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Thanks for asking me, ‘Which country's healthcare system can be emulated in India? ‘.I was in the Govt service (Defence) for more than three decades before I entered the private health care. With experience in both the sectors, I think I am qualified to answer this question.Before I discuss which system is better for India, its better to start with a brief history of health care in India to give orientation and ground for appreciating the ground reality.The first medical institution in India was founded in 1664 by the British East India Company, and it stands today as the proud Govt General Hospital (GGH), Chennai. Surprisingly, this hospital is younger to Taj Mahal by about 30 years only.Govt General Hospital (GGH), Chennai. ( Source: Google)The first medical college in India was started in Calcutta (1835) followed by the Madras Medical College (1835).BTW, I want the readers to know that the 2nd oldest Eye hospital to establish in the world after London, is Eye Hospital, Chennai, and not in Germany or France or America!!!These two medical colleges-Calcutta and Madras- formed the mother colleges to provide instruction in modern medicine, and their alumni went on manning the future medical colleges established gradually in various cities across India over a period of time.In the hospitals attached to the medical colleges, treatment was always free and till the early sixties, higher specialty treatment was available only in the medical college hospitals. Mighty MGR was treated in Govt.General Hospital (GGH), Madras, when he was near fatally shot at. Medical treatment in private was confined to only OP cases.This brief introduction is meant to let the readers appreciate that even the rapacious colonial masters considered health care is the responsibility of the state. The policy of free treatment has been in continuation till now albeit in such a diluted fashion that now the health care in govt hospitals is considered a mere tokenism.It will be of interest for the readers to know that in British India, there were two classes of doctors- The Indian Medical Service( IMS) on par with the ICS in status with even higher remuneration, and the lower qualified licentiates. Dr. Ronald Ross of malarial Parasite cycle fame, the second to win the Nobel Prize (NL) in the category of Medicine and physiology (1902), belonged to the Indian Medical Service (IMS). ( We for some unfathomable reasons do not count him among the NLs from India though the Nobel committee records him from India, officially ( born in Almora).The Bhore Committee:Abhorred by the discriminating two types of quality in medical care, in 1945, the Bhore committee strongly recommended to abolish the licentiate system and bring in uniformity in medical education across the country such that the basic medical qualification for practice of modern medicine remains only MBBS. This committee also recommended primary health care centres and secondary care centres at the district headquarters, and various other reforms that paved the way for expansion of healthcare, medical colleges and district hospitals and various specialties immediate post-independence.Till 1975 the products of these institutions were treated on par with the British qualified doctors, and the doctors qualified before 1975 could straight away register with the General Medical Council (GMC) of great Britain without exam (PLAB) and could practice anywhere in the commonwealth. Following introduction of bridge courses to grant MBBS to the graduates of integrated system ( ayurvedic and other licentiates) and ever falling standards, the GMC derecognized Medical Council of India in 1975. Instead of improving the standards we retaliated by derecognising diplomas of Royal Colleges (FRCS & FRCP), the craze for which only increased after that.The Deterioration of Govt Hospitals:The high quality medical manpower thus produced also has a flip side. After the mid-sixties, when the medical institutions started showing signs of deterioration due to failure of administration to improve the infrastructure commensurate with time, and poorer remuneration of doctors ( purchase power of doctors salary reduced nearly 10 times by the sixties compared to 1917), these highly competent doctors found themselves not fitting into the dated hospitals and started to see greener pastures away from govt. service. Slowly but surely many ambitious and talented doctors started quitting the govt. service to enter lucrative private practice. This is the beginning of flourishing of private practice. It gradually started to acquire commercial tones from the early eighties while the government hospitals showed further decline in the scope and quality of medicare both due to lack of leadership at the helm and over crowding with patients who could not afford private care.Importance of InvestigationsWith rapid strides in medicare and introduction of new gadgets and investigations, the domain of clinical medicine has gradually receded back giving way to objective investigation dependent diagnosis and medicare. This is one of the causes for growing trust deficit between doctors and patients. But patients have to understand that early diagnosis is lifesaving