View from ringside: A conversation with Dr. Margaret Goodman of VADA on PEDs, fighter health and more

Photo: Doug Benc/Getty Images

Brent Brookhouse of Bloody Elbow speaks to VADA president and former ringside physician Dr. Margaret Goodman about her career around the fight game, fighter safety and performance enhancing drugs.

This is the first edition of a new series. "View from ringside" will focus on long form interviews with non-fighter personalities from around the fight world. Trainers, judges, commentators, ring announcers or, in this case, a fight doctor turned leader in the PED prevention movement.

Dr. Margaret Goodman is a neurologist who became one of the fight game's most prominent ringside physicians. She now holds a position as President and Board Chairwoman at the Voluntary Anti-Doping Agency (VADA), one of the most prominent players in the anti-doping movement in combat sports. Jim Lampley named Dr. Goodman his "person of the year" in combat sports in 2012 for her role with VADA.

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Brent Brookhouse: We'll start from the beginning, your VADA bio goes over some of your background, but give me the short version of how a neurologist ends up working as a ringside doctor.

Dr. Margaret Goodman: When I moved to LV from California to start my practice, I loved professional wrestling and boxing. Yes, I was a huge wrestling fan. I watched every boxing match I could. One night while waiting for the Simon Brown-Terry Norris fight to begin on HBO, I heard Jim Lampley out in front of Valley Hospital saying that the fight was canceled due to Brown's dizziness, and they were calling in me! My phone rang, and from that time on I decided I would train to become a ringside physician. Flip Homansky, who eventually became my significant other, advised me to go to as many fights as possible and work the amateurs. In the interim, I performed neurology consults on the occasional fighter (Foreman, Hearns, etc.). About 18 months later, the NSAC needed some new physicians and I was accepted. For another few years I happily worked wrestling -- even Mexican wrestling, midget wrestling -- and smaller boxing matches. There is no course that will teach you this craft. It involves judgment, respect for the fighters and the sport.

I think the toughest part was working with the NSAC's medical advisory board and seeing how things are from behind the scenes. I believed, and still do, that the most important job a commission physician can have is determining when a fighter needs to retire. I was fortunate to be head of the medical advisory board for 6 years.It isn't glamorous or fun; it creates strong enemies. Sadly, the fans and media usually know when a fighter should no longer compete before a commission. The infrequency of commissions making these tough determinations saddens me more than anything. You are seeing many MMA fighters that shouldn't be allowed to continue as well, but no commission is being proactive.

BB: If I'm being honest, for a long time, I used to think "ugh, she's the worst!" whenever I'd sit down to watch boxing on HBO or Showtime and they would announce that you were the ringside physician for the fight. It all basically stemmed from the Joel Casamayor/Diego Corrales fight. it was two of my favorite fighters squaring off in a bout I was thrilled to watch and it was shaping up to be a great fight when you stopped it after the end of the sixth round due to cuts inside Corrales' mouth. Looking back at it now, it's a perfectly justifiable stoppage...

MG: Many things were at play--as is true in all fights. Sadly, it was tough to explain the viewers. First approaching him, he spit out a solid cup of blood. I should have been fired if I allowed the fight to continue with the injuries Diego had in his mouth. Turned out his mouthpiece had been cut because it was uncomfortable. It ended up being like a saw in his mouth every time he was struck. Fighters are to have 2 mouthpieces, but Diego had only one.

BB: But have there been times where you've been uncomfortable with your own stoppages? Where you look at them after the fact and think "I should have let that go"? If not uncomfortable, are there times where it is harder to stop a fight because you feel for the fighter and his position in the fight, his pleadings to let it continue or because you feel like you're intruding on a great fight?

MG: I have never felt that I made an error in recommending a stoppage. To the contrary, it is the other way around. When you strive to be better at anything, it is tough to not second guess yourself. I worked two fights where fighters have died. It wasn't that the fights should have been stopped differently, but more that I wish I had known more about the fighters before they fought or were even licensed. One bout ended from a body shot; the boxer took few head shots. He collapsed 2 days later due to severe brain swelling and very little bleeding. Boxers don't die in the ring solely because of the fight. On autopsies, you often see more than one area of bleeding that occurred at a different time. It is what happened to them in the fight before, or more likely the gym where they have sustained a life-threatening injury or the start of an injury. It may be they even had some predisposition. Pre-fight exams remain too short, and the physicians never spend enough time with the fighters beforehand.

