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Should we ban boxing?

BMJ 2016; 352 doi: (Published 27 January 2016) Cite this as: BMJ 2016;352:i389

Rapid Response:

Boxing: the pain won’t last forever, but the memories will

Entering the search term “boxing injury” in PubMed produces over 760 returns, the earliest reference dating back to 1948. It was Romino1 who shortly after the end of World War II expressed concern about intracranial injuries related to boxing. In other words, the medical literature has been devoting attention to the health consequences and ethical concerns surrounding boxing for decades. Since about 20052 this topic has been expanded by a vast body of published comments and studies about similar concerns applying to mixed martial arts (MMA) and extreme fighting. These two disciplines can be considered as often even more aggressive forms of combat sports that have been around and have increased in popularity since about 1993-1995.

All these studies have resulted in numerous bar graphs, line graphs and pie charts that have been shown by speakers, waved by health policy makers, and projected on screens during symposia and press conferences. Their impact on the individual boxing enthusiast and his entourage compares in effectiveness to telling people they should not attempt to evade taxes because doing so is not a very nice thing. Academics and health workers choosing to face a seasoned boxer and trying to win a fight, whether with statistics or their fists, are, no doubt, brave and committed, but perhaps also more at a disadvantage than they may be willing to accept. I would venture that if the academics would instead choose to put on a pair of gloves, enter the ring or octagon and break a bit of sweat for a minute or 2-3, they might gain more respect from any combat athlete and have a higher chance to be listened to than by scoring high in the Science Citation Index ...

When entering a culture fundamentally different from one’s own listening and understanding is more important than telling. There is a reason why people become boxers or fighters rather than physicians and professors: family, finances, school performance, delinquencies, lifestyle, network, whatever. Earning an income and feeding a family requires a bit more than just performing well at school, as is shown everyday by hundreds of thousands of minorities, whatever the basis of their minority status, who often are doing less well in professional life for reasons not in any way linked to their intelligence or devotion. So yes, there is often a reason why someone ends up being a boxer or MMA fighter rather than a tennis or golf player, and I doubt that in most cases health has very much to do with that decision.

What these sports all do is offer entertainment. They do not “intent to harm”, they intent “to offer entertainment”. The entertainment factor of unusual, difficult or dangerous events is often perceived as more valuable by the target audience than some random easy to find activity. For that reason, the target audience, including the sponsors and commercial entities, are willing to pay a substantial price. Sure, there is also a target audience that pays a high price for golf or tennis, but the culture, target audience, and athletes involved likely are not identical to those we find in boxing and MMA.

Rudd et al.3 wonder if boxing can be made safer. The answer, to some extent, is ‘yes’, by crafting very restrictive rules and by additional protective gear. The downside of such attempts would be that doing so would decrease the realistic conditions of the sport and change the sport itself. Even today the audience would rather see someone win by knock-out than on points, and this for the same reason. Jūdō a combat sport of Japanese origin, over the last 20-30 years has lost much of its attractiveness and audience, due to its increasingly restrictive rules that now conflict with many of its taught techniques, its aims and its original spirit as a martial art. Precisely for that reason, many jūdōka have joined or shown interest in the more realistic conditions of MMA. Fighters want to see and be entertained by fights fought by fighters, not by an accumulation of constant penalties and points issued by a referee eagerly believing that the audience is there to watch him.

Rudd et al. 3 furthermore argue that the health concerns surrounding boxing make it socially irresponsible to allow this sport to continue. This is a statement, I think, that many philosophers would like to dissect and reflect about. Ultimately, it is about defining the role of the government. In that respect, boxing is not a disease threatening the well-being of the general society. Rather, it is a choice, though, perhaps not always a free choice, when that choice is motivated by unemployment, restrictive financial circumstances, and similar; however, it still remains an activity in which two adults engage, that is, two consenting adults. Those two factors –consent and being an adult– have been perceived as a critical value in most Western democratic societies. It is one of the major arguments for legalizing gay marriage, allowing pornography, or legalizing euthanasia.

Many would argue that, only when the effect of an activity of or between two consulting adults can be documented to significantly negatively affect the well-being of others, there is a role for the government to act in a restrictive way to protect the others, or, when the people choosing to engage in a certain risk activity are minors deemed to be at an age where they cannot fully make responsible choices. Government policies restricting smoking are a good example of this. Governments do not prohibit adults from smoking; however, they do restrict the environments in and the ages at which one is allowed to smoke. Democratic governments also do not tend to prohibit to consenting adults many other risk behaviors, including not using condoms even when one is infected with an STD. The government ‘informs’ and ‘discourages’, but otherwise, does not make such behaviors illegal as long as those engaging in it have reached the age of consent and as long that there is no malicious intent to harm. Lewis and Wang3, therefore, are correct when they point out that during the 18th and 19th centuries when boxing was banned illegal fights continued often leading to more traumatic results since physicians could not legally assist such fights. In modern days, with increased international transportation and mobility, it is likely that such combat sports practices and events would simply be moved to countries with less restrictive laws.

There is, however, another concern which Rudd et al. are not considering, namely, whether it is fair to expect national health insurance systems, and hence the general population, to carry the financial burden of those willfully engaging in avoidable high-risk behaviors that lead to frequently or extensively having to make use of costly medical facilities. Perhaps that would be a more appropriate question for society to reflect about.

1 Romino JD. Boxing and intracranial injuries. W V Med J 1948;45(1):19.

2 Kochar T, Back DL, Mann B, Skinner J. Risk of cervical injuries in mixed martial arts. Br J Sports Med 2005;39(7):444-7.

3 Rudd S, Hodge J, Finley R, Lewis P, Wang M. Should we ban boxing. BMJ 2015;352:i389. doi: 10.1136/bmj.i389.

Competing interests: The author founded and previously also was the chair of various medical committees in several combat sports federations and associations. He also is a Team Physician™, a high-performance coach, an instructor and a former elite jūdō athlete, and a former practitioner of Kyokushinkai-style full-contact karate, all without ever intentionally causing any bodily harm to either himself, his opponents, his students, or his teachers.

30 January 2016
Carl De Crée
Senior Research Professor of Exercise Science and Sports Medicine
Ghent University
B-9000 Ghent, Belgium