often and it is sometimes intense investigation dependent. By the time the diagnosis of cancer stomach can be made clinically, the patient has passed beyond the stage of operability / cure. Only sophisticated investigations offer hope of early diagnosis and pave way for effective treatment.Since the answer is becoming too big, I will rather try to be more concise.The National Health Service (1948) in the UK is considered one of the ideal health care services on the earth. More patients have trust in the NHS doctors and the services than those who decry them.It offers stratified health care where a General Practitioner is the entry level medicare provider and the patient gets referred if the disease/ condition falls outside the GP’s expertise. A specialist cannot be approached by walking in, like in India. Patient has to patiently wait for his/ her turn for treatment/ procedure while emergencies are immediately attended. The waiting for knee replacement can run to months while it can be fixed in less than a week in India.Though the quality of care is high, this waiting time for procedures can be frustrating. ( One Indian family known to me returned back to India when the waiting for a D&C was told six months).The doctors in UK are well paid and fall into the 2nd highest social strata with such income after entrepreneurs and business houses. But these days many NHS doctors find the job highly stressful and I heard from friends in NHS expressing frustration at the working conditions due to ever increasing complexity of managing of patients in advanced years with multi co-morbid diseases, and lack of say in the matters that affect the doctors. Yet NHS continues to be popular. Private healthcare though exists in Britain, its not the main player and only the rich can afford.The American system is highly evolved in so far as providing treatment with cutting edge technology is concerned but quite costly to the point that patients sometimes choose to suffer the disease rather than go to a hospital. Without insurance, it’s difficult to bear the costs of American medical treatment. A profession of ‘billing’ has emerged from this complexity of American system, which, honestly I, an outsider, found too complex to bother to know about. The system is lawyer and litigation oriented. No prescription comes without extreme investigation. No one wants to miss any and that ‘you-never know-syndrome works to the hilt.I have seen their hospitals. Simply superbly maintained and meticulously managed. There is a lot to learn from their attention to the minutest detail.Now coming to India. When the govt has failed to introduce such facilities as required and in demand, the private sector has evolved to fill the vacuum and take care of the needs of population. Many good hospitals have come up to provide contemporary medicare at a fraction of what it costs abroad. Be it liver transplant or bone marrow transplant India has the expertise widely available, if I may say, more wider and accessible than the America. No frustratingly long waiting lists unlike the West. India even started attracting medical tourism.But Indian private care suffers from the following.Lack of institutionalism. With rare exceptions, a consultant in private works almost unsupervised/ unaudited unlike in govt sector where the treating physician cannot do things the way he wants. This lack of scrutiny or overseeing has given rise to suspicion and dubious practices.Though insurance is becoming popular, most families end up spending from pocket and the burden can be quite heavy and sometimes almost make the patients bankrupt following the treatment of major diseases. This is not the fault of doctors. Medical equipment are imported and costlier than they are abroad and their maintenance is very costly. Gadgets become obsolete in about a maximum of 5 years.Many patients do not buy insurance or budget for medical treatment like they do for education and weddings etc. leading to despair, and find the doctors soft target to attack to vent out their frustration. Its no solution at all.Reforms in Govt HospitalsThe existing Govt hospitals are to be expanded with establishment of more peripheral treatment centres especially cancer centres across the nation and augmenting the strength of specialist doctors with built in performance based incentives.With the existing salaries and work culture of staff, quality in govt hospitals is a mirage. Hire and fire system and delegation of powers to the deans with autonomy only will bring in changes.The existing system is highly bureaucratic and inefficient to give desired results. The deans with supporting young hospital management guys as administrators shall be given powers and made responsible for omissions and commissions. And the selection of deans shall be confined only to those with outstanding annual performance reports and not based on seniority alone.The private hospitals shall have some kind of peer audits and regulation to check if they are following established norms of practice. Ethical and transparent billing shall become the norm.We are evolving but the recent move by the govt to introduce bridge courses and allowing vaids of other systems to practice modern medicine is an ill-conceived move