BB: As a neurologist, is there a fundamental unease for you being involved with sports like boxing and mixed martial arts where, to put it bluntly, a primary goal is to inflict trauma to the brain of your opponent?

MG: No, odd that never existed. I think it was because I was so in awe of the responsibility in having the opportunity to protect fighters.

BB: On that topic, while you're obviously deeply concerned with the presence of PEDs in sports, do you feel like boxing and MMA have a full hold on head trauma? While most sports high in contact are focused on the "concussion crisis" and head trauma, boxing and MMA seem to be pretty quiet on that front with the only real talk being claims from Dana White about the "safety" of the sport, pointing to the lack of deaths in the UFC as proof of said safety. Are there steps that should be taken to fully grasp the long-term damages potentially done to fighters in fight sports? With many people claiming that it's too expensive to do long-term studies with repeated neurological scans, what are some good measures to track the impact of training and fights on the fighters? I believe we had a discussion a few years ago where you suggested recording fighter voices to track speech changes as part of the licensing process, is that something worth pursuing?

MG: I would look at the work the Lou Ruvo center is doing in Las Vegas. The prospective study run by Dr. Charles Bernick will hopefully be very helpful in studying the long term impact of brain injury in boxers and MMA athletes. I met with Dr. Bernick before the study began to discuss the aspects of the fighters I would study. I believe they have included all, including assessing speech patterns over time.

BB: That being said, do you see any major areas from a fighter safety standpoint that need addressing at the commission level?

MG: Every area affecting fighter safety should be addressed further than it is. The most crucial I continue to believe is in the licensing process that is not nearly strict enough. A boxing/MMA license is a privilege given to individuals who are fit to undertake the physical demands of a fight. A fighter must prove his fitness. I know of only a couple commissions willing to stand up and prevent a fighter from competing before it is too late.

BB: When you said that you feel a commission has an important role in determining when a fighter needs to retire. In the cases where they're not speaking up, is it entirely that the commission "doesn't know" or do you think there is some desire to not interfere with fights that bring money in to the state as well as leverage from promoters with a lot of influence?

Are there obvious steps that should be taken to somewhat remove opinion and personal judgement from the process? In many cases it seems like a matter of common sense. But, as an outsider, it seems like it would be a lot easier to tell a fighter it's time to hang up the gloves were it a matter of inability to pass more thorough exams. In my years covering boxing and MMA I've covered a lot of commission meetings and with fighters over 35 years of age, it seems like a really unscientific process for older fighters to be granted a license.

MG: I think that all commissions are torn. Many commissioners around the country are political appointees with little or no knowledge of MMA and boxing. They are hopefully fans, but that might be the extent of their knowledge base. They may not have an understanding of the seriousness of mismatches, unfit fighters and the licensing process. Most commissions require little medical testing, and often suspensions are inadequate.

I once gave a talk in front of the ABC entitled, "How to do the right thing and become the most hated person in boxing." This is before MMA (was licensed anywhere). The seminar was centered on the process a commission needs to go through when denying licensure to a fighter that should no longer be in the ring. In bigger state commissions there is huge pressure on the regulators to allow a fight to take place. Many times regulators rationalize: "we'll license him for one fight; we'll approve the match if he's matched light; or if it is lesser rounds." This is unfair to the fighters.

If a fighter is for one reason or another unfit, none of this matters.Boxing isn't golf and there is no senior division. Often licensing of a fighter that is showing wear and tear in the sport becomes a series of rationalizations by all. It happens all too frequently in most jurisdictions. If the commission denies a license then the fighter often comes back with a group of attorneys arguing the opposite. It astounds me some of the physicians that will stand up and say a fighter is fit when they know little or nothing about that athlete--they have never even reviewed all their fights. Many commissioners/commissions don't have the personnel and funds to fight these cases. Years ago in NV, they would quietly advise the promoter to not try to get their fighter licensed here. In some instances, like with Terry Norris, I welcomed them forward so we could stop the fighter from fighting. I knew that if they took them to a weaker commission, the commission would acquiesce and grant a license.

