Tag Archives: CTE

Book Review: “Damage: The Untold Story Of Brain Trauma In Boxing” By Tris Dixon,

Boxing’s Human Demolition Derby

By Mike Silver

The wealth of information contained in this remarkable book is more important than 100 medical papers about brain damage in boxing because it is written in layman’s language and exposes the personal stories behind the cold statistics and scientific jargon. Its words should serve as a clarion call for action on behalf of the athletes for whom boxing is not so much a choice as a calling. In bringing attention to this serious topic Tris Dixon does not seek to abolish boxing—although there is a strong case to be made for that both medically and morally—but to try and make a dangerous sport less dangerous by shining a light on a subject that is too often ignored or neglected by the boxing establishment. 

The first chapters reveal a litany of neurological studies that emphatically link boxing to chronic traumatic encephalopathy (CTE), which is a medical term for brain damage caused by repetitive concussive and/or sub concussive blows to the head. At least 70 years before Dr. Bennet Omalu famously discovered and published his findings on chronic traumatic encephalopathy in American football players, neurologists in the 1920s and 1930s had already made that same connection as it relates to professional boxers. At that time CTE was known to the general public by a different name—“punch drunk”. The term was used to describe boxers “who were losing their faculties in the form of slurred speech, awkward movement, memory loss, and other degenerative behavioral changes.” Eventually scientists and neurologists stopped using the pejorative “punch drunk” and replaced it with the more elegant sounding “dementia pugilistica”, which is just another name for CTE.

That would mean from the beginning of the last century to the present thousands upon thousands of boxers have been afflicted with varying degrees of brain damage.

Subsequent studies indicated the condition was not confined to any specific population of prizefighter. “It was not just the old fighters who suffered from it”, writes Dixon. “Nor, as the early research showed, was it just novices, sparring partners, and fall guys. Some fighters were burnt out before others, some fought long, hard careers, some were ‘punchy’ after a dozen fights.” Most alarming of all was a consensus by the scientists that approximately 90% of all professional boxers were affected in some way. That would mean from the beginning of the last century to the present thousands upon thousands of boxers have been afflicted with varying degrees of brain damage.

CTE is a progressive condition that slowly but surely gets worse over time. Dixon describes the ongoing research that is attempting to understand why some boxers develop symptoms early and others seem able to function normally until their 50s or early 60s when they suddenly drop off the cliff, so to speak, and quickly descend into a haze of mental confusion and premature senility even though the boxer has retired from the ring and repeated head traumas are at an end.

In addition to explaining the science, Dixon does not shy away from questioning the moral ambiguities of the sport. He quotes Dr. Ernst Jokl, whose book The Medical Aspects of Boxing (1941) is considered a seminal work for its time: “Of all the major sports, boxing occupies a special position since its aim is that of producing injuries, more particularly to the brain…similar injuries occur in sports other than boxing, e.g., in football or wrestling. But here they are accidents rather than sequale of intentional acts. Only in boxing are traumatic injuries unavoidable even if the rules are adhered to.”

Second-impact syndrome, which can result in permanent brain damage, is a common occurrence in many prizefights and sparring sessions…

Dixon notes that in recent years researchers have determined that one of the most dangerous aspects of both boxing and football is second impact-syndrome “when someone suffers a second concussion while still suffering from the first.” Second-impact syndrome, which can result in permanent brain damage, is a common occurrence in many prizefights and sparring sessions yet “is not widely discussed in boxing when it should be a regular part of the conversation…[it] is one of the most serious threats to brain injury, both in the long and short term. In second-impact syndrome, the first hard hit has done more damage than anyone suspects and then the boxer takes a follow-up shot and life can be irreparably changed. A fighter can be hurt in sparring and still not be healed by fight night, when disaster can strike.” The danger is compounded in the presence of an incompetent referee or ringside physician. Dixon laments the fact that boxing does not have the equivalent of the “tap out” in mixed martial arts (MMA) contests. But the “I am willing to be carried out on my shield” mentality is embedded into the culture of this ancient sport and in the minds of its fighters. Even so, modern gloved boxing was never meant to be a human demolition derby or a fight to the death.