which will sure to destroy what little we have achieved in the medical care.Instead of exploring ways to increase the penetration of the available medical expertise through better infrastructure and performance based incentives, government is trying to tinker with the system, which can do irreparable damage to the health of profession itself. In the sixties integrated system guys were there who were later conferred MBBS and this half baked guys were the weakest links in the chain. I have known such guys and their below par competence.Accreditation of hospitals through agencies like NABL etc shall be made mandatory for all the corporate hospitals and NABH norms shall be applied for all the private and govt labs. Drug control shall be more stringent. These are the pressing needs not bridge courses to ayurvedic vaids and exempting exams to pathetically trained foreign qualified doctors who could not clear the national exam. Their pass rate at 7–13% speaks of volumes of their quality. Exempting them from examination amounts to promoting quackery on one side and killing the majesty of noble profession. If people have complaints about quality of doctors, to avoid them, they shall support quality measures.Politicians come and go but its the systems which remain in place and guie the society.How much it costs annually per head for free health care?It needs about 5–6 thousands per head per year to provide primary care for every individual in the society .And it can go up much higher if tertiary and quaternary treatments are added. The govt just doesn’t have that kind of money and for that matter no govt on earth can afford nearly 8 trillion rupees /annum to provide high quality free treatment for 1.3 billion people.My viewCulturally, Indians abhor long waiting and queuing up at the government clinics for minor ailments. Primary care for trivial ailments may be left as it is going on now- part private and part public with choice left to the patients.Secondary and tertiary care and trauma care require urgent attention. It shall be fully augmented at all levels in taluks and cities and govt shall ensure quality through new additional recruitment, implementing modern well established norms of management and adequate funding. While insurance base shall get expanded for those wanting private care.Quaternary care shall be such, part of the costs shall be borne by the beneficiary. If it has to be free, cost overruns will destroy the quality to make it dysfunctional. No govt can spend tens of lakhs of rupees per patient.

NO, we will never have another era such as the 1980’s, with Duran, Leonard, Hearns and Hagler; those days are over forever.CREDIT PICTURE PININTERESTWhy?Skilled athletes no longer choose boxing. There are less trainers, no great trainers, less fights, and greater knowledge of the brain damage which boxing inevitably brings.The future of boxing is that it will increase it’s decline to a minor niche sport.I strongly agree with my friend Keith Scott that unless we get real all time greats in the game, it will continue to slip away. And for a huge number of reasons, we are unlikely to ever get 4 fighters like Leonard, Duran, Hearns, and Hagler.Why?Boxing is in real trouble, and sliding down away for a number of reasons, but the seven best reasons are:there are fewer great athletes going into boxing; especially fewer skilled big men; most great athletes are choosing sports world wide that do not involve large men hitting them in the head, and which are not as dangerous overall;size does not mean skill; people mistake larger for better;there are far few good trainers, and the great trainers are a distant memory;there are fewer fights, so fewer opportunities to learn and develop;there are fewer African-American boxers as there are other opportunities, both in sports, and out of sports, than being punched in the head;there are too many sanctioning organizations, too many titles, too many warring promoters in bed with the sanctioning organizations, and the best fighters do not fight each other;the increasing evidence that boxing leads directly to brain damage and neural traumaSo let us discuss them all:There are fewer great athletes going into boxing, especially fewer big menEvery fighter and trainer alive agrees that the numbers of fighters, the far fewer great athletes boxing, especially in the higher weights, is proof that the best athletes, instead of picking boxing, as they did in Ali’s day, now pick other sports.CREDIT PICTURE KENTUCKY SPORTS RADIOEmmanuel Steward said of today’s bigger fighters, "they are nowhere near as skilled as the old fighters. All the good big men are in the NFL or NBA!" He went on to say that the money is so good in the NBA and NFL, which have medical coverage and a good pension plan to boot, that fighters like Foreman and Liston, would today be in other sports.Angelo Dundee said before he died, "the great heavyweights are gone. Lennox Lewis was the last great heavyweight you will see in your lifetime. These guys coming up just can't box!" Dundee reinforced what Manny Steward said, that “today’s big men are simply not as good athletes as their Golden Age predecessors.”CREDIT FOR QUOTES TO The Arc of Boxing: The Rise and Decline of the Sweet Science: Mike