Outside the Ring: Dr. Nitin Sethi

By Jill Diamond on August 15, 2015
Outside the Ring: Dr. Nitin Sethi
"The boxers are the shining stars. I admire and respect their dedication and passion."

“Some of my colleagues may not support my work as a ringside physician. I, though, have a different opinion…”

Sports and Philanthropy: A series of articles dedicated to those who’ve given their all and still give more. Each article will feature a different community champion; no belts, no medals, no ratings… just good people passing it on.

I’ve always found it intriguing that a doctor, a person sworn to protect the human body, would officiate in an arena where people are sworn to destroy the human body. What’s the genesis behind this? Well, we are people first, not just professionals, and our love for things don’t always stem from, or preclude our work. Still, in the case of a physician, combat sports must present a particular conflict; an obstacle they must overcome in order to take pride in what they do. Especially in states like New York and California, where a doctor can actually stop a fight. The responsibility that comes with that choice can be foreboding. The cheers and boos from people standing on one side of the decision or another can be disheartening. Nothing you learn in medical school could possibly prepare you for this.

So into the equation comes Dr. Nitin Sethi, a familiar and popular presence at the fights. In his bow tie, casual suit, and always smile, he spends one entire day at the weigh-ins doing medical evaluations on the boxers, and the next sitting at ringside. He’s often the first to arrive at the venue and the last to leave. He takes his position as a ringside physician very, very seriously. As a skilled neurologist, he makes less for a fight than for an office visit. Yet, he spends hours, scrutinizing boxers for any signs of physical impairment before releasing them after a bout. And when he’s not at a fight, or the hospital, he can be found at Mendez Boxing Gym, punching the bag, throwing a jab, and sometimes, like in the case of one gym owner, giving sage advice that saves a life.

His reputation among the community is golden. He has personally been responsible for helping many people get proper care when they’ve been abandoned by the system. So what makes a man like this dedicate so much of his life to a sport which seemingly contradicts Hippocrates’ intent? Why does he love the sport so much he’d risk reputation and criticism from his peers? Let’s find out.

Nitin K. Sethi, MD, MBBS, FAAN
Assistant Professor of Neurology
New York-Presbyterian Hospital
Weill Cornell Medical Center

Tell me a little about your transition from India to USA?

I was born in Buffalo, New York. My parents who are both doctors came from India in the ‘70s to do their respective residencies, my father in neurology and my mother in pediatrics. A month after I was born, they moved back to India. I was raised in India and since my father was a neurologist in the Indian Army we lived all over India. My schooling, medical school and later residency in Internal Medicine were all in New Delhi. I came to New York City in 2003 and joined St. Vincent’s Medical Center where I did my residency in Neurology. I further did a two-year fellowship in Clinical Neurophysiology from New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.

Your medical affiliations?

I am currently Assistant Professor of Neurology at New York-Presbyterian Hospital, Weill Cornell Medical Center. I am a Diplomate of National Board (DNB) Internal Medicine (India). I am board certified in Neurology from the American Board of Psychiatry and Neurology (ABPN) and a Diplomate of American Board of Clinical Neurophysiology (ABCN) with added competency in Central Clinical Neurophysiology, Epilepsy Monitoring, Intraoperative Monitoring. I am also a Diplomate of American Board of Psychiatry and Neurology (ABPN) with added competency in Epilepsy and Sleep Medicine. With respect to boxing I am American College of Sports Medicine (ACSM)/Association of Ringside Physicians (ARP) Certified Ringside Physician

You come from a family of doctors, what brought you to Boxing?

Growing up in India, I never was exposed to boxing. Squash and soccer were my two passions in school. I came to NYC in 2003 and joined neurology residency in St. Vincent’s Medical Center. I was new to the city, had few friends and no family here. After a long day at the hospital, I would go and sit in Union Square and read. I joined a gym called 24/7 which was on 14th Street. One day I was peeking into a boxing class. The trainer (Tyrone Efferson) saw me and asked me my name. I said my name was Sethi (I had realized by then that in America people found it hard to pronounce my first name Nitin). He said “Sethi, do you want to box?” I said yes and that was when boxing found me. I started training with Tyrone. I have vivid memories of my first few months of boxing training. I was so stiff that for the first few months, Tyrone did not allow me to hit the bag. He made me do the two-step with a girl in our class called Gina. Tyrone still recalls my utter inability to jump rope at that time. Over time I got my stance right, then came the jab, the cross and the hook. A few years later Tyrone introduced me to Mendez Boxing gym. At Mendez I met Ray Velez and he became my trainer. I have stayed at Mendez Boxing gym since then. Over the years Francisco Mendez (owner of the gym) has become a dear friend and the gym and the boxers who work out there my extended family here in NYC. 

