Friday, February 29, 2008

Players' Responsibility: Who Owns It?

The Red Sox accepted a Presidential invitation to meet President Bush and tour the White House and visited Washington Wednesday. After spending time at the White House, the team also visited wounded service personnel at Walter Reed Army Hospital. Several members of the team and management weren't present, and Sports Radio vilified them today.

If I ever got invited to the White House (actually I did interview for a position there once), I'd certainly go, provided no medical or family emergency prevented it. As for Walter Reed, I spent two months during my Pulmonary/Critical Care fellowship there, and it's quite an intriguing place. The Army has a very robust and sophisticated relationship between its medical department and troops...a difficult task for doctors, who tend to have an independent streak. Walter Reed hasn't gotten such good publicity lately, but during my remote and peacetime duty there, I considered it a very special place.

We know that a few individuals didn't attend, but we don't know why. Do we need to know? As far as I know, nobody was making a political statement, and I can't pretend to know the obligations of more than a few people with whom I am close.

Stephen Covey did an interview once where he talked about a fellow on a train with several poorly supervised, loud, and difficult young children. A passenger on the train upbraided the father for his lack of oversight. To which the father replied that he hadn't been able to control the children very well since their mother died recently. Needless to say, the critical fellow traveler was embarrassed at his lack of knowledge of the context.

When I can I listen to sports radio. But I do try to distinguish the difference between content and context. Radio personalities get paid to apply labels and frequently (and by choice) live in the harsh world of black and white. Player A doesn't go to the White House and doesn't support injured soldiers. What a heel! Maybe so, but what if the player had a sick or needy relative or friend, or just another conflict? Are the humanitarians of the Morning Show without fault or am I just imagining things?

Suffice it to say, I guess it wasn't my turn to watch the Red Sox players today, or judge them either. Tomorrow is another day.

Sunday, February 24, 2008

Quiet Sunday?

Not exactly a quiet Sunday as the Red Sox ink Terry Francona to a three year extension with options and sign Bartolo Colon to a minor league contract.

Francona's pair of World Series pelts in four seasons reversed his perceived failures during his prior tenure with the Phillies. Francona is in the top 100 managers all time with 660 wins and has the highest post-season winning percentage of any manager with at least twenty decisions.

One would have to expect Francona to be ebullient with financial security for life, and from an ego perspective, recognition of his achievements as Red Sox manager. Francona has shown an ability to extract the best from his troops, and keep problems contained and in house.

As for Colon, the Sox roll the dice on the 34 year-old right-hander known for a pair of twenty game winning seasons, most recently in 2005, and a perennial weight problem.

Tuesday, February 19, 2008

Schill Out

Nobody has a greater vested interest in Curt Schilling's baseball career than...Curt Schilling. In a very real sense, Schilling's dilemma resembles what in medicine was called 'risk contracts'. As a patient you would ask yourself are you better off if the physician (and the entire entourage) caring for you gets paid for what they do, or what they do not.

Are you better off getting some riskier elective surgery or taking medical treatment? The answer is, as always, it depends...on many factors.

The Red Sox, with Schilling under contract, would like to extract some value (public relations aside) from Schilling's ability to pitch, whenever and whatever that might be. If Schilling needs (and has surgery) the presumption is that the Red Sox get nothing from the righthander this season. Ergo, a conflict arises, what is good for Schilling over the remainder of his career (whatever the duration) or what is good for the Red Sox now. Is this a 'zero sum' game, or is everyone likely to be unhappy? If Schilling were 32 years old and had three years left on a deal, would the recommendation be the same or different?

What is medically right (if that is known) is not always the same as what is expedient. Physicians and patients usually do not live in a world of black and white, but grey and greyer. Should I stop drug A so I can have surgery, realizing that stopping the medication alters the overall risk equation. If the risk equation is overwhelmingly on your side, you still can lose through chance.

I cared for a patient eons ago when I was in the service who was scheduled for a risky, and major surgery that was canceled at the last minute for an emergency case. The patient left in tears, physically and emotionally prepared to accept that risk that day. The surgery happened the next week...and the patient died during the operation. That was irony for me.

I don't have the smallest claim on knowing what is 'right' for Curt Schilling, but I do favor him having the authority and the accountability of making that decision. I'm sure that Red Sox and MLB policy dictates not only a second opinion but probably an arbitration procedure. Of course, sometimes life gets in the way of our best plans.

Sunday, February 17, 2008

Injecting Some Sense into this Argument

I don't play a doctor on television; I practice medicine in real life. The mind-numbing, constant barrage of Reality TV (nobody holds the clicker to your head) evidently has rendered us victim to a national stupidity.

I give injections on most days - flu shots, pneumonia vaccine, tuberculin tests, hepatitis immunizations, tetanus, B12. Over the years I'm sure I've given thousands, many to those with serious underlying health problems - cancer, diabetes, heart, lung, or renal disease. How many people have gotten abscesses from one of these injections? I can't remember one (although I'll acknowledge my memory isn't getting any better).

