opposite: Those who have suffered concussions are more susceptible to further head trauma for seven to 10 days after the injury… Pellman and his group have also stated repeatedly that their work shows “no evidence of worsening injury or chronic cumulative effects of multiple MTBIs in NFL players.” But a 2003 report by the Center for the Study of Retired Athletes at the University of North Carolina found a link between multiple concussions and depression among former pro players with histories of concussions. A 2005 follow-up study at the Center showed a connection between concussions and both brain impairment and Alzheimer’s disease among retired NFL players.

4-Ira Boudway “The NFL’s Secret Finances: A $10 Billion Mystery,” BloombergBusiness, September 4, 2014

5-The FRONTLINE Interviews: League of Denial: The NFL’s Concussion Crisis 

6-Gallup (Trust in Physicians) Honesty/Ethics in Professions, December 2015

7-Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H. “Public Trust in Physicians — U.S. Medicine in International Perspective,” 
N Engl J Med 2014; 371:1570-1572 October 23, 2014 DOI: 10.1056 http://www.nejm.org/doi/full/10.1056/NEJMp1407373

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.