Aarati 0:10 Hi everyone, and welcome back to the Smart Tea podcast, where we talk about the lives of scientists and innovators who shape the world. How are you doing Arpita? Arpita: 0:20 I'm good. I am so thrilled it is no longer 95 degrees in the city. That was not, that was not my favorite. Aarati: 0:28 Yeah. Arpita: 0:29 That was tough. Aarati: 0:31 Yeah. I'm the opposite. I love, I love the hot weather, but yeah, San Francisco, it's like unnatural for San Francisco. Arpita: 0:41 It is unnatural for San Francisco. I, I can't. I want it to be 60 degrees always, which it is now, but that, that heat wave was tough for me. I was, sweating in my apartment. All the windows are open. And I was like, I can't do this. Aarati: 0:56 Yeah. You remind me of, uh, my little worms that were very particular about the weather when I was in grad school and our experiments would not work if the weather was not perfect for some reason. If it was warm and sunny outside, all the experiments would work. If it was rainy, they were just not happy and so the weather conditions had to be perfect. It was such a pain. Arpita: 1:22 I have a very narrow homeostasis. Is the conclusion here. Yeah. Can't be too sleepy. Can't be too hungry. Can't be too cranky. Can't be too hot. I'm really just a, I'm just a worm. I'm just a worm. Aarati: 1:36 That's what. That's the great thing about working from home, I feel like, because you can maintain that homeostasis so much easier. You have like snacks within reach and like, you know, your pets are within reach of any time you need like emotional support. Arpita: 1:51 Yeah, I never get ready. Aarati: 1:53 Yeah, in the office, it's like, oh, I can't eat at like this time. It's not lunchtime yet. I have to keep working. I'm cold or warm or something. It's so hard in the office. Arpita: 2:05 Yeah, it's true. It's true. How are you? You went on a little trip. Aarati: 2:10 I did. Yes, I went to visit my friend in SoCal again. So I went to visit her for that one off Las Vegas trip. And then a week later, it was her son's birthday, so I went down again, like a week later to, yeah, to help with decorating the house and all of that kind of stuff. So it was really fun. Yeah, it was. Arpita: 2:31 Did you have a nice birthday? Aarati: 2:33 Yeah, it's like a two year old's birthday. He's at the phase right now where he's obsessed with Mickey Mouse. So we were, you know, decorating the whole house with Mickey Mouse balloons. And we had little headbands that had like the two ears on top, um, for everyone to wear. So Arpita: 2:48 That's really cute. Aarati: 2:49 Yeah. It's like one of the few words he can say is Mickey. So, okay. We know we know. Arpita: 2:57 Keep your priorities straight for sure. Aarati: 2:59 Yeah. Yeah. But it was, it was really good. So it was fun. I'm, I'm glad I went, um, although the drive down there is so long and we are driving through like, 95 degrees weather. I was like, if I blow a tire out here, I'm screwed. Arpita: 3:15 So, oh my god, I would cease to exist. Aarati: 3:17 Yeah. So, so hot. And they live in the middle of the desert, I think I mentioned before too, so on his birthday it was definitely over 100 degrees. So, thank god for AC. Arpita: 3:30 Yeah, I think that's the big thing is, Like, there is no AC in San Francisco because it's never hot, and so when it's hot outside, it's whatever temperature is outside is also inside my apartment, so there's no, like, reprieve, you know, you're just sweating and melting. Aarati: 3:47 Yes, I think the Bay Area... Arpita: 3:49 Makes me seem like a baby, but, like, if you lived in these 110 degree places with no AC, you would agree with me. Aarati: 3:56 No, but that's, that's what I think. I think the Bay Area has always kind of just been temperate. And so I think at most people will have heating. Yeah. And now AC is something that people are like having to add to like their homes. They're like having to buy it and install it in their homes because it's climate change and whatnot. But you know, we've never, we don't usually have these really hot days. So. Arpita: 4:21 Yeah. Aarati: 4:22 Yeah. Oh, also though, we were talking about worms earlier and I was very excited to see that the Nobel prize was given in physiology and medicine to two worm scientists. I was like, yes, C elegans getting their spotlight shown on them. Um, but I was especially excited because that paper about micro RNAs in C. elegans was like the foundation of my PhD. It's like the first paper that I would have had to read. Yeah. It was like the basis for all my work kind of. Um, I wasn't working with, um, micro RNA is necessarily, but like, yeah, I was working with, RNA interferencee and silencing. And so it's related. And so it's like, this was definitely the first paper that kind of talked about that. And so it was definitely one of the first papers that I read. And so I was like, Oh my gosh, I know those people don't know them. I haven't met them, but I've read their paper. I know who they are. Their names are familiar. It's like very exciting. So yeah! Arpita: 5:32 That's really funny. Um, no, I love that. When I saw that headline, the first thing that I saw, I somehow didn't process micro RNA and I just saw mRNA. And I was like, wait, have we not known about this for a really long time? Messenger, messenger, messenger RNA. And then I was like, Ooh, I'm back now. I was like, I got it. Aarati: 5:52 Yeah. For me though, like, and maybe it's because I studied it, but I was like, micro RNAs we've known for a really long time, like, how has this not gotten the Nobel Prize before this? And then I saw that they like discovered it in the 90s. And I was like, yeah, that's still been a really long time. I guess it just took. This long for us to really understand how ubiquitous they are and how like important they are. There's just so many micro RNAs now and they're being used for so many things. Um, Arpita: 6:23 So many therapies too. Aarati: 6:25 Exactly. And preventative care and early diagnosis and things like that. So I think just kind of the weight of that discovery has finally hit home, I guess. So I was glad that it was. Finally, I, I just kind of had the like, wait, it hasn't been recognized already? Yeah,, so I'm really glad it finally got its due. Arpita: 6:47 Yeah, no, that was awesome. I, it's kind of fun to have it be Nobel prize season. Aarati: 6:52 