Sadly, by the time the tests are abnormal, it is too late. Yes, the tests are important, but there are more important ways of determining fitness along with tests: how the fighter walks, talks, reacts once hit, their balance. No test will give you all these answers. It stresses the importance in following a fighter over time.

The problem is the current system and lack of uniformity regarding suspensions, tests required for licensing, follow-up tests.

BB: On to your current role...What compelled you to get involved with VADA? Why is this the cause you felt you needed to be involved in?

MG: Truthfully, it never was a cause I wanted to take on. It certainly isn't something that wins you any friends or admirers. Commissions are not supportive because they believe it is making it seem as though they are doing a poor job; promoters/networks are worried it will limit fights; and the cheating athletes like the lax system. I was writing for The Ring on PEDs. I spoke with a number of boxing and anti-doping people on the topic, including Dr. Don Catlin, Victor Conte, and many fighters, and came to better understand how both sports and the commissions were largely ineffective at deterring PED use. I also came to understand the dangers to all fighters--whether using or not--of the lax system. Several people I spoke with suggested I should start a program and, despite my reluctance to get involved, I began looking into what it would take to do so.

BB: It seemed like VADA was really picking up steam in terms of involvement with major boxing events last year, then the Amir Khan/Lamont Peterson situation happened, where Peterson failed a test and the fight was ultimately canceled. It seemed like many people wanted to blame VADA for the situation, specifically on the notification of the promoters and fighters involved. Was there anything that you feel like VADA should have done differently in the situation? Or do you feel that everything was done correctly as agreed upon between the agency and the involved parties and Golden Boy and the NSAC felt the need to take public shots at VADA because the promoters lost their fight and the NSAC lost money from the fight taking place?

MG: Taking pot shots at anything that limits a fight taking place is understandable---not right, but understandable. When you work fights, promoters, fighters and even cornermen use the officials to lobby for a rematch. But the only individuals responsible for a fight being canceled from a doping violation are the athletes that violated the rules in the first place and took the substance. When establishing VADA and working with several people experienced in anti-doping, including our chief legal counsel, Ryan Connolly who helped run the UCLA Olympic anti-doping lab, we wanted to have VADA work similarly to an Olympic program. That means following similar protocols and policies. That is more complex in boxing and MMA when it is hard or impossible to find a substitute athlete if one fails a drug test, as occurred in the unfortunate circumstances surrounding the cancellation of the Khan/Peterson fight. There are stringent rules in place requiring proper authorization to release medical information to third parties such as a fight promoter. VADA now requires athletes to authorize us in writing to release both A and B results to the commission, the ABC, the promoter and record keeper (Fightfax/MMA LLC).

BB: There was a very public situation with Shane Carwin and VADA last year where the agency agreed to provide the drug testing for his fight with Roy Nelson but an article had been placed on the VADA website referencing Carwin's position as coach on The Ultimate Fighter and asking if his role was to teach the young fighters "how to juice," a reference to Carwin's own alleged involvement with a steroid distribution ring in his pre-UFC days. Obviously that would seem to be something that should never have made it onto the VADA site, I believe you took the stance that it was an intern who placed it. Is that correct? Is there more to that story?

MG: It was a third-party article from Cagestoker blog that was posted on the VADA site. As you can see on our site, VADA routinely posts articles written by others that involve PEDs, fighter health, etc. That article was one of them. After the article was posted I reviewed and found that it lacked journalistic integrity, and it was removed. It was unfortunate that people implied that the article originated from VADA when it did not. Now I personally review any third-party article that gets posted/linked on the VADA site or is tweeted.

BB: Many pointed to the Carwin article as proof that there would have been a "bias" present in the testing. With your use of WADA approved labs it would seem near impossible to alter any test results as you're not conducting the actual testing of the samples. Not to completely lead with this question, but reporting them any different from what the actual results are would be near impossible as well, considering that the lab could come forward and say that it isn't the result they found. Correct?

