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SABR 44 Research Presentations: Injuries, Surgery, and Drugs

These SABR researchers are sharp as tacks. Or maybe needles: the first three research presentations today were on surgery, injuries, and drugs. All of these are complex issues and of course each research presentation is only 20 minutes long, so you really only see the very tip of the iceberg on each presenter’s research. I urge anyone reading this who is interested in what you see to contact each researcher individually to find out more.

In this set:
Framing of Experimental Medical Procedures in Baseball, Coral Marshall
Just a Little Bit Outside…, Nicholas Miceli and Tom Bertoncino
Too Much, Too Fast, Too Young: Major League Baseball’s Struggle to Control Its Menacing Drug Problem, Joe Thompson

Under the cut:

Official description from the program book:

RP02: Framing of Experimental Medical Procedures in Baseball
Coral Marshall 
Marshall investigates how the media has portrayed experimental sports surgeries in baseball over time, specifically using framing theory and an inductive content analysis of newspaper and blog coverage of these surgeries from their inception to the present day. From Tommy John Surgery to Schilling Tendon Procedure to Bartolo Colon’s shoulder, there is no shortage of controversial procedures in baseball that give the media something to talk about. Marshall hypothesizes that certain procedures that were once seen as novel or controversial are no longer framed as such, and are considered commonplace by the media, fans, and the league. She will discuss the role the media has in shaping the perception of “performance enhancement versus science versus performance enabling versus cheating and ethics” in experimental procedures.
Coral Marshall ( is currently a doctoral student in the College of Communication and Information Sciences at the University of Alabama. She interned for SABR during her Masters program in Sport Management, at California State University, Long Beach, and assisted with the Long Beach Convention. She attended the Minneapolis convention as a Yoseloff Scholar. Her baseball research interests are historical in nature, and her communication research interests focus on sport and deviance. Her love of baseball comes from watching countless Angels’ games with her dad, Jeff.

I learned a lot in this presentation, which was on the ways medical procedures are portrayed in the media, even if I’m not sure I completely grasped the conclusions presented. Here’s the basic rundown:

Back in 1974 Tommy John underwent the now-famous ulnar collateral ligament (UCL) surgery that bears his name. That year, the medical journal paper on the procedure was published (and Dr. James Andrews was one of the co-authors on the paper). In recent years, what was then a highly experimental procedure (that no one knew for sure if it would work) has been transformed in an occurrence so commonplace that Dr. Andrews labeled it an “epidemic.” How did we get here?

Coral Marshall gave us the basics of framing theory to start:
Goffman (1074) “Framing is the lens through which we see the world.”
Gitlin (1980) “Orients the world through the way mass communication systems present info to us and the selection emphases and exclusion of information.”
Entman “Framing is how we make info more salient.”

The main example of framing being used here is whether various medical procedures are being framed as “experimental” or in a commonplace manner, where articles are merely “informative.” Using inductive content analysis (i.e. counting up all the uses of certain terms and their frequency), articles in the media accessible through Proquest and Google were analyzed.

Marshall expected to find John’s surgery framed as experimental. But looking at the 1974 articles that appeared, there were between 20 and 30 articles on the subject.
61% of them referenced Tommy John in the headlines
22% of articles on Dr. Jobe (who performed the surgery) focused on the UCL surgery
17% were framed as “informative”
while only 5% were “experimental”

Perhaps some of why the articles seemed non-fazed by the whole thing is that Jobe himself was pretty non-plussed, and only a few articles described the surgery as “serious” or “a question mark.”

Interestingly, none of the articles from the 1970s referenced the ulnar collaterl ligament by name!

But the in 1976 when John returned to the mound, a new spate of articles appeared. These seemed to frame the surgery in a more experimental (or perhaps sensationalist? -ctan) light.

Compare that to Curt Schilling’s tendon surgery. Instead of the 1974 20 articles for TJ, Schilling had 1913 articles on the subject! This one was framed as experimental all over the place, calling him a “guinea pig” et cetera. Marshall speculated on the change in the way news is consumed, what with the 24-hour constant news cycle now. I’d also say that more articles were written because it happened during a ridiculously historic postseason run that was prone to sensationalizing in the first place. If Schilling had the surgery on July 4th, I think you would have seen half that many articles, but the fact that it was during the postseason brought it more national attention.

