The outsider and inside air

A deeply unconventional scientist, a must-have coronavirus gadget, and what happened to suicide rates during lockdown.

Dr Bennet Omalu (right) with Will Smith, who played him in the film Concussion.

THE HERETIC
[This post inspired by this paper by Gregory Hollin, a sociologist at the University of Leeds.]

In recent years there has been a steep rise in public concern over brain injury in sports that involve ball-to-head contact, like football and rugby. The UK parliament has just published a report on “concussion in sport”. In the US, it’s a huge issue because there’s now a heap of evidence linking American football, as played in the NFL, to a degenerative brain disease known as chronic traumatic encephalopathy (CTE).

The link between sport and brain damage has been known about for over a hundred years, but its current salience goes back to a breakthrough made by a Nigerian-American physician called Dr Bennet Omalu in 2005. Omalu, a forensic pathologist, then at the University of Pittsburgh, conducted a study of brain tissue from a former Pittsburgh Steelers player called Mike Webster who had died in middle age after years of severe depression and violent mood swings. Webster’s brain was deemed normal at autopsy, but Omalu found evidence of CTE. In a published paper, he called for further study of CTE and its connection to football.

Omalu did not have a history of research in sport-related brain injury, and his intervention in the field met strong resistance from those who did. Instead of reflecting on Omalu’s finding, most experts dismissed it out of hand. Scientists associated with the NFL called for the paper’s retraction, arguing that it was “completely wrong” and “a failure”.

Brain injury was something that happened to boxers, not footballers. What did Omalu know about sport?

But Omalu persisted, making further studies, while other scientists, stimulated by his findings, carried out their own research. And the evidence began to pile up: Omalu was right. Although it took several years, the NFL was eventually forced to acknowledge, momentously, that CTE is indeed associated with the sport.

That changed the study of sport, and sport itself, forever. In 2016, Omalu was awarded the American Medical Association’s highest honour. He published a book about his struggle to get to the truth about CTE, and in 2015 a film was made about his story (Concussion).

Why was it Omalu who made this discovery? He was not privy to some specialised scientific knowledge or tool unavailable to those in the field, nor was he regarded as an especially brilliant researcher. It’s more that he had a very different mindset to the scientists who studied sports concussion. He was an outsider able to see things the insiders were blind to.

First of all, Omalu was an immigrant. It’s well established that immigrants drive national innovation and creativity. That’s for a variety of reasons but one is that immigrants see everything in the country through fresh eyes. Omalu had no feel for the game of American football. He thought it was a really weird sport played by men in funny costumes (which, let’s face it, it is). Most American scientists were so familiar with the NFL that they found it hard to believe such a great national tradition could be doing harm to people’s brains.

Some of the scientists involved depended on the NFL for income and status, and hence were not neutral, but, as in the case of John Yudkin, the bias was more widespread that an interest-based explanation can account for. A kind of thoughtless consensus has developed. Science is meant to be objective, by definition, but scientists are subject to collective cultural biases, just like the rest of us. Omalu was unburdened by this one.

The second reason that Omalu saw things differently is that he is deeply religious. He describes his religion as “a fusion of Roman Catholicism and Igbo tribal mysticism”. In his memoir, religion is not marginal to the story of his discovery but central to it. Not many scientists are religiously minded. Vanishingly few hold a firm belief in the existence of ghosts, as Omalu does.

Omalu’s brand of spirituality gave him a different kind of relationship with his subject. To him, Webster’s brain was not a piece of inert matter, but the physical manifestation of a spirit that was “yearning to communicate” with him from beyond the grave. He believed that deceased NFL players wanted to heard, wanted their story to be told, and wanted him to help them. So that’s what he set out to do, by engaging in an enquiry few of his peers thought worth pursuing.

In recent years Omalu has become something of a pariah to the scientific community, and not without reason. He exaggerates the novelty of his discovery, makes false claims about the prevalence of brain disease, and has made personalised attacks on credible scientists who have done much to advance our understanding of CTE in sport.

This is not quite a “one good man” story, then. It’s more of a paradox: scientific breakthroughs can come from modes of thinking that are highly unscientific.

(If you’re interested, do check out Hollin’s paper.)

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CLEARING THE AIR

I recently ventured into Soho for lunch with my friend Rob Blackie. As soon as we took a table at Cafe TPT he plonked this device on the table (well, a device like this one, not necessarily this one). As well as being a brilliant digital marketer, Rob is something of a science geek. He explained to me that the gadget was tracking the amount of carbon dioxide in the room. In a room where the air is circulating well, the CO2 from our exhalations will stay relatively low, but in a space that isn’t ventilated, the CO2 will build up. So as you’ve guessed, CO2 works as a good proxy for the potential presence of Covid particles. Get above a certain level of CO2 (over 700 or so) and you should be concerned. As it happens, Cafe TPT was very well ventilated (for that and other reasons I recommend it) but Rob has been in restaurants where the device has registered uncomfortably high levels, at which point he asks the restauranteur to open a door or window. Why not make all public indoor spaces track CO2? Ventilation is the big missing public health message of this crisis, perhaps because it took scientists a while to establish that Covid is airborne. UPDATE: as The Ruffian goes to press, we learn that the authorities are changing the message.

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