Boxing debate
Boxing – the BMA’s position
September 2007
(This briefing paper applies to the UK)
Introduction
Since the early 1980s, the BMA has called for a total ban on amateur and professional boxing in the UK. As a first step, there should be a ban on children below the age of consent from boxing.
The BMA’s opposition to boxing is based on medical evidence that reveals the risk not only of acute injury but also of chronic brain damage which is sustained cumulatively in those who survive a career in boxing. It may take many years before boxers and ex-boxers find out they are suffering from brain damage. The BMA believes that there is sufficient evidence for the risks of brain injury associated with boxing for the Secretary of State at the Department for Culture, Media and Sport to call for an independent inquiry into these risks.
In 1993 the BMA’s report The Boxing Debate, found no evidence to suggest that boxing was any safer in the 1990s than it was when the BMA began its campaign in the 1980s.
In a new report Boxing, an update from the Board of Science (September 2007) the BMA extends its call for a complete ban on amateur and professional boxing to include mixed martial arts (MMA) competitions.
In 1991, eleven national medical associations Reference 1 added their voice to the opposition to boxing, and expressed their concerns regarding the dangers of boxing believing that ultimately it should cease to exist. The medical associations stated that modern medical technology demonstrates beyond doubt that chronic brain damage is caused by the recurrent blows to the head experienced by all boxers, amateur and professional alike. “As long as it is legal to hit an opponent above the neck, there are no safety precautions which can be taken to prevent this damage.” Reference 2
In 2005 the World Medical Association [WMA] stated that “Boxing is a dangerous sport. Unlike most other sports, its basic intent is to produce bodily harm in the opponent. Boxing can result in death and produce an alarming incidence of chronic brain injury. For this reason, the WMA recommends that boxing be banned.”
Damage caused by boxing
Pro-boxing arguments point out the fact that other sports result in injury, but the major concern over boxing is the brain damage sustained cumulatively rather than in any one recorded instance. In addition to causing some major acute injuries, boxing can lead to chronic damage following repeated trauma. Each time someone is hit on the head they may sustain a minor degree of brain injury. Once damaged, the brain is increasingly susceptible to further damage. Boxing also damages the eyes, ears and nose - in some cases there may be permanent sight or hearing loss.
Doctors are gravely concerned about the risk of serious impairment to those who survive a career in boxing. These are the post-traumatic brain diseases which can result in a progressive failure of brain function. In the last few years fighters have been left wheelchair bound, blind and comatose after going into the ring. All boxers are at risk of acute and chronic brain and eye injuries. Boxing, therefore, cannot be justified on health and safety grounds as an appropriate or legitimate ‘sport’.
Brain injury
Whereas much of the rest of a boxer's body is protected by bone, fat, skin and well developed muscle, the brain is encased only by the skin-covered skull and attached to its interior by fine filaments of blood vessels and nerves. (One of the most useful models to describe the structure is that of a jelly suspended in a box by threads on all sides). When a boxer sustains a direct blow to the head - which has been likened to the effect of being hit by a 12lb padded, wooden mallet travelling at 20mph - the head rotates sharply and then returns to its normal position at a much slower speed. In addition, the different densities of the different parts of the brain also move at different rates and the overall result is to create a "swirling" effect inside the brain. The resulting damage is surface damage from the brain hitting against the inner surface of the skull; tears to the nerve networks; tension between the brain tissue and blood vessels may cause lesions and bleeding; pressure waves created causing differences in blood pressure to various parts of the brain; and (rarely) large intracerebral clots (as sustained by the boxer, Michael Watson in September 1991).
The effect on a boxer includes, grogginess, weakness, paralysis, weakening of limbs, inability to focus, possible loss of consciousness, ie. the "knock-out". The long-term effects are cumulative and may not show immediately after a match. Most signs of damage are more likely to appear towards the end of a boxer's career or even after retirement. Stretched fibres may recover after many weeks but cut nerve fibres do not repair. Ex-boxers are less able to sustain natural ageing of brain or diseases of brain and may be more likely to suffer diseases such as Alzheimer's and Parkinsonism. Boxers' brains are smaller, surface grey matter is thinner, fluid-containing ventricles enlarged because of the decrease in white matter.
Injury to the eye
Eyes are protected by very hard bone on a many sides but are very vulnerable to direct hits from below. Damage may result from direct contact or from shock waves set up in fluid contents. Depending on the force of the blow, damage may result in haemorrhage into the anterior chamber of the eye, permanent enlargement of the pupil, recession of the angle of the anterior chamber (which can lead to glaucoma in later life), dislocation of the position of the lens in the eye, choroidal haemorrhage (bleeding into the structures at the back of the eye) and retinal detachment following retinal tears.
Review of evidence
The BMA has been calling for more studies of boxers to be undertaken over long periods of time. In addition it suggests that the British Boxing Board of Control and the Amateur Boxing Association are in a unique position to assist in recording injuries to both brain and eye.
The very small numbers of subjects involved make it very difficult to extrapolate the findings to the entire boxing population. Unfortunately, none of the studies followed boxers throughout their careers and into retirement, enabling an analysis of any progressive deterioration in neurological function. However, general conclusions could be made:
Safety
Many people think that boxing could be made safer - by the use of head guards or shorter rounds, for example. Evidence suggests that these changes have minimal effect and in some cases might even have the reverse effect. Even the existence of medical specialists at the ring-side would not protect boxers suffering acute haematomas, for example. Boxing does not provide a unique opportunity for working class boys to "better" themselves, which is a popular, if patronising, argument. However, the BMA believes that the Government should give more consideration to the provision of leisure facilities for the young, particularly in inner cities.
Professional boxers
Studies confirm that professional boxers suffer from a cumulative effect of damage to the brain, often resulting in `punch drunk' syndrome. This damage may not show up until after the boxer has retired.
Amateur boxers
The evidence regarding amateur boxers is far less clear cut and a number of studies found no evidence of cumulative brain damage. The sample populations were relatively tiny and most authors felt that it would be difficult to extrapolate their findings with any degree of certainty. Also, rules and regulations of boxing and medical controls differed widely from country to country, so it was very hard to make comparisons.
Mixed martial arts
As with boxing the BMA opposes mixed martial arts (MMA) fighting and calls for a complete ban on this type of contact sport. Ultimate fighting can be extremely brutal and has been described as ‘human cockfighting’. It can cause traumatic brain injury, joint injuries and fractures.
The BMA believes that doctors cannot stand by while violent fighting tournaments are allowed to take place. Large amounts of money can be earned by participants, promoters and others linked to ultimate fighting but no amount of money can compensate for permanent brain damage and premature death.
For further information, please contact the parliamentary unit:
Email: parliamentaryunit@bma.org.uk.
References:
- The countries represented by these national medical associations were: Australia, Bangladesh, Canada, Denmark, Finland, Ghana, Ireland, New Zealand, Nigeria, Norway and South Africa.
- Headway press release 23/3/07