Yes, definitely. Um, so speaking of amazing scientists, uh, who are we doing today? Arpita: 6:59 Okay, so we're, I have a theme this week. Aarati: 7:02 Oh, excellent. I love a theme, you know. Arpita: 7:04 Uh, well, we are, um, fully in NFL season and I decided to do a scientist who has gotten a lot of notoriety from the NFL and this is Dr. Bennet Omalu. Who is the person who brought CTE to the limelight. So Aarati: 7:26 What is CTE? Arpita: 7:27 We're going to find out. And I, you, I think you've probably heard of this. Um, he was an interesting character in this story. Turned out to be a little bit more crazy than I was expecting. So I'm excited to jump into it. Okay. So, Bennet Ifekandu Omalu was born in Nigeria in September 1968, and he was born in the middle of the Nigerian Civil War. So the war forced his family to leave their gated compound that they had in their village, but then eventually at the end of the Civil War, they were able to come back and they had a pretty, pretty comfortable lifestyle. Um, his mom was a seamstress and his dad was a civil engineer and like a pretty big community leader. Aarati: 8:14 I just wanted to say real quick, um, I'm really glad you're doing someone who's not an American or not European because I feel like, a lot of, a lot of scientists that kind of have the limelight shone on them are from the western world. And so I'm really, really glad you're doing someone from Nigeria. That's amazing. Arpita: 8:34 It was not really intentional, but great. Aarati: 8:36 Yeah. Arpita: 8:36 Okay, he was the sixth of seven children. And he was super smart. He was accepted to the federal government college when he was 12. And then when he was 15, he started medical school at the University of Nigeria. And this is a little bit different. So he graduated with a bachelor's of medicine and surgery and MBBS in 1990. Um, and so when he was done with that, he did a clinical internship and three years of service work in another city called Jos. And so Nigeria was having, um, a lot of political conflict around this time, and so there was a presidential candidate named Moshud Abiola, and he was trying to bring, like, a lot of change and democracy to the country, and he lost the presidency in 1993, and Bennet started to feel really cynical about the Nigerian government and its future, so he started thinking about emigrating. So a few years later in 1994, he came to Seattle and he started working on a fellowship in epidemiology at the University of Washington. And very soon after that, he moved to New York City where he started working at Columbia University's Harlem Hospital Center, and he did a residency in anatomic and clinical pathology. Aarati: 9:55 Wow. Arpita: 9:55 This is just his background here. Aarati: 9:57 Okay. Arpita: 9:58 Okay. So now his story kind of gets interesting. So once he's done all this training, he moves to Pittsburgh because now he's a pathologist. So he's training under this world renowned pathologist named Cyril Wecht at the county coroner's office. And while he was working there, he did an autopsy in 2002, and his patient was Mike Webster, who was, uh, formerly a center for the Pittsburgh Steelers. And so, Mike, after his NFL career, died really suddenly at the age of 50. And it was after several years of struggling with cognitive issues like intellectual impairment, mood disorders, depression, drug abuse, and he had several suicide attempts. Um, and his cause of death was listed as a heart attack, but Bennet was like,"I don't know, something seems kind of weird here." Aarati: 10:54 Yeah. Arpita: 10:54 And he looks at Webster's brain as part of a normal autopsy. And it looked pretty normal, but because he had some suspicions, Bennet then conducted independent, uh, tissue analyses and he suspected that Mike Webster suffered from something called Dementia Pugilistica. I did not think about saying this out loud. Hold on. Aarati: 11:19 Dementia Arpita: 11:21 Pugilistica. Yeah, I was right. Okay. Aarati: 11:23 Yeah? Okay. Arpita: 11:23 Okay. Aarati: 11:24 I do think I know where this is going. I think I have heard of. Arpita: 11:27 You have. Aarati: 11:27 I don't, I don't follow football at all really, but I have heard of traumatic brain injuries and kind of the controversy around this. So yes. Arpita: 11:37 Yeah. Oh yeah. So. He suspected that Mike Webster suffered from Dementia Pugilistica, which is a specific type of dementia that comes from repeated blows to the head. And up until this point, it was seen in boxers who understandably had this. So he sliced and stained the brain tissue samples, um, and he found large accumulations of tau protein in his brain, um, and these accumulations can affect things like mood, emotions, and executive functions, and it's really similar to the way we think of accumulation of beta amyloid protein, which is what we see in Alzheimer's disease. Aarati: 12:20 Right. So tau protein is associated with these kind of mood disorders and... Arpita: 12:27 Yeah, elevated tau protein. Aarati: 12:29 Elevated tau protein, the same way that beta amyloids are or elevated beta amyloid levels are associated with Alzheimer's. Okay. So it's like a marker of kind of like, yeah. Okay. Kind of like a marker of that disease. Arpita: 12:43 Exactly. So in healthy brains, tau protein is a structural protein, so it helps give shape and structure to neurons and their axons. So it helps them stay the way they should be with these like long, drawn out, um, axons and for them to hold their shape and form these connections. But too much of this is associated with all of these other disorders. Aarati: 13:06 Okay. Okay. Gotcha. Arpita: 13:09 And so Bennet reported and he said, quote,"These abnormalities were not something that I thought I should be seeing in a 50 year old man." End quote. And so he is a little bit concerned about this and he runs it by some of his colleagues and the departments of neurology and neuropathology at the University of Pittsburgh. And they agree that the tau pattern was pretty unusual. So he publishes his findings in the journal Neurosurgery in 2005 in a paper titled Chronic Traumatic Encephalopathy in a National Football League Player. Aarati: 13:43 Oh, so he just did this on one player and published a paper on it. Okay, I would have thought he would have... I don't know. I guess you can't really do that kind of diagnosis on people who are