Saturday, July 30, 2011

The Final Week! Italy and Istanbul


I wanted to travel to Italy because Italy is the home of an interesting problem: former professional soccer players are being diagnosed with Amyotrophic Lateral Sclerosis (ALS) at over six times the normal population. It’s a problem that we are seeing in America with former professional football players being diagnosed at a similar rate. If you’ve been following our research you know that our Dr. Ann McKee connected brain trauma to ALS in football players and boxers. I suspect the same in soccer players, but we’ll need evidence to get there.

Dr. Colombo
My first stop this morning was with Dr. Massimo Colombo of the University of Milan. He is a former team doctor for one of the big Milan football clubs. The hospital was about 100 degrees, windows open – not a place for me at 270 pounds. Very Italy. Dr. Colombo didn’t know why I came – he was meeting with me on the recommendation of Dr. Nicoteri in Germany. He believe the concussion problem is underappreciated, and that doctors have to fight with team management to rest players with concussions. He shared with me the story of doctors from a different local pro football team, to remain nameless, who have systematically bought time for concussed players by naming a ‘scientific institute’ for injuries that purports to have precise objective ways to determine when an athlete can return to play. Somehow the club management has bought in to the idea that there is a perfect science to coming back from injuries, and the doctors are not hassled. It’s interesting.

Mario Negri

From there I caught a cab across town to meet Prof. Massimo Masserini of Universita‘degli studi di Milano-Bicocca and Dr. Mario Salmona, Instituto di Ricerche Farmacologiche „Mario Negri“ Milano, and the head of the Department of Molecular Biochemistry and Pharmacology. Mario Negri has nearly 700 scientists and staff working in one building on various projects, which Dr. Salmona said helps facilitate learning and collaborations. Dr. Masserini and Salmona are working both together and separately on multiple projects on neurodegenerative diseases, including nanotechnology.

When I shared my work and my concerns about headers in soccer, one of the doctors, who I won’t identify, said, “So you want to change soccer?” I said, “We changed football in America, it can be done.” He said, “Yes, but in Italy, they might shoot you.” I’m not sure if he was joking. We discussed opportunities to collaborate, and then they introduced me to Dr. Elisabetta Pupillo, who is doing a lot of epidemiological work on Amyotrophic Lateral Sclerosis. She shared with me some preliminary data on history of concussions and risk of ALS, but I’m sworn to secrecy!


This morning Nicole and I grabbed a train to Torino, Italy, home of the 2006 winter Olympics. The trip was to meet with Dr. Adriano Chio, a neurologist who has done some of the research in Italy finding that soccer players have a higher risk of ALS. I knew of Dr. Chio because he was interviewed for the HBO Real Sports with Bryant Gumbel piece from August 2010 that broke Dr. McKee’s discovery. We discussed his thoughts on the theory and work that is being done in Italy. He even told me they had a case a while back of a female soccer player who developed ALS and fronto-temporal dementia at the same time – I am suspicious, and wish Dr. McKee could have looked at that case. I enjoyed the discussion, learned a lot, and I look forward to finding ways to work together in the future. Nicole and I headed back to the train station and caught a high speed train to Rome.


I’d never been to Rome before, so it was difficult for me to appreciate just how old and amazing some structures are. So I was sure to get in some tourism and pictures before heading over to the Italian Olympic Committee (CONI), aka Scuola dello Sport. Prof. Carlo Tranquilli, Direttore Sanitario and Head of the Traumatology and Rehabilitation Department at the Institute of Medicine and Sport Science of the CONI put together a meeting with the top sports medicine researcher s in Italy. I was blown away – there were over 20 doctors and medical staff in the room to hear me speak, and then a few Italian researchers presented their work. It was very cool, as I was familiar with some of the studies they presented, so it was exciting to put faces with the names I’d been reading for years. I must thank former Eisenhower Fellow Pia Marconi for making it happen. Our work was incredibly well received and the audience were real policy makers – one asked, “What’s your thoughts on BMX bikes? We have a meeting tomorrow to discuss regulation.” I was influencing policy in real time. I told him about the multiple former “Extreme Sports” stars whose families have been calling, worried about CTE symptoms in their 40’s. I am worried about the lack of regulation over that activity.

That evening five former Eisenhower Fellows took Nicole and I to dinner in Rome at a fabulous place with the most famous Sicilian chef in the country. Great food, small portions. It’s keeping me from gaining weight, but it’s also making me perpetually hungry. Where are my American portions?! Antonio Colombo organized the dinner, and we were joined by Pia Marconi and others, most of whom were involved with civil service. The Fellows there believe that Eisenhower Fellowships can help them build a stronger government, and therefore recruit in that direction. After reading an article about Prime Minister Berlusconi’s Bunga Bunga parties and other issues they have had, I can see why.


The next morning Nicole and I flew to Istanbul, Turkey, with the main goal of meeting Dr. McKee for a conference on Motor Neuron Disease sponsored by the Kirac Foundation and organized by Dr. Bob Brown, an ALS researcher extraordinaire and a brilliant doctor that we, through Dr. McKee, have begun collaborating with. The first night, however, I met with the Eisenhower Fellows. The Istanbul EF crew have a great reputation for having one of the strongest alumni associations on record. They are led by 82 year-old Nezir Kirdar, an entrepreneur who was forced to leave Iraq just prior to Desert Storm and resettled in Istanbul. He was the younger member of the Iraqi parliament at one time, and actually met Eisenhower at the White House when he was a Fellow! He assembled a team of VIP fellows, many of whom were involved in the medical field, and we had a wonderful dinner at a club on the Asian bank of the Bosphorus. I was told Attaturk, the father of modern Turkey, founded the club and was a member, with the intention of it enable and train Turkish men to conduct more Western-style business. He also gave me a terrific speech on how I need to both take advantage of and give back to the Fellowship.


The next morning I headed over to the conference and heard some terrific presentations – the one that stood out the most, other than Dr. McKee’s, focused on why, in ALS, only some motor neuron cells die, and others, perhaps right next to them, survive unharmed. One of the experts began the discuss talking about the fact that while we focus on a small number of types of neurons, the reality is there are probably more than 10,000 unique types, and each one is vulnerable to different problems. Dr. Chris Henderson went through some studies they’d conducted that found that found a specific genetic marker that predicted which cells would die in a rat with ALS and which would survive. It was really exciting, and of course we talked about collaboration…


FINALLY, the next day we picked up Dr. McKee and did some tourism. We were very lucky to be escorted by a Turkish couple. When I was in Brussels for the EUVP, I met Gokce Uysal, a prominent Turkish economist, who was also participating in the program. She and her husband took us to the Blue Mosque, the Hagia Sofia, and the Grand Bazaar. What a way to wind down the trip!

I could not be more thankful for the opportunity, and I thank Eisenhower Fellowships for the experience and for helping advance the cause to Europe. This is only the beginning!

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