Damage, Inc.: One Fan's Decision To Leave the Sport of MMA

Editor's note: This article, by Ivan Trembow, was re-published with permission. It's something to consider as we are still young in this sport, and perhaps unaware of what fate awaits today's generation of cage fighters.

A few weeks ago, I made the decision that I am no longer going to be watching MMA (or football, or boxing, or kickboxing).

It was very difficult for me to come to this decision, because MMA has not just been my favorite sport for as long as I can remember; it has also been my biggest interest and passion in life for as long as I can remember. The sport of MMA has been what I often go to bed thinking about, it has been what I've written about for years, it has given me something to look forward to during many tough times, and it has been the sport that I've defended to any of my friends or family who oppose it. I know that no longer watching MMA is going to leave a void in my life, and that no longer watching football, boxing, or kickboxing is going to be easy by comparison.

Very few days have gone by over these many years during which I haven't either read about, or written about, or watched MMA, and for good reason: The technique involved in MMA, the fact that a fighter can employ dozens of different strategies and try to go about winning in so many different ways, the fact that all of those strategies have counter-strategies (and those counters have counters), the fact that there are so many different ways to win... These are the things that have always made me feel that MMA is the most exciting sport in the world to watch.

At the same time, I know that I can't watch it anymore, and I'd like to explain what led to my decision to no longer watch the sport that I've loved so much for so many years.

I recently watched a segment on an episode of the HBO newsmagazine "Real Sports" that I had saved on Tivo. The segment was about a peer-reviewed scientific study that links brain injuries such as concussions to ALS (and to syndromes like ALS), which is probably the single worst way for a human being to (slowly and painfully) die.

After watching this segment, I went online and started reading. And reading. And reading. I read about concussions for hours and hours, then for the better part of a couple days. (One of the many, many articles that I found was one on Sherdog.com, written by Dr. Matt Pitt on the subject of brain injuries in MMA)

While of course everyone has known for years that concussions are "bad for you" in general, the scientific community has only begun to fully understand the wide scope of the long-term consequences of concussions in the past few years. Studies have recently been conducted on the brains of dead football players, boxers, and pro wrestlers. Many of these athletes lived long enough to finish their careers, but nowhere near a normal life expectancy, and the alarming trend in the studies of these athletes' brains is that they had brain damage that was far worse than anyone suspected or could have imagined.

Specifically, they had chronic traumatic encephalopathy, or CTE.

Some of these athletes had drastic behaviorial changes before their deaths, some of them developed Alzheimer's-like syndromes, some of them developed ALS-like syndromes, some of them killed themselves, and some of them killed others before killing themselves (such as pro wrestler Chris Benoit, who murdered his wife Nancy and his seven-year-old son Daniel before killing himself in 2007).

While these studies have not yet looked at the brains of dead MMA fighters, in part because the sample size of dead athletes in the relatively young sport of MMA hasn't been as large yet, common sense dictates that many of the same findings that these researchers have made about football's effects on the brain later in life, and boxing's effects on the brain later in life, will also apply to MMA.

Yes, MMA is "safer than boxing," but I think I must have been kidding myself to ever think that "safer than boxing" meant "relatively safe," no matter how much the athletic commissions and MMA promoters deny or downplay the long-term brain issues associated with MMA. People in football and boxing made the same denials for many years until the evidence became too overwhelming to deny anymore.

If one uses the threshold that suffering three or more concussions causes an athlete to be much more likely to develop CTE (even though recent research has shown that you don't need to have suffered three concussions to have a greatly increased risk of CTE), what's the percentage of MMA fighters who haven't had three concussions?

Most MMA fighters have been concussed at least that many times, some far more than that. The case of Kazushi Sakuraba is probably the most sad, grotesque, and heartbreaking (and Sakuraba recently said that he wants to fight for five to ten more years). Yes, that's in Japan, but even in the United States, this country's financially motivated athletic commissions don't seem to think twice about licensing someone like, say, Wanderlei Silva, who has been knocked out cold several times in official MMA fights and, by his own admission, was knocked out cold numerous additional times during full-contact training sessions at Chute Boxe.


Unconscious MMA Fighters Continuing to Get Punched

While MMA is safer than boxing overall, there are some ways in which MMA is actually less safe than boxing. One example: While it's true that giving boxers a standing-eight-count to get back to their feet after a knockdown really just enables boxers to take more punishment after they get back up, there is one thing that you rarely see in boxing, but which takes place all the time in MMA and is not even considered anything out of the ordinary: Fighters getting punched in the head repeatedly after they've already been knocked unconscious by a devastating strike to the head.

When an MMA fighter has very clearly knocked his or her opponent unconscious, it is the exception, not the norm, for the fighter to stop like Gerald Harris did after his recent knockout win over Dave Branch.

