It is the best of times and the worst of times for Mixed Martial Arts in Ireland. The best of times for the many who derive real pleasure and pride from the accomplishments of our elite international fighters. It is the worst of times for the hundreds of ordinary Irish MMA fighters who compete in events that are dangerous.

There were 16 cage fighting events in Ireland last year. Spectator numbers varied from 200 to 9,000. A few weeks ago, two 17-year-olds fought at an event with no cage-side doctor. In events where doctors are present, the promoters who run these shows choose if they have one doctor or two. They decide. In other words, fighter safety is determined by the commercial promoters.

MMA is not illegal. Unsafe MMA is not illegal. The Health Safety Authority is legally powerless to enforce safety standards for fighters in the cage, although they can act if an employee slips on a wet floor outside the cage.

In reality, the aim of most promotions is to provide a platform for fighters and few make much money. No promoter wants an injured fighter, but safer events cost more money and so there is a clear conflict of interest. A cage-death may change that. The legal retrospectoscope will no doubt be costly for someone.

My innate response is to recoil from intentional brain trauma in sport. Yet I confess that when two men fight, ancient parts of my brain - perhaps amygdala, perhaps hypothalamus - want to know who wins. If we ban MMA, we must ban boxing. Perhaps too cigarettes and obesity since they also cause self-inflicted brain injury, like stroke and dementia. My innate response also recoils at that prospect.

In 1367, the Normans used the Statutes of Kilkenny to ban hurling. They declared "do not, henceforth, use the plays which men call horlings, with great sticks and a ball upon the ground, from which great evils and maims have arisen". The ban didn't work and nowadays the GAA minimises those "great evils and maims" by well-funded safety protocols.

The biggest argument to ban MMA is chronic traumatic encephalopathy (CTE). CTE typically presents after the athlete has retired from sport. It turns a fast brain into a slow one. The sport that brought joy in an athlete's early life, in middle life brings apathy, depression, impulsivity, substance abuse, and breakdown in social and family relationships. Later, harder neurological signs emerge including amnesia (especially new memory acquisition), slurred speech, and poverty of movement. CTE may affect up to one in five retired professional boxers. The risk in MMA must surely be similar though the sport is too new to know. If MMA remains ungoverned we may never know. And CTE is an issue for rugby and American football. Where to draw the line is unclear to me.

I believe that MMA will never be banned in Ireland. I believe pragmatism should replace choruses of criticism, often well founded. We need constructive solutions to make it safer. The government should have a role. Limbo leaves fighter safety at the whim of commercial promotions.

Michael Watson was a magnificent boxer. In 1991, during a super-middle world title fight against Chris Eubank, he suffered a subdural brain haemorrhage. The inadequacy of safety that night ruined his life. It nearly ended boxing and it financially crippled the British Boxing Board of Control. The final outcome impelled boxing to adopt good governance and significantly reduce risk. There will still be deaths in boxing but fewer avoidable deaths.

Professional boxing now sets the standard in pre-fight assessment and careful aforethought of emergency safety procedures. This was achieved through a strong governing body and proper funding. But it took the destruction of the left side of Michael Watson's brain to achieve this.

Twenty-five years on and MMA needs the same medicine. I cannot overstate how many MMA fighters and coaches have voiced that same view to me. Outside the cage the fighters I know are meticulously attentive to their health. They eat well, they exercise, are disciplined and brave. Last year a nascent governing body was formed by these same people. It is called the Irish Amateur Pankration Association, or IAPA. Pankration, a Greek term for mixed forms of combat, was chosen because the 'MMA' label is toxic to some.

The goal of the IAPA is to submit MMA to accountable governance and take control of safety from commercial promotions. It has set minimal safety standards such as mandatory annual medical examination and blood testing. It has started keeping medical data on individual fighters and enforcing suspension periods for knockout. It runs educational events. In 2015 the IAPA hosted an international health and safety conference, the first of its kind anywhere. That 500 MMA fighters and coaches participated is a powerful demonstration of the desire for change.

But the IAPA is unfunded and lacks status and direction.

I am convinced that we can make MMA safer through funding, governance and mainstreaming. I would like to see the Department of Sport engage at grassroots level. I would like to see Sport Ireland formally recognise its existence. To be consistent with their mission statement "to plan, lead and co-ordinate the sustainable development of competitive and recreational sport in Ireland". In other words, exactly what MMA fighters cry out for.

And it is inconsistent in another way. Although there are no data on the number of MMA fighters in Ireland, it is certainly growing at a faster rate than boxing. Since 2012 the IABA, the amateur boxing equivalent to the IAPA, received €3m in government funding. This funding has made boxing safer. During the same period, MMA received nothing.

Last night, the National Basketball Arena hosted a cage fight where 30 men and two women fought without safety measures commensurate to the risk. This was a commercial promotion and no law was broken. Basketball Ireland has an excellent safety record for their own members. They have invested in proper concussion protocols for that stray nociceptive ball that hits a player's head. They can afford to do so because they are funded by Sport Ireland. For me, there is hypocrisy; cage fighters and basketballers deserve the same.

Professor Dan Healy is expressing his personal views in this article. He is a Consultant Neurologist at Beaumont Hospital and the Royal College of Surgeons. His special interests are genetic disorders of the nervous system and disorders of movement

Sunday Indo Sport