In brief: Boxing has been criticized as a brutal sport, and many have called for its abolition. The authors reviewed the literature on the health hazards of boxing and found that it has a lower fatality rate than several other sports, including horse racing and parachuting. The most serious health effect of boxing is a chronic encephalopathy that affects the pyramidal, extrapyramidal, and cerebellar systems. Often called punchdrunk syndrome, it appears to be directly related to skill level and frequency of participation. Symptoms usually do not appear until after the boxer has retired. The authors suggest that a national boxing council and a medical surveillance program are necessary to enforce uniform licensing and medical standards and to generate data for research.