Justice Committee on April 15th, 2013

[Dr. Samuel Jeffrey Gutman]

Thank you.

I think your characterization is accurate that this is an outdated clause or section of the code and that this is merely an issue of updating it to reflect the reality of today. I would also point out that it has been reiterated several times that, to be clear, there are other ways to win a mixed martial arts contest in addition to striking. Similar to things like judo and others, striking is a part of the sport. It is not the only way, and incapacitation by knockout is not the only way to win the contest.

Lastly, if I could take the opportunity to point this out, it hasn't been mentioned what definition we're using in terms of huge health outcomes. I'm an emergency physician and have been in practice for 25 years. I have seen a handful of concussions caused by mixed martial arts. I've seen many, many caused by snowboarding, by skiing, and by many other sports. So in proportion to participation, this is a very small blip on the horizon, on the radar, relative to other sports.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

I appreciate hearing that testimony.

I'm going to be switching back to the CMA for a moment, Mr. Chair.

I had the opportunity to teach martial arts professionally for 15 years and certainly I am alarmed when I hear that someone equates mixed martial arts or other disciplines to barroom brawling. To me that is an indication that my former field needs to do a lot more work to present its many health benefits. Furthermore, Dr. Reid, when you say that someone is just there, regardless of discipline....

By the way, Mr. Goguen is correct. There is full contact karate. Certain systems teach full contact karate and concussions do sometimes happen. However, to say that a player or an athlete is there simply to harm another human being, that takes away from all the tenets of traditional martial arts: respect, discipline, focus. Again, this is an athletic endeavour and that kind of equation is disrespectful, given the many things that structured sport does.

Yes, hockey, football, mixed martial arts, these sports have to improve. I simply point out that banning an activity can create an underground economy where there is very little sanctioning and oversight, and where children and young people could get into it and be harmed. I think that would be disappointing.

I also find it disappointing that we are not pointing out the specifics as to how mixed martial arts, as a discipline and an athletic endeavour, could improve its outcomes, whether that be through better sanctioning, whether that be through, as Mr. Wright said, more international standards to make it truly an Olympic or amateur sport, or through ensuring that the instructors who are currently teaching our young people are teaching in a way that emphasizes health and safety throughout.

In most martial arts schools, particularly with submission wrestling or judo, one of the first things they teach you is how to bow. The second thing they teach you, Mr. Chair, is how to tap, so that you're training in a safe environment. The importance of that is stressed. While I totally respect where the Canadian Medical Association is coming from, for you to advocate a ban without any data and put more people at risk, rather than make suggestions that can be implemented—

[The Chair, Conservative, Mike Wallace]

Do they teach you how to cut someone off? Because I have to do that right now.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

Obviously the martial arts disciplines have a little more engagement to do. I ask the CMA to come to the table and to give us things we can work on because it's about improving human beings, not harming them.

[The Chair, Conservative, Mike Wallace]

Are you asking for any response from them or are you just making a comment?

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

Mr. Chair, I would like to hear their response.

[The Chair, Conservative, Mike Wallace]

Okay, we'll give Dr. Reid a chance to respond to that, if she would like.

[Dr. Anna Reid]

Thank you very much for that. We're happy to work, at any time, in terms of improving health outcomes for patients. If there's a conversation that has been started, we'd be happy to engage in that for sure.

Perhaps I misunderstand mixed martial arts, but I must say, the times I've seen it on television, parts of it seemed like a barroom brawl to me. Perhaps I've watched the wrong segments of it.

We're certainly interested in anything we can do to improve the health of our patients but we still find that this sport is very troubling as it is.

[The Chair, Conservative, Mike Wallace]

From the New Democratic Party, Mr. Allen.

[Malcolm Allen, NDP, Welland, ON]

Thank you, Chair. Thank you, witnesses.

I think, Dr. Reid and your colleague in Vancouver, the difficult part here quite frankly is that we have two expert medical opinions about a legal question. As Dr. Reid said, she's not a lawyer. Neither am I, by the way.

[Françoise Boivin, NDP, Gatineau, QC]

We like you anyway.

[Malcolm Allen, NDP, Welland, ON]

I won't suggest anything about lawyers. It would be unbecoming of me as a guest of the justice committee to suggest something, Mr. Chair.

I, like my friend, Madame Boivin, am not surprised about the CMA's position. Clearly sport, especially a contact sport—and I'll use contact sport in a general term.... Mixed martial arts is a contact sport. In fact basketball is a contact sport. In fact Wilt Chamberlain said that basketball is a contact sport, but football is a collision sport. So it is a question of large folks quite often up against each other in one form or another, the difference being that there are certain rules.

