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Amateur Boxing Linked to Brain Cell Injury
Source: Media Release
September 12, 2006


CHICAGO –A study of 14 Swedish amateur boxers suggests that they have higher levels of certain chemicals in their cerebrospinal fluid in the days following a bout, indicating injuries to neurons and other cells important to brain function, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.

About 20 percent of professional boxers develop chronic traumatic brain injury, according to background information in the article. Some studies have suggested that amateur boxers also damage their nervous systems, but because their shorter bouts allow fewer blows to the head and because they must wear safety equipment, the effects tend to be less severe. These studies have been based on assessment of thinking, learning, memory and other brain functions long after boxing, rather than an immediate test performed soon after a fight.

Henrik Zetterberg, M.D., Ph.D., The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden, and colleagues obtained spinal fluids (via spinal tap) from 14 amateur boxers (11 men and three women, average age 22 years) seven to 10 days after a bout and again three months later, after a rest from boxing. At the first assessment, the boxers reported how many hits to the head they received during the match and underwent physical and neurologic examinations; none showed signs of brain injury. The researchers also tested the cerebrospinal fluids of 10 healthy men who were not boxers as controls. Levels of several chemicals that indicate damage to brain cells (neurons) and their axons, the thread-like extensions of the cell that reach toward other brain cells to transmit electrical impulses, were measured.

Seven to 10 days after a boxing match, the group of boxers had higher average levels of chemicals known as neurofilament light protein and total tau than they did three months later. “The cerebrospinal fluid levels of these proteins increase in disorders with neuronal and axonal degeneration and damage, and the increase is known to correlate with the size of the brain lesion,” the authors write. “When applied to the results of this study, the increases in neurofilament protein and total tau probably reflect damage to neuronal axons from hits to the head during a bout.” They also had elevated levels of glial fibrillary acidic protein, which indicates damage to the astroglia, specialized cells that surround neurons to insulate and support them. An increase in this chemical was also recently found in patients who experienced severe brain injury, and the levels were linked to the patient’s clinical outcome. Levels of all three chemicals were significantly higher in the seven boxers who had sustained more than 15 hits to the head or experienced grogginess during or after a bout, compared with those who had 15 or fewer hits to the head and no grogginess.

Compared with the non-boxers, immediately after a bout the boxers had higher levels of neurofilament light protein and glial fibrillary acidic protein. Three months later, the boxers still had higher levels of neurofilament light protein than the control subjects.

“Amateur boxing is associated with acute neuronal and astroglial injury,” the authors conclude. “If verified in longitudinal studies with extensive follow-up regarding the clinical outcome, analyses of cerebrospinal fluid may provide a scientific basis for medical counseling of athletes after boxing or head injury.”  (Arch Neurol. 2006;63:1277-1280. Available pre-embargo to the media at www.jamamedia.org.)

Editor’s Note: This study was supported by grants from the Swedish Medical Research Council and the Swedish Council for Working Life and Social Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

# # #

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

Media Advisory: To contact Henrik Zetterberg, M.D., Ph.D.., e-mail henrik.zetterberg@clinchem.gu.se.

http://www.ama.com.au/web.nsf/doc/SHED-5F7FVZ/$file/healths_gd_ps_boxing.pdf  Australian Medical Association - recommendations 1997

Anti-boxing lobby

The Australian Medical Association (AMA) policy
The Australian Medical Association has for the past ten years had a policy position that professional boxing be banned and that amateur boxing be "discouraged". However their stated strategy was to destroy amateur boxing first as a means of achieving a professional ban. Other medical bodies such as the National Health and Medical Research Council and the Public Health Association had issued policies that are basicly carbon copies of the AMA resolution.

In November 1997 a revised policy was announced in Australian Medicine journal. The AMA now says it will lobby for changes in the rules to protect contestants. President Dr Keith Woollard was quoted as saying "we're keen to modify the sport until such time as it is banned". However the actual lobbying activities by the AMA since then have not changed - they are intent on destroying the sport.

