AT A SHOE DEALER CONVENTION in Boston in 1920, Dr. Jacob Lowe showed off an invention he called the Foot-O-Scope. His fluoroscope used an X-ray tube to produce a fluorescent image of the bones in a foot as well as the shoe around it, ensuring a perfect fit. It was a modification of a device the Boston physician created during World War I to examine the injured feet of servicemen without removing their boots.
By the early 1950s, some 10,000 shoe-fitting fluoroscopes were in operation across the country, according to medical historians Jacalyn Duffin and Charles Hayter. The machines were especially popular with kids, who delighted in looking through the viewing port to see their bones light up.
When two significant medical journals warned in 1949 about radiation exposure from the devices, the industry first dismissed and then disputed those concerns. The warnings became harder to ignore: A shoe model suffered a radiation burn so severe her leg had to be amputated. By 1970, the machines were widely banned.
To today’s risk-averse parents, stories of children being needlessly exposed to radiation at the shoe store sound unfathomable. A generation from now, the work of another Boston physician, Dr. Ann McKee, may mean people will react with the same incredulousness to stories of how parents once signed up their 6-year-olds to play tackle football. Or maybe even how talented young men willingly smashed their heads into the heads of other talented young men every weekend in autumn, seeking glory and big paydays.
If that wholesale change in public opinion comes to pass, expect historians to credit McKee’s pioneering work. In charting the arc of football as our national obsession, there’s a good chance 2017 will mark the start of its irreversible decline.
For her skill and relentlessness in pursuing research that is forcing us to confront hard truths most of us would rather avoid, McKee is our Bostonian of the Year.
ANN MCKEE IS AN UNLIKELY WARRIOR against football. The 64-year-old was raised in Appleton, Wisconsin, as a devoted Green Bay Packers fan. Her older brother Chuck was the star quarterback for both the public high school and private college, Lawrence University, in town. Ann, the youngest of five McKee children, idolized Chuck. Despite being a free-spirited artist who turned her bedroom walls into a psychedelic canvas, Ann scrapped her plans for an art career to follow Chuck’s footsteps into medical school.
In 1981, while she was a resident in internal medicine in Cleveland, her older sister Ginny was killed in a car crash. Devastated, Ann decided she needed a change and switched to neurology. She married a fellow doctor, they moved to Boston in 1984, and she took the following year off to be with their newborn daughter. Returning to work, she made another switch, from neurology to neuropathology. Friends were surprised such a sociable person was choosing a solitary life in the lab studying brain samples, but Chuck got it. “Pathology really spoke to Annie because it’s visual,” he says, “and she’s always been a visual person.”
She remained in the lab for decades, even as other parts of her life changed — she had a son, got divorced and remarried, had another daughter, and divorced again. She came to focus on Alzheimer’s and other neurodegenerative diseases, studying brain after brain, including those of deceased participants in the famed Framingham Heart Study.
McKee, now the director of neuropathology for VA Boston and a professor at the Boston University School of Medicine, autopsied the brain of boxer Paul Pender in 2003. Given his dementia, she expected to find Alzheimer’s, and stained brain tissue looking for certain markers. While a buildup of a protein called tau is present in Alzheimer’s, it was everywhere in Pender’s brain. “I’d never seen a pattern like this,” she says. “It was amazingly florid.” She found the same pattern in another boxer.
McKee’s career didn’t begin its dramatic turn until 2008, when she teamed up with health advocate and former professional wrestler Chris Nowinski, who was recruiting brain donations from families of deceased athletes. McKee found similar patterns of the neurodegenerative disease known as chronic traumatic encephalopathy, or CTE, in several former NFL players. As CTE causes the brain to deteriorate and shrink, large amounts of tau accumulate in nerve cells, like tangles of yarn.
Those ex-NFL players had died in their 40s, after being plagued by depression, anxiety, impulsive behavior, and memory loss — demons that tormented them and their families. When McKee found CTE in the brain of an 18-year-old high school athlete, she became alarmed.
Since then, she and her team at BU’s CTE Center have found the disease in the brains of hundreds of former athletes — in football, hockey, and other contact sports — as well as military personnel exposed to head trauma. Her research has helped dispel the belief that only concussions trigger CTE. Repeated “subconcussive” blows are the real drivers, she says. As she told Congress last year, these hits occur in football on “every single play of the game.”
The quiet lab denizen has seen her profile grow. She admits her first press conference was a deer-in-the-headlights ordeal. Before writing her opening remarks the first time she testified in Washington, she had to Google “What’s in a congressional statement?”
