13.7: Cosmos And Culture
Fri July 26, 2013
Is It Fair For Baseball To Reject Drugs But Embrace Surgery?
Originally published on Fri July 26, 2013 1:05 pm
Doping in sports is back in the news and you don't need to be a sports fan to have heard about it. The PBS Newshour devoted a segment to the recent disclosure that Tyson Gay, America's top sprinter and self-declared Mr. Clean, had failed a drug test. And then there's the especially grisly story of Ryan Braun — known lovingly to his fans as the Hebrew Hammer — who is suspended for the rest of the season for as-of-yet undisclosed drug abuses. (It is said that there are more suspensions on the way.)
I seem to be the only person to have noticed that there is irony in the fact that in the very same week that Braun is suspended, the Baseball Hall of Fame is honoring Frank Jobe at this weekend's award ceremony in Cooperstown, New York.
Who is Frank Jobe and what is his contribution to the sport of baseball? Jobe is the inventor of ulnar collateral ligament (UCL) reconstruction, known widely as Tommy John surgery (after its first patient).
The background: Pitching is bad for you. The act of pitching tears shoulder capsules and destroys elbow ligaments. Pain is a pitcher's bedfellow. For an astonishing first-person account of the glory and pain of pitching, see Bob Ojeda's New York Times Magazine piece from last year.
Or just call to mind the iconic photograph of Sandy Koufax with his left arm in a bucket of ice after a game.
Tommy John — watch the the Grantland short Tommy and Frank — tells how the pain in his pitching arm began when he was 13! If you want to pitch, you learn to live with it.
Success as a pitcher has always been a battle with pain and a race against time. When the pain is too great, it's time to stop. Many pitchers need to hang up their cleats before they get started, still in high school or the minor leagues. For others, the end of the line comes later.
Enter Frank Jobe: he developed a way not merely to mitigate injury, but completely to undo the effects of years of damage to the ligaments in the elbow. Tommy John surgery allows pitchers not merely to extend their careers, but to have careers that by all genetic rights they never should have had. John himself went on to pitch for another 14 years after what would have been the career-stopping blow-out of his elbow. It is now commonplace for pitchers to undergo Tommy John surgery at the start of their careers. About 500 major leaguers have had Tommy John. It is impossible to say how many children, minor leaguers and college athletes have undergone the expensive procedure.
Why is Frank Jobe being honored at the Baseball Hall of Fame? He has transformed the game by completely reshaping the career of a pitcher. From the press release:
The ground-breaking work of Dr. Frank Jobe to conceptualize, develop, refine and make main stream Tommy John Surgery, a complex elbow procedure that has furthered the careers of hundreds of ballplayers, is a testament to the positive role of medicine in our game's growth.
"The positive role of medicine in our game's growth."
That sounds about right. Jobe deserves the honor he is receiving. Baseball players and fans are and should be grateful.
But now we come to the source of the irony I mentioned above: Why do we view the use of Jobe's particular brand of artificial, performance-altering technology as exemplary of the positive role medicine plays in baseball, but we view the use of other kinds of medical technologies — performance-enhancing medicines — as somehow anathema?
Don't surgery and the medicines have broadly the same effects: that of enabling athletes to play better longer and to manage pain and recover from injury?
Why are drugs bad whereas surgery is just fine?
Some of you may be quick to notice that steroids and other PEDs are banned. It's cheating to use them. But not so surgery, which is entirely on the up and up.
But this just begs the issue. Why have we banned use of performance enhancing medicine but not surgery? Why do we salute the surgeons and vilify the pharmacists?
And let's not forget that we discount the achievements of athletes who used performance enhancing drugs even before these substances were banned. Drug use in baseball isn't thought of bad because it is banned. We banned the use of drugs because it's bad. And so the question is: what's so bad about it? Why is it cheating to take medicines but not cheating to get your elbow rebuilt?
Nor is it any help to be reminded that the use of performance enhancing drugs is dangerous.
So is surgery!
And anyway, consider that the use of PEDs would be much less dangerous if they could be administered, as with surgery, under the guidance of doctors.
You might argue that PEDs raise, or at least alter, the quality of play. Tommy John surgery, in contrast, just extends the life of a player.
But this doesn't withstand scrutiny. You can count on one hand the number of pitchers who have thrown more than 700 games, won more than 285, pitched more than 160 complete games, gotten more than 2200 strikeouts and have thrown more than 4600 innings. (See here for a persuasive argument that John deserves to be in the Hall of Fame himself.) And Tommy John is one of them. But only thanks to the surgery.
At the opposite end of the spectrum, take the case of Jenrry Meija. The Mets drafted him when he was 16; he blew out his elbow when he was 22. Tommy John surgery has given him a second chance. He takes to the mound for the New York Mets this weekend. We have high hopes for him. He may go on to be a great pitcher! But if so, this will be thanks to the use of performance-enhancing surgical modifications of the body.
Surely, the use of surgery has transformed the game and made possible new kinds of achievement. This is why the Hall of Fame is honoring Jobe after all.
So we are thrown back on our question: What explains our positive view of the place of surgery in baseball when we think of medicine as such a destructive presence?
I can't say for sure, but here's a hypothesis. It has nothing to do with sports or with cheating, but everything to do with our ways of thinking about ourselves.
Despite the fact that surgeons go inside your body and rebuild parts and structures, we think of them as leaving you basically unaffected. Surgeons don't change your being any more than plumbers alter the architecture. Surgery is superficial.
But when it comes to drugs, an entirely different set of intuitions kick in. Drugs are not superficial. Drugs get inside you in a deeper way; drugs change you. And so we find ourselves inclined to think that if you need drugs to be a good athlete — or if you need drugs to be happy or live without anxiety or perform sexually — then, well, you are not really a good athlete (or a happy person or a good lover). Drugs make a person inauthentic.
Is this true?
Is there something intrinsically better about being a person who doesn't need to play with his or her biochemistry to be happy and productive?
And is there such a thing as a human life that is not caught up with the control of biochemistry? Isn't that what we do when we eat?
These are open questions. They are important. They go way beyond sports. Let's think about them seriously.