still living like he had to cut out a piece of their brain. Right? So, Arpita: 14:00 Right. Um, you do bring up an interesting point here in which that he did this on one person. So let's just bookmark that. Aarati: 14:07 It's an n of one. I would have... and that's why I'm surprised. I'm like, Oh, he was able to publish something with the n of one. Arpita: 14:13 I'm assuming he kind of did it as a case study. I didn't actually read this, this paper specifically, but I'm assuming he published it as a case study, but regardless. Aarati: 14:21 Yes. He probably mentioned that this was seen in boxers as well, like this is, he probably made that connection already. Arpita: 14:28 Right. Okay. So in this paper, Bennet calls for further study of this disease. So he said, quote,"We herein report the first documented case of long term neurodegenerative changes in a retired football player consistent with chronic traumatic encephalopathy, CTE. This case draws attention to a disease that remains inadequately studied in the cohort of professional football players with unknown true prevalence rates." End quote. So, he published this in 2005 thinking that NFL doctors would be really happy to read it and, you know, improve, um, you know, protection and help prevent this from happening more in the future. But initially, the paper didn't really get a lot of attention. But in May 2006, the members of the NFL's Mild Traumatic Brain Injury Committee, also abbreviated to the MTBI, called for the paper's retraction. And they wrote a letter requesting that the retraction characterize Bennet's description of CTE as, quote, completely wrong, and called the paper's paper, quote, a failure. However, the researchers stood their ground. Aarati: 15:39 I'm really shocked by, like, all of that. I'm first of all shocked by the fact that there already is a mild traumatic brain injury committee in the NFL. Like, even, even at this point, before he's even, like, he's just started to publish papers, they've already formed a committee knowing that... Arpita: 15:58 The committee existed. Aarati: 15:59 Yeah, like, it already existed, but that Arpita: 16:01 Yeah. Aarati: 16:01 Why does it exist except for the fact that this has been happening? People know that this is a thing so there has to be a committee around it. So it's like already, You already know this is a dangerous sport. You already have a committee about it Yeah, you already have that but then on top of that to reject his paper and just be like this has no merit It's like you're the freaking committee for it! What do you mean? Arpita: 16:26 It doesn't make any sense if anything it sort of like made it a little bit worse as we will see. Um, so the same year, 2006, another football player, Terry Long, committed suicide and he was 45 and he was also found to have elevated levels of tau protein in his brain, which Bennet said, quote, a 90 year old brain with advanced Alzheimer's end quote. Same as Mike Webster, Bennet claimed that Terry Long's football career had caused later brain damage and depression and mental health problems. Bennet also found evidence of CTE in the brains of a few other NFL players, Justin Strzelczyk, Andre Waters, and Tom McHale, and he published a follow up paper in the same journal, Neurosurgery, and it was published in November 2006. Aarati: 17:16 Sorry, had all of those people died? Arpita: 17:18 All these people died, separately. Aarati: 17:20 Oh, my gosh. Arpita: 17:21 Yeah, it like within several years of each other, like one died in 2004, one in 2006, one died in 2008, and they all died very young, like between 35 and 45. Aarati: 17:30 Oh, my gosh. 35 and 45. Holy crap. Arpita: 17:33 Yeah, super young. So he, he published a paper, including findings of all of these different people. So, the MTBI committee continued to discredit his research as flawed and did not acknowledge a link between the sport, football, and brain damage in former players. However, Bennet gained a really important supporter in a man named Dr. Julian Bales, who was the chairman of neurosurgery at the West Virginia School of Medicine, and he was also importantly a former team physician for the Steelers. So Dr. Julian Bailes, um, and a lawyer named Bob Fitzsimmons and Bennet all founded the Sports Legacy Institute to continue studies of CTE. Aarati: 18:23 This is just crazy to me. It's just so crazy that he's being met with so much resistance when all you have to do is watch any football game and see how they like smack into each other and be like, yeah, that could definitely cause some injury. Um, I don't even have to know anything about football to see that that could be a dangerous activity. Arpita: 18:44 Problem. Yeah. Aarati: 18:46 Yeah. It's not that far of a stretch to see that that could potentially cause some brain damage. And maybe you should be protecting against that. Yeah, Arpita: 18:58 Totally. So the NFL continues to evade this and deny that it's a problem. But Bennet and his supporters had a victory when Mike Webster's family was awarded a significant settlement in December 2006 from the NFL. Aarati: 19:13 And that was the first guy, right? Arpita: 19:15 The first guy. Aarati: 19:16 The first guy who, um, he studied. Arpita: 19:19 Correct. Yep. The first guy. For the following June, the NFL commissioner, Roger Goodell convened a quote "Concussion Summit" to discuss the issue with the NFL's MTBI committee chair, Dr. Ira Casson and told the press, quote,"In my opinion, the only scientifically valid evidence of a chronic encephalopathy in athletes is in boxers and in some jockeys," end quote. So the NFL just like doesn't. Really get behind CTE at all. Aarati: 19:53 That's, yeah, like I said, like, that's crazy. I mean, again, all you have to do is watch them and see, like, how violent the sport is and how, like, you know, that's insane. It's also just kind of crazy why there's so much pushback against it. Like what is, what is the deal with the pushback when, uh, when a scientist tells you, Hey, this could be a potential problem, maybe we should take steps to mitigate this problem. I don't know, like maybe look into better helmets or changing the rules so that, you know, there's not as much head contact or something. Like, can we work with this? I'm like, what is the pushback to just implementing that anyway, it's the kind of the same thing I see with climate change