As a neurologist, I was always interested in traumatic brain injuries and concussions. In 2012 (on the encouragement of my friend Boyd Melson, a professional boxer, who is like a brother to me), I applied to the New York State Athletic Commission (NYSAC) to be a ringside physician. After review, my application was approved and I became a ringside physician. I am very happy since I have been able to bridge my two loves of boxing and neurology.

You’ve written about a doctor’s relationship with boxing. Is it a conflict?

A lot has been written about ethical issues in boxing. Some view it as the “Sweet Science,” others as a barbaric sport that should be banned. The American Medical Association in 2007 recommended that until boxing is banned, head blows should be prohibited. The American Academy of Pediatrics (1997) opposes boxing as a sport for any child, adolescent, or young adult. The Australian Medical Association (2007) opposes all forms of boxing and recommends the prohibition of all forms of boxing for people younger than 18 years of age. The British Medical Association (2007) opposes amateur and professional boxing; calls for complete ban on boxing; recommends banning boxing for those younger than 16 years of age. The Canadian Medical Association (2002) recommended that all boxing be banned in Canada. So there does exist a moral and ethical conflict when it comes to medicine and boxing. Our medical associations do not support boxing and some of my colleagues may not support my work as a ringside physician. I, though, have a different opinion. I feel that as a doctor and a neurologist, I can help make boxing safe. A boxing match conducted under close medical supervision with preferably a neurologist at the ringside helps in timely identification of concussions and removal of the injured boxer from the ring. While we may not be able to prevent all injuries and some long-term neurological consequences of boxing such as chronic traumatic encephalopathy, we can at least ensure that we prevent irreversible devastating brain injury in some fighters.

Would you want your children to participate in a contact sport like boxing?

While I am passionate about boxing, I do realize that it is a contact sport where every punch is thrown with the idea of knocking your opponent out. Concussions occur frequently in boxing and there is risk of irreversible brain damage and long-term consequences such as chronic traumatic encephalopathy sometimes referred to as “dementia pugilistica.” I shall certainly expose my children to the sport of boxing but like any other parent, I shall make them aware of the risks involved. If they like boxing and want to continue, I shall find them a good trainer who closely supervises them.

Benefits of youth and boxing. Any?

That boxing is a great form of exercise is of little doubt. I can also speak from personal experience that boxing imparts discipline and structure to one’s life. Many inner-city and at-risk youths coming from broken homes, family violence or a life of crime and drugs find mentors when they join a boxing gym. For many of them their boxing coach becomes more than a coach, he becomes a father figure to them. To these youths boxing provides discipline, an outlet to relieve stress, commitment, teaches them about respect and more importantly gives them a self-identity.

MMA vs. Boxing, from an angle of skill and safety?

I have never worked as a doctor for a MMA fight and while I do watch MMA fights on the television, boxing remains my first love. From an angle of skill, in my opinion MMA and boxing are two very different sports and so comparing them is futile. There are athletes who have crossed over from boxing to MMA and vice-versa but they are a minority and not the rule. When it comes to safety, again MMA and boxing are two different sports. Likely the doctors who cover MMA fights see more and different orthopedic injuries than the ones who cover boxing.

Is there special training for ringside physicians?

Ringside physicians come from different specialty backgrounds. For example I am a neurologist but my colleagues may come from orthopedic, Internal Medicine or emergency medicine backgrounds. To be a ringside physician I applied to the New York State Athletic Commission. My application was reviewed and I was appointed as a panel physician. I then participated in a training program and worked alongside established ringside physicians as a trainee. I watched how the physicals were done at the time of weigh-in, the various forms which need to be filled out, the blood results and MRI scans which need to be reviewed before clearing a boxer to fight the next day. I spent time at the fights working alongside the established ringside physicians learning about boxer safety, the injuries commonly encountered and how they are managed. I was taught about the safety protocols in place, when and how to stop a fight (in New York State either the referee or the ringside physician can stop a fight) and how to evacuate an injured boxer from the ring to the locker room or to the nearest hospital. As ringside physicians we have regular continuing medical education (CMEs) and conferences. This helps to keep our knowledge up to date. The Association of Ringside Physicians (ARP) in conjunction with the American College of Sports Medicine has established a ringside physician certification program. Upon clearing this examination, one is certified as a ringside physician.

