By Pramit Mohapatra

Dr. Johnny Benjamin is Chairman of the Department of Orthopedics, Director of the Joint Implant Center and Director of Medical Specialty Procedures Surgery Center in Vero Beach, Florida. He works with many world-class caliber athletes including NFL stars Ray Lewis and Osi Umenyiora; 4-time light heavyweight world champion, Antonio Tarver; 3-time junior welterweight and welterweight world champion, Arturo Gatti; and 4-time welterweight and super welterweight world champion, Vernon Forrest, and lightweight champion Nate Campbell.

Dr. Benjamin, a Houston native, received his bachelor’s degree from Baylor University and his medical degree from the University of Texas. He underwent his orthopedic surgery training at Temple University Hospital in Philadelphia, Pa. His 6th year of post-doctoral education was completed at the Florida Spine Institute.

Dr. Benjamin took time out of his busy schedule to speak to me by phone on Monday, April 28. Our one-hour conversation spanned a number of topics related to the medicine of MMA and fighter safety as well as non-medical topics. What follows are the highlights of the second part of the interview. (For the first part of the interview, click here.)

FightTicker.com: How much of it is a concern that medical doctors who are often themselves MMA fans are used by MMA promotions to legitimize the sport? In other words, are there doctors who think it’s cool to hang out with an MMA crowd and support the sport but don’t truly look out for the fighters’ best interests?

Dr. Benjamin: Well, there’s a lot of questions in that question and I’ll try to break it down. There are doctors who certainly want to hang out with professional athletes of all ilks, MMA being one of them. No question. They’re fans and love to be friends, doctors which kind of becomes blurred. But, how many of those doctors are actually ringside physicians?

And, when [you] say, “Promoting the sport” how do [you] mean promoting the sport? Because I’ve never really seen a doctor associated, once again, with an MMA production. I don’t see them as medical spokespeople, which I think they should. I don’t seem them [as part of] medical advisory committees, which I think they should. So, I don’t really know how physicians are promoting the sport.

Do I think there’s a certain amount of conflict of interest for some physicians that could clear fighters and do certain things for professional athletes because of their adoration for the athletes? That’s a big problem all across sports.

I personally think those larger MMA organizations need medical spokespeople. And, I can tell you why if you’ve got the time.

FightTicker.com: Sure.

Dr. Benjamin: Perfect example. When you look at EliteXC, who now has a CBS contract and they’re probably going to be seen by more people in the United States and it’s going to a larger audience than it ever has…So, now MMA is truly going mainstream. It’s free and everybody can see it.

The problem is most people are going to see it – they’re going to see it for the first time – and they don’t understand it. And, I guarantee you the Monday after that event all the screams of “It’s a bloodspot” and “It’s human cockfighting” – remember all those things that MMA has tried to extricate themselves from, all those labels? Man. Just wait for the paper on Monday after that event.

And, why? It’s because I think the promoters have not really cared, to be honest with you, or really maybe even considered – I don’t know if they care or not – but I don’t think they’ve considered what’s going to happen if Gina Carano gets her face opened up and America has to see a girl with a bloody face. Now what you’re doing is you are going to be in crisis control mode.

Instead of educating the population saying, “You know what? Girls get cut all the time. Girls serve in the military. Women do all these things and, guess what, [it’s] not a big deal.” Those cuts, they may be bloody, and just because something creates blood doesn’t mean it’s particularly dangerous – it may be a bit gory for your taste but physicians are very good at stitching up cuts. Can’t remember the last time someone died from a cut on their face or a bloody nose. Now, it may be a bit shocking for you to see for the first time but hardly makes it dangerous.

But, you need to tell the mainstream public that before it happens. Not after because nobody’s listening then. Because now I was mortified when I thought, “Did you see what happened to that pretty girl?”

FightTicker.com: There are a couple of issues there. Do you think it was a mistake putting a female fight on the first network card?

Dr. Benjamin: Promoters are interested in one thing – putting butts in seats and getting people to watch. So, anything that has shock value is going to be on that card. It’s kind of interesting to me, even though I’m a huge Kimbo Slice fan and Kimbo Slice and Chuck Liddell are throwing barbs at each other which is good for MMA to a certain degree. You know, where they say, “The only bad publicity is no publicity.”