It's far more common for MMA fighters (like Hector Lombard and many, many others) to continue punching and punching, even after their opponent has very clearly been knocked unconscious, until the referee intervenes, which is often very late.

Sometimes, the fighter even throws one or two more punches after the referee intervenes (as was the case after Quinton Jackson knocked out Wanderlei Silva), and of course, the "go along to get along" athletic commissions sit on their hands and do nothing about it, not even issuing a small fine just to make the point that you shouldn't keep punching after the referee has intervened.

In addition to the times when it's obvious that a fighter is unconscious, there are also plenty of times when the punches to the head of the already-unconscious fighter are delivered in such rapid-fire fashion that it's impossible to fault the fighter who keeps punching (one example would be Cain Velasquez's knockout of Antonio Rodrigo Nogueira). In these cases, it's not as if the winning fighters had time to see that their opponents were already unconscious. However, to the losing fighters, the result is the same: Getting punched in the head repeatedly after they've already been knocked unconscious.

Many times (like in the aforementioned Nogueira-Velasquez fight), the knocked-out fighter wakes up very quickly after the punches stop. In these cases, they're usually able to give a post-fight interview with little-to-no ill effects apparent to the viewers at home. It's easy for many MMA fans (myself included) to delude ourselves into thinking that everything is okay in these situations. Two athletes competed, one of them won, one of them lost, and even if one of them got knocked out, they both seem fine now, but unfortunately, that's not the way it works. Many of the horrible symptoms of concussion-related brain damage take years to surface as the deposits of tau proteins in the brain build up over time.


Subconcussive Blows: No Concussions Necessary to Develop CTE

The study on the brain of deceased NFL player Chris Henry showed that you don't even need to have suffered a major concussion to have CTE, because you can also get CTE from many lesser blows to the head. Henry, who died during a domestic dispute in December 2009 at the age of only 26, was never diagnosed with a concussion during his football career, but the post-mortem examination of his brain revealed that he had CTE.

Think of all the times that MMA fighters get "rocked" or "buzzed" or "stung" during fights. An accumulation of these blows (both in fights and in training) can be more than enough to lead to athletes developing CTE and the associated problems that come with it, even if they are fortunate enough to go through their entire career without being knocked out.

The idea that you have to be a grizzled, old veteran of your sport to have CTE is an idea that is disproved by the Chris Henry case, and is further disproved by the recently released study on the brain of college football player Owen Thomas. Thomas, a captain on the University of Pennsylvania's football team, was only 21 years old and was never diagnosed with anything severe enough to be labeled "a concussion" during his football career. Thomas killed himself this past April, and a post-mortem examination of his brain revealed that he had CTE, which doctors believe was from an accumulation of subconcussive, "lesser" blows to the head.

How many MMA fighters have been "buzzed" or "stung" in fights that they've actually won? Too many to count. Sometimes, it's even discussed with a smile in the post-fight interview. There are many examples that I could cite, and one of them is when Rich Franklin said in the post-fight interview that he couldn't remember large portions of his unanimous decision victory against the late Evan Tanner, because he had been "rocked" earlier in the fight.

Many MMA fighters also suffer concussions and/or subconcussive blows to the head in fights that they lose, and they are often allowed to continue fighting even after they clearly should not be. To cite one of many possible examples, was there any doubt in anyone's mind that Jorge Gurgel was in no condition to continue fighting when he got "rocked" immediately after the bell sounded to end Round 1 of his recent fight against K.J. Noons? A glassy-eyed and woozy-looking Gurgel could barely make it back to his corner.

In the sixty seconds between rounds, Gurgel's corner-men, the ringside doctor, and the referee all failed to do their job. They apparently failed to realize that their job at that moment was to look out for the safety of the injured fighter and stop the fight, not to squeeze every last drop of "action" out of Gurgel. Predictably, shortly after the second round started, Noons stunned Gurgel again and won by TKO, but not before the amount of brain trauma suffered by Gurgel had far exceeded what it "needed" to be. Sadly, the case of Gurgel vs. Noons is not an isolated example; it's just one of the most obvious recent examples.

After a fight (or training session) in which a fighter gets "buzzed" or "stung" by subconcussive blows to the head, fighters sometimes have very few symptoms of a head injury. Sometimes, shortly after the offending strike, they have no symptoms whatsoever. Often, they can even pass neurological exams and feel 100% "recovered," while still having suffered brain damage that may only get worse in the years to come as deposits of tau proteins build up in their brains.