Do you think that the referees should be required to have some medical training?

I have a lot of respect for the referees. Most of them have fought themselves either as amateurs or as professionals. They have a trained eye and as they are in the midst of the action, they can see when a boxer is hurt or is not defending himself. While in New York State either the referee or the ringside physician can stop the fight, in some states only the referee has this authority. In my opinion while it should not be mandatory for referees to have medical training, all referees should be educated in recognizing concussions in the ring, especially of the more subtle grades 1 and 2 when the boxer is ‘out on his feet,’ unable to defend himself, looks dazed, staggers around the ring or rests on the rope but does not experience loss of consciousness, is confused, does not remember the round or walks to the wrong corner after the bell. After a boxer gets up from a knockout, instead of making the boxer walk straight to him, the referee should ask him to take a few steps forward and then a step to the side to better assess his balance. Ideally, a fight should be stopped by the referee after consulting with the ringside physician, after taking into account not just the most recent round but the previous rounds too, as well as the boxer’s and his corner’s body language. Good and constant communication between referee and ringside physician is the key. They should talk between the rounds and share their assessment of the boxer with each other, supplementing each other’s knowledge of medicine and boxing. The boxer’s safety should always precede all other considerations.

How does it feel to be accused of an early stoppage?

Everyone (the boxer, his corner, the audience, the media in attendance, the Commission and the ringside physicians) wants the fight to go on. But none of us want the fight to go on at the expense of a boxer’s health and safety. When we as ringside physicians stop a fight, sometimes we are booed by the audience and the boxer and his corner may express their displeasure at our decision. People are disappointed when a bad stoppage is made and appreciate a good stoppage. A boxer’s health and safety comes first and the decision to stop a fight is made with that in consideration. When passions have subsided, everyone understands and respects that.

What signs do you look for when you stop a fight?

During the fight, there is a ringside physician assigned to each corner and one who is in the back (locker room). We keep a close watch on the boxers especially if one of them is taking heavy blows to the head or body. In-between the rounds we might step up on the ring canvas and take a look at such a boxer. We try to do this without disrupting or intruding on the time which the corner has with its boxer. The idea is to look at the boxer—are his eyes focused? How is he interacting with his corner? Is he responding to questions appropriately? How steady was he on his feet as he walked back to his corner?

During a round if the boxer is clearly “hurt,” taking heavy blows, unable to defend himself, legs are wobbly or not wanting to continue, the referee usually picks that up and may stop the fight by himself or after discussing with the ringside physician.

What can a fighter do to protect themselves?

That is a tough question to answer as boxing is a contact sport and punches are thrown with the idea of knocking your opponent out. Some boxers have great defense and are rarely if ever “hurt.” Others are sluggers and can give and take punishment. Boxers rarely quit and many continue to fight even when they are hurt or have suffered a concussion. Boxers need to be educated about the signs and symptoms of concussion and traumatic brain injury. A boxer who during a fight experiences headache, has sudden change in vision, double vision, experiences problems with balance should bring it to the attention of the ringside physicians. Signs of traumatic brain injury are sometimes subtle and may not be picked up by the ringside physicians or the corner.

Fighters should know when to stop and seek medical attention. That is how they can protect themselves. 

What signs should they look for after the fight, or workout, that would signal a problem?

Traumatic brain injury at times may manifest a few hours after a fight so I recommend that after a fight a boxer be closely watched by his family or corner staff for at least 24 hours. This is especially important if the boxer sustained heavy blows to the head during the fight.  If the boxer develops headache, blurred vision, double vision, change in behavior, decreased alertness or responsiveness, problems with balance and gait, nausea or vomiting he should be immediately taken to the nearest hospital for evaluation.

Do you think gyms should be required to report injuries during sparring?

Reporting injuries sustained while sparring in boxing gyms while laudable is likely neither practical nor feasible. It shall also be very tough to enforce this. What is more practical is that we educate boxers in these gyms about concussion, its signs and symptoms. I love boxing and as a neurologist I also feel strongly that boxing can be made safer. Education is the key.

What about PEDs? How do they affect performance?

The use of performance-enhancing drugs in sports is a debate that evokes strong emotions. Boxing is no different and has had its share of controversies. VADA (Voluntary Anti-Doping Association) and USADA (United States Anti-Doping Agency) check boxers for PEDs. Boxers should check with their physician. The onus is on the boxers not to take anything classified as PED on the USADA or VADA list.