Silver, Foreword by Budd Schulberg: 9780786493876: Amazon.com: BooksThere are fewer fighters today compared to even 50 years agoThere are fewer fighters, fewer trainers, with less expertise fighting fewer fights, and not just in the US, but all over the world the totals are down.Fighters today fight far fewer rounds, box less in the gym, and simply do not learn the fundamentals of the game.By every metric that matters, the sport is far less healthy than it was 40-50 years ago. Those metrics include key indicators like the number of licensed fighters and the number of promoted events. Both are significantly lower than they were 50 years ago. In fact, both are significantly lower than they were in the 1930′s.Even counting the relatively greater popularity of the sport in England and Eastern Europe, there are still less fighters total, in the world, licensed to fight than there were in 1970, almost 50 years ago!There are less licensed trainers than there were 50 years ago!Fighters today fight far fewer fights, thus boxing infinitely fewer rounds, box less in the gym, and simply do not learn the fundamentals of the game, because practice makes perfect. Greater money for a single fight means fighters do not fight as much, and thus do not learn as much.There are also far fewer boxing events held. In addition, there are fewer fight clubs, licensed fighters, and licensed trainers today that in 1970, and in the US, fewer than even in 1930. Fewer boxers, fewer trainers, fewer events to box in, less training, less sparring, worse athletes - no wonder modern heavyweights especially are simply pitiful next to heavyweights from the past.CREDIT FOR ALL STATISTICS TO The Arc of Boxing: The Rise and Decline of the Sweet Science: Mike Silver, Foreword by Budd Schulberg: 9780786493876: Amazon.com: BooksThis era of fighters, especially heavyweights, is all time weak, skill wiseThe Arc of Boxing: The Rise and Decline of the Sweet Science: Mike Silver, Foreword by Budd Schulberg: 9780786493876: Amazon.com: BooksIn this riveting book, Mike Silver point by point by the numbers shows the ongoing deterioration of boxers' skills, their endurance, the decline in the number of fights and the psychological readiness of championship-caliber boxers. The strengths and weaknesses of today's superstars are analyzed empirically and compared to those of such past greats as Ali, Frazier, Foreman, Liston, Joe Louis, Sugar Ray Robinson, Jack Dempsey and Jake LaMotta - and the modern fighters simply do not stand up in the comparison.Fighters today fight far fewer rounds, box less in the gym, and simply do not learn the fundamentals of the game.There are fewer trainers, with less expertise fighting fewer fights.The numbers do not lie. Tyson Fury and Luis Ortiz are the only heavyweights in the top ten who actually can box! And Fury is coming off a near 4 year drink and drug binge, and Ortiz is at least 40! Oleksandr Usyk can actually box, but he is unproven as a heavyweight at this time.CREDIT FOR RECORDS TO The Arc of Boxing: The Rise and Decline of the Sweet Science: Mike Silver, Foreword by Budd Schulberg: 9780786493876: Amazon.com: BooksBigger does not mean better, except to fanboysThere are writers on here who know nothing of boxing, and who confuse size with skill.Boxing writer and historian, Frank Thomas, explains the difference between size and skill:"In the minds of some, size trumps all. Ergo, the Klitschkos [or Joshua] should defeat any other heavyweight who is not of similar stature. This gravely misunderstands the role of size in boxing, as amply demonstrated by yesteryear’s Primo Carnera, the Golden Age’s own Ernie Terrell, or modern fighters such as Nikolai Valuev and Lance Whitaker. In addition to height, it also misreads what “size” is.Many modern heavyweights are the same height as their 1970s counterparts, but pack twenty pounds or more of extra mass. Yet does that mass make them a better fighter? If it was earned by lifting weights, [or PED's] as is all too often the case, then the answer is no.Bulky muscles look impressive, but they do not help a fighter hit harder. Instead, they slow a fighter down and serve as useless bulk which must be hauled around the ring all night. Anyone who has trained using old school boxing methods is familiar with just how difficult it is to build good boxing muscle through weight lifting."Because fighters today are bigger, does not mean they are better. A physique like AJ's is useful if he is posing on a stage for Mr. Universe, and not a bit of help in the ring while a fat Mexican is pounding his huge posterior. His size helps him against boxers without the skill to actually box him.Ditto for Wilder - people ooh and ah about his being 6′7″ and knocking out 32 complete bums, and 5 journeyman - but he did not beat the only good fighter he faced.CREDIT Boxing writer and historian, Frank Thomas and The Arc of Boxing: The Rise and Decline of the Sweet Science: Mike Silver, Foreword by Budd Schulberg: 9780786493876: Amazon.com: BooksThe Great Trainers are a distant memoryTraining hasn’t improved in any way. If anything there are less qualified trainers than ever before. Joe Frazier commented in KO Magazine, March 1999, ‘These guys aren’t trained by real champions, by great