So, how is that your main event fight and he’s had three fights? Because he’s Kimbo Slice from the internet. So, what’s happening is, promoters are running the show and I’m not dogging promoters but promoters are in the business to make money. So, anything that has shock value – a three-fight fighter in no other sport would be a main event, except that’s Kimbo Slice.

Why is Gina Carano on this card? She’s Gina Carano, one of the better looking – they want to sell the sex appeal. So, you’ve got the MMA star in Kimbo Slice even though he doesn’t have much of a record yet. He may one day. We don’t know. And, you have the sex appeal of Gina Carano. Which, unfortunately, doesn’t completely respect her talents because she’s a tremendously talented MMA artist. But, they’re selling sex appeal on that one.

FightTicker.com: What do you think of the length of fights generally speaking – three five-minute rounds or five five-minute rounds – and do you think those are appropriate for seasoned veterans?

Dr. Benjamin: Three five-minute rounds? That’s very appropriate for a seasoned veteran. And, even for the championship fights, the five [five]-minute rounds. To me, the fourth and fifth rounds are particularly boring because those guys start getting gassed. And, if they can’t decide it in the first 15 minutes, why is another ten minutes really going to make a difference?

But, if they get to a level where on a larger show they’re truly competing for a belt that makes sense I understand why they go a bit longer. Just like in boxing a regular fight is 10 rounds, championship fights…are 12. Because they want to make you dig deeper and go for it because this is the championship.

The problem is everybody’s a champion. No matter how large a promotion is, you’ve got a champion. He might have only had two fights but he’s got a belt which is crazy. But, once again, it’s promotion.

FightTicker.com: Now, I once heard Dana White mention five five-minute rounds and then seven five-minute rounds [for championship bouts.] Do you think that’s pushing it too far?

Dr. Benjamin: Five five-minute rounds is pushing it. When’s the last time you saw the fifth round of a championship fight that was any good? I mean, it’s sad. Seven? Give me a break…I think that’s crazy. I think once again what you have is a promoter figuring out, “How can I ring the last dollar out of this sport?”

FightTicker.com: So, you think it’s perfect the way it is?

Dr. Benjamin: Wouldn’t say it’s perfect. But, making it longer doesn’t make it better. Makes it worse and increases the opportunity for injury. And, as a fan of the sport, it makes a poorer fight. Who wants to see that?

FightTicker.com: So, if anything, it sounds like you might even shorten it from where it is.

Dr. Benjamin: Definitely no more than five rounds. Three [rounds] for the majority of all fights makes plenty of sense.

FightTicker.com: What do you think of the state athletic commission-mandated regulations that have been applied to the sport? Is there more you think they could do to protect fighters?

Dr. Benjamin: I always think that there’s more that the states could do to protect fighters. But, let’s be honest. The states aren’t making money off the fighters; the promoters are making money off of fighters. So, to me, I think the promoters should be doing more to protect fighters. Because they’re the ones making the money.

It’s just like the things I’ve said about the NFL or other major sporting brands. They’re the ones making the real money. The state’s not making money. It’s the promoter. So, to me, your really only asset is the fighters. So, why not do everything to protect your golden goose? Not to make boring fights and have them in blow-up sumo-wrestler outfits. I’m not saying that. But, do the things that make sense to protect your athletes. Neuro-cognitive testing, shorter fights for guys who have lesser pedigrees and lesser experience in the game, mandate better mouthpieces for the combatants, don’t let people with mismatched records – don’t let 26-0 go against 1-0. Once again, it’s shock value.

You want Fedor and Fedor’s not going to fight just anybody, not for the money you’re paying him, so let’s get a 7’9” guy from Korea [Hong-Man Choi is 7’2” according to Wikipedia] and make him sort of a sideshow, a spectacle. Because he’s only had one fight.

FightTicker.com: About Hong-Man Choi, something came out today that he actually failed his physical for the army because he had some sort of pituitary gland issue.

