We've gone through years of peaks and valleys in this whole festival of affected and overly sanctimonious outrage around performance enhancers, with the awkwardly scripted admissions from A-Rod providing the latest jumping off point for the sports talkerazzi.
The outrage seems to stem from a belief that these enhancers give the current generation of players a leg up on their current competition, and moreover, skew the sacrosanct history of the game as it is written in the numbers they produce. If we were ever to turn a blind eye to this sort of behaviour, the argument goes, we'd be left with record books that diminish most of what has come before, and a game that is radically different from what we have come to love. With apologies to Fukuyama, it would be the End of History. And we'd all be poorer for it, or so they say.
But with all this talk of the unnatural advantages that modern anabolics and growth hormones provide to the nefarious and disreputable, we've been left to wonder about the place in baseball's dialectic that is occupied by one of the most ubiquitous and increasingly perfunctory procedures: ulnar collateral ligament reconstruction, or Tommy John Surgery.
While we drive ourselves nuts in trying to push back against medical science in some areas of baseball, Tommy John surgery is tacitly accepted as part of the game. Once a career-saving procedure and a last resort for pitchers, going for a "TJ" is so commonplace at this point that players seem to be going for this surgery as a preventative measure. Give up next year, the thinking seems to be, and get back five years on the other side with a brand new arm.
Nobody really thinks much about the competitive advantages that TJ surgery provides, and most view it in the same context as having a knee scoped or a labrum tear repaired. These surgeries and procedures are generally acceptable, it seems, because they are the pound of cure applied after someone has suffered an injury. That's the way we like our medicine.
The question is: Does this surgery, or even the knowledge that it is readily available, affect the competitive balance of the game? Do pitchers throw harder or throw pitches that they may have avoided in the past (e.g. sliders and splitters) because of the safety net that TJ procedures provide?
How conservative will a young pitcher be with his arm when he knows that, at worst, he can have his ligaments yanked out and replaced with stronger ligaments from his leg? And moreover, if there is any truth to the notion that pitchers eventually throw harder after having their UCL replaced, does this not constitute an unfair advantage?
Will Carrol and Thomas Gordon noted in a Baseball Prospectus piece in 2004 that some speculate that the "dead arm" that ended Sandy Koufax's career was in fact a wonky UCL that could have been fixed with this surgery. This raises for us a question: If we are going to insist on giving the utmost respect to the historical performances of hitters throughout the past century, shouldn't we be considering the number of injured arms throughout those eras?
To underscore the ubiquity of the procedure, that same BP article notes that Dr. Tim Kremchek performs 120 TJ's per year, roughly the equivalent of 10 big league pitching staffs. And he's just one surgeon.
If we find it morally problematic to reward Mark McGwire or Barry Bonds because they enjoyed an unfair advantage over the harball heroes that we see in gauzy sepia tones, then shouldn't we take into account the injured arms that threw only a couple of pitches to avoid pain, and that threw them slow and straight over the plate to Ted Williams or Mickey Mantle or Henry Aaron?
If we're going to heckle an easy target like Alex Rodriguez with catcalls of "A-Roid" and "A-Fraud", what sort of treatment should be given to Shaun Marcum when he returns? Because from our point of view, Marcum's Tommy John surgery seems to fall more in the category of being an ounce of prevention.