But to become a champion, wouldn't a boxer have to withstand a sufficient number of punches, 20 or 30 fights' worth, to affect his CAT scan, even if those punches didn't result in neurological or punch-drunk symptoms? Just when his work was beginning to pay off, would a doctor tell him he should stop? A real dilemma, Casson concedes. Still, he says, "A boxer ought to know what he's getting into if he wants to go on and be a champion. He should know what he may be sacrificing. A doctor has to tell the boxer if he thinks the fighter should stop, but in the end it's not really a medical decision. Society has to decide what we're going to do about boxing."
Just how bad is the brain damage that shows up on CAT scans and neuropsychological tests? For Quarry and Pacheco and perhaps Ali, it's not bad, not a disability. Minor memory failures aren't crippling. But aging certainly compounds whatever deterioration may exist, as all the research shows.
Physicians who disagree with the implications of Casson's work and that of researchers like Ross point out that there are no prospective studies; that is, studies that track a younger boxer with alleged abnormalities over a period of 10 or 20 years.
"I think we're jumping the gun," says Dr. Edwin Campbell, medical director for pro boxing in New York. Campbell helped enlist the fighters for Casson's studies and was a co-author, but says, "We just haven't done enough work yet. And we don't know how boxers compare with athletes in other sports, like football, who get frequent concussions."
Casson and Ross are the first to admit that more detailed, long-term work should be done. "But let's start now," Casson says, "before another generation of fighters comes through." Though Ross's work received considerable publicity, three months later he's frustrated by the lack of follow-up concern. "The big people in boxing haven't commented," he says. "Who's going to pay for these longer studies? What's being done? I'm afraid everything's going to die down."
The new legislation being discussed in Congress would create a commission to institute national standards among state commissions for all pro fights. There would be rigorous physical screenings and a "passport" for each boxer that would certify his medical history from past bouts. But CAT scans and full neurological exams before and after fights aren't practical—nor, at $300 apiece, cost-efficient, given what the average boxer earns. Casson and Siegel suggest that their neuropsychological tests, which are easy and cheap to administer, might serve as a first screen for possible brain damage. They have developed an "impairment index." If a fighter scores abnormally on at least half their tests, they have found, his CAT scan and/or EEG will also show abnormalities. Of course, no legislation is a substitute for vigilance and care within boxing itself. Dr. Battaglia of Oregon points to the ringside physicians. "If you've got problems on a CAT scan, you're too darn late," he says. "You've got to pick up the signs in these kids way before then. If I see a kid taking three licks now to put one in, as far as I'm concerned school's out—then you do the scan."
Will there be real reform? Cobb's reaction to the brain injury controversy may give a clue, even though he might be described as a boxing anarchist. "Dammit, I'm a grown man," he says heatedly. "If a man doesn't want to fight, then lay down, sucker. I'm not going to have someone run my life for me. If you get a federal commission involved, all you're going to have is a bunch of political appointees. A lot of flurry, a lot of fluff, all show and no go.
"I'm a whore who sells his blood instead of his ass. But that comes with the sport."