Thank you very much.

Good afternoon. I'm very pleased to have this opportunity today to appear before the committee.

Before proceeding, I'd like to remind the committee that I'm not a lawyer and I'm not an expert on mixed martial arts fighting. My expertise is not within the Criminal Code, nor in the particulars of sanctioned versus non-sanctioned fights. My expertise lies in the clinical aspects of emergency and family medicine.

As an emergency physician in Yellowknife, I often treat patients who have received severe head injuries as a result of risky behaviour or of not wearing helmets. I feel very frustrated because these are completely avoidable situations. As a family physician, I see the longer-term impacts of these injuries—lives that are forever changed and more difficult.

I also see patients with injuries that are much more subtle yet almost as devastating. Soft tissue brain injury cannot always be detected on a first visit but can lead to such problems as memory loss, depression, cognitive defects, job loss, and family breakdown. In all of these cases, I worry about my patients' futures.

I'm also here today representing the more than 78,000 Canadian physicians who belong to the Canadian Medical Association. Let me note that CMA policy is based on the decisions made by physician delegates to our annual general council, which this year will take place in Calgary. At our general council in 2010, a decisive 84% of delegates voted in favour of a motion calling for the CMA to advocate for a ban on mixed martial arts, also known as cage fighting. This is consistent with CMA policy set back in 1986 that called for a ban on boxing.

The reasons are not difficult to understand. One of the primary responsibilities of a physician is to promote good health. To this end, we are strongly in favour of physical activity, including martial arts such as judo and karate. However, cage fighting, like boxing, is distinct from many other sports in that the basic intent of the fighter is to cause harm in order to incapacitate his or her opponent. An activity in which the overriding goal is to pummel one's opponent into submission does not promote good health.

MMA fighting as it is currently practised consists largely of punches to the head, which we know lead to injuries to the head, which in turn can lead to brain injury. A study carried out in 1998 at Kingston General Hospital found that in almost 30% of cases of blunt head injury from a variety of causes, the patient showed signs consistent with brain injury.

There are long-term outcomes associated with brain injuries. Up to 40% of patients with mild traumatic brain injuries remain impaired for at least one year, and all individuals who survive these injuries require clinical assessment and follow-up.

I acknowledge that there's a lack of evidence on the nature and rate of severe brain injuries resulting from mixed martial arts fighting, as well as an absence of longitudinal studies on the long-term health implications of this type of combat. However, an extensive review in 2010 in the German medical journal Deutsches Ärzteblatt of the health implications of boxing found that it poses a high risk of acute injuries to the heart, bones, and head.

It also found that 10% to 20% of professional boxers suffer from persistent neuropsychiatric complications. In boxers with longer careers, the consequences of repetitive brain trauma can include Parkinson's disease, tremor, memory disorders, depression, aggression, addiction, and a boxer's dementia with neurobiological similarities to Alzheimer's disease.

The studies that do exist on mixed martial arts fighting indicate that for every 100 participations in a fight, there are anywhere from 23 to 28 injuries, including, but not limited to, many types of head injury. They include ocular injuries, such as ruptures of the eye socket or of the eye itself; facial injuries, including fractures; ruptures of the eardrum; concussions; and spinal injuries. We also know that deaths linked to mixed martial arts have occurred. A mixed martial arts fighter making his professional debut in South Carolina last summer died from brain hemorrhaging after receiving repeated blows to the head during the fight.

Following an event in June 2010 in Vancouver, a number of professional fighters had to be taken to emergency care at Vancouver General Hospital for cuts, fractured limbs, and severe facial injuries. Just two weeks ago, an Ontario man died shortly after losing an unsanctioned cage fight in Michigan.

The argument goes that unsanctioned fights are different. Is the key to winning any different? Are the injuries that are inflicted any different? These are questions I leave to you to answer.

Of course, cage fighting is not just a physical activity taken up by people as a pastime and a route to fitness. It is also a commercial enterprise. For parliamentarians and for society, the question of whether to legalize mixed martial arts under the Criminal Code comes down to a choice between money and health.

Again, I am not a lawyer. It is my duty to protect the health of patients and to promote non-harmful activities, and it is a mandate of the Canadian Medical Association to advocate for the highest standards of health and health care. For me, as a physician, it is about putting health first. I cannot condone punches to the head. I have too often seen the debilitating effects of head injuries on individuals and have been saddened to see the limitations imposed on their lives and on the lives of their families in the aftermath, limitations that in many cases will last a lifetime.

We therefore urge committee members and all members of Parliament to think long and hard before deciding whether it would be prudent to vote in favour of legalizing prize fights under Canada's Criminal Code.

Thank you very much.

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