And for most boxers, there seems to be little incentive to quit while they're ahead -- or still have one. Nearly every former heavyweight champion has made a comeback. There's no weight limit to keep heavyweights away from the ring, and the money is too good to renounce. The price is ending up punch-drunk, slug-nutty, slap-happy -- pick your phrase; dementia pugilistica is the clinical term. A partial list of champions and top contenders who died in gray oblivion: Jerry Quarry, Sugar Ray Robinson, Zora Foley. Wilfred Benitez is brain-damaged. Jimmy Bivins was recently discovered, starving and demented, in an attic in Cleveland. Floyd Patterson, the champ who emerged from the streets of Bedford-Stuyvesant to become one of New York's best-loved citizens, had to resign as state athletic commissioner last year when he revealed at a hearing that he could scarcely remember his wife's name. And it could well be that the rages of Mike Tyson are partly the product of organic brain damage. "Tyson can't fight anymore -- that's why he went into ear biting," says Dr. Allan J. Ryan, who co-founded the field of sports medicine in 1945 and has watched thousands of fights with a clinical eye. "He's virtually helpless in the ring, and if he continues to fight someone's going to kill him."

In the 1980s, the British and American medical associations, as well as the American Academy of Neurology, called for a ban on professional boxing. It's not going to happen. But the good news is that boxing is becoming somewhat safer -- referees generally intervene earlier to stop fights. The bad news is that many boxers aren't that happy about it -- especially when they lose the bout. Some die-hard fighters would still rather die hard. Consider the April 24 WBC middleweight title bout between Hacine Cherifi of France and Keith Holmes of Washington. In the seventh round, Cherifi received 28 unanswered blows, including several powerful crosses to the head that left him staggering at the ropes with his gloves down until the referee jumped in and called a TKO. Did Cherifi thank the referee for preserving his brain? Of course not. He tried to argue his way into more punishment, screaming that he'd been robbed: "I'm not knocked out, I'm still fighting!"

A boxer like Cherifi, who can take many blows before succumbing, is said to have "heart." And heart, in the words of neurologist Norman Relkin of the New York Presbyterian Weill Medical Center, "tends to correlate with chronic traumatic encephalopathy." Quarry, who died at 53 on Jan. 9 in a childlike state after many years of being dressed by others, was the emblematic big-hearted fighter. He would take round after round of pounding by the likes of Ali and Joe Frazier, but stayed on his feet to lose decisions or late-round KOs. It made him a popular fighter -- "a Quarry never quits," was the family motto; Quarry's boxing brothers Mike and Bob are also severely brain-damaged.

The truth is that while scientific knowledge of the damage boxing causes has become more and more precise, there is little consensus yet on what to do about it. Consider this example: Neurologists examining the brains of deceased fighters with dementia pugilistica frequently observe an unusual feature called a cavum septum pellucidum -- a rupture of the thin membrane, the septum pellucidum, that separates the fluid-filled ventricle in the middle of the brain. Scans of active boxers have detected this feature far more frequently than would be expected in the general population. Nobody knows for sure whether the membrane has any function (a role in the limbic system, which controls emotional impulses like rage, has been hypothesized). But even if the condition is meaningless in itself, it is probably a marker for brain damage. "The inference," says Relkin, the neurologist, "is that if there's been enough force delivered to the cranial cavity to create the cavum, there's been enough force to cause diffuse axonal injury" -- widespread death of brain cells.

Yet when Relkin finds a cavum in the brain of a boxer referred to him by the New York Athletic Commission, he does not automatically recommend that the boxer be suspended. There are both medical and political reasons for this. On the medical side, there isn't enough scientific data available to know whether the condition is dangerous, or even that a particular membrane was damaged by boxing -- although the abnormality is believed to occur naturally in only about 1 percent of the population. Relkin wouldn't let his own kid box with a cavum septi pellucidi -- "I wouldn't let my son box at all," he adds. But boxers are a caste apart. "This is their livelihood," he says. In Relkin's experience, "Even if they've been made aware of the risks, it has almost no influence on their decision to fight. This is an occupational hazard they are more than willing to accept."

More sophisticated exams will turn up more abnormalities -- but they aren't failsafe, and the cost rises as a factor of the level of detail. A cavum will turn up in a CAT scan, which may cost about $300. White matter damage appears in MRI scans, but they cost four times as much. Many changes won't turn up on either scan, or in a neurological exam: the theory of dementia pugilistica is that brain-cell death during a boxer's career isn't sufficient to cause obvious symptoms until later in life, when, as additional neurons die in the natural aging process, a critical mass of neuronal death leads to dementia. PET scans and other tools that measure blood flow and chemical changes in the brain might show such changes earlier on, but these scans are experimental at present.

Genetics may help. In a 1997 study published in the Journal of the American Medical Association, Jordan and Relkin found that boxers who have a gene variant called apoE4 -- a genotype originally linked to early-onset Alzheimer's disease -- were far more likely to develop severe brain disease, regardless of how many punches they took. Someday, prospective boxers could be screened for apoE4 -- about 25 percent of the population has one copy of the gene -- and kept out of the ring if they have it. But all these tests -- CAT scans, MRIs, genetic screens -- could end up being prohibitively expensive. "Who's going to pay for that?" asks Rob Lynch, the executive director of the California Athletic Commission. "Boxers won't pay for it."

The obvious answer is to have the moneybag promoters and TV networks shell out for the exams. It's the height of paternalism to think that just because boxers come from poor backgrounds, they are happy to make a living getting slowly battered to death. Some younger boxers clearly are not. That, at least, is the impression given by Mark "Too Sharp" Johnson, whom I found shadowboxing to the go-go rhythms of D.C.'s own Rare Essence at Finley's, a legendary boxing gym in northeast Washington. When I interviewed him last week, Johnson, who is 27, was already the IBF flyweight champ and, with a 36-1 record, ranked by Ring magazine as the world's fifth-best fighter. (He went on to whip Ratanchai Vorapin of Thailand on Saturday to gain the junior bantamweight title). Johnson already owns a barber shop and a hair salon, and he planned to use the $85,000 purse from the Vorapin fight to start an ice cream parlor. If he gets clobbered in the ring, Johnson says, he wants to be able to leave the sport gracefully. And he strongly supports tough medical exams -- of himself and his foes. "This isn't a sport like basketball or golf where your health doesn't have to be up to par," he says. "A lot of fighters who been knocked out are still fighting that shouldn't be fighting. There ought to be stiffer rules -- look at Muhammad Ali. I want to leave the profession in good health. I have kids I want to take care of."
salon.com | April 30, 1999

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