Dr. Benjamin: When you look at him, he looks like he does.

FightTicker.com: It’s interesting that…he couldn’t make the army but he was fine for the New Year’s Eve fight.

Dr. Benjamin: You say that generously. To me, it was a sideshow.

But, I think the onus should lie squarely on the promoter. They’re the one making the money. They’re the one putting on the event. State didn’t ask for you to do it. You asked the state to do it. So, why should you make taxpayers spend their dollars to make sure you have a safe show? Pay for it yourself. You’re the one benefiting the most.

FightTicker.com: If these promoters look at their fighters, even in the most callous terms, as commodities they should want their commodities to last longer.

Dr. Benjamin: The problem with it, after knowing enough promoters, [the promoters think], “I’ve got to pay for that.”

FightTicker.com: Right. So, you’re saying they think pretty short-term.

Dr. Benjamin: They think about this bout alone. The shortest of short-term. How do I fill up the arena tonight? And, guess what, if a guy gets hurt, I got 15 guys that will take his place…How do I put butts in seats tonight for the least amount of money possible?

Because it’s not what I make, it’s what I keep. So, if I can save a thousand dollars and have one less ringside physician, guess what? What does the state mandate? What is the least amount I can do? There you have it. It’s very short-sighted but they think, “Hey, you know what? There’s plenty of these guys out here who can fight” or play football or anything else for that matter. Athletes in general. There’s always another guy to take his place. So, if he gets hurt because I was saving money, wow, good luck to you son.

And, no one has guaranteed contracts either in this.

FightTicker.com: What do you think of the drug-testing policies that are in place right now throughout the country? The Nevada State Athletic Commission just went to year-round random testing. Are you in favor of this? Do you think it’s a good move?

Dr. Benjamin: Oh, absolutely. Drug-testing to this point has been a joke. Absolutely they need to have random testing. Or say, “Use what you want to use.” But, don’t be hypocritical about it. And if you say, “Oh, we’re trying to protect the integrity of the sport and health of the athletes” then protect the integrity of the sport and the health of the athletes. Test.

And, another thing that’s kinds of always been interesting to me is the way that these bodies test. It’s usually urine samples. Think about it. When’s the last time your doctor said, “We want to check your cholesterol, [we need] a urine sample”? What do doctors do? Take blood.

Hard to fake that. Hard to strap someone else’s blood to your leg, you know what I mean? Kevin Randleman had horse urine. You go to GNC, there’s all these products that supposedly cleanse your urine. Can’t make that claim with blood.

And they say, “Oh well, it’s violating their…” Violating their what? You want to participate in my organization, you want to make the money that I pay and we’re going to be serious about this, big boy, you’re a tough guy – roll up your sleeve. Phlebotomists make $7/hour.

“Oh, it’s more expensive than the urine testing.” It ain’t much. What does UFC make? $25 million a night, I hear, [is] the average haul from one of their shows? They can afford it.

FightTicker.com: Did you follow the Sean Sherk controversy last year?

Dr. Benjamin: Absolutely.

FightTicker.com: What are your opinions with what happened with that and the California State Athletic Commission? It kind of got ugly and it got convoluted.

Dr. Benjamin: I think it was silly well before [it got to] the state. I like UFC. I think they have a tremendous product. Their business practices are a bit suspect to me as far as not allowing their champions to fight other people’s champions to see who the best truly are. I think it hurts the sport.

And, I think for Dana White to say, “Oh well, we didn’t pay him his bonus. We sent out his check, but we didn’t pay him his bonus because he tested positive.” What does that do? Where’s the deterrent in that? You didn’t get your bonus? You still got paid.

Get caught in boxing, you get nothing. Zip. And, you’re going to lose your license for a year. And, the thing about it is, you don’t fight anywhere. So, you didn’t get paid for the fight you just had -- you’ve been training for six weeks usually for it -- none of your training staff got paid, you didn’t get paid, plus they’re going to fine you serious money, and you won’t work for a year.

