When people demand legislators outlaw a behaviour they consider problematic, it often serves as a convenient way for those people to avoid their own responsibility for that behaviour. The British Columbia Medical Association's call for a ban on mixed martial arts (MMA) is a case in point.
The BCMA passed a resolution in July calling for a ban on the sport, and plans to encourage the Canadian Medical Association to endorse the resolution at its annual meeting, which starts Sunday.
According to press reports, BCMA president Ian Gillespie offered two reasons for the resolution. First, he said that concern about brain injuries prompted the push to ban the sport, and second, he charged that, "The basic intent of the fighters is to cause harm in order to incapacitate his or her opponent." These arguments were also made by the British Medical Association in its recent call for a ban on MMA, and are identical to those offered by medical organizations around the world in support of a ban on boxing. But they're not nearly as compelling as they first sound.
Consider first what I will call the "argument from harm." There is no question that MMA fighters suffer from cuts and fractures, and, more disturbingly, from severe brain injuries. Two fighters have died of brain injuries suffered in sanctioned fights in the U.S., the most recent being Michael Kirkham, who succumbed after a match in South Carolina at the end of June.
As I previously argued, there is also little doubt that some fighters will also suffer chronic brain injury (chronic traumatic encephalopathy, or punch drunk syndrome) as a result of repeated head trauma. There is, therefore, evidence that MMA places fighters at significant risk of harm.
Yet a risk of harm accompanies participation in virtually any sport, particularly contact sports. Football, hockey and baseball players all experience a variety of injuries, including immediate and chronic brain injuries.
Indeed, boxing, to which MMA is often compared, is usually found fairly far down on top 10 lists of the most dangerous sports, which are typically headed by sports like rock climbing, horse racing and cheerleading, a sport that is a lot more dangerous than many people assume. Yet as MMA proponents stress, we don't hear medical organizations calling for a ban on these sports.
Mixed martial arts isn't found on any top 10 list, though that's because it has been the subject of very little research given its young age. I performed a Medline search of MMA, which returned only 22 studies, and only a handful of those dealt specifically with injuries associated with the sport.
Given that boxing compares relatively favourably to some ultra-dangerous sports, MMA proponents are quick to cite one 2006 study, which found that MMA compares favourably to boxing. The study, led by Gregory Bledsoe of Johns Hopkins Medical School, assessed 171 MMA matches in Nevada between 2001 and 2004, and found that the knockout rate (6.4 per cent) was little more than half that of boxing. Consequently, Bledsoe and his colleagues concluded that "the lower knockout rates in MMA compared to boxing may help prevent brain injury."
What proponents fail to mention, however, is that nearly 40 per cent of matches ended in TKOs, which may involve concussions -- that is, brain injuries -- or subconcussive blows that could also cause brain injuries.
Further, the U.S. air force's George Buse, a former martial artist and ringside physician, also published a paper in 2006 that supports the notion that MMA fighters are at risk of brain injury. Buse assessed 642 matches between 1993 and 2003 and found that head impact was the most common reason for stoppage of the match. Of the 642 matches, 62 ended by knockout and 120 by TKO; all knocked-out fighters showed physical signs of concussion.
Two more recent studies -- one in 2008 and one in 2010 -- also found a fair number of concussions among MMA participants, though the studies discovered that cuts were by far the most common injury. The risk of brain injury was also not out of line with that of other dangerous sports -in fact, the 2008 study, published in the British Journal of Sports Medicine, concluded that "the overall risk of critical sports-related injury seems to be low."
The argument from harm therefore fails to justify a ban on MMA, unless we also ban all other ultra-dangerous sports. And that leaves us with what I will call the "argument from immorality": The argument that, whatever the rate of injury, MMA ought to be banned because the intent of the sport is to incapacitate an opponent -- that is, because MMA is immoral.
If by "incapacitate" critics mean "knock out," then this argument is simply false. Many MMA fights end with a fighter "tapping out" after being caught in a hold from which he can't escape. This usually presents no risk of brain injury, except with a rear naked choke (sleeper hold), though it can and has led to other injuries, such as joint injuries.
It seems this argument has been imported from the argument against boxing, where, despite what boxers claim, the purpose really is to cause brain injury to your opponent. But even if we grant that this is true of MMA, which it isn't, the argument from immorality runs into trouble because there are many immoral behaviours that are not illegal, and that medical organizations are not lobbying to ban.
That said, the argument still has some merit. There is something barbaric about permitting people to intentionally cause severe injury to each other -- behaviours that would constitute serious criminal offences if they occurred outside the octagon. And critics often couple this argument with the related point that MMA competitions serve to promote violence, especially among young men.
In response, proponents argue, correctly, that MMA fighters are highly skilled and that unlike the anarchic "toughman" contests of the past, MMA fights today involve many rules that were imposed to protect the participants. And therein lies the solution to our problem.
In arguing against a ban on boxing, Raanan Gillon, a physician and ethicist who for 20 years edited the Journal of Medical Ethics, suggests that rather than place responsibility on legislators, critics should put the responsibility where it belongs -- on those who participate in boxing.
Gillon uses swordfighting as an analogy. While duelling with swords is no longer permitted, swordfighting still exists -- it is called fencing. The many precautions that exist, including the use of face masks and the rounding of the ends of the swords, eliminated the barbarity of the sport while still maintaining the skill level.
Gillon argues that boxing should follow the same approach, and we can make a similar argument with regard to MMA. Indeed, it seems MMA organizations have already begun to take this approach: As proponents note, rules, such as a ban on blows to the back of the head and neck, have been implemented to protect fighters. It seems they should therefore be open to further rule changes, including a ban on blows to the front of the head.
Critics might charge that changing the rules changes the sport. Of course it does, but then rules are always changing -- every sport is in a state of evolution. And any evolution that preserves skill but reduces risk of injury ought to be welcome. Further, physicians, given their unique expertise, are ideally situated to provide MMA organizations with advice on how to evolve the sport in a direction that emphasizes skill while reducing risk.
If that's not enough for physicians, then there is something else they can do, and that is take responsibility for themselves. If every doctor refused to participate in MMA, by refusing to provide medical certification for fighters or acting as ringside physicians, it would have a devastating effect on MMA.
It might not be a good effect, since it could return us to the toughman competitions of yore. But if physicians really find MMA so unsavoury, then it's incumbent upon them to stop enabling the activity. There really is no good reason why they should foist their responsibility onto legislators.
Indeed, inasmuch as MMA is a problem, the problem is caused by MMA organizations and their physician-enablers. And it is those organizations, and those physicians, who bear the responsibility of solving it.
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