Lure of cash and fame leaves sport caught in concussion’s moral maze | Sean Ingle

There’s a story Larry Holmes tells about the night he fought Muhammad Ali for the world title, 37 years ago today, that gives an insight into the epic self-delusion of the greatest heavyweight champion of all.

From the first bell Holmes grasped that Ali wasn’t the same man he had sparred with for years. That he was weak and “slower than Heinz ketchup”. Yet Ali’s “damn pride” meant that he would not quit. It took 10 rounds before Ali’s trainer, Angelo Dundee, pulled him out. Before then Holmes had started praying that he wouldn’t damage his friend permanently.

But even after enduring a 10-round beating that Sylvester Stallone described as “like watching an autopsy on a man who’s still alive”, Ali remained defiant. When Holmes visited him afterwards in his Las Vegas hotel, Ali told him: “The thing I can’t figure out is why I fought so bad. Something was wrong with me. Either I was too old or I was too light.” Taking thyroid medication to lose weight hadn’t helped, but Ali knew why his reactions had faded. His doctor, Ferdie Pacheco, had warned him “every goddam day” from the mid-1970s that it was brain damage.

Holmes urged Ali to retire but he refused to confront the truth. Instead he went quiet, and then “cupped his hands around his mouth, and began to make a crowd noise. ‘I … want … Holmes … I … want … Holmes.’” “Ali wouldn’t stop,” Holmes wrote in his autobiography. “I started to get embarrassed and felt like it was a good time to leave.”

I thought of that story last week when the Republic of Ireland striker Kevin Doyle announced his retirement, at 34, because he was worried about brain damage after suffering multiple concussions. Unlike Ali, he had known when to leave the stage.

Doyle’s decision came amid a blizzard of research suggesting chronic traumatic encephalopathy (CTE), the neurodegenerative disease found in people who have had multiple head injuries, could soon be diagnosed in living people.

On Tuesday, Boston University Medical School announced the discovery of a new biomarker – CCL11 – in the brains of deceased NFL players which they hope will be a significant breakthrough. Another neurologist, Sam Gandy, is optimistic that a different method to identify malfunction of a protein called tau in the brain will be a gamechanger.

There was also a fascinating new study on Ali himself, which shows that the deterioration in his speech began in his early 30s, a decade before he was diagnosed with Parkinson’s disease. Researchers at Arizona State University found that in 1968, Ali spoke at a rate of 4.1 syllables per second, about normal. But while most people see little decline in their speaking rate between 25 and 40, Ali’s plummeted 26 per cent – and the decline was always worse after he fought.

Visar Berisha, one of the study’s authors, told me that speech analysis is now able to provide early clues about neurological decline in a range of conditions, including Parkinson’s and Huntington’s. Eventually he hopes CTE will join that list.

However, most scientists agree that there will not be a single magical solution. Rather, at some point – perhaps within five years – a comprehensive panel that includes scans, blood, saliva and spinal-fluid samples, speech tests and concussion history will allow doctors to make a reasoned diagnosis.

That day will be both momentous and welcome. But the prominent sports scientist Ross Tucker remains cautious. “People think of it in really simple black and white terms – you can go in for a scan, you have damage, you stop playing,” he explains. “But let’s say if there is a battery of 10 tests with scans and biomarkers and you’re a 26-year-old rugby, soccer, or NFL player and you have five out of 10 ‘positive signs’, do you retire?

“If there is a near 100% certainty that playing on will lead to dementia the decision is easy,” he adds. But what if it’s 30%?” Then it becomes a probabilistic wager – and we all know how bad most professional sportsmen are at gambling.

There is also a possibility of legal challenges if the test is not watertight, and you can also imagine club lawyers demanding tests for CTE for liability purposes before some careers even start.

Tucker, who works for World Rugby, also points out that far more work will be needed to assess the likelihood of someone in every collision sport developing brain damage – and to understand how the condition develops over time. That might involve tracking hundreds of players aged over 30 to see how all aspects of brain function and physiology change.

It all adds up to a moral, medical and ethical maze – which increasingly applies to those of us who watch too. How long will the cognitive dissonance between the thrill of a big hit, or even of a centre-forward heading a winner, and the potential consequences to their brains last? On Sunday I went to Wembley to watch the NFL. Would anyone be shocked if in 50 years some sports no longer survive?

Ultimately, while we will soon have a better understanding of the risks of collision sports, the choice facing players will not be so different to those that confronted Ali and Doyle. Don’t be surprised if a large number find that thirst for fast money, fame and the thrill of the game is hard to quench.