Justice Committee on April 15th, 2013

[Dr. Samuel Jeffrey Gutman]

I think there are a number of ways or considerations regarding how to protect the athletes further. I don't think there is, as yet, consensus on what those would be. I might suggest things like taking objective measures of baseline brain or cognitive function prior to participation as well as doing testing at regular intervals, not just after a competition but on an ongoing basis. There is evolving science in diagnostic imaging that is still at, really, a research stage at this point, or an early clinical stage, that may shed some light on injury.

Part of the challenge with brain injury is that things like a CT scan provide you structural information but not necessarily functional information on how the brain is functioning. Some of the newer MRI technologies and quantitative electroencephalogram technologies will provide an objective measure of function as will applying these on a regular basis over time.

Part of the challenge with athletes in these competitions is that there is no way to truly, objectively, judge injury and whether they're at ongoing risk or severe risk. We have to find objective ways to measure and apply these standards rigorously and perhaps even limit the duration of competition. Muhammad Ali had a large number of fights in his career. Perhaps a top limit should be applied. These are things that are just opinion-based at this stage, but those are all ways that we could consider reducing the rates of injury.

[Alain Giguère, NDP, Marc-Aurèle-Fortin, QC]

Olympic boxers wear helmets. The Canadian Medical Association said that helmets could probably prevent many head injuries.

Do you agree with that?

[Dr. Samuel Jeffrey Gutman]

It's difficult to say. Again, there is no evidence on this. Some of the impact certainly would be absorbed by the helmet, but I wouldn't go so far as to say that a helmet would be protective to any significant degree. Helmets are used in amateur boxing, but there are also a number of other different rules, so the rates of concussions and head injury in amateur boxing are much lower. It's hard to say whether helmets alone would have a significant effect. They probably would be helpful, but it's difficult to say.

[The Chair, Conservative, Mike Wallace]

Thank you very much.

Our final questioner on my list is Mr. Armstrong from the Conservative Party.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Thank you, Mr. Chair. I want to thank our guests for being here today.

I'm going to start with Dr. Gutman.

Having heard the testimony of both our witnesses today and having more experience in the sport of MMA, do you feel there's an adequate understanding of your sport by the other witness?

[Dr. Samuel Jeffrey Gutman]

I would suspect that the other witness does not have the same depth of understanding, not having been at the event and not having participated.

Just reflecting on the comments, I would agree that if you turn the channel and look at it, it looks quite brutal. There is much more to the sport than that, so I would tend to agree with your comment.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

When we look at the sport on TV, it's a more professional level of that sport, like a professional NHL game or NFL game. But there are literally thousands and thousands of participants throughout the country who participate at an amateur level, more for health and fitness.

Am I accurate in saying that? Because I don't know a lot about the sport myself.

[Dr. Samuel Jeffrey Gutman]

Yes, I believe that's accurate. It's not the mandate of this committee, but I'm personally more concerned about the amateur ranks than the professional.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

If the sport becomes more regulated—and that's what we're talking about here today, that it's going to be a more regulated sport—would that not give authorities the ability to pass measures to make it safer and more protected at all levels, not only at the professional level?

[Dr. Samuel Jeffrey Gutman]

Absolutely. That's my goal.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Looking at other sports, football and baseball and hockey, we've seen a lot of changes in the rules and the equipment of those sports to make them safer, as a rule. Is that accurate, from your knowledge of all sports?

[Dr. Samuel Jeffrey Gutman]

Absolutely.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

In the end, don't you think having it sanctioned and having authorities able to control it more is going to protect people and make it safer?

[Dr. Samuel Jeffrey Gutman]

I believe so, yes.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Okay.

I'm going to turn to the CMA now. I know the CMA has been active in supporting this in other sports. I'm not being critical of the CMA, by the way. Don't you feel, though, that if it's sanctioned, if authorities have control over it, if the CMA and other medical authorities have brain research and ongoing research on concussions in several sports, we could see it be sanctioned in a way that would make it more protected and safer?

[Dr. Anna Reid]

There may be some benefit to sanctioned versus unsanctioned. I'm not sure if that's true but it may well be so. But still, the basic premise of intentionally striking people's heads is something that the CMA is opposed to and that many physicians are opposed to. This still continues to be the problem that we're grappling with, sanctioned or unsanctioned.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

When I was younger, I played football. As a defensive player in football—it's a collision sport, as was mentioned before—you try to lay a hit down on the other player and knock him down with great force in a lot of circumstances. I think there is a risk for spinal cord injuries. I know that when I played, it was always at the back of your mind. You were taught how to execute these hits and execute the skill level in this so that you would avoid spinal cord injuries.

But all sports, even non-collision sports, even in things like golf.... In golf, there are golf balls flying around in the air. You take steps to try to protect yourself. But isn't it the fact that all sports inherently do have some danger in them, and isn't it the fact that mixed martial arts is, I guess, a combat sport. Is that really what the CMA is against or is it really out to try to make all sports safer?

[Dr. Anna Reid]

Well, we're certainly interested in all sports being safer, and we've done a lot of work in terms of health promotion and injury prevention through time. But again, it's different from football. When you do a hit to someone else in football, the goal is to get that person out of the way so the ball can move down the field. I really don't see what the goal is to hitting someone's head, other than causing an injury to the head so that they can't stand up and keep fighting. This is the thing that we find difficult.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Just so I'm clear in understanding this, where the CMA is really drawing the line is not really the amount of injuries in the sport, it's actually that the intent of the sport is combative. That's where you're drawing the line.

[Dr. Anna Reid]

Yes. Our concern is very much regarding potential head injuries.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Which are caused from strikes directly to the head—

[Dr. Anna Reid]

Caused from intentional strikes for the reason to incapacitate so the fight can't go on....

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Thank you.

Thank you, Mr. Chair.

[The Chair, Conservative, Mike Wallace]

Thank you, Mr. Armstrong.

We have no further speakers, so I will just wrap up by saying thank you to both of our witnesses for coming today.

Regardless of the tough questions, you did a very good job under pressure today. I'd be happy to be...well, I don't want to be in your emergency room, but if you were looking after me I would feel confident. We want to thank all the physicians in this country for the work they do. Everyone who is part of the Canadian Medical Association does great work for Canadians, and we are thankful for that.

[Some hon. members]

Hear, hear!