E.J. Leavitt | When Neurological Studies Face Struggles

When Neurological Studies Face Struggles

E.J. Leavitt

Introduction:

Brain research plays an essential role in the scientific and medical fields. The brain is perhaps the most complex organ within the human body, and there is much that is not well understood. For example, the biochemical, developmental, and mechanical origins of conditions such as autism and Alzheimer’s disease present information that is yet to be discovered. Research involving the brain has also used up a significant amount of funding each year. The Alzheimer’s Association spends about $480 million on Alzheimer’s research alone each year (Boomer 2016). In the pursuit of these important neurological discoveries, however, there are often tough public relation barriers to cross when breakthrough or fraudulent studies are released.

When Findings Shake the Boat:

            In the fall of 2002, the people of Pittsburg, Pennsylvania lost a town hero of theirs, Mike Webster, who reportedly died due to a heart attack. Just about a decade and a half earlier, Webster played as a star center on the home NFL team, the Steelers. Standing with his burly frame of 6’1” and 255 pounds, he was known for his aggressiveness, skill, and strength in the sport. He was even inducted into the Hall of Fame nine years after he finished his time with the Steelers (Players 2016). However, even as he retired from football, his mind had already been falling apart. In the decade preceding his death, he developed depression, his behavior became increasingly erratic, he struggled to maintain his concentration, and the weight of it all eventually collapsed his family life (Litsky 2002).

            After Webster’s death, his body was taken to be examined by forensic neuropathologist Dr. Bennet Omalu, M.D. In a history that has also been portrayed in the 2015 film Concussion, Dr. Omalu became curious if the repeated concussions and head trauma sustained over a long career in the NFL played any part in the gradual degradation of Webster’s mental health. In collaboration with his colleagues at the University of Pittsburg, he found amyloid plaques and some neurofibrillary tangles in Webster’s neocortical regions, as well as damaged neurons in the frontal, parietal, and temporal areas of the cerebral cortex. The brain damage, of which the condition was named “chronic traumatic encephalopathy” (CTE) was evident mostly at a microscopic level, and in the publication of the study the team suggested that there are risks of long-term brain damage amongst players of the NFL (Omalu et al. 2005).

            As a result of their publication, Omalu and his team quickly received repercussions and oppositions. Omalu received phone calls that demanded that he retract his study from the Neurosurgery journal, and that his observations were somehow misinterpreted. Through his fax machine, Omalu received a single-spaced, six paged letter from Elliot Pellman, who was the chairman of the NFL’s “Mild Traumatic Brain Injury” committee at the time. The leading group of NFL team doctors was coming after Dr. Bennet Omalu, insisting that he was erroneous in his findings and that his publication should be removed.

            Dr. Omalu, shocked, investigated into the claims. He found that Dr. Pellman was in fact a rheumatologist, and that no one in the 14-member committee was a neuropathologist. Also, Pellman was found to have published a paper in 1994 stating that concussions were merely an occupational hazard – part of the profession in the NFL. With these discrepancies, Omalu responded to the criticisms, and the NFL responded again by requesting an independent expert in the field to review the samples of Webster’s brain tissue after the Neurosurgery journal declined to retract the paper. This researcher, Dr. Peter Davies from the Albert Einstein College of Medicine in New York whose career has been largely focused on Alzheimer’s research confirmed Omalu’s findings in astonishment, and wrote his report for the NFL that Omalu was right. Unfortunately, the NFL never released the report to the public.

            The conflict between Dr. Omalu, his team, and the NFL escalated to the point that Congress became involved. Experts across the field were invited into a committee for the hearing – with the exception of Omalu. Dr. Omalu was never welcomed into the committee, but pressure to further research and implement new safety protocols for concussions was successfully placed on the NFL (Laskas 2015). NFL officials were unwilling to acknowledge the findings in the study that Omalu produced, but after much scrutiny and testing, the condition that Mike Webster was found to have post-mortem was confirmed.

The bitter conflict that Dr. Bennet Omalu faced against the NFL achieved success in the end in promoting the safety of football and other sports players. Since 2005, several papers have been published about CTE and the post-career mental health of NFL players, and the field of research in sports-related head and brain injury has expanded. However, there is still much that remains to be done improve player safety in the NFL. In a 2012 study of 85 people with histories of mild traumatic brain injuries, 33 of the players were former football players from the NFL, and they showed evidence of CTE (Pro 2016).

The increased focus on brain injuries and football has also expanded to amateur athletics – for instance, the NFL controversy may have indirectly encouraged increased safety goals and participation in high school football. For the past couple of decades, it has become a common practice in high school football to require a symptom-free waiting period (SFWP) for players who sustain a concussion during practice or in a game. The SFWP requires that after sustaining a concussion, the affected player must not return to play (or practice) until he or she exhibits no symptoms of a concussion for a set amount of time. In a study performed from 2012 to 2014 measuring the percentage of SFWP use in southeastern Wisconsin, a surprising 99.3% of athletes used an SFWP after sustaining a mild traumatic brain injury. Between 1999 and 2004, only 60.3% of athletes sustaining concussions used SFWPs, as found from a similar study (Pfaller et al. 2016). Though it may not be a direct consequence of Dr. Omalu’s findings about CTE, it is evident that substantial progress has been made with player safety since the time of Omalu’s 2015 publication.