I think what happened with MMA, to be honest with you, is, who knew it was going to take off the way that it did? And, what’s happened right now is states are trying to catch up with limited tax dollars – catch up with this phenomenon. Because it was really no state’s priority because it wasn’t really that big. All of a sudden, it just went crazy and especially in Nevada for obvious reasons.
So, now states are trying to catch up and make the rules make sense.

FightTicker.com: Based on everything you know, do you tend to believe that Sherk did fail that test and that he deserved to be suspended?

Dr. Benjamin: Yes.

FightTicker.com: So, all the questioning that he did of the practices in the labs and stuff – you don’t put a lot of credence in that?

Dr. Benjamin: Absolutely none. Zero. That is lawyer-speak for “Let’s create grey.” Let’s create doubt – there’s always the reasonable doubt. Even if they know he did it, but you know what, if you can stir up enough grey maybe you’ll confuse the issue.

The issue’s you did it. And, now you’re questioning the lab and this and that and so forth? And, then it always comes out that the guy who sold you the stuff, he’ll finally fess up and say, “Oh yeah, he did it” when they’re no longer friends. Where was that argument you were making?

“That’s what my attorney told me to [say]. That’s what I paid for an attorney for.” An attorney – they’re not good because they tell the truth. They’re good because they create a reasonable scenario where you might not have done it.

I don’t pay an attorney to go in and tell the truth. I pay an attorney to go in and try to get me out of this. That’s the game. So, I don’t believe any of it.

FightTicker.com: So, what I’ve read online is that Sherk takes quite a few supplements and apparently he’s not going to stop that practice. Is it plausible that he may have tested positive because his supplements were tainted?

Dr. Benjamin: No. I don’t buy that either. When they first became popular with bodybuilders, say Y is a banned substance but there’s a substance X which is one step before Y and once you put it into your body it’s converted to Y so it’s pre-Y -- or X – so, “Ooh, you didn’t tell me I couldn’t take X.” Even though everyone knows that your body on the moment you inject it will convert it to this banned substance. “Ooh, but the rules say you didn’t say X. You said I couldn’t take Y. I didn’t take Y. Even though I immediately converted the X [to Y] in my body, your rules don’t say that.”

So, what happens is a lot of these supplements are precursors to banned substances. That’s what I would call a precursor – something that after you take it in the body and after metabolized it, it becomes that thing that you can’t take, that’s outlawed, that’s a precursor.

As it’s being created, it’s one step before that product. And, your body will handle that for itself. Once again, it’s people looking for an advantage. And, it’s commonly seen in guys that, for whatever reason, they start getting the tag that, hey, you know what, he gasses out. If he could just get a little more endurance. If it’s Phil Baroni. If the “New York Bad Ass” could just – man, he’s hell that first round but after he just gasses. Next thing you know, steroids come into the picture.

You know, he get’s injured a lot. He just doesn’t come back from…Next thing you know, HGH comes in the picture. Man, he was great but he looks like he’s on the waning portion of his career. Now, steroids and HGH come in the picture…

Man, I got to get back from this injury because I haven’t fought in awhile and this injury isn’t healing as quickly as I would like. Now, you’re looking for help.

So, if this is a banned substance, well, I can’t take that. But, some smart guy somewhere tells you, “Did you know this is a precursor to that banned substance? Take this. This isn’t illegal even though as soon as you put it into your body within 24 hours it’s converted to that illegal substance. You…can make the argument that you didn’t take anything on that banned list.

And, a great deal of the supplement argument is just that. And, a great deal of supplements don’t work anyway. Some of them are helpful. Most of them don’t work. Some of them are downright dangerous. Ephedra being one of them.

FightTicker.com: What about marijuana and how it affects fighter performance inside the ring? I think the most popular case is Nick Diaz.

Dr. Benjamin: Man, can he leave the weed alone?

FightTicker.com: I don’t think he can. I saw a documentary -- he takes them before triathlons as well.

Dr. Benjamin: Once again, it’s not that I hate attorneys. Some of my worst friends are attorneys. But, Nick Diaz – in California, it’s like an episode of Entourage. Hey, can I get a medical permit for…medicinal marijuana? Are you kidding me? Does Nick Diaz have attention deficit [disorder]? Are you kidding me? So, when a person wants to say, “I’ve got a license in the state of California because I need this for my glaucoma.” Huh?

