PART I: The Medical Aspects by Margaret Goodman, MD
There are so many “unappetizing topics” in boxing that no one wants to discuss; better left to “others.” Things no one wants to mention or they become a reality. BUT THEY ARE OUR REALITY! All you have to do is turn on a typical boxing show these days (many are Pay-Per-View) where an over-the-hill boxer, a once great champion, is trying to go another 10-12 rounds for a paycheck. To some, this is funny; it is entertainment. To us who love the sport and love the boxers who risk his or her life every time he or she enters the ring, it is a farce of what the sport should represent.
Most often, we come up with an acceptable rationale enabling us to turn a “blind eye”:
1) It’s an easy match - his opponent can’t bang;
2) He may be old, but he knows how to pace himself and won’t let himself get hurt;
3) The public wants to see it; or, better yet, 4) He passed all his tests.
We should ALL be ashamed. Better yet, whose fault is it?
On August 2nd at the recent Association of Boxing Commissions meeting held at the Miccosukee Resort in Miami, Florida, Dr. Flip Homansky and I decided to filet the issue open and discuss “Denying a Boxing License Based on Medical Reasons.” Just so you know from the start, there is no easy answer to this question. Oftentimes when you begin asking good questions, you just come up with more questions. I have always believed if we who respect boxing don’t start finding the right questions we will never locate the right answers.
As Dr. Homansky states time and time again, a boxing license is a PRIVILEGE and not a RIGHT! Why is this a tough concept? Perhaps because it takes tremendous work by a commission to determine who is affected and it is not easy to face. Every boxer who applies for a license to box has to prove why it should be granted. If you are Eric Morales or Marco Antonio Barrera, it is a given. However, if you can no longer take a punch, can’t avoid a punch, or are beginning to show wear and tear that is more than being in with too tough an opponent, a boxer needs to think about retirement.
Oops, I said the word.
Retirement has all kinds of connotations. In Webster’s Dictionary it means: “State of living a retired life; seclusion, privacy. To designate as being no longer qualified for active service.” It happens in all walks of life and I understand it can be emasculating, humiliating, or weakening if it is forced upon you. However, it can also be the natural progression of things. I have asked many great trainers when they recommend a fighter retire from the sport. Teddy Atlas advises, “I look at defense. When a fighter can no longer avoid more than 90% of the punches, or if there is an obvious decline in the number of punches he can escape, it is a clear indication that his reflexes and skills have deteriorated.” Emanuel Steward says, “I decide that a fighter should retire when he is receiving too much physical punishment in sparring as well as actual bouts. Great loss of balance when he misses blows and evidence that his mind seems to be set more on defense than offense.” The main problem comes when fighters won’t listen to their trainer’s advice, family’s advice, and they refuse to ignore what their body is telling them. It is so much more than age although ring age is a major factor.
In the past, many commissions (including ours) would essentially look the other way and hope fighters would retire on their own. That is human nature when the truth is tough to face…especially with lawyers testing your fortitude. “Go somewhere else and if you get a few wins under your belt, come back and then we’ll see.… Or better yet, let’s see how you are in the gym. If you look good …maybe....” These days, few retire. We are hopefully in a time where we strive to make the sport safer for those still in it, and in a time when we help those recognize the need to get out before it is too late. LEGALLY, if a fighter is placed on the Federal Suspension List, they cannot travel to another state (or Tribal Land affiliated with the ABC), and fight. HOWEVER, if a boxer is denied a boxing license EVEN FOR MEDICAL REASONS they can still go to another place and apply. That other place is not bound by any law to deny them a license, a la Mike Tyson. Maybe that doesn’t sound right, but it is the law. If a boxer is denied a license based on medical reasons, they can be listed on the Federal Suspension List for all to see, but no one is legally obligated to abide by the other state’s decision.
How can anyone say Sugar Ray Robinson’s dementia at the time of his death didn’t have to do with fighting over 100 bouts? Who could confuse Terry Norris’s speech pattern with just depression or a speech impediment (although he has always been one of the most beautiful, in-shape boxers this sport has ever seen)? Furthermore, who in their right mind can say Meldrick Taylor traveling from state to state to apparently avoid medical evaluation and expose himself to a commission with a conscience, is okay to get in the ring?
If we are honest with ourselves, at least the regulators, the commissions must look beyond the pressure dolled out by the fighters’ lawyers, the well-known names many of these fighters have, the promoters and the networks who want to bring a big fight to your state, and the fact that many boxers have nothing else planned to do in their life. Boxing is not golf, but it is also not smoking! The latter, a comparison made to our commission by a boxer’s attorney, “Hey, my doctor told me not to smoke as it is bad for my health, but I still have the right to do it! So, my fighter should make the choice when it comes to boxing.” However, unlike boxing, you do not need a license to smoke. When appropriate and in the best interest of the boxer, commissions must say, “No, we are not going to allow you to continue taking punishment in the gym and in the ring.”
