In March 2026, the issue of fighter safety was once again raised when the inquest into Ricky Hatton’s death reported evidence of brain damage, known as CTE (Chronic Traumatic Encephalopathy). Manchester South Coroner's Court heard from Hatton’s former partner, Jennifer Dooley, who described how, prior to his death, the former world champion struggled with memory loss and required support with planning his calendar. Despite these concerns, Hatton was due to fight in an eight round contest later in the year in Dubai, prompting further discussion as to what action the sport needs to take to mitigate further damage to its competitors.
At the forefront of a call for change in safety measures and boxing culture has been Dr Nitin Sethi, a neurologist, ringside physician and Chief Medical Officer for the New York State Athletic Commission. He sat down with BoxingScene to talk about CTE in boxing, medical evaluations prior to fighting, and what the boxers themselves need to reflect upon if they want a safer sport.
BS: My understanding is that CTE can't be picked up by an MRI and can only be established after death. But can a medical for a boxing license look for any symptoms that show the possibility of CTE?
NS: You're right, as of now the final diagnosis, the conclusive diagnosis, or you can say a definitive diagnosis of CTE is only made after death, when you look at the brain under a microscope. So, for example, if you look at some NFL players, some of them died by suicide. When their brains were looked at, and the biggest study was done on NFL players at Boston, and they looked at their brains. They do a brain cutting. You cut the brain and you look under the microscope, and they found evidence of CTE. And so the definitive evidence, the conclusive evidence, is made at a time of autopsy.
That said, now they have come out with some sort of clinical criteria, which might say or hint towards a concern for traumatic encephalopathy (CTE) being raised. They are based on, and you can look them up, they are based on things like slurred speech or other sorts of clinical signs. As of now, there is no biomarker which you can do in the living person. There's no blood or bone biomarker. There's no biomarker you can do on the spinal fluid which can make the diagnosis. But the diagnosis can be suspected, based on certain clinical symptoms or signs.
For example, let's look at (Muhammad) Ali and Ali towards his later years was struggling with slurred speech, a shuffling gait. There's a whole debate about Ali, whether he had actually Parkinson disease versus he had CTE, traumatic encephalopathy.
But clearly, which is the big point here, somebody has to voice those symptoms. They might be subjective. You as a patient say, “Listen, I think I'm struggling with memory,” or the family member points out that they are struggling in memory, or they feel their speech has deteriorated, or they feel they're having the shuffling gait, or other signs which hint at that. Or, for example, a big chunk of CTE symptoms are also neuro-psychiatric, like changes in mood and behaviour, anger issues, disinhibition. Now, these are things which somebody has to volunteer. Either you volunteer that, or a family member volunteers it. Somebody has to actually tell them, so that a concern is raised, and then a neurologist assesses these patients in a more conclusive way and tries to shed a better light on what he or she feels might be going on.
BS: It sounds like an incredibly difficult puzzle to piece together, because it's relying on the honesty of the fighter. And, as we know, fighters are too brave for their own good sometimes.
NS: Exactly. If you look at most commissions, there's an intake form and they fill out the form before every fight. There are questions which say, “Do you ever have headaches? Do you have any of these other symptoms? Do you have any other neurological signs and symptoms?” And the majority of time, they don't even look at it. They just say, “no, no, no, no, no.” And they sign off on it. Have you ever had any concerns raised for anything? “No, no, no, no.”
But let's assume somebody has a concern. At first in the NFL, what used to happen, you took a hit to the head, you shrug it off, and you continue playing. Don't tell your coach, don't tell the ref. Don't tell anybody that you feel you had your bell rung. You just continue. Today, if you feel something, you say something. Unless the fighter or somebody in his or her camp, whether that's the family member, whether there's a coach, volunteers that information, “I'm having some mood swings,” or “I've noticed some new mood swings.” This is the difficult thing.
BS: I was going to ask you whether you felt that the medical itself needed an overhaul, but it sounds like we’re coming back to a point you’ve made previously, which is that there's a cultural change that needs to take place in boxing, just as much as a change in the medical.