ex-fighters.”The best trainers in history were fighters who knew all the secrets of the game. Rocky Marciano's trainer, Charley Goldman, claimed to have had over 300 pro fights. Jack Blackburn, Joe Louis’ trainer, was one of the great fighters of the turn of the century and had over 160 pro fights. He fought the likes of Joe Gans, Sam Langford, and Harry Greb. They learned to fight by fighting, and then by working with other great trainers.That level of experience is completely gone from the sport today.Ray Arcel, Hall of Fame Trainer, who learned himself from some of the greats, like Benny Leonard and Whitey Bimstein, noted right before his death, "Boxing is not really boxing today. It’s theater. Some kids might look good. But they don’t learn their trade. If you take a piece of gold out of the ground, you know its gold. But you have to clean it. You have to polish it. But there aren’t too many guys capable (today) of polishing a fighter.”And that is what the Never was a coach misses, that fundamentals and training are missing, and in the heavyweights, athletic ability. The sport used to get the best athletes - now it gets those who can't play football or basketball...Multiple sanctioning bodies leave fans unsure who is champion of whatIt used to be there were eight undisputed champions. Now there are 17 weight classes, and five title belts, plus the Ring Championships, for a total of 102 champions for the 17 weight classes! Then they have super, interim, and regular champions, so they have, potentially, 306 champions! That is 306 compared to 8 in the days of Sugar Ray Robinson.Each of the five organizations, the WBC, WBA, WBO, IBF, and the IBO, charge sanctioning fees for their title fights. They also charge for their elimination fights, and for everything else they can manage to screw a penny out of fighters for. They are all allied in one form or another with certain promotors, and certain Television viewing options, et al. None of them work well with the others, and none of the viewing platforms do either. The horde of sanctioning organizations allows the horde of viewing platforms and promotors to con the public and bilk everyone out of more money.Until 1965 there was basically one champion - the WBA/WBC split over Ali’s rematch with Liston was a forerunner of multiple champions, and much confusion.CREDIT BOXING HISTORY RING MAGAZINEPromoters not letting fighters fight the best competitionEver since Floyd Mayweather introduced the value of “0” as in no defeats, no promoter wants to let a money fighter fight anyone who might endanger their value. Case in point: Eddie Hearn and Anthony Joshua. They could have had a Fury or Wilder fight years ago, but Hearn deliberately low-balled both.Nor is that the only case. Al Haymon won’t let Errol Spence fight Terrance Crawford, who is promoted by Bob Arum.People have asked "Did Pacquiao ever offer to fight Kell Brook? … Errol Spence? … Terence Crawford? … even Shawn Porter? " Yes, he wanted to fight all of them! Why didn't he fight them? Because never was, up until last year, he fought for Bob Arum, and all of them except for Brock fight for the same rival promoter who scuttled a Spence-Crawford fight, Al Haymon.Kell Brook worked for Eddie Hearn, who also has a poor relationship with Arum, and any Pacquiao vs. Brook fight would have been held in England, which neither Arum nor Pacquiao was keen on. Now Manny works for Al Haymon, who also has a poor relationship with Eddie Hearn - and that fight won't get made not because Manny does not want it (Kell Brook trying to starve himself back to welterweight would be so weak Manny would eat him alive) but because Haymon won't work with Hearn.it used to be that the best fought the best, but now, it is simply not the case, most of the time.Bob Arum just announced this week that Terrence Crawford may fight an MMA bout and then a boxing match with a UFC star because they cannot get any of Al Haymon’s welterweight stable into the ring.That says it all. The best welterweight boxer in the world has to consider fighting an MMA star because rival promoters keep the other good welterweights from boxing him.Racism was one ugly reason so many great Black fighters arose back in the day, and it has less effect in bringing poor kids to boxing todayJon Jones mentions this all the time - and he is spot on.Ken Burns, the great filmmaker who produced “Unforgivable Blackness” about Jack Johnson, has noted that young Black men flocked to boxing in the 20th century as a way to earn a living. He also noted with the real end of segregation in the 1960’s, there appears to be far fewer young African-American men boxing because there are other, better, ways to make a living, in other sports, and in general.WK Stratton wrote in Floyd Patterson how boxing was one of the few avenues to a young Black man in the 1940’s and 1950’s to escape poverty.Although things are not completely rosy today, and there are other avenues to get out, and other sports, the NFL and NBA, which pay more on average, and are less dangeorus.The rising, indisputable proof that boxing causes brain damage and neural illnessAccording to the latest research, ALL boxers, every single one, 100% of them, suffer brain trauma from boxing; ALL OF THEM, EVERY