His (Ali’s) family did not want to believe or admit that boxing was the cause.

Of course no book on brain injuries in boxing would be complete without mentioning the most famous boxer of them all—Muhammad Ali. Dixon devotes several chapters to Ali, starting when Ali began to show symptoms of CTE while still fighting. By his early 40s (a few years after he retired) Ali’s hand tremors, slowing of his speech and movement noticeably worsened. His family did not want to believe or admit that boxing was the cause. They claimed that he had Parkinson’s disease and his condition had nothing to do with boxing. While it’s possible that in later years he may have developed Parkinson’s disease Dixon quotes several prominent doctors who state unequivocally that boxing was the primary cause of Ali’s infirmity.

Ali actually suffered from Parkinson’s syndrome, which is destruction by trauma to the same parts of the brain that are destroyed by someone who develops Parkinson’s disease. It is not the same as Parkinson’s disease and has a different cause.

Ali actually suffered from Parkinson’s syndrome, which is destruction by trauma to the same parts of the brain that are destroyed by someone who develops Parkinson’s disease. It is not the same as Parkinson’s disease and has a different cause. CTE, which can cause Parkinson’s syndrome, is identified at autopsy by the presence of tau protein in the brain. Tau gradually breaks down brain cells, causing the reduced state fighters find themselves in while they’re still alive. Dr. Robert Cantu, one of the world’s foremost neurosurgeons, and senior advisor to the NFL Head, Neck and Spine Committee states that “CTE is a highly serious issue itself, but it could also be an accelerant to other neurological illnesses”, something he is almost certain of. “Of the great fighters who died and were diagnosed with dementia, Parkinson’s, ALS, or Alzheimer’s over the years, there is not only a chance that it was just CTE misdiagnosed, but it could have triggered different medical problems. You’ve got dementia, Alzhiemer’s, Parkinson’s but you got it twenty or thirty years earlier. But there are pure cases of CTE, and in those cases they’re probably not an accelerant, just the result.” Dr. Ann McKee, another renowned neuropathologist interviewed by Dixon, “has checked more than twenty-five boxers’ brains and has yet to see one that has not had CTE from fighting.”

“Statistics from CompuBox, which compiled the punch stats from 47 of Ali’s 61 professional fights, revealed he was hit 8,877 times.”

Dixon tells us that in 1981 a CAT scan of Ali’s brain was taken just before his last fight. It showed the type of atrophy that show up in 50 percent of boxers with more than 20 bouts—a percentage far higher than in the general population. This type of abnormality is found four times as frequently in boxers as in non-boxers. In the latter half of his 20 year career Ali absorbed a huge number of punches: “Statistics from CompuBox, which compiled the punch stats from 47 of Ali’s 61 professional fights, revealed he was hit 8,877 times.” That number does not include all the hits he took in countless rounds of sparring. Ali had stayed too long and paid a terrible price. At the time of his death at the age of 74 in 2016 Ali “had been unwell for 3 decades.” His brain damage was severe, and it was all due to boxing—not Parkinson’s disease as has so often erroneously been credited for his condition. Had Ali donated his brain for research the diagnosis of CTE would have been confirmed, as it has with the dozens of deceased boxers (and many more football players) who willed their brains to science. Instead, the most recognizable face on the planet was propped up as an advocate to find a cure for Parkinson’s disease. All well and good, but what he should have been was the poster person for brain damage in boxing.

Frankie (Pryor) told Dixon she wished that Ali’s family had publicly acknowledged the reason behind the icon’s demise as that could have helped countless more fighters understand what happened to them.