The AMA policy begins with the sweeping statement that "all forms of boxing are public demonstrations of interpersonal violence which is unique among sporting activities". So, a rugby tackle isn't interpersonal violence?

The AMA policy quotes another body of self-appointed boxing experts (the National Health and Medical Research Council) in stating that "victory is obtained by inflicting on the opponent such a measure of physical injury that the opponent is unable to continue...". The silvertails who wrote that line have never been to any amateur boxing bouts; most amateur bouts are won on points, not by knockouts.

The anti-boxing lobby
The anti-boxing arguments are an example of a phenomenon which one philosophy writer has called " the hypocrisy of selective concern". The same commentator notes that one of the major causes of death in the USA is un-necessary surgery by doctors (40,000-80,000 avoidable deaths per annum!).

In reality, amateur boxing is less dangerous than many other amateur sports.

The AMA says boxing is dangerous. Whilst amateur boxing certainly entails risks, definitive research (and common sense) shows that amateur boxing is no riskier than many other popular sports including football, horse racing and skydiving.

There are occasional deaths in boxing (though there have been no deaths in Australia asscoiated with amateur boxing). But when a death occurs in boxing, the anti-boxing lobbies talk it up with phrases like "Yet another boxing death" and call for boxing to be banned; but when a death occurs in football or racing, there is no such talk of abolishing the sport. The reaction to sports deaths is extremely selective and loaded; so dead motor racing drivers are praised as fallen heroes, but dead boxers are called victims of a violent, unsafe and barbaric practice "which shouldn't be called a sport"!

Amateur boxing in Australia accounts for negligible injuries, and very few of them are serious. Other amateur sports (especially football) account for massive numbers of injuries (and the social cost thereof). In the state of New South Wales during the twelve-year period to 1996, 49 rugby players suffered permanent paralysis below the neck. (Rotem, T.R., Lawson, J.S., et al Severe Cervical Spinal Cord Injuries related to Rugby Union and League Football in New South Wales, 1984-1996 Medical Journal of Australia, 1998; 168).

To put the risks in perspective, here are some pertinent US figures on sports fatalities:

Fatality rate per 100,000 participants Horse-racing 128
Sky-diving 123
Hang gliding 55
Mountaineering 51
Scuba diving 11
Motorcycle racing 7
College football 3
Boxing 1. 3

Cited in Cantu, Robert (Editor) Boxing and Medicine. Human Kinetics, Illinois, 1995 (pp xi-xiii)

The "intentional injury" argument
Faced with the fact that boxing is less dangerous than many other sports, the traditional fall-back argument is that the sport intentionally aims to cause concussion and brain injury by blows to the head. Other anti-boxing lobbies repeat this same falsehood.

And it is a falsehood. The aim of amateur boxing is to win points by more skillful punches; concussing your opponent is NOT the aim. You don't need to injure your opponent to win an amateur boxing match, and you don't get extra points for a knockout; read the scoring rules and see for yourself. Most amateur bouts are won on points, not by knockout.

The corollary claim is that most injuries in other sports (especially football) are accidental. Consider rugby; sure some rugby injuries are truly accidental (such as inadvertent collisions), but many of the more serious injuries are a direct outcome of the way the game is played. Tackles are deliberate and injuries (including concussions) are an inevitable consequence. To call the resulting injuries "accidental" whilst calling a boxing injury "deliberate" is irrational and dishonest.

Treating head injuries consistently
In the USA, football leads to 250,000 concussions annually and accounts for 95% of all catastrophic sports injuries*. You don't need to be Einstein to predict that a similar scenario applies in Australia; but has anybody heard the AMA calling for a ban on football?

*Cited in Cantu, Robert (Editor) Boxing and Medicine Human Kinetics, Illinois, 1995 (pp197-198)

Health is not the issue, it's the excuse
The so-called medical arguments against boxing are not based on objective health and safety issues at all, since some other sports are far more dangerous than boxing, yet attract no AMA criticism whatsoever.

Can you imagine the AMA targeting the Australian Rugby League about the safety risks in rugby? Not likely, since the good doctors know they'd be pilloried. But they see boxing as a "soft target" because it's a minority sport, without funding or significant sponsorship, and therefore easy to beat up.

