Yesterday I apologized for falsely suggesting that Dr. Robert Cantu had airbrushed the history of chronic traumatic encephalopathy research in his remarks last week at the Dave Duerson brain study press conference.
Today I offer an extended P.S. on the nuances of that research and its political landmines. The story of CTE involves maimed and prematurely dead athletes, of course. But it also includes egos, grants, media coverage … in sum, careers. The behind-the-scenes rivalry between the Boston research group, led by the Sports Legacy Institute’s Chris Nowinski and Boston University Medical Center’s Cantu, and the West Virginia research group, led by Drs. Julian Bailes and Bennet Omalu, is a glimpse into that world. The stakes are high for the parties – and for the rest of us.
Let’s stipulate that any controversy over the origins of the naming of this brain disease is a sideshow in comparison with the substance of what Omalu brought to the table – unfortunately, it was literally the autopsy table – over the last decade. I would summarize it thusly:
- For many years, there was an understanding that boxers suffered various symptoms resembling Parkinson’s Disease, accompanied by dementia.
- There was also an escalating appreciation that people in all walks of life who suffered major traumatic brain injury could develop a disease that resembled Alzheimer’s.
- Beginning with Mike Webster in 2002 and continuing through to the Nowinski group’s initial and breakthrough finding, on pro wrestler Chris Benoit in 2007, Omalu put what we now call CTE on the map. Omalu determined that minor blows to the head, over time, with or without documentation – notably in football, hockey, lacrosse, and wrestling – could result in a disease distinct from Alzheimer’s. Omalu is publishing an overview on all this in the journal Neurosurgery; it is available in advance in electronic form, and I wrote about it here on March 9. See “Concussion Research Pioneer Bennet Omalu Returns to ‘Neurosurgery’ Journal,” http://wrestlingbabylon.wordpress.com/2011/03/09/concussion-research-pioneer-bennet-omalu-returns-to-%E2%80%98neurosurgery%E2%80%99-journal/.
Omalu has defined CTE as a disease entity. He also has confirmed that what we used to think of as Parkinson’s or Alzheimer’s or their offshoots are not these diseases in victims of CTE, which has distinct pathognomonic diagnostic features.
Nomenclature aside, there was no media attention given to CTE until after the publication of the Mike Webster paper in 2005.
About that nomenclature:
- There is evidence that “punch drunk syndrome” in boxers, or dementia pugilistica, was also being called “traumatic encephalopathy” as early as the 1930s.
- A 1996 paper in Pathology, “Dementia Pugilistica in an Alcoholic Achondroplastic Dwarf,” by David J. Williams and Anthony E.G. Tannenberg,” says that dementia pugilistica is “otherwise known as chronic progressive post-traumatic encephalopathy of boxing.” Not exactly the same as CTE – though so close that I probably would have felt compelled yesterday to clarify and apologize to the Boston folks even if they hadn’t also shared with me …
- A 1966 paper from Proceedings of the Royal Society of Medicine, “Mental Sequelae of Head Injury,” by Henry Miller, has a subsection headed “Chronic Traumatic Encephelopathy.” Though Miller did not seem to go anywhere with this term in the body of the article, nor give it the abbreviation CTE, the exact sequence of the three words clinched at least the minimal point that great minds prior to Omalu had thought at least somewhat alike. And it confirmed that I’d stubbed my toe in my May 3 story on Duerson.
I haven’t yet gotten to my promised oration on how fetishized peer-review literature too often amounts to trees falling in a forest with no one around to hear or act on them. I’ll get to that next, I think.