Thursday, February 13, 2020

Dr. Jonathan Gelber Examines The Intersection of Law and Medicine in Sports

Dr. Jonathan Gelber's book Tiger Woods's Back and Tommy John's Elbow: Injuries & Tragedies That Transformed Careers, Sports, and Society packs a lot of interesting information into less than 200 pages. Dr. Gelber begins with the legend of the "Cobra Effect," which is an example of the sociological concept of unintended consequences: as the story goes, an Indian Raj sought to curb the presence of cobras in his territory by offering a bounty for dead cobra skins--but the unintended consequence was that his citizens bred cobras in order to kill them for the bounty, and then after the Raj canceled the bounty the breeders set these cobras loose in the countryside since there was no longer any value for killing the cobras.

There are many examples of the "Cobra Effect" in Dr. Gelber's book, and here is one to whet your appetite to read about the rest of them.

It is well known that L.A. Dodgers' pitcher Sandy Koufax retired in 1966 at age 30 to prevent permanent damage to his left (pitching) elbow. Dr. Robert Kerlan, the Dodgers' team doctor, diagnosed Koufax with arthritis, the result of years of trauma to Koufax' elbow. A few years after Koufax retired, Dr. Kerlan partnered with Dr. Frank Jobe to form the Kerlan-Jobe Clinic, which later became world-famous for treating athletes from a variety of sports.

In 1974, Tommy John--then a pitcher for the Chicago White Sox--suffered an elbow destabilization injury that Dr. Gelber suggests was similar to the one that had eventually forced Koufax to retire. Dr. Jobe, consulting with hand surgeon Dr. Herbert Stark, decided to perform a radical new surgery, taking a tendon from John's forearm and carefully threading it through John's elbow to stabilize the joint. John went on to win more games after undergoing the procedure than he had won before, and the operation is now known as Tommy John surgery.

The "Cobra Effect" here is that Tommy John surgery has gone from being a radical solution to an injury that threatened to end a pitcher's career to a procedure that has become commonplace among young pitchers, many of whom undergo the surgery not to cure injury but based on the false belief that the surgery inherently increases performance levels. As a result of this, Tommy John has publicly stated his opposition to how prevalent his namesake surgery has become among young athletes, noting that over half of such surgeries are performed on patients who are between 15-19 years old, and that one in seven of those kids will never fully recover.

Other "Cobra Effect" stories examined by Dr. Gelber include Magic Johnson and HIV, Lyle Alzado and steroids, Len Bias and drug abuse/mandatory minimum sentencing, Hank Gathers and athlete screening for underlying health issues, Ayrton Senna/Dale Earnhardt and race car safety issues, Duk-koo Kim and efforts to make boxing safer, Tom Brady and measures to protect the quarterback from injury, plus Tiger Woods' back injury and the use/abuse of opioid drugs. 

This book is thought-provoking, and I recommend it with just two caveats: (1) The existence of a "Cobra Effect" is suggested but not conclusively proven in some of the examples and (2) the book would be even better if it had been lengthier so that some of the issues raised could be discussed in more depth.

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