Obviously there are certain rules in mixed martial arts, and I can appreciate what my friend, Mr. Albas, was saying earlier, because clearly I'm not someone who has participated in those things, albeit I headed a soccer ball for a long time and maybe that's what caused me to come into this field. I don't know. Then again I'm a Scotsman, so maybe that's the case.

I'm not surprised by what you have said. Actually it's hard to disagree that striking someone will cause an injury. I think we all know that. I think if Mr. Albas were to come over here and strike me on the side of the head—of course he would never do that—it could be hurtful and could do who-knows-what kind of damage. I think we all get that. The issue becomes what we do in a legal process. I think you said earlier you're not really prepared as a physician—a very qualified and eminently qualified physician, I may add—to try to do this.

Let me turn to your colleague in Vancouver, who talked about how we need to do harm reduction, because I actually know a fair amount about harm reduction. I come from a family whose careers are in Canadian mental health and who talk about harm reduction, especially with schizophrenics and bipolar folks who also are dually diagnosed with addiction issues.

So sir, I look to you to give us some suggestions given what you see, since you're looking at it at an upper level, if you will. These are prize fights, and quite often you might be a ring physician.

One of the things that strikes me about it—no pun intended—when I watch—and I only see things on television—is that the difference between boxing and cage fighting.... I don't want to use mixed martial arts in this sense, because it gives the wrong connotation sometimes, even though they use that. I think Mr. Albas is correct. Mixed martial arts as was taught by him and by his colleagues in the field may look a lot different from that. The difference is that in boxing if you knock the opponent down, you can't hit them again. But if you knock your opponent down in that particular cage, you can hit them again. The referee is supposed to step in and do all those sorts of things, but how many times have you seen someone, whose eyes are literally starting to roll back in their head, still receive two or three blows while they are on the ground? I don't mean on the way to the ground, because in boxing clearly you can hit an opponent on the way to the canvas.

What do you see as that harm reduction strategy you're suggesting that might actually be helpful for this committee to know about? Because I don't think we are going to get a legal opinion from either one of you, quite frankly, about the clause. I'm interested in what you have to say about that.

[Dr. Samuel Jeffrey Gutman]

Thank you.

With regard to just using the term “cage fighting”, I think that's a loaded term. Mixed martial arts occurs in a ring as well. The connotation of cage fighting brings with it something distasteful, perhaps, so I prefer the term mixed martial arts.

With regard to harm reduction, I divide it into pre, during, and post in terms of the medical assessments that occur, the referees, and sanctioning.

First and foremost, before the fight, before the competition, it's important to assess the weight classes to ensure that it is an equal competition of skill, not unmatched. In the professional ranks, matchmaking is a crucial portion of protecting the athletes. If a very highly skilled competitor goes against an amateur, the risk to the amateur, or a new amateur, is substantial. So matchmaking is important.

Physical assessments in terms of capability to compete at that level, cardiovascular fitness, vision testing, CT scanning, electroencephalograms, plus or minus cognitive testing using some of the validated concussion assessment tools—some of these things are currently in play and some of them should be in play. I would suggest that opening this debate up further to the medical community and engaging as opposed to banning would enable some of these pre-competition metrics to go into force.

During the competition, the safety of the athlete is wholly dependent on the skill, experience, and training of the referee. The referee is the one who will stop that second, third, fourth blow that you referred to. Yes, by rules, they can continue to strike until the opponent is unable to protect themselves, which is a judgment call by the referee. Therefore, higher-skill-level referees, more training, protect the athletes further.

After the competition, assessment by an experienced physician who has the capacity to make an assessment using a standardized scale and then apply a prohibition to competition for 30, 60, 90 days or more, subject to additional conditions such as assessment by neurologists and the like, occurs in the professional ranks, where there's appropriate sanctioning, versus underground.

I have one example here from the Lower Mainland. One competitor was in a professional fight in one location. The next night they competed in another location. That is completely unacceptable in any rank. However, there is no governing body. There is no ability to prohibit that in many of these competitions.

That's where people are getting harmed. That's where the second-impact syndrome, as it's referred to, causes extensive damage after a brain has been injured. That's what we're trying to avoid. By bringing this out of the shadows further, we can protect combatants more.

[The Chair, Conservative, Mike Wallace]

Thank you, Doctor.

Thank you, Mr. Allen. I gave you the exact same time as Mr. Albas, so there you go.