Frankie Pryor knows about CTE first hand. She is one of several wives of former champions who were interviewed by Dixon. Frankie’s late husband, Aaron “Hawk” Pryor, was one of the greatest fighters of the past 50 years. But, like so many others, he became a boxing casualty. Frankie told Dixon she wished that Ali’s family had publicly acknowledged the reason behind the icon’s demise as that could have helped countless more fighters understand what happened to them. “It was kind of always my one regret because the one fighter who had the notoriety and could have brought a lot of attention to this was Ali”, she said. “And then they went off on this Parkinson’s thing…I don’t think it was done maliciously. Maybe Lonnie [Ali’s wife] didn’t fully understand the impact, but just to say, ‘it wasn’t boxing, it was Parkinson’s.’ No it wasn’t.”

How sad for this tragic sport that there is no Muhammad Ali Center for patients and family members who are dealing with boxing induced brain damage.

There is a research center named for Ali in Phoenix, Arizona—the Muhammad Ali Parkinson’s Center. It is described as “a comprehensive resource center for patients and family members dealing with Parkinson’s disease.” That is the legacy the champ’s family prefers. But what does that legacy mean to the legions of damaged boxers who, like Ali, are suffering the debilitating effects of chronic traumatic encephalopathy? How sad for this tragic sport that there is no Muhammad Ali Center for patients and family members who are dealing with boxing induced brain damage.

Nevertheless, research into the causes and treatment of CTE continues thanks to the efforts of Dr. Robert Cantu, Dr. Ann McKee, and Dr. Charles Bernick. They are at the forefront of the science seeking to detect and track the earliest and most subtle signs of brain injury in those exposed to head trauma. A remedy to treat, or perhaps even reverse, the damage done by the tau protein is a long way off. Many of the studies will not bear fruit for another 10 or even twenty years. In the meantime what can be done to limit the damage? The answer: Plenty, but only if there is the will to change. Among the changes that Dixon says should be considered are glove size, reducing exposure by limiting the number of rounds and their duration, better education for referees and ringside physicians, and the use of head guards.

Dixon points out “the lack of detailed education with trainers, through commissions or sanctioning bodies. No memos have gone out since CTE was confirmed.

There are many people and organizations in the professional boxing world that are not anxious to accept the findings of the scientists or do anything of significance that might make the sport less dangerous. Dixon points out “the lack of detailed education with trainers, through commissions or sanctioning bodies. No memos have gone out since CTE was confirmed. Nothing changed, yet this—punch–drunk syndrome—was boxing’s problem before it was anyone else’s.” In the words of Chris Nowinski, a former Harvard football player, WWE wrestler, and founder of an organization called the Concussion Legacy, “Fighters are on their own…If you compare boxing to what’s happening in football or other sports there’s virtually no one looking out for the athletes…Without a centralized organization, there’s nowhere for boxers to get educated, no go to source, no self-help manuals, and no union.” Absent a centralized organization or boxers’ union (don’t hold your breath waiting for that to happen) the major promoter/entrepreneurs are in control. Referees and ringside officials are licensed by state boxing commissions but they are paid by the promoter. This is a clear conflict of interest as the promoter has a vested interest in seeing that a promising fighter under contract to him does not lose. Referees and ringside physicians should be completely independent of having anything to do with a promoter or sanctioning organization. Dr. Margaret Goodman, a respected former ringside physician for the Nevada Boxing Commission, explained how a promoter’s influence can determine who officiates: “If you [the ringside physician] stop a fight or recommend a fight should be stopped from a promoter that has big connections with the commission, you’re never going to work another fight again. Same thing for the referees. Same thing for the judges…there are too many outside influences, and the overall health of the sport has not improved as much as it could from those factors as well, which most people don’t take into account.” No one wants to see a boxer seriously injured but with no effective oversight in place the pervasive greed and corruption of promoters and sanctioning organizations takes precedence over any concern for the boxer’s health.

One cannot help but be moved and disturbed by the author’s accounts of his interviews with these damaged gladiators.

The best parts of the book involve Dixon’s description of his personal interaction with the boxers and their families. One cannot help but be moved and disturbed by the author’s accounts of his interviews with these damaged gladiators. Although the boxers were concerned about the long term effects of their punishing careers most said—and it speaks to the pull of this sport and how central it is to their lives—that they would do it again even if it meant winding up with brain damage.