The opening words of the AMA policy ("All forms of boxing are public demonstrations of interpersonal violence ...") expose the AMA's real objection to the sport - they are ideologically opposed to the sport.

The rhetoric about safety and injury is simply a smokescreen for an ideological or personal bias against boxing. Pressure an anti-boxing proponent about their lack of facts, and they'll soon descend to perjorative words like "barbaric" and "violent". It's this emotional reaction that drives their opposition, and their attempts to dress up these emotional responses in pseudo-medical terminology are dishonest and unethical.

It's a safe bet that most of those opposed to boxing have never been to an amateur match. How much easier it is to demonise something when you have never seen it, and never talked to the boxers or their families.

This page was last updated on 02 January 2006

The American Association of Professional Ringside Physician’s (AAPRP) Medical Conference was held September 22-25, 2005 at the Tropicana Casino Resort in Atlantic City, New Jersey. Over 150 doctors, commissioners, members and guests attended this year’s conference on boxing safety. This year’s program took on a greater meaning with the news of the Leavander Johnson tragedy and the urgency to develop protocols with the goal of preventing further boxing deaths. A moment of silence was observed during the program in honor of Mr. Johnson and his dedication to the sport.

The program began with Bruce Spizler, Esq. (ABC Legal Counsel) updating the AAPRP

AAPRP Presents Medical Recommendations to Improve Boxing Safety

At the request of boxing commissions and in response to the recent ringside tragedies, The American Association of Professional Ringside Physicians (AAPRP) announced today recommendations to improve safety in professional boxing. At the recent AAPRP Medical Conference in Atlantic City, New Jersey, the AAPRP Board Members in cooperation with the AAPRP membership discussed immediate changes in boxing to decrease the likelihood of additional injuries or catastrophes in boxing. Dr. Michael Schwartz, AAPRP Chairman stated, “It is time that we urge all commissions across the world to develop uniformed standards to protect these athletes. In an inherently dangerous sport, it is imperative that these recommendations be adopted immediately in the hope of saving a life. Obviously, additional research is needed and we ask all of our ringside physician experts to continue to investigate and develop ringside protocols to improve the sport.”

Below are the AAPRP Recommendations:

1) All sparring should take place with oversized gloves to minimize the cumulative forces of the punches during training. (i.e. Heavyweights 20-22 oz gloves...Middleweights 16 oz gloves and lightweights 12 oz gloves, etc.)

2)Minimize head shots during training to decrease the likelihood of pre-existing damage prior to entering the ring for the competition.

3)All states immediately adopt the minimum medical requirements of the ABC and AAPRP. If these requirements are not adopted, the AAPRP asks promoters and sanctioning bodies to consider not holding boxing matches in these venues until they comply with these recommendations.

4)Boxers who have not fought for over 12 months should not fight more than 10 rounds. The question of inactivity raises concerns about the likelihood of increased risks of injuries based on inactivity and conditioning.

5)Fighter's not be permitted to lose more than 3% body weight at the weigh-in before a fight. Additionally, no fighter gaining more than 5% body weight should be permitted to compete after the weigh-in.

6)Medial data bank is implemented immediately to follow the medical history during a boxer's career.

7)Promoters, managers, cornermen, commissioners are encouraged to anonymously report boxer's whom they believe are showing early changes consistent with brain damage. This information will then be investigated and (if necessary) be utilized to require more tests or to terminate a boxer's career.

8)The ringside physician should remain at the venue until all the competitors have left the

9)The ringside physician should notify the local hospital and on-call neurosurgeon that a
boxing match will be taking place.

10) No fighter who is Hepatitis C or HIV antibody positive should be permitted to fight even
if the virus is undetectable in their blood.

11) Further research (i.e. the medical severity index, the Impact concussion study, rapid
HIV/infectious disease testing, etc.) is encouraged and should be utilized to determine
those at greater risk for injury.

12) A minimum of two ringside physicians should attend every boxing match.

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