SINGLE ONE, THOUGH NOT EVERY ONE DEVELOPS ACTIVE NEUROLOGICAL DISORDERS.So far the research indicates 17 out of 100 develop pugilistic dementia, and about 23% more develop other neurological symptoms.Again, according to the most recent studies, EVERY SINGLE BOXER has brain damage - the key appears to be, most appear to be uneffected by it, BUT IT IS STILL THERE.In fact, according to very reputable studies by British researcher Dr. A.H. Roberts, any fighter who fights professionally, has a 100% chance of having brain trauma - but that trauma is not necessarily disabling, nor is it certain to develop into dementia. A fighter’s chances of developing dementia pugilistica (DP), (also called chronic traumatic brain injury (CTBI), and chronic traumatic encephalopathy (CTE)) are approximately 17 out of 100 if the figures consistent with the general population of boxers holds true for him.According to a retrospective, randomized study by Dr. A.H. Roberts regarding CTBI among ex-boxers competing in Great Britain, ALL boxers tested had evidence of chronic brain injury, and approximately 17% had symptoms consistent with DP, which was believed to have been the result of repetitive concussive and/or sub-concussive head traumas, generally over the course of many years.In other words all boxers had some evidence of chronic trauma, and 17 boxers out of 100 suffered dementia as a direct result of fighting. The key appears to be length of time during which repetitive concussive and sub-concussive blows to the head were suffered.The sad truth is, most boxers do not have long, happy, healthy, lives. The ones that escape with their faculties intact, most often do not escape with their money intact, nor are they able to successfully translate their fame into lasting fortune.CREDIT: Dr. A.H. RobertsThe problem is the trauma that head blows bring appears to be permanentOne might think that a defensive master like Floyd Mayweather, for instance, is less likely than most to develop pugilistic dementia, but that does not factor in the ferocious sparring sessions he engaged in at Mayweather Gym, and it does not factor in that the critical factor appears to be length of time fighting. The longer one fights, the worse the trauma, and greater liklihood of dehabilitating damage.Indeed, the fighter generally regarded as the ultimate defensive fighter, the finest of all time, Willie Pep, died of pugilistic dementia.According to the American Medical Association, up to 40 percent of ex-boxers have been found to have symptoms of chronic brain injury. Most of these boxers, about 60%, have relatively mild symptoms. But about 13–20% suffer severe, progressive, impairment. Recent studies have shown that almost all professional boxers (even those without symptoms) have some degree of brain damage.How much impairment do boxers suffer? it depends on the individual, how long they fought, how many blows they took, and a host of factors. One thing is certain, beyond any reasonable doubt as Dr. Max Hietala, MD, PhD, says: "the more you get punched in the head, the greater the possibility of long term damage. Period."A study by the American Academy of Neurology in 2007 found blows to the head in amateur boxing appear to cause brain damage. "This data shows blows to the head in boxing, over time, are associated with neurochemical evidence of brain damage," said study author Max Hietala, MD, PhD, with Sahlgrenska University Hospital, Goteborg, Sweden.CREDIT: Dr. Max Hietali, MD. PhD; American Medical AssociationBut what about the effects of boxing over time?What is the truth about boxing, blows to the head, and cognitive impairment?The cumulative effect of head blows in boxing is vicious.One highly regarded scientific study, by the Mild Traumatic Brain Injury Committee, National Football League, and published in the US National Library of Medicine National Institutes of Health Search database, addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions.Head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head center of gravity (CG) , which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle.Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.Interestingly, the hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts.In other words, a Olympic class amateur boxer throwing a hook matches any blunt force trauma of a full body NFL impact. A pro boxer, especially a heavyweight hooker such as Mike Tyson, would vastly exceed NFL full body impact with a single left hook.Stop and think about it: one hook from someone like Mike Tyson is more damaging than a full body collision from a 300 pound NFL player launching himself at your head.Another study by the American Academy of Neurology in 2007, "Does Amateur Boxing Cause Brain Damage?" which appeared in Science Daily on 3 May 2007, found blows to the head in amateur boxing cause brain damage, according to research that presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007.For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing for amateurs- but the study stipulated that continued fighting, for years, would cause no return to normality, and progressive degeneration.Another study, published in Frontiers of Public Health published on July 21, 2014, by the Maryland State