Her relationship with the NFL has had its twists. When she briefed league officials in 2009, she found them dismissive. Then they gave her an unsolicited $1 million grant, later committing $30 million to fund studies by her and other researchers, including her BU clinical colleague Robert Stern. But after giving less than half the funds, the NFL pulled out.
As McKee’s findings became more damning, some fellow scientists accused her of overstating her case. After all, she had not randomly selected the brains she was analyzing. They had been donated by family members who suspected the disease based on their loved ones’ symptoms. Yet McKee has been careful over the years to acknowledge this so-called selection bias. And she stresses that while most brains came through cold-calling of families early on, these days most donations are unsolicited. She says admission to her lab’s brain bank, which now has nearly 500 brains, is not based on symptoms, only on exposure to head trauma through contact sports or military experience. “Either these loved ones are incredibly good diagnosticians,” she says, “or CTE is a lot more common than people think.”
Her contributions have sometimes been glossed over. The 2015 Will Smith movie Concussion focused on the early work by Dr. Bennet Omalu in diagnosing CTE in certain ex-NFL players. Rare was the media coverage that asked what MTV News did: “Why did Concussion leave out the woman leading its game-changing movement?”
McKee brushed off those distractions and focused on amassing more data — 60 papers and counting — to satisfy doubters like the doctor who told a Zurich conference her papers were “very poor science.”
“How many cases is it going to take for people to believe you?” McKee says, identifying with climate-change scientists. “I feel like I’ve got bullet holes all through me.”
Along the way, her nieces took to calling her Auntie Badass.
“It takes so much courage to be the lead in scientific research that most people just don’t want to believe,” says Lisa McHale, whose late husband, Tom, an ex-NFL player, was diagnosed with CTE by McKee.
Despite all the pushback, McKee has seen the impact of her work. During a return to Congress last year, she appeared with Jeff Miller, the NFL’s top safety official. Pressed by a congresswoman about whether he believed there was a link between football and CTE, Miller replied, “Certainly, based on Dr. McKee’s research, there’s a link.” The frank admission was so unlike the NFL’s previous statements that the congresswoman asked him to repeat it.
The NFL’s new chief medical officer, Dr. Allen Sills, says McKee has “contributed important pieces to a complicated puzzle.” While acknowledging “it is clear there can be long-term health risks associated with repetitive head injuries,” Sills stresses that researchers still need to determine “what exactly those are, how they manifest, who is at risk for neurodegenerative disease, what causes it, and why.”
McKee saw her work gain the most traction this year. Her team identified a promising biomarker that could eventually lead to diagnosis of CTE in the living. There was more evidence showing the risks associated with youth tackle football, played by more than 1 million American kids ages 6 to 12. And there was McKee’s diagnosis of CTE in former Patriot and convicted murderer Aaron Hernandez, six months after he took his own life in jail.
Attracting the most attention was the paper McKee and her colleagues wrote for the Journal of the American Medical Association. It reported that of the 202 brains of former football players McKee’s team had analyzed, 177 had CTE. And when it came to ex-NFL players, 110 of the 111 had the disease.
She stresses that CTE prevalence in the general population of former NFL players is nowhere near 99 percent. But, she says, “it cannot be rare.” Even accounting for selection bias, the JAMA paper’s numbers were devastating for football. “It was a real tipping point,” McKee says. “I don’t feel like I’m swimming upstream anymore.”
Her findings prompted the usually measured broadcaster Bob Costas to declare that football’s days are numbered. “The reality,” he told a crowd last month, “is that this game destroys people’s brains.”
ON THE LAST MONDAY in November, McKee and I sit in a bar in Boston’s South End. It’s around the corner from her older daughter’s apartment, where McKee has been staying during the week since she sold her house in Wayland. She spends weekends with her boyfriend in Ogunquit, Maine, in a house she is rehabbing. Despite her research, her boyfriend, who grew up with her in Wisconsin, can’t resist watching Packers games. McKee, who was once such a big Cheesehead that she got nervous before every game, doesn’t watch football anymore, spending that time painting.
Still, she has agreed to my request to watch a Monday Night Football game. She speculates that it might take as long as a generation for Americans to abandon the NFL in droves. “Our national identity is so interwoven with football,” she says, taking a swig from her Coors Light. Until then, she fears we’ll see more denial. “People want to blame the victims.”
Glancing at the screen as a Baltimore Raven tackles a Houston Texan, she says, “That looked pretty clean.”
Although there are several dozen people in the bar, at some point I realize no one seems particularly invested in the game. “Is anyone else here watching the game besides us?” I ask.
Scanning the place, she says, “I don’t think so.” The cheering and shouting all seem to be coming from the guys crowded around the dartboard in the back.
Maybe, she quips, we could be looking at our future. “Darts!”