Frontline Documentary Investigates NFL And Brain Injuries
October 8, 2013 1:19 p.m.
Jim Gilmore, Frontline Producer
Dr. Alexander Khalessi, Director of Endovascular Neurosurgery and Surgical Director of NeuroCritical Care at UC San Diego
Related Story: Frontline Documentary Investigates NFL And Brain Injuries
CAVANAUGH: The NFL's season is in full swing, but this year, there's a parallel drama being played out far from the action on the field. An investigation into the effects of concussion and repeated head injuries to football players may rock the very foundations of the sport. In San Diego, we felt the shock of losing Chargers great Junior Seau to suicide, and it was found that he was suffering from chronic brain injury. Tonight KPBS will air a frontline documentary called League of Denial. It looks into how the NFL is responding to increasing evidence that repeated head injury puts players at risk for degenerative brain diseases. My guests, Jim Gilmore is with us, producer for Front line. And welcome to the program.
GILMORE: Thank you. Glad to be here.
CAVANAUGH: Doctor Alexander Khalessi is director of endovascular neurosurgery, and surgical director of neurocritical care at UC San Diego. Welcome back.
KHALESSI: Thanks very much, Maureen.
CAVANAUGH: I'd like to start with a clip from a League of Denial. This is Peter Keating.
NEW SPEAKER: The way the NFL handled this is for 15 years to do research that looks awfully like it was designed to say that the league was okay in doing what it was doing, which wasn't much, to protect players from the injuries of concussions.
CAVANAUGH: That is from the documentary. And Jim, as the producer for this documentary, this film is being put out in conjunction with the book of the same name. That was the focus of their investigation?
GILMORE: The book is being put out by very impressive journalists with ESPN. And they started about two years ago, investigating this whole area. And I think they and we as well, our focus was to look at the history of this debate. A debate that goes back to the late 80s, really, about the concerns over concussions. And to follow the years and the important events that took place. And as our knowledge grew on what the dangers were, and yet at the same time how the NFL throughout this period of time seemed to deny the seriousness of it. And whenever they could, sort of pooh-pooh basically some of the research that was out there.
CAVANAUGH: Jim, a lot of this information about professional football and head injuries, and the possibility of future brain disease, that has been out, and the public hasn't heard about this for a while. What does this documentary tell viewers that's new or more comprehensive.
GILMORE: I think one of the things that Frontline has always done better, we pull together the entire story, we put it in one place, and we put it into perspective. We have the best voices, important voices on all sides that talk about an issue. And people will say, listen, I followed this story forever. And I've read every article. But this is the first time it all made sense because it was all in one place. So my stitching a story together, by pulling some of the material that's already been out there but bringing it to our audience in a new way in one place at one time for two hours on television, oftentimes it puts it into perspective, like it has to be done so you understand the way forward.
CAVANAUGH: In many ways, the story starts out, the whole story of what we know about the link between head injury and future brain disease starts out with a tragic end to former Pittsburgh Steeler Mike Webster. How did his death lead to research into football and brain injury?
GILMORE: We spent a lot of time in the first hour looking at Webster's case because it's so powerful and so important a case. Mike was wonderful to everyone in Pittsburgh and everyone who loves the game of football. Amazing, powerful man named Iron Mike, center for the Steelers, four super bowl wins, are almost 20 years in the league. A guy who was kind hearted, a great family man, and a great football player. What happened in his retirement is very quickly he went downhill and basically became addled, and it was something that seemed to be like senility. He ended up losing all his money because of not being able to care for himself economically or medically. Had not enough money to go to dentists or doctors. Would superglue his teeth together. His family broke apart his, his wife and he broke up. Then he died at the age of 50 of a heart attack. He ends up, luckily, going to the morgue in Pittsburgh under the care of a doctor, a Nigerian doctor by the name of Bennett Omalo who doesn't understand what happened to this man. It didn't make sense. He thought there was something wrong, and he wanted to find out what it was. And despite everybody else saying there's nothing wrong with this guy's brain, he died of a heart attack, he spent the time to evaluate the brain. They took slices of the brain, sent them away, and tested them, and what he found was that Mike Webster had a has, CTE, chronic traumatic encephalopathy, something that had never been found in a football player before. Something similar to what was found in boxers for many years. And there was an extremely important turning point. This is the first time that it was acknowledged. And it sent doctor Omalo and others down this path to investigate it and find out if Mike Webster was the only one.
CAVANAUGH: Doctor colessy, what is CTE? What does it do to the brain?
KHALESSI: It's a terrific question, Maureen. I think there are several features of the story that Jim related that I think are important for your viewers. It remains an autopsy diagnosis. Unfortunately right now, we don't have a way in real-time to identify it for existing players or their patients. From a clinical standpoint, it divides into four progressive stages. The first time is usually you have a disruption of emotion. You can develop aggressive behavior, you can become depressed, you can see the disruption in your day to day life. As it progresses, you start start to lose certain functions, and in the late stage Udevelop full dementia. Our thinking now is with repeated blows to the head, you can develop a secondary pattern of injury in the brain. We find certain abnormal proteins, and we think that leads to this diagnosis. And from a scientific standpoint, CTE is really the first condition where we see these findings from an environmental insult. That is we see these type was proteins in Alzheimer's and other forms of dementia. But one of the real things that distinguishes CTE, it's the first time that we see a normal neuronal response in the setting of an environmental insult. It's difficult to understand upfront who's going to develop this condition. So the jury is absolutely still out on whether it's due to repeated blows to the head, due to blows to the head in close sequence to one another during a period of vulnerability, or if there are other underlying factors that actually predispose someone to develop this condition based on their genetic makeup or other things like smoking, other drugs, or psychosocial stressors.