Athletic Commission, the Department of Psychiatry, University of Maryland School of Medicine, and other entities, attempted to measure cognitive impairment in boxers from head trauma.Among professional boxers, the majority of injuries occur in the facial area (51%). Additional areas of injury include the hands (17%), eyes (14%), and nose (5%).Evidence from amateur and professional settings suggested that boxers may suffer from acute cognitive impairment post-injury. Areas of dysfunction noted include delayed memory, information processing and verbal fluency, and spatial and mathematical processing. Dr. Collie Moriarity also found significant slowing in simple and choice reaction time among a group of amateur boxers whose matches were stopped by the referee.Interest in the chronic consequences of professional boxing is longstanding. In 1928, H. A. Martland published a seminal article titled “Punch Drunk” in which he hypothesized about the relationship between boxing and brain injury.Overtime this condition has also been called dementia pugilistica (DP), chronic traumatic brain injury (CTBI), and chronic traumatic encephalopathy (CTE).Remember Dr. Roberts research: 17 boxers out of 100 suffered dementia as a direct result of fighting.In all studies, the deadliness of boxing cannot be overstated. The force of a professional boxer's fist is equivalent to being hit with a 13-pound bowling ball traveling 20 miles per hour, or about 52 times the force of gravity.According to the Journal of Combative Sport, from January of 1960 to August of 2011, there were 488 boxing-related deaths. The journal attributes 66 percent of these deaths to head, brain or neck injuries; one was attributed to a skull fracture.CREDIT Mild Traumatic Brain Injury Committee, National Football League; US National Library of Medicine National Institutes of Health; Journal of Combative Sport, Frontiers of Public Health; Maryland State Athletic Commission; Department of Psychiatry, University of Maryland School of MedicineAccording to an explosive new study out of Australia, more damage is done neurologically from sparring than from fights.Let that sink in: more brain trauma long term damage is done to fighters sparring than in actual fights.Indeed, boxers are more at risk of brain damage when sparring during training than in actual fights, because of the amount of sheer hours spent sparring, and the cumulative effects of it, according to a research study by a Australian doctor and researcher whose expertise is extremely highly regarded.CREDIT FOR PICTURE TO UNSPLASHIn a thesis prepared with colleague Michael Wang and published in the British Medical Journal, Dr Peter Lewis described boxing as “a popular activity with many health benefits” but also stressed the dangers, finding that most of the trauma contributing to brain damage boxer sustain happens in training, especially in sparring, rather than in fights.Sparring a bigger risk than real boutsIt appears all too many fighters and trainers are too old school and tough about possible brain trauma, concussions, in sparring sessions.Think about the sheer number of hours fighters spend sparring as opposed to in actual fights, and this is exactly and precisely why more neural trauma occurs during sparring than real fights.And, there is no ring doctor present during sparring, and no mandated sit outs for suspected concussions!Examination, treatment of any suspected trauma, MUST be by qualified physicians and medical experts to prevent permanent harm, or even death, whether in sparring or in actual bouts!CREDIT DOCTORS PETER LEWIS AND MICHAEL WANG, AND THE BRITISH MEDICAL JOURNALIt is vital to note that no distinction is made between Class I and II concussions. That is not a decision for a layman to make, the medical professionals, in particular the Association of Ringside Physicians, mandates treatment, concussion protocols, and treatment preferably by a neurologist or neurosurgeon.The Association of Ringside Physicians has awoken as well to the inherent dangers in sparring, and has recommended not only that any boxer or MMA fighter sustaining a concussion at any time and place be barred from competing, but that a combat sports athlete’s suspension continue until a specialist physician trained in concussion management clears the fighter to return, however long that may take. Specialist physicians trained in concussion management include neurologists, neurosurgeons and primary care sports medicine physicians.https://bjsm.bmj.com/content/bjs...CREDIT THE ASSOCIATION OF RINGSIDE PHYSICIANSNor is sparring of any type risk free, even without a concussion! Trauma appears to accumulate, whether an overt injury occurs or not.Dr. Lewis’s work seems to indict that the damage is cumulative, and sparring over the long term creates lasting brain trauma even if you never fight a bout.We can only hope that fighters we see and care about are one of the 83 out of 100 boxers who seem to escape pugilistic dementia, but sadly, only time will tell.But the unquestioned advances in neural research, and the devastating effects of boxing, are having an effect on the number of young kids willing to risk their brains in the sweet science.CREDIT DOCTORS PETER LEWIS AND MICHAEL WANG, AND THE