Okay, we know what is “right,” but how do you really identify these fighters and how do you proceed. Again, these are tough answers to find. Many savvy boxing folks say to me, “Hey, if you get the ‘tests’ I’m sure that will tell you the guy shouldn’t fight.” From a medical perspective there is a lot wrong with this thinking:
#1. Doctors are human. Medicine and tests can’t always tell when a fighter is beginning to show damage to his/her brain until it is way too late. Most doctors have never had the opportunity to examine athletes, let alone a professional boxer. So they don’t know what kinds of changes represent chronic brain injury as a result of boxing or even less about which fighters are susceptible to acute/potentially lethal brain injury. How can a doctor begin to really say a fighter is having neurological problems if they have no comparison exam done years before?
#2. What tests do you do? Just as age is impossible to use by itself (otherwise you risk legal retribution), tests have to be used in context. If a fighter has a baseline MRI (Magnetic Resonance Imaging) Scan of the brain when they begin their career, you can look at one several or even just a few years down the road to say the shrinkage of their brain is out of line. A good exam by a neurologist just isn’t enough. There are certain neurologists specializing in detecting dementias (like Alzheimer’s/Dementia Pugilistica), but for one of these experts (most are at respected universities) to go on record and say this fighter needs to quit boxing is tough. These doctors, irrespective of their convictions, might be subject to court action if they did so. If the scans or other specialized tests (including PET scans, neuropsychological testing and EEG’s) that can run thousands of dollars won’t prove it, and the doctors may need more exposure to a fighter to state the reality, how can a commission act?
#3. We are the experts. Kind of corny, but just like Dorothy in the “Wizard of Oz” who all she had to do was click her heels together to get home, the answer is right in front of our eyes. Commissions and Medical Advisory Boards see the same fighters year after year. We watch them fight, not only in our state, but also on television. Just as the boxers and their “hangers on” may fail to recognize the truth, we, part of a commission, can come to the right conclusion. If you watch Riddick Bowe/Evander Holyfield I, compare Bowe’s performance and his post-fight interview with Jim Lampley, and then immediately juxtapose it to Bowe/Golata II, listen to the Bowe’s post-fight interview with Larry Merchant, it no longer takes the Chairman of the Mayo Clinic Neurology Department to tell you this previously wonderful champion should no longer be allowed in the ring.
All other sports doctors are paid by the team to get the athletes back out there. Individuals who work for commissions are paid by their respective states. Hopefully, barring any unforeseen conflicts of interest, these individuals are in the best position to appropriately judge when a fighter is okay and when he or she is not.
What are the symptoms? Another difficult answer, but the operating word here is “comparison.”
1 Changes in a fighter’s articulation (slurred speech)
2 Problems with balance/coordination
3 Loss of memory/confusion
4 Behavioral problems/depression/mood swings/paranoia
Which fighters are at risk? These are some of the things to consider:
1 Total number of fights (both amateur and professional)
2 Number of TKO’s/KO’s
3 Number of losses
4 Years of the fighter’s career
5 Poor performance history
6 Fight frequency
7 Sparring regimen
8 Age at retirement
9 Use of drugs/alcohol
10 Family history of dementia/genetics
The presentation made before the ABC by Flip Homansky (as a Regulator and former Medical Advisory Board Chairman) and I (as current Medical Advisory Board Chairman) demonstrated not only is this a big part of our job in working for a commission, but it is the most important service we have to offer. It isn’t fun, it isn’t easy, it takes countless hours of evaluation, and lastly, it takes great strength to sit there and say “no” to a kid who wants nothing more than one more fight. To do any less, is shirking your duty, and selling out your convictions. To not do this makes us a partner contributing to the potential ill health of a fighter.
Dr. Homansky and I would like to take this opportunity to thank Tim Lueckenhoff, ABC President, and the ABC for allowing us to discuss this important issue on their very busy agenda.
PART II in this series will be by Dr. Flip Homansky as to a Regulator’s perspective on boxing license denials; Part III will be by Nevada Chief Deputy Attorney General Keith Kizer discussing the legal position.
Dr. Margaret Goodman is a Ringside Physician and Chairman of the Medical Advisory Board of the Nevada State Athletic Commission.
Dr. Margaret Goodman practices in Las Vegas, Nevada, where she is a licensed ringside physician since 1994. Her medical specialty is in the field of Neurology. Dr. Goodman was appointed by Nevada’s Governor, Kenny C. Guinn, in September of 2001, to serve as Chairman of the Medical Advisory Board to the Nevada State Athletic Commission. Although she is Chairman of the Commission’s Medical Advisory Board, all of the views, opinions, and/or recommendations contained herein are solely her own and do not necessarily reflect those of Nevada’s Commission. All readers are strongly cautioned that the information contained herein is not intended to, and never should, substitute for the necessity of seeking the advice of a qualified medical professional whenever a boxer or his/her representatives have specific questions regarding the best course of action that a boxer should take. Furthermore, since it is possible that general information herein may pertain only to a law, regulation, rule or acceptable standard of practice for a particular jurisdiction, a boxer or his/her representatives must always inquire with the appropriate licensing jurisdiction to determine the applicable laws, regulations, rules, and acceptable standards of practice for each jurisdiction.
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