Steroids, Tommy John, and Cataracts: What's the Difference?

Summer 2010's federal indictment of former All-Star pitcher and seven-time Cy Young winner Roger Clemens on federal perjury charges related to steroid use reignited the debate over the impact of steroids (legal in professional baseball prior to 1990) on professional sports. In its bumbling rush to judgment, Major League Baseball (MLB)—and Congress—has enshrined steroid use as the game's singular bête noire to the exclusion of other, potentially more far-reaching game-changers. Steroid use, it turns out, may be only the beginning. For instance, what does MLB propose to do when an athlete is seriously injured and surgery not only returns him to his pre-injury level of performance, but actually enables him to surpass it? In a number of cases, that's exactly what happens.

Along comes Stephen Strasburg, the twenty-two-year-old Washington Nationals phenom with a one hundred mile per hour fastball who sustained a season-ending tear of the ulnar collateral ligament (UCL) in his pitching arm during a game last August. (Coincidentally, if not presciently, the incident occurred within forty-eight hours of Clemens's August 19 indictment.) Strasburg will likely be out for some or all of 2011. The hiatus puts his gaudy 92 strikeouts in 68 innings pitched temporarily in storage. In the meantime, he awaits the outcome of surgery and months of strenuous rehabilitation that will determine the extent to which he can return to, or exceed, his record-threatening, pre-op form. And therein lies the rub.

In 1974, Los Angeles Dodgers pitcher Tommy John underwent a successful experimental procedure to repair his torn UCL. This procedure dramatically improved his chance to recover from what would otherwise be a career-ending (or career-shortening) injury. Since then, Tommy John operations (said to be the most important advance in baseball "since the invention of the breaking ball") have resulted in an 85 percent to 90 percent complete recovery rate, extending the major-league lives of scores of pitchers.¹ Strasburg underwent the surgery September 2.

Despite the hype, pitchers alleged to have used steroids don't always improve their performance, including, ironically, Roger Clemens. His earned run average, a critical marker of a pitcher's success, was calculated by researchers at Columbia and the University of Chicago to be .32 runs worse during steroid use than his pre-use ERA. In contrast, there is evidence that performance improves after a Tommy John operation. "Players can and do come back, sometimes even better," says CBSSports.com's David Andriesen, occasionally gaining an "extra 2-3 MPH on their fastball."² For former American League hurler Billy Koch, the gain was even greater; his fastball reportedly jumped from the mid-90s pre-op to 108 post-op.³ Hardball Talk/NBC Sports commentator D. J. Short says Strasburg "has the potential to come back from the surgery even stronger than before."⁴

Should a steroid-free, Tommy John-reconstructed, potentially stronger, and better post-op Strasburg, and others in a similar position, be banned from the sport or get an asterisk next their names—similar to the asterisks proposed for steroid users by some baseball record book purists? Worse, what happens when a fading lefty decides to test the limits himself and seeks a surgeon who will "repair" a ligament that is not torn? New medical technology is already available to artificially prolong or enhance performance life and bulk up the statistics of an otherwise healthy player.

The Strasburg dilemma suggests we might need a considered, viable approach sooner rather than later. Sports columnist Kevin Blackistone argues that baseball is exiting the steroid era and is now "firmly entrenched in the surgical era."⁵ More insidiously, while some observers say it's a "misconception" that pitchers improve after Tommy John surgery, its universal acceptance and high success rate has encouraged parents to request the procedure for their uninjured children.

Legal concerns aside, it is hard to understand why a professional athlete's steroid use as a potential career enhancer should be any more suspect and penalized than a player who chooses...