BRITISH MEDICAL JOURNALAn honest comparison of today’s fighters to past eras shows they are simply not as goodThe best way to compare eras is to use Boxrec’s computer rankings. Their system is not foolproof, it has flaws, but it is the best, most objective, attempt to rank fighters across time, factoring in quality of opposition, et al.Let us compare the welterweights of the 80’s, and today:#1 Tommy Hearns (ranked as a junior middleweight, but fought in the era of the Four Kings at welterweight)#1 Roberto Duran (ranked as a lightweight, but fought in the era of the Four Kings at welterweight)#4 Ray Leonard#5 Pernell Whitaker#20 Simon Brown#21 Carlos Palomino#24 Donald Curry#25 James McGirt#33 Milton McCory#38 Meldrick Taylor#40 Lloyd Honaghan#46 Aaron Davis#54 Marlon Starling#57 Chrisanto Espansa#65 Ernie Lopez#66 Maurice Blocker#96 Pipino Chuevas#98 Harold Volbrecht18 of the top 100 welterweights of all time fought primarily in the 1980’sThe welterweights of today:#2 Manny Pacquiao#10 Terrance Crawfold#14 Danny Garcia#37 Adrian Broner#39 Shawn Porter#49 Keith Thurman#59 Erol Spence#65 Ernie Lopez#68 Amir Khan9 of the top 100 welterweights are fighting todayThere are only half the high quality fighters, and they are generally ranked lower, than those of the 1980’sHeavyweights are even worse!It is by the numbers the worst heavyweight era in history, bar none.Technically current heavyweights - with the exception of Tyson Fury - are poor technical boxers, poor athletes, (compared with the past), handicapped by warring promoters, and 4 different sanctioning bodies.Even Tyson Fury, in his prime, barely beat a 40 year old Wlad Klitschko, who would have beaten him silly five years earlier.Fury is the best of what is probably the worst era in boxing history.these are the top 100 heavyweights fighting today, and we will compare them to the 1980’s:(Usyk is not counted, as he is untested against a top 1000 heavyweight and his record was as a cruiserweight)#31 Tyson Fury#34 Anthony Joshua#54 Alexdr Povetkin#55 Marco Huck#63 Deontay Wilder#85 Andy Ruiz6 top 100 but only two in the top fifty, for all their sizeHow about the top 100 fighters active in 1980–1990?#6 Larry Holmes *# 10 Joe Frazier *#18 George Foreman *#26 Ken Norton#37 Mike Weaver#40 Mike Dokes#42 Jerry Quarry#58 Gerrie Coetzee#63 James Douglas#67 Jimmy Young#69 Oliver McCall#70 Pinklon Thomas#73 Tim Witherspoon#78 Tony Tubbs# 82 Joe Bugner#87 Leon Spinks#90 Ray MercerFive in the Hall of Fame, four top twenty, 17 top 100.The numbers do not lie. The number of skilled fighters has declined dramatically - half in the welterweight class, one third in the heavyweights.CREDIT FOR ALL RANKINGS, RATINGS, AND RECORDS TO BOXRECBottom line: I hope you enjoyed watching Lennox Lewis 20 years ago, he is the last great heavyweight champion you will seeLennox Lewis was the last great heavyweight undisputed champion, and, as a great trainer said, likely the last we will see in our lifetime.First, the best athletes quit being boxers, especially heavyweights, then the great trainers disappeared, then fewer fights were held, then there were four major sanctioning bodies instead of two, with a fifth one rising its ugly head, and five champions in every one of the now 17 weight classes, then the major promoters decided to keep their fighters from fighting each other, and finally, scientists and doctors are saying that boxing kills your brain.You will never see an era like the Four Kings again.

No one knows accurately but a expected time can be predicted based on factors already mentioned in other answers and individual’s response towards cancer.A decision to refuse treatment has its own risks as well. Declining treatment seems reasonable where the benefits from treatment are expected to be modest, but the side effects from conventional(chemo,radiation,surgery) medical treatments are substantial. This is very common in the palliative care setting. However as a practitioner it gets very frustrating in few situations where there is clear need for medical requirement and potential cure of associating ailments but the treatment is declined.Some individuals want to try Complementary and Alternate Medicine (CAM) as substitute,however there is no compelling evidence that shows CAM is a replacement to conventional medical care.Besides the several factors that are mentioned in other answers, most patients or family members ask ‘Does positive attitude affect cancer’? Many people would want to believe the power of mind can control serious disease,although it is comforting belief but not entirely true.[1]Positive attitude, however can have significant impact on quality of life. Optimistic people are more likely to eat well, exercise, practice other helpful behaviours (coping with emotions such as guilt,fear anxiety sadness all part of normal emotions that comes due to major life change) and take better care of themselves.The decision to undergo treatment or decline treatment is Individual’s choice but to make the right decision the individual should have every right of information to aid their decision.In underrepresented patients, to ensure logistic feasibility, the institutions form a multidisciplinary team to make a decision.Footnotes[1] Attitudes and Cancer