MLB's Newest Battle is Over the Ethics of Tommy John Surgery in a Time of Pandemic

John Hickey

It’s a given that baseball would be a different sport without the revolution made possible by Tommy John surgery.

Developed in 1974 by Los Angeles Dodgers’ team physician Dr. Frank Jobe, it’s a surgical procedure in which the ulnar collateral ligament in a player’s – usually but not always a pitcher – arm is replaced by a tendon from elsewhere in the patient’s body.

The procedure was named after Dodgers’ starter Tommy John, who pitched 15 years and won 164 games after Jobe performed the surgery on his left arm.

Certainly the 2020 Oakland A’s would be a different team without it. Three of the club’s top six starters – A.J. Puk, Jesus Luzardo and Chris Bassitt – all have had the surgery and have returned. On the disabled list is Daniel Gossett, who is recovering from his surgery but who could pitch later this year, if there is a season. And two former A’s pitchers of recent memory, Jharel Cotton and Kendall Graveman, are back throwing elsewhere after the career-saving procedure.

Back in the 1970s and 1980s, Tommy John surgery was hit-and-miss, a procedure of last resort. Now it’s all but routine, and both teams and pitchers have confidence that they’ll be back.

However, Tommy John surgery is in a bit of an ethical crisis mode right now. In the midst of the national COVID-19 coronavirus pandemic, the American College of Surgeons has recommended all elective surgery be postponed, a feeling supported by the U.S. Surgeon General.

In an interview in the San Francisco Chronicle last week, Dr. Neal ElAttrache defended players, including the Mets’ Noah Syndergaard, the Red Sox’s Chris Sale and Tyler Beede of the Giants. ElAttrache is the current Dodgers’ and Rams’ team physician and the current gold standard among Tommy John practitioners.

“I know that I’m going to get criticized for taking care of these kinds of guys, but it’s essential to their livelihoods,” ElAttrache told the Chronicle.If you have somebody’s career at stake and they lose two seasons instead of one, I would say that is not a nonessential or unimportant elective procedure.”

The assumption underlying that logic is that the needs of the one outweigh the needs of the many. It is, after all, still elective surgery.

In a story posted Monday morning by Sports Illustrated’s Emma Baccellieri, medical ethicists, including Stanford professor David Magnus and Baylor professor Christopher Scott question not whether it’s legal to have these procedures now, but whether it is moral.

“At the present time, I don’t think there’s even a question that it would be inappropriate and should not be done in any areas that are hit hard by COVID,” Magnus said. “And I think it’s arguably a bad idea to do anywhere right now…. Even in areas where there have been no reported cases, or very few, and it hasn’t spread yet, that’s changing by the hour. Maybe right at this moment, they don’t need the space, or the personnel that would be involved in the procedure, but that can change so rapidly that I think it would be an irresponsible use of resources. Nobody should be doing this.”

Beede had his surgery done in Texas, Syndergaard’s took place in Florida and it was announced Monday that Sale had just undergone surgery performed by ElAttrache in Los Angeles.

The question remains whether this is a good idea in a time when the American medical system keeps getting stretched thinner and thinner.