MMA brain injuries, potential solutions, and why the concussion debate needs a makeover

Photo by Esther Lin of MMA Fighting

The issue of concussions in sports, and MMA specifically, continues to dominate public debate, but what questions should we be asking, and what solutions could benefit Dana White and Zuffa headquarters?

An old Irish playwright said it best; "science never solves a problem without creating ten more."

And yet this truth seems to be lost on observers these days. Or if not lost, simply misunderstood. I mention this because the discourse on concussions seems to have reached its climax, where all the evidence is in, and we're finally justified in saying, about football for example, that "the obvious thing to do is to stop playing the dumb and violent 19th century game".

Those were the words of New Yorker scribe, author, and public intellectual Malcolm Gladwell in a speech given to the University of Pennsylvania earlier this year.

A premature look into the future of football with the concussion crisis in mind, was observed last year in Tyler Cowen and Kevin Grier's excellent Grantland article, noting "Before you say that football is far too big to ever disappear, consider the history: If you look at the stocks in the Fortune 500 from 1983, for example, 40 percent of those companies no longer exist. The original version of Napster no longer exists, largely because of lawsuits. No matter how well a business matches economic conditions at one point in time, it's not a lock to be a leader in the future, and that is true for the NFL too. Sports are not immune to these pressures. In the first half of the 20th century, the three big sports were baseball, boxing, and horse racing, and today only one of those is still a marquee attraction."

With the NFL agreeing to a $765 million settlement in August, its theoretical demise is right on track. Unless you ignore the fact that said number represents less than ten percent of the NFL's $9 billion in annual revenue. But nevermind that...

The question for UFC fans, is of course, should MMA be worried about a similar problem? After all, a settlement even half that size would be much harder for Zuffa to navigate around (not that I'm arguing for its likelihood).

An incredibly well done article for the Star-Ledger has been done by Matthew Stanmyre, on the dangers of MMA. I say incredibly well done because it is. The anecdotes of the fighters struggling to live a normal life with the burden of injury should make any MMA fan uneasy.

In recounting former UFC fighter Tom DeBlass' experiences, Stanmyre notes that "This spring, for example, DeBlass was ordering takeout from Conca D'oro Restaurant in Forked River for a gathering at his home. Minutes later, he called back and tried to order his own meal again, forgetting he had already done so."

These are the kind of stories that should trouble us, and make us think critically about a sport we've come to love. The takeaway from these articles is not that "well no shit fighters will suffer brain injury if they get punched and kicked in the head for a living", which is sadly the view of some observers, but that a discussion needs to be had about policies that should be in place to protect the fighters.

But on to the point of the science, this is where things get tricky. Stanmyre's article does little to note the actual studies done on MMA's brutality. There's no reason to discount the stories of fighters as actual evidence when they parallel the common post-concussive narrative. But just as Gladwell's outrage oversimplifies the issue, so too does Stanmyre.

One of the things David Epstein intoned in my interview with him is how the 'public tenor' has exceeded the actual science in relation to concussions in sports.

Keep in mind, such sentiment stands in stark contrast to those like Elliot Pellman, or Dion Sanders, who like a pair of young earthers, seemed to think there wasn't a problem at all.

But there are a lot of unanswered questions about Chronic Traumatic Encephalopathy; the brain disease now associated exclusively with concussions. Which is why the 4th International Conference on Concussion in Sport in Zurich, comprised of noted academic superstars on the issue like Bob Cantu and Kevin Guskiewicz, had this to say:

"At present, there are no published epidemiological, cohort or prospective studies relating to modern CTE. Owing to the nature of the case reports and pathological case series that have been published, it is not possible to determine the causality or risk factors with any certainty. As such, the speculation that repeated concussion or subconcussive impacts cause CTE remains unproven. The extent to which age-related changes, psychiatric or mental health illness, alcohol/drug use or co-existing medical or dementing illnesses contribute to this process is largely unaccounted for in the published literature."

(Emphasis mine) The skepticism is not about how a fighter's health is affected by a violent sport, but about what set of circumstances come together to produce such a life altering illness.

This is the notion to keep in mind moving forward. Not to panic fighters into believing every symptom, or moment of sorrow is mathematically bound by the sport they compete in to make a living, but to inform them of the true nature of the debate.

And there's plenty of discuss. For one, forget about "protective equipment". Some of the more amusing information coming out of the biomechanics lab by Cleveland Clinic Researchers is that the vintage leatherhead helmets were actually safer in some cases than modern football helmets.

And there are still plenty of preventative measures.

Preliminary research indicates that injuries are more likely to occur in training, and typically involve less experienced fighters (with head, neck, and face injuries representing 38% of those reported). Perhaps Zuffa could start a program that equips gyms with proper physicians able to oversee the training room atmosphere.

In addition, much is known about the increased risk of brain injury given the presence of the ApoE4 gene. LA physician, Brandon Coltby, offers ApoE4 testing in children to concerned parents. Neurologist Barry Jordan out of New York has expressed a desire to make genetic screening for ApoE4 mandatory for boxers. Here is yet another way Zuffa could lead the charge on fighter safety.

While there's a concern there about making the incorrect assumption that genes entail determinism, it's simply a potential health risk that fighters should be informed of, with their consent, no different from the BRCA genes and their relation to breast cancer.

MMA won't lose itself to its inherently violent nature. As long as people want to watch, and they will, others will supply them with that the public demands. But it could lose itself to a different kind of obscurity...where fifteen years from now, its educated fans know enough to look away when the promoters do the same.

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