MG: Correct. VADA is voluntary and no fighter is ever obligated to participate. That includes a fighter's opponent. VADA is only the organization that facilitates the fighter to be tested. Although the laboratories are blind to whose specimen is whose, they follow-up closely if there is an abnormal result and how that result is handled.

BB: Cost is often the biggest reason we hear that someone like the UFC can't be fully involved with VADA, or Dana has talked about not having time to "fly around and test everyone." is there a way to mitigate the cost for an entire promotion? What would it cost for the UFC to have year round testing for their fighters through VADA and would it add any extra stress for the fighters and promotion beyond the fighters having to submit samples when the testers come knocking?

MG: I think the costs could be easily mitigated if all the fighters in an organization like the UFC were involved. There could be a nominal charge per fighter. Not every fighter would be tested, but some might be tested many times. It would be a way to begin. It would include the most stringent testing at any time during the entire year. The threat of unannounced, rigorous testing at any time would be a strong deterrent to PED use. Only random year-round unannounced blood and urine testing by an independent party will make a dent in curbing PED use.

BB: Ultimately, is the battle with PEDs in sports a losing game? Are we in a position where we're just trying to catch what we can catch but with the knowledge that a portion of the fighters will always be on "something?" and is the statement that the drugs will always be ahead of the testing fair?

MG: I wouldn't call it a losing game, but something that is an ever-changing field. You're never going to completely rid society of crime, but that doesn't mean you should stop enforcing laws against criminal behavior. Same goes for PED use. The greatest problem with the current system is that commissions' protocols are archaic. Panels and methods of doping are constantly evolving, and so should the programs commissions institute. The Olympics realized the need for this evolution years ago, which led to many great scientific advancements, and ultimately the creation of WADA. There are many clean fighters, and it is only fair to them to expand and advance PED testing to bring the level of abuse down. The repercussions in not doing so are too great. Not continuing to advance PED testing is a disservice to combat sports, dangerous and I do believe defrauds the public.

BB: On the "clean fighter" front, Bill Brady of the NSAC said at a recent meeting that he believes that the fact that they catch so few fighters with positive drug tests is proof that "probably 97% of fighters are not doping at all." That seems like an absurdly low number to me...

MG: I have great respect for Bill Brady, but unfortunately that statement is simply not accurate. It may be accurate to say that 97% of athletes can pass a commission's day-of-fight drug test, but that certainly doesn't mean that 97% of fighters aren't doping.

BB: Lastly, Testosterone Replacement Therapy (TRT) has become a major hot button topic in fight sports. Do you have any thoughts on the prevalence of TRT in the fight game? It seems like something where we hear about more and more fighters who are getting exemptions for testosterone use to "achieve normal human levels." Is it right to allow TRT in high rates simply to be "fair" to the fighters so they can fight with up to a 6:1 testosterone ratio?

MG: I think TRT is widely used in boxing and MMA--either illegally or with a TUE. Except in the most rare of circumstances, TUEs for TRT should not be granted. Period.

It is simply sanctioned steroid use that is unfair to the opponent and harmful to the long-term health of the user. It is almost impossible that a normal healthy fighter should need TRT, suffers from hypogonadism and is competitive. I suspect most athletes with low testosterone levels have already risked their health by using steroids in the past, causing their bodies to produce less testosterone. Allowing them to continue to inflict damage upon their bodies by sanctioning further steroid use is a huge step in the wrong direction and will only lead to more widespread PED use.

And the idea that athletes can legally have up to a 6:1 T/E ratio is a complete misnomer. The 6:1 ratio comes from a time where there was no scientific method to distinguish between testosterone naturally produced by the body and testosterone from an exogenous source (not produced by the body), so the Olympics used this ratio as a legal means to declare a testosterone violation without having "false positives." It turns the concept on its head to say that athletes are "allowed" to have up to a 6:1 T/E; that is simply not accurate, although it is often misunderstood. An athlete administering exogenous testosterone can have a 1:1 ratio (or even less), yet he is still gaining illicit and significant performance enhancement and endangering his health (and the health of his opponent) by his use. Now that the science has improved so that CIR testing can effectively distinguish between endogenous and exogenous testosterone, the T/E ratio no longer needs to be used and the 6:1 concept should go away.

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