is like, okay, even if you don't believe it's a thing, even if you don't believe that traumatic brain injury is happening, is there a downside to just investing in, you know, designing better helmets or you know, changing the rules slightly so that you cannot smash head on into something, you know, like I just don't understand the intense pushback. If, if anything, you're just making it safer. Why is there a problem? Arpita: 21:14 I think, I mean, it's, I think it's really just money is, I mean, obviously it's the biggest thing, right? It's like their, their, their profit margins on this are so high and the NFL generates like billions of dollars in revenue. And so if you're, if you're putting money into something else or admitting that what you're doing is dangerous or has a problem, then there is a chance that you are going to, you know, lose your fan base. There's a chance that, you know, people are going to come out against this. So if you continue to deny and say that your sport is actually safe, then you're maintaining the status quo, which I think is the biggest thing here. Because it's based on a fan base. It's right. It's like you have to the entire revenue stream is based on people. Being excited about it. And so if there's reason to believe that their favorite players are in fact, you know... Aarati: 21:55 In harm's way? Arpita: 21:56 In harm's way, right. It's like, that's, that's going to ruin it. Aarati: 22:00 Yeah, I would just do it on the downlow then. I feel like I'm maybe being very naive, but Arpita: 22:06 it's a little naive, but I understand. You're an idealist. Aarati: 22:09 Every, yeah, like every year or whatever you design new helmets anyway, like the decoration change or the color schemes change, just, you know, put in a few safety measures into that new helmet quietly. It doesn't, you can call it a style element. I don't know. Arpita: 22:24 Oh, sweet Aarati. Aarati: 22:25 I know. Arpita: 22:26 Sweet, sweet Aarati. Aarati: 22:26 I'm just like, I just want the world to be a good and safe place. Why is that too much to ask? Arpita: 22:34 Okay, so back to Bennet. Bennet moved to California in 2007 and he started a new job as chief medical examiner, uh, in San Joaquin County. Um, and he continued some post grad education, um, and earned his MBA in 2008. He also published his first book, Play Hard, Die Young, Football, Dementia, Depression, and Death. A really fun title. Aarati: 23:00 Yeah. Arpita: 23:01 Um, and he advanced the study of CTE by branching out to athletes from other sports as well as war veterans. Aarati: 23:10 Oh, wow. Arpita: 23:11 And then by 2009, his work on CTE was finally starting to gain traction. He was profiled in GQ, which really detailed his efforts to raise awareness of football related brain injuries, and then especially highlighted the NFL's refusal to cooperate. So the NFL commissioner, as a result of this, and other executives were then called to testify before a house judiciary committee, which then started an overhaul of the MTBI and rule changes to enhance safety as well as a lawsuit that was brought forth by thousands of former players against the NFL. Aarati: 23:47 Oh, wow. So he's really blowing this up now. He's like, fine, if you're not going to just do this internally, I'm going to just take it to the public and make sure that people know about this. Yeah, good for him. Arpita: 24:01 So the NFL then didn't publicly acknowledge the link between concussions sustained in football and long term neurological effects until December 2009, which was seven years after Bennet's original discovery in Mike Webster. But even up until 2013 at the annual meeting of the American Academy of Clinical Neuropsychology, the AACN, this included a debate between two sports concussion experts which looked at the validity or even like the existence of CTE. And then finally, in March 2016, the NFL's Senior Vice President for Health and Safety Policy testified before Congress that the NFL now believed that there is a link between football and CTE. And then in 2016, the American Medical Association awarded Bennet with their highest honor, the Distinguished Service Award, for his work on CTE. Aarati: 24:51 Hi everyone, Aarati here. I hope you're enjoying the podcast. If so, and you wish someone would tell your science story, then check out Sykom. That's S- Y- K- O- M, and it's a science communications company that I founded. Sykom partners with academic researchers, tech companies, non profits, or really any scientist to create clear, engaging, scientifically accurate media. Whether you need an explainer video, a facelift for your slide presentation, or a blog article to inform readers of the latest research in your field, Sykom can help you simplify your science. Okay, back to the story. Wow. So how long did that take them to like, from when he first published? It was over 10 years, right? Arpita: 25:37 Yeah. 11 years. Cause the first paper was 2005. So this story eventually reached Hollywood and Will Smith landed the starring role in the 2015 movie Concussion. And Will Smith spent a lot of time learning his distinct Nigerian accent and intonation and his mannerisms and received a lot of acclaim for this role. So, for Bennet, the release of concussion served as the ultimate validation for all of his years of hard work. He was also the lead author in a published study in November 2017 that for the first time confirmed CTE in a living person. So, with some of his colleagues, he found that a radioactive chemical tracer called FDDNP binds to tau proteins, which is detectable by a PET scan and associated with some of the other distinctive uh, topographical distribution characteristics of CTE. So they tested this and over a dozen, just a dozen, former NFL players and then this was confirmed after former linebacker Fred McNeill passed away and it was confirmed post mortem. Aarati: 26:48 Okay, so they actually diagnosed him while he was still alive, and then once he died, they were able to do the full autopsy and kind of confirm the results. Arpita: 26:59 So, since then, and since all this research has sort of come out in like the early aughts, CTE has been established as a progressive degenerative disease. Brain disease that's associated with head trauma. It's not limited to football or boxing. It's been found in athletes who played soccer, hockey, rugby, mixed martial arts, and