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Q&A WITH DR. BARRY D. JORDAN: CHIEF MEDICAL OFFICER FOR THE NEW YORK STATE ATHLETIC COMMISSION

UP CLOSE & PERSONAL

“If boxing were banned, it would just go underground…As long as it exists, we should try to make it as safe as possible.”

The Up Close& Personal column will regularly feature neurologists who do interesting things outside of or related to the field of neurology. We welcome your suggestions for neurologists to feature in Neurology Today. Send your ideas toneurotoday@LWW.com.

As a child growing up in Brooklyn and Queens, Barry D. Jordan, MD, played a lot of sports, especially basketball, baseball, and football. So it seems only fitting that he would one day specialize in sports injuries. Currently, the 45-year-old neurologist directs the brain injury program at the Burke Rehabilitation Hospital in White Plains, NY.

Dr. Jordan graduated from Harvard Medical School in 1981 before going on to become Associate Professor of Clinical Neurology at Cornell University Medical College.

Over the course of his career, he has received an array of awards, including a Medical Scientific Award from the World Boxing Council in 1997. In 2000, he was named one of the “Best Doctors in New York” by New York Magazine.

Dr. Jordan has also garnered attention in his role as Chief Medical Officer for the New York State Athletic Commission, which oversees professional boxing in that state. He has held that position since last September, and also serves as the medical advisor to the Association of Boxing Commissions.

Over the summer the spotlight turned on him – and the health hazards of boxing in general – following the death of Beethavean Scottland, a boxer who died in early July at age 26 from head injuries sustained in the ring.

In a phone interview with Neurology Today, Dr. Jordan discussed the tragic incident, his work and research on boxing, and his views on how the sport can be made safer.

WHY DID YOU GET INTERESTED IN SPORTS MEDICINE– BOXING, IN PARTICULAR?

Early on, I wanted to be an optometrist. But I was always interested in math and science. In college, I decided I wanted to be a neurologist. Since I was always interested in sports and neurology, I wanted to combine both interests. I gravitated toward boxing, because it is a field known to produce a lot of sport-neurology-related injuries.

WHAT DO YOU DO FORTHE NEW YORK STATE ATHLETIC COMMISSION (NYSAC)?

Any boxer who competes in New York has to be cleared by me. All boxers must have a physical exam, a CAT scan, an eye exam, and an electrocardiogram every year. They must be tested for HIV and hepatitis B and C every three months.

HOW MIGHT YOU MAKE BOXING SAFER?

We need to improve the medical attention boxers receive. In some states, the neurological tests are not administered. Standards should be set so that all states are performing the same tests. Also, boxers should be medically evaluated before each competition. Right now testing varies among the states.

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We also need to make sure that trainers are educated on these sports-related injuries. They are with the boxers most of the time, and presently, their training is limited. They should know to look out for warning signs of trouble and to determine when a boxer needs to take a break from fighting and sparring. I've known some boxers to do 50 rounds in one week. That's incredible.

WHAT KIND OF TRAINING IS AVAILABLE TO THE TRAINERS?

We do conduct seminars for the trainers but they could be a little more stringent – and they are not mandatory.

WHAT WAS YOUR REACTIONTO MR. SCOTTLAND'S DEATH?

Unfortunately, catastrophic events like this happen. It's the result of the nature of the sport. Severe acute injuries, such as the one sustained by Beethavean Scottland, are relatively rare. The bigger problem is the chronic, cumulative effects of boxing over time, and not severe acute injuries. You can never make boxing 100 percent safe.

WHAT ROLE DID YOU PLAY IN MR. SCOTTLAND'S LAST FIGHT?

I was the ringside doctor at his last fight. I told the referee after the seventh round to stop the fight the next time Mr. Scottland was hit hard. But the fighter rallied and won the eighth and ninth rounds before being knocked out in the tenth and final round. I came under fire for not stepping in to stop the fight sooner. The New York State Assembly's Democratic majority has said it will investigate the fight, even though the NYSAC's advisory board has determined no further study is warranted.

WOULD YOU DISCUSS YOURRESEARCH ON BOXING-RELATEDNEUROLOGICAL INJURIES?

I've worked with colleagues on several reports on the long-term, cumulative brain injuries suffered by athletes. For example, we found that some boxers may be genetically predisposed to develop chronic traumatic brain injury after years in the ring. We isolated the gene form, APOE e4, which increases a boxer's risk of developing long-term brain damage – the same gene variation that seems to predispose some patients for Alzheimer disease. We found it makes boxers more likely to suffer long-term damage from head shots over the course of 12 or more bouts. About 20 percent of boxers have chronic traumatic brain injury. About 25 to 30 percent of the general population has the gene form APOE e4.

In 1999, I co-authored a study in Neurology that found that professional soccer players score poorly compared with other athletes on tests of memory and visual processing. We found that professional, high-level soccer players who frequently head the ball or collide with other players on the field could run the risk of long-term brain injury. This type of long-term, cumulative brain injury may never go away.

WHAT WOULD YOU LIKE TO SEE HAPPEN AS A RESULT OF YOUR RESEARCH?

I hope that one day there might be enough evidence to support a screening procedure to identify fighters at a greater risk for head trauma. I also wish that trainers could keep a closer eye on boxers who test positive for the APOE e4 gene form. It could be helpful if all boxers could one day be tested for the gene form.

HOW DO YOU RESPOND TO THE AAN POSITION THATBOXING BE BANNED?

If boxing were banned, it would just go underground. Athletes would be boxing in bars and basements without any medical supervision whatsoever. This sport will not go away – and obviously, you can't make it 100 percent safe. But as long as it exists, we should try to make it as safe as possible.

©2001 American Academy of Neurology