In a revealing scene from the current movie Concussion, former Pittsburgh Steeler team physician Dr. Julian Bailes (Alec Baldwin) and county coroner Dr. Cyril Wecht ( Albert Brooks) examine pathology slides of the brain of a retired player who died presumably due to repeated head trauma.
Bailes explains to Wecht that NFL team physicians must administer all sorts of drugs to players, from painkillers to antidepressants, in order to keep them playing.
An outraged Wecht says disapprovingly, “It’s not medicine.”
Bailes explains, “It’s business.”
Concussion is based on the true story of Dr. Bennet Omalu (Will Smith), the forensic pathologist who discovered a unique type of brain damage, chronic traumatic encephalopathy (CTE), in several NFL players who died after retirement. The movie depicts the NFL attempting to suppress Dr. Omalu’s findings, the implication being that the League had a conflict of interest because admitting the dangers of head trauma while playing football would be bad for business.
The movie is well-done but, typical of today’s Hollywood, there is little nuance: characters are either good (Omalu and his colleagues) or bad (the NFL and their representatives). Unlike real life, there is little middle ground.
One way the movie identifies villains is that they are the ones with conflicts of interest – it’s about business. A former NFL commissioner (bad guy) is identified as having worked for a law firm that defends Big Tobacco. A player on the NFL compensation committee (bad guy) is called “a sell-out” by a player who was denied a settlement for his injuries. (That player on the compensation committee was former Chicago Bear Dave Duerson, who later committed suicide, and his family has objected to how he is portrayed in the film). In the movie, Dr. Bailes (good guy) is redeemed when he leaves his position as an NFL team physician and joins Dr. Omalu’s side.
But movies “based on true stories” don’t necessarily tell the whole truth. While Dr. Omalu did identify CTE in football players, he did not give the condition its name as the movie claims. It was named in boxers decades ago by earlier physicians.
That is trivial. More importantly, scientists, including in this case Dr. Omalu, often have significant conflicts of interests too. The brain findings he described were all postmortem and there is currently no way to identify CTE before death. Consequently, there are tremendous medical and financial incentives to discover a test that will demonstrate findings of CTE in living patients. And Dr. Omalu is a partner in a company that proposes to do exactly that.
The company, Taumark, owns exclusive rights to a radioactive compound that, when injected into the bloodstream, is supposed to show up in brain scans and identify CTE. If successful, the test would be extremely expensive and the demand would be tremendous. In 2013, after an initial study of five NFL players, the company was deluged by demands from professional athletes and the parents of amateur football players.
Unfortunately, right now the technique remains an experimental research tool. Independent experts caution it has no proven clinical value at present. “The whole field is in a very early state since we don’t even know what CTE is,” said Dr. Douglas Smith, a traumatic brain injury researcher at the University of Pennsylvania. “Instead of having everybody in a mad dash to get a scan, we need to vet these tests so they are validated.”
This did not deter two of Dr. Omalu’s partners from issuing unfounded claims on the company website stating, ““Despite the devastating consequence of traumatic brain injury and the large number of athletes, military personnel and other head trauma victims at risk, until now, no method has been developed for early detection or tracking of the brain pathology associated with these injuries.” Shortly after that, the FDA, which has not approved Taumark’s compound for clinical use, forced them to remove that claim.
Preventing and detecting brain injury in athletes is a huge emerging industry and Dr. Omalu’s company could reap immense profits. While his company goes about raising millions of start-up dollars, he is notably reticent about the details of going forward. He told a Pittsburgh interviewer, ““It’s a business. I cannot reveal the corporate plans…when people say ‘for-profit business,’ I don’t want people to say that as a derogatory (term)…no, it is something good.”
It certainly might be. There is nothing illegal about medical researchers partnering in commercial ventures. As for being unethical, these types of relationships are encouraged by virtually every American university, so much so that issues of conflict of interest are often glossed over. When I taught medical ethics to students and residents, they saw no problem with doctors partnering, although they were nearly unanimous that it was unethical if politicians did something similar.
As a Taumark partner, Dr. Omalu has an undeniable interest in the successful outcome of his company’s brain trauma research. In no way does this mean Taumark’s work will automatically be biased or invalid. But it does mean there will inevitably be questions about Dr. Omalu’s credibility and even his integrity, which was depicted as unimpeachable in Concussion.
As Dr. Bailes observed, “It’s business.”
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