even BMX bike riding. And outside of sports, CTE has also been reported in military personnel, um, particularly those exposed to blast injuries, and it's even seen in people who have been exposed to domestic violence. It's basically a problem in any individual who's been exposed to some kind of head trauma. So most of what we know suggests that imaging technologies may be able to detect CTE in living people based on that paper from 2017 that I was talking about. But the only proven and like official way to diagnose this condition is through an autopsy. Um, But while you're living, CTE produces a range of neurological symptoms, including depression, memory loss, confusion, impaired judgment, impulse control issues, aggression, Parkinsonism, and eventually progressive dementia. And some people with CTE have even attempted suicide, as we mentioned. Aarati: 28:12 Yeah, that's so scary. Um, if they, are able to diagnose it in people and maybe you're getting to this, but if they're able to diagnose it in people while they're living, is there any treatments that they can have? Arpita: 28:25 Not right now. Yeah, not right now. Aarati: 28:29 Oh my gosh. So it's kind of like a death sentence almost like if you have these symptoms and you do this PET scan and they figure out that your tau levels are elevated, you're It's kind of like you might die early. It sounds like, yeah. Oh, that's so... that would be heartbreaking news. I feel like for anybody Arpita: 28:51 And it's not super clear. So we're going to get into the diagnosis a little bit more. Um, so symptoms of CTE can, well, first of all, they're really broad, right? Like all those things that I listed could be theoretically anything, right? It could be. a tumor. It could be, you know what I mean? It could be literally anything. Um, and symptoms of CTE generally go unnoticed until years or even decades after the brain trauma has occurred, or the person has even stopped playing sports. So sometimes it can be really hard to connect the two. Um, and CTE has also been documented in people as young as 17, according to a 2016 study in JAMA. Um, and just like you asked, symptoms can be managed, but the condition itself can't be cured. So the biggest thing is minimizing risk. Aarati: 29:37 So it can't, it can't be reversed, but you can kind of prevent it from getting worse? Arpita: 29:43 You can specifically manage the symptoms is really the biggest thing. So if you've got like vestibular stuff you can do vestibular training. If you have, you know, dizziness, you can manage that, but like the underlying cause can't be changed. Aarati: 29:57 Okay, like our brain naturally will deteriorate as we get older and older, right? So I feel like first of all, it's irreversible, but then naturally it would, it would get worse. And the only thing you can do is manage your symptoms. That sucks. Arpita: 30:12 Totally. so, increased awareness of CTE has started, like, a whole field of new research, partly because a lot of players and their families have donated brains of at risk people after they've passed away. So, to help identify patterns, there's been an effort to start the CTE Center through Boston University, which has a brain bank of over 600 specimens and tissue samples. Aarati: 30:35 Whoa, a brain bank. Never heard of that before. That's cool. That reminds me of that scene in Young Frankenstein. Have you seen that movie? It's a funny movie with Gene Wilder, and he's Dr. Frankenstein, and he's trying to build Frankenstein's monster, um, and he asks his henchman, Igor, or sometimes pronounced I- gore, to go get him a brain and then Igor gets him a brain and he puts it in the monster and the monster comes to life and it's like going nuts like going berserk and he's like, what's going on? Like, what brain did you get me? You were supposed to get me like this amazing scientist brain or something because this guy was supposed to be like the monster was supposed to be an intellectual, you know, but he's clearly not and Igor is like,"It was Abby someone" and he's like,"Abby someone?" He's like, yeah, Abby, Abby normal. And it's like, are you telling me how I put an abnormal brain into this? It just reminded me of that. Like you went to the brain bank and you got an abnormal brain for my monster. Arpita: 31:41 That's really funny. Aarati: 31:43 You idiot. Yeah. It's a funny movie. It's a good one for Halloween. It's hilarious. Arpita: 31:49 Good spooky movie. Aarati: 31:50 Yeah. Arpita: 31:51 Okay, so talking about overall exposure. You don't need to have a concussion in order to be at risk for CTE, so a hit to the head that doesn't cause symptoms or that can't be diagnosed with standard clinical tests can still increase long term brain damage. So something that researchers have been exploring is the potential dangers of cumulative sub concussive hits or blows that don't cause diagnosable symptoms. So a concussion is defined as a hit to the head that results in clinical symptoms. So something like this would cause your brain to move within the cerebrospinal fluid, which kind of acts like a cushion. So your brain is hitting the inside of the skull, often multiple times. And this can result in things like headache, dizziness, disorientation, difficulty focusing your eyes, trouble concentrating. Remembering things, crying easily, feeling issues, or having any sleep problems. Um, but contrastingly, a sub concussive hit doesn't look like anything. It doesn't produce clinical symptoms. So there isn't a real way to measure or diagnose it. And there's no way to look at two different sub concussive hits and say, Oh, this one was dangerous. And this one wasn't the only risk factor that we have is the duration of these Repeated hits, so like the duration of contact play or exposure to contact sports, and essentially the cumulative nature of those hits. This doesn't make concussions unimportant. So if you get a concussion, you probably have had many more subconcussives. blows. So we don't have an understanding if there is a threshold to concussions or subconcussions that results in CTE. So it's like, if you get this number and now you're at a risk, or if you get this number, you're at a higher risk because We don't really have that kind of data, and it's also challenging because based on an autopsy, not everyone who has had a history of head trauma develops CTE or CTE symptoms. So in