Are Surgery and Doping the Same Thing?

Why should some medical advancements be embraced in human athletics while others are spurned? That's the provocative question advanced by best-selling author Malcolm Gladwell in an article and podcast from The New Yorker from 2013 that I recently discovered.

Gladwell, author of research-oriented books like “The Tipping Point” and “Blink,” suggests the Tommy John surgery many pitchers in baseball undergo (developed by the late orthopedic surgeon Dr. Frank Jobe it is named after the Los Angeles Dodgers pitcher who was its first patient) is similar to a performance-enhancing drug. The reconstructive surgery involves replacement of a ligament in the elbow with a tendon from another part of the body or from a cadaver. Originally designed to repair elbows damaged by the repetitive motion of pitching, some now think the surgery improves performance beyond pre-surgical levels.

Linking advancements in surgery of this nature to performance-enhancing substances like those allegedly used by disgraced baseball superstar Alex Rodriguez, Gladwell, who referred to post-surgery Tommy John as having a “bionic arm,” thinks human athletes should be permitted to use any type of drug they wish, provided it is FDA approved and is disclosed by the athlete.

“People loved Tommy John,” he wrote. “Maybe Alex Rodriguez looks at Tommy John — and at the fact that at least a third of current major-league pitchers have had the same surgery — and is genuinely baffled about why baseball has drawn a bright moral line between the performance-enhancing products of modern endocrinology and those offered by orthopedics.”

Horse racing doesn't have a Tommy John surgery — at least not yet. Some might suggest the operations to straighten angular limb deformities of young foals qualify as performance enhancing (or performance enabling). Others believe throat surgeries could be classified as helping performance in the same way that banned race-day substances clenbuterol or albuterol help horses breathe better during competition.

Gladwell's article was actually a review of the book “The Sports Gene: Inside the Science of Extraordinary Athletic Performance,” by David Epstein. The author attempts to explain why so many distance runners hail from Kenya or sprinters from Jamaica. Is it a matter of some humans being superior at certain athletics because of, as Gladwell says, “dumb genetic luck,” or is there more to it? And why should those without the genetics not be allowed to use science (aka drugs) to narrow the gap?

The late Charles Harris, a New York-based horse owner who for years fought for clean sport, once suggested the same thing as Gladwell, that all drugs should be permitted in racing, so long as they are disclosed. At least that would level the playing field, he said.

As athletics, horse racing and veterinary and genetic science move forward, will Gladwell be proven right? Will that bright moral line separating doping from science or surgery become less defined?