Marshall also looked at Bartolo Colon’s stem cell treatments (400+ articles, many calling it a “miracle” and “last resort” and “controversial”) and Alex Rodriguez’s Orthokine treatments where they centrifuged his blood and injected it back into his knee (only 23 results, what’s up with that?). One curious question is why the medical tourism these players take part in (Colon to the Dominican, A-Rod to Germany) isn’t called medical tourism in any of the articles, yet note that of the 23 articles on A-Rod, 21 of them mentioned Kobe Bryant by name (he’d undergone the treatment and recommended it to Alex).

There was a bit more data analysis and numbers that I did not catch in my notes. Marshall’s basic conclusion is that the association of famous athletes with various experimental medical procedures has a similar power to a celebrity endorsement in making the public accepting of a treatment. Athlete endorsements create a positive frame. Kobe Bryant’s endorsement seems to mean more than Dr. James Andrews’s. She also raised some questions such as: at what point is an experimental medical procedure going to be considered cheating? Was Tiger Woods getting Lasik the tipping point for Lasik becoming commonplace?

Future research: Marshall would like to do an experiment with showing the articles to subjects, but replacing the famous names with other players or unknown names, measuring will people react differently because a famous athlete is getting a procedure versus Joe Schmoe is doing it. I hope she presents that at a future SABR convention because I’m sure the results will be fascinating.


RP04: Just a Little Bit Outside …
by Nicholas Miceli and Tom Bertoncino
Miceli and Bertoncino examine two things: (1) Do pitch counts influence injury rates; and (2) is it possible to predict approaching injury for pitchers? With the use of PITCHf/x, Retrosheet, MLB Gameday, and Baseball Prospectus injury data, they use several models including survival analysis to examine pitcher injuries during the 2008-12 seasons. Their findings are similar to those found in quality control, examining when a process is going out of control and needs to be adjusted. In this case, the process involves expensive pitching talent and the adjustment is more problematic than a machine’s tune up.
Nicholas Miceli ( is an Associate Professor of Human Resource Management, at Park University in Parkville, MO (Kansas City). He has a Ph.D. in Management (University of Oklahoma) and a M.S. in Public Health / Epidemiology (Ohio State University). His previous baseball-related research dealt with performance and compensation, and was published in theJournal of Quantitative Analysis in Sports in 2009 (“If the Team Doesn’t Win, Nobody Wins …”).
Tom Bertoncino (

Not as much research into major league epidemiology has been done, but there’s starting to be some now. Miceli and Bertoncino looked at a number of studies to begin, one on the major leagues, and some on youth and college pitchers.

Among the ones they looked at:
MLB epidemiology study of 7 seasons
pitchers accounted for 34% higher incidence of injuries than fielders
they spent more DL days (62% to 38%)
shoulder (31%) and elbow ( 26%) accounted for greater amount of injuries

NCAA study 1988-2004
pitchers are 20.9% of reported injuries, second only to base runners
of all shoulder injuries 73% of them are to pitchers

What causes injury? They identified the following:
1) Pitch velocity
2) Pitch type — slider and curve increased risk of elbow pain 86% and shoulder pain by 52% (changeup only linked to 12% of injuries)
3) Fatigue and Biomechanical Deficiency
4) Strength Training and Conditioning (or lack thereof)

They stressed that this is an exploratory study and although the Pitch F/X data is plentiful and rich, there are some problems with it. They looked at over 4 million pitches.

One counterintuitive finding in the study is that pitch counts have an effect, but it’s not the effect you think it will be. Because pitch counts are already being artificially limited, that causes the injury-pitch count relations to be the inverse of what you expect! (“not statistically significant”)

The other one is that when we consider fatigue as a factor, we expect more injuries to occur at the end of the season, when in fact the highest injury rate is in the FIRST month of the season, and the rates decline as the season progresses. Also more injuries to younger players, not older ones. Both point to a possible explanation that pitchers coming into the season are not yet in shape to pitch, and especially younger ones. (I also wonder if the older pitchers who are not showing injuries are less prone to them while the younger population gets weeded out over time.)

“Tell me something I don’t know” was the title of one of their slides, which summarized the following:
The culprit is in the mix of pitches thrown.
They summarized the data so we know the proportion of pitch times thrown between injury episodes by pitchers.
Uninjured pitchers hard their entire season summarized.
If they had injuries, they had “buckets” of between-injury performance episodes.

Results? Showing increased likelihood of injury:
Being a starting pitcher was still 1.55x more risky than being a reliever.