some studies, boxers with head injuries only have CTE of autopsy 17 percent of the time. However, the reverse, everyone who has had CTE, on autopsy have had repeated blows to their head. Aarati: 34:06 That makes sense. I'm surprised the number is so low though. Only 17%. Arpita: 34:11 That was one study that I found. Aarati: 34:12 Wow. Arpita: 34:13 So I don't think it's always quite that low. Um, I also think it really depends on the sport and how likely they are to get like a really bad concussion, which is, you know, mild traumatic brain injury. Aarati: 34:26 Yeah, that makes sense. I feel like there must be something also in terms of like football, boxing, rugby, you would kind of get a lot of repeated hits to the head, whereas other some of the other sports you were mentioning, like being a jockey, I feel like that would only happen if you like fell off the horse or something. And so hopefully that wouldn't happen all the time. Yeah. Arpita: 34:51 So that makes sense. Aarati: 34:52 Yeah, I'm assuming people are also kind of studying the differences in the head injuries in those kinds of cases. Arpita: 35:01 No, that that makes a lot of sense. I think you're right. Okay, and this is where I thought this way got really interesting. So, some researchers say that the data that Bennet has presented are compelling, but not definitive. So, one researcher at BU, which I discovered BU has, like, one of the best concussion clinics in the country. Aarati: 35:21 Oh, really? Arpita: 35:21 Um, said that in science, we try to have controls and recruit randomly for studies. Research on CTE to date hasn't been random. It's been people calling a university or someone like Dr. Omalu and saying, I want you to have my brain. Such volunteers often have symptoms, which boosts the chances that investigators will find abnormalities and potentially skew their conclusions. Researchers emphasize that there is an ongoing need for perspective and longitudinal studies. These would follow random players over time and observe who does and does not develop CTE symptoms or have evidence of disease in their brain. Comparisons would then be made between players between different outcomes, people who play different positions, and people in general population or those who aren't exposed to head trauma. And it's really likely that there are not only different thresholds or recurrent blows to the head, but that there's also genetic factors and other things that affect your resistance or vulnerability to developing CTEs. It's not actually random, obviously. Aarati: 36:20 Yeah, that just seems like so much effort because you would have to follow these football players for years throughout their career and kind of make a note of every time they got hit in the head.... Arpita: 36:37 oh, yeah. Aarati: 36:37 ...from anything, you know, either from... Arpita: 36:40 totally. Aarati: 36:40 ...smashing into another player, smashing into a wall, smashing into the field, like anything that could, you know, potentially have hit their head. I don't know. That just seems kind of like a really intensive study, isn't it? Arpita: 36:56 Sure. But you know, who collects so much recording of all of their players playing football? The NFL, the NFL cash, also the NFL. So it's like if you wanted to, Aarati: 37:07 If you wanted to. Yeah, that's what I was going to say. Yeah. So I was like, first of all, Instead of starting this study now, why don't we go back and look at all the recordings? Arpita: 37:15 Every single tape of a play, every single play ever. Yeah, it exists. Aarati: 37:20 Yeah, it already exists. All these recordings exist. I feel like that's a little bit easier. But I've, I also was wondering about like animal models, like can they do this in mice or rats or something. And I mean, obviously, now I'm having an image of mice playing football, which is kind of hilarious. But I mean, could they, I feel like they must some, some researchers must study this in animal models, right? Arpita: 37:48 So, fun fact, the first lab that I worked in, um, as like a baby, baby scientist before I was even a grad student, um, was a TBI lab and we used mice and it was actually so horrible. I really hated it so much, but we would basically like stabilize the mouse's head in this like little chamber and they would like have like um, like a padding on both sides to keep its head still and we would give them TBI. So there was a little piston that applied like a certain amount of pressure and force, and we would give them like a very pointed TBI and then study it. And it was really sad, but yeah, yes. To answer your question, we can give mice TBI. Yes. Aarati: 38:29 And then you can study that. Yeah, I feel like... Arpita: 38:32 I didn't like it. Aarati: 38:33 Yeah. No, I mean, this is why, like, I drew the lines at working with worms, but Arpita: 38:40 Like, I get it. It's like important research, but like, I was like, this is not. Aarati: 38:43 Yeah. Yeah. But I feel like that. That also might yield a little bit more information faster than sitting down and watching like 20 years worth of NFL tapes. I mean, you know, already just to watch those tapes is a huge endeavor. Um, And then to follow current footballers would be another huge endeavor and take a lot of time and a lot of money. So, Arpita: 39:11 Right. Yeah, if you want to, you could. Aarati: 39:13 If you wanted to, you could. Yeah. But I was just saying like animal models might, you know, help shed a little bit of light a little bit faster and then maybe we could refine or what's the word like streamline our studies and human Arpita: 39:26 Our studies. Aarati: 39:26 Yeah, because we would know kind of more exactly what we're looking for. Arpita: 39:31 No, I agree with that. I think that's true. Aarati: 39:33 And the NFL could fund that research in mice or whatever animal model. That would work too. In my perfect world, I was going to say. In my perfect ideal, like rainbow world. Arpita: 39:48 Literally never going to happen. But yeah, we can hope. Aarati: 39:51 I know. Arpita: 39:52 Okay, so now we get to the part of the story where things really take a left turn. Um, so as of 2020, Bennet has withdrawn from the CTE research committee and has turned himself into an evangelist, kind of. So he travels the world and he sells this really distorted version of what scientists know about CTE and contact sports. So