CAVANAUGH: That goes to the very heart of what League of Denial is about. The authors say that the NFL tries and continually tries to hide the links between football and brain damage. How has the league done that, according to the authors?
GILMORE: In 1994, they set up a committee called MTBI, or mild traumatic brain injury commit, and they ended up putting out 16 reports over a period of year, up to 2007, and most of these reports ended up defining a lack of seriousness when it came to what was really going on, when it came to concussions. There were points made that it didn't seem there was any concern over long-term damage to the brain from these traumatic hits to the head. It seemed that people could go back into a game even though they had suffered from a concussion. There were hints of the fact that even though there was no studies done, that even children or people playing, younger kids playing high school and before that could possibly also go back into the game after having a concussion. This went on for a lot of years. And there was at the same time other scientists coming up with very important points of view about what was going on. Long-term studies were never done by the MTBI. And so that was really what was necessary. And as more and more pressure was brought on the league and even up to the point of 2009 with Congress really pushing on whether the NFL was acting to some extent like the tobacco industry had in denying any connection to these illnesses, more was done. But to this day, they deny that there's enough evidence of causation or any evidence enough evidence about prevalence of these injury to know for sure what the truth is. But the pathologists that we talked to, and they are really sort of a main focus of this program and sort of the heroes, I think there's about 46 players now that they've investigated the brains of and out of that 46 NFL players, 45 out of them have CTE. And they see this as a red flag, and they see this as evidence that there's a possibility that the prevalence is much greater, certainly much greater than the NFL has ever admitted to.
CAVANAUGH: Now, doctor colessy, you're part of a new program that started this year, sitting on the sidelines at Chargers games. What are you doing there as a neurosurgeon? What are you trying to observe?
KHALESSI: Yeah, it's a terrific question. I think it's important for your viewers that they understand that I in no way speak on behalf of the league or the NFL. Buff one of the several things that the NFL has done, led in large part by the head of the concussion committee, has started this unaffiliated commercial traumatic program. And that involves -- the unaffiliated part applies to not being affiliated to any particular team. There is a fully trained neurosurgeon on both sidelines at every NFL game this year. And the idea is that that individual could communicate with an ETC spotter, reviewing all the replays on look for hits. If there's ever a situation where a player in real-time sustains what appears to be a concussion, the physicians can call upon the neuroconsultant to make the assessment to determine whether the patient is able to return to play. And I think to Jim's earlier comment, the discussion essentially divides into two separate phases. The first phase is in real-time making precisely those types of assessments. Does someone have ongoing neurological problems because of head injury? It's important to define what a concussion actually is. It's not a permanent structural insult to the brain. In the same way that an orchestra plays a symphony, your nerves have to fire in a very concerted way for us to function properly. So it's a disruption of that function of the brain that can be temporary. So being able to determine whether someone has ongoing symptoms, there's a situation where they should be removed from any sort of contact situation. And there have been a lot of games in looking at people overtime and making sure that that person is not subjected to further risk. And I think that in academic neurosurgery, sometimes something we've taken very seriously for a long time, and I'm grateful that someone who's at a university where people have devoted their whole lives to parsing out these kind of questions that now the investments are being made to not only protect our young people, to protect our military personnel returning with blast injuries, and of course our professional athletes but also to apply the lessons learned in that situation to a much broader range of neurologic diseases.
CAVANAUGH: Go ahead, Jim.
GILMORE: I was just going to comment. I think what he says is very important. And some of the folks that we talked to in the film bring up the point that of course the brain is the most complicated piece of the body that there is, and it's very, very hard to understand. And that's why this is such a complicated discussion. And one of the real concerns that a lot of the doctors that we talked to about is the difference between a 13-year-old or an 8-year-old and a 30-year-old. And the differences in that is important to this debate as well. This whole issue of how the game is played and what is defined as the problems or lack of problems when it comes to potential long-term effects is all filter down to colleges and high schools and younger kids that are playing nationwide up to 3 million kids, and that's where a real concern is also. As doctor Cantu talks about, before the age of 14, a child's brain and neck and anatomy is so different, and they're affected so much more, that one has to be very, very careful. And what we've always found is that even though there are -- there certainly are changes being made by the NFL and the pro level a lot more is being done like practices they're not always hitting each other, they're not full-contact, and yet in neighborhoods around America, a lot of that information doesn't pass down quickly. And I know in my town, the kids that are playing football, eight, nine, 10-year-olds are still having full contact during every practice. And this is why this debate is so important to have. And I think one of the main reasons we made the film.
CAVANAUGH: League of denial airs tonight on KPBS television. Thank you both very much.
KHALESSI: Thank you, Maureen.
GILMORE: Thank you very much, Maureen.