Dead Pro Wrestlers- finding the best comp

The great FiveThirtyEight blog has an interesting link today about professional wrestlers dying at a young age, inspired in part by the death of the Ultimate Warrior, Jim Helwig, at age 54.

As the blog posts notes, professional wrestlers have been known to be dying young for quite a while.  The Ultimate Warrior's death was startling because he had just been inducted into the WWE Hall of Fame as part of the Wrestlemania 30 tribute a few days earlier, and that he had given a speech about legacy that in retrospect was prescient of his upcoming death.

The observation of wrestlers dying young has been documented for years.  Deadspin has a Dead Wrestler blog, and there is a decent (not great) book about dead wrestlers written by the author of the blog called The Squared Circle: Life, Death, and Professional Wrestling.

There is not much disputing that professional wrestlers die at a young age.  The big question is why.

I have a unique insight since, as far I know, I am the only practicing MD/PhD in the world who seriously contemplated a career as a professional wrestler.  When I was a junior in college at the University of Wisconsin, I was trying to decide which pathway to pursue.  I wanted to be a pro-wrestler, but I realized that while I was big by normal human being standards (at that time, I was 6'2.5" and 215 lbs), I was small for a pro-wrestler, so I gave my 6 months to learn how to perform a moonsault.  For the uninitiated, a moonsault is a standing back flip off of a 5 foot platform.  Even after 6 months working into a gymnastics pit, I kept landing on the back of my neck, so at the urging of my gymnastics coach I gave up my dream as a wrestler and went to med school.

But I kept following wrestling, and kept seeing my childhood heroes die young.  I read the stories about how they were linked to steroid usage- NY Post columnist Phil Mushnik has made a career of pushing this theory- and assumed it was true.

However, now that I am practicing physician who treats athletes, I am pretty sure this conventional line of thinking is not true.  I do not think anabolic steroid usage is the main reason wrestlers are dying young.

In the specific case of the Ultimate Warrior, Jim Helwig, he died of cardiovascular disease.  It is certainly possible that he developed hypertrophic cardiomyopathy from anabolic steroid usage, but that was not specifically listed as his cause of death, which would provide a more direct linkage.

There are a few key things that I think will help understand why wrestlers die young- pro wrestlers have the combined lifestyle of two groups- bodybuilders, and stand-up comedians.

What pro wrestlers have in common with bodybuilders:
- anabolic steroid usage
- weight lift a lot
- large, muscular physiques

What pro wrestlers have in common with stand-up comedians:
- on the road all the time
- shift of the natural body clock (staying up late, getting up late, with frequent time shifts)
- frequent alcohol use
- frequent use of downers
- frequent substance abuse
- extreme personality types

What I would love to see the author of the FiveThirtyEight blog is run a similar data set with both body builders and stand up comedians.  I think he will find that stand up comedians die at a young age, in a way that is comparable to Pro Wrestlers, while bodybuilders do not.

Just as a quick comparison:
The FiveThirtyEight blog used Wrestlemania 6 as a starting point, which took place in 1990, and found that 12 of 36 participants are now dead.  Of note, three are women, who likely didn't use anabolic steroids (Miss Elizabeth may have- she was living with Lex Luger at the time, who used all sorts of drug cocktails).

Let's compare that to comparable events for both bodybuilders and stand up comedians in 1990.

The pinnacle of body building is the Mr Olympia show.  Wikipedia has a list of the top 14 for the 1990 Mr Olympia show, won by Lee Haney.
- Frank Hillebrand died of a heart attack at age 45
- Andreas Munzer died of multi-organ failure at age 32
- I cannot find data on Mike Christian.  For the purposes of this discussion, I will presume he is dead.

There obviously may be some measurement error related to reliable reporting, but that is 3 out of 14 bodybuilders dead, or 21%, as compared to 33% of the wrestlers from the same time frame.  I'll admit that that is more bodybuilder deaths than I was anticipating, but still not quite comparable to wrestlers.

Looking at stand-up comedians- I am struggling to find a comparable Wrestlemania or Mr Olympia type event that would make a good comp.  If any readers have a good comparable event, I would love their feedback.  I've looked for a comprehensive list of comedians who appeared on HBO Comedy Specials in 1990, but couldn't find such a list.

Just as an example, though, here is a brief list of contemporary comedians who died young:
- Richard Jeni
- Mitch Hedberg
- Bill Hicks
- Greg Giraldo
- Bernie Mack
- Chris Farley
- Sam Kinison
- Patrice O'Neil
- John Candy
- Phil Hartman
- John Ritter

My impression, semi- quantitatively, is that the list of stand-up comedians is more similar to the pro wrestler list than are the list of bodybuilders.

A few years ago, I heard an interview with Craig Shoemaker, discussing the suicide of his close friend Richard Jeni.  Shoemaker's theory was that Jeni's body was messed up from years of never having a normal sleep schedule.  That is consistent with my clinical experience- one of the worse prognostic signs for patients is an abnormal sleep schedule, and lifestyle factors (particularly drug usage).

So what do I think is going on clinically?

I think we are dramatically over-estimating the risk of anabolic steroid usage, and dramatically underrating the risk of things like alcohol, muscle relaxants, abnormal sleep schedules, frequent travel, and hanging out with people who have similar lifestyle habits.

I hope we are focusing on the right issue.