Mr. Wilks, you have the floor.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you, Mr. Chair.

I'll try to be quicker than my colleagues.

[The Chair, Conservative, Mike Wallace]

Yes, that would be nice.

[David Wilks, Conservative, Kootenay—Columbia, BC]

To the witnesses, thank you very much for coming today.

In my 20 years as a police officer, where I was involved in many a barroom brawl, historically there are chairs, tables, and glass bottles involved. Historically it's started by a blind-side hit. Historically it's not one-on-one. It's normally induced by a lot of alcohol and a lot of drugs.

Having said that, my question to both the witnesses is fairly succinct. I'm going to take the opposite side of it, just for that sake. Assuming this passes through this place, passes through the House of Commons, and passes through the Senate, my question to either of you is this. Certainly to the CMA there seems to be some concern with regard to the fighting. Assuming this goes through, what types of protections would you suggest could be implemented to make the sport safer?

[Dr. Anna Reid]

Assuming it does go through, I think the recommendations of my colleague here are all very pertinent. Clearly he's very concerned about doing the sport in the safest way possible. I think what he's recommended in terms of the pre-, during, and post-assessment would be very important. I think those are all good protections.

We continue, as I've stated many times here now, to be very uncomfortable with the sport, for the reasons I've already stated. But if it were to pass, certainly the CMA is in favour of harm reduction models. In fact, we've been involved in harm reduction for many other things—with respect to addictions and mental health issues, for example—so certainly, if it were to pass, the harm reduction model is one that we would support. However, we don't feel that it should be the first line of defence.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you.

To the other witness, if I may, a member of our caucus, the member for Yukon, has had five professional fights within MMA and has provided me with some information as well.

To the witness in Vancouver, correct me if I'm wrong, but post-fight through MMA and UFC, there is a certain amount of time when you're not allowed to fight, even if you want to fight. I wonder if you could expand upon some of the rules that are in effect already for safety precautions.

[Dr. Samuel Jeffrey Gutman]

Yes. Thank you.

Seven or eight years ago, I believe, the unified rules of mixed martial arts were adopted by most. That limited the types of striking that were allowed, which has reduced the incidence of serious injury. I apologize, in that there are no statistics available on what these rates are, but things like elbow strikes vertically to the head have been removed, as have other such dangerous acts. Rules are important.

You're correct when you say that in the professional ranks fighters are not allowed to compete. Jurisdictions are different. Part of the challenge is that there's a patchwork of different sanctioning bodies, unfortunately. The B.C. government is trying to unify it into a provincial commission, which would help, and to have a clearing house where athletes are not allowed to compete for a period of time. Those periods vary, but you're correct.

Additionally, it really falls on the ringside physician who applies a suspension to use some judgment on how long that suspension should be. In my own experience, there were no guidelines and no knowledge or information on how to apply those, so in my own practice I've aggregated information. When there are other physicians working with me, we provide information to them on what recommendations we suggest. In my opinion, those sanctions and prohibitions should be based on a higher level, on a commission level, be it provincially or beyond.

[The Chair, Conservative, Mike Wallace]

Thank you, Mr. Wilks.

Our next questioner, from the New Democratic Party, is Mr. Giguère.

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

Good afternoon. Thank you for being here to provide us with insight.

You're no doubt familiar with the boxer Muhammad Ali. He fought in matches that were well-supervised and he won. Unfortunately, however, the last time I saw a picture of him, he had serious health problems. Could you please comment on health problems like those, on the high incidence of those problems among people who take part in violent fighting and on the possibility of limiting the recurrence of those injuries?

Perhaps the Canadian Medical Association representative could start. Then I'd like to hear your response.

[Dr. Anna Reid]

Well, certainly I think everybody knows about Muhammad Ali and his Parkinson's disease, which is felt to be as a result of repeated blows to the head. We do know from the boxing studies that there are, as I mentioned, potential long-term effects from repeated blows to the head. This includes anything from memory loss to personality changes to movement disorders, which Parkinson's is part of, and Alzheimer-like symptoms, quite apart from the mental health issues that have been associated with severe head injuries, such as depression, behavioural changes, and those sorts of things.

We know some of that from the boxing literature. Again, as we've said, we don't have the studies for mixed martial arts at this time, but we feel that there may well be similar potential injuries.

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

How can we prevent those injuries?

[Dr. Anna Reid]

Well, I think probably the best way to avoid a serious head injury is to wear a helmet, although there's not a whole bunch of literature on whether helmets are completely protective for concussions.