(Written by Ewan Ross: research assistant
For Hollywood, a film about medicine and public health is unusual. ‘Concussion’ is exactly this, it tells the story of the doctor who showed that the repeated head injuries that American Footballer players are subject to are causing significant damage to the brain. This isn’t intended as an informative documentary – but we might learn something! I won't talk in detail about Chronic Traumatic Encephalopathy here. “Concussion” is about entertainment, while it is a little unusual it has all the elements in place.
Dr Bennett Omalu (played by Will Smith) is an eccentric but brilliant doctor and polymath and yet a classic underdog. Dr Omalu is a Nigerian born Pathologist working in Pittsburgh, Pennsylvania. He discovers that American Football is causing very serious damage to the player’s brains later in their lives. But when he tells this story he comes up against the apparently unstoppable force of the National Football League, the company behind professional American Football, who want to keep this quiet. Quickly this becomes an important battle to expose the truth.
Dr Omalu happens to be the pathologist who is asked to work out how ‘Iron Mike’ Webster has died, aged 50. Mike Webster is considered one of the greatest players of all time and his fall from grace after retirement was astonishing. The film shows him living in a truck, confused and angry having abandoned his family. It is by any measure a very bad picture indeed. He has nothing left from his glorious career as a 4 time Superbowl winner with the Pittsburgh Steelers. Other players come to him to share their fears, similar problems they are having, memory failure, sudden bursts of anger and family breakdown. It is sad to accept that these problems do indeed occur far too often to patients after suffering a head injury. His own physician, who worked with him during his playing career is at a loss. Webster self administers shocks from Taser to help him forget pain and sleep, and soon is found to have passed away. Surely they can find something that explains his suffering?
Dr Omalu is shocked to find that the brain of this man looks completely normal from his routine tests and so he sets off on this own self funded and controversial mission to discover the cause of Websters suffering. He pores over slices of brain tissue and then shares them with some expert colleagues. The human brain has no natural shock absorber to protect it from the 70,000 impacts that he calculates that a professional Footballer might sustain over a long career. The majority of the game is built around using the head as the tip of a battering ram to control the play. Omalu argues that a common head collision can be 100 G (100 times the force of gravity) – which is consistent with scientific reports using accelerometers to measure this. He also talks of a cascade that “unleashed killer proteins upon Mike Webster’s brain” referring to a damaged form of the Tau protein, that is seen to be damaged in other neurodegenerative diseases and is thought to be the cause of the problem a new disease they call ‘Chronic Traumatic Encephalopathy’ or CTE. They have to gain more evidence after their discovery with Webster and in due course other former NFL players have similarly suffered and also died, often through suspected suicide. From dramatized depictions as well as news and archive footage, their suffering is harrowing to watch. The researchers convince families and players to help with their studies and eventually diagnose 3 further players with CTE after their deaths, Terry Long, Andre Waters and Justin Strzelczyk. In a dramatic scene, Omalu curiously states “3 cases is the scientific burden of evidence. We have 4. That is far beyond anything the NFL can or cannot deny”. It’s a bizarre statement and I can’t find anything to support the 3 cases theory! And with that the science part of the film is effectively over now I’m afraid. It’s a bit rushed to say the least.
It was always likely to be rushed in fairness. Even now we don’t completely understand CTE very well, a decade later. And importantly, there are some boxes to tick to make a ‘successful’ modern movie. We are constantly reminded that Omalu wasn’t born in America and is struggling to prove himself as a good American. Some time is spent convincing us that he wants to build a fantasy house. He meets the only female character in the film early after he is told to get a girlfriend and a dull romance plays out – it’s an embarrassing representation in a film that lacks any other female roles. In any case – boxes are ticked.
The story that we really get in to is the fight to show the NFL that the brain damage is a real and serious consequence of the game. As soon as Omalu and his colleagues publish their first study and begin to talk about their new diagnosis of CTE they are threatened, taunted and blackmailed by those who wish to protect the sport. The film does point out that while American Football is a sport, it is also an ‘entertainment product’ and a huge money business. For many fans the big hits are the entertainment. If you take away the crushing force of the tackle you take away everything that makes this game popular. ‘Concussion’ has a hard time getting its message just right but in the end it comes over. It wants to say that the head injuries are real and cause serious damage, that the NFL has been dishonest and guilty of some very serious misinformation but above all the sport is still a beautiful thing. Its as if even the film is holding back a little so as not to damage the glory of the game.