“Fighters must be made to understand the cumulative toll sparring and boxing takes on them and they need to be prepared to walk away when the time comes.”

Dixon concludes with the following words: “The sport might not be able to save every fighter but it must give them the best chance of saving them from themselves. Fighters must be made to understand the cumulative toll sparring and boxing takes on them and they need to be prepared to walk away when the time comes. That is the hardest part for many fighters, and it’s why the sport should do more to help as they start a new chapter….It’s time boxing confronts its own worst problem, stops ignoring it, and steps up to address it at all levels. This is a sport of courage and it will take bravery but it’s happened in football, soccer, and rugby although it should not be up to other sports to take on boxing’s biggest fight.” It is a fight that is long overdue.

Damage: The Untold Story Of Brain Trauma In Boxing 

By Tris Dixon

Hamilcar Publications, 227 Pages, $29.99

Mike Silver’s books include “The Arc of Boxing: The Rise and Decline of the Sweet Science” and “Stars in the Ring: Jewish Champions in the Golden Age of Boxing-A Photographic History”; His most recent book is “The Night the Referee Hit Back: Memorable Moments From the World of Boxing”.

“The Brain Of A Boxer”, Documentary Available April 6th

The Brain Of A Boxer
This Very Important Documentary
Available On Amazon, ITunes, and Google Play April 6th

A year and a half ago I had the opportunity to view Unforgotten: The Story Of Paul Pender at the Boston Film Festival has won numerous awards. The movie, directed by Felice Leeds, looks at the life of former Middleweight Champion Paul Pender, and included rare footage of Paul’s career along with much interesting commentary. More importantly, it took an in-depth view of the toll repeated trauma to the the head took on the former champ’s brain. The movie has now been released to the public and is available at Amazon, iTunes, and Google Play. It has been renamed The Brain Of A Boxer. The new title, along with its broad availability, will, I hope, ensure this important film receives a wide viewership.

When Paul Pender died in 2003 after suffering years from symptoms of dementia, it was concluded the cause of death was due to Alzheimer’s disease. It wasn’t until his courageous widow Rose allowed research to be done on his brain that it was found that he had not been suffering from Alzheimer’s, but rather it was Chronic Traumatic Encephalopathy (CTE) that caused the deterioration in Paul’s brain and eventually led to his death. Furthermore, this damage very possibly began during his days playing high school football.

Paul Pender

Much has been learned about CTE in recent years. Lawsuits reaching into the billions of dollars have been filed against the NFL by families of football players suffering from this horrible, and very preventable, disease. Public awareness is growing about the injuries being inflicted on the young participants who engage in contact sports. More parents are less inclined to allow their children to play football our climb into a boxing ring because of the high risk of brain damage involved in such participation. However, the public still has a desire to view these sports and is willing to pay huge sums of money to do so, and as long as the money is there people will be enticed to take up these professions.

In The Brain Of A Boxer you will learn much about the causes of and the research being done about CTE. Most of us assume brain damage is caused by serious concussions which usually result in unconsciousness. However, research has shown how even minor hits to the head, especially when received by young adults and children, causes damage. It is very important for parents to be aware of the dangers involved in many of the sports their children are participating in, and to find alternatives for them. Learning the competitive spirit and having children challenge themselves physically is a very important part of growing up, but having a brain that is injured beyond repair is not worth the price of that experience.

In making The Brain Of A Boxer, Felice Leeds has included interviews with many people from the world of boxing as well as from medical circles. Hearing from those who knew Paul Pender gives us insight into the man. Paul hardly fit the stereotype of the boxer as is seen in so many Hollywood movies. He had a deep intellect and a love for language. It would have been no surprise had he followed a different path in life, such as becoming a college professor.

Former boxers, boxing experts, and friends of Pauls such as former Champ Tony DeMarco, Joe DeNucci, historians Dan Cuoco and Mike Silver, former amateur boxing star Richard Torsney, sportswriter Bud Collins, and Richard Johnson the curator of the Sports Museum in Boston all bring their memories of Paul Pender to life. He was a complicated and interesting man.