Three-minute rounds for women? Fifteen rounds for men?

I think that is something to be decided by the individual Boxing Commissions and organizations such as World Boxing Council (WBC), International Boxing Federation( IBF), World Boxing Association (WBA), and World Boxing Organization (WBO) which sanction world championship boxing bouts.

What awards/honors do you have?

I have received resident and fellow scholarships awards from the American Academy of Neurology and American Epilepsy Society. I am Associate Editor of the Easter Journal of Medicine. I am also humbled by my patients who have made monetary donations to my hospital in my honor.

What charitable organizations are you involved in?

I am the Director and Chief Coordinator of the Brain Care Foundation of India. The website can be assessed at www.braincarefoundation.com. I started this organization with my father Dr. P.K Sethi who is also a neurologist. He is not just my father, he is my best friend and someone who I respect as a neurologist. The focus of the brain care foundation is on prevention by creating community awareness about the diseases which inflict the brain and also on management and rendering effective treatment of neurological diseases I also run a blog which can be found at www.braindiseases.wordpress.com and a website www.braindiseases.info. The blog and website have information related to common neurological diseases.

A story to share?

I have had many interesting experiences as a ringside physician. I have seen concussions, deep lacerations, shoulder dislocations, eye and dental injuries. It has been a fascinating journey thus far.

A fight you’d like to sit ringside at?

If I could go back in time it would be Johnson vs. Jeffries. I have read accounts of that fight and the atmosphere was electric. It was a turning point in the history of American boxing.

A fight you wish you hadn’t?

When I am working a fight, I am acutely aware of the responsibility that rests on me and that is to ensure the health and safety of the boxers. I take this responsibility very seriously. I would not like to be at a fight where a boxer suffers grievous injury on my watch.

What are your thoughts about matchmaking?

Again a topic which is controversial in boxing. Without getting into the debate of matchmaking vs. match fixing, all I would say is from a purely medical perspective it is best if the two boxers are closely matched in their skills, the number of fights fought, wins and losses.

Certainly it’s not the pay, so why do you give up two days as a ringside?

Ringside physicians are paid a very nominal amount and it is certainly not for the money that we do this. Most of us are passionate about the sport and feel strongly that our presence ringside helps protect the boxers.

Someone you admire?

I admire the boxers first and foremost. At Mendez gym, I see the amount of hard work, blood, sweat and commitment which goes into training for a fight. The boxers are the shining stars of boxing. I admire and respect their dedication and passion.

What can we do to make the sport safer and still maintain its flavor?

I think the future of boxing is bright and in safe hands. It is a sport which has a large fan base and hopefully in the years to come this shall only grow. I consider myself privileged and honored to be a part of this great sport entrusted to take care of its shining stars.

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Outside the Ring: Dr. Nitin Sethi

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  1. Irish Frankie Crawford Beat Saijo aka Gimpel 08:01am, 08/16/2015

    Another great one in this series. He seems like a great guy and the fighters are truly blessed when he is at ringside. Which reminds me….when guys start a zero in the gym and really apply themselves and stick with it as he obviously did they invariably end up very strong in the fundamentals as so many of the female fighters do. Ahhhh….“match fixing” is it?.The mother’s milk of professional boxing to be sure.

  2. KB 06:14am, 08/16/2015

    Good post, Mike.

  3. Mike Silver 07:37pm, 08/15/2015

    It used to be that every ringside physician in NY state would enter the ring and face the fighter to get a better view if he thought an evaluation was necessary in between rounds. I haven’t seen that in NYS in years. In years past it was not considered good ringside medicine to just “step up on the canvas” and try to gain a peek over the shoulders of seconds who are trying to obscure the view of the doctor. Better practice would be for the physician to step into the ring and tell the cornermen to step aside in order gain a better look and ask the boxer some pertinent questions. I am glad Dr. Sethi is a ringside physician. We need more like him. His heart is in the right place, but when appropriate his place should be in the ring and not on the apron. Hopefully he will correct this inadequate response in practice today.

  4. Ted Sares 01:45pm, 08/15/2015

    This is truly valuable info for the serious boxing fan who worries that not enough is being done. A remarkable job on second read and I have forwarded it to all the boxing medical people I know.

  5. KB 10:02am, 08/15/2015

    wow. that’s a lot of hard and solid work. Thanks Jill

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