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Can boxing be made safer? Yes but the culture needs to change

Photograph by Anthony Geathers 

You may ask why a neurologist like myself has become such a passionate advocate for boxing. It’s very simple—I love the sport. In fact, I love it so much, I train in a boxing gym. It has led me to become a ringside physician for many major fights in New York State. But there are a few things about the sport that continue to trouble me as a ringside physician.

Recently the boxing world has been mourning the deaths of a number of boxers in the ring or in the immediate aftermath of a bout.  As a physician, I take an oath to always protect the health of my patients. While ringside medicine is practiced in a different arena than within the confines of a hospital or ER, my duties and obligations to protect the health and safety of the fighters should never waiver. When they enter that ring or cage, they entrust me with their most precious possession of health.

Few people realize the pressures that doctors work under at ringside. Recently, I had to make the difficult decision to stop a bout on medical grounds with only 30 seconds left on the clock in the last scheduled round. I stopped the fight, only to be berated by the fighter’s corner like I have never been before. The F word was used repeatedly for what I had done, and I was told what they thought of me in rather colorful language. Stepping away, I remained calm and ensured that the fighter was safe.

As I see it, when I “hung up my gloves” at the end of a long night (with back to back boxing events on Friday and Saturday night), I had the satisfaction of knowing that I had done the job which I am entrusted with to the best of my capability. That job is to protect the fighter first and foremost. As a fan, I may see it differently and want the fight to go down to the final bell, but we are not there as fans. We are there as doctors with the sole job of protecting the fighter.

As a doctor, I can tell you for certain, 30 seconds in a fight truly matters. One punch can be the difference between life and death. The final punch can have a fatal effect. So while we, as ringside physicians, endure the wrath of trainers, the media and sometimes the fighter himself, for stopping a fight, we can not let this discourage or intimidate us to make comprises on a fighter’s safety.

That said, we have to continuously strive to provide the best medical care and attention to the fighters. This includes looking more closely at dangerous weight cutting practices and anything else that can impede a fighter’s ability to compete evenly in the ring with full health. Analyzing what we do and improving our current medical policies and protocols should be an ongoing task. The more time I spend ringside, the more I realize that the odds are stacked against physicians at ringside.  In the office or hospital/ER setting, a patient comes to us, mostly voluntary, seeking help and care. On questioning, he/she gives us a detailed history. The family is often there to supplement the history. Contrast that to ringside, where on direct questioning, frequently the patient (boxer) and his family (corner) falsely deny that anything is wrong and are often upset and angry that we even dared to ask the question!

As physicians, we do not have X-ray vision. How can we be expected to make a medical call from a distance, without the benefit of an honest history or a quick examination?  Many do not realize that once a brain bleed has occurred and the pupils are unreactive (fixed) and dilated, there is precious little we physicians can do ringside to “save” that athlete. Even if that athlete reaches the hospital alive in a timely fashion as a result of our collective efforts, the resulting decompressive surgery is carried out as a last ditch, palliative life-saving procedure. That athlete shall never be the same again and will have significant residual neurological deficits. Our goal should be to prevent such a devastating injury from ever occurring in the first place, not just to manage it after it has unfortunately occurred.

A few years ago, I wrote a short letter titled “Boxing can be made safer,” in response to an editorial in a leading neurology journal calling for a ban on boxing and MMA. I argued passionately that boxing and MMA can be made safer with improved medical policies designed to protect the health and safety of the combat sport athlete. I still stand by my stated position that boxing can be made safer, but the change has to come from inside. In the National Football League (NFL), the culture has already changed from a previously held view of “suck it up and shake it off” to one of “if you feel something, sit it out“. Athletes are now encouraged to report their symptoms of concussion/traumatic brain injury (even if minor and subjective) to the athletic trainers and doctors on the sidelines.

The word “No más” (Spanish for “No more”) gained boxing notoriety when Sugar Ray Leonard fought Roberto Durán on November 25, 1980. At the end of the eighth round, Durán turned away from Leonard towards the referee and quit by apparently saying, “No más!” Durán’s stature as a boxer was never the same again after uttering those two simple words.

Over the years, the boxing culture has evolved to one of never saying, “No más.” The fighter’s mentality is never to quit no matter what the circumstances. Doing so brings disgrace to the fighter, his family and his corner. This mentality and culture needs to change. Boxers and corner staff should be educated and encouraged to actively recognize and report to the ringside physician any subjective symptoms of concussion and traumatic brain injury, such as headache, subjective feeling of dizziness or light headedness, blurring of vision, double vision, confusion and a feeling of fogginess. “When in doubt, sit it out” is not equivalent to “No más”.

“For he that fights and walks away, may live to fight another day” historically attributed to Demosthenes, a Greek orator, should be the new mantra of boxing. There is no shame in this; just smartness.

Let’s come back to the fight that I stopped 30 seconds before the final bell. The boxer, when checked post-fight, had a mini mental status examination (MMSE) score of 19, down from a previous documented score of 25 recorded at the time of the weigh-in physical. And this was when checked at least 15 minutes after the fight was over. He was obviously concussed, and I had made the right call to stop the fight on medical grounds.

The boxing culture needs to change. This change shall only come over time with education, and when we put the health of the fighter first. As physicians, it is our duty to educate the boxing community. I hope physicians who practice ringside medicine shall join me in this effort. Together we can make a difference and making boxing safer.

N.K. Sethi is a board certified neurologist at New York-Presbyterian Hospital, Weill Cornell Medical Center. He also serves as Chief Medical Officer for the New York State Athletic Commission (NYSAC). The views expressed in this article are his only and do not reflect the views of the NYSAC.

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