Now, let’s be honest. If you need this because you’re a terminal cancer patient and you have six months to live and the side effects of marijuana can help you with your chemotherapy, I don’t think you’re competing in MMA, are you?

“I have a medical permit to get high.” Come on. Some of these guys who have tremendous talent need to grow up.

FightTicker.com: Out of curiosity, how would marijuana affect the fighter’s performance? Could it enhance it?

Dr. Benjamin: Physiologically speaking, it shouldn’t enhance your performance because it’s in basic terms a downer. Makes you mellow. Which to me seems counterintuitive to what a fighter would want. But, if it helps a fighter – one of the problems with fighters when they go to the big stage and you see all the times people’s first few times they go on the big stage, they’re so anxious and anxiety is so bad that they burn up tremendous amounts of energy with anxiety. And, they gas out because they couldn’t handle the big stage. That’s what they always say. What’s going to happen to the kid when he gets under the bright lights? That means, how is he going to handle his nerves?

So, if I can smoke a blunt and handle my nerves maybe it’s an enhancer for me. If I have a hard time sleeping a few nights before my bout comes up because it’s going to be on the UFC show [or] it’s going to be on CBS, maybe smoking a blunt helps me sleep better so that I’m more rested. So, I don’t think that it’s going to help you within the match but I think it helps you prepare for the match. It helps you get sleep when you need it; it helps you deal with your nerves if you’re a person who gets very anxious before fights.

I don’t think it’s going to make your takedowns any better. But, I think it’s going to make your nerves a whole lot better where you don’t burn energy with anxiety.

FightTicker.com: What’s the worst-case scenario for MMA in terms of an injury? Sometimes people say, “Prepare for the worst, hope for the best.” When you’re preparing for the worst, what is that?

Dr. Benjamin: Well, obviously the worst is Sam Vasquez in Houston, who was killed after MMA. It can happen in any contact sport. All contact sports have seen [death]. Even non-contact sports have seen death. Fortunately, extremely rare in MMA.

FightTicker.com: Is that luck for MMA? Can we continue to expect this very low rate of death compared to boxing in MMA?

Dr. Benjamin: Yes, you will have a continued low rate of death in MMA compared to boxing because of the accumulation of punches. Unfortunately, what you see in boxing is the guy who died in boxing wasn’t the guy who caught one, got clipped on the chin, and went down and was out. He’s the guy who caught eight to 10, 12 rounds of a steady beating. He’s the guy, unfortunately, that – it’s the accumulation of blows.

So, I think it will always be low relative to boxing. The concern that I have about MMA is the lesser shows. Now, everybody – I watch “Inside MMA” on HDNet, I’m a fan of the show and they show, “From the Armory in Topeka, Kansas, this is Topeka Cagefighting.” And, I look at it and sometimes they don’t even have proper lighting. A guy can go into a certain portion of the frame and we can’t even see him.

So, my concern is on the smaller level shows where money is very much a concern, you’re not going to have the proper safeguards in place. And, that will definitely increase your chance for a serious injury. I look at some of these guys and I think, “Good lord. Looks like he just came off of somebody’s roof. When’s the last time this guy jogged around the block?” Who paid him for the fight?

So, I think with the lesser shows and with difficulty making money and money always being tight in those smaller shows, those are the guys with lesser talent, lesser cardio – those are the places where I’m afraid to see someone get hurt.

FightTicker.com: Between the promotions and the state athletic commissions, at an event, what are the minimum standards that should be always adhered to to make sure the fighters have a safe environment?

Dr. Benjamin: I think you should always have more than one ringside physician that’s actually trained to be a ringside physician. Just because they have a medical license doesn’t make them a ringside physician. I think there should be a state course that they’re required to take as part of the licensing process.

Every event should have an ambulance, an EMT on staff because if somebody needs to be transported, they need to be transported quickly.

I think there needs to be standardization to the medical clearance for fighters. There should be a testing protocol for the United States – it shouldn’t be every state makes up their own rules.

