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.

Jim Brown Explains Why He Retired in his Prime

Certain sports legends maintain a mystique forever because we never saw them decline: Sandy Koufax's fastball will always be untouchable in our mind's eye and Bjorn Borg simultaneously dominated Wimbledon and the French Open in a way that is unlikely to ever be matched--but the definitive example of someone who retired at the top of his game is Jim Brown.

Brown won eight rushing titles in nine seasons while earning three MVPs and leading the Cleveland Browns to the 1964 NFL title. His 12,312 career rushing yards lapped the field (and stood as the all-time standard for two decades), his 106 rushing touchdowns and 126 total touchdowns remained NFL records for three decades after he retired and he is almost universally considered to be the greatest running back--if not the greatest player, period--in NFL history. In 1965, Brown led the league in rushing yards (1544, the second best total of his career), rushing attempts (289), rushing touchdowns (17), long rushing gain (67 yards), yards from scrimmage (1872) and total touchdowns (21, three more than his previous career-high). Brown carried Cleveland to the East Division title with an 11-3 record--best in the league--before Cleveland lost 23-12 to the Green Bay Packers in the NFL Championship Game.

At that point, Brown planned to play at least one more season. He went to Europe in the offseason to star in the now-classic film The Dirty Dozen but because of delays in the shooting schedule he was not able to make it back to the United States in time for training camp. Cleveland owner Art Modell publicly threatened to fine Brown, prompting Brown to write a letter to Modell stating his intention to retire. Brown recently read that letter, in its entirety, to Branson Wright of The Plain Dealer. Here are some excerpts:

I'm very sorry to see you make the statements that you did, because it was not a victory for you or I but for the newspapermen. Fortunately, I seem to have a little more faith in you than you have in me. I honestly like you and will be willing to help you in any way I can but I feel you must realize that both of us are men and that my manhood is just as important to me as yours is to you...

You must realize that your organization will make money and will remain successful whether I am there or not. The Cleveland Browns are an institution that will stand for a long, long time. I am taking on a few projects that are very important to me. I have many problems to solve at this time and I am sure you know a lot of them. So if we weigh this situation properly, the Browns have really nothing to lose but Jim Brown has a lot to lose. I am taking it for granted that I have your understanding and best wishes, for in my public approach to this matter this will be the attitude that I will prevail...

I will give you any assistance I can and hope your operation will be a success.

Brown told Wright: "I like the letter and it was a very important statement for me to make. It represented everything about me. I think it's fair. I think it's clear. I think it's considerate. I think it shows that I'm interested in my family and my career and I knew that when I wrote it that it could be 50 years later and it would still be me. I've always taken pride in the fact that my statements over the years, they always lasted, because I think that being truthful and representing yourself as a man will always stand up. So, I'm surprised that you had (a copy of) this but I am proud that as a young man I had the ability to articulate in this way and show the kind of fairness that's in this letter."

Regarding the general subject of when an athlete should retire, Brown added these thoughts: "Athletes usually stay too long. They stay past their peak. They hold on and they become, in some cases, not pathetic but you just can't outdo yourself. Old Jim Brown can't outdo a young Jim Brown and whenever you are compared to yourself you are always going to lose. So, in order to give the fans their money's worth I think that you should always leave on time so they can remember the best of you and you can remember the best of you and you will have that forever. They can never say that I was going downhill or they can never attach a negative to my career. So, it's not even complicated. It's the right thing to do to move out on time."