he does paid speaking engagements, expert witness testimony, and in several books that he has authored, he portrays CTE as an epidemic and himself as a crusader fighting not against just the NFL, but also against the medical science community, which he claims is too corrupted to acknowledge the clear cut evidence that contact sports destroys lives. He's built a really lucrative career as an expert witness for hire in lawsuits, and he charges a minimum of $10,000 per case. And his speaking engagements have an average of $27,500 each. Aarati: 40:52 Oh my goodness. Arpita: 40:53 So, as we now know, CTE should definitely be taken seriously and studied more. And as much as we do know that, the brain science community and the neurosurgery committee has a really wide consensus that Bennet routinely exaggerates his accomplishments and dramatically overstates the risk of CTE in contact sports. And this really fuels misconceptions about the disease. Um, and so this was from a Washington Post paper, and like a deep dive into CTE and then specifically into Bennet's role in this disease. So, during some of the speaking engagements that he has, he offers statistics that are distorted and they cultivate a reputation that he is like the premier expert on the disease, even though he has not been involved in the research in many years at this point. And according to, you know, doctors and concussion researchers, his definition of CTE is outdated. Too broad and describes characteristics that can be found in normal healthy brains and one expert at Stanford said, quote,"My God, if people were actually following his criteria, the prevalence of this disease would be enormous. There's absolutely no evidence to support that." End quote. Aarati: 42:11 So according to him, like 80 percent of the human population probably has CTE from something or another. He's just really just overblown it completely. Arpita: 42:20 Completely overblown it. So when he's asked to refute these allegations, Bennet says that the naysayers are from sports leagues who are bolstering fake news. And I was like, oh my god, dear god. Aarati: 42:32 Here we go with the theories and the conspiracies and muddying the waters. Arpita: 42:38 And I was like, I can't with this right now. Um, and so Bennet is a deeply religious man and he believes that he is on a mission from God and he views scientists who question him with suspicion and hostility. And he says, quote,"As a Christian, I believe after death there is judgment," end quote. And he told a lawyer in a deposition one time when asked about experts who raised doubts about his theories he says, quote,"They will all answer for this on judgment day", end quote. I'm like, okay, you're a crazy person. Aarati: 43:07 Wow. Yeah, no, I mean, it is the job of scientists to question everything. Arpita: 43:12 For sure. Aarati: 43:13 Even if another scientist is saying it, you have to go through and validate that. You have to go ask questions. That's the job of a scientist. And I really have a problem with people mixing their faith with things where faith does not belong. Like, faith in science? No. Faith in government? No. Like, stop, stop mixing these things. Like, it's fine to have your faith, you know, you do you in that regard. But.... Arpita: 43:38 But saying that you're not going to go through something because you just believe it's to be, believe it's true on face value, because God said so, is just not the scientific method. That's the biggest problem here. Aarati: 43:49 Yeah, and not letting anyone question you. Like, a good scientist should invite questions and would be happy to be like, Oh, that part of what I was saying is wrong. And now we know a little bit more about that and I'm happy to say that in that one specific thing, I was wrong, but now we know more and I will change my view and I will change what I'm saying. And they would be thrilled by that. A good scientist, I feel like Arpita: 44:16 I don't know if they'd be thrilled. But yeah, they would at least be open to the idea. Aarati: 44:19 They would be. Or they would be accepting. They would be accepting and be like, okay, Okay. I was wrong about this one thing. The evidence points in a different direction. I will amend my views because that's how science works, right? We all think one thing. We get evidence to the contrary. We all amend our views. That's kind of Arpita: 44:35 I think this is still a little bit too idealistic, but in general. At the very least, the journal would retract your paper, so that's how that's how it should work. Aarati: 44:44 Oh, I'm just talking about like a little thing, you know, like, just not the whole CTE concept in general, not the whole traumatic brain injury concept in players in general, but just like, if you did have an idea that a specific thing was causing it, or there was a specific symptom that was, you know, Associated with CTE and then it turns out that no, you can't really say that, then okay, amend your views. But you don't have to change your whole entire message. Arpita: 45:13 As much as this really surprised me about his overall story. Um, just the fact that he kind of seems a little bit strange now, it's actually not like this left turn happened overnight. So shortly after the first paper was published in 2005, um, a team at BU published a paper on CTE and they referenced Bennet's paper. Um, and Bennet was definitely not the first person to describe CTE, even though he claims that he was. Um, it had been documented in other sports before and he wasn't like the person to name this disease. He just discovered it in a football player and then it went viral, so to speak. Aarati: 45:51 Got it. Arpita: 45:51 And in his, in Bennet's memoir slash autobiography he falsely accused the first author of this BU paper for trying to take credit for his discovery, which was like, definitely not his discovery. Um, and most alarmingly in recent news as of 2022, scientists, uh, have looked at his 2006 paper where he describes more tau than doctors would expect to find in the brains of all those football players. But for reasons that he did not explain and chooses not to explain, for the paper he selected images that could have come from the brain of a 50 year old, like, healthy man or like someone who is healthy. Aarati: 46:36 Oh wow. Arpita: 46:37 So just like you said. Aarati: 46:38 Yeah. Arpita: 46:39 Someone who's