Indeed, many of the characters, from doctors to NFL representatives explain why they have not and will not speak up for players health because it would destroy the game, thinking it is better to sacrifice some players health and ultimately their lives than to sacrifice their favourite sport. Employer, entertainer, charity, educator and salvation are all words used to describe the NFL. Team doctor’s explain why they didn’t protect their players more, they just did “whatever it takes to keep the whole thing going”, put a plaster on it and send them back on to the field. All too late someone remarks, “It’s not medicine, I don’t know what it is” but I feel that they get away with it.
Omalu’s detached position is important. He is happy to admit that he knows nothing about the game, and this way he has none of the sentimental bias of the others. The NFL has commissioned its own reports in to the danger of head injuries and perhaps unsurprisingly they find nothing to worry about. This is relevant throughout science. The outcome of some research may well depend on who has paid to have it conducted. The tactics of the NFL to discredit the science and bully the scientists to keep them from their work is terrible. Their efforts to keep players, fans and everyone in the dark about what they really knew about the risk of brain injury come across as clearly wrong. The comparison is made to the actions of the big tobacco companies in the 1990’s when they scrambled to deny the impact of smoking tobacco on people’s health and it is probably a fair one. But I can’t help think that the guilty individuals and organisations who are depicted here escape the tackle a little too easily. There is forced sense of resolution at the end of the film that never really makes it clear what has happened or what has changed. ‘Concussion’ may have a medical point to make but it is also a film that wants to embody the American dream and unfortunately this acts as a defence of this sports entertainment industry.
Still, there is now a much wider sense of acknowledgement that head injuries are a real problem in American football, and high impact sports generally, including Rugby where the story is just getting started. The NFL has a compensation fund and has given money for health checks and research. This film tells an important story that does speak of the science, and it does show the real issues that scientists and doctors meet when they say something that isn’t popular, or isn’t profitable. Its not a perfect film by any means – but I’m glad that this has contributed to a bigger conversation about head injury and safety in sports. It is bound to be part of the ongoing discussion and I guarantee that you’ll go on to read more after watching it!
Further reading:
The original article that inspired the film:
http://www.gq.com/story/nfl-players-brain-dementia-study-memory-concussions
and an update
http://www.gq.com/story/update-game-brain
For Hollywood, a film about medicine and public health is unusual. ‘Concussion’ is exactly this, it tells the story of the doctor who showed that the repeated head injuries that American Footballer players are subject to are causing significant damage to the brain. This isn’t intended as an informative documentary – but we might learn something! I won't talk in detail about Chronic Traumatic Encephalopathy here. “Concussion” is about entertainment, while it is a little unusual it has all the elements in place.
Dr Bennett Omalu (played by Will Smith) is an eccentric but brilliant doctor and polymath and yet a classic underdog. Dr Omalu is a Nigerian born Pathologist working in Pittsburgh, Pennsylvania. He discovers that American Football is causing very serious damage to the player’s brains later in their lives. But when he tells this story he comes up against the apparently unstoppable force of the National Football League, the company behind professional American Football, who want to keep this quiet. Quickly this becomes an important battle to expose the truth.
Dr Omalu happens to be the pathologist who is asked to work out how ‘Iron Mike’ Webster has died, aged 50. Mike Webster is considered one of the greatest players of all time and his fall from grace after retirement was astonishing. The film shows him living in a truck, confused and angry having abandoned his family. It is by any measure a very bad picture indeed. He has nothing left from his glorious career as a 4 time Superbowl winner with the Pittsburgh Steelers. Other players come to him to share their fears, similar problems they are having, memory failure, sudden bursts of anger and family breakdown. It is sad to accept that these problems do indeed occur far too often to patients after suffering a head injury. His own physician, who worked with him during his playing career is at a loss. Webster self administers shocks from Taser to help him forget pain and sleep, and soon is found to have passed away. Surely they can find something that explains his suffering?