Most risky pitch types:
4 seam fast ball 4.3x
2 seam 3.6x
Sinker 3.3
Cutter 2.3

Very surprising at first to note that the curveball doesn’t seem to cause injury at the major league level (perhaps it’s major league selection bias?) and is only a problem for young, underdeveloped arms/musculature, or that the ones who have the underlying physiology to be injured by it are weeded out.

Meanwhile protective benefits seem to be had from throwing the “plain” fastball and the knuckleball.

I had a bit of a problem with this, which is a function of how Pitch F/X classifies pitches. What the hell is a “plain” fastball if not a four-seam fastball? Clearly more analysis is needed and more and better pitch classification data needs to be collected in the future.

Meanwhile, they had some recommendations:
1) Pay attention to previous injury history. Pitchers get hurt as kids and these injuries stay with them for life.
2) Push for improved coaching practices at the youth, high school, and college levels where these injuries first happen.
3) More research is needed.

Finally, we had:

RP05: Too Much, Too Fast, Too Young: Major League Baseball’s Struggle to Control Its Menacing Drug Problem
Joe Thompson
Non-academic histories of baseball’s drug problems center on the steroid issue, and few touch on drug problems or baseball’s drug policies before the 1990s. In academia, there are just a handful of histories even mentioning baseball’s early drug problems. Thompson explores the failure of the MLBPA and baseball executives to develop a strong drug program, allowing players to feel immune from disciplinary actions, risk their overall health, and cause negative public perceptions of baseball and its players. His primary focus concerns itself with the Bowie Kuhn and Peter Ueberroth administrations because they were the first baseball commissioners to address the drug problem directly.
Joe Thompson  is a lecturer at the University of Houston. He will be entering the Ph.D. program at the University of Houston in the fall of 2014. The focus of his dissertation will be expansion of his master’s thesis to include the steroid problems that have plagued the game since the late 1980s. He has participated in the Houston SABR chapter’s book project,Houston Baseball: The Early Years, 1861-1961. He presented his first academic paper at the National Baseball Hall of Fame in May 2013 on professional women’s baseball in Texas during the 20th century. Joe’s wife, Susan Thompson, and their children, Josh Hansen, Jordan and Kayla Thompson, are all enthusiastic Astros fans.

I actually came in slightly late to Thompson’s presentation, and I find I can’t adequately recap all the historical information presented. But he traced the history of the dance between the MLBPA and the commissioner’s office/owners. There were epic battles between Bowie Kuhn and Marvin Miller, for example. Kuhn wanted to use all the disciplinary powers granted to the commissioner because he was a hard-liner. Miller believed that was overreach, saying that “to my mind Kuhn’s worst actions” were against players for things that happened off the field (and therefore shouldn’t have been Kuhn’s purview).

Things came to a head in the 1980s when the cocaine problem developed. With free agency players had a lot of extra money, and they always had a lot of extra time on their hands, and that bred right into the rise of cocaine use. In 1983 Miller stepped aside and Ken Moffet took his place with the MLB Players Association. Moffet began to work with commissioner Lee MacPhail on a joint drug program and was essentially fired for doing so.

Next came Donald Fehr, who surprisingly enough also worked on a drug program with MLB. The players opposed all testing, but by bringing the opinions of medical doctors into the mix, a “probably cause” scenario was accepted, and the drug problem was reframed from a disciplinary problem to a MEDICAL one, one that applied pre-established treatment conditions. In 1984 the Joint Drug Agreement was signed. It was historic and unprecedented for its time. It also seemed very much aimed at the cocaine problem.

Unfortunately a big step backward came in 1985. The Pittsburgh Drug Trials were a huge scandal. During the 1985 World Series the owners abandoned the 1984 Joint Agreement, hoping that they would find some way to make an end run around the union. They wanted something like the NBA’s program which was “tough on drugs.” There were a few more feints and cases (see Joel Youngblood, Thomas Roberts, etc) and ultimately Peter Ueberroth declared to Congress that the drug problem in baseball had been beaten… when it pretty clearly had not.

Thompson’s most salient point to me was in his conclusion: the gaping hole left by the abandonment of the 1984 agreement was what allowed the steroid era to begin and to flourish. (And the steroid era only ended with the eventual imposition of a new drug policy, brought about partly by Congressional pressure.)

Food for thought, eh?

More tomorrow!

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  1. MASH Report (8/11/14) | FanGraphs Fantasy Baseball on Monday, August 11, 2014 at 2:35 pm

    […] • A small summary on three injury centered SABRE presentations. […]

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