NS: I think certainly we can do even better in the medicals. We can make the medicals even tighter. For example, we can standardise MRIs. Instead of making MRIs every three years, let's have MRIs done every year. There's no harm in doing an MRI every year. There's no radiation exposure. In the end, it all boils down to who pays for it. Promoters have to pay for that MRI every year. Now, are the promoters ready to pay for it?
Also, let’s make it mandatory that every athlete should have a neurocognitive evaluation. Let's assume every three years, and especially if you're over the age of 40, you have to have it every year. Now, when you do a neurocognitive evaluation you’ve got to meet a neuropsychologist. The neuropsychologist will sit with you and complete a battery of tests designed to look at your attention, concentration, memory, different types of memory, standardised tests thrown in to look at anxiety, depression, scales, and then a final report comes out.
But a neurocognitive or a neuropsychological evaluation in America, if you're paying out of pocket, costs you $1,500. Now, who's going to pay for it? I've been in this sport for a long time and if you look at all my publications I keep saying we have to do more to make the sport safer, but I keep coming back to a big part of this is the culture of boxing has to change. Boxers have to realise that this is a sport where there's a very high risk of acute neurological injuries and that people unfortunately can die in the ring. But also the bigger part of the iceberg is the chronic injuries which are occurring. If you ask, “how many boxers develop CTE?” we don't have any data to guide us. How many boxers, and after how many years?
So, that brings forth questions like, should there be a mandatory age for them to retire? Because if you look at CTE, the more you have fought, the more blows you have taken to the head, the more likely you're going to have some of something like the CTE, or the possibility of CTE to develop. Should there be a cut off amount for the amount of punishment a boxer should be allowed to take? After (a certain age), you say, “no, no, you got to hand up your gloves. No boxing after the age of 40.”
A mandatory age for retirement, neurocognitive violations, MRIs more frequently. There are ways you can medically try to even make it stronger, but it boils down to the boxing community stepping up and saying, “we are willing to pay for that.”
When I look at the NFL, I feel what happened was that the call to change came from inside. It was retired NFL players who said, “make the sport safer for us.” I think in boxing, the call to make boxing safer has to come from the boxers themselves, that they have to understand. But unfortunately, by the nature of the sport, the fact that it's, like, “No mas! Never say ‘no mas!’ Continue fighting!” It's a very hard sport. I've tried very hard, and I've worked endlessly, to try to say that this sport cannot be made 100 per cent safe and that boxers need to take responsibility for their health. Now, a disturbing thing which is happening is all of these boxers who had retired now coming out of retirement and starting boxing again.
BS: This is exactly what Ricky Hatton had planned for December 2025, just before he died. He was due to fight in Dubai at 46 years old.
NS: Your brain is not what it is when you are twenty versus when you are in your forties. You know it, I know it. So that's another thing which is coming in here, where these boxers are coming out of retirement, fighting at fifty. They are crossing over, they are boxing, then they're doing bare-knuckle fighting, some of them are crossing over to MMA. They are sustaining hits in a different way. It's very hard to track their brain health. Secondly, as you know very well, what we see in the ring is a fraction of the punishment they take when they are training. I mean, how many times are they sparring? What are they doing in the gym? We have no idea how much impact the boxer has taken. Another factor we don't know is what lifestyle these boxers are living. Are they living healthy lifestyles when they're not boxing? A lot of them are probably not. We know about many boxers who have substance abuse problems, alcohol, other things. So, it all adds up to a healthy brain versus an unhealthy brain. I don't think you can look at it all in complete isolation.
BS: We've talked before about the NFL being unionised, and that making such a difference to organising and propelling the work to make safer changes, whereas boxers are such a disparate group who won’t organise themselves.
NS: That's true. They don't want to organise themselves. There are vested interests everywhere and in the end, I always feel that whether we are a boxer or whether we are just a normal human being, we all have to take responsibility for our own health. If you don't take responsibility for your own health you end up in danger of losing your health. So, we all have to take responsibility.