And, I think with contact sports that the larger shows should have the neuro-cognitive testing – it’s not expensive. It is an expense, no question about it, but it’s not particularly expensive. And, that’s to learn about the concussion rates and when is it safe for an athlete to go back.

FightTicker.com: I’ll give you four sports, if you could rank them from safest to least safe: MMA, boxing, football, and hockey.

Dr. Benjamin: I’d be happy to do that. One thing, let’s define what we’re considering safe – what we’re considering dangerous, rather. If dangerous is potential career- and/or life-threatening injuries, to me those are the most dangerous. Cuts, bruises, broken bones, and so on and so forth – physicians are very good at treating those.

So, the biggest thing for [those four], which are all contact sports – the most dangerous thing is concussions.

So, I would say, of that group, I would say MMA is the safest followed by – I would put boxing, football, and hockey all on the same plane.

I think football is finally starting, slowly [and] painfully, to address concussion issues but that’s just because they’ve had some high-profile disasters and for no other reason.

FightTicker.com: What you’re saying based on these rankings is MMA has a bad reputation basically because people don’t know about it. What do you think of people who are still ignorant about MMA and bash it without taking the time to learn the sport, in particular journalistic pieces [about] the sport and in particular recently youth MMA?

Dr. Benjamin: What it is, once again, is emotion beyond reason. And, that happens in most things that are new – must be bad for you. Look at that – that can’t be good. But, I think the reason that has persisted and been allowed to exist is because, who is promoting MMA? Promoting it beyond, “how much money can I make on this card?”

Who is educating the public to what is MMA and what’s it really about? It’s not the promoters because that costs money. I’m hoping, truthfully, that it’s going to be these major television stations that are bringing MMA to the mainstream. I hope that CBS is smart enough to say – and NBC with Strikeforce even though it’s on at two o’clock in the morning, who’s going to stay up to watch it? But, hopefully CBS will say, “You know what, we need to get out ahead of this thing, okay, before we start catching a whole lot of bad press from the bible belt and various other places, that oh my goodness, their letting girls fight?”

It’s antiquated thinking. Guess what people, women are going to war-torn areas and serving in the military. So, I think Gina Carano fighting at the Prudential Center is not the most dangerous thing she could do. And, does she have a chance of getting a cut on her pretty face, not to be disrespectful to Gina Carano? Sure she does. She could get killed in Iraq.

So, what I’m truly hoping is that CBS will see this or someone at CBS will think, “We need to get out there and educate the public a little bit before May 31.” We need to have a medical advisory committee that works for CBS that could say, “Hey, here’s some things that you could do.”

Or, what if you had a doctor on the show as a spokesperson that when someone got knocked out could explain to the audience what was actually going on? Instead of a couple of guys sitting ringside going, “Whoa, that was an ugly knockout.” Did you see the way his legs folded? During that time there could be someone who actually is credible saying, “That’s not as bad as it seems” or “That’s something that they definitely need to be concerned about” or “It’s an ugly cut but five stitches will take care of that.” “It’s bloody and ugly because a scalp wound is very bloody. It’s not particularly dangerous. Can’t remember the last time someone died from a scalp wound…It is very bloody because that’s a very vascular-rich area of the body because there’s hair. Hair needs a lot of blood to grow therefore the scalp has a lot of capillaries in it. So, you cut the scalp, it will bleed profusely. Scary, certainly. Not dangerous.”

But, the commentary we are probably assured to get is, “Oh my god, look at all that blood.” If you see blood, it can’t be a good thing, right?

So, I think that since the promoters aren’t going to do it, since the promoters are interested in one thing and one thing alone for the most part and that’s making money, they’re not going to spend their money to do it. So, I think the networks that are now going to provide it to the masses – I think they need to be very, very smart to do some education of the masses. They need to recognize that that blow to the head created a nasty cut – it’s bloody, not particularly dangerous.

And, Gina Carano’s a highly-trained adult athlete who happens to be a woman who decided that this is what she wanted to do. And, [if] she gets a cut on her face, Gina Carano will be okay. If she gets her nose broken, not very pretty but hardly life-threatening.