a little bit older, not that 50s old, but you would expect some tangles, right? It's just like a process of aging. So it's like definitely not to say that Mike Webster or some of these other football players didn't have CTE, but it's more that the evidence that Bennet has presented in his papers is not consistent with a CTE diagnosis. Aarati: 46:58 Yeah. Arpita: 46:58 So it's a little weird. Aarati: 47:01 And I think that's the problem. Like, once you start punching holes, like the whole thing falls apart. Arpita: 47:05 The whole thing falls apart. Yep. Yeah. And so this story is like still kind of unfolding. So Bennet continues to believe that every single person who plays for the NFL will suffer some degree of CTE. And this might be true that there's like a higher likelihood of NFL players getting head injury. There just isn't any. enough data to make this kind of claim. And in recent years, like you mentioned, the NFL actually has started taking concussion much more seriously. And to their credit, they have been, you know, put more effort in making like customized helmets and like working on biomechanics of this stuff. And their reasons are, you know, money motivated, right? These players make them a lot of money. So if they get concussions that are no longer able to play, they're no longer able to generate this kind of revenue. Regardless, they're still putting a lot more effort into player safety. Aarati: 47:49 Yeah. And I bet the fans also were a big push behind that. Like once the fans got wind that they're like you were saying, like their favorite player might be in danger, then they're going to put pressure on the NFL to be like, Hey, make sure our players stay safe. Yeah. You need to be doing something about this. Arpita: 48:07 And this actually happened, um, just a few weeks ago. The, Miami Dolphins, quarterback who has had many, many concussions, uh, is now out for the season because he's had another concussion. So it's like, this stuff comes up, like, all the time. Um, and, you know, Bennet is alive and well. So he's 51. He lives in Sacramento with his wife and his two children. He works part time as an associate professor at the University of California, Davis, but most of his income comes from being an expert witness. Uh, and during a, deposition last year, he testified that he earned over 900, 000 in 2018. So like, He's just printing money based on his CTE situation. But like I mentioned, this Washington Post paper was like really revealing that like the scientific community does not respect him. His papers have potentially a lot of holes in them. And this isn't to say that, you know, CTE isn't real or that we shouldn't think about head trauma as something that's real. It's more that this has been overblown. And he, yeah. You know, I think got a lot of attention for being a whistleblower, which, like, he was, right? It's like, yes, like, I do think this is something that required more attention, but the way that he has portrayed this as something that everyone who plays a contact sport is going to have is just, you know, fear mongering. Aarati: 49:32 Yeah, I can see that. I can see how like people kind of knew it was a thing. But then once he connected it to football, football has such like a massive fan base, like in a way that boxing doesn't have Arpita: 49:47 Like, he poked a bear. Aarati: 49:48 Yeah, like people knew about it in boxing. But like, you know, you have your boxing fans and you know, but like football is just like crazy in America. It's just huge in America. Yeah. And so once you blow the whistle on something in football, it's just going to get blown up so big. And then I think he got a taste of that it sounds like almost, and then he just kept on trying to blow it up and blow it up and blow it up. And it's like, okay, yeah, you, you made a big splash. Arpita: 50:16 You're no longer a scientist, right? And this point you're no longer a scientist. And that's, yeah, that's the story of Bennet. Oh my gosh. Aarati: 50:24 Amazing. That's, it's kind of sad in a way that he's gone so far afield, astray, you know, um, but you said he's still at UC Davis? He's a professor at UC Davis? Arpita: 50:38 Yeah, he's like super part time. I think he just maintains an appointment there, but. Yeah. Okay. It's like, he's really controversial in science because scientific community doesn't really respect him. But yet he's still like printing money, basing all the, doing all these speaking engagements. And he is still like in the press. Like when I was Googling his name, it's like, he comes up on press articles. Like he's saying words out there to the press, but that doesn't mean that they're accurate. Aarati: 51:00 I gotcha. Gotcha. Yeah. It is, it is kind of like that, where do you draw the line between science and sensationalism kind of thing? Exactly. You know, everyone wants science to be really sexy and amazing and, you know, just this huge. Arpita: 51:16 And he's delivering. He's delivering on that. He is, right? It's like something that's, you know, beloved. Aarati: 51:21 But you can't do that without accuracy. And that's the problem. Arpita: 51:25 Totally. That is the problem. Yeah, I know. It's, it's really quite interesting. Like, the controversy around this is like multifold, right? It's like him versus the NFL, like him versus the scientific community. He also has, like, a million degrees, and so he does have the credibility of having, like, a lot of letters behind your name, and it's like, that does not a scientist make, but, you know, it, it does work. does help, you know, the public eye that you have some, at least on paper credibility. Aarati: 51:53 Yes. Arpita: 51:53 It's like a Dr. Oz situation. Aarati: 51:55 Yes. Oh yeah. Good, good connection. Yes, absolutely. Well, great story. That was amazing. I've definitely heard of this kind of thing before. I don't follow football at all, but even I know about this story in general. So really, really fascinating to hear about him. Great stories. Thanks for listening. If you have a suggestion for a story we should cover or thoughts you want to share about an episode, reach out to us at smarttpodcast. com. You can follow us on Instagram and Twitter at smarttpodcast and listen to us on Spotify, Apple podcasts, or wherever you get your podcasts and leave us a rating or comment. 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