Dr. Ann KcKee

For the medical perspective we hear from Dr. Ann McKee who’s tireless research on CTE has done so much to shed light on this terrible problem. Dr. McKee was recently named Bostonian of the Year by the Boston Globe. She has been studying the brains of deceased athletes for a number of years and the results of her findings are stunning. It has been learned that CTE can show up in the brains of athletes at a very young age. It is a progressive disease that gets worse with time and has no cure. It is also a very preventable disease. By no longer allowing athletes to receive trauma to the head the disease can be eliminated from sports.

Rose Pender

Ms Leeds describes Rose Pender, the widow of Paul, as the true hero in this story. It was Rose who made the very difficult decision to allow her husband’s brain to be used for research. Paul Pender’s brain was the first to be studied. If not for the actions of this very courageous woman research into CTE may have been delayed for years.

The Brain Of A Boxer is a very interesting and important film. For those who love boxing there is much to enjoy. The archival footage is just amazing. Hearing the voice of Paul Pender as he talks about the dark side of boxing is eye opening. Also, for those of us who have loved boxing all of our lives, it forces us to confront some very difficult realities. Is the pleasure we get from watching athletes inflict head injuries on each other really something we should accept? Is it time to rethink how we view contact sports? And just maybe we should ask ourselves, would we allow our sons and daughters to take part in sports that can cause such serious damage to their brains? If the answer is no, than we have to deal with the question of allowing others to do so.

The Brain Of A Boxer is an important contribution to the discussion surrounding these issues. It is an excellent film, well crafted and fascinating to watch.

Richard Johnson, the curator of the Sports Museum in Boston, best described it. I believe he was quoting Paul Pender when he said “It is a full day if you have laughed and cried.” This documentary will make you do both.

Tony DeMarco and Felice Leeds

Many thanks to Felice Leeds for making this film. I urge everyone to see it now that they have the chance. It will make you laugh and cry. And I hope it will make you think about the price so many athletes pay for entertaining us.

The Brain Of a Boxer
Directed By Felice Leeds
Available at iTunes, Amazon, and Google Play
For more information go to:
http://facebook.com/unforgottenchamp

Unforgotten, The Paul Pender Story

A Very Important Film That Will Save Lives

by Bobby Franklin

unforgotten-the-story-of-paul-pender_poster_goldposter_com_1-jpg0o_0l_800w_80qA few years ago film director Felice Leeds got in touch with me about a film she was making about Paul Pender. She told me it would be dealing with more than just Paul’s career as a boxer. We exchanged emails and phone calls. Occasionally, I would hear the production was making progress, but I have been approached by other people trying to make boxing films, and they never seem to go anywhere. With this history, I really wasn’t expecting much from Ms Leeds’ project.

Last Sunday I finally got to see the finished product at a screening at the Boston Film Festival. Not only is this documentary one solid production, it is also an extremely important film.

In 2003 former World Middleweight Champion Paul Pender died at the age of 72. For the previous 15 years it had been thought Paul was suffering from Alzheimer’s Disease. It wasn’t until his brain was examined after his death that it was discovered not to be Alzheimer’s but rather Chronic Traumatic Encephalopathy (CTE), a disease caused by mild repetitive trauma to the head. These sub-concussive blows to the head are most serious when received at a young age. It was found that Paul had a very serious stage of the disorder CTE (stage 4). It became the  index brain for the research that is ongoing Boston University and is the brain all other cases are compared to.

Paul Pender
Paul Pender

Unforgotten, The Paul Pender Story tells us about Paul’s life, his boxing career, his outspokenness about the corruption in the sport, and his battle with recurring hand injuries that often put his quest for the title on hold. There is amazing footage of Paul’s fights, of him training at the New Garden Gym, as well as taped interviews with the champ. Watching the Brookline fireman’s rise to the top culminating in his winning the title from Sugar Ray Robinson is a great story in itself, and boxing fans will be thrilled with just that.