Many of the fighters who are suffering concussions or subconcussive blows to the head today, and are at risk for developing CTE, may not experience any of the signs of CTE for many years, giving them a false sense of security in some cases. (How many fighters are able to rationalize anything to themselves by saying, "No matter how many other fighters are suffering from Health Problem X, that's not going to happen to me"?) By the time that any symptoms of CTE become apparent, years' worth of additional brain damage may have been inflicted.

These fighters and their doctors would have no way of knowing for sure if they have CTE while they're alive, because CTE can currently only be diagnosed by removing and examining someone's brain tissue after they have died.

One of the reasons that some athletes who suffer brain injuries later develop CTE, and some don't even if they have suffered the same number of brain injuries, is genetic. In 70% of the brains that they have studied, doctors at the Brain Injury Research Institute have found a gene that is believed to be a precursor gene. As is the case with many diseases, this indicates that some people are more susceptible to developing CTE if they are exposed to risk factors such as a brain injury, and some people are less susceptible.


Fighters Who Have Been Reduced to Shells of their Former Selves

There are countless fighters in MMA who have been reduced to shells of their former selves when it comes to their in-ring (or in-cage) performances, in part because they have taken so much punishment to the head over the years. In some cases, while these fighters' situations are still viewed as sad, many MMA fans (myself included) have been able to rationalize this in the past by saying, "Well, they're in their late 30s or 40s," which is generally considered "old" in sports. But in addition to the fact that being in one's late 30s or 40s is not "old" in life, many of these fighters don't even meet the sports definition of "old."

To name just a few examples: Jens Pulver is 35 (and though his recent losses have come by submission, he has gotten knocked down or "rocked" shortly before the submission in most of those fights). Antonio Rodrigo Nogueira is 34 (though an accident during his childhood may have accelerated his decline a couple of decades later). Keith Jardine is 34 (and he recently said that he had the "worst migraine in the world" and was "in a bad situation" before and during his fight against Trevor Prangley, but he fought anyway). Wanderlei Silva is 34 (and, in addition to the fact that he has been knocked out numerous times, he has lost five of his last seven fights). Andrei Arlovski is just 31 (and, in addition to the fact that he has lost his last three fights, he has been knocked out six times during his career).

I could list many more MMA fighters who have been reduced to shells of their former selves in the ring/cage; I have only listed fighters who are 35 years old or younger to illustrate the point that a fighter doesn't even have to be considered "old" by sports standards in order to fit that description.

Like athletes in other sports, all too many MMA fighters on the tail end of their careers don't know when the time has come for them to retire from the sport, and there's always one promoter or another who is still willing to book them (and many athletic commissions who are willing to license them).

In sports that don't involve brain injuries as an inherent part of the sport, staying around for too long in search of the next moment of glory, or the next adrenaline rush, or simply the next paycheck, can lead to athletes getting embarrassed or having their legacies diminished in some way.

In sports that do involve brain injuries as an inherent part of the sport, such as MMA, boxing, and football, staying around for too long in search of the next mega-dose of adrenaline can also lead to athletes significantly worsening the brain damage that they've already suffered.

Some MMA fighters (like Chuck Liddell) have taken so much punishment to the head that they actually speak differently than they used to. One of the biggest examples of slurred speech in boxing in the past several years is, ironically, James Toney, whose speech is so slurred that he sounds nothing like he did when he was younger. When Toney recently entered the world of mixed martial arts, this exposed MMA fans, writers, and fighters to Toney's badly slurred speech, which is something that they might not have previously been aware of.

Sadly, when it comes to how most people reacted to this, there seemed to be more people who thought it was funny that Toney needed subtitles than there were people who wondered why a fighter with such badly slurred speech was still being licensed to fight in MMA, boxing, or any other combat sport.

These are just some of the examples that I could cite, and these examples only include fighters from fairly well-known MMA promotions. Undoubtedly, there are countless other fighters that I have never heard of, fighting on small MMA shows, who could also be accurately described as shells of their former selves in the ring or cage.


MMA Fighter Suicides

Sadly, many of the times that we hear about these fighters in smaller MMA promotions are when something horrible happens, such as when a fighter dies from brain injuries suffered in a specific fight (like Sam Vasquez in 2007 and Michael Kirkham in 2010), or when a fighter commits suicide.

Both CTE and Alzheimer's disease involve tau protein deposits in the brain. These deposits affect different parts of the brain in people with CTE than they affect in people with Alzheimer's, although CTE can end up leading to many of the same symptoms, such as severe memory loss and other aspects of dementia.

Due to the parts of the brain that are affected, two of the problems faced by people with CTE are severe depression and decreased impulse control. If the combination of severe depression and decreased impulse control sounds dangerous, it should, as this deadly combination may have contributed to the suicides of football players and boxers.