When a Fraudulent Study Emerges:

            Although hotly contested by doctors within the NFL, Dr. Omalu’s study was found to be legitimate, and it has led to many good changes. However, what happens when a scientist manages to publish a study with falsified results and fraudulent conclusions? In 1998, such a study was published in the United Kingdom, and its influence has sparked persistent negative consequences since that time. This article, “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”, was published in The Lancet by Andrew Wakefield, and was retracted by the publisher in 2004. The study claimed that there was a connection between autism spectrum disorder and the mumps-measles-rubella (MMR) vaccine (Novella 2010).

            Eyebrows were raised within the medical and scientific communities after the release of Wakefield’s study. First, the sample size that Wakefield used to collect his data consisted of only 12 children. Also, upon closer observation of the confidential medical forms and documents that were used in the study, a Sunday Times investigation found that Wakefield manipulated data for the study to produce correlations that suggest that the MMR vaccine causes autism. After its investigation, the Sunday Times presented figures regarding the paper’s impact. Before, the rate of inoculation was about 92%, and after the paper’s release, these rates fell below 80%. In addition to these rates, in 2008, researchers recorded 1,348 cases of measles. Just a decade before, only 56 cases of measles were confirmed (Deer 2009).

            The repercussions of Wakefield’s study led to more than an increased incidence of measles within the U.K. In the U.S., a measles outbreak occurred in San Diego in 2008 due to an intentionally unvaccinated child who contracted the disease while in Switzerland (AOL 2001). In a study analyzing the incident, 839 individuals were exposed, and 11 children who did not receive the MMR vaccine were infected with the disease. As published in the journal Pediatrics, what prevented a larger outbreak was the high vaccination rate within the affected community (Sugerman et al. 2010). Fortunately – and thanks to the strong use of the MMR vaccine – many potential measles infections were avoided. Unfortunately, the number of individuals are getting measles in communities that at one time achieved herd immunity.

            The costs of the MMR vaccine study also incurs a high cost to the public. The 2008 outbreak mentioned previously led to costs totaling to about $177,000 – which amounts to $10,376 a case. Another study looking at a 2007 mumps outbreak in Nova Scotia estimated costs of nearly 2.5 million Canadian dollars, at CDN $3,511 per case (Janes 2010). The costs and increased incidence of mumps and measles serves as a stark reminder that there is much to be done in the fields of public health, vaccine awareness, and education to resolve the many problems caused by Andrew Wakefield’s 1998 study.

Conclusion:

            There are essential pieces of information that are gained from research of the brain. From learning more about the mechanisms of autism, Alzheimer’s disease, concussions, and CTE, for instance, there is much to learn about the human brain. It is important for the public to be well-educated regarding emerging studies and breakthroughs (including those not directly related to the brain). Also, effective prevention of fraudulent studies – including the detection and rapid removal of questionable studies – may also assist in preventing severe economic costs and medical incidents. If the public health and research communities can learn from the stories of Dr. Omalu and Andrew Wakefield in preparation for future events, many tragedies and costs may be avoided.

References:

AOL Editors. The autism vaccine fraud: Dr. Wakefield’s costly lie to society. AOL. Retrieved October 28, 2016 from http://www.aol.com/article/2011/01/12/autism-vaccine-fraud-wakefield-cost-money-deaths/19793484/?gen=1

Boomer Report. 2016. Alzheimer’s Association. Retrieved October 28, 2016 from http://www.alz.org/boomers/

Deer, Brian. 2009. MMR doctor Andrew Wakefield fixed data on autism. The Sunday Times. Retrieved October 26, 2016 from http://www.thesundaytimes.co.uk/sto/public/news/article148992.ece

Janes, Ashley. 2010. Economic burden of the Nova Scotia mumps outbreak. Dalhousie University. Retrieved October 28, 2016 from http://dalspace.library.dal.ca//handle/10222/13100

Laskas, Jeanne Marie. 2015. The doctor the NFL tried to silence. The Wall Street Journal. Received October 28, 2016 from http://www.wsj.com/articles/the-doctor-the-nfl-tried-to-silence-1448399061

Novella, Steven. 2010. The Lancet retracts Andrew Wakefield’s article. Science-Based Medicine. Retrieved October 28, 2016 from https://www.sciencebasedmedicine.org/lancet-retracts-wakefield-article/

Omalu, B. I., DeKosky, S. T., Minster, R. L., Kamboh, M. I., Hamilton, R. L., and Wecht, C. H. 2005. Chronic traumatic encephalopathy in a national football league player. Neurosurgery 57: 183-134

Pfaller, A. Y., Nelson, L. D., Apps, J. N., Walter, K. D., and McCrea, M. A. 2016. Frequency and outcomes of a symptom-free waiting period after sport-related concussion. The American Journal of Sports Medicine 10:1-6.

Players. 2016. Mike Webster. National Football League. Retrieved October 28, 2016 from http://www.nfl.com/player/mikewebster/2528439/profile

Pro Football. 2016. The N.F.L’s tragic C.T.E. roll call. The New York Times. Retrieved October 27, 2016 from http://www.nytimes.com/interactive/2016/02/03/sports/football/nfl-brain-disease-cte-concussions.html

Sugerman, D. E., Barskey, A. E., Delea, M. G., Ortega-Sanchez, I. R., Bi, D., Ralston, K. J., Rota, P. A., Waters-Montijo, K., and LeBaron, C. W. 2010. Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated. Pediatrics 125: 747-755