Writer put off by violence

On Monday, a writer named Ivan Trembow released a long and impassioned essay on why he'll no longer pay attention to football, boxing or mixed martial arts: the prevalence of chronic traumatic encephalopathy (CTE), which amounts to the scrambling of brain matter after repeated blows to the head. Autopsies conducted on the brains of combat-sport athletes have revealed tissue that resembles that of Alzheimer's patients; while alive, they can exhibit signs of depression or erratic behavior. It's nasty business.

Trembow believes it has become too obvious what MMA does to athletes -- their repeated concussions, slurred speech and ominous long-term prognosis -- and is no longer comfortable participating as a spectator. Having seen his byline appear in MMA forums on a regular basis since 2003, that's a heady statement. The problem is that that neither he nor anyone has any conclusive clue what this sport will do to fighters' quality of life because no one is yet old enough to have himself sliced up for science. (Diagnosing CTE requires a brain in a pan and a sharp knife.)

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Football players have become the tragedies of this subject because enough retired players have passed on for researchers to draw definitive conclusions -- none of them positive. But there are dramatic differences between the damage to which an NFL player is subjected and the environment in a cage.

There are 16 weeks in an NFL regular season, not including playoffs. Each game lasts an hour in regulation. That leaves players exposed to 16 hours, minimum, of "live" play time to ram heads. Until recently, the norm was that even players who got cracked one week would gamely trudge in the next week -- and often, on the next play -- and further endanger their brains. The astonishing frequency of head-on collisions is what has made so many of these players statistics: The worst thing for a concussed brain is to get clocked again.

In MMA, elite athletes might fight a total of three times a year. Assuming they're all title bouts (five rounds instead of three), that leaves them at risk for no more than 75 minutes out of the year -- usually less, and at intervals spaced three to four months apart. The window of misfortune for fighters is only a fraction of that for football players, presuming they're smart enough not to savage one another in training.

What alarms Trembow -- and others -- about MMA is the punctuating shots, the blows that follow when an athlete is already effectively finished. (Think of Dan Henderson's jumping right hand that crashed into an already unconscious Michael Bisping.) If the worst thing for an injured brain is immediate further injury, this is catastrophic.

The "but" is that no one is sure at what interval an unnecessary blow becomes a contributing factor toward morbidity. A fighter with a concussion who gets into a fight 10 minutes later is begging for trouble. But what about a fighter who receives blows literally a fraction of a second after unconsciousness? The brain is already being jarred; you might turn a mild concussion into a worse concussion, but that's not necessarily clinically significant.

Margaret Goodman, M.D., a former ringside physician for the Nevada Athletic Commission, told me earlier this year: "You're getting an added concussive effect and getting a more pronounced concussion by the repeated blows. I wouldn't think it would predispose them to something worse."

She's not 100 percent sure of that; neither is Trembow in his assertion that bad ends await fighters. Science is an inexact science. There are literally dozens (if not hundreds) of variables that can affect whether a combat athlete retires with his head largely intact or suffers from debilitating damage that ruins the last act in life. Punches that are so concussive in the first five minutes of a bout lose steam by the fourth or fifth; fighters may have genetic predispositions to trauma; fighters may train foolishly, getting dazed in the gym; fighters may not take advantage of the dimensions in MMA that allow them to minimize blows to the head.

And although it's only one brain, the lone MMA fighter autopsied by Julian Bailes, M.D., who helped pester the NFL into concussion-treatment reform, was inconclusive in diagnosing CTE.

Ten or 20 years from now, I have no doubt we'll see cautionary tales emerge from this sport. But the consent of the athlete is what prevents him from being morally reprehensible. Fighters fight because they want to -- many of the guys who make millions of dollars today entered the sport when it paid pennies. It's their choice. And CTE or not, there is no lifestyle that reduces the risk of death.