Boxing, dementia and Parkinson's

25 January 2002

Published in The Age

Any sport whose heroes end up demented could be a candidate for a basic rethink. But dementia pugilistica has had little effect on boxing’s popularity. The syndrome embraces all manner of neurological problems, including the early onset of Parkinson’s and Alzheimer’s diseases.

Both Jack Dempsey and Joe Louis suffered brain damage. Former world heavyweight champion Floyd Patterson has Alzheimer’s. In 1999, former star of the ring Jerry Quarry died of complications from pneumonia brought on by dementia, aged 53. By 50, the dementia had destroyed Quarry’s memory and wrecked his motor skills.

The greatest of them all, Mohammed Ali, now 60, has Parkinson’s.

Early warning signs of dementia pugilistica include extreme intolerance to alcohol, and confrontations with the law - which is interesting in light of Mike Tyson’s infamous recent behaviour.

Depending on which study you read, between 15 and 40 percent of former boxers have “chronic brain injury” - embracing speech difficulties, unsteadiness, memory loss and behavioural problems.

Professor John Pearn, Surgeon General of the Australian Defence Force, believes he has a solution:

“I have long advocated the simple rule change of putting the head out-of-bounds,” he writes in Medicine Today. “With the likelihood of boxing continuing, and in the context of recent evidence linking subclinical brain damage with the sport, this simple rule change could obviate the need for a complete ban.”

The amateur sport, with its mandatory headgear and short bouts, is acknowledged to be somewhat safer. However Dr Pearn believes that “the risk of chronic brain injury to all serious boxers - professionals and amateurs alike - is high”. This includes “the DDP syndrome - dementia pugilistica, deafness and Parkinson's disease” - as well as eye damage such as retinal detachment.

Following the death of Gold Coast bantamweight Ahmad Popal in Melbourne last year, a concerned Victorian Government stepped in with mandatory three-year brain scans for boxers.

Like its British and American counterparts, the Australian Medical Association advocates a complete ban - something which has already happened in some Scandinavian countries.

Associate Professor Richard Macdonell, of the Australian Association of Neurologists, agrees:

“The Association is totally opposed to boxing and would prefer to see this activity cease in Australia,” he said.

However neurologist Dr Ira Casson, of the New York School of Medicine - who treats many of America’s most famous boxers - believes a ban will not work:

“I’m afraid that if you do that, boxing will go to countries which don’t ban it. And there will be less medical regulation and less safety measures. So fighting will still go on, but it will be more damaging for the fighters. Anyway, there are obvious financial considerations - so boxing is not going to be banned, at least in America. There’s too much money involved.”

Dr Casson thinks a ban on head-punching is unrealistic for the same reasons:

“Would it cut down on brain damage? Absolutely. But I think, again, it would force boxing out of the country, and it would go underground.”

But whilst acknowledging that genetic predisposition will alter susceptibility from fighter to fighter, Dr Casson is in no doubt as to boxing’s lethal risks:

“Despite what safety measures have been put in over the years, there’s still a risk of death or permanent brain injury every time a boxer steps into the ring. The number of boxers who have died in the ring worldwide is now way over 700. More common is the chronic brain injuries that especially professional boxers can incur. That’s related to the number of fights they have. It’s well-documented from autopsy, from CAT-scans and MRI scans, and clinically by neurologists.

“Some fighters will have a significant problem with thinking ability - a dementia kind of process. Others will develop paranoid thoughts, or Parkinsonian syndrome, or cerebellar dysfunction - trouble with balance and co-ordination. And most  will have various combinations of these.

“If you look through obituaries of old fighters, you’re struck by how many of them had Parkinsonism related to their boxing.”

Arthur Tunstall, who boxed in the 1930s, isn’t having a bar of these claims. For 48 years Tunstall was secretary of the Amateur Boxing Union of Australia.

“And I’ve been secretary of the NSW Amateur Boxing Association for 60 years,” he said. “And we’ve never had a fatality.”

“As for the professionals, the first person they pick on is Mohammed Ali. And that’s absolutely bloody ridiculous. I’ve got four friends who’ve died with the same disease [Parkinson’s], and they wouldn’t know what a boxing ring looks like.

“Kerry Packer’s father, Frank, was the amateur champion of NSW. Sir William McKell, who was the first Australian-born Governor-General of Australia, was the NSW welterweight champion. Weary Dunlop, the hero of Changi, was the middleweight champion of Victoria. Jeff Fenech has had three world championship belts. I don’t think there’s anything wrong with his brain.

“Professionals don’t fight 15 rounds any more - they’re lucky if they fight 12 for a world title. I keep saying to the AMA, please come up with some statistics. I’ve given them statistics of 5000 amateur boxers with all their records - I got it from Canada - and there’s nobody suffered with any brain damage.

“I tell the AMA: Why aren’t you chasing the footballers the way you chase boxing?”

What does Tunstall think of a ban on head-punching?

“Is anybody going to watch it? You go to the pros to see blood. Let’s be honest.”

Grant Peters, Secretary General of Amateur Boxing Australia Inc, is scornful of the AMA’s claims of brain damage:

“That organisation has been given many opportunities to produce their so-called evidence when appearing before various government sub-committees. But when we have a boxing medical practitioner attend, they never appear to be able to substantiate their statements. In fact in many cases where we ask them to debate the argument on TV, they will not when we have our medical advisers to counter their arguments - because they are completely ignorant of the work conducted by the AIBA [world body of amateur boxing] Medical Commission.

“The prestigious Johns Hopkins University conducted an independent study of CNS [central nervous system] function in 400 US amateur boxers. Various tests were carried out prior to them commencing training and competition and again two years later. They found no evidence that amateur boxers sustained any brain damage.”

Some boxing insiders - including Jeff Fenech - believe trainers allow their boxers to take too much punishment, and are thus sometimes responsible for injuries.

Others claim that this largely working class sport has been singled out unfairly by middle-class medicos and politicians. After all, heading the ball in soccer can also cause brain damage. Mountain climbing is perilous as boxing. Rugby is not without its grave mishaps.

Yet few sports have as much scientific evidence stacked against them. The first boxer with Parkinsonian symptoms was diagnosed in 1928. Today, boxers as young as 25 can incur brain damage. A survey of British neurosurgeons found they had treated 12 jockeys, five footballers, two rugby players, two wrestlers, one parachutist - and 290 boxers.

Is boxing going down for the count? Referring to the 1838 rule prohibiting punches below the belt, Professor Pearn comments:

“In the perspective of progressive rule changes, acknowledgement of the brain's societal supremacy over the testicles is long overdue.”