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Editor,—I read the article on sport medicine and the ethics of boxing1 with disappointment this month. It rehearsed arguments that are already familiar to sports physicians faced with difficult decisions about how to approach boxing, without taking things further on. In addition, there are medical, social, and ethical points that are not fully addressed in the article.
Medically, epidemiological studies have established that there are a number of popular sports in which the injury and mortality statistics are greater than in boxing. A ban or boycott in rugby, equestrianism, or formula one car racing has not been contemplated by the medical profession.
Socially, the background of most doctors ensures that, unlike some other high risk sports, the cultural significance of boxing in some parts of our society is extremely poorly understood. Boxing represents a relatively safe and desirable alternative to other possible activities for some young people, and it is often the continuation of a family heritage.
Ethically, one cannot separate the desire of boxers to succeed from the financial and social encouragement that is widely offered to those at the top level by people with money and influence. These individuals, and not the boxers, are the ones who should be targeted by those who want to change the status quo.
Personally, the boxers with whom I have been privileged to work have been among the most honest, friendly, and unassuming of the athletes I have encountered. They have a strong tradition of self discipline and decency that puts some other sports, and sometimes the politics of their own sport, to shame.
I do not believe that any sports physician can approach boxing feeling totally at ease with the ethics of their position, but a practical, sensitive, and informed debate is what I, for one, would really appreciate.
This letter was shown to the authors, who reply as follows:
Dr Cowie alleges that we simply “rehearse” familiar arguments about boxing, In fact, boxing attracts scant attention in the literature, beyond proposals that would ban it outright or take a complete “hands off” approach. Interestingly, Cowie attributes a position on banning boxing to us, despite our statement that “we... offer only qualified support for these efforts”.
As we argue, the case for boxing is weak. However, we advocate a position that continually accommodates new evidence, including clinical, sociological, and psychological data on why athletes box; the risks they assume; and the factors that shape the perception of this sport.
Cowie remarks that physicians tend to misunderstand “the cultural significance” that boxing has “in some parts of our society”. This is hard to argue against, if only because perfect empathy with patients rarely occurs in the clinical encounter.1a The key seems to lie in what one makes of this potential for misunderstanding. For her part, Cowie claims that boxing is a “relatively safe and desirable alternative to other possible activities”. This strikes us as vague, bordering on evasive.
Desirable, or relatively safe, compared to what?
As one researcher warns, “it is hard to think of a sporting practice that has been so thoroughly mythologised and so little researched by social scientists”.2 The prevalent belief, glamorised by Hollywood, that boxing is for many a ticket out of the ghetto, lacks empirical support, and there is room to question the moral relevance that this portrayal would have anyway. First, some evidence shows that even boxers intent on turning pro come mainly from the working classes. Secondly, if criticism would deny such boxers a shot at a promising future, we wonder what was so promising about it in the first place. And if boxers have few “safe and desirable alternative[s]”, criticism of boxing is less a threat to the boxer than the threat of injustice, that of having to choose between the risks in boxing and those associated with, say, crime and poverty.3 Boxers who feel compelled to box suffer diminished autonomy long before they feel the effects of our commentary. The economic inequities that Cowie mentions, between the athletes and their handlers, only compound this injustice.
Finally, Cowie accuses us of overlooking the risks in “rugby, equestrianism”, and motor racing. Admittedly, these sports give rise to injustice, exploitation, and excessive health risks. There is also the possibility of destructive violence in contact sports like boxing and hockey.4 We grant that many sports deserve increased moral and medical scrutiny, as does the possible link between high risk sport and aggressive, violent behaviour in ordinary interaction.5 Yet this hardly means that our interest in boxing is misplaced. One can analyse a few aspects of boxing while also welcoming broader dialogue regarding sports and the physician's obligations.