Dr Omalu is shocked to find that the brain of this man looks completely normal from his routine tests and so he sets off on this own self funded and controversial mission to discover the cause of Websters suffering. He pores over slices of brain tissue and then shares them with some expert colleagues. The human brain has no natural shock absorber to protect it from the 70,000 impacts that he calculates that a professional Footballer might sustain over a long career. The majority of the game is built around using the head as the tip of a battering ram to control the play. Omalu argues that a common head collision can be 100 G (100 times the force of gravity) – which is consistent with scientific reports using accelerometers to measure this. He also talks of a cascade that “unleashed killer proteins upon Mike Webster’s brain” referring to a damaged form of the Tau protein, that is seen to be damaged in other neurodegenerative diseases and is thought to be the cause of the problem a new disease they call ‘Chronic Traumatic Encephalopathy’ or CTE. They have to gain more evidence after their discovery with Webster and in due course other former NFL players have similarly suffered and also died, often through suspected suicide. From dramatized depictions as well as news and archive footage, their suffering is harrowing to watch. The researchers convince families and players to help with their studies and eventually diagnose 3 further players with CTE after their deaths, Terry Long, Andre Waters and Justin Strzelczyk. In a dramatic scene, Omalu curiously states “3 cases is the scientific burden of evidence. We have 4. That is far beyond anything the NFL can or cannot deny”. It’s a bizarre statement and I can’t find anything to support the 3 cases theory! And with that the science part of the film is effectively over now I’m afraid. It’s a bit rushed to say the least.
It was always likely to be rushed in fairness. Even now we don’t completely understand CTE very well, a decade later. And importantly, there are some boxes to tick to make a ‘successful’ modern movie. We are constantly reminded that Omalu wasn’t born in America and is struggling to prove himself as a good American. Some time is spent convincing us that he wants to build a fantasy house. He meets the only female character in the film early after he is told to get a girlfriend and a dull romance plays out – it’s an embarrassing representation in a film that lacks any other female roles. In any case – boxes are ticked.
The story that we really get in to is the fight to show the NFL that the brain damage is a real and serious consequence of the game. As soon as Omalu and his colleagues publish their first study and begin to talk about their new diagnosis of CTE they are threatened, taunted and blackmailed by those who wish to protect the sport. The film does point out that while American Football is a sport, it is also an ‘entertainment product’ and a huge money business. For many fans the big hits are the entertainment. If you take away the crushing force of the tackle you take away everything that makes this game popular. ‘Concussion’ has a hard time getting its message just right but in the end it comes over. It wants to say that the head injuries are real and cause serious damage, that the NFL has been dishonest and guilty of some very serious misinformation but above all the sport is still a beautiful thing. Its as if even the film is holding back a little so as not to damage the glory of the game.
Indeed, many of the characters, from doctors to NFL representatives explain why they have not and will not speak up for players health because it would destroy the game, thinking it is better to sacrifice some players health and ultimately their lives than to sacrifice their favourite sport. Employer, entertainer, charity, educator and salvation are all words used to describe the NFL. Team doctor’s explain why they didn’t protect their players more, they just did “whatever it takes to keep the whole thing going”, put a plaster on it and send them back on to the field. All too late someone remarks, “It’s not medicine, I don’t know what it is” but I feel that they get away with it.
Omalu’s detached position is important. He is happy to admit that he knows nothing about the game, and this way he has none of the sentimental bias of the others. The NFL has commissioned its own reports in to the danger of head injuries and perhaps unsurprisingly they find nothing to worry about. This is relevant throughout science. The outcome of some research may well depend on who has paid to have it conducted. The tactics of the NFL to discredit the science and bully the scientists to keep them from their work is terrible. Their efforts to keep players, fans and everyone in the dark about what they really knew about the risk of brain injury come across as clearly wrong. The comparison is made to the actions of the big tobacco companies in the 1990’s when they scrambled to deny the impact of smoking tobacco on people’s health and it is probably a fair one. But I can’t help think that the guilty individuals and organisations who are depicted here escape the tackle a little too easily. There is forced sense of resolution at the end of the film that never really makes it clear what has happened or what has changed. ‘Concussion’ may have a medical point to make but it is also a film that wants to embody the American dream and unfortunately this acts as a defence of this sports entertainment industry.
Still, there is now a much wider sense of acknowledgement that head injuries are a real problem in American football, and high impact sports generally, including Rugby where the story is just getting started. The NFL has a compensation fund and has given money for health checks and research. This film tells an important story that does speak of the science, and it does show the real issues that scientists and doctors meet when they say something that isn’t popular, or isn’t profitable. Its not a perfect film by any means – but I’m glad that this has contributed to a bigger conversation about head injury and safety in sports. It is bound to be part of the ongoing discussion and I guarantee that you’ll go on to read more after watching it!
Further reading:
The original article that inspired the film:
http://www.gq.com/story/nfl-players-brain-dementia-study-memory-concussions
and an update
http://www.gq.com/story/update-game-brain