Football players are getting bigger. The game is getting faster. Now, the chorus of concern is getting louder. At least four recent studies have raised serious questions about the impact of pro football on the brains of players. But are they being driven mad by the game?
Garrett Webster treasures every memory of his father, legendary Pittsburgh Steeler Mike Webster.
"These [rings] are, I guess you could say what my dad got back for giving his life, three Super Bowl rings and a Hall of Fame ring," Garrett Webster said. "My dad was everyone I wanted to be. I mean he was smart, funny and he was caring and loving. To me he was Iron Mike. ..."
"Iron" Mike Webster, as he was known, was a seemingly indestructible center for the Steelers during the 1970s and '80s. He played 150 straight games, winning four Super Bowls. He was selected to the Pro Bowl nine times.
Dr. Julian Bailes, chairman of neurosurgery at the West Virginia University Hospitals, was team doctor toward the end of Webster's playing career.
"He was the consummate professional, one of the greatest players on perhaps the greatest team ever," he said. "And he was the leader; he was the center of the line and was the focal point. And I think he was the spiritual leader in many ways of that team."
That's why nobody could understand Mike Webster's behavior after he retired from the game at age 38.
"It was a fast, major change," Garrett Webster said. "We would go through times where he would have absolute mood swings and just destroy things in our apartment, our house, his memorabilia."
"I remember one time he got so angry ... he smashed the porcelain sink to pieces," he said. "Then other things started to change. We noticed he wasn't there for birthdays, we noticed he was forgetting to come home at night. We noticed he would disappear for days, weeks on end."
Quirky Behavior Incomprehensible to Friends
Mike Webster's life began to disintegrate. He started living out of a truck, used a Taser gun to ease his back pain and put Super Glue on his teeth. His behavior was incomprehensible to friends and family -- and its connection to the game he loved seemed unclear. Mike Webster was never known to have suffered a single documented concussion during 17 years of pro football.
On a cold September morning in 2002, just after his 50th birthday, Mike Webster died.
Dr. Bennet Omalu, a neuropathologist who grew up in Nigeria and was qualified to practice in the United States, was working as a medical examiner in Pittsburgh at the time of Webster's death and performed the autopsy. He confirmed that Webster had died of a heart attack.
"However, a question kept on lingering in my mind. The heart attack could not explain his life after football. I had to provide an explanation for that," Omalu told "Nightline." "I took out his brain, and I was extremely disappointed when I opened up his skull and his brain looked normal. His brain looked like a perfect textbook picture of a normal brain."
Determined to find answers, Omalu got permission to continue studying Webster's brain. After months of painstaking microscopic analysis, a whole new scientific account began to unravel. Omalu said what he found was nothing less than a new medical condition.
Researcher: Blows to Head Kill Brain Cells, Lead to Dysfunction
Omalu compared a region of the brain of a normal, middle-aged individual to a football player's. His analysis showed an accumulation of brown staining in the football player's brain.
The brown blotches mark the accumulation of tau protein -- an abnormal substance that can emerge within the brain after repeated blows to the head. It's known to kill off brain cells, ultimately leading to cognitive dysfunction, even dementia, Omalu said. It's rare to find accumulation in the brain of a 90-year-old -- but at the time it was almost unheard of in a man of 50.
Omalu said that scientific papers have suggested that as few as three major head impacts can result in the abnormalities.
"One individual may just have one major impact to the head. Another individual may have two, another individual may have 1,000 before they will develop this disease," Omalu said.
In the absence of any title for his discovery, he called the disease chronic traumatic encephalopathy, or CTE. He wrote up his findings and sent them to the prestigious academic journal Neurosurgery.
But there was a swift reaction. Several doctors on a committee convened by the NFL to study brain trauma demanded its retraction. But the journal was satisfied with Omalu's work and refused.
"I thought it was my responsibility as a physician. I've seen something unique to report to the general scientific community," Omalu said.
A few months later, Omalu would receive the body of another storied football player. His findings were the same.
"This is how diseases are discovered and identified. So I published the second case. Oh, newspapers, some doctors went to the press. In fact they were insinuating I was practicing voodoo medicine," Omalu told "Nightline." "They called me names -- preposterous, unscientific methods. But again, you seek the truth, and the truth will set you free."
Bailes was the first and most senior clinician in the country to support Omalu's research.
"I reviewed Dr. Omalu's publication, the first one, the sentinel case of Mike Webster. It obviously struck a chord with me because I felt that I knew Mike very well professionally and personally," he said. "The letter of retraction demanded by the NFL was also unusual, and I thought inappropriate, and I thought they had missed the point."