While doctors have not yet tested the brains of dead MMA fighters to look for CTE, a troubling number of MMA fighters have commited suicide in recent years, and several more have attempted suicide. The actual numbers may be higher because this is just what I could find in a Google search, but these are the minimum numbers.

Since 2006, at least six MMA fighters have committed suicide, and three of those MMA fighters are believed by police to have killed someone else before they killed themselves. Additionally, three other MMA fighters have attempted suicide during the same time period.

The six MMA fighters who have committed suicide in the past four years are Shelby Walker in 2006; Jeremy Williams and Justin Levens in 2007; Cliff Moore in 2008; and Bobby Suggs and Kenny Trevino in 2010.

When the subject of MMA fighters committing suicide has been raised on the Internet, an all-too-common reaction is something to the effect of, "Well, those fighters weren't on the biggest MMA shows," as if that somehow changes the fact that these people were professional MMA fighters, and that they were human beings who had families (as did their victims in the murder-suicide cases).

In the case of Justin Levens, police say that he killed his wife, Sarah McLean-Levens, shortly before killing himself in 2007.

In the case of Bobby Suggs, police say that he killed his ex-girlfriend, Amber Zavala, shortly before killing himself earlier this year.

In the case of Kenny Trevino, both Trevino and his ex-girlfriend, Tiffanie Perry, were found dead in an apartment earlier this month. Their deaths are still being investigated, but police have indicated that Trevino was despondent and suicidal over his recent break-up, and that they are treating the case as a murder-suicide.

The MMA fighters who have had suicide attempts since 2006 are Andrei Arlovski, Mike Guymon, and Junie Browning.

How many of these MMA fighters who killed themselves or others had CTE? There's no way to know for sure, because post-mortem testing on their brain tissue was not done by the Brain Injury Research Institute, or by the Center for the Study of Traumatic Encephalopathy at Boston University, the two organizations that have been at the forefront of CTE-related research. But I'd have to be kidding myself to think that the number of those fighters who had CTE is zero.


Painkiller Abuse in MMA

The issues with brain injuries have added to concerns that I've had for a long time about the problem of painkiller abuse in MMA, especially given the fact that the decreased impulse control that is associated with CTE is believed to make athletes who have CTE more likely to become addicted to a variety of substances.

A large percentage of the people that I grew up watching in pro wrestling have died prematurely, and while many of the published autopsy reports noted street drugs or steroids as a primary or secondary factor in their deaths, the single biggest killer of pro wrestlers over the years (as noted on autopsy reports) has been the abuse of painkillers, which is also a growing problem in MMA.

In most of the biggest MMA promotions, if you get injured during a fight, the promotion will pay for your medical expenses as a result of that injury. However, if you get injured during training camp, you are on your own financially with those injuries. Furthermore, since your paycheck as a fighter comes when you fight, it sets up a system in which you are essentially encouraged to go into fights with training injuries, because you need that next paycheck unless you're one of the few fighters like Brock Lesnar or Chuck Liddell with millions of dollars in the bank.

Continuing to train through injuries is something that goes hand in hand with painkiller abuse, as does going through with fights while injured, which is why there are more and more MMA fighters who have problems with painkillers.

Taking into account the fact that the vast majority of painkiller abusers are going to try to keep it hidden and are going to be reluctant going to admit to it publicly, just think of all the MMA fighters who have publicly admitted to abusing painkillers: Frank Mir, Joe Riggs, Kevin Randleman, Mark Coleman, Don Frye, and Mark Kerr, to name a few.

Then there are the MMA fighters who have denied it publicly, but whose friends, family, coaches, or training partners have discussed their issues with painkiller abuse, like Paulo Filho and Karo Parisyan.

Then there are the MMA fighters who abused painkillers in their pro wrestling days, like Brock Lesnar, who has said that he used to eat prescription pain pills like they were candy.

Again, logic dictates that these fighters represent a small fraction of the fighters who have actually abused painkillers.


A Recipe for Disaster

As I said at the beginning of this post, I have loved MMA for as long as I can remember.

However, the facts remain that when you combine the issue of painkiller abuse in MMA with the lack of collective bargaining, medical insurance, pension plans, or any athletic commissions that have the ability (or the desire) to conduct drug testing that is even remotely close to the standards of the World Anti-Doping Agency, and you combine all of that with the avalanche of emerging science about concussions, CTE, Alzheimer's-like syndromes, and even ALS-like syndromes, it adds up to a recipe for disaster in the years to come, and I just can't watch it anymore.

At the same time, I want to make it clear that I have still have a great deal of respect for the fighters who put their lives on the line by competing in MMA. I'm also not trying to act like I'm taking a moral high ground and looking down on anyone who watches MMA and continues to watch MMA in the future. I'm just saying that for me, personally, I can't continue to watch it.