It may be the worst job in combat sports. Yet Dr. Gerard Varlotta has never shied away from being at ringside for the last three-plus decades, looking out for the safety of professional fighters. 

Think about it. You’re someone trained to keep people healthy, and now you’re sitting there watching two combatants trade blows that could harm them in the present or the future. There’s no ability to be a fan, no opportunity to lean back and enjoy the action in the ring, whether it’s two club fighters or the elite superstars of the sport. There’s just a job to do, but Varlotta embraces it as much now as he did 30 years ago because while it may be the worst job in combat sports, it may also be the most important.

“You have to be prepared,” said Varlotta when asked what a typical fight night is like for him. “In New York, we now have the best protocols that are there that have been developed by the commissioner. We have a medical director who is very proactive, and it's better to call a fight too soon than too late. Same as it's better to trade a pitcher too soon than too late in his career in order for you to get the best trade result. You don't want to wait until it's obvious to everybody. So I think that by preparation, you can then feel comfortable with what you're doing. 

“During the weigh-in, we learn a lot about the fighter,” he continues. “We learn about their history, we learn about how they interact with the doctor and the corner, also, and the handlers. And you have to know that that's where you really need to get an initial understanding of the fighter. So by observation and having conversations with the fighter and his corner in the pre-fight physicals, if they're trying to hide something, if they're trying to be obstructive in getting the information you need to make the fighter safe, that is taken under advisement and you now have a little bit more understanding of how to handle a situation during the fight.” 

And even before the opening bell of the evening, Varlotta would sit down with the late, great Harold Lederman to pick his brain about the fights about to ensue and the fighters competing in them. 

“Harold was a very big proponent of safety and boxing, and I used to sit with him maybe close to an hour before the fight and get an understanding of his perspective of the fighters and whether it's a mismatch fight or whether somebody has something that I needed to know about,” recalled Varlotta. “And Harold was absolutely the one person who shaped me the most in understanding the fight game and understanding how to care for the fighter. So that would happen. I would be done with my pre-fight evaluations, and I would have an hour, maybe two, to sit and to gather myself as more fighters came in. And we made sure the ambulance was in the right spot, and we made sure that our emergency evacuation plan was understood by everybody. So it wasn't just downtime, it was time when I was still trying to learn about these fighters so that when I'm there at ringside, I'm there in the best capacity that I could be. And as the best advocate for the fighter.”

It's why the medical staff for the New York State Athletic Commission, which includes Varlotta and Chief Medical Officer Dr. Nitin Sethi is considered to be among the best in the world. It’s also why Varlotta felt the need to gather his friends and colleagues in the business to contribute to a book called the “Association of Ringside Physicians’ Manual of Combat Sports Medicine.” 

At 613 pages, it’s not a light beach read, nor is it meant to be, but for a fight fan, it’s compelling reading when it comes to what goes on outside the ropes, and for medical professionals tasked with keeping boxers and mixed martial artists safe, it’s essential.

Seriously, it’s a book that should be in the hands of every state athletic commission and international regulatory body, and in the hands of their doctors. Varlotta calls it the Bible. And he’s right.

“This is the first comprehensive information that can be passed on for someone to then be involved in the fights,” he said. “So I think every commission should have it. It should be at ringside, it should be in the commission locker room, it should be where people have access to it and can then use it in order to make the life of fighters better.”

Varlotta isn’t trying to sell books. And again, it isn’t light reading, but with 71 respected contributors from around the medical and combat sports world, this gives ringside physicians the knowledge they know to do the best they can for the fighters who are very much in a life and death situation every time the fists start flying. And as far as Varlotta is concerned, this book was necessary.

“The initial concept was about five years ago, when myself and a few other board members at the time for the Association of Ringside Physicians decided that we needed something that was tangible in writing because us having conferences and us doing things was only able to relay a certain amount of information to people. And when the conference is over, you really can't go back and have it as a reference point. So I started and took on the lead role but I have a number of co-editors that I've worked with over the years. Some have come and some have gone, but the main ones are Dr. Nitin Sethi, Dr. Randa Bascheron and Dr. Guillem Gonzalez-Lomas are the key people. And there's others that were instrumental in the administrative component of putting the book together. But the concept began about five years ago and it took a total of three years to have the chapters written, rewritten and organized.”

Released earlier this year, Varlotta says the initial reaction has been “great,” and several commissions have ordered books for their physicians and medical advisory boards. That’s a great thing, because while commissions like New York, Nevada and California have been among the standard bearers when it comes to safety, what about a state that put on three shows a year and doesn’t have the elite medical staff at ringside for those shows? Now getting this book in their possession becomes the real challenge.

“I think it's extremely important because to be thrown into the ring without having the proper training and without having the proper knowledge of boxing or MMA, you're looking to get severely injured,” he said. “And I think that if you throw a physician into the medical ring of having to care for a boxer or MMA athlete and you are not prepared, you are looking to get severely hurt in some way. Your job is to protect the fighter and, therefore, you have to have the right knowledge in order to do your job and protect the fighter to the best of your abilities. But your abilities have to be elevated to match the demands of MMA and boxing.”

It’s not a perfect science by any means, and a tragedy can happen in the most random of circumstances without any warning. But information is power, and when asked the state of medical care in the fight game in 2023 as compared to when he started working at ringside, Varlotta says there really is no comparison, that yes, fighters are better protected today than ever before.

“They are, as much as they can be in a combat sport,” he said. “Just like in motocross or the Indy 500 races, they're always going to have the one-off accident and an unfortunate circumstance that's going to lead to someone's death or paralysis or something else. So those are the one-off instances, and you can always go back and look and say, ‘Well, I should have done this, I should have done that in order to not have gotten to the point.’ But there can be a catastrophic event that occurs suddenly and acutely for no reason. It can happen in the first round and not be anything cumulative. But the commissions have significantly upgraded the medical knowledge, the medical requirements and the pre-fight physical requirements since I've started, and part of working with the ABC (Association of Boxing Commissions) is to make sure that all the commissions are on the same page.”

The next step is to make sure they’re all on the same 613 pages that Varlotta and company are on with their book, the most important for boxing since Tris Dixon’s “Damage.” No, it’s not pleasant to think about everything that can go wrong in a fighter’s life, but if some pitfalls can be avoided, it’s worth reading about and dealing with the cold, hard truths of this business.