After the revelation of steroid use by Alex Rodriguez, I wrote about why it made perfect sense to me that the majority of baseball players would take steroids (in the posting — Steroids and Game Theory, also re-posted at Draft MVP.) But the next discussion I’d like to have is about the phrase ‘performance enhancing’, while leaving out the word ‘drugs’. Many of the same reasons that players would risk their health for steroids apply to the use of elective Tommy John surgery or laser eye surgery solely to improve performance. While not illegal, these procedures should create similar concerns as steroid use. However, there hasn’t been much public discussion against these measures, yet there is potentially similar long-term health risks.
Tommy John Surgery
In this New York Times article from 2007- Fit Young Pitchers See Elbow Repair as Cure-All, it cites this exchange from a promising 17 year old pitcher and an orthopedic surgeon.
“While examining a 17-year-old pitcher for a knee injury last year in Nashville, Dr. Damon H. Petty was asked a chilling question by the teenager and his father: If reconstructive elbow surgery were performed on his healthy throwing arm, might he gain some speed on his fastball?”
As the article states, the doctor dissuaded him and explained that the entire premise was a myth– this type of ligament reconstruction surgery, often called Tommy John surgery, would only restore the elbow to its original state prior to injury, not improve velocity from pre-surgery levels.
While the assertion that Tommy John surgery could increase the velocity of a pitcher from pre-surgery levels may not be true, there may be doctors who would disagree for the right price…for the right price, there usually is someone who will say what the patient wants to hear. Also, some patients may convince the doctor that the surgery is needed. In the article, Dr. Petty mentions one patient, a minor leaguer whose injury did not look to require surgery, who eventually had the surgery with another surgeon by falsifying his symptoms. Also, the article cites one ball player’s parent who believes that a different player they knew increased his velocity by 3-5 miles– the perception is out there that this type of surgery can be a performance enhancing activity.
The widespread use of steroids demonstrates that some players will go for whatever edge they can get, and this performance enhancing alternative is completely legal. There are, of course, short and long-term health risks any time surgery is performed. Infection, fractures, nerve irritation and numbness are all possible risks from this type of surgery.
Laser Eye surgery
In baseball, hand/eye co-ordination is critical to success at the plate. After all, hitting a baseball is arguably the hardest thing to do in sports, with only a 30% success level being considered All-Star material. So, it would stand to reason that laser eye surgery to improve players with below optimal 20/20 vision is an accepted and natural step. However, is it acceptable for a player to go through elective surgery to obtain vision that is better than 20/20? Would that create an unfair competitive advantage just as steroids? These are not hypothetical situations– in this article, If steroids are cheating, why isn’t LASIK, from Slate magazine from a couple of years ago, the following examples, amongst many, were cited:
- Jose Cruz, then an outfielder for the Toronto Blue Jays, was 20/30 when he went for an eye exam. Five days later, he was under the beam. “The doctor kind of talked me into it,” Cruz told the Toronto Star. He came out 20/15.
- According to the Orange County Register, Gary Sheffield, then an outfielder for the Los Angeles Dodgers, had eyesight better than 20/20 when he asked for laser surgery to raise his batting average. His doctor talked him out of it.
Laser eye surgery is a relatively new procedure without years of data chronicling what kinds of long-term symptoms one will have 20-30 years post-surgery. Having the surgery when it is not necessary or going through a risky surgery to get better results than acceptable norms clearly raises moral, ethical, and fair play concerns just as steroids have.
The Role of the Team Doctor
My initial hypothesis after reading stories like the ones above was that the $ amount baseball teams pay their team doctor’s would have abnormally increased over the last 10 years. As we’ve seen with steroids, the baseball establishment has been more than happy to look the other way at performance enhancing activities when it is below the public radar. Thus, doctors who would identify and proactively push elective surgeries to improve players’ performance could lead to higher salaries or possibly bidding wars between teams. However, much to my surprise, I’ve learned that a trend for the last several years, has been that medical practices have been paying baseball teams to perform the exclusive medical services for the team. In this NY times article, Bill Pennington reports the New York University Hospital for Joint Disease signed a 7 year contract with the NY Mets in 2001 for more than $1 million a year to be the medical partner of choice of the Mets. In exchange, the medical partner basically promotes the relationship as a core marketing message to obtain and retain patients. With this type of investment in the baseball relationship, I have my doubts that the medical team supporting the team would put the brakes on surgeries that may not be absolutely necessary medically but are being pursued primarily for performance enhancement reasons.
In summary, elective surgeries such as Tommy John or laser eye surgery have become more common and are even being considered by younger high-school and college players. These surgeries may not be medically needed and are being pursued for performance reasons, sometimes due only to a perception that performance will increase. Furthermore, many medical partners have invested heavily to have the right to perform the medical services for baseball teams and may not be inclined to question potentially unnecessary procedures.