There was now no stopping Omalu. A third body was delivered to his laboratory. Omalu noticed that all of his cases displayed common symptoms, including memory loss, insomnia, alcohol use, drug use and diminished executive functioning, or the loss of the ability to engage in complex mental functioning like business investments and money management. They were paranoid, exhibited manic depressive episodes, breakdown in social relationships and had criminal tendencies, he said.
Helmets Provide 'False Sense of Security'
Since the discovery, Omalu has gone on to study the brains of 7 other retired pro football players postmortem. Along with Bailes, he is beginning to understand how these microscopic injuries may occur at the point of collision.
"Two major things -- one is the helmet and the cranium suddenly stop, but nonetheless the brain continues forward, hits the inside of the skull, it bounces back and hits the back of the skull and maybe reverberated a second time. In addition, there is rotator effects where there is a rotation, and that also is a very common way that fibers get torn," Bailes said.
The NFL and several manufacturers have focused resources on improving helmet safety. But helmets, Bailes said, may now be part of the problem.
"The helmet has given a false sense of security, and I think for many players it has been a weapon. It has led paradoxically, unfortunately, ironically, to some of the injuries that we are currently seeing," he told "Nightline." I think the helmet as it has evolved in parallel, has led paradoxically to players sticking their head in with a false sense of security."
And while helmets cannot protect the brain within the skull, there is a further problem: What about players like Webster who never experience a career-ending concussion but instead suffer the cumulative effects of up to 50 head collisions per game, season after season?
"I think there is a phenomenon called subconcussive impacts, a subconcussive blow? the question it begs is: does that lead to microscopic damage? Can it lead to that?" Bailes said. "We don't have that definitive answer. But we've got several linemen who did not have career-ending concussions, who were later found at an earlier age to have extensive brain damage."
NFL Implements Safety Regulations
"Nightline" spoke to Dr. Joseph Maroon, a neurosurgeon and current doctor for the Pittsburgh Steelers, who represents the NFL. He's also a member of the NFL Mild Traumatic Brain Injury Committee.
When asked if he was concerned about that area where an individual isn't concussed but nevertheless has taken repeated blows to the head, Maroon said it's an area that should be more carefully examined.
"I think that's an important observation and consideration. Absolutely, I think that's an important new emphasis on what happens to the brain and head in football," Maroon said.
The NFL says it has implemented several safety regulations to protect players in the event of an overt concussion.
"It clearly has instituted educational programs to inform the athletes, the players, the coaches, and the trainers, of just what is a concussion and of the long term consequences of concussion," said Maroon. "It's instituted a whistle-blower hotline so that if any athlete feels like he is being pushed back into play too soon, he can directly report this anonymously to the NFL."
In a statement provided to "Nightline," the NFL said: "We have more resources than ever devoted to the care of this injury and to the education of players and their families, as well as coaches and team personnel. ... Hundreds of thousands of people have played football and other sports without experiencing any problem of this type. There continues to be considerable debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors, including pre-existing conditions or family history."
But the issue of subconcussive blows to the head is far more problematic to address because no method of measuring them currently exists.
"I think there is yet more to learn. And I think the phenomenon of subconcussive impacts is important to understand," Bailes said.
Brain Injuries in Football Players
A phone survey commissioned by the NFL and completed at the University of Michigan found that pro football players are 19 times more likely to be diagnosed with dementia, Alzheimer's disease or other memory-related illness than the same 30- to 49-year-old-age group in the general population.
But the NFL has since dismissed those findings as unscientific, pointing out that the survey makes no link between concussions and memory disorders and has now funded a study due out next year that looks at the long-term effects in the brain of its retired players.
For Omalu and Bailes, the evidence is already there -- etched in the brain tissue under their microscopes.
"I believe that football is the greatest sport in the world, and I played it for 10 years and I have children and if they want to play it, they can play it, and I think there are so many, many benefits of football, any organized sport," he said. "We are trying to draw attention to what we believe is a real finding. I think it's irrefutable. I don't think any physicians in this country or worldwide have refuted the findings that Bennet Omalu first discovered. Let's, if we can agree upon that, let's move on to making it safer and trying to prevent it."
"They should have been more acknowledging, should have been more proactive, but the truth is that this story is over with -- Mike Webster is not coming back," said his son. "Now, let's learn from the Mike Webster mistake."
Webster is spoken of in hushed tones by the faithful fans of the Pittsburgh Steelers. His heroic status on the field made him legendary. Perhaps his greatest legacy will not be the games he won, but the way his life was lost.
"I am building toward my father's legacy to the game being that no family has to go through what our family went through," Garrett Webster said. "That is what I want his legacy to be. ... It's funny, for all the Super Bowls, and all the things he has, his legacy is going to be greater in death than it was ever in life, and that is just ... I am so honored by that."