Fighting and intentional head shots in hockey should be banned because of the risk to players of serious brain injury, says a doctor at the helm of the Canadian Medical Association Journal.
In an editorial headlined Stop the violence and play hockey, interim editor-in-chief Dr. Rajendra Kale writes that as a relative newcomer to Canada, he was amazed to see the skill, speed and physical fitness exhibited by players of what is arguably the country's favourite game.
"Simultaneously, I was appalled by the disgraceful and uncivilized practice of fighting and causing intentional head trauma," the neurologist said in an interview from Ottawa.
"It doesn't seem to fit in ... I almost thought that these were two different games being played," said Kale, who moved to Canada from London more than three years ago.
His is the latest voice to call for an end to incidental and intentional head-bashing in professional hockey, which has led to a growing list of players sustaining concussions that have sidelined them from the game — among them top goal-producers Sidney Crosby and Claude Giroux, and veteran defenceman Chris Pronger.
The NHL and NHL Players' Association did not immediately respond to a request for reaction to the editorial.
But Canucks defenceman Kevin Bieksa had plenty to say about the editorial following a game in Vancouver on Monday.
"Is he on the Board of Governors for the NHL? Then who cares what this guy thinks?" said Bieksa. "Fans have their opinions, but at the end of the day they're not going to change our game."
"I think fighting is part of the game," he added. "(Kale's) a doctor and we're making him a little bit of money on the side. He gets to fix us up. We'll let him do his job, and he should let us do our job."
While the NHL has instituted some rule changes to cut down on head shots and is punishing offenders with tougher penalties, the league and others argue that fights and hard checks are integral parts of the game. Ridding hockey of such physicality could lead to fans deserting the game for other entertainment, they say.
"It is an argument, but I think it is an extremely weak argument," countered Kale. "If you ban the fighting and the intentional head-hitting, you do not know what's going to happen."
He cites the example of legislation to prohibit smoking in bars and restaurants, which owners predicted would decrease the number of customers and sound the death knell of their businesses.
"This did not happen," Kale writes. "Instead the rates of admission to hospital for heart attacks and lung diseases decreased.
"If fighting is banned, several spectators who currently do not watch the game may start watching it."
Mounting scientific evidence suggests that repeated concussions — and even multiple sub-concussive brain injuries over time — could be linked to chronic traumatic encephalopathy, or CTE, an irreversible condition that progressively destroys brain tissue and can lead to dementia.
"You don't have to be a great expert in neurology to understand what's going on," said Kale. "The simple, plain message is that the brain does not like being hit, and if you hit it repeatedly it will get damaged. It's a delicate organ."
Earlier this month, researchers at Boston University reported on the brain of Derek Boogaard, the former NHL enforcer who died in May at age 28 from an overdose of alcohol and the pain killer oxycodone. Their examination showed he was in the early stages of CTE, which often is marked by such mood and behavioural disorders as depression, impulsiveness and aggression.
At the time, NHL commissioner Gary Bettman said there is not enough data yet to draw conclusions about any link between concussions and CTE.
"There's no control element because you have to look at everything that went on in a person's life before you can make a judgment as to what a brain may show when you open it up," Bettman said. "I think it's unfortunate that people use tragedies to jump to conclusions that probably at this stage aren't supported."
Dr. Michael Cusimano, a neurosurgeon at St. Michael's Hospital in Toronto and a vocal proponent for brain-injury prevention, interpreted the comment as almost blaming the victim.
"People like Bettman are failing their own responsibility to their league and they're failing their moral responsibility to players and clubs," Cusimano said in a recent interview. "It's going to come back and bite the NHL because parents will take their kids out of that sport and the market share will drop."
Still, many players insist that hard-hitting checks and fighting are just part of the fast-paced game and it's unrealistic to believe those aspects can be dissected out of the sport.
Count Toronto Maple Leafs defenceman Jay Rosehill among those who don't think fighting will be taken out of the game.
Rosehill fought Los Angeles forward Kyle Clifford in the first period Monday and felt like he did his job because the Leafs scored right after.
"I know they're kind of altering right now with different rules and what not," said Rosehill. "The powers that be want it in there right now. The fans like it, the players like it, so I don't see any reason why it would change any time soon."
Minnesota forward Kyle Brodziak, who also played Monday, added his support to fighting.
"As long as I've played the game, fighting's been in it. It's tough to really envision it not being a part of the game," he said.
"It's tough to really comment on because I know how serious head injuries are, but being more of a traditionalist I can't envision a game without it being a part of it."
Kale is aware of that attitude, but said he has a question for those players: "Do you want to be rich, famous and demented and dead at 40?
"They need to think about that seriously. They must be clear in their mind that there is a huge risk in this for themselves."