However, there’s much more to this fine movie. We learn that on top of being a great boxer, Pender was also a very intelligent man who attended elocution school and loved to quote Shakespeare. If things had been a bit different for him he very well may have ended up a college professor. He certainly possessed the intellect for it. We also become aware that his very strong brain was also being damaged over his years of playing contact sports.

While CTE was first thought to primarily affect boxers (dementia pugilistica) it has been found to be prevalent among football players as well. It is a progressive disease that can also occur in anyone, not just participants in contact sports, but also in those who have suffered repeated repetitive head trauma in other ways.

Dr. Ann McKee directs the Boston University CTE Center based at the Veteran’s Administration Medical Center in Bedford, MA. In the film she points out how the younger a person is when they suffer a head injury the more susceptible they become to developing CTE later in life. It is very possible Paul Pender already had damage from his days of playing high school football

It is very possible Paul Pender already had damage from his days of playing high school football

in Brookline. If that damage already existed it would have been exacerbated by his career as a boxer. This is something that should give every parent pause when they are considering allowing their son or daughter to play a contact sport. Once damaged, the brain does not heal.

Tony DeMarco and Felice Leeds
Tony DeMarco and Felice Leeds

In a panel discussion after the film Dr. Robert Cantu, author of Concussions And Our Kids, talked about someday having tests that will show whether or not signs of CTE are beginning to show in the brain. Right now the only way to know for certain is to examine a brain after the patient has died. Could finding markers early on help prevent the onset of symptoms later in life? That is a question that can’t be answered, but at least the person, such as a boxer, could be denied a license to fight so that the damage is not made worse. He also points out that research needs to be done on the brains of people who have participated in contact sports but are asymptomatic. It has always been a puzzlement as to why some athletes, in spite of having received repeated blows to the head, never develop CTE. There is so much more to be learned about this terrible but preventable disease.

This movie is great on so many levels. It finally gives Paul Pender the respect and recognition he deserves for his great boxing ability. He has been known as the forgettable boxer, but

after watching this film you will never forget Paul Pender

after watching this film you will never forget Paul Pender.

Audiences are also brought back to the days when boxing was one of the most popular sports in the country. The time when great fighters like Tony DeMarco made Bostonians proud. Tony, along with fellow boxers Joe DeNucci, Tom McNeeley, and Matt Farago are interviewed. Former great amateur boxer Richard Torsney, a longtime friend of Pender’s, gives us insight into the personal side of the Champ. Historian Dan Cuoco and author Mike Silver (Stars In The Ring and The Arc of Boxing) not only share their insights about the finer points of the art of boxing, but also discuss the emotional side of  what it means to be a boxer. Mr. Silver describes it as a “Calling”.

Rose Pender
Rose Pender

Director Felice Leeds reminds us of a person who should definitely not be forgotten, and that is Rose Pender, Paul’s widow. Ms Leeds describes her as the true hero in this story, and I couldn’t agree more. It is Rose who got this all started by making the difficult decision to allow Paul’s brain to be used for research. This courageous woman who spent years caring for her husband while raising a family now has allowed the rest of us to benefit from the research that is based on her husband’s brain. Her action will save lives and prevent much suffering. We all owe Mrs. Pender much gratitude.

Felice Leeds has made a fine documentary. As I wrote earlier, it is an important piece of work and deserves a wide audience. It is time we as a society look at what is happening on the playing fields and in the boxing rings. It is time we consider the danger we are putting our fellow human beings into for the purposes of entertainment. It is time we work to make sports safer while still retaining the competitiveness that builds character and self-discipline.

Richard Johnson, the curator of the Sports Museum in Boston, best described this film during the panel discussion. I believe he was quoting Paul Pender when he said “It is a full day if you have laughed and cried.” This documentary will make you do both.

Many thanks to Felice Leeds for making this film. I urge everyone to see it when they have the chance. It will make you laugh and cry. And I hope it will make you think about the price so many athletes pay for entertaining us.

Trailer: Unforgotten, The Story of Paul Pender from Felice Leeds on Vimeo.