There is absolutely no reason I can think of (absent arms) to give a B12 injection into somebody's buttocks. Studies on cadavers years ago showed that a majority of intramuscular injections wind up in lipomatous (fat) tissue anyway. And as pop culture (movies) remind us, "pitcher's got a big butt" as in fat.

I spoke with an Orthopedist the other day whom I consider an expert in sports medicine, and a very thoughtful guy. He has performed major joint surgery on professional athletes, and attends the latest informative conferences in the field. He described his peers as believing HGH simply to be 'the fountain of youth'. I didn't ask him whether he uses it in his practice, but it certainly makes you wonder.

Let's make this perfectly clear - the use of performance enhancing drugs isn't about right or wrong, vanity, establishing any moral high ground, or staking out new territory in human frailty, it is all about the money. Whether we're discussing Andy Pettitte, Rodney Harrison, Ben Johnson, Lance Armstrong, or other celebrity-athletes, the conversation revolves around the direct link between superior performance and escalating salaries and endorsements.

Yes, professional athletes pride themselves on 'helping the team' and playing at peak efficiency. But society rewards them and their sport for the performance, not the effort. If were all about effort, the Special Olympics would be America's top sport.

But what about Congressional hearings? That's another story, face time for politicians who aspire to power, the other side of the ego and money coin.

Yes, I'm sure Roger Clemens and many of his peers are 'great guys'. After all, isn't shaking down little kids for 20 dollar autographs the American Dream?

Saturday, February 16, 2008

Sign Francona and a Restaurant Suggestion

It's early spring training at the proverbial Camp Tranquility. Clay Buchholz versus Julian Tavarez doesn't exactly cut it as a quarterback controversy.

How much does Terry Francona mean to the Red Sox? Anybody who can will a pair of World Series and deal with the chucklehead players and media deserves an extension. I'm sure Francona also can recognize that the Sox value both continuity and his ability to 1) communicate with players and 2) incorporate organizational philosophy into game situations. Yes, he's had some good fortune, like Okajima's outperformance and the achievements of the rookies last season. But isn't that where chance favors the prepared mind?

Are you watching the NESN Spring Training coverage? Me neither, at least not yet.

Off the warning track? Like Indian food? I do, but I don't want to go into Cambridge or Boston to get it. There's a relatively new Indian food restaurant in Wakefield (Water Street) named India's Finest and we had a terrific meal there tonight for a reasonable price. Just be careful how spicy you want it...

Wednesday, February 13, 2008

Simple Solution. Amnesty or Not?

I didn't watch the testimony of Capitol Hill today. This matter belonged in the province of MLB, an organization apparently too busy coining money to solve a simple problem.

As a lawyer told me once, "This isn't about right or wrong. It is all about money."

If I were Bud Selig (God forbid), this is how I would solve the issue, with a brief and simple solution.

"To all professional baseball players:

We have endured hardship to our integrity and game because of the widespread use of performance enhancing drugs. We must rid our game of this travesty as soon as possible, with a program of both healing and enforcement. All affected players, major and minor league will have seven days effective from the release of this statement to submit a statement acknowledging use of performance enhancing drugs. Submission of a 'previous user' statement results in immediate and total amnesty for any and all use of performance enhancing drugs, with no suspension, fine, or other penalty.

Those found to be in violation of baseball's identified drug policy after this date, or who declined amnesty will forfeit the right to play Major League Baseball should prior or future violations be discovered. Forever. Without exception...after due process substantiating the use."


Bud Selig, Commissioner of Baseball

Of course, this could never happen, because the MLBPA would argue that this is not a negotiated policy, and the Players' Union often appears to have more interest in maintaining the status quo than ridding the sport of performance-enhancing drugs.

Nota bene: I served in the US Navy for ten years, subject to random drug testing.

Thursday, February 07, 2008

Shouldering the Load

Well, it's never boring, as we approach the dawn of the 2008 season. Curt Schilling, All-Star, World Series hero, blogger, and political pundit appears headed for the shelf, with the only question being, for how long. Schilling has a combination of shoulder and biceps injury, which accoompanying greybeard status, can't be a good career prognosticator.

Will the Red Sox regret not trading for Johan Santana under these circumstances? I hope not, because they continue to maintain control of young talent at the major league level, and have been ranked as the number two organization (behind Tampa Bay) in minor league talent.

If Schilling is done, that certainly promotes much better opportunity for Clay Buchholz to join Josh Beckett, Daisuke Matsuzaka, Tim Wakefield, and Jon Lester as frontrunners for the starting rotation.

Recent Sox acquisitions of Sean Casey and resigning of Bobby Kielty have firmed up the overall roster.


Schilling (DL)

The obvious short and long-term issues include:
1) What is the future of Coco Crisp?
2) Will Theo Epstein be able to find additional reliable lefthanded bullpen help?
3) Does Schilling's injury make Julian Tavarez more important?
4) What's the long-term catching situation?
5) Will the Red Sox pick up Manny Ramirez's option after the season?

Baseball fever? Does Brian McNamee really have the goods on Roger Clemens? The timing is certainly suspicious, waiting until Clemens' deposition on Capitol Hill to spring the 'bloody sponge' gambit.